Epidemiological and clinical assessment of a shared territorial malaria guideline in the 10 years of its implementation (Barcelona, North Metropolitan Area, Catalonia, Spain, 2007–2016)

Abstract

BackgroundMalaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation.ResultsA total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34–0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia.ConclusionsAfter 10 years of surveillance, a moderate increase in malaria incidence was observed, mostly P. vivax cases imported from the Indian sub-continent. Although severe malaria cases have been frequently reported, none of the patients died and organ sequelae were rare. Conceivably, the participation of the Primary Care and the District and Third Level Hospital professionals defining surveillance, diagnostic tests, referral criteria and clinical management can be considered a useful tool to minimize malaria morbi-mortality.

Epidemiological and clinical characteristics of imported malaria in adults in Milan, Italy, 2010–2015

“…The aim of this retrospective study was to describe the epidemiological and clinical characteristics of the imported malaria cases observed in Milan in the period 2010-2015. In addition, we compared it with those described in other recently published European studies [2][3][4][5][6][7][8][9][10].. During the study period, 180 cases of malaria were diagnosed in 177 patients (124 males, 70.1%, and 53 females, 29.9%). Their median age was 38 years (IQR 29-49); 117 (66%) were aged <45 years.…”

“…In our case, these times were both very short (a median of 3 hours), possibly because our ED staff always includes a specialist in infectious diseases, an organisational condition that, to the best of our knowledge, does not exist at other Italian hospitals. The frequency of severe falciparum malaria varies widely in the European studies cited above (from 4.6% in Spain to 36.3% in UK) possibly because of the different criteria for severe malaria adopted [3][4][5][6][7][8][9][10]. The determination of HIV serology is recommended in febrile tropical travellers, but the findings of three recent studies from Spain and the UK indicate that compliance with this recommendation is only 27-48% [3][4][5].…”