Epidemiology of imported malaria among children and young adults in Barcelona (1990-2008)

Abstract

BackgroundIncreasing international travel and migration is producing changes in trends in infectious diseases, especially in children from many European cities. The objective of this study was to describe the epidemiology and determine the trends of imported malaria in patients under 20 years old in the city of Barcelona, Spain, during an 18-year period.MethodsThe study included malaria cases that were laboratory confirmed and reported to the malaria register at the Public Health Agency of Barcelona from 1990 to 2008, residing in Barcelona and less than 20 years old. Patients were classified as natives (born in Spain) or immigrants. Differences in the distribution of demographic, clinical characteristics, and incidence per 100,000 person-year evolution were analysed. Natives and immigrants were compared by logistic regression by calculating the odds ratio (OR) with a 95% confidence interval (CI) and Chi-square for a linear trend (p < 0.05).ResultsOf the total 174 cases, 143 (82.1%) were immigrants, 100 (57.5%) were female, 121 (69.5%) Plasmodium falciparum, and 108 (62.1%) were visiting friends and relatives (VFR) as the reason for travel. Among the immigrants, 99 (67.8%) were from Equatorial Guinea. Immigrant cases more frequently travelled to Africa than natives (p = 0.02). The factors associated with imported malaria among immigrant residents was travelling for VFR (OR: 6.2 CI 1.9-20.2) and age 15-19 (OR: 3.7 CI 1-13.3). The incidence increased from 1990 to 1999 (p < 0.001) and decreased from 2000 to 2008 (p = 0.01), although the global linear trend was not statistically significant (p = 0.41). The fatality rate was 0.5%.ConclusionsThe majority of cases of malaria in population less than 20 years in Barcelona were immigrants, travelling to Africa for VFR and Plasmodium falciparum was most frequently detected. The trend analysis of the entire study period did not show a statistically significant decline. It is recommended to be aware of malaria, especially among children of immigrants who travel to their parent's home country for VFR. Better access to pre travel advice should be provided.

Adolescents Traveling to High-Risk Destinations: Review and Considerations for Clinicians

“…21 In another study of imported malaria among persons <20 years of age in Spain during 1990-2008, adolescents 15-19 years old accounted for 50 out of 174 cases; 88% of adolescents 15-19 years were immigrants. 22 In this study, traveling to VFRs and an age of 15-19 years were statistically significantly associated with imported malaria among immigrant residents (odds ratios [ORs] = 6.2 and 3.7, respectively). 22 Dengue and other vector-borne diseases are also serious infections for travelers to endemic areas.…”

“…22 In this study, traveling to VFRs and an age of 15-19 years were statistically significantly associated with imported malaria among immigrant residents (odds ratios [ORs] = 6.2 and 3.7, respectively). 22 Dengue and other vector-borne diseases are also serious infections for travelers to endemic areas. In a series of 8 cases of severe dengue in pediatric VFR travelers after a trip to the Caribbean, six were adolescents (median age: 13.6 years).…”

Parasitosis importadas en la población inmigrante en España

“…Un total de 15 estudios describían las características de los casos de malaria importada en inmigrantes 3,[9][10][11][28][29][30][31][32][33][34][35][36][37][38] . La mayor parte procedían del África Subsahariana (85-96%), seguido de Asia (3-13%) y Latinoamérica (0,5-8,7%) siendo P. falciparum la especie más frecuente (55-94%), seguido de P.vivax (2-30%)que fue la espe-cie más frecuente en los inmigrantes de América Latina (71%) y Asia (69%) 31,32 .…”

“…En los estudios revisados no se observaron diferencias por sexo entre los casos de malaria importada 28,29,31,32 . Hasta un 77% de los casos de malaria se dieron en el grupo de los inmigrantes VFR seguido del grupo de inmigrantes recién llegados y turistas, y menos de un 5% de los afectados realizó profilaxis para la prevención de malaria durante el viaje.…”

“…Hasta un 77% de los casos de malaria se dieron en el grupo de los inmigrantes VFR seguido del grupo de inmigrantes recién llegados y turistas, y menos de un 5% de los afectados realizó profilaxis para la prevención de malaria durante el viaje. La malaria no complicada fue el modo de presentación habitual en los casos diagnosticados en inmigrantes, aunque entre las series revisadas se incluyeron casos en inmigrantes que cumplían criterios de malaria grave o de ingreso hospitalario 28,29,31,32 . En un estudio se observó que del total de casos de malaria detectados en una unidad de medicina tropical, los casos de malaria submicroscópica (diagnóstico por PCR, no detectables por microscopia convencional) constituyeron el 35,5%, de los que el 87,5% fueron diagnosticados en inmigrantes, y en 28% se acompañó además de síntomas 36 .…”