Imported malaria in Finland 2003-2011: prospective nationwide data with rechecked background information

Abstract

BackgroundAlthough described in several reports, imported malaria in Europe has not been surveyed nationwide with overall coverage of patients and individually rechecked background information. Plasmodium falciparum infections have been reported despite regularly taken appropriate chemoprophylaxis, yet the reliability of such questionnaire-based retrospective data has been questioned. This was the starting-point for conducting a prospective nationwide survey of imported malaria where compliance data was double-checked.MethodsData was collected on all cases of imported malaria confirmed and recorded by the reference laboratory of Finland (population 5.4 million) from 2003 to 2011, and these were compared with those reported to the National Infectious Disease Register (NIDR). Background information was gathered by detailed questionnaires sent to the clinicians upon diagnosis; missing data were enquired by telephone of clinician or patient. Special attention was paid to compliance with chemoprophylaxis: self-reported use of anti-malarials was rechecked for all cases of P. falciparum.ResultsA total of 265 malaria cases (average annual incidence rate 0.5/100,000 population) had been recorded by the reference laboratory, all of them also reported to NIDR: 54% were born in malaria-endemic countries; 86% were currently living in non-endemic regions. Malaria was mainly (81%) contracted in sub-Saharan Africa. Plasmodium falciparum proved to be the most common species (72%). Immigrants constituted the largest group of travellers (44%). Pre-travel advice was received by 20% of those born in endemic regions and 81% of those from non-endemic regions. Of those with P. falciparum, 4% reported regular use of appropriate chemoprophylaxis (mefloquine or atovaquone/proguanil or doxycycline for regions with chloroquine-resistant and atovaquone/proguanil or doxycycline for regions with mefloquine-resistant P. falciparum); after individual rechecking, however, it was found that none of them had been fully compliant.ConclusionsInformation on compliance with chemoprophylactic regimen cannot be relied on, and it should be rechecked if malaria is suspected. The results of the present study suggest that mefloquine, atovaquone/proguanil and doxycycline are effective as chemoprophylaxis against P. falciparum malaria, when taken conscientiously.

Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast

“…The lack of data correlating platelet levels and bleeding does not prove the absence of an association, as some instances of minor bleeding may have not been registered in the medical charts. Anaemia was found in 34% of patients upon admission, a value close to what has been reported in a previous study on imported malaria in the Canary Islands [ 20 ], in which the majority of cases were caused by P. falciparum . From the beginning of treatment of patients with anti-malarials, there was a reduction in haemoglobin, haematocrit and red blood cells, as previously reported [ 36 ].…”

“…The proportion among of Plasmodium species that caused infection in the present study cohort was different from what is observed in Brazil as a whole (where P. vivax accounts for nearly 85% of cases), but was very similar to what has been previously reported for this region [ 6 , 7 ]. A higher incidence of P. vivax infections, compared to P. falciparum infections, is different from what is observed in Europe and the USA, where most imported cases come from Africa [ 18 - 20 ], but is similar to what is observed in Australia, where most cases come from Asia [ 16 , 21 ]. Notably, although the peak of cases detected in our study in 2004 does not directly mirror the profile of Brazil, where the highest incidence of malaria cases took place in 2005; however, 2004 was still marked by one of the highest number of cases [ 22 ].…”

“…A higher incidence of P. vivax infections, compared to P. falciparum infections, is different from what is observed in Europe and the USA, where most imported cases come from Africa [18-20], but is similar to what is observed in Australia, where most cases come from Asia [16,21]. Notably, although the peak of cases detected in our study in 2004 does not directly mirror the profile of Brazil, where the highest incidence of malaria cases took place in 2005; however, 2004 was still marked by one of the highest number of cases [22].…”

The Overview of Malaria Cases in Trenggalek District based on The Epidemiological Triangle

“…Kasus serupa terjadi di Finlandia, sebagian besar pasien yang terdata terjangkit malaria merupakan laki-laki dengan besaran 76% dengan riwayat dari daerah endemis malaria. (Siikamäki, Kivelä, Lyytikäinen, & Kantele, 2013). Hasil penelitian serupa tentang manifestasi malaria di Mangaluru India selatan menunjukkan sebagian besar pasien malaria adalah laki-laki sebesar 92,80%, dan sebagian besar individu dengan besaran 77,80% bermigrasi atau pendatang ke Mangaluru, dari daerah lain dan 96% datang untuk bekerja (Gai et al, 2018).…”

Malaría á Íslandi, sjaldgæf en stöðug ógn fyrir ferðalanga

“…Í nýlegri rannsókn kom í ljós að enginn í hópi finnskra sjúklinga með malaríu árin 2003-2011 hafði tekið fyrirbyggjandi lyf á réttan hátt. 26 Í danskri rannsókn höfðu 65% þeirra sem fengu malaríu ekki tekið nein fyrirbyggjandi lyf. 17 Því virðist sem afar sjaldgaeft sé að fá malaríu séu lyfin á annað borð tekin samkvaemt ráðleggingum.…”