Imported malaria in Scotland – An overview of surveillance, reporting and trends

Unger, Holger W.; McCallum, Alison; Ukachukwu, Vincent; McGoldrick, Claire; Perrow, Kali; Latin, Gareth; Norrie, Gillian; Morris, Sheila; Smith, Catherine C.; Jones, Michael E.

doi:10.1016/j.tmaid.2011.10.001

Cited by 11 publications

(22 citation statements)

References 25 publications

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“…Whilst this risk group has not previously been identified in the UK, data from Scotland in 2006–2008 showed that business travellers imported a greater number of cases than VFR travellers despite high reported prophylaxis uptake [16]. Business travellers have also been identified as a risk group in Japan and Switzerland [38,39], and they are a large and increasing group of patients in Europe (almost 19% [1,40,41]), and in the UK the number of business traveller cases has almost doubled between the period 2007–2011 [5].…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for UK Plasmodium falciparum cases

Pinsent

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Griffin

et al. 2014

Malar J

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BackgroundAn increasing proportion of malaria cases diagnosed in UK residents with a history of travel to malaria endemic areas are due to Plasmodium falciparum.MethodsIn order to identify travellers at most risk of acquiring malaria a proportional hazards model was used to estimate the risk of acquiring malaria stratified by purpose of travel and age whilst adjusting for entomological inoculation rate (EIR) and duration of stay in endemic countries.ResultsTravellers visiting friends and relatives and business travellers were found to have significantly higher hazard of acquiring malaria (adjusted hazard ratio (HR) relative to that of holiday makers 7.4, 95% CI 6.4–8.5, p < 0. 0001 and HR 3.4, 95% CI 2.9-3.8, p < 0. 0001, respectively). All age-groups were at lower risk than children aged 0–15 years.ConclusionsThese estimates of the increased risk for business travellers and those visiting friends and relatives should be used to inform programmes to improve awareness of the risks of malaria when travelling.

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Section: Discussionmentioning

confidence: 99%

“…The majority of these infections are acquired in West Africa [16], even though these areas are not frequent destinations for UK residents [3,14]. Travellers VFR visit areas where malaria is more readily transmitted and tend to stay for longer than those who travel for any other purpose [17-20].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for UK Plasmodium falciparum cases

Pinsent

Read

Griffin

et al. 2014

Malar J

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“…According to a previous study [52], the majority (70%) of immigrants returning to their malaria endemic countries of origin did not receive travel information through a pre-travel consultation in Taiwan; more than 40% reported that they did not use measures to prevent insect bites. These behaviors have been suggested to be due to a lack of knowledge of malaria transmission and prevention [53], a belief that malaria is a minor illness, an erroneous trust in lifelong immunity, and the relatively high cost of prophylaxis [3,52,54]. All these data indicate that more educational approaches should be targeted toward travelers who visit and immigrants from malaria endemic areas.…”

Section: Discussionmentioning

confidence: 99%

The Epidemiology of Imported Malaria in Taiwan between 2002–2013: The Importance of Sensitive Surveillance and Implications for Pre-Travel Medical Advice

Chen¹,

Chang

Chen

2014

IJERPH

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The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20–5.74). The reproductive number under control (Rc) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan.

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“…This passive case detection system has been shown to identify at least 66% of cases of falciparum malaria in the UK 12 and over 90% of cases in Scotland. 13 The MRL database was used to identify the location of every notified case of falciparum malaria in the UK in the years 2008, 2009 and 2010. For Greater London, the notifying hospital's name was recorded given the large number of hospitals; outside Greater London, the notifying hospital's town was recorded.…”

Section: Methodsmentioning

confidence: 99%

Geographical concentration of falciparum malaria treated in the UK and delay to treatment with artesunate in severe cases: an observational study

et al. 2012

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ObjectivesTo quantify geographical concentration of falciparum malaria cases in the UK at a hospital level. To assess potential delay-to-treatment associated with hub-and-spoke distribution of artesunate in severe cases.DesignObservational study using national and hospital data.Setting and participants3520 patients notified to the Malaria Reference Laboratory 2008–2010, 34 patients treated with intravenous artesunate from a tropical diseases centre 2002–2010.Main outcome measuresGeographical location of falciparum cases notified in the UK. Diagnosis-to-treatment times for intravenous artesunate.ResultsEight centres accounted for 43.9% of the UK's total cases; notifications from 107 centres accounted for 10.2% of cases; 51.5% of hospitals seeing malaria notified 5 or fewer cases in 3 years. Centres that saw <10 cases/year treat 26.3% of malaria cases; 6.1% of cases are treated in hospitals seeing <2 cases/year. Concentration of falciparum malaria was highest in Greater London (1925, 54.7%), South East (515, 14.6%), East of England (402, 11.4%) and North West (192, 5.4%). The North East and Northern Ireland each notified 5 or fewer cases per year. Median diagnosis-to-treatment time was 1 h (range 0.5–5) for patients receiving artesunate in the specialist centre; 7.5 h (range 4–26) for patients receiving it in referring hospitals via the hub-and-spoke system (p=0.02); 25 h (range 9–45) for patients receiving it on transfer to the regional centre from a referring hospital (p=0.002).ConclusionsMost UK hospitals see few cases of falciparum malaria and geographical distances are significant. Over 25% of cases are seen in hospitals where malaria is rare, although 60% are seen in hospitals seeing over 50 cases over 3 years. A hub-and-spoke system minimises drug wastage and ensures availability in centres seeing most cases but is associated with treatment delays elsewhere. As with all observational studies, there are limitations, which are discussed.

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Imported malaria in Scotland – An overview of surveillance, reporting and trends

Cited by 11 publications

References 25 publications

Risk factors for UK Plasmodium falciparum cases

Risk factors for UK Plasmodium falciparum cases

The Epidemiology of Imported Malaria in Taiwan between 2002–2013: The Importance of Sensitive Surveillance and Implications for Pre-Travel Medical Advice

Geographical concentration of falciparum malaria treated in the UK and delay to treatment with artesunate in severe cases: an observational study

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