Trends in imported malaria during the COVID-19 pandemic, Spain (+Redivi Collaborative Network)

Abstract

Introduction The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date. Methods Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. PCR) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed. Results In total, 1751 cases of malaria (1751/26601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (IQR: 27–44.7) years and most occurred in VFR-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to P. falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (p < 0.001)(attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to P. falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively). Conclusions After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with imported malaria may present and/or be diagnosed late during this public health crisis and health care professionals should be alerted to the recent increase in severe cases.

Analysis of time delays in imported malaria diagnosis: not only on the patient’s shoulders.

“…The period of the SARS CoV2 pandemic seems to be related to a higher probability of serious cases but not to a greater diagnostic delay, although due to the small number of patients treated during this period, data should be interpreted with caution. Other studies including a higher proportion of patients diagnosed during this pandemic period have also shown higher rates of severe malaria cases and longer diagnostic delays, but data are heterogeneous [7,8,[38][39][40]. Such ndings could be due to underdiagnosis of milder malaria cases as a result of the saturation of the healthcare systems, as well as to a lower diagnostic offer.…”

First documented case of Plasmodium knowlesi infection in Denmark in a traveller returning from Malaysian Borneo

“…The decreased travel activity during 2019-2020 led to a steep decline in travelassociated infections, including malaria (21). With lifted restrictions after the COVID-19 pandemic, travel activity has increased, and several European countries have recently reported serious malaria cases (22,23). In Denmark (J. Kurtzhals, personal communication, July 2021), a fatal case of P. falciparum malaria after relaxation of travel restrictions was observed.…”

Updates on Malaria Epidemiology and Prevention Strategies

“…As travel increases again, the number of imported malaria cases are rising. Of concern, several recent publications have highlighted an increase in severe malaria cases [ 3 , 4 , 12 ]. A report on malaria among personnel in the French Armed Forces noted an increase in severe cases in 2020 which was not attributed to an increased incidence in the cohort or decreased compliance with chemoprophylaxis [ 12 ].…”

“…Mirroring the decrease in population movements worldwide during the pandemic due to travel restrictions, the incidence of travel-related infections also decreased [ 2 ]. Despite this, several reports during the pandemic years alerted to a possible increase in severe malaria among persons returning from endemic areas and the possible causes are under investigation [ 3 ]. Travel is expected to gradually return to pre-pandemic levels so the possible spread of Plasmodium spp.…”