Plasmodium falciparum malaria is a serious health hazard for travelers to malaria-endemic areas and is often diagnosed on return to the country of residence. We conducted a retrospective study of imported falciparum malaria among travelers returning to France from malaria-endemic areas from 1996 through 2003. Epidemiologic, clinical, and parasitologic data were collected by a network of 120 laboratories. Factors associated with fatal malaria were identified by logistic regression analysis. During the study period, 21,888 falciparum malaria cases were reported. There were 96 deaths, for a case-fatality rate of 4.4 per 1,000 cases of falciparum malaria. In multivariate analysis, risk factors independently associated with death from imported malaria were older age, European origin, travel to East Africa, and absence of chemoprophylaxis. Fatal imported malaria remains rare and preventable. Pretravel advice and malaria management should take into account these risk factors, particularly for senior travelers.
Imported malaria is increasingly reported in Europe and North America, with an estimated 30,000 cases yearly.[1,2] In 2000, the countries with the highest rates of imported malaria were France (≈8,000 estimated cases), United Kingdom (2,069 cases), United States (1,402 cases), Italy (986 cases), and Germany (732 cases).[3,4] Imported Plasmodium falciparum malaria is a serious health hazard for travelers to malaria-endemic areas, owing to the potentially severe illness and high case-fatality rates (case-fatality rate per 1,000: France 4; Italy 6.5; UK 8.5; USA 13; Germany 30.4).[4,5] Risk factors associated with fatal imported malaria are poorly known. Limited series have suggested that the fatality rate is significantly lower for migrants from malaria-endemic areas than for patients from areas not endemic for the disease.[6–8] Antimalarial chemoprophylaxis, even incomplete or inappropriate, may also confer a degree of protection.[9–11] Better knowledge of the characteristics and risk factors for fatal imported malaria might help to improve prevention and patient management. We retrospectively analyzed the main features of fatal imported falciparum malaria observed in France during 1996–2003 and compared them with those for nonfatal cases.
Source : https://www.medscape.com/viewarticle/558121_1350