A local outbreak of autochthonous Plasmodium vivax malaria in Laconia, Greece—a re-emerging infection in the southern borders of Europe?

Andriopoulos, Panagiotis; Economopoulou, A.; Spanakos, Gregory; Assimakopoulos, George

doi:10.1016/j.ijid.2012.09.009

Cited by 52 publications

(38 citation statements)

References 13 publications

(13 reference statements)

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“…Rising rates of travel to and from endemic areas has resulted in imported malaria being frequently reported in malaria-free countries, with occasional secondary transmission 7 . However, this travel expansion has not been ubiquitous, with historical and economic ties driving growth along certain routes far more than others, and resulting in uneven malaria movement 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Such cases continue to pose challenges for diagnosis and management, with malaria remaining an infrequently encountered disease for many physicians in non-endemic areas, 4 where it can be expensive to treat 5 and result in high mortality 6 . Moreover, with anopheles vectors still present in many non-endemic countries, imported cases can also cause secondary transmission, 7 although the chances of resumption of endemic transmission are very small 8 . Finally, although the effects of imported malaria on malaria-free countries are problematic, data on the features of imported cases can also provide valuable information about both the epidemiology of malaria in endemic regions where surveillance systems are weak, and on how malaria moves around the world 2 …”

Section: Introductionmentioning

confidence: 99%

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The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics

Tatem

Jia

Ordanovich

et al. 2017

The Lancet Infectious Diseases

172

155

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SummaryBackgroundMalaria remains a problem for many countries classified as malaria free through cases imported from endemic regions. Imported cases to non-endemic countries often result in delays in diagnosis, are expensive to treat, and can sometimes cause secondary local transmission. The movement of malaria in endemic countries has also contributed to the spread of drug resistance and threatens long-term eradication goals. Here we focused on quantifying the international movements of malaria to improve our understanding of these phenomena and facilitate the design of mitigation strategies.MethodsIn this meta-analysis, we studied the database of publicly available nationally reported statistics on imported malaria in the past 10 years, covering more than 50 000 individual cases. We obtained data from 40 non-endemic countries and recorded the geographical variations.FindingsInfection movements were strongly skewed towards a small number of high-traffic routes between 2005 and 2015, with the west Africa region accounting for 56% (13 947/24 941) of all imported cases to non-endemic countries with a reported travel destination, and France and the UK receiving the highest number of cases, with more than 4000 reported cases per year on average. Countries strongly linked by movements of imported cases are grouped by historical, language, and travel ties. There is strong spatial clustering of plasmodium species types.InterpretationThe architecture of the air network, historical ties, demographics of travellers, and malaria endemicity contribute to highly heterogeneous patterns of numbers, routes, and species compositions of parasites transported. With global malaria eradication on the international agenda, malaria control altering local transmission, and the threat of drug resistance, understanding these patterns and their drivers is increasing in importance.FundingBill & Melinda Gates Foundation, National Institutes of Health, UK Medical Research Council, UK Department for International Development, Wellcome Trust.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics

Tatem

Jia

Ordanovich

et al. 2017

The Lancet Infectious Diseases

172

155

View full text Add to dashboard Cite

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“…Although P. vivax is currently found mainly in tropical regions,42 as is P. falciparum , its endemic and epidemic transmission was previously common throughout the temperate zones during summer months (including the short subarctic summer), and these areas remain susceptible to its reintroduction 43–45…”

Section: Mosquito Stages and Vectorial Capacitymentioning

confidence: 99%

Implications of Plasmodium vivax Biology for Control, Elimination, and Research

Olliaro¹,

Barnwell²,

Barry³

et al. 2016

Am J Trop Med Hyg

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This paper summarizes our current understanding of the biology of Plasmodium vivax, how it differs from Plasmodium falciparum, and how these differences explain the need for P. vivax-tailored interventions. The article further pinpoints knowledge gaps where investments in research are needed to help identify and develop such specific interventions. The principal obstacles to reduce and eventually eliminate P. vivax reside in 1) its higher vectorial capacity compared with P. falciparum due to its ability to develop at lower temperature and over a shorter sporogonic cycle in the vector, allowing transmission in temperate zones and making it less sensitive to vector control measures that are otherwise effective on P. falciparum; 2) the presence of dormant liver forms (hypnozoites), sustaining multiple relapsing episodes from a single infectious bite that cannot be diagnosed and are not susceptible to any available antimalarial except primaquine, with routine deployment restricted by toxicity; 3) low parasite densities, which are difficult to detect with current diagnostics leading to missed diagnoses and delayed treatments (and protracted transmission), coupled with 4) transmission stages (gametocytes) occurring early in acute infections, before infection is diagnosed.

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“…The risk of introducing P. vivax into previously malaria-free areas is related to population movements [28], as recently demonstrated in Greece [1, 8, 34]. Thus, extensive knowledge about local epidemiology and the genetics of P. vivax malaria is of the highest importance in order to achieve effective control measures in malaria-endemic areas.…”

Section: Introductionmentioning

confidence: 99%

An outbreak of locally acquired Plasmodium vivax malaria among migrant workers in Oman

et al. 2017

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Plasmodium vivax is the most widely distributed human malaria parasite. Outside sub-Saharan Africa, the proportion of P. vivax malaria is rising. A major cause for concern is the re-emergence of Plasmodium vivax in malaria-free areas. Oman, situated in the south-eastern corner of the Arabian Peninsula, has long been an area of vivax malaria transmission but no locally acquired cases were reported in 2004. However, local transmission has been registered in small outbreaks since 2007. In this study, a local outbreak of 54 cases over 50 days in 2014 was analyzed retrospectively and stained blood slides have been obtained for parasite identification and genotyping. The aim of this study was to identify the geographical origin of these cases, in an attempt to differentiate between imported cases and local transmission. Using circumsporozoite protein (csp), merozoite surface protein 1 (msp1), and merozoite surface protein 3 (msp3) markers for genotyping of parasite DNA obtained by scrapping off the surface of smears, genetic diversity and phylogenetic analysis were performed. The study found that the samples had very low genetic diversity, a temperate genotype, and a high genetic distance, with most of the reference strains coming from endemic countries. We conclude that a small outbreak of imported malaria is not associated with re-emergence of malaria transmission in Oman, as no new cases have been seen since the outbreak ended.

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A local outbreak of autochthonous Plasmodium vivax malaria in Laconia, Greece—a re-emerging infection in the southern borders of Europe?

Cited by 52 publications

References 13 publications

The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics

The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics

Implications of Plasmodium vivax Biology for Control, Elimination, and Research

An outbreak of locally acquired Plasmodium vivax malaria among migrant workers in Oman

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