Area of exposure and treatment challenges of malaria in Eritrean migrants: a GeoSentinel analysis

Abstract

BackgroundRecent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea. A descriptive analysis of GeoSentinel cases of malaria in Eritrean migrants was done together with a literature review to elucidate key attributes of malaria in this group with a focus on possible areas of acquisition of malaria and treatment challenges.ResultsA total of 146 cases were identified from the GeoSentinel database from 1999 through September 2017, with a marked increase in 2014 and 2015. All patients originated from Eritrea and the main reporting GeoSentinel sites were in Norway, Switzerland, Sweden, Israel and Germany. The majority of patients (young adult males) were diagnosed with malaria following arrival in the host country. All patients had a possible exposure in Eritrea, but may have been exposed in documented transit countries including Ethiopia, Sudan and possibly Libya in detention centres. Most infections were due to Plasmodium vivax (84.2%), followed by Plasmodium falciparum (8.2%). Two patients were pregnant, and both had P. vivax malaria. Some 31% of the migrants reported having had malaria while in transit. The median time to onset of malaria symptoms post arrival in the host country was 39 days. Some 66% of patients were hospitalized and nine patients had severe malaria (according to WHO criteria), including five due to P. vivax.ConclusionsThe 146 cases of mainly late onset, sometimes severe, P. vivax malaria in Eritrean migrants described in this multi-site, global analysis reflect the findings of single-centre analyses identified in the literature search. Host countries receiving asylum-seekers from Eritrea need to be prepared for large surges in vivax and, to a lesser extent, falciparum malaria, and need to be aware and prepared for glucose-6-phosphate dehydrogenase deficiency testing and primaquine treatment, which is difficult to procure and mainly unlicensed in Europe. There is an urgent need to explore the molecular epidemiology of P. vivax in Eritrean asylum-seekers, to investigate the area of acquisition of P. vivax along common transit routes and to determine whether there has been re-introduction of malaria in areas, such as Libya, where malaria is considered eliminated, but where capable vectors and Plasmodium co-circulate.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2586-9) contains supplementary material, which is available to authorized users.

Prevalence and pattern of waterborne parasitic infections in eastern Africa: A systematic scoping review

“…Most of malaria reports were based on retrospective hospital record surveys with some indication that diagnoses were based mostly based on blood smear examination. Prevalence of malaria was estimated at 2.9–4.31% in Ethiopia ( Taffese et al, 2018 ), an annual episode of 9 million people in Sudan ( Abdalla et al, 2007 ), 13.0% in Tanzania ( Khatib et al, 2018 ), 146 hospital cases in Madagascar ( Schlagenhauf et al, 2018 ), 1.4–2.0% in Seychelles ( Ihantamalala et al, 2018 ) and <5.0% in Djibouti ( Ollivier et al, 2011 ).…”

Retrospective data analyses of social and environmental determinants of malaria control for elimination prospects in Eritrea

“…Missing the infected individuals driving residual transmission (individuals with clinical immunity) or potential sequestration [27,28] of P. vivax, potentially explains the unstable malaria incidence and resultant epidemics or outbreaks in the latter years. A small fraction of clinical diagnosis implies that it could increase drug resistance due to misdiagnosis and overtreatment [25,29]. It will also be challenging and take longer to reach a stable suppression of malaria transmission and transmission tail.…”

Where do Eritrean migrants get infected with malaria? The importance of considering the migration route

“…Dear Editor : We read with interest the paper by Sonden et al [1] confirming the large increase in numbers of Plasmodium vivax cases diagnosed in Europe during the years 2014 and 2015, mainly due to newly arrived Eritrean migrants. Using the GeoSentinel surveillance network data, we recently published similar trends with regards to P. vivax in Eritrean migrants presenting in Europe but also in Israel [2]. Among 146 Eritrean migrants with malaria presenting at GeoSentinel clinics between 1999 through September 2017, the proportion of P. vivax infections was 84.2% (123/146), followed by P. falciparum (12/146; 8.2%), which does not reflect the local epidemiology in Eritrea, where there is a large predominance of P. falciparum reported [3,4].…”

“…We conducted a survey among GeoSentinel clinics regarding availability of primaquine and G6PDH deficiency testing. Our results were that in several European countries, primaquine is only available through hospital pharmacies or through an international pharmacy with delays in procurement and results of testing may take days (1-14 days) [2]. Point of care G6PDd tests are largely unavailable.…”

“…This situation raises several important questions – where do the Eritrean migrants get infected with malaria on their migration route? Our study [2] proposed that the acquisition of P. vivax likely occurred somewhere underway, possibly in Sudan or Ethiopia, or perhaps even in camps in Libya, a country that is currently considered malaria-free; this question is of medical and epidemiological importance. Competent malaria vectors are present in Libya and as camps are populated with migrants, some of whom may be infected by Plasmodium spp.…”