Epidemiology and clinical features of imported malaria: a 14-year retrospective single-centre descriptive study in Prague, Czech Republic

Abstract

Background Malaria represents one of the most important imported tropical infectious diseases in European travellers. The objective of the study was to identify changes in the epidemiological features of imported malaria and to analyse the clinical findings and outcomes of imported malaria. Methods This single-centre descriptive study retrospectively analysed the medical records of all imported malaria cases in travellers treated at the Department of Infectious Diseases of University Hospital Bulovka in Prague from 2006 to 2019. Results The study included 203 patients with a median age of 37 years (IQR 30–48) and a male to female ratio of 3.72:1. Plasmodium falciparum was the predominant species (149/203), and its proportion significantly increased from 35/60 cases (58.3%) in 2006–2011 to 69/80 (86.3%) in 2016–2019 (p < 0.001). In contrast, the incidence of Plasmodium vivax malaria decreased from 19/60 cases (31.7%) in 2006–2011 to 5/80 (6.3%) in 2016–2019 (p < 0.001). Malaria was imported from sub-Saharan Africa in 161/203 cases (79.3%). The proportion of travellers from Southeast and South Asia decreased from 16/60 (26.7%) and 6/60 (10.0%) in 2006–2011 to 2/80 (2.5%) and no cases (0.0%) in 2016–2019, respectively (p < 0.001 and p = 0.006). Tourism was the most common reason for travel (82/203), however, the proportion of non-tourists significantly increased over time from 29/60 (48.3%) in 2006–2011 to 55/80 (68.8%) in 2016–2019, p = 0.015. Severe malaria developed in 32/203 (15.8%) patients who were significantly older (p = 0.013) and whose treatment was delayed (p < 0.001). Two lethal outcomes were observed during the study period. Conclusions This study demonstrated a significant increase in P. falciparum malaria, which frequently resulted in severe disease, especially in older patients and those with delayed treatment initiation. The rising proportion of imported malaria in non-tourists, including business travellers and those visiting friends and relatives, is another characteristic finding analogous to the trends observed in Western European and North American centres. The described changes in the aetiology and epidemiology of imported malaria may serve to optimize pre-travel consultation practices and improve post-travel diagnostics and medical care.

An epidemiological analysis of severe imported malaria infections in Sri Lanka, after malaria elimination

“…Imported malaria continues to be reported in Sri Lanka in travellers returning from malaria endemic countries. With an estimated 233 million cases of malaria being reported from the WHO African Region in 2022 [ 30 ], accounting for approximately 94% of the cases globally it is to be expected that most imported malaria cases diagnosed in non-endemic Western countries and countries which have eliminated malaria, such as Sri Lanka and Kyrgyztan, being acquired from Africa [ 31 – 37 ].…”

“…Trojánek et al . , in a 14 year retrospective single-centre descriptive study carried out between 2006 and 2019 in Prague, Czech, reported that 32 (15.8%) of the 203 individuals diagnosed with malaria presented with features of severe P. falciparum malaria (including one co-infection with P. ovale ), with two deaths (case fatality rate of 1.0%) [ 31 ]. Spain reported 108 cases of imported malaria between April 2013 and April 2018 of which 13 (12%) developed severe malaria [ 32 ].…”