Non-imported malaria in non-endemic countries: a review of cases in Spain

Abstract

Spain declared the elimination of malaria in 1964. In non-endemic areas, the overwhelming majority of malaria cases are acquired abroad, and locally acquired infections are rare events. In Spain, malaria is a statutorily notifiable disease. During these fifty years more than ten thousand malaria cases have been reported, and about 0.8% of them did not have a history of recent travel. In this report, it was carried out a review of the ways in which malaria can be transmitted in non-endemic areas and a short description of the Spanish cases, aggregated by their transmission mechanisms. Four cases contracted malaria by mosquito bites; there were two autochthonous cases and two of “airport malaria”. The other 28 cases were: congenital malaria cases, transfusion-transmitted malaria, post-transplant cases, nosocomial transmission and cases in intravenous drug users. In addition, in 1971 there was an outbreak of 54 cases due to exposure to blood or blood products. So, while malaria usually is an imported disease in non-endemic areas, it should not be excluded in the differential diagnosis of persons who have fever of unknown origin, regardless of their travel history.

A systematic review of transfusion-transmitted malaria in non-endemic areas

“…Therefore, it was not possible to infer any particular geographical pattern of TTM, whose occurrence may reflect people movements due to historical events as well as the proximity to a malaria endemic areas; an example is provided by the numerous army returnees from Vietnam to USA in the late 1960s who were not identified at the time as potential malaria infected blood donors, and caused an increase of TTM cases in the following years in USA [ 9 ]. Also, a limitation of this systematic review was due to the selection of exclusively case reports in order to describe the main characteristics of each episode; thus, prevalence studies were discarded as well as data on the occurrence of “transfusion outbreaks” such as the 54 cases of P. vivax TTM reported by the WHO to have taken place in Spain in 1971 due to a single blood bank in Barcelona [ 14 ]. Further limitations are due to the intrinsic nature of a systematic review based on different reports hampering the possibility to ascertain retrospectively how reliable were the clinical history and the timing of the diagnosis for each TTM case.…”

Új korszak és új szempontok a transzfúziós kórokozó-átvitel kockázatában, különös tekintettel a rendszeres plazmaeredetű készítményre szoruló haemophiliás betegekre

“…A betegség közismerten szúnyogcsípéssel terjed, de endémiás területeken (például Benin) a véradók 30%-a Plasmodium falciparum-pozitív. A betegség transzfúzióval átvihető [11,12] nem csak az endémiás területeken. Jelenleg az FDA a donorok szűrését javasolja, illetve 1 év várakozást azon donorjelölteknél, akik előzőleg maláriás területre utaztak.…”

“…Jelenleg az FDA a donorok szűrését javasolja, illetve 1 év várakozást azon donorjelölteknél, akik előzőleg maláriás területre utaztak. Leukodepletio itt nem segít [8,11].…”

Partitioning the influence of ecology across scales on parasite evolution

“…Although mosquitoes have occasionally spread malaria parasites over extreme distances (e.g., Velasco et al. ), more commonly, human movement spreads malaria parasites from high to low transmission zones (Tatem and Smith ; Sorichetta et al. ).…”

“…These last two proxies for parasite fitness reflect the fact that infectious humans or mosquitoes are required to introduce parasites into susceptible human populations. Although mosquitoes have occasionally spread malaria parasites over extreme distances (e.g., Velasco et al 2017), more commonly, human movement spreads malaria parasites from high to low transmission zones (Tatem and Smith 2010;Sorichetta et al 2016). All else being equal, a parasite strategy that maximizes the total number of hosts infected over a transmission season (i.e., the epidemic size) should also maximize the chances of being introduced into susceptible populations via infected host movement.…”