Research paper
Epidemiological and clinical features of imported malaria at the three main hospitals of the Friuli-Venezia Giulia Region, Italy

https://doi.org/10.1016/j.idh.2017.08.007Get rights and content

Highlights

  • Imported malaria cases continue to occur in non-endemic regions among travellers returning from malaria endemic countries.

  • At particular risk of acquiring malaria is the group of immigrants identified as visiting friends or relatives (VFRs).

  • The goal of this study is to review the current trends of imported malaria in the Friuli-Venezia Giulia region (FVG).

Abstract

Background

Imported malaria cases continue to occur in non-endemic regions among travellers returning from tropical and subtropical countries. At particular risk of acquiring malaria is the group of travellers identified as immigrants who return to their home country with the specific intent of visiting friends or relatives (VFRs) and who commonly believe they are immune to malaria and fail to seek pre-travel advice. Our aim was to review the current trends of imported malaria in the three main hospitals of the Friuli-Venezia Giulia region (FVG), North Eastern Italy, focusing in particular on patient characteristics and laboratory findings.

Methods

In this retrospective study, we examined all malaria cases among patients admitted from January 2010 through December 2014 to the emergency department of the three main hospitals located in FVG.

Results

During the 5-year study period from 2010 to 2014, there were a total of 140 patients with a diagnosis of suspected malaria and who received microscopic confirmation of malaria. The most common species identified was P. falciparum, in 96 of 140 cases (69%), followed by P. vivax (13%), P. ovale (4%), P. malariae (4%), and mixed infection (4%). The most common reason for travel was VFRs (54%), followed by work (17%), and recent immigration (15%). Moreover, 78% of all patients took no chemoprophylaxis, 80 (79%) of whom were foreigners. Notably, the percentage of Italian travellers who took chemoprophylaxis was only 20% (8 of 39 Italian cases), and the regimen was appropriate in only four cases. Parasitaemia greater than 5% was observed in 11 cases (10%), all due to P. falciparum infection.

Conclusions

We highlight that VFRs have the highest proportion of malaria morbidity and the importance of improving patient management in this category. These data are useful for establishing appropriate malaria prevention measures and recommendations for international travellers.

Introduction

According to the latest World Health Organization (WHO) estimates, there were 212 million new cases of malaria worldwide in 2015 (range, 148–304 million), with the heaviest burden in the WHO African Region, which accounted for most global cases (90%) [1]. International travel to endemic regions is growing steadily and despite attempts to increase the availability of adequate chemoprophylaxis in recent years, imported malaria cases continue to occur in non-endemic regions among travellers returning from tropical and subtropical countries. At particular risk of acquiring malaria is the group of travellers identified as immigrants who return to their home country with the specific intent of visiting friends or relatives (VFR) and who commonly believe they are immune to malaria and fail to seek pre-travel advice [2], [3], [4]. The latest data on reported malaria cases in Europe are available from the European Centre for Disease Prevention and Control (ECDC) Annual Epidemiological Report. In 2014, 6017 confirmed malaria cases were reported by 26 European Union (EU) or European Economic Area (EEA) countries [5]. About 6377 cases of imported malaria were diagnosed in Italy from 2000 to 2008; 4621 cases in foreigners and 1756 in Italian citizens. Plasmodium falciparum accounted for up to 83.1% of cases, followed by Plasmodium vivax (8.4%), the second most common species identified among malaria cases diagnosed in Italy [6], [7], [8]. The goal of this study is to review the current trends of imported malaria in the three main hospitals (University Hospital of Trieste, Hospital of Pordenone, and Santa Maria della Misericordia University Hospital of Udine) of the Friuli-Venezia Giulia Region (FVG), a little-investigated area of north-eastern Italy, focusing in particular on patient characteristics and laboratory findings among adults and children diagnosed with imported malaria.

Section snippets

Methods

In this retrospective study, we examined all malaria cases among patients admitted from January 2010 through December 2014 to the emergency department of the University Hospital of Trieste, Hospital of Pordenone, and Santa Maria della Misericordia University Hospital of Udine.

Data were collected anonymously at each hospital and entered into standardised data forms. Demographic and clinical variables collected were as follows: date of birth, sex, nationality, countries of travel, reasons for

Main epidemiologic characteristics

During the 5-year study period from 2010 to 2014, there were a total of 140 patients with a diagnosis of suspected malaria and who received microscopic confirmation of malaria. The most common species identified was P. falciparum, in 96 of 140 cases (69%), followed by P. vivax (13%), P. ovale (4%), P. malariae (4%), and mixed infection (4%). Morphological characteristics of parasites were uncertain in 9 of 140 cases (6%); these were identified as Plasmodium spp. The number of annual cases

Discussion

In this local study of 140 imported malaria cases diagnosed during 2010–2014 in the three main hospitals of FVG in north-eastern Italy, we revealed a quite stable trend, with a slight increase from 2010 to 2013.

According to the latest national surveillance data [6], [7], we found that most patients with malaria were foreigners (72%) travelling to West Africa, particularly to Ghana, Burkina Faso, and Nigeria (45% of all travellers). The East African country at particular risk was Ethiopia (32%

Ethics

This study was deemed exempt from the Regional Friuli-Venezia Giulia Ethics Committee. The study was conducted in a manner consistent with the Declaration of Helsinki.

Authorship statement

Stano P. and Camporese A. conceived the idea, designed the study, participated in data collection, performed data analysis and interpretation, contributed to critical review of the manuscript. Arzese A, Merelli M, Mascarello M, Maurel C. participated in data collection, contributed to data interpretation and critical review of the manuscript. The other authors contributed to critical review of the manuscript.

Conflicts of interest

The authors have no conflicts of interest to report.

Funding

No funding for this work was received.

Provenance and peer review

Not commissioned; externally peer reviewed.

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