Imported malaria in Finland 2003-2011: prospective nationwide data with rechecked background information

Malaria Journal

Research

Heli Siikamäki¹  Pia Kivelä¹  Anu Kantele²  Outi Lyytikäinen³ 

[1] Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital, Aurora Hospital, PO Box 348, Building 5, 3rd floor, FI-00029, Helsinki, HUS, Finland;Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital, Aurora Hospital, PO Box 348, Building 5, 3rd floor, FI-00029, Helsinki, HUS, Finland;University of Helsinki, Institute of Clinical Medicine, University of Helsinki, PO Box 20, FIN-00014, Helsinki, Finland;Department of Bacteriology and Immunology, University of Helsinki, Haartman Institute, University of Helsinki, PO Box 21, FIN-00014, Helsinki, Finland;National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland;

关键词: Malaria;    Imported malaria;    Europe;    Pre-travel advice;    Visiting friends and relatives;    VFR;    Chemoprophylaxis;    Mefloquine;    Atovaquone/proguanil;    Doxycycline;   

DOI  :  10.1186/1475-2875-12-93

 received in 2012-11-27, accepted in 2013-01-06,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundAlthough described in several reports, imported malaria in Europe has not been surveyed nationwide with overall coverage of patients and individually rechecked background information. Plasmodium falciparum infections have been reported despite regularly taken appropriate chemoprophylaxis, yet the reliability of such questionnaire-based retrospective data has been questioned. This was the starting-point for conducting a prospective nationwide survey of imported malaria where compliance data was double-checked.MethodsData was collected on all cases of imported malaria confirmed and recorded by the reference laboratory of Finland (population 5.4 million) from 2003 to 2011, and these were compared with those reported to the National Infectious Disease Register (NIDR). Background information was gathered by detailed questionnaires sent to the clinicians upon diagnosis; missing data were enquired by telephone of clinician or patient. Special attention was paid to compliance with chemoprophylaxis: self-reported use of anti-malarials was rechecked for all cases of P. falciparum.ResultsA total of 265 malaria cases (average annual incidence rate 0.5/100,000 population) had been recorded by the reference laboratory, all of them also reported to NIDR: 54% were born in malaria-endemic countries; 86% were currently living in non-endemic regions. Malaria was mainly (81%) contracted in sub-Saharan Africa. Plasmodium falciparum proved to be the most common species (72%). Immigrants constituted the largest group of travellers (44%). Pre-travel advice was received by 20% of those born in endemic regions and 81% of those from non-endemic regions. Of those with P. falciparum, 4% reported regular use of appropriate chemoprophylaxis (mefloquine or atovaquone/proguanil or doxycycline for regions with chloroquine-resistant and atovaquone/proguanil or doxycycline for regions with mefloquine-resistant P. falciparum); after individual rechecking, however, it was found that none of them had been fully compliant.ConclusionsInformation on compliance with chemoprophylactic regimen cannot be relied on, and it should be rechecked if malaria is suspected. The results of the present study suggest that mefloquine, atovaquone/proguanil and doxycycline are effective as chemoprophylaxis against P. falciparum malaria, when taken conscientiously.

【 授权许可】

CC BY   
© Siikamäki et al.; licensee BioMed Central Ltd. 2013