Original article
Imported malaria in children in Madrid, Spain, 2007–2013Malaria importada en niños en la Comunidad de Madrid, 2007-2013

https://doi.org/10.1016/j.eimc.2016.11.014Get rights and content

Abstract

Background

The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15–20% of imported malaria, with known higher risk of severe disease.

Material and methods

A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007–2013).

Results

A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p < 0.05).

Conclusions

VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population.

Resumen

Antecedentes

En los últimos años la mayoría de los casos de malaria en Europa se han producido en personas asentadas en zonas no endémicas que viajan a su país de origen para visitar a amigos y familiares (VFR). Los niños representan el 15-20% de la malaria importada, con el conocido alto riesgo de enfermedad grave.

Material y métodos

Estudio multicéntrico retrospectivo en 24 hospitales en Madrid, que incluyó pacientes menores de 16 años con diagnóstico de malaria (2007-2013).

Resultados

Se registraron 149 episodios en 147 niños. Plasmodium falciparum fue la especie más frecuentemente aislada. Veinticinco niños padecieron paludismo grave y hubo una muerte relacionada con la malaria. Los pacientes VFR representaron el 45,8% de nuestros niños estudiados. Solo 17 de los VFR habían recibido profilaxis y en solo 4 casos la tomaron apropiadamente. Estos pacientes presentaron con más frecuencia fiebre (98% vs 69%), retraso en el diagnóstico más de 3 días (62 vs 37%) y trombocitopenia (65 vs 33%).

Conclusiones

Los niños VFR representaron una gran proporción de casos de paludismo importado en nuestro estudio. Rara vez tomaron la profilaxis de forma adecuada. Además estos niños presentaron un mayor retraso en la consulta al médico tras la aparición de síntomas, con el subsiguiente retraso en el diagnóstico. Es necesario tomar las medidas preventivas adecuadas, como la educación o el consejo pre-viaje, en esta población.

Section snippets

Background

Great efforts have been developed in the last years to fight against malaria worldwide. Although there has been a reduction in the incidence in the past years, especially in some regions of Africa and the region of Americas, there were still an estimated 214 million cases of malaria in 2015 and 438,000 deaths worldwide. Ninety percent of all malaria deaths occur in sub-Saharan Africa, and 70% in children under five years-old.1

Even though the global burden of malaria is largely carried by

Patients and methods

A retrospective study was performed in 24 hospitals (five of them tertiary) from the Public Health System in the Community of Madrid (CAM), Spain. All children younger than 16 years diagnosed with malaria between January 2007 and January 2013 were included. This study was approved by the Ethics Committee.

Main characteristics of the study participants, including epidemiological data (country of origin, travel history, antimalarial prophylaxis, underlying conditions or concurrent infections,

Epidemiological characteristics

During the study period 149 episodes of malaria were reported in 147 paediatric patients (49% males). The estimated burden of malaria in children in CAM for this period was 1.68/100,000 per year. The median age at diagnosis was 72 months (IQR 35–119), and 39% were younger than 5 years old. Every year most cases were reported during summer (June–September), with a small peak between January and February. The trend along the years of the study remained stable (Fig. 1).

Patients were commonly born

Discussion

This is to our knowledge one of the largest series of imported malaria in children in our country. There are few studies of paediatric malaria in developed countries to date.

The high proportion of children less than five years observed is concerning, being this group at special risk of developing severe malaria. We observed also that many of them use to travel to endemic-areas without the appropriate prophylaxis measures. This feature has been observed also in other imported malaria series in

Conclusions

The characteristics of children with imported malaria in Madrid are similar to those previously described in Western Europe. Epidemiological changes in worldwide malaria infection are to be noticed, as observed in our study, with no episodes of malaria observed in children coming from the region of Americas.

Over the past years there are concerns based on the reports of malaria cases in Europe from children VFRs. We observed that these children delay the visit to the physician, dilating the

Funding

The authors acknowledge no financial support.

Conflict of interests

The authors declare that they have no conflict of interest.

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