Original articleImported malaria in children in Madrid, Spain, 2007–2013Malaria importada en niños en la Comunidad de Madrid, 2007-2013
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.
References (30)
- et al.
Imported malaria in children: a review of clinical studies
Lancet
(2007) - et al.
Severe malaria in children in intensive care. National survey 1990–1995
Arch Pediatr
(2000) - et al.
Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial
Lancet
(2010) - et al.
Diagnóstico y tratamiento de la malaria importada en España: recomendaciones del Grupo de Trabajo de Malaria de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI)
Enferm Infecc Microbiol Clin
(2015) World malaria report 2015
(2015)World malaria report 2012
(2012)- et al.
Clinical practice: the diagnosis of imported malaria in children
Eur J Pediatr
(2011) - et al.
Malaria in children
Mediterr J Hematol Infect Dis
(2012) - et al.
Health challenges of young travellers visiting friends and relatives compared with those travelling for other purposes
Pediatr Infect Dis J
(2012) Informe Semanal Epidemiológico de Vigilancia
(2015)
Management of severe malaria: a practical handbook
Prospective, national clinical and epidemiological study on imported childhood malaria in the United Kingdom and the Republic of Ireland
Pediatr Infect Dis J
Imported malaria in children: a comparative study between recent immigrants and immigrant travellers (VFRs)
J Travel Med
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2021, Travel Medicine and Infectious DiseaseCitation Excerpt :Some studies suggest that immigrants from malaria endemic countries are often unaware of the potential risks of returning to their country of origin and they assume that their children, many of whom were born in non-endemic countries, are protected from malaria because of their African origin [6,8,43]. Consequently, as well-established by previous studies [13,15,26,29,38,40,44], adherence to antimalarial prophylaxis in our cohort was extremely poor. Therefore, pediatricians should give clear advice on chemoprophylaxis to the families when planning the travel and, according to the high percentage of severe cases, we encourage further study to assess the barriers for pre-travel advice and target educational programs addressed to the immigrant communities regarding travel risks and preventive measures.
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