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The Importance of an Active Case Detection (ACD) Programme for Malaria among Migrants from Malaria Endemic Countries: The Greek Experience in a Receptive and Vulnerable Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114080. [PMID: 32521653 PMCID: PMC7312366 DOI: 10.3390/ijerph17114080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022]
Abstract
Greece has been malaria-free since 1974. In October 2011, following an outbreak of 36 locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases. We evaluated the PACD program for the years 2012–2017 using indicators such as the number of locally acquired cases, the detection rate/sensitivity and the timeliness of diagnosis and treatment. We visited each migrant home every 7–15 days to screen migrants for malaria symptoms, performing Rapid Diagnostic Tests (RDTs) and blood smears on symptomatic patients. We estimated: (i) the number of malaria cases detected by the PACD, divided by the total number of reported malaria cases during the same period among the same population; (ii) the time between onset of symptoms, diagnosis and initiation of treatment. The total number of migrants who were screened for malaria symptoms for the years 2012–2017 was 5057 with 84,169 fever screenings conducted, while 2288 RDTs and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reported in 2012 and 2015, respectively. Sensitivity of PACD ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness between diagnosis and treatment initiation was 0 h. The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction.
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Species composition, geographical distribution and seasonal abundance of the Anopheles maculipennis complex along the Upper Rhine, Germany. Parasitol Res 2019; 119:75-84. [PMID: 31832758 DOI: 10.1007/s00436-019-06551-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
Between May and September 2016, mosquitoes were collected on a biweekly basis at 55 locations with CO2-baited encephalitis vector surveillance traps along the Upper Rhine, Germany, to evaluate the species composition, geographical distribution and abundance of the Anopheles maculipennis complex, some members of this complex being considered vectors of historical malaria in Germany. A total of 2115 Anopheles maculipennis complex specimens were collected during the season, of which a sample of 1252 individuals was determined to species level by amplification of species-specific internal transcribed spacer 2 (ITS2) sequences. A total of 856 individuals of Anopheles daciae (68.37%), 394 Anopheles messeae (31.47%) and 2 Anopheles maculipennis s.s. (0.16%) were recorded. The number and proportion of A. daciae was remarkably higher in the northern meandering zone of the Upper Rhine (843 specimens, 79.90%), than in the more canalised southern furcation zone where A. messeae with 183 collected specimens represented 92.89% of 197 classified individuals. The average number of collected A. maculipennis s.l. individuals per trapping site was 38.45, equalling 0.64% of the total mosquito collection. Despite an increase in imported malaria cases, this comparatively low abundance of A. maculipennis s.l. may indicate a low risk of endemic malaria transmission by members of the A. maculipennis complex today. The proportionally dominance of A. daciae suggests that this species could be suspected the main historical vector of malaria in the Upper Rhine region. Sequence analyses of the ITS2 fragment revealed intraindividual polymorphisms within 3 of 5 diagnostic nucleotides in all specimens of A. daciae, raising the question if additional loci should be considered, to gain further insight into the taxonomical relation to A. messeae.
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Vatandoost H, Raeisi A, Saghafipour A, Nikpour F, Nejati J. Malaria situation in Iran: 2002-2017. Malar J 2019; 18:200. [PMID: 31208453 PMCID: PMC6580592 DOI: 10.1186/s12936-019-2836-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is considered as a major threat to health systems. It is still considered as one of the most important infectious diseases in Iran, but with an elimination goal in 2025. This study aimed to review the malaria situation in Iran over the 16 years. Methods The data was collected from epidemiological registration forms that had been completed by physicians and malaria focal points in the National Centers for Disease Control and Prevention. Results During the study period, 134,273 malaria cases were reported. The malaria incidence decreased from 0.24/1000 cases in 2002 to 0.01/1000 in 2017. From 2009 onward, the number of imported cases increased in comparison with the autochthonous and indigenous cases. Most cases were seen in males and people over 15 years of age. Moreover, the dominant registered reports were from rural areas. Most malaria cases were reported from the south and southeastern of Iran. Plasmodium vivax was the dominant species. Conclusion The dramatic drop in the incidence of autochthonous cases can hopefully support malaria elimination as a major goal in the near future.
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Affiliation(s)
- Hassan Vatandoost
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Raeisi
- National Program for Malaria Control, Center of Disease Control & Prevention, Ministry of Health and Medical Education, Tehran, Iran
| | - Abedin Saghafipour
- Department of Public Health, School of Public Health, Qom University of Medical Sciences, Qom, Iran.
| | - Fatemeh Nikpour
- National Program for Malaria Control, Center of Disease Control & Prevention, Ministry of Health and Medical Education, Tehran, Iran
| | - Jalil Nejati
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Vygen-Bonnet S, Stark K. Changes in malaria epidemiology in Germany, 2001-2016: a time series analysis. Malar J 2018; 17:28. [PMID: 29334944 PMCID: PMC5769339 DOI: 10.1186/s12936-018-2175-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/08/2018] [Indexed: 11/15/2022] Open
Abstract
Background German surveillance data showed a sharp rise of malaria cases in 2014 and 2015 due to the increased arrival of refugees from malaria endemic countries. A time series analysis of data from 2001 to 2016 was performed in order to describe the epidemiology of imported malaria in Germany in general and of the recent increase in particular. Results In total, 11,678 malaria cases were notified between 2001 and 2016 (range 526–1063 cases/year). Newly arriving refugees averaged 10 cases/year (1.5%) in 2001–13 and 292.5 cases/year (28.3%) in 2014–15. Plasmodium (P.) falciparum was the most frequently reported species (range 57.2–85.8%), followed by P. vivax (range during 2001–2013: 7.6–18.1%; during 2014–2015, mean 31.3%). In 2014–15, 22.3% of all P. vivax cases were refugees from Eritrea and 3.3% from other countries of the Horn of Africa; in 2015 and 2016, 19.5% were refugees from Afghanistan and Pakistan. Five P. knowlesi malaria infections were reportedly acquired in Thailand between 2012 and 2016. Total numbers of malaria notifications among native Germans and residents with migration background showed an increasing trend since 2007. Chemoprophylaxis use was reported for 24.3% (1695/6984) of cases and showed a declining trend. Native German cases took significantly more frequently chemoprophylaxis than cases with migration background (32.6% vs. 17.9%; p < 0.001). Discussion/conclusions The steep rise in vivax malaria notifications in 2014 and 2015 was mainly due to newly arriving refugees from Eritrea but also from other countries of the Horn of Africa and South Asia. Clinicians should include malaria in their differential diagnosis in case of a febrile illness in the respective population and consider vivax malaria even if arrival to Germany dates back several months. Over the past 10 years, malaria notifications among native Germans and residents with migration background showed an increasing trend. Use of chemoprophylaxis was insufficient in both groups and deteriorating. New strategies need to be found to increase compliance to chemoprophylaxis recommendations. The surveillance provides valuable data for epidemiological assessment of imported malaria in Germany.
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Affiliation(s)
- Sabine Vygen-Bonnet
- Unit of Gastrointestinal Infections, Zoonoses and Tropical Infections, Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Klaus Stark
- Unit of Gastrointestinal Infections, Zoonoses and Tropical Infections, Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestr. 10, 13353, Berlin, Germany
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Kanayama A, Arima Y, Matsui T, Kaku K, Kinoshita H, Oishi K. Epidemiology of Imported Malaria Cases in Japan, 2006-2014: A Sentinel Traveler Surveillance Approach. Am J Trop Med Hyg 2017; 97:1532-1539. [PMID: 29140229 PMCID: PMC5817757 DOI: 10.4269/ajtmh.17-0171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/15/2017] [Indexed: 11/07/2022] Open
Abstract
Malaria continues to be imported into Japan. To better assess the risk of imported malaria, we describe malaria species, suspected country/area of infection (accounting for the number of travelers), demographic characteristics, clinical manifestation, and healthcare access, based on the national surveillance data from 2006 to 2014. Among 557 cases, the median age was 33 years (range: 1-83 years), and 76% were male; 306 (55%) were classified as Japanese based on the reported name. The majority were Plasmodium falciparum infections (58%), followed by Plasmodium vivax infections (30%). Most P. falciparum cases were acquired in Africa and P. vivax in Asia/Oceania. Notification rates per 10,000 Japanese travelers for P. falciparum were highest for Africa, P. vivax were highest for Asia/Oceania, and high for both species for Papua New Guinea. Ten percent of the cases were clinically severe at the time of notification. Nearly 80% of severe cases were P. falciparum infections, and among P. falciparum cases, Japanese ethnicity was associated with severe case status (P = 0.03). Plasmodium falciparum cases among Japanese cases showed that older age (≥ 50 years) was associated with severe case status (odds ratio = 5.4; 95% confidence interval = 1.9-15.2), adjusted for sex and healthcare access. More informative assessments are possible by accounting for the number of travelers. Older Japanese represent an important demographic to target prevention and early treatment efforts for malaria.
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Affiliation(s)
- Atsuhiro Kanayama
- Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
- Division of Infectious Diseases Epidemiology and Control, National Defense Medical College Research Institute, Saitama, Japan
| | - Yuzo Arima
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tamano Matsui
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koki Kaku
- Division of Infectious Diseases Epidemiology and Control, National Defense Medical College Research Institute, Saitama, Japan
| | - Hitomi Kinoshita
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
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Mòdol JM, Roure S, Smithson À, Fernández-Rivas G, Esquerrà A, Robert N, Méndez M, Ramos J, Carreres A, Valerio L. Epidemiological and clinical assessment of a shared territorial malaria guideline in the 10 years of its implementation (Barcelona, North Metropolitan Area, Catalonia, Spain, 2007-2016). Malar J 2017; 16:365. [PMID: 28893258 PMCID: PMC5594461 DOI: 10.1186/s12936-017-2007-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation. RESULTS A total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34-0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia. CONCLUSIONS After 10 years of surveillance, a moderate increase in malaria incidence was observed, mostly P. vivax cases imported from the Indian sub-continent. Although severe malaria cases have been frequently reported, none of the patients died and organ sequelae were rare. Conceivably, the participation of the Primary Care and the District and Third Level Hospital professionals defining surveillance, diagnostic tests, referral criteria and clinical management can be considered a useful tool to minimize malaria morbi-mortality.
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Affiliation(s)
- Josep M. Mòdol
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Sílvia Roure
- Unitat de Salut Internacional Metropolitana Nord, Santa Coloma de Gramenet, Catalonia Spain
| | - Àlex Smithson
- Internal Medicine Service, Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Catalonia Spain
| | - Gema Fernández-Rivas
- Department of Microbiology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Anna Esquerrà
- Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Neus Robert
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - María Méndez
- Pediatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Javier Ramos
- Internal Medicine Service, Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Catalonia Spain
| | - Anna Carreres
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Lluís Valerio
- Unitat de Salut Internacional Metropolitana Nord, Santa Coloma de Gramenet, Catalonia Spain
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Yeruva SLH, Sinha A, Sarraf-Yazdy M, Gajjala J. Imported Malaria over Fifteen Years in an Inner City Teaching Hospital of Washington DC. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:261-4. [PMID: 27417079 PMCID: PMC4977779 DOI: 10.3347/kjp.2016.54.3.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/24/2016] [Accepted: 05/02/2016] [Indexed: 11/29/2022]
Abstract
As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment.
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Affiliation(s)
| | - Archana Sinha
- Department of Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Mariam Sarraf-Yazdy
- Department of Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Jhansi Gajjala
- Department of Infectious Disease, Howard University Hospital, Washington DC, USA
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Tahir HM, Mehwish, Kanwal N, Butt A, Khan SY, Yaqub A. Genetic diversity in cytochrome c oxidase I gene of Anopheles mosquitoes. Mitochondrial DNA A DNA Mapp Seq Anal 2015; 27:4298-4301. [PMID: 26365229 DOI: 10.3109/19401736.2015.1082104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Genetic diversity in cytochrome c oxidase I (coxI) among 7 species of Anopheles mosquitoes from Pakistan, and 37 species from different geographical regions of the world, was recorded. Automatic Barcode Gap Discovery (ABGD) analysis revealed a clear gap between intraspecific and interspecific distances of 7 species from Pakistan. However, genetic distances of 37 Anopheles species failed to adequately differentiate species in a global context. Intraspecific and interspecific divergences for 7 Anopheles species of Pakistan varied from 0.0% to 2.5% (mean = 0.49%) and 8% to 22.3% (mean = 12.77%), respectively. Similarly, intraspecific distances for 37 species from different parts of world ranged from 0.0% to 11.2% (mean = 0.65%) while values of interspecific divergences ranged from 3.4% to 35% (mean = 11.75%). Although phylogenetic tree revealed separate clades for 7 Anopheles species of Pakistan, it failed to produce separate clades for 37 species of the world. It is concluded that although standard barcode region is helpful for identifying Anopheles mosquitoes, combination of multi-locus approaches and morphology may be required to accurately identify species in this genus.
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Affiliation(s)
| | - Mehwish
- a Department of Zoology , University of Sargodha , Pakistan
| | - Nailla Kanwal
- a Department of Zoology , University of Sargodha , Pakistan
| | - Abida Butt
- b Department of Zoology , University of Punjab , Lahore , Pakistan , and
| | | | - Atif Yaqub
- c Department of Zoology , GC University , Lahore , Pakistan
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Piperaki ET, Mavrouli M, Tseroni M, Routsias J, Kallimani A, Veneti L, Georgitsou M, Chania M, Georgakopoulou T, Hadjichristodoulou C, Tsakris A. Assessment of antibody responses in local and immigrant residents of areas with autochthonous malaria transmission in Greece. Am J Trop Med Hyg 2015; 93:153-8. [PMID: 26013377 DOI: 10.4269/ajtmh.14-0420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 02/01/2015] [Indexed: 11/07/2022] Open
Abstract
Greece has been officially malaria free since 1974. However, from 2009 to 2012, several locally acquired, cases of Plasmodium vivax malaria were detected, in immigrants and in Greek citizens. In this study, the antibody (Ab) response of Greeks and immigrants with documented malaria was initially assessed, followed by an Ab screening of Greeks and immigrant residents of local transmission areas. Of the 38 patients tested, 10.5% of Greeks and 15.7% of immigrants were positive 5-7 months after infection. Of the 1,019 individuals from various areas of Greece, including those of autochthonous transmission, 85 of the 721 (11.8%) immigrants were positive, whereas all 298 Greeks were negative. The rapid Ab titer decline observed is reasonable, given the non-endemic epidemiological setting. The seroepidemiological findings indicate that the local Greek population remains malaria naive and that at this point Greeks are unlikely to serve as reservoir for the infection of local mosquitoes.
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Affiliation(s)
- Evangelia-Theofano Piperaki
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Maria Mavrouli
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Maria Tseroni
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - John Routsias
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Athina Kallimani
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Lamprini Veneti
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Maria Georgitsou
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Maria Chania
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Theano Georgakopoulou
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Christos Hadjichristodoulou
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
| | - Athanassios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece; General Hospital of Sparti, Sparti, Greece; Department of Hygiene and Epidemiology, Medical School, University of Thessaly, Larissa, Greece
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Broderick C, Nadjm B, Smith V, Blaze M, Checkley A, Chiodini PL, Whitty CJM. Clinical, geographical, and temporal risk factors associated with presentation and outcome of vivax malaria imported into the United Kingdom over 27 years: observational study. BMJ 2015; 350:h1703. [PMID: 25882309 PMCID: PMC4410619 DOI: 10.1136/bmj.h1703] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine temporal and geographical trends, risk factors, and seasonality of imported vivax malaria in the United Kingdom to inform clinical advice and policy. DESIGN Observational study. SETTING National surveillance data from the UK Public Health England Malaria Reference Laboratory, data from the International Passenger Survey, and international climactic data. PARTICIPANTS All confirmed and notified cases of malaria in the UK (n=50,187) from 1987 to 2013, focusing on 12,769 cases of vivax malaria. MAIN OUTCOME MEASURES Mortality, sociodemographic details (age, UK region, country of birth and residence, and purpose of travel), destination, and latency (time between arrival in the UK and onset of symptoms). RESULTS Of the malaria cases notified, 25.4% (n=12,769) were due to Plasmodium vivax, of which 78.6% were imported from India and Pakistan. Most affected patients (53.5%) had travelled to visit friends and relatives, and 11.1% occurred in tourists. Imported P vivax is concentrated in areas with large communities of south Asian heritage. Overall mortality was 7/12,725 (0.05%), but with no deaths in 9927 patients aged under 50 years. Restricting the analysis to those aged more than 50 years, mortality was 7/2798 (0.25%), increasing to 4/526 (0.76%) (adjusted odds ratio 32.0, 95% confidence interval 7.1 to 144.0, P<0.001) in those aged 70 years or older. Annual notifications decreased sharply over the period, while traveller numbers between the UK and South Asia increased. The risk of acquiring P vivax from South Asia was year round but was twice as high from June to September (40 per 100,000 trips) compared with the rest of the year. There was strong seasonality in the latency from arrival in the UK to presentation, significantly longer in those arriving in the UK from South Asia from October to March (median 143 days) versus those arriving from April to September (37 days, P<0.001). CONCLUSIONS Travellers visiting friends and family in India and Pakistan are most at risk of acquiring P vivax, and older patients (especially those >70 years) are most at risk of dying; these groups should be targeted for advice before travelling. The risk of acquiring vivax malaria is year round but higher during summer monsoons, masked by latency. The latency of time to clinical presentation of imported vivax malaria in the UK is highly seasonal; seasonal latency has implications for pretravel advice but also for the control of malaria in India and Pakistan. A reduced incidence of vivax malaria in travellers may mean further areas of South Asia can be considered not to need malaria chemoprophylaxis.
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Affiliation(s)
- Claire Broderick
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Valerie Smith
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Marie Blaze
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Peter L Chiodini
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Christopher J M Whitty
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Odolini S, Gautret P, Kain KC, Smith K, Leder K, Jensenius M, Coyle CM, Castelli F, Matteelli A. Imported Plasmodium vivax malaria ex Pakistan. J Travel Med 2014; 21:314-7. [PMID: 24889386 DOI: 10.1111/jtm.12134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/25/2014] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND According to WHO, 1.5 million cases of malaria are reported annually in Pakistan. Malaria distribution in Pakistan is heterogeneous, and some areas, including Punjab, are considered at low risk for malaria. The aim of this study is to describe the trend of imported malaria cases from Pakistan reported to the international surveillance systems from 2005 to 2012. METHODS Clinics reporting malaria cases acquired after a stay in Pakistan between January 1, 2005, and December 31, 2012, were identified from the GeoSentinel (http://www.geosentinel.org) and EuroTravNet (http://www.Eurotravnet.eu) networks. Demographic and travel-related information was retrieved from the database and further information such as areas of destination within Pakistan was obtained directly from the reporting sites. Standard linear regression models were used to assess the statistical significance of the time trend. RESULTS From January 2005 to December 2012, a total of 63 cases of malaria acquired in Pakistan were retrieved in six countries over three continents. A statistically significant increasing trend in imported Plasmodium vivax malaria cases acquired in Pakistan, particularly for those exposed in Punjab, was observed over time (p = 0.006). CONCLUSIONS Our observation may herald a variation in malaria incidence in the Punjab province of Pakistan. This is in contrast with the previously described decreasing incidence of malaria in travelers to the Indian subcontinent, and with reports that describe Punjab as a low risk area for malaria. Nevertheless, this event is considered plausible by international organizations. This has potential implications for changes in chemoprophylaxis options and reinforces the need for increased surveillance, also considering the risk of introduction of autochthonous P. vivax malaria in areas where competent vectors are present, such as Europe.
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Affiliation(s)
- Silvia Odolini
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
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Ashfaq M, Hebert PDN, Mirza JH, Khan AM, Zafar Y, Mirza MS. Analyzing mosquito (Diptera: culicidae) diversity in Pakistan by DNA barcoding. PLoS One 2014; 9:e97268. [PMID: 24827460 PMCID: PMC4036727 DOI: 10.1371/journal.pone.0097268] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although they are important disease vectors mosquito biodiversity in Pakistan is poorly known. Recent epidemics of dengue fever have revealed the need for more detailed understanding of the diversity and distributions of mosquito species in this region. DNA barcoding improves the accuracy of mosquito inventories because morphological differences between many species are subtle, leading to misidentifications. METHODOLOGY/PRINCIPAL FINDINGS Sequence variation in the barcode region of the mitochondrial COI gene was used to identify mosquito species, reveal genetic diversity, and map the distribution of the dengue-vector species in Pakistan. Analysis of 1684 mosquitoes from 491 sites in Punjab and Khyber Pakhtunkhwa during 2010-2013 revealed 32 species with the assemblage dominated by Culex quinquefasciatus (61% of the collection). The genus Aedes (Stegomyia) comprised 15% of the specimens, and was represented by six taxa with the two dengue vector species, Ae. albopictus and Ae. aegypti, dominant and broadly distributed. Anopheles made up another 6% of the catch with An. subpictus dominating. Barcode sequence divergence in conspecific specimens ranged from 0-2.4%, while congeneric species showed from 2.3-17.8% divergence. A global haplotype analysis of disease-vectors showed the presence of multiple haplotypes, although a single haplotype of each dengue-vector species was dominant in most countries. Geographic distribution of Ae. aegypti and Ae. albopictus showed the later species was dominant and found in both rural and urban environments. CONCLUSIONS As the first DNA-based analysis of mosquitoes in Pakistan, this study has begun the construction of a barcode reference library for the mosquitoes of this region. Levels of genetic diversity varied among species. Because of its capacity to differentiate species, even those with subtle morphological differences, DNA barcoding aids accurate tracking of vector populations.
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Affiliation(s)
- Muhammad Ashfaq
- Biodiversity Institute of Ontario, University of Guelph, Guelph, ON, Canada
- * E-mail:
| | - Paul D. N. Hebert
- Biodiversity Institute of Ontario, University of Guelph, Guelph, ON, Canada
| | - Jawwad H. Mirza
- National Institute for Biotechnology and Genetic Engineering, Jhang Road, Faisalabad, Pakistan
| | - Arif M. Khan
- National Institute for Biotechnology and Genetic Engineering, Jhang Road, Faisalabad, Pakistan
| | - Yusuf Zafar
- Pakistan Atomic Energy Commission, Islamabad, Pakistan
| | - M. Sajjad Mirza
- National Institute for Biotechnology and Genetic Engineering, Jhang Road, Faisalabad, Pakistan
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Wichtige, durch Vektoren übertragene Infektionskrankheiten beim Menschen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:557-67. [DOI: 10.1007/s00103-013-1925-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Zeller H, Marrama L, Sudre B, Van Bortel W, Warns-Petit E. Mosquito-borne disease surveillance by the European Centre for Disease Prevention and Control. Clin Microbiol Infect 2013; 19:693-8. [PMID: 23607415 DOI: 10.1111/1469-0691.12230] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For a few years, a series of traditionally tropical mosquito-borne diseases, such as chikungunya fever and dengue, have posed challenges to national public health authorities in the European region. Other diseases have re-emerged, e.g. malaria in Greece, or spread to other countries, e.g. West Nile fever. These diseases are reportable within the European Union (EU), and the European Centre for Disease Prevention and Control collects information in various ways to provide EU member states with topical assessments of disease threats, risks and trends for prompt and appropriate public health action. Using disease-specific expert networks, the European Surveillance System (TESSy) collects standardized comparable information on all statutory communicable diseases in a database. In addition, the event-based surveillance aims to detect potential public health threats early, and to allow timely response and support to blood deferral decisions for pathogens that can be transmitted through blood donation. Laboratory capacity for early detection is implemented through external quality assessments. Other activities include the development of guidelines for the surveillance of mosquito vectors, and the production of regularly updated maps on the currently known occurrence of mosquito vector species.
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Affiliation(s)
- H Zeller
- European Centre for Disease Prevention and Control, Stockholm, Sweden.
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