Malaria imported to Denmark remains stable

In 2016, a total of 101 cases of imported malaria were notified by Danish laboratories to Statens Serum Institut.

The number of malaria cases notified as having been imported to Denmark in 2016 was in line with the numbers reported the past few years, see the Figure below .

EPI-NEWS 2017 no 26 - figure 1

Of the cases for which the presumed country of infection was stated (96 cases), 86% had been acquired in Africa and 14% had been acquired in Asia. 2016 saw no imported cases from either Central & South America or Oceania.

As in 2014 and 2015, 2016 saw many cases of vivax malaria among fugitives refugees from Eritrea. But whereas 2014 and 2015 mainly brought malaria cases in young male adults, 2016 also saw a high occurrence of children from Eritrea with vivax malaria. The relevant healthcare workers therefore need to be specially attentive to fugitives from Eritrea who should be allocated relevant and rapid laboratory testing for malaria in case of even minimal clinical suspicion of the condition.

Overall, the cases of the severe falciparum malaria were almost exclusively imported from Africa, 96%. Among the African cases, 66% were caused by falciparum malaria, whereas 28% of the cases were caused by vivax malaria, all of which were seen in travellers from Eritrea and/or Ethiopia.

The malaria cases that were imported from Asia were all caused by vivax malaria, acquired during stays in either Afghanistan, Pakistan or India. No cases of vivax malaria were recorded from South-east Asia.

For common travellers, the main risk is that they may become infected with serious falciparum malaria in Africa, whereas the risk of malaria outside of Africa is very limited and mainly due to vivax malaria. Immigrants and their children who visit their countries of origin generally constitute the main risk group, as these persons typically stay for longer periods of time with their family and sometimes in areas with a considerable local risk of malaria. Thus, a relatively high number of malaria cases were imported from Asia, from three countries in particular: India, Afghanistan and Pakistan. On the other hand, only very few malaria cases are seen among travellers returning from the remaining parts of Asia, including the majority of South-east Asia, despite the large number of Danish tourist travellers to several of these countries. Furthermore, only very few cases of malaria are observed in travellers returning from Central & South America, where the risk of becoming infected with malaria as a traveller should therefore be considered very low. 
For more information, please see EPI-NEWS 26/17, which also includes a case story describing a severe case of falciparum malaria imported from the Limpopo province in South Africa.

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