Epidemiology and clinical features of vivax malaria imported to Europe: sentinel surveillance data from TropNetEurop.

BACKGROUND: Plasmodium vivax is the second most common species among malaria patients diagnosed in Europe, but epidemiological and clinical data on imported P. vivax malaria are limited. The TropNetEurop surveillance network has monitored the importation of vivax malaria into Europe since 1999. OBJECTIVES: To present epidemiological and clinical data on imported P. vivax malaria collected at European level. MATERIAL AND METHODS: Data of primary cases of P. vivax malaria reported between January 1999 and September 2003 were analysed, focusing on disease frequency, patient characteristics, place of infection, course of disease, treatment and differences between network-member countries. RESULTS: Within the surveillance period 4,801 cases of imported malaria were reported. 618 (12.9%) were attributed to P. vivax. European travellers and immigrants were the largest patient groups, but their proportion varied among the reporting countries. The main regions of infection in descending order were the Indian subcontinent, Indonesia, South America and Western and Eastern Africa, as a group accounting for more than 60% of the cases. Regular use of malaria chemoprophylaxis was reported by 118 patients. With 86 (inter-quartile range 41-158) versus 31 days (inter-quartile range 4-133) the median symptom onset was significantly delayed in patients with chemoprophylaxis (p < 0.0001). Common complaints were fever, headache, fatigue, and musculo-skeletal symptoms. All patients survived and severe clinical complications were rare. Hospitalization was provided for 60% and primaquine treatment administered to 83.8% of the patients, but frequencies varied strongly among reporting countries. CONCLUSIONS: TropNetEurop data can contribute to the harmonization of European treatment policies.

Assessment of sun reactive skin type with multiple correspondence analysis, hierarchical and tree-structured classification methods.

The sun reactive skin type classification is based on sunburn susceptibility, tanning ability and phenotypic information. As subjects rarely match all features of a given skin type, the attribution to a class is partially subjective. The aims of the study, were to analyse the contribution of each characteristic to the classification made by the expert, and to establish a classification based on a statistical approach conducted on 212 women living in the Ile-de-France area. Multiple regression was used to construct a formula for each phototype. The coefficients obtained demonstrated that the importance of each characteristic was extremely variable from one phototype to another, suggesting that the phototype determination could be facilitated by adding a weight for every characteristic in the decision. Then, multiple correspondence analysis and clustering analysis methods showed that one phototype could be divided into two more homogenous classes.