Malaria in Eritrean migrants newly arrived in seven European countries, 2011 to 2016.

Global migration has resulted in a large number of asylum applications in Europe. In 2014, clusters of Plasmodium vivax cases were reported among newly arrived Eritreans. This study aimed to assess malaria among Eritrean migrants in Europe from 2011 to 2016. We reviewed European migration numbers and malaria surveillance data for seven countries (Denmark, Germany, Netherlands, Norway, Sweden, Switzerland and the United Kingdom) which received 44,050 (94.3%) of 46,730 Eritreans seeking asylum in Europe in 2014. The overall number of malaria cases, predominantly P. vivax, increased significantly in 2014 compared to previous years, with the largest increases in Germany (44 P. vivax cases in 2013 vs 294 in 2014, p < 0.001) and Sweden (18 in 2013 vs 205 in 2014, p < 0.001). Overall, malaria incidence in Eritreans increased from 1-5 to 25 cases per 1,000, and was highest in male teenagers (50 cases/1,000). In conclusion, an exceptional increase of malaria cases occurred in Europe in 2014 and 2015, due to rising numbers of Eritreans with high incidence of P. vivax arriving in Europe. Our results demonstrate potential for rapid changes in imported malaria patterns, highlighting the need for improved awareness, surveillance efforts and timely healthcare in migrants.

Malaria cases in Switzerland from 2005 to 2015 and recent rise of imported Plasmodium vivax malaria.

Reporting cases of malaria to the Federal Office of Public Health has been mandatory in Switzerland since 1974. We analysed notifications of imported confirmed malaria cases between 2005 and 2015 in Switzerland or Liechtenstein. Data for previously visited countries, nationality and reason for travelling were analysed. In contrast with the impressive drop of malaria cases reported worldwide since 2000, we found that the number of malaria cases imported yearly in Switzerland doubled in 2014 and 2015 compared to the average for the preceding decade. Since 2014, Plasmodium vivax infection represented 36% of all diagnosed malaria cases in Switzerland, compared to 11% in the decade leading to 2013. Most of the vivax malaria patients originated from the Horn of Africa, especially from Eritrea. This rise in cases was a consequence not only of an increase in the number of Eritrean refugees, but also their vivax malaria incidence rate, which jumped from 1-3‰ previously to 12‰ in 2014. This is a trend that is not matched by national statistics in Eritrea. An unreported increased incidence in the country of origin (Eritrea) might be the cause of the rise of Pv cases imported into Switzerland, but infections are also likely to occur along the harsh and long migration journey. This epidemiology highlights the need to register and use primaquine for the treatment of latent-phase P. vivax malaria in Switzerland, a medicine currently neither marketed nor systematically reimbursed. Moreover, general practitioners should be aware of this specific epidemiological situation in order to avoid misdiagnosis of febrile Eritreans even months after they reach Switzerland.

Low and Declining Risk for Malaria in Visitors to Indonesia: A Review of Local Indonesian and European Travelers' Data and a Suggestion for New Prophylactic Guidelines.

INTRODUCTION: The world's malaria map is constantly changing and with it the risk for travelers to contract malaria. While some efforts to appreciate the malaria situation for indigenous populations in Indonesia have been made recently, there is only sparse data in the literature on the risk for travelers to Indonesia. METHODS: Data were collected from the Indonesian Ministry of Health (MoH), the World Health Organization (WHO), the Indonesian official statistics website Badan Pusat Statistik (BPS), and from the different European national surveillance bodies. Finally, a comparison between recent official guidelines for prevention of malaria in travelers from Germany, the United States, the UK, and from WHO was done. RESULTS: Data from Denmark, Germany, Sweden and Switzerland show a steady decline of imported cases of malaria from Indonesia from 1997 to 2013, with a leveling off during the last few years. In our study material, the Plasmodium falciparum incidence 2009 to 2013 was 0.35 cases per 100,000 visits and the Plasmodium vivax incidence 1.3 cases per 100,000 visits, with a 95% confidence interval of 0.1-0.9 and 0.7-2.2, respectively. Indonesian data also show a decline of malaria cases-the Annual Parasite Index (API) for all species of malaria has decreased from 4.68 cases per 1,000 inhabitants in 1990 to 1.38 cases per 1,000 inhabitants in 2013. CONCLUSION: Based on these data updated recommendations for malaria prophylaxis in travelers to Indonesia are suggested.