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Imported cases of malaria in Spain: observational study using nationally reported statistics and surveillance data, 2002-2015.
Malar J. 2019 Jul 10; 18(1):230.MJ

Abstract

BACKGROUND

Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD).

METHODS

Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors.

RESULTS

A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy.

CONCLUSIONS

The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.

Authors+Show Affiliations

National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII), 28029, Madrid, Spain. zherrador@isciii.es. Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain. zherrador@isciii.es.National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.Hospital Universitario Gregorio Marañón, Madrid, Spain.National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII), 28029, Madrid, Spain. Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31291951

Citation

Herrador, Zaida, et al. "Imported Cases of Malaria in Spain: Observational Study Using Nationally Reported Statistics and Surveillance Data, 2002-2015." Malaria Journal, vol. 18, no. 1, 2019, p. 230.
Herrador Z, Fernández-Martinez B, Quesada-Cubo V, et al. Imported cases of malaria in Spain: observational study using nationally reported statistics and surveillance data, 2002-2015. Malar J. 2019;18(1):230.
Herrador, Z., Fernández-Martinez, B., Quesada-Cubo, V., Diaz-Garcia, O., Cano, R., Benito, A., & Gómez-Barroso, D. (2019). Imported cases of malaria in Spain: observational study using nationally reported statistics and surveillance data, 2002-2015. Malaria Journal, 18(1), 230. https://doi.org/10.1186/s12936-019-2863-2
Herrador Z, et al. Imported Cases of Malaria in Spain: Observational Study Using Nationally Reported Statistics and Surveillance Data, 2002-2015. Malar J. 2019 Jul 10;18(1):230. PubMed PMID: 31291951.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Imported cases of malaria in Spain: observational study using nationally reported statistics and surveillance data, 2002-2015. AU - Herrador,Zaida, AU - Fernández-Martinez,Beatriz, AU - Quesada-Cubo,Víctor, AU - Diaz-Garcia,Oliva, AU - Cano,Rosa, AU - Benito,Agustín, AU - Gómez-Barroso,Diana, Y1 - 2019/07/10/ PY - 2019/03/01/received PY - 2019/07/03/accepted PY - 2019/7/12/entrez PY - 2019/7/12/pubmed PY - 2019/11/5/medline KW - Imported malaria KW - Malaria KW - Malaria chemoprophylaxis KW - Non-endemic areas KW - Spain SP - 230 EP - 230 JF - Malaria journal JO - Malar J VL - 18 IS - 1 N2 - BACKGROUND: Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD). METHODS: Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors. RESULTS: A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy. CONCLUSIONS: The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/31291951/Imported_cases_of_malaria_in_Spain:_observational_study_using_nationally_reported_statistics_and_surveillance_data_2002_2015_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-019-2863-2 DB - PRIME DP - Unbound Medicine ER -