Incidence of malaria and risk factors in Italian travelers to malaria endemic countries
Received 18 May 2009; received in revised form 1 February 2010; accepted 4 February 2010. published online 08 March 2010.
Summary
Background
Imported malaria has been an increasing problem in Italy in the last three decades of the 1900s, representing the main risk for travelers visiting tropical and sub-tropical countries where malaria is endemic. Even though the total number of imported cases has been declining since 2000, malaria still represents the most frequent notifiable imported disease in Italy. The present study analyzes all the malaria cases reported in Italy in 2000–2006 in order to assess the trend of incidence over the time and reviewing the risk factors for travelers visiting malaria endemic countries.
Methods
All 2000–2006 case report forms were analyzed. The incidence of malaria in Italian travelers was calculated by continent and by countries most visited, using data provided by the Ministry of Transportation.
Results
Out of the 5219 malaria cases reported and confirmed in the study period five were autochthonous and 5214 imported, 1518 of which occurred in Italian citizen and 3696 in foreigners. Between 2000 and 2006 imported malaria cases fell from 977 to 630 respectively, with a total reduction of about 36%. Most of the cases were contracted in Africa (93%) and Plasmodium falciparum was the etiological agent in 83% of the cases, with an annual average fatality rate of about 0.5%. The average of the crude incidence rate (CIR) among Italians was calculated by continent for both global cases (gCIR) and for P. falciparum cases (pfCIR) resulting of 1.2/1000 and 0.9 for Africa, 0.08/1000 and 0.02 for Asia, 0.03/1000 and 0.003 for Central and South America, respectively. The gCIR by continent slightly but decreased constantly over the study period.
Discussion
The different factors which may influence the risk of contracting malaria for travelers visiting endemic countries and the strategy to reduce completely the number of fatal cases were considered and discussed.
aIstituto Superiore di Sanità, Department of Infectious, Parasitic and Immuno-mediated Diseases, Vector-Borne Diseases and International Health Unit, Viale Regina Elena, 299, 00161 Rome, Italy
bMinistry of Health, Direzione Generale della Prevenzione Sanitaria, Section Malattie Infettive e Profilassi Internazionale, Via Giorgio Ribotta, 5, 00144 Rome, Italy
cCentro Studi e Ricerche di Sanità e di Veterinaria dell'Esercito, Via di Santo Stefano Rotondo, Rome, Italy
dIstituto Superiore di Sanità, Epidemiology of Infectious Diseases, Viale Regina Elena, 299, 00161 Rome, Italy
ABSTRACT