A study published in Travel Medicine and Infectious Disease provides valuable information on where, how and the contract because the Italians malaria.
on 5219 cases of malaria diagnosed in Italy in 2000-2006, 1518 occurred in Italian travelers, foreigners in 3696, while 5 cases were autochthonous (from accidental exposure). The incidence of malaria in Italian travelers by region was calculated on the basis of data provided by the Ministry of Transport, using as denominator the number of passengers who have flights from Italy to countries where malaria is endemic.
As we have changed the incidence of malaria in Italy during the period under study?
The trend is decreasing, with a 36% reduction (44% among Italians and 32% among travelers of foreign origin).
In such areas the Italians have been infected and what are the Plasmodium species responsible?
In Africa 86% of cases (incidence 01/02/1000). Followed by Asia (incidence 0.08/1000), Central America (0.03/1000) and southern (0.003/1000). Plasmodium falciparum is the predominant species (73% and 82% of the total cases of malaria infections acquired in Africa). Following Plasmodium vivax (16% of all cases), prevalent outside of Africa. Finally, Plasmodium ovale (9%) and malariae (2%). The cases acquired in Africa and on Italian travelers have been divided into two groups, respectively, from West Africa (56%) and South East (44%) the average rate of incidence was equal to 4.1.1000 in the first group and 0.6/1000 in the second. In the first group the incidence was particularly high in Burkina Faso and Mali (06/01/1000), the second in Madagascar (1/6/1000) and Mozambique (01/04/1000).
E 'unique situation in Kenya, which saw a decrease in the incidence (from 0.4/1000 to 0.1/1000), but the continuous growth of Italian visitors, the absolute number of cases is still high.
What is the trend in mortality?
During the period under study were stable the number of deaths from malaria is the case fatality rate (0.5-1.7%), despite the decrease in the incidence of malaria.
What data are emerging with regard to foreign nationals?
represent about 2 / 3 of the total. Most (96%) became infected in Africa, especially in the West (88.7%). The deaths were 6 (corresponding to an average fatality rate of 0.2% from Plasmodium falciparum). In particular, it is a constant number of travelers on Immigrants VFR (visiting friends and relatives), who are not aware of the short length of semi-immunity in people from endemic areas.
What are the factors risk in Italian travelers?
E 'analysis was made of the main risk factors, not summarized here due to space. Among the risk factors examined, I think are particularly interesting are the following:
a) lack of awareness of risk, many travelers are not aware that in Africa, malaria is a disease of only rural but can also occur in urban centers and tourist areas hotels and resorts with a high level: 119 cases in Kenya and 21 contracts on the island of Zanzibar (Tanzania) involving Italian tourists who stay in hotels located on the coast for an average of 6-8 days;
b) how to conduct the chemoprophylaxis: 27% (299 subjects) of Italians who have contracted malaria chemoprophylaxis claims to have done. However, one third of the 299 patients had not completed chemoprophylaxis, while the remaining 2 / 3 claimed to have taken the correct profile. The latter had used a drug appropriate? Not always, it appears that 40% had used drugs inadequate in relation to the area visited, or drugs not listed in the official recommendations.
The findings in turn raise some questions, including the following:
Because the incidence of malaria in Italian travelers is declining?
likely contributed to this reduction a greater awareness of the risk for travelers in a wider dissemination of information on malaria, on the internet, together with the availability of Travel Medicine clinics in all ASL. I should note, however, that in recent years there has been a reduction in the incidence of malaria in sub-Saharan African populations, as reported by Wendy Prudhomme O'Meara et al. in a review recently published in the Lancet Infectious Diseases (Changes in the burden of malaria in sub-Saharan Africa. The Lancet Infectious Diseases 2010, 8:545-555 doi: 10.1016/S1473-3099 (10) 70096-7
www.thelancet.com / journals / LanInfo / issue / current ).
Why, despite a decrease in the incidence, the fatality rate among Italian travelers is almost the same?
The authors put forward two hypotheses: the first is that the phenomenon is linked to certain strains particularly virulent Plasmodium falciparum, the second is that it involved a delay in diagnosis. This in turn could be the result of a delay in the patient's medical advice; also the presence of nonspecific symptoms and sometimes, especially in winter, superimposed on a flu-like clinical picture, can mislead the physician.
What actions can be taken to reduce the incidence and mortality from malaria among travelers and among the Italian immigrants who return to their country of origin?
actions are threefold: to inform travelers, increasing risk awareness and knowledge of the symptoms that require immediate medical attention, proper prophylaxis (both pharmacological and antivettoriale), an early diagnosis that allows treatment to begin soon drug.
Bibliographic Reference
Roberto Romi, Daniela Boccolini, Stefania D'Amato, Corrado Cenci, Mario Peragallo, Fortunato D'Ancona, Maria Grazia Pompa, and Giancarlo Majori. Incidence and risk factors of malaria in Italian travelers to malaria endemic countries. Travel Medicine and Infectious Disease Volume 2010:8;
144-154 doi: 10.1016/j.tmaid.2010.02.001
www.elsevier.com / locate / tmaid
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