Eritrean and Sudanese migrants presenting with malaria in Israel

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.

Spectrum of infectious diseases among newly arrived Eritrean refugees in Switzerland: a cross-sectional study

OBJECTIVES

Our study aimed at determining the prevalence of selected infectious diseases among recently arrived Eritrean refugees in Switzerland.

METHODS

In this cross-sectional study, asymptomatic Eritrean migrants aged ≥16 years who arrived <24 months ago were recruited at refugee centres in Switzerland. Infectious disease screening included serology for HIV, hepatitis B and C, syphilis and schistosomiasis, polymerase chain reaction (PCR) for malaria, stool microscopy for helminths and intestinal protozoa and circulating cathodic antigen (CCA) testing in urine for schistosomiasis.

RESULTS

Among 107 participating Eritrean refugees, point-of-care CCA urine test for Schistosoma mansoni was positive in 43 patients (40.2%; 95% CI 31.9-49.5). Stool microscopy detected eggs of S. mansoni in 23 (21.5%; 95% CI 13.7-29.3), Hymenolepis nana in 11 (10.3%; 95% CI 4.5-16.0), and cysts of Giardia intestinalis in 7 participants (6.5%: 95% CI 1.9-11.2). Two tested positive for hepatitis B (1.9%; 95% CI 0.0-4.4) and one for syphilis (0.9%; 95% CI 0.0-2.8), none tested positive for HIV or hepatitis C. Malaria PCR was positive in six participants (5.6%; 95% CI: 1.2-9.9).

CONCLUSIONS

Given the high prevalence of S. mansoni infection and potentially severe long-term sequelae of untreated schistosomiasis, routine screening for schistosomiasis in refugees from Schistosoma-endemic regions should be recommended.

High incidence of Plasmodium vivax malaria in newly arrived Eritrean refugees in Sweden since May 2014

Since May 2014, an increase in Plasmodium vivax malaria has been observed in Sweden. As of 31 August 2014, 105 malaria cases have been reported in newly arrived Eritrean refugees, 84 of them P. vivax. The patients were mainly young men and reported migration through Ethiopia and/or Sudan. Severe anaemia and long symptom duration reflect inadequate healthcare during migration. Countries currently hosting Eritrean refugees need to consider P. vivax malaria in this group of migrants.