Increasing imported malaria in children and adults in Tuscany, Italy, (2000 to 2017): A retrospective analysis

A decade of travel-associated malaria at King Fahad Hospital of the University in the Eastern Province of Saudi Arabia

Travel-associated malaria is a health hazard, even in non-malaria endemic regions. This is a hospital-based retrospective study of 12,931 febrile patients who presented at King Fahad Hospital of the University (KFHU) from January 2009 to December 2019. Patients either returning from malaria endemic countries and/or for whom malaria was suspected, had blood films microscopically screened for malaria parasites. Malaria prevalence was very low in febrile patients attending KFHU. Out of the 12,931 febrile patients, 0.63% (n = 81) were malaria positive, all travel-related, except for one case of transfusion malaria. Indian nationals were the most infected (29.6%, n = 24), followed by Sudanese nationals (24.7%, n = 20). P. falciparum (47%, n = 38) and P. vivax (42%, n = 24) were the predominant species. The majority of P. falciparum (64.5%, n = 20) cases were from African nationals and the majority of P. vivax (72.7%, n = 24) cases were from Asia. The highest percentage of malaria patients were adult (90%, n = 73), males (85.2%, n = 69), ages ranged from 6 to 65, with a mean of 34.6 years. Most of the malaria cases presented at the emergency room (ER), only 3 required critical care. Only sex, hospitalized in-patient (IP) and attendance at ER were statistically associated with malaria. In the presence of a potential vector, travel-associated malaria in non-malaria endemic areas should be monitored to guide control strategies.

Author summary: Malaria is a neglected potentially fatal tropical mosquito-born disease. Travel-associated malaria is a health hazard, even in non-malaria endemic regions. In spite of previous efforts to estimate malaria prevalence, morbidity and mortality in Saudi Arabia in the last decade, there have been no studies that determine the prevalence of malaria in Al-Khobar, Eastern Province of Saudi Arabia. Malaria prevalence was very low in febrile patients (81/12,931) attending King Fahad Hospital of the University over a decade. Cases were all travel-related, except for one case of transfusion malaria. Indian nationals were the most infected (29.6%), followed by Sudanese nationals (24.7%). P. falciparum (47%) and P. vivax (42%) were the predominant species. The majority of P. falciparum (64.5%) cases were from Africa and the majority of P. vivax (72.7%) cases were from Asia. No patient factors predicted malaria in febrile travelers. In non-malaria endemic areas, in the presence of a potential vector, patients with acute fever coming from endemic areas or having received blood transfusion, should be screened for travel-associated malaria to guide control strategies.

Tuberculosis burden in immigrants and natives, adults and children, in Tuscany between 2000-2018

BACKGROUND

Updated data on epidemiology of tuberculosis are needed in Italy. The aim of this study is to evaluate trends in incidence and associated lethality of tuberculosis in immigrants compared with Italians.

METHODS

All tuberculosis cases diagnosed from 2000 to 2018 in 31 Tuscan hospitals were retrospectively identified.

RESULTS

In 10,827 tuberculosis cases 6715 were males (62%), 4312 (60%) were Italian-born. Hospitalization rate was 15.37/100,000 population/year. The most common comorbidity were liver disease (832/10,827; 7.7%), COPD (675/10,827; 6.2%), cancer (614/10,827; 5.7%). HIV was more frequent in the immigrants (p < 0.001). Extra-pulmonary tuberculosis cases (EPTB) were mainly localized in pleura (740/3,894, 19%) and lymph nodes (449/3,894, 11,5%). HIV was associated with an increased risk of EPTB (OR 3.51 95% CI 2.92-4.23, p < 0.0001). EPTB risk was increased in South Asian-born patients (OR 1.77, 95% CI 1.46-2.15, p < 0.0001) as well in African-born patients (OR 1.13, 95% CI 1.03-1.24, p = 0.0091), who were at risk for gastroenteric tuberculosis (OR 3.74, 95% CI 2.69-5.22, p < 0.0001). Overall mortality rate was 0.006 per 1000. Most of death cases (89%) were Italians (p < 0.02) and mainly affected by pulmonary tuberculosis (PTB).

CONCLUSIONS

In Tuscany, tuberculosis is still a health concern in terms of both morbidity and mortality.

Rising temperature and its impact on receptivity to malaria transmission in Europe: A systematic review

BACKGROUND

Malaria is one of the most life-threatening vector-borne diseases globally. Recent autochthonous cases registered in several European countries have raised awareness regarding the threat of malaria reintroduction to Europe. An increasing number of imported malaria cases today occur due to international travel and migrant flows from malaria-endemic countries. The cumulative factors of the presence of competent vectors, favourable climatic conditions and evidence of increasing temperatures might lead to the re-emergence of malaria in countries where the infection was previously eliminated.

METHODS

We performed a systematic literature review following PRISMA guidelines. We searched for original articles focusing on rising temperature and the receptivity to malaria transmission in Europe. We evaluated the quality of the selected studies using a standardised tool.

RESULTS

The search resulted in 1'999 articles of possible relevance and after screening we included 10 original research papers in the quantitative analysis for the systematic review. With further increasing temperatures studies predicted a northward spread of the occurrence of Anopheles mosquitoes and an extension of seasonality, enabling malaria transmission for annual periods up to 6 months in the years 2051-2080. Highest vector stability and receptivity were predicted in Southern and South-Eastern European areas. Anopheles atroparvus, the main potential malaria vector in Europe, might play an important role under changing conditions favouring malaria transmission.

CONCLUSION

The receptivity of Europe for malaria transmission will increase as a result of rising temperature unless socioeconomic factors remain favourable and appropriate public health measures are implemented. Our systematic review serves as an evidence base for future preventive measures.