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Lee EH, Miller RH, Masuoka P, Schiffman E, Wanduragala DM, DeFraites R, Dunlop SJ, Stauffer WM, Hickey PW. Predicting Risk of Imported Disease with Demographics: Geospatial Analysis of Imported Malaria in Minnesota, 2010-2014. Am J Trop Med Hyg 2019; 99:978-986. [PMID: 30062987 PMCID: PMC6159573 DOI: 10.4269/ajtmh.18-0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although immigrants who visit friends and relatives (VFRs) account for most of the travel-acquired malaria cases in the United States, there is limited evidence on community-level risk factors and best practices for prevention appropriate for various VFR groups. Using 2010–2014 malaria case reports, sociodemographic census data, and health services data, we explored and mapped community-level characteristics to understand who is at risk and where imported malaria infections occur in Minnesota. We examined associations with malaria incidence using Poisson and negative binomial regression. Overall, mean incidence was 0.4 cases per 1,000 sub-Saharan African (SSA)–born in communities reporting malaria, with cases concentrated in two areas of Minneapolis–St. Paul. We found moderate and positive associations between imported malaria and counts of SSA- and Asian-born populations, respectively. Our findings may inform future studies to understand the knowledge, attitudes, and practices of VFR travelers and facilitate and focus intervention strategies to reduce imported malaria in the United States.
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Affiliation(s)
- Elizabeth H Lee
- The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robin H Miller
- The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Penny Masuoka
- The Henry M Jackson Foundation, Bethesda, Maryland.,The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | - Robert DeFraites
- The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Stephen J Dunlop
- University of Minnesota, Minneapolis, Minnesota.,Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Patrick W Hickey
- The Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Haile M, Lemma H, Weldu Y. Population Movement as a Risk Factor for Malaria Infection in High-Altitude Villages of Tahtay-Maychew District, Tigray, Northern Ethiopia: A Case-Control Study. Am J Trop Med Hyg 2017; 97:726-732. [PMID: 28722582 DOI: 10.4269/ajtmh.17-0129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Key goal and targets of the Ethiopia National Malaria Control Program are to achieve malaria elimination within specific geographical areas with historically low malaria transmission and to reach near-zero malaria transmission in the remaining malarious areas by 2020. However, back and forth population movement between high-transmission and low-transmission area imposes challenge on the success of national malaria control programs. Therefore, examining the effect of human movement and identification of at-risk populations is crucial in an elimination setting. A matched case-control study was conducted among 520 study participants at a community level in low malaria transmission settings in northern Ethiopia. Study participants who received a malaria test were interviewed regarding their recent travel history. Bivariate and multivariate analyses were carried out to determine if the reported travel was related to malaria infection. Younger age (adjusted odds ratio [AOR] = 3.20, 95% confidence interval [CI]: 1.73, 5.89) and travel in the previous month (AOR = 11.40, 95% CI: 6.91, 18.82) were statistically significant risk factors for malaria infection. Other statistically significant factors, including lower educational level (AOR = 2.21, 95% CI: 1.26, 3.86) and nonagricultural in occupation (AOR = 2.0, 95% CI: 1.02, 3.94), were also found as risk factors for malaria infection. Generally, travel history was found to be a strong predictor for malaria acquisition in the high-altitude villages. Therefore, besides the existing efforts in endemic areas, targeting those who frequently travel to malarious areas is crucial to reduce malaria infection risks and possibility of local transmissions in high-altitude areas of northern Ethiopia.
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Affiliation(s)
- Mebrahtom Haile
- Federal Ministry of Health, Addis Ababa, Ethiopia.,School of Water and Public Health, Ethiopian Institute of Water Resource, Addis Ababa University, Ethiopia
| | - Hailemariam Lemma
- Public Health Department, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Yemane Weldu
- Department of Medical Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Vector-borne diseases: Reconciling the debate between climatic and social determinants. ACTA ACUST UNITED AC 2016; 42:211-212. [PMID: 29769985 DOI: 10.14745/ccdr.v42i10a09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Evans AB, Kulik D, Banerji A, Boggild A, Kain KC, Abdelhaleem M, Morris SK. Imported pediatric malaria at the Hospital for Sick Children, Toronto, Canada: a 16 year review. BMC Pediatr 2014; 14:251. [PMID: 25281037 PMCID: PMC4287547 DOI: 10.1186/1471-2431-14-251] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Children under 5 represent 86% of annual malaria deaths in the world. Following increasing trends in international travel, cases of imported malaria are rising in North America. We describe the epidemiology of malaria diagnosed at a tertiary care pediatric center in the multicultural city of Toronto. Method Retrospective chart review of all laboratory confirmed malaria from birth to <18 years between July 1, 1997 and June 30, 2013. Epidemiological data, travel history, chemoprophylaxis history, as well as clinical presentation, diagnosis and treatment were extracted. Results In total 107 children were diagnosed with malaria in the 16 year time period. Plasmodium falciparum malaria was identified in 76 (71%), Plasmodium vivax in 28 (26%). Median age of infected children was 6.7 years where 35% of children were born in Canada, 63% were recent or previous immigrants. Of those who resided in Canada, reason for travel included visiting friends or relatives (VFR) 95% and tourism or education (5%). Most common countries of infection were Ghana (22%), Nigeria (20%) and India (14%). Median parasitemia at presentation to our institution was 0.4% (IQR 0.1-2.3) with a maximum parasitemia of 31%. Nineteen (18%) met the WHO criteria for severe malaria due to hyperparasitemia, with 3 of these cases also meeting clinical criteria for severe malaria. One third of patients had a delay in treatment of 2 or more days. Ten percent of children had seen two or more primary health care professionals prior to admission. Prophylaxis was documented in 22 (21%), and out of those, 6 (27%) were appropriate for the region of travel and only 1 case was documented as adherent to their prescription. There were no cases of fatality. Conclusion Malaria continues to be a significant disease in returning travelers and immigrant or refugee populations. An increase in physician awareness is required. Appropriate pre-travel advice, insect protection measures, effective chemoprophylaxis is needed to reduce the incidence and improve the management of imported pediatric malaria.
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Affiliation(s)
| | | | | | | | | | | | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G1X8, Canada.
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Nelder MP, Russell C, Williams D, Johnson K, Li L, Baker SL, Marshall S, Bhanich-Supapol W, Pillai DR, Ralevski F. Spatiotemporal dynamics and demographic profiles of imported Plasmodium falciparum and Plasmodium vivax infections in Ontario, Canada (1990-2009). PLoS One 2013; 8:e76208. [PMID: 24098780 PMCID: PMC3786973 DOI: 10.1371/journal.pone.0076208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022] Open
Abstract
We examined malaria cases reported to Ontario's public health surveillance systems from 1990 through 2009 to determine how temporal scale (longitudinal, seasonal), spatial scale (provincial, health unit), and demography (gender, age) contribute to Plasmodium infection in Ontario travellers. Our retrospective study included 4,551 confirmed cases of imported malaria reported throughout Ontario, with additional analysis at the local health unit level (i.e., Ottawa, Peel, and Toronto). During the 20-year period, Plasmodium vivax accounted for 50.6% of all cases, P. falciparum (38.6%), Plasmodium sp. (6.0%), P. ovale (3.1%), and P. malariae (1.8%). During the first ten years of the study (1990-1999), P. vivax (64% of all cases) was the dominant agent, followed by P. falciparum (28%); however, during the second ten years (2000-2009) the situation reversed and P. falciparum (55%) dominated, followed by P. vivax (30%). The prevalence of P. falciparum and P. vivax cases varied spatially (e.g., P. falciparum more prevalent in Toronto, P. vivax more prevalent in Peel), temporally (e.g. P. falciparum incidence increased during the 20-year study), and demographically (e.g. preponderance of male cases). Infection rates per 100,000 international travellers were estimated: rates of infection were 2× higher in males compared to females; rates associated with travel to Africa were 37× higher compared to travel to Asia and 126× higher compared to travel to the Americas; rates of infection were 2.3-3.5× higher in June and July compared to October through March; and rates of infection were highest in those 65-69 years old. Where exposure country was reported, 71% of P. falciparum cases reported exposure in Ghana or Nigeria and 63% of P. vivax cases reported exposure in India. Our study provides insights toward improving pre-travel programs for Ontarians visiting malaria-endemic regions and underscores the changing epidemiology of imported malaria in the province.
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Affiliation(s)
- Mark P. Nelder
- Enteric, Zoonotic and Vector-borne Diseases, Communicable Disease Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Curtis Russell
- Enteric, Zoonotic and Vector-borne Diseases, Communicable Disease Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Dawn Williams
- Surveillance Services, Communicable Disease Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Karen Johnson
- Surveillance Services, Communicable Disease Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Lennon Li
- Analytic Services, Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
| | | | - Sean Marshall
- Analytic Services, Knowledge Services, Public Health Ontario, Toronto, Ontario, Canada
| | | | - Dylan R. Pillai
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Filip Ralevski
- Parasitology, Public Health Ontario Laboratory - Toronto, Public Health Ontario, Toronto, Ontario, Canada
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Lee CS, Gregson DB, Church D, Laupland KB, Eckhardt R, Ross T, Chan W, Pillai DR. Population-based laboratory surveillance of imported malaria in metropolitan Calgary, 2000-2011. PLoS One 2013; 8:e60751. [PMID: 23613742 PMCID: PMC3626683 DOI: 10.1371/journal.pone.0060751] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/02/2013] [Indexed: 12/02/2022] Open
Abstract
Increased travel leads to a heightened risk of imported infectious diseases. Patterns of immigration to countries like Canada have changed such that countries of malaria endemicity are frequented in larger numbers. In keeping with the changes in travel patterns and immigration, the major metropolitan city of Calgary has seen a dramatic rise in malaria incidence over the last decade. Fuelling this rise in Calgary has been the apparent complacence with prophylaxis in individuals visiting friends and relatives and potentially inadequate public health intervention in areas of the city with increased immigration and lower socioeconomic status.
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Affiliation(s)
- Clara S. Lee
- Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Daniel B. Gregson
- Calgary Laboratory Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine and Medicine, The University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, The University of Calgary, Calgary, Alberta, Canada
| | - Deirdre Church
- Calgary Laboratory Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine and Medicine, The University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, The University of Calgary, Calgary, Alberta, Canada
| | - Kevin B. Laupland
- Calgary Laboratory Services, Calgary, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, The University of Calgary, Calgary, Alberta, Canada
| | - Rose Eckhardt
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Terry Ross
- Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Wilson Chan
- Calgary Laboratory Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine and Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Dylan R. Pillai
- Calgary Laboratory Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine and Medicine, The University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, The University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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