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Vincent R, Coulibaly KS, Ahmed A, Ahmed Y, Hanna TA, Ravi S, Hawkes MT, Gnidehou S. Access to healthcare services and confidence in healthcare professionals' management of malaria: the views of Francophone sub-Saharan African Immigrants living in western Canada. BMC Public Health 2023; 23:2456. [PMID: 38066503 PMCID: PMC10704657 DOI: 10.1186/s12889-023-17266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There is a paucity of knowledge about the healthcare attitudes and practices of French-speaking immigrants originating from Sub-Saharan Africa (FISSA) living in minority settings. The purpose of this study was to characterize FISSA healthcare experiences and confidence in the malaria-related knowledge of health professionals in Edmonton. METHODS A structured survey was used to examine a cohort of 382 FISSA (48% female; 52% male) living in Edmonton. FISSA general healthcare attitudes, experiences and satisfaction with the Canadian healthcare system were studied. Healthcare Competency Perception (HCP) was characterized by using an index score. Statistical analyses were performed to evaluate the impact of healthcare experiences and other outcomes. RESULTS Intriguingly, while only 42% of FISSA had a French-speaking family physician, 83% (197/238) of those who had received health care services in Alberta found that access to medical treatment was easy, and 77% (188/243) were satisfied with received care. Although 70% (171/243) of FISSA did not receive services in French, 82% (199/243) surprisingly reported having good levels of comprehension during their visits. Satisfaction with care was associated with having a family physician (p = 0.018) and having health insurance (p = 0.041). Nevertheless, confidence in the healthcare system's ability to treat malaria effectively was significantly lower, with only 39% (148/382) receiving a positive score on the HCP index. CONCLUSION This study provides an important insight into FISSA experience with and perception of the Alberta's healthcare system.
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Affiliation(s)
- Rémi Vincent
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | | | - Ali Ahmed
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Youssef Ahmed
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Taylor A Hanna
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Srilata Ravi
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Michael T Hawkes
- Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sedami Gnidehou
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada.
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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2
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Harish V, Buajitti E, Burrows H, Posen J, Bogoch II, Corbeil A, Gubbay JB, Rosella LC, Morris SK. Geographic clustering of travel-acquired infections in Ontario, Canada, 2008-2020. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001608. [PMID: 36963058 PMCID: PMC10022755 DOI: 10.1371/journal.pgph.0001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/20/2023] [Indexed: 03/19/2023]
Abstract
As the frequency of international travel increases, more individuals are at risk of travel-acquired infections (TAIs). In this ecological study of over 170,000 unique tests from Public Health Ontario's laboratory, we reviewed all laboratory-reported cases of malaria, dengue, chikungunya, and enteric fever in Ontario, Canada between 2008-2020 to identify high-resolution geographical clusters for potential targeted pre-travel prevention. Smoothed standardized incidence ratios (SIRs) and 95% posterior credible intervals (CIs) were estimated using a spatial Bayesian hierarchical model. High- and low-incidence areas were described using data from the 2016 Census based on the home forward sortation area of patients testing positive. A second model was used to estimate the association between drivetime to the nearest travel clinic and incidence of TAI within high-incidence areas. There were 6,114 microbiologically confirmed TAIs across Ontario over the study period. There was spatial clustering of TAIs (Moran's I = 0.59, p<0.0001). Compared to low-incidence areas, high-incidence areas had higher proportions of immigrants (p<0.0001), were lower income (p = 0.0027), had higher levels of university education (p<0.0001), and less knowledge of English/French languages (p<0.0001). In the high-incidence Greater Toronto Area (GTA), each minute increase in drive time to the closest travel clinic was associated with a 3% reduction in TAI incidence (95% CI 1-6%). While urban neighbourhoods in the GTA had the highest burden of TAIs, geographic proximity to a travel clinic in the GTA was not associated with an area-level incidence reduction in TAI. This suggests other barriers to seeking and adhering to pre-travel advice.
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Affiliation(s)
- Vinyas Harish
- MD/PhD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Holly Burrows
- Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Joshua Posen
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - Isaac I. Bogoch
- Division of Infectious Diseases, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Jonathan B. Gubbay
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- * E-mail:
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3
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Lieu A, Mah J, Desgagnés N, Pillai DR. The impact of the COVID-19 pandemic on malaria in returning travellers in Canada: a retrospective population-based cohort study. J Travel Med 2022; 29:6585752. [PMID: 35567486 PMCID: PMC9129210 DOI: 10.1093/jtm/taac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022]
Abstract
In high-income, low-prevalence settings, travel patterns largely govern malaria transmission; the COVID-19 pandemic has led to travel restrictions resulting in a decrease in malaria case incidence. The proportion of travellers seeking pre-travel has decreased; with the easing of borders, an increase in malaria cases may occur.
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Affiliation(s)
- Anthony Lieu
- Division of Infectious Diseases, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Jordan Mah
- Division of Infectious Diseases, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Canada.,Internal Medicine, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Noémie Desgagnés
- Division of Internal Medicine, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Dylan R Pillai
- Division of Infectious Diseases, Department of Medicine, Cummings School of Medicine, University of Calgary, Calgary, Canada.,Department of Pathology and Laboratory Medicine, Cummings School of Medicine, University of Calgary, Calgary, Canada
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4
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Gaps in knowledge and practices of malaria prevention in Francophone African immigrants in Metropolitan Edmonton. Malar J 2022; 21:197. [PMID: 35729617 PMCID: PMC9215031 DOI: 10.1186/s12936-022-04210-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Important knowledge gaps exist in the understanding of the management of the risks of imported malaria in Canada among Francophone immigrants from sub-Saharan Africa (FISSA). The aim of this cross-sectional study was to investigate the malaria related-knowledge, attitude and practices (KAP) of FISSA in Edmonton, where these immigrants are in an official minority language situation and the impact of language barriers on these factors. Methods A structured survey was used to examine the KAP of 382 FISSA in the Edmonton area from 2018 to 2019. Fisher’s Exact Test was applied to determine if there were associations between knowledge of malaria and different risk factors. Results Almost all FISSA (97%) had an accurate knowledge of fever as the key symptom of malaria. Interestingly, 60% of participants identified bed nets as a preventive method and only 19% of participants had accurate knowledge of malaria transmission. An accurate knowledge of symptoms was significantly associated with a high perceived risk of contracting malaria [odds ratio (OR) 4.33, 95% confidence interval (CI) 1.07–20.62]. Furthermore, even though 70% of FISSA had a high perceived risk of contracting malaria in endemic regions, only 52% of travellers had a pre-travel medical encounter. Importantly, language was not the predominant reason for not seeking pre-travel medical advice, although 84% of respondents chose French as their official language of preference when seeking medical advice. Having a French-speaking physician was correlated with satisfactory prevention knowledge (OR 1.96, 95% CI 1.16–3.35). With respect to health-seeking behaviour, 88% of respondents with a child < 5 years of age would seek medical care for fever in the child after travel to sub-Saharan Africa (SSA). Conclusion This study highlights that factors other than knowledge, risk assessment, and language might determine the lack of compliance with pre-travel medical encounters. It underscores the need for effective strategies to improve this adherence in minority settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04210-w.
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Forgie EME, Brooks HM, Barton M, Hawkes MT. Pediatric Malaria: Global and North American Perspectives. Pediatr Clin North Am 2022; 69:47-64. [PMID: 34794676 DOI: 10.1016/j.pcl.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Malaria is a leading cause of death in children less than 5 years of age globally, and a common cause of fever in the returning North American traveler. New tools in the fight against malaria have been developed over the past decades: potent artemisinin derivatives; rapid diagnostic tests; long-lasting insecticidal bed nets; and a new vaccine, RTS,S/AS01. Thwarting these advances, parasite and Anopheles vector resistance are emerging. In the meantime, clinicians will continue to see malaria among febrile travelers from the tropics. Early recognition, diagnosis, and treatment can be lifesaving, but rely on the vigilance of frontline clinicians.
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Affiliation(s)
- Ella M E Forgie
- Department of Anthropology, University of Alberta, Tory Building, 11211 Saskatchewan Drive, Edmonton, Alberta T6G 2H4, Canada
| | - Hannah M Brooks
- Faculty of Nursing, University of Alberta, 5-143 Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada
| | - Michelle Barton
- Department of Paediatrics, Division of Pediatric Infectious Diseases, Schulich School of Medicine, Western University, Children's Health Research Institute, Lawson Health Research Institute, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Michael T Hawkes
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; Women and Children's Health Research Institute, Edmonton, Canada.
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6
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Niederhauser C, Galel SA. Transfusion-Transmitted Malaria and Mitigation Strategies in Nonendemic Regions. Transfus Med Hemother 2022; 49:205-217. [PMID: 36159954 PMCID: PMC9421689 DOI: 10.1159/000525414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malaria is a mosquito-borne infectious disease caused by protozoan parasites of the genus Plasmodium. These parasites can be transmitted by blood transfusion especially through Red Cell Blood Concentrates collected from asymptomatic and parasitemic donors. As migration of populations from endemic areas to Europe and overseas recreational travel to endemic regions increase, there is growing risk of transfusion-transmitted malaria (TTM) in nonendemic regions of the world. The present work provides an overview of the mitigation strategies in nonendemic countries and their effectiveness and discusses possible approaches to evolve the strategies in order to maintain both a safe and adequate blood supply. Summary The historical and current situation of malaria and TTM in Europe and on the North American continent are described. The infectivity of Plasmodium in blood components and the consequences of TTM are presented, along with the regulations and guidelines for TTM mitigation in Europe, USA, and Canada. The regulations/guidelines currently in place in Europe allow a certain amount of leeway for local policies. A questionnaire was used to survey European countries regarding their current strategies and recent TTM cases. From the questionnaire and published cases, approximately 20 cases of TTM were identified in the past 20 years in the USA and Europe. The vast majority of implicated donors have been former residents of malaria-endemic areas, particularly former residents of hyperendemic areas in Africa. The most recent TTM cases are discussed in detail to provide insight into the gaps in current strategies. The utility and uncertainties of pathogen reduction and serological and molecular testing methods are discussed. Key Messages Overall, the risk of transfusion-associated malaria in nonendemic countries is considered to be low and very few TTM cases occurred in these regions in the last 20 years. The questionnaire-based strategy with questions about risk in relation to malaria exposure with or without selective testing based on questioning seems to be relatively effective, although rare and sometimes fatal transmissions still occur. An outstanding question is whether in the future molecular methods may further improve the safety of blood products and help constrain the loss of donors.
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Affiliation(s)
- Christoph Niederhauser
- Interregional Blood Transfusion SRC, Bern, Switzerland
- Institute for Infectious Disease, University of Bern, Bern, Switzerland
- *Christoph Niederhauser,
| | - Susan A. Galel
- Roche Diagnostics Solutions, Pleasanton, California, USA
- Stanford University School of Medicine, Palo Alto, California, USA
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7
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Buss I, Genton B, D'Acremont V. Aetiology of fever in returning travellers and migrants: a systematic review and meta-analysis. J Travel Med 2020; 27:5955503. [PMID: 33146395 PMCID: PMC7665639 DOI: 10.1093/jtm/taaa207] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Numerous publications focus on fever in returning travellers, but there is no known systematic review considering all diseases, or all tropical diseases causing fever. Such a review is necessary in order to develop appropriate practice guidelines. OBJECTIVES Primary objectives of this review were (i) to determine the aetiology of fever in travellers/migrants returning from (sub) tropical countries as well as the proportion of patients with specific diagnoses, and (ii) to assess the predictors for specific tropical diseases. METHOD Embase, MEDLINE and Cochrane Library were searched with terms combining fever and travel/migrants. All studies focusing on causes of fever in returning travellers and/or clinical and laboratory predictors of tropical diseases were included. Meta-analyses were performed on frequencies of etiological diagnoses. RESULTS 10 064 studies were identified; 541 underwent full-text review; 30 met criteria for data extraction. Tropical infections accounted for 33% of fever diagnoses, with malaria causing 22%, dengue 5% and enteric fever 2%. Non-tropical infections accounted for 36% of febrile cases, with acute gastroenteritis causing 14% and respiratory tract infections 13%. Positive likelihood ratios demonstrated that splenomegaly, thrombocytopenia and hyperbilirubinemia were respectively 5-14, 3-11 and 5-7 times more likely in malaria than non-malaria patients. High variability of results between studies reflects heterogeneity in study design, regions visited, participants' characteristics, setting, laboratory investigations performed and diseases included. CONCLUSION Malaria accounted for one-fifth of febrile cases, highlighting the importance of rapid malaria testing in febrile returning travellers, followed by other rapid tests for common tropical diseases. High variability between studies highlights the need to harmonize study designs and to promote multi-centre studies investigating predictors of diseases, including of lower incidence, which may help to develop evidence-based guidelines. The use of clinical decision support algorithms by health workers which incorporate clinical predictors, could help standardize studies as well as improve quality of recommendations.
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Affiliation(s)
- Imogen Buss
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Blaise Genton
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Valérie D'Acremont
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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8
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Arinaitwe E, Dorsey G, Nankabirwa JI, Kigozi SP, Katureebe A, Kakande E, Rek J, Rosenthal PJ, Drakeley C, Kamya MR, Staedke SG. Association Between Recent Overnight Travel and Risk of Malaria: A Prospective Cohort Study at 3 Sites in Uganda. Clin Infect Dis 2020; 68:313-320. [PMID: 29868722 DOI: 10.1093/cid/ciy478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/31/2018] [Indexed: 11/14/2022] Open
Abstract
Background Human movement can undermine malaria control efforts. However, understanding of the association between travel and malaria infection in Africa is limited. We evaluated the association between recent overnight travel and malaria incidence in Uganda. Methods All children aged 0.5-10 years and 1 adult living in 266 randomly selected households within 3 different regions of Uganda were followed up prospectively. Information on overnight travel was collected in 2015-2016. Malaria, defined as fever with parasites detected by microscopy, was measured using passive surveillance. Results At least 1 overnight trip was reported by 64 of 275 (23.3%) participants in Walukuba, 37 of 317 (11.7%) in Nagongera, and 19 of 314 (6.1%) in Kihihi. Among individuals who traveled, the incidence of malaria was higher in the first 60 days after traveling, compared with periods without recent travel at all 3 sites (overall, 1.15 vs 0.33 episodes per person-year; incidence rate ratio, 3.53; 95% confidence interval, 1.85-6.73; P < .001). Risk factors for malaria within 60 days after overnight travel included young age (19.5% in children vs 4.9% in adults; odds ratio, 5.29; 95% confidence interval, 1.34-21.0; P = .02) and not using an insecticide-treated net during travel (18.0% for no use vs 4.1% for any use; 5.10; 1.07-24.5; P = .04). Conclusions Recent overnight travel was associated with a higher incidence of malaria. Individuals who travel may represent a high-risk group that could be targeted for malaria control interventions, particularly use of insecticide-treated nets.
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Affiliation(s)
- Emmanuel Arinaitwe
- London School of Hygiene and Tropical Medicine, United Kingdom.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco
| | | | - Simon P Kigozi
- London School of Hygiene and Tropical Medicine, United Kingdom.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - John Rek
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, United Kingdom
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9
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Marasinghe DH, Cheaveau J, Meatherall B, Kuhn S, Vaughan S, Zimmer R, Pillai DR. Risk of malaria associated with travel to malaria-endemic areas to visit friends and relatives: a population-based case-control study. CMAJ Open 2020; 8:E60-E68. [PMID: 31992561 PMCID: PMC6996033 DOI: 10.9778/cmajo.20190070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Reports relying on population-based data and using epidemiologic methodologies such as case-control study designs for malaria in travellers and multivariable regression analysis of risk factors are rare. The aim of this study was to investigate the epidemiologic characteristics of travellers who tested positive for malaria after visiting friends and relatives in malaria-endemic areas to determine the risk of malaria associated with such travel. METHODS Using routinely collected data from a population-based laboratory database, we conducted a case-control study of symptomatic people returning from travel to malaria-endemic areas who presented for malaria testing in Calgary from 2013 to 2017. We used a multivariable logistic regression to analyze the association between the presence of malaria and other risk factors. RESULTS There were 251 confirmed malaria cases during the study period, of which 219 were matched to 1129 returning travellers without malaria. Based on the multivariable regression, the odds of a traveller who visited friends and relatives in malariaendemic areas being diagnosed with malaria was 2.82 (95% confidence interval [CI] 1.42-5.92) times greater than that of other travellers to these regions. Adults (odds ratio [OR] 3.62, 95% CI 1.66-8.84), males (OR 2.70, 95% CI 1.56-4.80), travellers to Africa (OR 11.52, 95% CI 6.33-22.05) and those who did not seek pretravel advice (OR 0.38, 95% CI 0.20-0.70) were more likely to be diagnosed with malaria. Although those travelling to visit friends and relatives tended to stay longer in endemic areas than other travellers, visit duration was not associated with an increased likelihood of malaria in the model. The annual incidence of malaria was highest (13.34 per 100 000) in metropolitan wards associated with lower socioeconomic status and immigrant communities. INTERPRETATION Travellers who visited friends and relatives in malaria-endemic areas were less likely than other travellers to these regions to seek pretravel advice, take prophylaxis and have a visit duration less than 2 weeks; travelling to Africa and being male increased the odds of being diagnosed with malaria, independent of other factors. These data suggest that targeted strategies to provide pretravel care to travellers who visit friends and relatives in malaria-endemic areas may aid in reducing the burden of malaria in this population.
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Affiliation(s)
- Dewdunee H Marasinghe
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - James Cheaveau
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Bonnie Meatherall
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Susan Kuhn
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Rudolf Zimmer
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Dylan R Pillai
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta.
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10
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Redditt V, Bogoch I, Rashid M. A 38-year-old man with fever and a history of malaria. CMAJ 2019; 190:E1081-E1082. [PMID: 30201615 DOI: 10.1503/cmaj.171128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Vanessa Redditt
- Crossroads Clinic (Redditt, Rashid), Women's College Hospital; Department of Family and Community Medicine (Redditt, Rashid), University of Toronto; Divisions of General Internal Medicine and Infectious Diseases (Bogoch), University Health Network; Department of Medicine (Bogoch), University of Toronto, Toronto, Ont
| | - Isaac Bogoch
- Crossroads Clinic (Redditt, Rashid), Women's College Hospital; Department of Family and Community Medicine (Redditt, Rashid), University of Toronto; Divisions of General Internal Medicine and Infectious Diseases (Bogoch), University Health Network; Department of Medicine (Bogoch), University of Toronto, Toronto, Ont
| | - Meb Rashid
- Crossroads Clinic (Redditt, Rashid), Women's College Hospital; Department of Family and Community Medicine (Redditt, Rashid), University of Toronto; Divisions of General Internal Medicine and Infectious Diseases (Bogoch), University Health Network; Department of Medicine (Bogoch), University of Toronto, Toronto, Ont.
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11
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Akselrod H, Swierzbinski MJ, Zheng Z, Keiser J, Parenti DM, Simon GL. Characteristics and Severity of Disease among 100 Cases of Imported Malaria Seen at a U.S. University Hospital, 2000-2017. Am J Trop Med Hyg 2019; 99:1511-1517. [PMID: 30350769 DOI: 10.4269/ajtmh.18-0608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Malaria acquired in endemic areas poses a substantial risk to travelers arriving in or returning to the United States. Timely diagnosis and recognition of severe illness are crucial; however, many U.S.-based clinicians lack familiarity with this disease. We conducted a retrospective review of 100 cases of malaria in adults seen at a single urban university hospital during 2000-2017. Descriptive and analytical statistics were calculated, including logistic regression modeling case severity. Most of the patients presented with Plasmodium falciparum (76%), most commonly after travel from sub-Saharan Africa (94%). Prior malaria experience was common (50%), but adherence to a prophylactic regimen was exceedingly rare (4%). Twenty-one patients had severe malaria, including 10 with cerebral malaria. Severity was predicted by high parasitemia, bandemia, hypoglycemia, and hypotension at the time of presentation. In 24 patients, the initial treatment regimen was changed, usually because of the appearance of clinical deterioration or drug toxicity. One patient required intravenous artesunate. All patients survived, although one suffered fetal loss. Among 30 patients initially evaluated at other institutions, 43% had been treated for an alternative diagnosis. The most common reasons for transfer of patients to our hospital were inadequate facilities and lack of expertise with malaria. There needs to be increased awareness among U.S.-based travelers and clinicians regarding malaria as a potentially lethal condition, emphasizing the use of appropriate prophylaxis. Our simple model of disease severity could serve frontline physicians when deciding which patients should be admitted to the intensive care unit or transferred for higher level care.
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Affiliation(s)
- Hana Akselrod
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matthew J Swierzbinski
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Zhaonian Zheng
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - John Keiser
- Department of Pathology, George Washington University School of Medicine and Health Sciences; Washington, District of Columbia
| | - David M Parenti
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Gary L Simon
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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12
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Ng V, Rees EE, Lindsay LR, Drebot MA, Brownstone T, Sadeghieh T, Khan SU. Could exotic mosquito-borne diseases emerge in Canada with climate change? CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2019; 45:98-107. [PMID: 31285699 PMCID: PMC6587696 DOI: 10.14745/ccdr.v45i04a04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Of the 3,500 species of mosquitoes worldwide, only a small portion carry and transmit the mosquito-borne diseases (MBDs) that cause approximately half a million deaths annually worldwide. The most common exotic MBDs, such as malaria and dengue, are not currently established in Canada, in part because of our relatively harsh climate; however, this situation could evolve with climate change. Mosquitoes native to Canada may become infected with new pathogens and move into new regions within Canada. In addition, new mosquito species may move into Canada from other countries, and these exotic species may bring exotic MBDs as well. With high levels of international travel, including to locations with exotic MBDs, there will be more travel-acquired cases of MBDs. With climate change, there is the potential for exotic mosquito populations to become established in Canada. There is already a small area of Canada where exotic Aedes mosquitoes have become established although, to date, there is no evidence that these carry any exotic (or already endemic) MBDs. The increased risks of spreading MBDs, or introducing exotic MBDs, will need a careful clinical and public health response. Clinicians will need to maintain a high level of awareness of current trends, to promote mosquito bite prevention strategies, and to know the laboratory tests needed for early detection and when to report laboratory results to public health. Public health efforts will need to focus on ongoing active surveillance, public and professional awareness and mosquito control. Canadians need to be aware of the risks of acquiring exotic MBDs while travelling abroad as well as the risk that they could serve as a potential route of introduction for exotic MBDs into Canada when they return home.
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Affiliation(s)
- V Ng
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - EE Rees
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - LR Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - MA Drebot
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - T Brownstone
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - T Sadeghieh
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
- Department of Population Medicine, University of Guelph, Guelph, ON
| | - SU Khan
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
- Department of Population Medicine, University of Guelph, Guelph, ON
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13
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Boggild AK, Geduld J, Libman M, Yansouni CP, McCarthy AE, Hajek J, Ghesquiere W, Mirzanejad Y, Vincelette J, Kuhn S, Plourde PJ, Chakrabarti S, Greenaway C, Hamer DH, Kain KC. Spectrum of illness in migrants to Canada: sentinel surveillance through CanTravNet. J Travel Med 2019; 26:5159662. [PMID: 30395252 DOI: 10.1093/jtm/tay117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to ongoing political instability and conflict in many parts of the world, migrants are increasingly seeking asylum and refuge in Canada. METHODS We examined demographic and travel correlates of illnesses among migrants to Canada to establish a detailed epidemiologic framework of this population for Canadian practitioners. Data on ill-returned Canadian travellers presenting to a CanTravNet site between 1 January 2015 and 31 December 2015 were analyzed. RESULTS During the study period, 2415 ill travellers and migrants presented to a CanTravNet site, and of those, 519 (21.5%) travelled for the purpose of migration. Sub-Saharan Africa (n = 160, 30.8%), southeast Asia (n = 84, 16.2%) and south central Asia (n = 75, 14.5%) were the most common source regions for migrants, while the top specific source countries, of 98 represented, were the Philippines (n = 45, 8.7%), China (n = 36, 6.9%) and Vietnam (n = 31, 6.0%). Compared with non-migrant travellers, migrants were more likely to have a pre-existing immunocompromising medical condition, such as HIV or diabetes mellitus (P < 0.0001), and to require inpatient management of their illness (P < 0.0001). Diagnoses such as tuberculosis (n = 263, 50.7%), hepatitis B and C (n = 78, 15%) and HIV (n = 11, 2.1%) were over-represented in the migrant population compared with non-migrant travellers (P < 0.0001). Most cases of tuberculosis in the migrant population (n = 263) were latent (82% [n = 216]); only 18% (n = 47) were active. CONCLUSIONS Compared with non-migrant travellers, migrants were more likely to present with a communicable infectious disease, such as tuberculosis, potentially complicated by an underlying immunosuppressing condition such as HIV. These differences highlight the divergent healthcare needs in the migrant population, and underscore the importance of surveillance programmes to understand their burden of illness. Intake programming should be adequately resourced to accommodate the medical needs of this vulnerable population of new Canadians.
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Affiliation(s)
- Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada
| | - Jennifer Geduld
- Office of Border and Travel Health, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Michael Libman
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cedric P Yansouni
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne E McCarthy
- Tropical Medicine and International Health Clinic, Division of Infectious Diseases, Ottawa Hospital and the University of Ottawa, Ottawa ON, Canada
| | - Jan Hajek
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver British Columbia, Canada
| | - Wayne Ghesquiere
- Infectious Diseases, Vancouver Island Health Authority, Department of Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Yazdan Mirzanejad
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver British Columbia, Canada.,Fraser Health, Surrey, British Columbia, Canada
| | - Jean Vincelette
- Hôpital Saint-Luc du CHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Susan Kuhn
- Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine, Alberta Children's Hospital and the University of Calgary, Calgary, Alberta, Canada
| | - Pierre J Plourde
- Travel Health and Tropical Medicine Services, Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Sumontra Chakrabarti
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Christina Greenaway
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Kevin C Kain
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,SAR Laboratories, Sandra Rotman Centre for Global Health, Toronto, ON Canada
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14
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Affiliation(s)
- Felicia A Scaggs Huang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Elizabeth Schlaudecker
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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15
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Tatem AJ. Underestimate of annual malaria imports to Canada - Author reply. THE LANCET. INFECTIOUS DISEASES 2018; 17:142-143. [PMID: 28134114 DOI: 10.1016/s1473-3099(17)30025-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew J Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK; Flowminder Foundation, Stockholm, Sweden.
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16
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Underestimate of annual malaria imports to Canada. THE LANCET. INFECTIOUS DISEASES 2018; 17:141-142. [PMID: 28134112 DOI: 10.1016/s1473-3099(17)30010-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 11/24/2022]
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17
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Kong LY, Libman MD, Yansouni CP. Travel-Related Infections Among Pregnant Travellers to the Tropics: An Overview. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:460-472. [PMID: 29307707 DOI: 10.1016/j.jogc.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Abstract
Infectious diseases acquired during travel pose a significant health risk to pregnant travellers, who are more susceptible to both acquiring certain infections and developing severe complications. A review of the literature focusing on recent evidence-based guidelines was conducted with attention to tropical infections in the pregnant patient. A summary meant to serve as a succinct reference for health care professionals caring for pregnant women is presented. Magnitude of risk, clinical features, management, and preventive strategies of major travel-acquired infections of pertinence to the pregnant traveller are summarized, including malaria, arboviral infections, foodborne infections, helminthic infections, and influenza. Tables with details on specific infections within each group and guidance for reducing travel-related health risks in the pregnant patient are presented.
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Affiliation(s)
- Ling Yuan Kong
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC.
| | - Michael D Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC
| | - Cedric P Yansouni
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montréal, QC
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18
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Zimmer R. Competing visions for travel health services in Canada. J Travel Med 2018; 25:4991787. [PMID: 29726915 DOI: 10.1093/jtm/tax096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/14/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Rudy Zimmer
- Department of Community Health Sciences, The University of Calgary, Calgary, Alberta, Canada
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19
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Rainova IG, Harizanov RN, Kaftandjiev IT, Mikov OD, Tsvetkova ND. Imported malaria in Bulgaria, status and prognosis after eradication in 1965. J Infect Public Health 2017; 11:534-539. [PMID: 29126828 DOI: 10.1016/j.jiph.2017.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/25/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This retrospective analysis assessed all recorded malaria cases in Bulgaria after 1965, when the country was certified as malaria-free by the World Health Organization (WHO), and evaluated the readiness of the public health system to interrupt an outbreak of local transmission in case of infection importation. METHODS The cases were analyzed according to causative species; geographic origin of the imported case; and the citizenship, age, and gender of the infected individuals. RESULTS In the 50-year study period (1966-2015), there were a total of 3011 cases of malaria imported to Bulgaria from different regions of the world. The majority of the cases originating in Africa were caused by Plasmodium falciparum (65.5%), while most of these originating in Asia were caused by P. vivax (80.9%). The potential season for malaria transmission in Bulgaria is from April to October, and 58.5% of the malaria cases were imported during that time of the year. CONCLUSIONS The increasing movement of people to and from areas endemic for malaria requires the health authorities of countries with appropriate conditions for reintroduction to conduct enhanced measures for surveillance and control of this potentially deadly disease.
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Affiliation(s)
- Iskra G Rainova
- National Centre of Infectious and Parasitic Diseases, Department of Parasitology and Tropical Medicine, 1504 Sofia, 26 Yanko Sakazov Blvd., Bulgaria
| | - Rumen N Harizanov
- National Centre of Infectious and Parasitic Diseases, Department of Parasitology and Tropical Medicine, 1504 Sofia, 26 Yanko Sakazov Blvd., Bulgaria.
| | - Iskren T Kaftandjiev
- National Centre of Infectious and Parasitic Diseases, Department of Parasitology and Tropical Medicine, 1504 Sofia, 26 Yanko Sakazov Blvd., Bulgaria
| | - Ognyan D Mikov
- National Centre of Infectious and Parasitic Diseases, Department of Parasitology and Tropical Medicine, 1504 Sofia, 26 Yanko Sakazov Blvd., Bulgaria
| | - Nina D Tsvetkova
- National Centre of Infectious and Parasitic Diseases, Department of Parasitology and Tropical Medicine, 1504 Sofia, 26 Yanko Sakazov Blvd., Bulgaria
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20
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Mòdol JM, Roure S, Smithson À, Fernández-Rivas G, Esquerrà A, Robert N, Méndez M, Ramos J, Carreres A, Valerio L. Epidemiological and clinical assessment of a shared territorial malaria guideline in the 10 years of its implementation (Barcelona, North Metropolitan Area, Catalonia, Spain, 2007-2016). Malar J 2017; 16:365. [PMID: 28893258 PMCID: PMC5594461 DOI: 10.1186/s12936-017-2007-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation. RESULTS A total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34-0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia. CONCLUSIONS After 10 years of surveillance, a moderate increase in malaria incidence was observed, mostly P. vivax cases imported from the Indian sub-continent. Although severe malaria cases have been frequently reported, none of the patients died and organ sequelae were rare. Conceivably, the participation of the Primary Care and the District and Third Level Hospital professionals defining surveillance, diagnostic tests, referral criteria and clinical management can be considered a useful tool to minimize malaria morbi-mortality.
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Affiliation(s)
- Josep M. Mòdol
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Sílvia Roure
- Unitat de Salut Internacional Metropolitana Nord, Santa Coloma de Gramenet, Catalonia Spain
| | - Àlex Smithson
- Internal Medicine Service, Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Catalonia Spain
| | - Gema Fernández-Rivas
- Department of Microbiology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Anna Esquerrà
- Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Neus Robert
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - María Méndez
- Pediatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Javier Ramos
- Internal Medicine Service, Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Catalonia Spain
| | - Anna Carreres
- Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia Spain
| | - Lluís Valerio
- Unitat de Salut Internacional Metropolitana Nord, Santa Coloma de Gramenet, Catalonia Spain
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21
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Detection of Plasmodium Infection by the illumigene Malaria Assay Compared to Reference Microscopy and Real-Time PCR. J Clin Microbiol 2017; 55:3037-3045. [PMID: 28768730 DOI: 10.1128/jcm.00806-17] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/27/2017] [Indexed: 01/06/2023] Open
Abstract
Malaria is one of the leading causes of infectious disease in travelers returning from the tropics. The diagnosis of malaria is typically performed by examining Giemsa-stained thick and thin peripheral blood smears, which is time consuming, labor intensive, and requires high levels of proficiency. Alternatively, loop-mediated isothermal amplification (LAMP) is a new molecular method, which is rapid, sensitive, and requires less capital equipment and technological training. We conducted a retrospective study comparing two formats of a commercial LAMP assay (Meridian illumigene malaria [M] and malaria Plus [MP]) versus reference microscopy on archived blood specimens (n = 140) obtained from unique returning travelers suspected of having malaria. Discrepant results were resolved by either repeat testing or a laboratory developed ultrasensitive real-time PCR method. On initial testing, the Meridian illumigene M and MP kits had sensitivities of 97.3% (95% confidence interval [CI], 90.7 to 99.7%) and 100.0% (95.1 to 100.0%) and specificities of 93.8% (84.8 to 98.3%) and 91.5% (81.3 to 97.2%), respectively, versus reference microscopy. We project a significant cost reduction in low prevalence settings where malaria is not endemic with LAMP-based malaria screening given the excellent negative predictive value achieved with LAMP.
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22
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Vinnemeier CD, Rothe C, Kreuels B, Addo MM, Vygen-Bonnet S, Cramer JP, Rolling T. Response to fever and utilization of standby emergency treatment (SBET) for malaria in travellers to Southeast Asia: a questionnaire-based cohort study. Malar J 2017; 16:44. [PMID: 28122576 PMCID: PMC5264331 DOI: 10.1186/s12936-017-1678-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines in several European countries recommend standby emergency treatment (SBET) for travellers to regions with low or medium malaria transmission instead of continuous chemoprophylaxis: travellers are advised to seek medical assistance within 24 h in case of fever and to self-administer SBET only if they are not able to consult a doctor within the time period specified. Data on healthcare-seeking behaviour of febrile travellers and utilization of SBET is however scarce as only two studies were performed in the mid-1990s. Since tourism is constantly increasing and malaria epidemiology has dramatically changed in the meantime more knowledge is urgently needed. Methods Some 876 travellers to destinations in South and Southeast Asia with low or medium malaria transmission were recruited in the travel clinic of the University Medical Center Hamburg-Eppendorf. Demographic and travel-related data were collected by using questionnaires. Pre-travel advice was carried out and SBET was prescribed in accordance to national guidelines. Post-travel phone interviews were performed to assess health incidents during travel and individual responses of travellers to febrile illness. Results Out of 714 patients who were monitored, 130 (18%) reported onset of fever during travel or 14 days after return. Of those travellers who reported fever, 100 (80%) carried SBET during travel. The vast majority of 79 (79%) febrile travellers who carried SBET did not seek medical assistance. Overall, 14 (14%) febrile patients who carried SBET and six (20%) patients who did not carry SBET took the correct measure (doctor visit or timely SBET administration) as a response to febrile illness, respectively. Only two travellers self-administered SBET, but both of them applied the wrong regimen. Conclusions In view of declining malaria transmission and improving medical infrastructure in most countries of Southeast Asia and obvious obstacles concerning SBET as shown in this study the current strategy should be re-evaluated. Pre-travel advice concerning malaria in SEA should focus on appropriate mosquito bite protection and clearly emphasize the need to see a doctor within 24 h after onset of fever.
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Affiliation(s)
- Christof D Vinnemeier
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Camilla Rothe
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno Kreuels
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Vygen-Bonnet
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jakob P Cramer
- Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Thierry Rolling
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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