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Malar J. 2018 Nov 29;17(1):443. doi: 10.1186/s12936-018-2586-9.

Area of exposure and treatment challenges of malaria in Eritrean migrants: a GeoSentinel analysis.

Author information

1
WHO Collaborating Centre for Travel Medicine, Travel Clinic and Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, 8001, Zurich, Switzerland. Patricia.schlagenhauf@uzh.ch.
2
Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
3
Department of Global Health, Boston University School of Public Health and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
4
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
5
Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
6
Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.
7
Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals (HUG), Geneva, Switzerland.
8
Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany.
9
WHO Collaborating Centre for Travel Medicine, Travel Clinic and Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, 8001, Zurich, Switzerland.
10
University Hospital, Department of Infectious Diseases, University of Zürich, Zurich, Switzerland.
11
The Center of Geographical Medicine-Dept. of Internal Medicine "C"-Sheba Medical Center Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
12
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
13
Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, USA.
14
Ottawa Hospital and Department of Medicine University of Ottawa, Ottawa, Canada.
15
Bronx Lebanon Hospital, New York, USA.
16
Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
17
Institute for Tropical Diseases, Harbour Hospital Rotterdam, Rotterdam, The Netherlands.
18
Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA.
19
J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada.
20
University Hospital Institute for Infectious and Tropical Diseases, Aix-Marseille University, Marseille, France.

Abstract

BACKGROUND:

Recent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea. A descriptive analysis of GeoSentinel cases of malaria in Eritrean migrants was done together with a literature review to elucidate key attributes of malaria in this group with a focus on possible areas of acquisition of malaria and treatment challenges.

RESULTS:

A total of 146 cases were identified from the GeoSentinel database from 1999 through September 2017, with a marked increase in 2014 and 2015. All patients originated from Eritrea and the main reporting GeoSentinel sites were in Norway, Switzerland, Sweden, Israel and Germany. The majority of patients (young adult males) were diagnosed with malaria following arrival in the host country. All patients had a possible exposure in Eritrea, but may have been exposed in documented transit countries including Ethiopia, Sudan and possibly Libya in detention centres. Most infections were due to Plasmodium vivax (84.2%), followed by Plasmodium falciparum (8.2%). Two patients were pregnant, and both had P. vivax malaria. Some 31% of the migrants reported having had malaria while in transit. The median time to onset of malaria symptoms post arrival in the host country was 39 days. Some 66% of patients were hospitalized and nine patients had severe malaria (according to WHO criteria), including five due to P. vivax.

CONCLUSIONS:

The 146 cases of mainly late onset, sometimes severe, P. vivax malaria in Eritrean migrants described in this multi-site, global analysis reflect the findings of single-centre analyses identified in the literature search. Host countries receiving asylum-seekers from Eritrea need to be prepared for large surges in vivax and, to a lesser extent, falciparum malaria, and need to be aware and prepared for glucose-6-phosphate dehydrogenase deficiency testing and primaquine treatment, which is difficult to procure and mainly unlicensed in Europe. There is an urgent need to explore the molecular epidemiology of P. vivax in Eritrean asylum-seekers, to investigate the area of acquisition of P. vivax along common transit routes and to determine whether there has been re-introduction of malaria in areas, such as Libya, where malaria is considered eliminated, but where capable vectors and Plasmodium co-circulate.

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