Changes in malaria epidemiology in Germany, 2001-2016: a time series analysis

Area of Science:

• Epidemiology
• Infectious Diseases
• Public Health Surveillance

Background:

• German surveillance data revealed a significant increase in malaria cases during 2014-2015.
• This rise was attributed to the influx of refugees from malaria-endemic countries.
• A time series analysis from 2001-2016 was conducted to understand imported malaria trends.

Purpose of the Study:

• To describe the epidemiology of imported malaria in Germany.
• To analyze the recent increase in malaria cases, particularly in relation to refugee arrivals.
• To assess trends in chemoprophylaxis use among different population groups.

Main Methods:

• Time series analysis of German malaria surveillance data from 2001 to 2016.
• Categorization of cases by Plasmodium species, origin of infection, and patient background (refugee status, migration background).
• Analysis of reported chemoprophylaxis use and trends.

Main Results:

• A total of 11,678 malaria cases were reported between 2001 and 2016.
• Newly arriving refugees accounted for a substantial proportion of cases in 2014-2015 (28.3%), a significant increase from previous years (1.5%).
• Plasmodium vivax became more prevalent in 2014-2015, with refugees from Eritrea and the Horn of Africa being key affected groups; chemoprophylaxis use declined overall and was lower in individuals with a migration background.

Conclusions:

• The increase in Plasmodium vivax malaria was largely driven by refugees from Eritrea, the Horn of Africa, and South Asia.
• Clinicians must consider malaria, especially Plasmodium vivax, in febrile patients with relevant travel or refugee history.
• Insufficient and declining chemoprophylaxis use in both native Germans and residents with migration backgrounds highlights the need for improved strategies to increase compliance.