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Trends in imported malaria during the COVID-19 pandemic, Spain (+Redivi Collaborative Network)
Francesca F Norman1, Begoña Treviño-Maruri2, José Manuel Ruiz Giardín3
1National Referral Unit for Tropical Diseases, Infectious Diseases Department. Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
Introduction:
The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date.
Methods:
Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. polymerase chain reaction) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed.
Results:
In total, 1751 cases of malaria (1751/26 601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (interquartile range: 27-44.7) years and most occurred in visiting friends and relatives (VFR)-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to Plasmodium falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (P < 0.001) (attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to Plasmodium falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively).
Conclusions:
After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with imported malaria may present and/or be diagnosed late during this public health crisis and health care professionals should be alerted to the recent increase in severe cases.
Insights
Imported malaria cases, particularly severe Plasmodium falciparum infections, significantly increased in Spain post-COVID-19 travel restrictions. Healthcare professionals must remain vigilant for these serious imported malaria cases.
Area of Science:
- Epidemiology
- Infectious Diseases
- Global Health
Background:
- The COVID-19 pandemic disrupted global malaria prevention and management.
- Data on travel-related malaria infections during the pandemic are limited.
- Understanding trends in imported malaria is crucial for public health.
Purpose of the Study:
- To analyze epidemiological and clinical characteristics of imported malaria cases in Spain.
- To identify yearly trends in imported malaria from pre-pandemic to current years.
- To assess the impact of the COVID-19 pandemic on malaria case numbers and severity.
Main Methods:
- Retrospective analysis of malaria cases recorded in the +Redivi network (October 2009–December 2021).
- Inclusion of patients diagnosed with malaria using standard diagnostic methods.
- Analysis of total cases, patient types, and severe malaria cases per year.
Main Results:
- 1751 malaria cases identified (6.6% of total), predominantly in males and visiting friends and relatives (VFR)-immigrants.
- Most infections acquired in sub-Saharan Africa, primarily Plasmodium falciparum.
- A significant increase in severe malaria cases observed, particularly in 2021 (17.2%), mainly in travelers and VFR-immigrants.
Conclusions:
- Imported malaria cases and severe malaria incidence rose following COVID-19 travel restrictions.
- Late presentation and diagnosis of imported malaria may occur during public health crises.
- Healthcare professionals need heightened awareness of the recent surge in severe imported malaria cases.
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