Airport and luggage (Odyssean) malaria in Europe: a systematic review

BackgroundAirport and luggage (also called Odyssean) malaria are chance events where Plasmodium infection results from the bite of an infected mosquito which was transported by aircraft from a malaria-endemic area. Infrequent case reports and a lack of central data collection challenge a comprehensive overview.AimTo update the epidemiological, clinical and biological understanding of airport and luggage malaria cases in Europe.MethodsWe conducted a systematic review of studies indexed from 1969 to January 2024 in MEDLINE, Embase and OpenGrey databases. A data call to EU/EEA and UK public health institutes was launched in December 2022.ResultsOf the 145 cases (89 cases from 48 studies and 56 cases from the data call) described from nine countries, 105 were classified as airport malaria, 32 as luggage malaria and eight as either airport or luggage malaria. Most airport malaria cases were reported in France (n = 52), Belgium (n = 19) and Germany (n = 9). Half of cases resided or worked near or at an international airport (mean distance of 4.3 km, n = 28). Despite disruptions in air travel amid the COVID-19 pandemic, one third of cases reported since 2000 occurred between 2018 and 2022, with a peak in 2019.ConclusionWhile airport and luggage malaria cases are rare, reports in Europe have increased, highlighting the need for effective prevention measures and a more structured surveillance of cases in Europe. Prevention measures already in place such as aircraft disinsection should be assessed for compliance and effectiveness.