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A cluster of airport malaria in Belgium in 1995
J Van den Ende1, L Lynen, P Elsen
1Instituut voor Tropische Geneeskunde, Antwerpen. JVDE@ITG.BE
Abstract:
In Europe 64 cases of airport malaria have been registered between 1969 and 1996, most of them in France, Switzerland and Belgium. In the summer of 1995 six cases of airport malaria occurred at the International airport of Brussels, Belgium. Of the six patients three were airport employees, three were occasional visitors. One patient died, the diagnosis was made by PCR amplification and DNA sequencing after exhumation. Two different species of Plasmodium were detected, and infections occurred on at least two different floors of the airport. An inquiry revealed that the cabin of airplanes is correctly sprayed, according to WHO recommendations, but that the inside of the hand luggage, the cargo hold, the animal compartment, the wheel bays and container flights remain possible shelters for infected mosquitoes. In a case of fever of unknown origin, airport malaria should be considered in the differential diagnosis, especially during hot summers, and when thrombocytopenia is present. Additional antimosquito measures should be generalised, encompassing highly exposed personnel, container content and handling buildings, animal cages, wheel bays, and the boundary between the sorting and the reception of luggage.
Insights
Airport malaria, a rare disease, can occur in non-endemic areas. Investigations revealed potential mosquito breeding sites within airports, highlighting the need for enhanced control measures.
Area of Science:
- Medical Entomology
- Tropical Medicine
- Public Health
Background:
- Airport malaria cases, though rare, have been documented in Europe, with a notable cluster in Brussels in 1995.
- This phenomenon involves malaria transmission occurring in non-endemic regions, often linked to international travel hubs.
Observation:
- Six cases of airport malaria were identified at Brussels International Airport in 1995, affecting both employees and visitors.
- One fatality occurred, with diagnosis confirmed post-exhumation via PCR amplification and DNA sequencing, revealing two Plasmodium species and infections on multiple airport levels.
Findings:
- Standard aircraft cabin spraying was compliant with WHO recommendations.
- However, specific airport areas like hand luggage, cargo holds, animal compartments, and wheel bays were identified as potential mosquito shelters.
- Infections occurred on at least two different floors within the airport.
Implications:
- Airport malaria should be considered in the differential diagnosis for fever of unknown origin, particularly during warm weather and in the presence of thrombocytopenia.
- Expanded mosquito control measures are recommended, targeting high-risk airport zones and personnel to prevent future transmissions.