Malaria Imported by Travelers: The Israeli Experience

Indigenous malaria has been successfully eradicated in North America, Europe, and a few other previously endemic locations. Extensive antimalarial programs, improvement of health care services, and advances in socioeconomic development have all contributed to one of the most significant achievements in public health of the 20th century.1 Nevertheless, a new malaria transmission pattern is increasingly seen in these areas nowadays. The constantly mounting movement of travelers from developed countries to the tropics and the affluent immigration to the industrialized world from countries where malaria has remained endemic are responsible for the emergence of imported malaria.2 Most physicians who studied medicine in developed countries, although familiar with the classic presentation of the disease, have rarely seen a single case of malaria during training and believe that it is an exotic illness existing elsewhere. It is important therefore to characterize the demographic and clinical features of imported malaria, which is practically the only malaria now seen in the industrialized world, and to make it more familiar to health care providers. This need is further emphasized by the emerging problem of drug-resistant malaria, which may be atypical in patients who had received inappropriate prophylaxis. In Israel malaria is almost exclusively an imported disease. It occurs in Israelis who visit or work in endemic areas and in immigrants, invariably from Ethiopia. The majority of Ethiopian immigrants arrived in two waves in 1985 and 1991 and do not represent an ongoing malaria problem.3 The features of the disease in this population were extensively reported elsewhere.3,4 In the present report we examine the characteristics of malaria imported to Israel by travelers.