The Changing Pattern of Imported Malaria in the Academic Medical Centre, Amsterdam

Background: Since 1988, the incidence of malaria imported into the Netherlands has been stable, but the population groups have remarkably changed. Methods: The records of all patients with malaria in the Academic Medical Centre, Amsterdam, between October 1991 and December 1994 were analyzed. Results: Of the 286 patients, 149 (52%) were Dutch citizens and 114 (40%) were originally from malaria endemic areas (92 immigrants, 22 asylum-seekers), whereas between 1979 and 1988 these figures were 85 and 15%. The remaining 23 (8%) patients were 11 children born in the Netherlands to immigrants, 10 foreigners from nonmalarious areas, and 2 for whom the origin is unknown. Plasmodium falciparum was found in 197 (69%) patients, mostly acquired in subSaharan Africa; P. vivax (61 patients, 21%) was mainly acquired in Asia. Two vivax infections proved to be chloroquine-resistant. The compliance with the malaria chemoprophylaxis was poor: only 38% (30/80) of the Dutch citizens and 8% (4/52) of the settled immigrants and children were fully compliant. Severe complicated falciparum malaria developed in 18 (10%) patients, two of whom died. The majority of the falciparum cases were treated with halofantrine or sulfadoxine-pyrimethamine. Artemisinin was used in two. Conclusions: Among the patients with imported malaria, settled immigrants and their (nonimmune) children constitute a growing number. Compliance with chemoprophylaxis is decreasing in Dutch travelers and remains poor in the immigrants. Quinine was increasingly used both as initial treatment for severe falciparum malaria as well as in patients with nonsevere malaria who were nauseated or vomiting.