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Volume 11, Number 3—March 2005

Research

Malaria Risk in Travelers

Helena Hervius Askling*†, Jenny Nilsson*†, Anders Tegnell*, Ragnhild Janzon*, and Karl Ekdahl*‡Comments to Author 
Author affiliations: *Swedish Institute for Infectious Disease Control, Stockholm, Sweden; †Karolinska University Hospital, Stockholm, Sweden; ‡Karolinska Institute, Stockholm, Sweden

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Table 4

Estimated number of travelers to malaria-endemic areas, respondents in the tourist database (controls), and reported patients with travel-associated malaria, 1997–2003*

Age/sex/region† Estimated no. 
of travelers Controls Reported cases Risk per 100,000 95% CI Multivariate odds ratio 95% CI Incidence/ 100,000
Total 3,560,000 881 857 24 22–26 36,865
<6 y 70,000 18 38 54 31–95 4.8 1.5–14.8 No data
7–18 y 300,000 74 91 30 22–41 2.7 1.1–6.0 No data
19–45 y 1,630,000 404 506 31 27–35 4.1 1.9–9.0 No data
46–65 y 1,340,000 331 205 15 13–18 2.0 0.9–4.3 No data
>65 y
220,000
54
17
7.7
4–13
1.0
Reference
No data
Men 1,790,000 444 536 30 26–34 1.7 1.3–2.3 No data
Women
1,770,000
437
321
18
16-21
1.0
Reference
No data
Arab countries and Iran‡ 220,000 44 4 1.8 0.7–5.1 1.7 0.5–6.4 1,279
Indian subcontinent 120,000 31 74 62 41–94 57.4 23–141 366
East Asia 2,050,000 517 111 5.4 4.4–6.6 5.6 2.5–12.5 205
West Africa 80,000 22 242 302 196–468 277 112–683 13,356
East Africa 90,000 18 216 240 148–388 341 134–866 7,126
Central Africa 30,000 8 107 357 174–732 317 108–930 5,508
Southern Africa 170,000 42 78 46 32–67 49.6 21–119 7,742
Central America + Caribbean 550,000 43 7 1.3 0.6–2.7 1.0 Reference 155
South America 250,000 61 18 7.2 4.3–12.2 7.1 2.7–18.4 1,205

*With a multivariate odds ratios (with 95% confidence intervals [CI]) for the risk factors age, sex, and travel destination from a logistic regression model, and incidence per 100,000 inhabitants as reported to the World Health Organization (15).
†Malaria-free countries as defined by the World Health Organization (16).
‡Arab countries and Iran = Bahrain,† Iraq, Iran, Jordan,† Kuwait,† Lebanon,† Oman, Qatar,† Saudi Arabia, Syria, United Arab Emirates, Yemen; Indian Subcontinent = Afghanistan, Bangladesh, Bhutan, India, Maldives,† Nepal, Pakistan, Sri Lanka; East Asia = Brunei, Burma, Cambodia, China, Hong Kong,† Indonesia, Japan,† Laos, Malaysia, Mongolia,† Philippines, South Korea, Singapore,† Taiwan,† Thailand, Tibet,† Vietnam; West Africa = Benin, Burkina Faso, Cape Verde, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Senegal, Sierra Leone, The Gambia, Togo; East Africa = Burundi, Djibouti, Eritrea, Ethiopia, Kenya, Rwanda, Seychelles,† Somalia, Sudan, Tanzania, Uganda; Central Africa = Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo, Equatorial Guinea, Gabon, Niger, Nigeria, São Tomé et Principe; Southern Africa = Angola; Botswana, Lesotho, Madagascar, Malawi, Mauritius,† Mozambique, Namibia, South Africa, Zambia, Zimbabwe; Central America and Carribean = Antigua and Barbuda,† Bahamas,† Barbados,† Belize, Bermuda,† Cayman Islands,† Costa Rica, Cuba,† Dominica,† Dominican Republic, El Salvador, Grenada,† Guadeloupe,† Guatemala, Honduras, Jamaica,† Haiti, Martinique,† Mexico, Netherlands Antilles,† Nicaragua, Panama, Puerto Rico,† St. Christopher and Nevis,† St. Lucia/St. Vincent,† Saint Kitts-Nevis,† The Grenadines,† Trinidad and Tobago,† Virgin Islands;† South America = Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, Uruguay,† Venezuela.

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