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Volume 15, Number 2—February 2009

Research

Imported Malaria in Children in Industrialized Countries, 1992–2002

Katrin Stäger, Fabrice Legros, Gérard Krause, Nicola Low, David Bradley, Meghna Desai, Simone Graf, Stefania D’Amato, Yasutaka Mizuno, Ragnhild Janzon, Eskild Petersen, John Kester, Robert Steffen, and Patricia SchlagenhaufComments to Author 
Author affiliations: University of Zurich, Zurich, Switzerland (K. Stäger, R. Steffen, P. Schlagenhauf); Centre National de Référence de l'Epidémiologie du Paludisme d'Importation et Autochthone, Paris, France (F. Legros); Robert Koch Institut, Berlin, Germany (G. Krause); University of Bern, Bern, Switzerland (N. Low); Health Protection Agency, London, UK (D. Bradley); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M. Desai); Swiss Federal Office of Public Health, Bern (S. Graf); Ministero della Salute, Rome, Italy (S. D’Amato); Jikei University School of Medicine, Tokyo, Japan (Y. Mizuno); Swedish Institute for Infectious Disease Control, Solna, Sweden (R. Janzon); Statens Serum Institut, Copenhagen, Denmark (E. Petersen); United Nations World Tourism Organization, Madrid, Spain (J. Kester)

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Table 3

Case rates for children in industrialized countries with malaria imported from Africa, 1992–2002*

Country of origin† Region of case acquisition
Western Africa
Eastern Africa
Central Africa
Southern Africa
All African regions
No. Rate
(95% CI) No. Rate
(95% CI) No. Rate
(95% CI) No. Rate 
(95% CI) No. Rate
(95% CI)
Denmark 46 47.7
(34.9–63.6) 87 54.7
(43.9–67.5) 10 434.8
(208.5–799.6) 1 0.8 
(0.02–4.5) 144 37.8
(31.9–44.5)
France 3,777 110.6
(107.1–114.2) 1,339 25.7
(24.4–27.1) 1,400 216.3
(205.1–228.0) 1 0.1 
(0.001–0.7) 6,517 65.0
(63.4–66.6)
Germany‡ 344 38.3
(34.3–42.5) 129 4.6
(3.8–5.4) 76 68.0
(53.6–85.2) 5 0.2 
(0.07–0.5) 554 8.9
(8.2–9.7)
Italy§ 323 40.2
(35.9–44.8) 24 2.0
(1.3–2.9) 31 39.5
(26.8–56.1) 1 0.3 
(0.006–1.4) 379 15.2
(13.7–16.8)
Japan 8 7.0
(3.0–13.8) 3 1.1
(0.2–3.1) 4 102.6
(27.9–262.6) 1 0.5 
(0.01–2.6) 16 2.6
(1.5–4.2)
Netherlands 172 35.3
(30.2–41.0) 32 0.6
(0.4 – 0.9) 51 103.9
(77.3–136.6) 1 0.1 
(0.0–0.7) 256 13.9
(12.2–15.7)
Sweden¶ 55 51.1
(38.5–66.5) 48 9.0
(6.6–11.9) 21 244.2
(151.2–373.3) 0 0.0 
(0.0–1.7) 124 14.9
(12.4–17.8)
Switzerland 97 54.9
(44.5–67.0) 37 4.4
(3.1–6.1) 85 121.6
(97.2–150.4) 2 0.5 
(0.06–1.9) 221 15.0
(13.1–17.1)
United Kingdom 1,749 177.3
(169.0–185.8) 406 9.7
(8.8–10.7) 91 82.3
(66.8–101.1) 14 0.4 
(0.2–0.7) 2,260 26.3
(25.2–27.4)
United States
1,181
160.6
(151.6–170.1)

191
9.9
(8.5–11.4)

91
62.6
(50.4–76.8)

8
0.5 
(0.2–1.0)

1471
33.7
(32.0–35.5)
Total 7,752 99.1
(96.9–101.3) 2,296 13.0
(12.5–13.5) 1,860 151.6
(144.8–158.6) 34 0.3 
(0.2–0.5) 11,942 32.4
(31.8–33.0)

*Rates per 10,000 arrivals of children <18 years of age, except in the United Kingdom, where data were available only for children <17 years of age. Regions are classified according to United Nations World Tourist Organization (18). Denominators include only countries for which data were available. No data were available for arrivals to Gabon and Burundi for any country. For some African countries data are available for only some sources, e.g., arrivals to Sierra Leone available for only Denmark, United Kingdom; arrivals to Mozambique available for only United Kingdom, United States (details available on request). Western Africa comprises Benin, Burkina Faso, Cape Verde, Ghana, Guinea, Guinea Bissau, Côte d’Ivoire, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, The Gambia, and Togo; Eastern Africa comprises Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique, Reunion, Rwanda, Seychelles, Somalia, Sudan, Tanzania, Uganda, Zambia, and Zimbabwe; Central Africa comprises Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo (Zaire), Equatorial Guinea, Gabon; Sao Tome et Principe; and Southern Africa comprises Botswana, Lesotho, Namibia, South Africa, and Swaziland.
†No data available from Australia.
‡Data from 1993–2002 only.
§Data from 1998–2002 only.
¶Data from 1997–2002 only.

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