Volume 11, Number 3—March 2005
Research
Malaria Risk in Travelers
Table 4
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.
References
- World Tourism Organization. World tourism barometer. 2004;2:1–22.
- Jelinek T, Schulte C, Behrens R, Grobusch MP, Coulaud JP, Bisoffi Z, Imported falciparum malaria in Europe: sentinel surveillance data from the European Network on Surveillance of Imported Infectious Diseases. Clin Infect Dis. 2002;34:572–6. DOIPubMedGoogle Scholar
- Toovey S, Jamieson A. Rolling back malaria: how well is Europe doing? Travel Med Infect Dis. 2003;1:167–75. DOIPubMedGoogle Scholar
- Ekdahl K, ed. Communicable diseases in Sweden 2002. The yearly report of the Department of Epidemiology. Stockholm: Swedish Institute for Infectious Disease Control; 2003.
- Phillips-Howard PA, Radalowicz A, Mitchell J, Bradely DJ. Risk of malaria in British residents returning from malarious areas. BMJ. 1990;300:499–503. DOIPubMedGoogle Scholar
- Hill DR, Behrens RH, Bradley DJ. The risk of malaria in travelers to Thailand. Trans R Soc Trop Med Hyg. 1996;90:680–1. DOIPubMedGoogle Scholar
- Lobel HO, Phillips-Howard PA, Brandling-Bennett AD, Steffen R, Campbell CC, Huong AY. Malaria incidence and prevention among European and North American travelers to Kenya. Bull World Health Organ. 1990;68:209–15.PubMedGoogle Scholar
- Steffen R, Heusser R, Mäckler R, Bruppacher R, Naef U, Chen D, Malaria chemoprophylaxis among European tourists in tropical Africa: use, adverse reactions and efficacy. Bull World Health Organ. 1990;68:313–22.PubMedGoogle Scholar
- World Health Organization. Development of recommendations for the protection of short-stay travelers to malaria endemic areas. Memorandum from two WHO meetings. Bull World Health Organ. 1988;66:177–96.PubMedGoogle Scholar
- Ryan ET, Kain KC. Health advice and immunization for travelers. N Engl J Med. 2000;342:1716–25. DOIPubMedGoogle Scholar
- Spira AM. Assessment of travelers who return home ill. Lancet. 2003;361:1459–69. DOIPubMedGoogle Scholar
- Health Canada. 2000. Canadian recommendations for the prevention and treatment of malaria among international travelers. (cited 13 Jan 2005). Available from http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/00vol26/26s2/index.html
- Kofoed K, Petersen E. The efficacy of chemoprophylaxis against malaria with chloroquine plus proguanil, mefoquine, and atovaquone plus proguanil in travelers fron Denmark. J Travel Med. 2003;10:150–4. DOIPubMedGoogle Scholar
- Swedish Travel and Tourist Data Base. TDB. Resurs AB, Sweden. (cited 24 Jan 2004). Available from http://www.resursab.se/
- World Health Organization. Global atlas of infectious diseases: Global Roll Back Malaria Online Database. (cited 24 Jan 2004). Available from http://www.who.int/GlobalAtlas/DataQuery/quickQuery.asp
- World Health Organization. Countries and territories with malarious areas. Geographical distribution. International Travel and Health 2003. (cited 24 Jan 2004). Available from http://www.who.int/ith/chapter07_01.html
- Jansson A, Arneborn M, Ekdahl K. Sevsitivity of case reporting in the Swedish statutory surveillance of communicable diseases 1998–2002. Epidemiol Infect. In press.PubMedGoogle Scholar
- Muehlberger N, Jelinek T, Schlipkoeter U, von Sonnenburg F, Nothdurft HD. Effectiveness of chemoprophylaxis and other determinants of malaria in travellers to Kenya. Trop Med Int Health. 1998;3:357–63. DOIPubMedGoogle Scholar
- Mölle I, Christensen KL, Hansen PS, Dragsted UB, Aarup M, Buhl MR. Use of medical chemoprophylaxis and antimosquito precautions in Danish malaria patients and their traveling companions. J Travel Med. 2000;7:253–8. DOIPubMedGoogle Scholar
- Schlagenhauf-Lawlor P, ed. Travelers’ malaria. Hamilton, Ontario: BC Decker Inc; 2001.
- Bacaner N, Stauffer B, Boulware DR, Walker PF, Keystone JS. Travel medicine considerations for North American immigrants visiting friends and relatives. JAMA. 2004;291:2856–64. DOIPubMedGoogle Scholar
- Brunvatne R, Blystad H, Hoel T. Health hazards for immigrants when travelling to their home countries. Tidsskr Nor Laegeforen. 2002;122:1568–72.PubMedGoogle Scholar
- Blystad H. Import of malaria to Norway 1989–98. Tidsskr Nor Laegeforen. 2000;120:1653–7.PubMedGoogle Scholar
- Muhlberger N, Jelinek T, Gascon J, Probst M, Zoller T, Schunk M, Epidemiology and clinical features of vivax malaria imported to Europe: sentinel surveillance data from TropNetEurop. Malar J. 2004;3:1–7. DOIPubMedGoogle Scholar
- Swedish Institute for Infectious Disease Control. Annual epidemiological report 2003. (cited 24 Jan 2004). Available from http//www.smittskyddsinstitutet.se
- Trape JF, Rogier C. Combating malaria morbidity and mortality by reducing transmission. Parasitol Today. 1996;12:236–40. DOIPubMedGoogle Scholar
- Beier JC, Killeen GF, Githure JI. Short report: entomologic inoculation rates and Plasmodium falciparum prevalence in Africa. Am J Trop Med Hyg. 1999;61:109–13.PubMedGoogle Scholar
- Mapping malaria risk in Africa/Atlas du risque de la malaria en Afrique. Gambia malaria prevalence model. March 2002. (cited 24 Jan 2004). Available from http://www.mara.org.za/maps.htm
- Breman JG. The ears of the hippopotamus: manifestations, determinants and estimates of the malaria burden. Am J Trop Med Hyg. 2001;64(1–2 Suppl):1–11.