No 25 - 2011

Malaria 2010

In 2010, a total of 61 cases of imported malaria were notified by Danish laboratories, Table 1. Among the cases for which the presumed country of infection was stated, 91% (43/47) had been acquired during stays in Africa and the bulk of cases were associated with West Africa (63%). The remaining 9% of the cases were acquired in Asia. Among cases with a species-specific diagnosis, 78% were caused by Plasmodium falciparum and 80% hereof were presumably acquired in Africa.

A single case of falciparum malaria was imported from Asia (Myanmar), while the remaining three Asian cases were caused by vivax malaria. The median age was 32 years (range 3 to 66). Males comprised 64%, females 36%. A total of 40% of the cases were Danish travellers, while the remaining 60% were of non-Danish origin.

Commentary
The number of notified malaria cases in 2010 was largely in line with that observed in 2009. Furthermore, the previously observed decreasing trend for malaria among Danish travellers was maintained, EPI-NEWS 25/08 (pdf). The main problem is the risk of serious falciparum malaria in Africa. This is particularly relevant for immigrants, who typically return to their countries of origin for prolonged visits. The same tendency is seen in most other European countries, which underlines the need for extra preventive measures in this group of travellers.
(L.S. Vestergaard, H.V. Nielsen, Malaria Reference Laboratory, DBMP)

Updated recommendations for malaria prophylaxis and vaccination

As previously, a reference group has revised and updated the SSI country-specific recommendations for malaria prophylaxis and vaccination in connection with travels abroad. In 2011 the following changes apply:

Malaria prophylaxis

• Belize: low risk in Cayo (lowered)
• Brunei: V in group 2-4 (new)
• Columbia: Putumayo ceases to be a risk area
• Georgia: Transmission from June to October (extended from July)
• Oman: v in group 2-4 (The North Sharqiya region added as risk area)
• Panama: Kuna Yala new risk area
• Paraguay: Canindeyu ceases to be a risk area
• Peru: Piura/Tumbes new risk areas
• Saudi Arabia: x from September until and including January in group 2-4 (Southern border to Yemen)
• Uzbekistan: v from June to Oct. in gr. 2-4 (Southeastern border areas)
• Venezuela, Amazonas: The Rio Negro area is discontinued. Venezuela, Bolivar: The Canoni area is discontinued.

In countries marked with a small letter, the malaria risk only applies in part of the territory and a description of the updated risk areas is available in Danish at www.ssi.dk/rejser (Danish language): Select ”sygdomsforekomst = malaria” and place the arrow above the red area.

For information on mosquito bite prophylaxis and chemoprophylaxis in children and during pregnancy, see EPI-NEWS 19/05 (pdf) and EPI-NEWS 24/10 (pdf). 

Vaccination

Yellow fever
Yellow fever vaccination requirements:

• Australia: broadened to comprise travellers older than one year of age who within the past six days have stayed for a minimum of one night in Sao Tomé and Principe, Somalia or Tanzania
• Costa Rica: vaccination no longer required for travellers from Argentina, Panama and Trinidad & Tobago
• Niue: age limit changed from one year to nine months
• Syria: New six month age limit for vaccination (NB: vaccination is contraindicated below 9 months of age)
• Yellow fever vaccination recommendations:

In relation to yellow fever risk areas, WHO has introduced a new category of countries/areas for which vaccination is not generally recommended. This category includes areas with a low risk of encountering yellow fever. Vaccination may, however, be considered for some travellers to such areas, e.g. increased risk of exposure due to long-term travelling, intense exposure to mosquitoes or in situations where mosquito bite prophylaxis is not an option.

When considering vaccination, individual risk factors such as age and immune status and the risk of side effects should be included in the assessment.
The African countries which are comprised by the new category include Sao Tomé and Principe, Tanzania and Eritrea and parts of Ethiopia, Kenya, Somalia, The Democratic Republic of Congo and Zambia. ´

In South America, the following areas are comprised: costal areas of Columbia, Ecuador, Peru, Venezuela (limited coastal area in the centre of the country), the northern part of Argentina towards the border with Paraguay and Trinidad. Transit stays in these areas may trigger vaccination requirements when travellers continue their journey to other countries.

For a map presenting the mentioned areas and a detailed risk description, please see www.ssi.dk/rejser.

For Brazil, two new risk areas have been added: the majority of the state of Rio Grande do Sul and central parts of the state of Sao Paolo. However, the state of Esprito Santo is discontinued.

Hepatitis A

According to the latest WHO map of countries with a moderate to high risk, vaccination is recommended for following European countries also for group 2 travellers: Poland, the Czech Republic, Slovakia, Hungary, Slovenia, Croatia, Macedonia, Montenegro, Serbia, Estonia, Latvia and Lithuania.

Hepatitis B

Japan: also group 3 travellers.
Tuberculosis - Slovakia: discontinued (from group 4)

(M. Buhl, Danish Society of Travel Medicine, S. Thybo, Danish Society for Infectious Diseases, J. Kurtzhals, Danish Society for Clinical Microbiology, N.E. Møller, Danish College of General Practitioners, L.S. Vestergaard, Danish Society for Tropical Medicine and International Health, K. Gade, Danish Paediatric Society, P.H. Andersen, Department of Epidemiology)

Individually notifiable diseases and selected laboratory diagnosed infections (pdf)

22 june 2011