No 25 - 2012

Malaria 2011

In 2011, a total of 74 cases of imported malaria were notified from Danish laboratories, Table 1.

Of the cases where the presumed country of infection was stated, 85% (58/68) were acquired during stays in Africa and 12% (8/68) in Asia. One case was acquired in South America (Peru) and another in Oceania (Papua New Guinea).

Among cases with a species-specific diagnosis, 69% were caused by Plasmodium falciparum, and all of these cases were presumably acquired in Africa. Furthermore, another six cases of Plasmodium ovale and one case of Plasmodium vivax of African origin were detected. All cases imported from Asia were caused by vivax malaria, including three cases in Danish tourists returning from Thailand.

The median age was 36 years (range 2 to 65). Among the cases for which gender was stated, males comprised 41% and females 59%.

Commentary

The number of notified malaria cases in 2011 increased slightly with respect to the two previous years when 61 and 54 cases were detected, respectively, EPI-NEWS 25/11 and 24/10, but remained lower than in 2008 when a total of 91 cases were detected, EPI-NEWS 24/09.

As previously, the primary problem is the risk of serious falciparum malaria in Africa, not least among immigrants who typically return to their countries of origin for prolonged visits and who may have a different risk perception and behaviour. However, the three cases of vivax malaria among Danish tourists returning from Thailand show that malaria should be taken seriously by all travellers to malaria areas including travellers to popular tropical vacation destinations even though the risk is not estimated to exceed a level at which mosquito bite prophylaxis is considered adequate protection.

In May-October 2011, Greece experienced a relatively large outbreak of locally acquired vivax malaria, EPI-NEWS 48/11. The outbreak was brought to a halt thanks to comprehensive control, infection tracing and surveillance measures implemented by the Greek authorities with support from the WHO and the ECDC.

To avoid future malaria outbreaks in Europe, improved diagnostics and surveillance measures are needed along with a heightened level of international cooperation on surveillance and more information about areas that hold a potential for malaria infection. In Europe there is consensus on the need to reinforce anti-malaria measures to ensure that the WHO objective on the eradication of malaria from the European area before 2015 is reached. Updated suggestions for malaria prophylaxis will be published in an upcoming issue of EPI-NEWS.

(L.S. Vestergaard, H.V. Nielsen, Ref. Lab. For Malaria, Microbiology & Infection Control)

Miba

The Danish Microbiology Database (MiBa) is a nationwide, automatically updated database of microbiological test results. All Danish departments of clinical microbiology and Statens Serum Institut (SSI) are connected.

MiBa holds test results as from 1 January 2010. One of the objectives is to give the treating physician access to all of a patient's microbiological test results regardless of where these were made, e.g. in connection with acute admission or transfer to another hospital.

A second objective is to ensure timely and complete reporting of notifiable infectious diseases and microorganisms data to SSI.

Additionally, MiBa may, in future, provide data to other databases thus providing a unique basis for national research projects.

The basic principle of MiBa is that whenever a test result is sent from a department of clinical microbiology, an electronic copy is sent to MiBa. All data are exchanged via the Danish Healthcare Data Network.

MiBa was established in close cooperation between the departments of clinical microbiology, laboratory system suppliers, MedCom and Statens Serum Institut in the context of a grant provided by the Danish Ministry of Health. The establishment of MiBa is part of a series of efforts to upgrade and digitalize public communication.

The monitoring module is currently being developed. Data extraction for the monitoring will be in accordance with Executive Order on Physicians' Notification of Infectious Diseases (Executive order no. 277 of 14/4/2000) including subsequent amendments (Executive Order no. 1102 of 20/9/2007).
Access to test results is operative since the spring of 2010, but so far only employees at microbiological departments and the SSI have had access to search for MiBa results.

All physicians have access to microbiological test results via the Laboratory Portal (Laboratorieportalen) which holds a joint presentation of laboratory test results including: clinical biochemistry, pathology and microbiology. The microbiological results are extracted from the MiBa. Access to the Laboratory Portal is achieved via Sundhed.dk using a staff certificate/Nem ID. The primary sector can also access the data via WebReq using their dedicated practice system. For more information, please see: www.ssi.dk/miba.

(M. Voldstedlund, M. Haahr, Dept. of Infectious Disease Epidemiology)

Varicella vaccination: Changed recommendation

The registration of the varicella vaccine Varilrix® has been changed to include children from the age of nine months of age. Furthermore, two doses are recommended for all vacinees, regardless of age. The second dose should be given a minimum of six and never less than four weeks after the initial dose. The vaccine is administered subcutaneously, preferably to the upper arm (regio deltoidea).

Vaccination of non-immune persons with close contact to individuals at high risk of severe varicella infection is recommended with a view to avoiding infection. Close contact means parents and siblings of high-risk patients along with physicians and other healthcare professionals. Varicella vaccine can be used as post-exposure prophylaxis if given within three days after exposure, EPI-NEWS 5/05.

(Dept. of Inf. Disease Epidemiology)

20 June 2012