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. 2010 Oct 28:9:300.
doi: 10.1186/1475-2875-9-300.

Declining incidence of imported malaria in the Netherlands, 2000-2007

Gini G C van Rijckevorsel  1 , Gerard J B Sonder, Ronald B Geskus, Jose C F M Wetsteyn, Robert J Ligthelm, Leo G Visser, Monique Keuter, Perry J J van Genderen, Anneke van den Hoek
Affiliations

Declining incidence of imported malaria in the Netherlands, 2000-2007

Gini G C van Rijckevorsel et al. Malar J. .

Abstract

Background: To describe the epidemiology and trends of imported malaria in the Netherlands from 2000 through 2007.

Methods: Based on national surveillance data regarding all reported infections of imported malaria, diagnosed 2000 through 2007, incidence and trends of imported malaria in the Netherlands were estimated. Travellers statistics were used to estimate incidence, and data on malaria chemoprophylaxis prescriptions were used to estimate the number of unprotected travellers.

Results: Importation of malaria to the Netherlands is declining even as more travellers visit malaria-endemic countries. On average, 82% were acquired in sub-Saharan Africa, and 75% were caused by Plasmodium falciparum. The overall incidence in imported falciparum malaria fell from 21.5 to 6.6/10,000 of unprotected travellers. The percentage of unprotected travellers rose from 47% to 52% of all travellers. The incidence of imported falciparum infections is greatest from Middle and West Africa, and decreased from 121.3 to 36.5/10,000 travellers. The import of malaria from this region by immigrants visiting friends and relatives (VFR) decreased from 138 infections in 2000, to 69 infections in 2007.

Conclusion: The annual number of imported malaria shows a continuing declining trend, even with an increasing number of travellers visiting malaria endemic countries. VFR import less malaria than previously, and contribute largely to the declining incidence seen. The decline is not readily explained by increased use of chemoprophylaxis and may reflect a reduced risk of infection due to decreasing local malaria transmission as observed in some malaria endemic areas. Nevertheless, the increasing number of unprotected travellers remains worrisome.

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Figures

Figure 1
Figure 1
Fitted trends in probability of infection for the four categories of patients with imported malaria, the Netherlands, 2000-2007. The probability of infection is shown with 95% confidence intervals.
Figure 2
Figure 2
Number of collected prescriptions for malaria chemoprophylaxis (shown in bars), and total number of travellers to malaria-endemic regions (shown in line), the Netherlands, 2000-2007.
Figure 3
Figure 3
Overall incidence of imported Plasmodium falciparum malaria in the Netherlands, 2000-2007, and number of travellers to malaria endemic regions.
Figure 4
Figure 4
Region-specific of imported Plasmodium falciparum malaria in the Netherlands, 2000-2007, and number of travellers to malaria endemic regions - Africa.
Figure 5
Figure 5
Region-specific of imported Plasmodium falciparum malaria in the Netherlands, 2000-2007, and number of travellers to malaria endemic regions - Central and South America.
Figure 6
Figure 6
Region-specific of imported Plasmodium falciparum malaria in the Netherlands, 2000-2007, and number of travellers to malaria endemic regions - Asia.
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