High attack rate for malaria through irregular migration routes to a country on verge of elimination

Abstract

Irregular migration in the form of human smuggling and human trafficking is recognized as a global public health issue. Thirty-two cases of Plasmodium falciparum were detected in 534 irregular migrants returning to Sri Lanka via failed human smuggling routes from West Africa in 2012, contributing to the largest burden of imported cases in Sri Lanka as it entered elimination phase. Beyond the criminality and human rights abuse, irregular migration plays an important, but often forgotten, pathway for malaria re-introduction. Active surveillance of the growing numbers of irregular migrant flows becomes an important strategy as Sri Lanka advances towards goals of malaria elimination.

Figure 1

Map showing annual parasite incidence (API) (total number of positives cases per 1000 risk population) for the year 2002 superimposed with place of destination of returnee cases.

Figure 2

Irregular migration routes from Sri Lanka to Canada via West Africa. Blue indicates air routes and red markers represent the nine countries to which migrants entered before travelling via land routes to converge on a single port (Sierra Leone) to board a cargo vessel. Red dotted line represents the planned sea route. (Image developed by corresponding author. Map derived by Google maps).