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. 2022 Sep 17;29(6):taac083.
doi: 10.1093/jtm/taac083.

Trends in imported malaria during the COVID-19 pandemic, Spain (+Redivi Collaborative Network)

Francesca F Norman  1 , Begoña Treviño-Maruri  2 , José Manuel Ruiz Giardín  3 , Beatriz Gullón-Peña  1 , Fernando Salvador  4 , Nuria Serre  2 , Marta Díaz-Menéndez  5 , Eva Calabuig  6 , Azucena Rodriguez-Guardado  7 , Itxaso Lombide  8 , Ana Pérez-Ayala  9 , Diego Torrús  10 , Josune Goikoetxea  11 , Magdalena García-Rodriguez  12 , Jose A Pérez-Molina  1 ; +Redivi Study Group
Affiliations

Trends in imported malaria during the COVID-19 pandemic, Spain (+Redivi Collaborative Network)

Francesca F Norman et al. J Travel Med. .

Abstract

Introduction: The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date.

Methods: Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. polymerase chain reaction) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed.

Results: In total, 1751 cases of malaria (1751/26 601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (interquartile range: 27-44.7) years and most occurred in visiting friends and relatives (VFR)-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to Plasmodium falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (P < 0.001) (attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to Plasmodium falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively).

Conclusions: After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with imported malaria may present and/or be diagnosed late during this public health crisis and health care professionals should be alerted to the recent increase in severe cases.

Keywords: Plasmodium; COVID-19; Malaria; SARS-CoV-2; immigration; travel.

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