Severe Imported Malaria, France | CDC EID

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Volume 17, Number 5–May 2011
Research
Severe Imported Plasmodium falciparum Malaria, France, 1996–2003
Elise Seringe, Marc Thellier, Arnaud Fontanet, Fabrice Legros, Olivier Bouchaud, Thierry Ancelle, Eric Kendjo, Sandrine Houze, Jacques Le Bras, Martin Danis, and Rémy Durand, for the French National Reference Center for Imported Malaria Study Group1

Author affiliations: University Pierre et Marie Curie, Paris, France (E. Seringe, M. Thellier, M. Danis); Groupe Hospitalier Pitié-Salpĕtrière, Paris (E. Seringe, M. Thellier, M. Danis); Centre National de Référence du Paludisme, Paris (M. Thellier, F. Legros, E. Kendjo, S. Houze, J. Le Bras, M. Danis, R. Durand); Institut Pasteur, Paris (E. Seringe, A. Fontanet); Conservatoire National des Arts et Métiers, Paris (A. Fontanet); Hôpital Avicenne, Bobigny, France (O. Bouchaud, ôpital Cochin, Paris (T. Ancelle)

Suggested citation for this article


Abstract

Little is known about severe imported Plasmodium falciparum malaria in industrialized countries where the disease is not endemic because most studies have been case reports or have included < 200 patients. To identify factors independently associated with the severity of P. falciparum, we conducted a retrospective study using surveillance data obtained from 21,888 P. falciparum patients in France during 1996–2003; 832 were classified as having severe malaria. The global case-fatality rate was 0.4% and the rate of severe malaria was ≈3.8%. Factors independently associated with severe imported P. falciparum malaria were older age, European origin, travel to eastern Africa, absence of chemoprophylaxis, initial visit to a general practitioner, time to diagnosis of 4 to 12 days, and diagnosis during the fall–winter season. Pretravel advice should take into account these factors and promote the use of antimalarial chemoprophylaxis for every traveler, with a particular focus on nonimmune travelers and elderly persons .


Each year, a growing number of persons from industrialized countries travel to developing countries. Among these millions of travelers, 20% to 70% report some illness associated with their travel and ≈3% report fever (1). Malaria appears to be the most common cause of fever in returned travelers. Because of its potential severity, Plasmodium falciparum infection must be considered in all febrile persons who return from an area where malaria is endemic. Depending on the country of importation and the year, ≈2%–16% of P. falciparum imported malaria infections are severe cases according to the World Health Organization (WHO) definition, and ≈10% of severe cases end with the death of the patient despite appropriate antimalarial treatment (2).

Globally, epidemiologic and pathophysiologic research studies on malaria are mainly based on disease in children <5 years of age in areas where malaria is endemic. Little is known about severe imported malaria, which primarily affects nonimmune adults. Most previous studies that have focused on severe imported malaria have been case reports or have included <200 patients (3–12). Recently, we published an analysis of risk factors associated with death in a series of 96 malaria-related deaths of 21,888 patients with imported P. falciparum malaria (2). Characteristics independently associated with death were older age, being a native of an area where malaria is nonendemic, infection occurring in eastern Africa, and absence of appropriate chemoprophylaxis. This database, including the characteristics of 832 case-patients with severe disease, provides a unique opportunity to analyze the risk factors for severe imported malaria in France. We conducted a retrospective analysis of the main features of severe imported malaria cases compared with nonsevere cases that occurred during 1996–2003 in France. Increased knowledge in this area may lead to improvement in terms of prevention and patient management. full-text (large): Severe Imported Malaria, France | CDC EID


Suggested Citation for this Article
Seringe E, Thellier M, Fontanet A, Legros F, Bouchaud O, Ancelle T, et al. Severe imported Plasmodium falciparum malaria, France, 1996–2003. Emerg Infect Dis [serial on the Internet]. 2011 May [date cited]. http://www.cdc.gov/EID/content/17/5/807.htm

DOI: 10.3201/eid1705.101527



1Additional members of the French National Reference Center for Imported Malaria Study Group who contributed data are listed in the Technical Appendix [ 21 KB, 3 pages].


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Rémy Durand, Laboratoire de Parasitologie-Mycologie, Hôpital Avicenne, AP-HP, 125 Rue de Stalingrad, 93009 Bobigny CEDEX, France; email: remy.durand@avc.aphp.fr