Imported Plasmodium vivax Malaria ex Pakistan

Authors

  • Silvia Odolini MD,

    Corresponding author
    1. University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
    • Corresponding Author: Silvia Odolini, MD, University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, P.le Spedali Civili, 1-25123 Brescia, Italy. E-mail: silvia.odolini@gmail.com

    Search for more papers by this author
  • Philippe Gautret MD, PhD,

    1. Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
    Search for more papers by this author
  • Kevin C. Kain MD,

    1. Centre for Travel and Tropical Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
    Search for more papers by this author
  • Kitty Smith FRCP, PhD,

    1. Brownlee Centre for Infectious & Communicable Diseases, Glasgow, Scotland
    Search for more papers by this author
  • Karin Leder MD, PhD,

    1. Victorian Infectious Disease Service, Royal Melbourne Hospital and Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
    Search for more papers by this author
  • Mogens Jensenius MD, PhD,

    1. Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
    Search for more papers by this author
  • Christina M. Coyle MD, MS,

    1. Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, NY, USA
    Search for more papers by this author
  • Francesco Castelli MD, FRCP,

    1. University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
    Search for more papers by this author
  • Alberto Matteelli MD

    1. University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
    Search for more papers by this author

Abstract

Background

According to WHO, 1.5 million cases of malaria are reported annually in Pakistan. Malaria distribution in Pakistan is heterogeneous, and some areas, including Punjab, are considered at low risk for malaria. The aim of this study is to describe the trend of imported malaria cases from Pakistan reported to the international surveillance systems from 2005 to 2012.

Methods

Clinics reporting malaria cases acquired after a stay in Pakistan between January 1, 2005, and December 31, 2012, were identified from the GeoSentinel (http://www.geosentinel.org) and EuroTravNet (http://www.Eurotravnet.eu) networks. Demographic and travel-related information was retrieved from the database and further information such as areas of destination within Pakistan was obtained directly from the reporting sites. Standard linear regression models were used to assess the statistical significance of the time trend.

Results

From January 2005 to December 2012, a total of 63 cases of malaria acquired in Pakistan were retrieved in six countries over three continents. A statistically significant increasing trend in imported Plasmodium vivax malaria cases acquired in Pakistan, particularly for those exposed in Punjab, was observed over time (p = 0.006).

Conclusions

Our observation may herald a variation in malaria incidence in the Punjab province of Pakistan. This is in contrast with the previously described decreasing incidence of malaria in travelers to the Indian subcontinent, and with reports that describe Punjab as a low risk area for malaria. Nevertheless, this event is considered plausible by international organizations. This has potential implications for changes in chemoprophylaxis options and reinforces the need for increased surveillance, also considering the risk of introduction of autochthonous P. vivax malaria in areas where competent vectors are present, such as Europe.

Ancillary