GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine, is supported by Cooperative Agreement U50/CCU412347 from the Centers for Disease Control and Prevention. Dr J. Torresi and Professor G. V. Brown are supported by the Clinical Center for Research Excellence, National Health and Medical Research Council of Australia. Apart from this, the authors had no financial or other conflicts of interest to disclose.
Imported Plasmodium vivax Malaria: Demographic and Clinical Features in Nonimmune Travelers
Article first published online: 8 MAR 2006
Journal of Travel Medicine
Volume 11, Issue 4, pages 213–219, July 2004
How to Cite
Elliott, J. H., O—Brien, D., Leder, K., Kitchener, S., Schwartz, E., Weld, L., Brown, G. V., Kain, K. C., Torresi, J. and the GeoSentinel Surveillance Network (2004), Imported Plasmodium vivax Malaria: Demographic and Clinical Features in Nonimmune Travelers. Journal of Travel Medicine, 11: 213–219. doi: 10.2310/7060.2004.19004
- Issue published online: 8 MAR 2006
- Article first published online: 8 MAR 2006
Background: Imported malaria is an important problem in nonendemic countries due to increasing travel to and immigration from malaria-endemic countries. Plasmodium vivax malaria is relatively common in travelers but there are few published data regarding the outcome of P. vivax malaria in this group.
Methods: We analyzed 209 cases of P. vivax malaria that were reported to the GeoSentinel network and the VIDS database, Royal Melbourne Hospital. Analyses were performed on data including demographics, pretravel encounter, antimalarial prophylaxis, exposure history, type of travel, countries of recent and past travel, clinical presentation, treatment, outcome and final diagnoses.
Results: The majority of patients were travelers (61%), followed by expatriates (13%) and recent immigrants or foreign visitors (12%). Recent travel to Oceania, sub-Saharan Africa, and South and Central America was significantly more likely to be associated with P. vivax malaria than travel to all other regions. The clinical presentation of P. vivax malaria acquired in the Pacific region is indistinguishable from infection with P. falciparum. The use of chloroquine prophylaxis did not prolong the incubation period. Relapse of infection was not infrequent, and the only significant predictor of relapse was travel to Papua New Guinea (PNG), regardless of primaquine dose. Travelers returning from PNG were eight times more likely to relapse after primaquine treatment compared to travelers with P. vivax malaria acquired elsewhere.
Conclusions: We have presented details of the epidemiology, clinical presentation and management of infection with P. vivax malaria in travelers. P. vivax malaria is an important cause of morbidity in travelers, and relapse following primaquine treatment is especially problematic with P. vivax malaria acquired in PNG.