Malaria after international travel: a GeoSentinel analysis, 2003–2016
Identifieur interne : 000210 ( Pmc/Checkpoint ); précédent : 000209; suivant : 000211Malaria after international travel: a GeoSentinel analysis, 2003–2016
Auteurs : Kristina M. Angelo [États-Unis] ; Michael Libman [Canada] ; Eric Caumes [France] ; Davidson H. Hamer [États-Unis] ; Kevin C. Kain [Canada] ; Karin Leder [Australie] ; Martin P. Grobusch [Pays-Bas] ; Stefan H. Hagmann [États-Unis] ; Phyllis Kozarsky [États-Unis] ; David G. Lalloo [Royaume-Uni] ; Poh-Lian Lim [Singapour] ; Calvin Patimeteeporn [États-Unis] ; Philippe Gautret [France] ; Silvia Odolini [Italie] ; François Chappuis [Suisse] ; Douglas H. Esposito [États-Unis]Source :
- Malaria Journal [ 1475-2875 ] ; 2017.
Abstract
More than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation.
Records with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria.
There were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20–75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single
Malaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized.
Url:
DOI: 10.1186/s12936-017-1936-3
PubMed: 28728595
PubMed Central: 5520359
Affiliations:
- Australie, Canada, France, Italie, Pays-Bas, Royaume-Uni, Singapour, Suisse, États-Unis
- Géorgie (États-Unis), Massachusetts, État de New York
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Amsterdam, Netherlands</nlm:aff>
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<affiliation wicri:level="2"><nlm:aff id="Aff10"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0941 6502</institution-id>
<institution-id institution-id-type="GRID">grid.189967.8</institution-id>
<institution>Department of Medicine,</institution>
<institution>Emory University,</institution>
</institution-wrap>
Atlanta, GA USA</nlm:aff>
<country>États-Unis</country>
<placeName><region type="state">Géorgie (États-Unis)</region>
</placeName>
<wicri:cityArea>Atlanta</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Lalloo, David G" sort="Lalloo, David G" uniqKey="Lalloo D" first="David G." last="Lalloo">David G. Lalloo</name>
<affiliation wicri:level="1"><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 9764</institution-id>
<institution-id institution-id-type="GRID">grid.48004.38</institution-id>
<institution></institution>
<institution>Liverpool School of Tropical Medicine,</institution>
</institution-wrap>
Liverpool, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Liverpool</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Lim, Poh Lian" sort="Lim, Poh Lian" uniqKey="Lim P" first="Poh-Lian" last="Lim">Poh-Lian Lim</name>
<affiliation wicri:level="1"><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="GRID">grid.240988.f</institution-id>
<institution>Institute of Infectious Diseases and Epidemiology,</institution>
<institution>Tan Tock Seng Hospital,</institution>
</institution-wrap>
Singapore, Singapore</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Singapore</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff13"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2224 0361</institution-id>
<institution-id institution-id-type="GRID">grid.59025.3b</institution-id>
<institution>Lee Kong Chian School of Medicine,</institution>
<institution>Nanyang Technological University,</institution>
</institution-wrap>
Singapore, Singapore</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Singapore</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Patimeteeporn, Calvin" sort="Patimeteeporn, Calvin" uniqKey="Patimeteeporn C" first="Calvin" last="Patimeteeporn">Calvin Patimeteeporn</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2163 0069</institution-id>
<institution-id institution-id-type="GRID">grid.416738.f</institution-id>
<institution>Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases,</institution>
<institution>Centers for Disease Control and Prevention,</institution>
</institution-wrap>
1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30329 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Géorgie (États-Unis)</region>
</placeName>
<wicri:cityArea>1600 Clifton Rd NE, Mailstop E03, Atlanta</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Gautret, Philippe" sort="Gautret, Philippe" uniqKey="Gautret P" first="Philippe" last="Gautret">Philippe Gautret</name>
<affiliation wicri:level="1"><nlm:aff id="Aff14"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2176 4817</institution-id>
<institution-id institution-id-type="GRID">grid.5399.6</institution-id>
<institution>Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes,</institution>
<institution>Aix Marseille Université, Tropical IHU-Méditerranée Infection,</institution>
</institution-wrap>
Marseillle, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Marseillle</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Odolini, Silvia" sort="Odolini, Silvia" uniqKey="Odolini S" first="Silvia" last="Odolini">Silvia Odolini</name>
<affiliation wicri:level="1"><nlm:aff id="Aff15"><institution-wrap><institution-id institution-id-type="ISNI">0000000417571846</institution-id>
<institution-id institution-id-type="GRID">grid.7637.5</institution-id>
<institution>Department of Infectious and Tropical Diseases,</institution>
<institution>University of Brescia and Spedali Civili General Hospital,</institution>
</institution-wrap>
Brescia, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Brescia</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Chappuis, Francois" sort="Chappuis, Francois" uniqKey="Chappuis F" first="François" last="Chappuis">François Chappuis</name>
<affiliation wicri:level="1"><nlm:aff id="Aff16"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0721 9812</institution-id>
<institution-id institution-id-type="GRID">grid.150338.c</institution-id>
<institution></institution>
<institution>Geneva University Hospital,</institution>
</institution-wrap>
Geneva, Switzerland</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Geneva</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Esposito, Douglas H" sort="Esposito, Douglas H" uniqKey="Esposito D" first="Douglas H." last="Esposito">Douglas H. Esposito</name>
<affiliation wicri:level="2"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2163 0069</institution-id>
<institution-id institution-id-type="GRID">grid.416738.f</institution-id>
<institution>Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases,</institution>
<institution>Centers for Disease Control and Prevention,</institution>
</institution-wrap>
1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30329 USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Géorgie (États-Unis)</region>
</placeName>
<wicri:cityArea>1600 Clifton Rd NE, Mailstop E03, Atlanta</wicri:cityArea>
</affiliation>
</author>
</analytic>
<series><title level="j">Malaria Journal</title>
<idno type="eISSN">1475-2875</idno>
<imprint><date when="2017">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p id="Par1">More than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">Records with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">There were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20–75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single <italic>Plasmodium</italic>
species diagnosis, most frequently <italic>Plasmodium falciparum</italic>
(4011; 76%). Travellers with <italic>P. falciparum</italic>
were most frequently VFRs (60%). More than 40% of travellers with a trip duration ≤7 days had <italic>Plasmodium vivax</italic>
. There were 444 (8%) travellers with severe malaria; 31 children had severe malaria. Twelve travellers died.</p>
</sec>
<sec><title>Conclusion</title>
<p id="Par4">Malaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized.</p>
</sec>
</div>
</front>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">Malar J</journal-id>
<journal-id journal-id-type="iso-abbrev">Malar. J</journal-id>
<journal-title-group><journal-title>Malaria Journal</journal-title>
</journal-title-group>
<issn pub-type="epub">1475-2875</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
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</journal-meta>
<article-meta><article-id pub-id-type="pmid">28728595</article-id>
<article-id pub-id-type="pmc">5520359</article-id>
<article-id pub-id-type="publisher-id">1936</article-id>
<article-id pub-id-type="doi">10.1186/s12936-017-1936-3</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research</subject>
</subj-group>
</article-categories>
<title-group><article-title>Malaria after international travel: a GeoSentinel analysis, 2003–2016</article-title>
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<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Angelo</surname>
<given-names>Kristina M.</given-names>
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<address><phone>(404) 639-7026</phone>
<email>kangelo@cdc.gov</email>
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<xref ref-type="aff" rid="Aff1">1</xref>
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<contrib contrib-type="author"><name><surname>Libman</surname>
<given-names>Michael</given-names>
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<address><email>michael.libman@mcgill.ca</email>
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<xref ref-type="aff" rid="Aff2">2</xref>
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<given-names>Eric</given-names>
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<address><email>eric.caumes@aphp.fr</email>
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<given-names>Davidson H.</given-names>
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<address><email>dhamer@bu.edu</email>
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<given-names>Karin</given-names>
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<xref ref-type="aff" rid="Aff8">8</xref>
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<given-names>Stefan H.</given-names>
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<address><email>shagmann@northwell.edu</email>
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<xref ref-type="aff" rid="Aff9">9</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kozarsky</surname>
<given-names>Phyllis</given-names>
</name>
<address><email>pkozars@emory.edu</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff10">10</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lalloo</surname>
<given-names>David G.</given-names>
</name>
<address><email>David.Lalloo@lstmed.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff11">11</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lim</surname>
<given-names>Poh-Lian</given-names>
</name>
<address><email>poh_lian_lim@ttsh.com.sg</email>
</address>
<xref ref-type="aff" rid="Aff12">12</xref>
<xref ref-type="aff" rid="Aff13">13</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Patimeteeporn</surname>
<given-names>Calvin</given-names>
</name>
<address><email>xxe9@cdc.gov</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gautret</surname>
<given-names>Philippe</given-names>
</name>
<address><email>philippe.gautret@club-internet.fr</email>
</address>
<xref ref-type="aff" rid="Aff14">14</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Odolini</surname>
<given-names>Silvia</given-names>
</name>
<address><email>silvia.odolini@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff15">15</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chappuis</surname>
<given-names>François</given-names>
</name>
<address><email>francois.chappuis@hcuge.ch</email>
</address>
<xref ref-type="aff" rid="Aff16">16</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Esposito</surname>
<given-names>Douglas H.</given-names>
</name>
<address><email>hgj4@cdc.gov</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><collab>for the GeoSentinel Network<contrib-group><contrib contrib-type="author"><name><surname>Javelle</surname>
<given-names>Emilie</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Castelli</surname>
<given-names>Francesco</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Matteelli</surname>
<given-names>Alberto</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Perignon</surname>
<given-names>Alice</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Rothe</surname>
<given-names>Camilla</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Rapp</surname>
<given-names>Christoph</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Ficko</surname>
<given-names>Cecile</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Schwartz</surname>
<given-names>Eli</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>von Sonnenburg</surname>
<given-names>Frank</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Piyaphanee</surname>
<given-names>Watcharapong</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Silachamroon</surname>
<given-names>Udomsak</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Boggild</surname>
<given-names>Andrea</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Van Genderen</surname>
<given-names>Perry</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Torresi</surname>
<given-names>Joe</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Jensenius</surname>
<given-names>Mogens</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Kanagawa</surname>
<given-names>Shuzo</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Kato</surname>
<given-names>Yasuyuki</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Yansouni</surname>
<given-names>Cedric</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>McCarthy</surname>
<given-names>Anne</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Kelly</surname>
<given-names>Paul</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Goorhuis</surname>
<given-names>Bram</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>López-Vélez</surname>
<given-names>Rogelio</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Norman</surname>
<given-names>Francesco</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Mendelson</surname>
<given-names>Marc</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Vincent</surname>
<given-names>Peter</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Gkrania-Klotsas</surname>
<given-names>Effrossyni</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Warne</surname>
<given-names>Ben</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Malvy</surname>
<given-names>Denis </given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Duvignaud</surname>
<given-names>Alexandre</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Bottieau</surname>
<given-names>Emanuel</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Clerinx</surname>
<given-names>Joannes</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Coyle</surname>
<given-names>Christina</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Àsgeirsson</surname>
<given-names>Hilmer</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Glans</surname>
<given-names>Hedvig</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Schlagenhauf</surname>
<given-names>Patricia</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Weber</surname>
<given-names>Rainer</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Mockenhaupt</surname>
<given-names>Frank</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Harms-Zwingenberger</surname>
<given-names>Gundel</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Beeching</surname>
<given-names>Nicholas</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Hajek</surname>
<given-names>Jan</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Ghesquiere</surname>
<given-names>Wayne</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Wu</surname>
<given-names>Henry</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Barnett</surname>
<given-names>Elizabeth</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Hockberg</surname>
<given-names>Natasha</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Yoshimura</surname>
<given-names>Yukiriro</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Tachikawa</surname>
<given-names>Natsuo</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Cahill</surname>
<given-names>John</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>McKinley</surname>
<given-names>George</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Stauffer</surname>
<given-names>William</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Walker</surname>
<given-names>Pat</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Kuhn</surname>
<given-names>Susan</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Chen</surname>
<given-names>Lin</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Leung</surname>
<given-names>Daniel</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Benson</surname>
<given-names>Scott</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Larsen</surname>
<given-names>Carsten Schade</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Wejse</surname>
<given-names>Christian</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Field</surname>
<given-names>Vanessa</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Licitra</surname>
<given-names>Carmelo</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Klochko</surname>
<given-names>Alena</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Hynes</surname>
<given-names>Noreen</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Perez</surname>
<given-names>Cecilia Perret</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Connor</surname>
<given-names>Bradley</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Murphy</surname>
<given-names>Holly</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Pandey</surname>
<given-names>Prativa</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Vincelette</surname>
<given-names>Jean</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Barkati</surname>
<given-names>Sapha</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Florescu</surname>
<given-names>Simin Aysel</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Popescu</surname>
<given-names>Corneliu Petru</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Blumberg</surname>
<given-names>Lucille</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>De Frey</surname>
<given-names>Albie</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Anderson</surname>
<given-names>Susan</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Shaw</surname>
<given-names>Marc</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Hern</surname>
<given-names>AnneMarie</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Molina</surname>
<given-names>Israel</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Yates</surname>
<given-names>Johnnie</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Siu</surname>
<given-names>Hugo</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Valdez</surname>
<given-names>Luis Manuel</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Haulman</surname>
<given-names>Jean</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Roesel</surname>
<given-names>David</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Phu</surname>
<given-names>Phi Truong Hoang</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Borwein</surname>
<given-names>Sarah </given-names>
</name>
</contrib>
</contrib-group>
</collab>
</contrib>
<aff id="Aff1"><label>1</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2163 0069</institution-id>
<institution-id institution-id-type="GRID">grid.416738.f</institution-id>
<institution>Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases,</institution>
<institution>Centers for Disease Control and Prevention,</institution>
</institution-wrap>
1600 Clifton Rd NE, Mailstop E03, Atlanta, GA 30329 USA</aff>
<aff id="Aff2"><label>2</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8649</institution-id>
<institution-id institution-id-type="GRID">grid.14709.3b</institution-id>
<institution></institution>
<institution>McGill University Centre for Tropical Diseases,</institution>
</institution-wrap>
Montreal, Canada</aff>
<aff id="Aff3"><label>3</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1955 3500</institution-id>
<institution-id institution-id-type="GRID">grid.5805.8</institution-id>
<institution>Service des Maladies Infectieuses et Tropicales, GH Pitié-Salpêtrière,</institution>
<institution>Université Pierre et Marie Curie,</institution>
</institution-wrap>
Paris, France</aff>
<aff id="Aff4"><label>4</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7558</institution-id>
<institution-id institution-id-type="GRID">grid.189504.1</institution-id>
<institution>Department of Global Health and Center for Global Health and Development,</institution>
<institution>Boston University School of Public Health,</institution>
</institution-wrap>
Boston, MA USA</aff>
<aff id="Aff5"><label>5</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2157 2938</institution-id>
<institution-id institution-id-type="GRID">grid.17063.33</institution-id>
<institution>Tropical Disease Unit,</institution>
<institution>University of Toronto,</institution>
</institution-wrap>
Toronto, Canada</aff>
<aff id="Aff6"><label>6</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0624 1200</institution-id>
<institution-id institution-id-type="GRID">grid.416153.4</institution-id>
<institution>Victorian Infectious Diseases Service,</institution>
<institution>Royal Melbourne Hospital,</institution>
</institution-wrap>
Victoria, Australia</aff>
<aff id="Aff7"><label>7</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7857</institution-id>
<institution-id institution-id-type="GRID">grid.1002.3</institution-id>
<institution>School of Public Health and Preventive Medicine,</institution>
<institution>Monash University,</institution>
</institution-wrap>
Victoria, Australia</aff>
<aff id="Aff8"><label>8</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000000084992262</institution-id>
<institution-id institution-id-type="GRID">grid.7177.6</institution-id>
<institution>Center for Tropical and Travel Medicine, Department of Infectious Diseases, Academic Medical Center,</institution>
<institution>University of Amsterdam,</institution>
</institution-wrap>
Amsterdam, Netherlands</aff>
<aff id="Aff9"><label>9</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9278 1430</institution-id>
<institution-id institution-id-type="GRID">grid.428847.5</institution-id>
<institution></institution>
<institution>Steven and Alexandra Cohen Children’s Medical Center of New York,</institution>
</institution-wrap>
New Hyde Park, New York, NY USA</aff>
<aff id="Aff10"><label>10</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0941 6502</institution-id>
<institution-id institution-id-type="GRID">grid.189967.8</institution-id>
<institution>Department of Medicine,</institution>
<institution>Emory University,</institution>
</institution-wrap>
Atlanta, GA USA</aff>
<aff id="Aff11"><label>11</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 9764</institution-id>
<institution-id institution-id-type="GRID">grid.48004.38</institution-id>
<institution></institution>
<institution>Liverpool School of Tropical Medicine,</institution>
</institution-wrap>
Liverpool, UK</aff>
<aff id="Aff12"><label>12</label>
<institution-wrap><institution-id institution-id-type="GRID">grid.240988.f</institution-id>
<institution>Institute of Infectious Diseases and Epidemiology,</institution>
<institution>Tan Tock Seng Hospital,</institution>
</institution-wrap>
Singapore, Singapore</aff>
<aff id="Aff13"><label>13</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2224 0361</institution-id>
<institution-id institution-id-type="GRID">grid.59025.3b</institution-id>
<institution>Lee Kong Chian School of Medicine,</institution>
<institution>Nanyang Technological University,</institution>
</institution-wrap>
Singapore, Singapore</aff>
<aff id="Aff14"><label>14</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2176 4817</institution-id>
<institution-id institution-id-type="GRID">grid.5399.6</institution-id>
<institution>Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes,</institution>
<institution>Aix Marseille Université, Tropical IHU-Méditerranée Infection,</institution>
</institution-wrap>
Marseillle, France</aff>
<aff id="Aff15"><label>15</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000000417571846</institution-id>
<institution-id institution-id-type="GRID">grid.7637.5</institution-id>
<institution>Department of Infectious and Tropical Diseases,</institution>
<institution>University of Brescia and Spedali Civili General Hospital,</institution>
</institution-wrap>
Brescia, Italy</aff>
<aff id="Aff16"><label>16</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0721 9812</institution-id>
<institution-id institution-id-type="GRID">grid.150338.c</institution-id>
<institution></institution>
<institution>Geneva University Hospital,</institution>
</institution-wrap>
Geneva, Switzerland</aff>
</contrib-group>
<pub-date pub-type="epub"><day>20</day>
<month>7</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>20</day>
<month>7</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection"><year>2017</year>
</pub-date>
<volume>16</volume>
<elocation-id>293</elocation-id>
<history><date date-type="received"><day>23</day>
<month>5</month>
<year>2017</year>
</date>
<date date-type="accepted"><day>13</day>
<month>7</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>© The Author(s) 2017</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p id="Par1">More than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">Records with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">There were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20–75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single <italic>Plasmodium</italic>
species diagnosis, most frequently <italic>Plasmodium falciparum</italic>
(4011; 76%). Travellers with <italic>P. falciparum</italic>
were most frequently VFRs (60%). More than 40% of travellers with a trip duration ≤7 days had <italic>Plasmodium vivax</italic>
. There were 444 (8%) travellers with severe malaria; 31 children had severe malaria. Twelve travellers died.</p>
</sec>
<sec><title>Conclusion</title>
<p id="Par4">Malaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Malaria</kwd>
<kwd>International travel</kwd>
<kwd><italic>Plasmodium</italic>
spp</kwd>
<kwd>GeoSentinel</kwd>
</kwd-group>
<funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000030</institution-id>
<institution>Centers for Disease Control and Prevention</institution>
</institution-wrap>
</funding-source>
<award-id>U50CK00189</award-id>
</award-group>
</funding-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2017</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Australie</li>
<li>Canada</li>
<li>France</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>Singapour</li>
<li>Suisse</li>
<li>États-Unis</li>
</country>
<region><li>Géorgie (États-Unis)</li>
<li>Massachusetts</li>
<li>État de New York</li>
</region>
</list>
<tree><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Angelo, Kristina M" sort="Angelo, Kristina M" uniqKey="Angelo K" first="Kristina M." last="Angelo">Kristina M. Angelo</name>
</region>
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<name sortKey="Hamer, Davidson H" sort="Hamer, Davidson H" uniqKey="Hamer D" first="Davidson H." last="Hamer">Davidson H. Hamer</name>
<name sortKey="Kozarsky, Phyllis" sort="Kozarsky, Phyllis" uniqKey="Kozarsky P" first="Phyllis" last="Kozarsky">Phyllis Kozarsky</name>
<name sortKey="Kozarsky, Phyllis" sort="Kozarsky, Phyllis" uniqKey="Kozarsky P" first="Phyllis" last="Kozarsky">Phyllis Kozarsky</name>
<name sortKey="Patimeteeporn, Calvin" sort="Patimeteeporn, Calvin" uniqKey="Patimeteeporn C" first="Calvin" last="Patimeteeporn">Calvin Patimeteeporn</name>
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<country name="Canada"><noRegion><name sortKey="Libman, Michael" sort="Libman, Michael" uniqKey="Libman M" first="Michael" last="Libman">Michael Libman</name>
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<name sortKey="Kain, Kevin C" sort="Kain, Kevin C" uniqKey="Kain K" first="Kevin C." last="Kain">Kevin C. Kain</name>
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<country name="France"><noRegion><name sortKey="Caumes, Eric" sort="Caumes, Eric" uniqKey="Caumes E" first="Eric" last="Caumes">Eric Caumes</name>
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<country name="Australie"><noRegion><name sortKey="Leder, Karin" sort="Leder, Karin" uniqKey="Leder K" first="Karin" last="Leder">Karin Leder</name>
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<name sortKey="Leder, Karin" sort="Leder, Karin" uniqKey="Leder K" first="Karin" last="Leder">Karin Leder</name>
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<country name="Pays-Bas"><noRegion><name sortKey="Grobusch, Martin P" sort="Grobusch, Martin P" uniqKey="Grobusch M" first="Martin P." last="Grobusch">Martin P. Grobusch</name>
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<country name="Royaume-Uni"><noRegion><name sortKey="Lalloo, David G" sort="Lalloo, David G" uniqKey="Lalloo D" first="David G." last="Lalloo">David G. Lalloo</name>
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<country name="Singapour"><noRegion><name sortKey="Lim, Poh Lian" sort="Lim, Poh Lian" uniqKey="Lim P" first="Poh-Lian" last="Lim">Poh-Lian Lim</name>
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<name sortKey="Lim, Poh Lian" sort="Lim, Poh Lian" uniqKey="Lim P" first="Poh-Lian" last="Lim">Poh-Lian Lim</name>
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<country name="Italie"><noRegion><name sortKey="Odolini, Silvia" sort="Odolini, Silvia" uniqKey="Odolini S" first="Silvia" last="Odolini">Silvia Odolini</name>
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<country name="Suisse"><noRegion><name sortKey="Chappuis, Francois" sort="Chappuis, Francois" uniqKey="Chappuis F" first="François" last="Chappuis">François Chappuis</name>
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