Malaria in travelers: a review of the GeoSentinel surveillance network.
BACKGROUND
Malaria is a common and important infection in travelers.


METHODS
We have examined data reported to the GeoSentinel surveillance network to highlight characteristics of malaria in travelers.


RESULTS
A total of 1140 malaria cases were reported (60% of cases were due to Plasmodium falciparum, 24% were due to Plasmodium vivax). Male subjects constituted 69% of the study population. The median duration of travel was 34 days; however, 37% of subjects had a travel duration of < or =4 weeks. The majority of travellers did not have a pretravel encounter with a health care provider. Most cases occurred in travelers (39%) or immigrants/refugees (38%). The most common reasons for travel were to visit friends/relatives (35%) or for tourism (26%). Three-quarters of infections were acquired in sub-Saharan Africa. Severe and/or complicated malaria occurred in 33 cases, with 3 deaths. Compared with others in the GeoSentinel database, patients with malaria had traveled to sub-Saharan Africa more often, were more commonly visiting friends/relatives, had traveled for longer periods, presented sooner after return, were more likely to have a fever at presentation, and were less likely to have had a pretravel encounter. In contrast to immigrants and visitors of friends or relatives, a higher proportion (73%) of the missionary/volunteer group who developed malaria had a pretravel encounter with a health care provider. Travel to sub-Saharan Africa and Oceania was associated with the greatest relative risk of acquiring malaria.


CONCLUSIONS
We have used a global database to identify patient and travel characteristics associated with malaria acquisition and characterized differences in patient type, destinations visited, travel duration, and malaria species acquired.
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia. karin.leder@med.monash.edu.au
Karin
K
Leder
Jim
J
Black
Dan
D
O'Brien
Zoe
Z
Greenwood
Kevin C
KC
Kain
Eli
E
Schwartz
Graham
G
Brown
Joseph
J
Torresi
D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D017691:Caribbean Region / Q000453:epidemiology; D002489:Central America / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000469:parasitology; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D044349:Oceania; D011159:Population Surveillance; D012306:Risk; D013020:South America / Q000453:epidemiology; D014195:Travel