title: Risk factors for imported fatal Plasmodium falciparum malaria, France, 1996-2003.
abstract: Plasmodium falciparum malaria is a serious health hazard for travelers to malaria-endemic areas and is often diagnosed on return to the country of residence. We conducted a retrospective study of imported falciparum malaria among travelers returning to France from malaria-endemic areas from 1996 through 2003. Epidemiologic, clinical, and parasitologic data were collected by a network of 120 laboratories. Factors associated with fatal malaria were identified by logistic regression analysis. During the study period, 21,888 falciparum malaria cases were reported. There were 96 deaths, for a case-fatality rate of 4.4 per 1,000 cases of falciparum malaria. In multivariate analysis, risk factors independently associated with death from imported malaria were older age, European origin, travel to East Africa, and absence of chemoprophylaxis. Fatal imported malaria remains rare and preventable. Pretravel advice and malaria management should take into account these risk factors, particularly for senior travelers.
authors.affiliation: Centre National de Référence de l'Epidémiologie du Paludisme d'Importation et Autochtone, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Legros
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchaud
authors.forename: Thierry
authors.initials: T
authors.lastname: Ancelle
authors.forename: Amandine
authors.initials: A
authors.lastname: Arnaud
authors.forename: Sandrine
authors.initials: S
authors.lastname: Cojean
authors.forename: Jacques
authors.initials: J
authors.lastname: Le Bras
authors.forename: Martin
authors.initials: M
authors.lastname: Danis
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.forename: Rémy
authors.initials: R
authors.lastname: Durand
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D004641:Emigration and Immigration; D019353:Endemic Diseases; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016778:Malaria, Falciparum / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D014195:Travel