title: Imported malaria in a cosmopolitan European city: a mirror image of the world epidemiological situation.
abstract: BACKGROUND
  International travel and migration have been related with an increase of imported malaria cases. There has been considerable immigration to Barcelona from low-income countries (LIC) in recent years. The objective is to describe the epidemiology and to determine the trends of the disease in Barcelona.
  
  
  METHODS
  Analysis of the cases notified among city residents between 1989 and 2005. Patients were classified as: tourists, voluntary workers, resident immigrants (visiting friends and relatives, VFR) and recently arrived immigrants. An analysis was conducted using the chi2 test and comparison of means. As a measure of association we calculated the Relative Risk (RR) and Odds Ratio (OR) with a Confidence Interval of 95% (CI) and carried out a trends analysis.
  
  
  RESULTS
  Of the total of 1,579 imported cases notified, 997 (63.1%) lived in Barcelona city, and 55.1% were male. The mean age of patients was 32.7 years. The incidence increased from 2.4 cases/100,000 in 1989 to 3.5 cases/100,000 in 2005 (RR 1.46 CI:1.36-1.55). This increase was not statistically significant (trends analysis, p = 0.36). In terms of reason for travelling, 40.7% were VFR, 33.6% tourists, 12.1% voluntary workers and 13.6% were recently arrived immigrants. The most frequent species found was Plasmodium falciparum (71.3%), mainly in visitors to Africa (OR = 2.3, CI = 1.7-3.2). The vast majority (82.2%) had had some contact with Africa (35.9% with Equatorial Guinea, a Spanish ex-colony) and 96.6% had not completed chemoprophylaxis. Six deaths were observed, all tourists who had travelled to Africa and not taken chemoprophylaxis (3.9% fatality rate).
  
  
  CONCLUSIONS
  Over the period studied there is an increase in malaria incidence, however the trend is not statistically significant. Lack of chemoprophylaxis compliance and the association between Africa and P. falciparum are very clear in the imported cases. Most of the patients with malaria did not take chemoprophylaxis.
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Pza Lesseps, 1, 08023 Barcelona, Spain. jmillet@aspb.es
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Millet
authors.forename: Patricia
authors.initials: P
authors.lastname: Garcia de Olalla
authors.forename: Paloma
authors.initials: P
authors.lastname: Carrillo-Santisteve
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascón
authors.forename: Begoña
authors.initials: B
authors.lastname: Treviño
authors.forename: José
authors.initials: J
authors.lastname: Muñoz
authors.forename: Jordi
authors.initials: J
authors.lastname: Gómez I Prat
authors.forename: Juan
authors.initials: J
authors.lastname: Cabezos
authors.forename: Anna
authors.initials: A
authors.lastname: González Cordón
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
mesh_terms: D000328:Adult; D000818:Animals; D018890:Chemoprevention; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000302:isolation & purification; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014195:Travel; D016312:Treatment Refusal