title: Incidence of malaria and risk factors in Italian travelers to malaria endemic countries.
abstract: BACKGROUND
  Imported malaria has been an increasing problem in Italy in the last three decades of the 1900s, representing the main risk for travelers visiting tropical and sub-tropical countries where malaria is endemic. Even though the total number of imported cases has been declining since 2000, malaria still represents the most frequent notifiable imported disease in Italy. The present study analyzes all the malaria cases reported in Italy in 2000-2006 in order to assess the trend of incidence over the time and reviewing the risk factors for travelers visiting malaria endemic countries.
  
  
  METHODS
  All 2000-2006 case report forms were analyzed. The incidence of malaria in Italian travelers was calculated by continent and by countries most visited, using data provided by the Ministry of Transportation.
  
  
  RESULTS
  Out of the 5219 malaria cases reported and confirmed in the study period five were autochthonous and 5214 imported, 1518 of which occurred in Italian citizen and 3696 in foreigners. Between 2000 and 2006 imported malaria cases fell from 977 to 630 respectively, with a total reduction of about 36%. Most of the cases were contracted in Africa (93%) and Plasmodium falciparum was the etiological agent in 83% of the cases, with an annual average fatality rate of about 0.5%. The average of the crude incidence rate (CIR) among Italians was calculated by continent for both global cases (gCIR) and for P. falciparum cases (pfCIR) resulting of 1.2/1000 and 0.9 for Africa, 0.08/1000 and 0.02 for Asia, 0.03/1000 and 0.003 for Central and South America, respectively. The gCIR by continent slightly but decreased constantly over the study period.
  
  
  CONCLUSIONS
  The different factors which may influence the risk of contracting malaria for travelers visiting endemic countries and the strategy to reduce completely the number of fatal cases were considered and discussed.
authors.affiliation: Istituto Superiore di Sanità, Department of Infectious, Parasitic and Immuno-mediated Diseases, Vector-Borne Diseases and International Health Unit, Viale Regina Elena, 299, 00161 Rome, Italy. roberto.romi@iss.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Romi
authors.forename: Daniela
authors.initials: D
authors.lastname: Boccolini
authors.forename: Stefania
authors.initials: S
authors.lastname: D'Amato
authors.forename: Corrado
authors.initials: C
authors.lastname: Cenci
authors.forename: Mario
authors.initials: M
authors.lastname: Peragallo
authors.forename: Fortunato
authors.initials: F
authors.lastname: D'Ancona
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Pompa
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Majori
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002489:Central America / Q000453:epidemiology; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology / Q000208:ethnology; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D044349:Oceania / Q000453:epidemiology; D012307:Risk Factors; D014195:Travel / Q000706:statistics & numerical data*