title: Epidemiology of imported malaria among children and young adults in Barcelona (1990-2008).
abstract: BACKGROUND
  Increasing international travel and migration is producing changes in trends in infectious diseases, especially in children from many European cities. The objective of this study was to describe the epidemiology and determine the trends of imported malaria in patients under 20 years old in the city of Barcelona, Spain, during an 18-year period.
  
  
  METHODS
  The study included malaria cases that were laboratory confirmed and reported to the malaria register at the Public Health Agency of Barcelona from 1990 to 2008, residing in Barcelona and less than 20 years old. Patients were classified as natives (born in Spain) or immigrants. Differences in the distribution of demographic, clinical characteristics, and incidence per 100,000 person-year evolution were analysed. Natives and immigrants were compared by logistic regression by calculating the odds ratio (OR) with a 95% confidence interval (CI) and Chi-square for a linear trend (p<0.05).
  
  
  RESULTS
  Of the total 174 cases, 143 (82.1%) were immigrants, 100 (57.5%) were female, 121 (69.5%) Plasmodium falciparum, and 108 (62.1%) were visiting friends and relatives (VFR) as the reason for travel. Among the immigrants, 99 (67.8%) were from Equatorial Guinea. Immigrant cases more frequently travelled to Africa than natives (p=0.02). The factors associated with imported malaria among immigrant residents was travelling for VFR (OR: 6.2 CI 1.9-20.2) and age 15-19 (OR: 3.7 CI 1-13.3). The incidence increased from 1990 to 1999 (p<0.001) and decreased from 2000 to 2008 (p=0.01), although the global linear trend was not statistically significant (p=0.41). The fatality rate was 0.5%.
  
  
  CONCLUSIONS
  The majority of cases of malaria in population less than 20 years in Barcelona were immigrants, travelling to Africa for VFR and Plasmodium falciparum was most frequently detected. The trend analysis of the entire study period did not show a statistically significant decline. It is recommended to be aware of malaria, especially among children of immigrants who travel to their parent's home country for VFR. Better access to pre travel advice should be provided.
authors: Epidemiology Service, Public Health Agency of Barcelona, Pza Lesseps, 1, 08023 Barcelona, Spain.
authors: Mireia
authors: M
authors: Garcia-Villarrubia
authors: Juan-Pablo
authors: JP
authors: Millet
authors: Patricia Garcia
authors: PG
authors: de Olalla
authors: Joaquim
authors: J
authors: Gascón
authors: Victoria
authors: V
authors: Fumadó
authors: Jordi Gómez
authors: JG
authors: i Prat
authors: Begoña
authors: B
authors: Treviño
authors: María-Jesús
authors: MJ
authors: Pinazo
authors: Juan
authors: J
authors: Cabezos
authors: José
authors: J
authors: Muñoz
authors: Francesc
authors: F
authors: Zarzuela
authors: Joan A
authors: JA
authors: Caylà
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016778:Malaria, Falciparum / Q000453:epidemiology*; D008297:Male; D013030:Spain / Q000453:epidemiology; D014195:Travel; D055815:Young Adult