title: Imported malaria in Poland 2003 to 2011: implications of different travel patterns.
abstract: BACKGROUND
  The number of imported malaria cases in Poland compared with other European countries remains low. However, in view of the high mortality and the large proportion of severe clinical forms, a better understanding of the problem is required.
  
  
  METHODS
  Data reported to the surveillance system in Poland between 2003 and 2011 were reviewed retrospectively. All cases were laboratory confirmed as outlined by the EU case definition. Statistical analysis was performed using Epi Info 3.5.3 and STATA 10.
  
  
  RESULTS
  A total of 189 confirmed malaria cases, including 5 that were fatal, were reported in Poland during the study period. All cases were imported: 72% came from Africa. Among cases with a species-specific diagnosis, 118 (73%) were caused by Plasmodium falciparum. The median age of individuals afflicted was 36 years and 74% were males. Most cases occurred among work-related travelers (40%) or tourists (38%). Individuals born in malaria-endemic countries constituted 12% of all cases. The severe malaria form was identified in 23% of all cases and was more frequent among cases caused by P. falciparum (32%), in people older than 50 years (39%), and in cases when diagnosis was delayed (36%). The severe form occurred only in 9% of cases originating from malaria-endemic countries and there were no fatalities in this group. Fatal outcomes were associated with a delay in diagnosis (fatality = 10.5%) and falciparum malaria (fatality = 4%). Most of the delays resulted from a delay in seeking medical care, and less frequently due to misdiagnosis.
  
  
  CONCLUSIONS
  Tourists and work-related travelers make up most of the malaria patients in Poland and they are at a greater risk of the severe form of malaria and consequently death, possibly due to the lack of immunity. Delayed diagnosis is associated with mortality, implying low awareness of the threat that malaria poses, both among patients and doctors.
authors.affiliation: Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Stępień
authors.forename: Magdalena
authors.initials: M
authors.lastname: Rosińska
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D057210:Delayed Diagnosis / Q000401:mortality / Q000517:prevention & control / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000401:mortality / Q000517:prevention & control / Q000706:statistics & numerical data; D019353:Endemic Diseases; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000401:mortality; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010963:Plasmodium falciparum / Q000302:isolation & purification / Q000472:pathogenicity; D011044:Poland / Q000453:epidemiology; D012720:Severity of Illness Index; D061665:Time-to-Treatment / Q000592:standards; D014195:Travel / Q000706:statistics & numerical data*