title: Low and Declining Risk for Malaria in Visitors to Indonesia: A Review of Local Indonesian and European Travelers' Data and a Suggestion for New Prophylactic Guidelines.
abstract: BACKGROUND
  The world's malaria map is constantly changing and with it the risk for travelers to contract malaria. While some efforts to appreciate the malaria situation for indigenous populations in Indonesia have been made recently, there is only sparse data in the literature on the risk for travelers to Indonesia.
  
  
  METHODS
  Data were collected from the Indonesian Ministry of Health (MoH), the World Health Organization (WHO), the Indonesian official statistics website Badan Pusat Statistik (BPS), and from the different European national surveillance bodies. Finally, a comparison between recent official guidelines for prevention of malaria in travelers from Germany, the United States, the UK, and from WHO was done.
  
  
  RESULTS
  Data from Denmark, Germany, Sweden and Switzerland show a steady decline of imported cases of malaria from Indonesia from 1997 to 2013, with a leveling off during the last few years. In our study material, the Plasmodium falciparum incidence 2009 to 2013 was 0.35 cases per 100,000 visits and the Plasmodium vivax incidence 1.3 cases per 100,000 visits, with a 95% confidence interval of 0.1-0.9 and 0.7-2.2, respectively. Indonesian data also show a decline of malaria cases-the Annual Parasite Index (API) for all species of malaria has decreased from 4.68 cases per 1,000 inhabitants in 1990 to 1.38 cases per 1,000 inhabitants in 2013.
  
  
  CONCLUSIONS
  Based on these data updated recommendations for malaria prophylaxis in travelers to Indonesia are suggested.
authors.affiliation: Department for Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Katarina M
authors.initials: KM
authors.lastname: Johansson Århem
authors.affiliation: Federal Department of Home Affairs, Federal Office of Public Health, Bern, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Gysin
authors.affiliation: Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Henrik V
authors.initials: HV
authors.lastname: Nielsen
authors.affiliation: National Malaria Control Program, Ministry of Health, Jakarta, Republic of Indonesia.
authors.forename: Asik
authors.initials: A
authors.lastname: Surya
authors.affiliation: Department for Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Hellgren
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D018890:Chemoprevention; D003718:Denmark; D005858:Germany; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000517:prevention & control*; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000517:prevention & control*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D013557:Switzerland; D014195:Travel; D006113:United Kingdom; D014481:United States; D014944:World Health Organization
chemical_list: D000962:Antimalarials