[Malaria in Iceland, a rare but looming threat for travelers].
BACKGROUND
Malaria is one of the most common causes of preventable deaths in the developing countries, especially among children. A previous study of imported malaria in Iceland during 1980-1997 identified 15 confirmed cases. The objective of this retrospective study was to update epidemiological data on malaria in Iceland, 1998-2014.


METHODS
The inclusion criteria were a positive thick or thin blood smear for malaria parasites at the Dept. of Microbiology at Landspitali University Hospital, which serves as a referral laboratory for malaria diagnosis in the country. Medical records of confirmed cases, nationwide sales data for antimalarial agents and international travel of Icelanders were reviewed.


RESULTS
Thirty-one cases of malaria were confirmed in Iceland during 1998-2014, 1.8 cases/year on average, a rate of 0.6 cases/100.000 inhabitants/year. The rate was 0.3/100.000 inhabitants/year in the previous study 1980-1997 (p=0.056). Plasmodium falciparum was identified in 71% of cases, P. vivax in 16%, P. ovale and P. malariae in 7% each. Only 2 patients (7%) had used chemoprophylaxis prior to diagnosis. Two patients needed intensive care, but no fatalities were documented. One patient had a relapse. The most common agent used for treatment was atovaquone with proguanil, however annual sales figures plateaued during 2010-2014 despite a significant increase in foreign travel by Icelanders during the same period.


CONCLUSIONS
The detection rate for malaria in Iceland showed a tendency for increase between study periods while a slight decrease was noted in the neighbouring countries at the same time. The importance of antimalarial chemoprophylaxis and other preventive measures among Icelandic travellers to endemic areas needs to be emphasized.


BACKGROUND
malaria, epidemiology, complications, treatment, travelers' health. Correspondence: Magnús Gottfredsson, magnusgo@landspitali.is.
Kristjan Godsk
KG
Rognvaldsson
Sigurdur
S
Gudmundsson
Magnus
M
Gottfredsson
D000962:Antimalarials / Q000627:therapeutic use; D006785:Hospitals, University; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D008499:Medical Records; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014195:Travel; D016896:Treatment Outcome
D000962:Antimalarials