title: Malaria in travellers returning or migrating to Canada: surveillance report from CanTravNet surveillance data, 2004-2014.
abstract: BACKGROUND
  Malaria remains the most common specific cause of fever in returned travellers and can be life-threatening. We examined demographic and travel correlates of malaria among Canadian travellers and immigrants to identify groups for targeted pretravel intervention.
  
  
  METHODS
  Descriptive data on ill returned Canadian travellers and immigrants presenting to a CanTravNet site between 2004 and 2014 with a diagnosis of malaria were analyzed. Data were collected using the GeoSentinel data platform. This network comprises 63 specialized travel and tropical medicine clinics, including 7 Canadian sites (Vancouver, Calgary, Toronto, Ottawa, Winnipeg and Montréal), that contribute anonymous, delinked, clinician- and questionnaire-based travel surveillance data on all ill travellers examined to a centralized Structure Query Language database.
  
  
  RESULTS
  During the study period, 20 345 travellers and immigrants were evaluated, and 93% had a travel-related diagnosis. Of these, 437 (2.1%) patients received 456 malaria diagnoses, the most common species beingPlasmodium falciparum(n= 282, 61.8%). People travelling to visit friends and relatives were most well-represented (n= 169, 38.7%), followed by business travellers (n= 71, 16.2%). Sub-Saharan Africa was the most common source region, accounting for 341 (74.8%) malaria diagnoses, followed by South Central Asia (n= 55, 12%). Nigeria was the most well-represented source country, accounting for 41 cases (9.0%). India, a high-volume destination for Canadians, accounted for 40 cases (8.8%), 36 of which were caused byPlasmodium vivax. Of 456 malaria diagnoses, 26 (5.7%) were severe. Of 377 nonimmigrant travellers with malaria, 19.9% (n= 75) travelled for less than 2 weeks, and 7.2% (n= 27) travelled for less than 1 week.
  
  
  CONCLUSIONS
  This analysis provides an epidemiologic framework for Canadian practitioners encountering prospective and returned travellers. It confirms the importance of preventive measures and surveillance associated with travel to sub-Saharan Africa and India, particularly by travellers visiting friends or relatives. Short-duration travel confers important malaria risk.
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Boggild
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Geduld
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Michael
authors.initials: M
authors.lastname: Libman
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Cedric P
authors.initials: CP
authors.lastname: Yansouni
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Anne E
authors.initials: AE
authors.lastname: McCarthy
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Jan
authors.initials: J
authors.lastname: Hajek
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Wayne
authors.initials: W
authors.lastname: Ghesquiere
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Jean
authors.initials: J
authors.lastname: Vincelette
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Susan
authors.initials: S
authors.lastname: Kuhn
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: David O
authors.initials: DO
authors.lastname: Freedman
authors.affiliation: Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild, Kain), University Health Network and the University of Toronto; Public Health Ontario Laboratories (Boggild), Public Health Ontario, Toronto, Ont.; Office of Border and Travel Health (Geduld), Public Health Agency of Canada, Ottawa, Ont.; JD MacLean Centre for Tropical Diseases and Division of Infectious Diseases, Department of Microbiology (Libman, Yansouni), McGill University Health Centre, Montréal, Que.; Tropical Medicine and International Health Clinic, Division of Infectious Diseases (McCarthy), Ottawa Hospital and the University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases (Hajek), Vancouver General Hospital, University of British Columbia, Vancouver, BC; Infectious Diseases, Vancouver Island Health Authority, Department of Medicine (Ghesquiere), University of British Columbia, Victoria, BC; Hôpital Saint-Luc du CHUM (Vincelette), Université de Montréal, Montréal, Que.; Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine (Kuhn), Alberta Children's Hospital and the University of Calgary, Calgary, Alta.; Center for Geographic Medicine, Department of Medicine (Freedman), University of Alabama Birmingham, Birmingham, Ala. SAR Laboratories (Kain), Sandra Rotman Centre for Global Health, Toronto, Ont.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain