Unit of Gastrointestinal Infections, Zoonoses and Tropical Infections, Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestr. 10, 13353, Berlin, Germany.
Malar J. 2018 Jan 15;17(1):28. doi: 10.1186/s12936-018-2175-y.
German surveillance data showed a sharp rise of malaria cases in 2014 and 2015 due to the increased arrival of refugees from malaria endemic countries. A time series analysis of data from 2001 to 2016 was performed in order to describe the epidemiology of imported malaria in Germany in general and of the recent increase in particular.
In total, 11,678 malaria cases were notified between 2001 and 2016 (range 526-1063 cases/year). Newly arriving refugees averaged 10 cases/year (1.5%) in 2001-13 and 292.5 cases/year (28.3%) in 2014-15. Plasmodium (P.) falciparum was the most frequently reported species (range 57.2-85.8%), followed by P. vivax (range during 2001-2013: 7.6-18.1%; during 2014-2015, mean 31.3%). In 2014-15, 22.3% of all P. vivax cases were refugees from Eritrea and 3.3% from other countries of the Horn of Africa; in 2015 and 2016, 19.5% were refugees from Afghanistan and Pakistan. Five P. knowlesi malaria infections were reportedly acquired in Thailand between 2012 and 2016. Total numbers of malaria notifications among native Germans and residents with migration background showed an increasing trend since 2007. Chemoprophylaxis use was reported for 24.3% (1695/6984) of cases and showed a declining trend. Native German cases took significantly more frequently chemoprophylaxis than cases with migration background (32.6% vs. 17.9%; p < 0.001).
DISCUSSION/CONCLUSIONS: The steep rise in vivax malaria notifications in 2014 and 2015 was mainly due to newly arriving refugees from Eritrea but also from other countries of the Horn of Africa and South Asia. Clinicians should include malaria in their differential diagnosis in case of a febrile illness in the respective population and consider vivax malaria even if arrival to Germany dates back several months. Over the past 10 years, malaria notifications among native Germans and residents with migration background showed an increasing trend. Use of chemoprophylaxis was insufficient in both groups and deteriorating. New strategies need to be found to increase compliance to chemoprophylaxis recommendations. The surveillance provides valuable data for epidemiological assessment of imported malaria in Germany.
德国的监测数据显示，由于来自疟疾流行国家的难民大量涌入，2014 年和 2015 年疟疾病例急剧上升。为了描述德国输入性疟疾的流行病学情况，特别是最近的上升情况，对 2001 年至 2016 年的数据进行了时间序列分析。
2001 年至 2016 年期间共报告了 11678 例疟疾病例（范围为 526-1063 例/年）。2001-13 年，新抵达的难民平均每年有 10 例（占 1.5%），2014-15 年有 292.5 例（占 28.3%）。疟原虫（P.）最常报告的物种是疟原虫（范围为 57.2-85.8%），其次是疟原虫（范围为 2001-2013 年：7.6-18.1%；2014-2015 年平均为 31.3%）。2014-15 年，所有疟原虫病例中有 22.3%来自厄立特里亚，3.3%来自非洲之角的其他国家；2015 年和 2016 年，19.5%来自阿富汗和巴基斯坦。据报道，2012 年至 2016 年间在泰国共发生了 5 例疟原虫感染病例。德国本土人和有移民背景的居民的疟疾报告总数自 2007 年以来呈上升趋势。据报告，有 24.3%（1695/6984）的病例使用了化学预防措施，且呈下降趋势。德国本土病例比有移民背景的病例更频繁地使用化学预防措施（32.6%比 17.9%；p<0.001）。
讨论/结论：2014 年和 2015 年间疟原虫病例的急剧上升主要是由于来自厄立特里亚的新抵达难民，但也来自非洲之角和南亚的其他国家。在相应人群中，发热性疾病的临床医生应将疟疾纳入鉴别诊断，并考虑即使到达德国已有数月之久，也可能患有疟原虫病。在过去的 10 年中，德国本土人和有移民背景的居民的疟疾报告总数呈上升趋势。两组人群的化学预防措施使用率均不足且呈下降趋势。需要找到新的策略来提高对化学预防措施建议的遵守率。监测为评估德国输入性疟疾的流行病学情况提供了有价值的数据。
