Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Centre National de Référence du Paludisme, Hôpital Pitié-Salpêtrière, France.
Sorbonne Université, Institut de Recherche pour le Développement, AP-HP, Centre National de Référence du Paludisme, Hôpital Bichât Claude-Bernard, Paris, France.
JAMA Netw Open. 2019 Apr 5;2(4):e191691. doi: 10.1001/jamanetworkopen.2019.1691.
Despite annually adapted recommendations to prevent malaria in travelers to endemic areas, France is still the industrialized country reporting the highest number of imported cases of malaria. Better understanding of the epidemiologic context and evolution during the past 2 decades may help to define a better preventive strategy.
To study epidemiologic trends of imported cases of malaria in travelers in geographic territories of France on the European continent (metropolitan France) from 1996 through 2016 to potentially explain the persistence of high imported malaria incidence despite national preventive measures.
DESIGN, SETTING, AND PARTICIPANTS: In a cross-sectional study, between January 1 and May 31, 2018, data were extracted from the French National Reference Center of Malaria Surveillance. Trends in patients with imported malaria in association with age, sex, ethnicity, purpose of travel, malaria species, severity of illness, case mortality rate, and endemic countries visited were analyzed in 43 333 malaria cases among civilian travelers living in metropolitan France.
Evolution of the main epidemiologic characteristics of patients with imported malaria.
Among the 43 333 patients with imported malaria in civilian travelers included in the study, 24 949 were male (62.4%), and 8549 were younger than 18 years (19.9%). A total of 28 658 malaria cases (71.5%) were among African individuals, and 10 618 cases (26.5%) among European individuals. From 1996 through 2016, the number of confirmed malaria cases peaked at 3400 cases in 2000, then declined to 1824 cases in 2005 and stabilized thereafter to approximately 1720 malaria cases per year. A total of 37 065 cases (85.5%) were due to Plasmodium falciparum. The proportion of malaria cases among African individuals rose from 53.5% in 1996 to 83.4% in 2016, and the most frequent motivation for traveling was visiting friends and relatives (25 329 [77.1%]; P < .001). Despite an increase in the proportion of severe cases, which rose from 131 cases (8.9%) in 1996 to 279 cases (16.7%) in 2016 (P < .001), mortality remained stable, being approximately 0.4% during the study period.
Beyond the apparent stability of the number of imported malaria cases in France, significant changes appear to have occurred among the population who developed malaria infection following travel in endemic areas. These changes may imply that adaptation of the preventive strategy is needed to reduce the burden of the disease among travelers.
尽管每年都有针对前往流行地区的旅行者的疟疾预防建议，但法国仍是报告输入性疟疾病例最多的工业化国家。更好地了解过去 20 年的流行病学背景和演变情况，有助于制定更好的预防策略。
研究法国本土（法国本土）旅行者输入性疟疾病例的流行病学趋势，以解释尽管采取了国家预防措施，但疟疾发病率仍居高不下的原因。
设计、地点和参与者：在一项横断面研究中，2018 年 1 月 1 日至 5 月 31 日期间，从法国疟疾监测国家参考中心提取数据。分析了 43333 例居住在法国本土的平民旅行者中输入性疟疾患者的年龄、性别、种族、旅行目的、疟原虫种类、疾病严重程度、病死率和流行国家等方面的主要流行病学特征的变化趋势。
输入性疟疾患者主要流行病学特征的演变。
在纳入研究的 43333 例平民旅行者输入性疟疾病例中，24949 例为男性（62.4%），8549 例年龄小于 18 岁（19.9%）。28658 例（71.5%）疟疾病例为非洲人，10618 例（26.5%）为欧洲人。1996 年至 2016 年，确诊疟疾病例数量在 2000 年达到 3400 例的峰值，然后在 2005 年下降至 1824 例，此后稳定在每年约 1720 例。共有 37065 例（85.5%）是由恶性疟原虫引起的。1996 年至 2016 年期间，非洲人疟疾病例比例从 53.5%上升至 83.4%，最常见的旅行动机是探亲访友（25329 例[77.1%]；P<0.001）。尽管严重病例的比例从 1996 年的 131 例（8.9%）上升到 2016 年的 279 例（16.7%）（P<0.001），但病死率保持稳定，研究期间约为 0.4%。
除了法国输入性疟疾病例数量的明显稳定外，在前往流行地区旅行后感染疟疾病的人群中似乎发生了重大变化。这些变化可能意味着需要调整预防策略，以降低旅行者的疾病负担。
