School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia.
Department of Infectious Diseases, Grampians Health, Ballarat 3350, Australia.
J Travel Med. 2024 Apr 6;31(3). doi: 10.1093/jtm/taad164.
Malaria continues to pose a significant burden in endemic countries, many of which lack access to molecular surveillance. Insights from malaria cases in travellers returning to non-endemic areas can provide valuable data to inform endemic country programmes. To evaluate the potential for novel global insights into malaria, we examined epidemiological and molecular data from imported malaria cases to Australia.
We analysed malaria cases reported in Australia from 2012 to 2022 using National Notifiable Disease Surveillance System data. Molecular data on imported malaria cases were obtained from literature searches.
Between 2012 and 2022, 3204 malaria cases were reported in Australia. Most cases (69%) were male and 44% occurred in young adults aged 20-39 years. Incidence rates initially declined between 2012 and 2015, then increased until 2019. During 2012-2019, the incidence in travellers ranged from 1.34 to 7.71 per 100 000 trips. Cases were primarily acquired in Sub-Saharan Africa (n = 1433; 45%), Oceania (n = 569; 18%) and Southern and Central Asia (n = 367; 12%). The most common countries of acquisition were Papua New Guinea (n = 474) and India (n = 277). Plasmodium falciparum accounted for 58% (1871/3204) of cases and was predominantly acquired in Sub-Saharan Africa, and Plasmodium vivax accounted for 32% (1016/3204), predominantly from Oceania and Asia. Molecular studies of imported malaria cases to Australia identified genetic mutations and deletions associated with drug resistance and false-negative rapid diagnostic test results, and led to the establishment of reference genomes for P. vivax and Plasmodium malariae.
Our analysis highlights the continuing burden of imported malaria into Australia. Molecular studies have offered valuable insights into drug resistance and diagnostic limitations, and established reference genomes. Integrating molecular data into national surveillance systems could provide important infectious disease intelligence to optimize treatment guidelines for returning travellers and support endemic country surveillance programmes.
疟疾在流行地区的国家仍然构成重大负担，其中许多国家缺乏分子监测手段。从返回非流行地区的旅行者疟疾病例中获得的见解，可以为流行地区的规划提供有价值的数据。为了评估从全球角度了解疟疾的潜力，我们检查了澳大利亚输入性疟疾病例的流行病学和分子数据。
我们利用国家传染病监测系统数据分析了 2012 年至 2022 年澳大利亚报告的疟疾病例。从文献检索中获取输入性疟疾病例的分子数据。
2012 年至 2022 年间，澳大利亚共报告了 3204 例疟疾病例。大多数病例（69%）为男性，44%发生在 20-39 岁的年轻人中。发病率在 2012 年至 2015 年期间先下降，然后在 2019 年上升。2012-2019 年期间，旅行者中的发病率在每 100000 次旅行中为 1.34 至 7.71 例。病例主要在撒哈拉以南非洲（n=1433；45%）、大洋洲（n=569；18%）和南亚和中亚（n=367；12%）获得。最常见的发病国家是巴布亚新几内亚（n=474）和印度（n=277）。疟原虫恶性疟原虫（n=1871）占病例的 58%，主要在撒哈拉以南非洲获得，间日疟原虫（n=1016）占病例的 32%，主要在大洋洲和亚洲获得。对输入性疟疾病例的分子研究发现了与耐药性和假阴性快速诊断检测结果相关的基因突变和缺失，并建立了间日疟原虫和疟原虫恶性疟原虫的参考基因组。
我们的分析强调了疟疾继续对澳大利亚造成输入性负担。分子研究为耐药性和诊断局限性提供了有价值的见解，并建立了参考基因组。将分子数据纳入国家监测系统可以为返回旅行者的治疗指南提供重要的传染病情报，并支持流行地区的监测规划。
