The third pea in the pod. Perry JJ van Genderen, MD, PhD Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands

Transcription

1 The third pea in the pod Perry JJ van Genderen, MD, PhD Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands

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3 IMPORTED MALARIA IN THE NETHERLANDS

4 Number of infections 800 imported malaria infections, 1979 t/m % underestimation included Year

5 Imported malaria in The Netherlands Continent Travellers Malaria cases P. falciparum Non-falciparum Annual malaria cases per 100,000 Dutch travellers Africa 1:3 (500,000) 1,993 1, Asia 1:2 (750,000) Americas 1:5 (300,000) Total 2,274* 1, % of all malaria cases originate from Americas; only 0.75% of all P. falciparum cases originate from Americas *excluding 158 cases with unknown species or unknown country

6 The example of travel to Suriname

7 CDC Yellow Book 2014 CDC Yellow Book 2016

8 German speaking countries

9 AP/M (D)

10 THE RISK OF ACQUIRING MALARIA FOR THE INDIGENOUS POPULATION IN SURINAME

11 Suriname Former Dutch colony ( Dutch Guyana ) Population (2013) 539,700 Urban 2/3 Rural 1/3 Population at risk Interior of Suriname 85,000 - Amerindians - Maroons (descendants of African slaves) - Garimpeiros (goldminers) Plasmodium species: P. falciparum (46%); P. vivax (54%) Main Anopheles species: An. darlingi (>90%) An. nuneztovari Malaria regions Coastal belt (free of malaria) DDT spraying Interior DDT spraying coverage 40% - failure

12 Malaria in Suriname During 1990s significant increase in malaria incidence One of the highest APIs of the Americas 2005: initiation of Medical Mission Malaria Programme (reducing transmission of malaria in high-risk communities in interior of Suriname) Vector control (Indoor residual spraying, insecticide-treated nets, entomological surveillance) Case management (diagnosis, treatment) Behavioural change communication, information, education and communication Surveillance (epidemic detection, passive and active case surveillance, malaria service deliverers) Monitoring and evaluation

13 Medical Mission Malaria Programme 56 permanent clinics 3 entomological surveillance sites

14 Autochtonous malaria cases in Suriname Hiwat H, et al. Novel strategies lead to pre-elimination of malaria in previously highrisk areas in Suriname, South America. Malaria Journal 2012;11:10

15 World Malaria Report 2014 Reported confirmed cases: 729 Reported deaths: 1 Population at risk: 84,700 ~ less than 1 case per 1,000

16 THE RISKS OF ACQUIRING MALARIA FOR TRAVELLERS TO SURINAME

17 Imported malaria in The Netherlands ex Suriname Total P.falc Nonfalc Denominator of Dutch travellers to Suriname is well known ~ 100,000 per year In past 5 years only 4 cases of malaria were seen, majority P. vivax

18 Risk of malaria in Suriname Indigenous population Dutch travellers < 1 case per 1,000 population < 1 case per 100,000/year (threshold for low-risk transmission 0-1 cases/1,000 population) (threshold for chemoprophylaxis 1 per 100,000/year)* * Behrens RH, et al. The incidence of malaria in travellers to South-East Asia: is local malaria transmission a useful risk indicator? Malaria Journal 2010;9:266

19 Malaria and Suriname 84% of population is living in a malaria free area 16% of population originally designated as living in high risk transmission is in fact now living in low-risk area Good infrastructure for diagnosis and treatment of malaria (also in the interior of Suriname) Successfull vector control programmes (substantial reduction of main vector An. darlingi) Special cross-border malaria control initiatives (French- Guyana) ~ migration of garimpeiros ( import malaria ) Risk for travellers is very low and relates mainly to acquisition of P. vivax malaria For the general Dutch tourist to Suriname bite prevention only will suffice; tailor-made advice for the adventurous ones

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21 The third s pea final plea Bite prevention only: Safeguard of every traveller Detailed information on local malaria risks and diagnostic and treatment facilities (plan B = test and treat) in relation to the common travel itineraries Active malaria surveillance in homecountry and active review and adaptation of malaria prevention policies Shared-decision making; traveller s preference for low risk areas is NO chemoprophylaxis* Bite prevention only is most commonly applied malaria prevention policy in retrospect, especially when considering all patients advised to use chemoprophylaxis or SBT but who failed to comply with that advice * Voumard R, et al. Recommendations for malaria prevention in moderate to low risk areas: traveller s choice and risk perception. Malaria Journal 2015;14:139