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Malaria Epidemiology & Prevention Strategies for Travellers
2019 - 2020
Olivia Veit, MD, MIH
-
Overview
• Malaria epidemiologie worldwide• Malaria in travellers (Switzerland, Germany)• (Methodologie of the Swiss Expert Comitee for Travel
Medicine (ECTM) for developing malaria preventionguidelines)
• Update of the Swiss/ German malaria preventionstrategies 2019 - 2020
• Other national prevention guidelines• Questions
2
-
3
-
4
Otto II
Heinrich III
Lothar III
Konrad IV
Heinrich VI
Malaria & the German `Kaisers´ & Popes
Damasus II
Leo IX
Viktor III
Stephan IX
Heinrich VI
Stefan Winkle, Hamburger Ärzteblatt 2006;60;162-3
-
8
DDT spraying team on bicycles (Malaria Eradication Program, 1947-1951)
A malaria warning sign on the Anzio front in Italy, May 1944
Soon after the World War II malaria was eliminated from Mediterranean region
-
Gething PW. Nature 2010;20:342-5.
Malaria
2018
53%
of earth
surface
27%
of earth
surface
1900
2018
Hay SI et al., Lancet Infect Dis. 2004
-
Changes of P. falciparum incidence
16Weiss Det al., Lancet, 2019
2005
2017
-
Malaria case incidence rate (cases per 1000 population at risk) by country, 2018
17WHO WMR 2019
-
Malaria Elimination
• Countries with at least 3 consecutive years with zero indigenous malaria cases may request WHO certification of elimination
• 2018: 24 countries with less than 10 indigenous cases
19WHO, WMR 2019
19 countries with zero malaria cases for 3 years and more
-
20Bhath S .et al., Nature, 2015
Factors contributing to control malaria
Since 2000 estimated 663 Mio clinical cases averted
-
21
-
Worldwide Malaria Situation
3.3 billion at risk
2018: 228 million malaria cases worldwide 213 Mio (93%) WHO African region 50% in 6 countries: Nigeria (25%), DRC (12%), Uganda (5%), Côte d’Ivoire, Mosambiuque amd Moger (each 4%)
3.4% WHO South- East Asia region 2.1% WHO Eastern Mediterranean region
No local cases in China (since 2017), El Salvador, Iran, Malaysia, and Timor-Leste
22WHO, WMR 2019
-
Worldwide Malaria Situation2010 - 2018
Overall: 71 to 57 per 1000 population at risk No significant progress since 2014 - 2018
By WHO Region: SEA: 70% decrease (17/1000 in 2010 to 5/1000 in 2018)
• Mainly India, Indonesia, Greater Mekong Region
Africa: 22% reduction in incidence (2018: 229/1000) Southern Africa increase between 2015 and 2018
Americas: moderate incidence increase (Venezuela!)
23WHO ,WMR 2019
-
Falciparum Malaria among cabincrew members, Dar es Salaam
• Between 2017 – 2019: 1.Switzerland: 15 cabin crew members with
Falciparum malaria2.All stayed in Dar Double Tree by Hilton Hotel (1-2
nights)• Visited other places within the city of Dar es Salaam
or small nearby islands
-
Malaria mortality worldwide
26
2018
• 405 000 (similiar to 2017)• 94% in sub-saharan Africa
Especially children
-
Estimated malaria cases by WHO Region, 2017/2018
27WHO, WMR 2018
2018: Pv 50% Pv 75%
-
Challenges of malaria control
• Lack of sustainable and predictable international and domestic funding
• Strong malaria surveillance• Mosquito control measures• Risks posed by conflict in malaria endemic zones• Anomalous climate patterns• Emergence of parasite resistance to antimalarials• Mosquito resistance to insecticides
34
-
Change of malaria riskand consequences fortravellers
-
Imported malaria cases to Switzerland and Germany
36
-
Imported malaria cases to Switzerland + Germany2009 - 2018
37
no data on travel destination: 30-35%
D: ~ 30%CH ~ 10%A: ~ 10%
Absolute casesversus
cases per (increasing) number of travelers (rates)
Veit, data collected from FOSP Switzerland and Robert Koch Institut, Germany, 2019
Diagramm1
200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009
201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010
201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011
201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012
201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013
201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014
201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015
201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016
201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017
201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Years
Number of imported cases
Total Imported Malaria Cases to Germany and Switzerland, 2009-2018
677
802
728
668
776
1177
1285
1195
1227
1167
Travel destionation total
2009200920092009200920092009200920092009
2010201020102010201020102010201020102010
2011201120112011201120112011201120112011
2012201220122012201220122012201220122012
2013201320132013201320132013201320132013
2014201420142014201420142014201420142014
2015201520152015201520152015201520152015
2016201620162016201620162016201620162016
2017201720172017201720172017201720172017
2018201820182018201820182018201820182018
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown destination
111
101
10
133.0238095238
121.7663551402
11.5789473684
15
6
9
25
139
118
21
152.538961039
129.328
23.1724137931
15
7
8
15
142
123
19
152.1428571429
131.856
20.3103448276
12
2
10
11
107
91
16
110.7876106195
93.935483871
16.8
6
2
4
4
128
116
5
133.8181818182
120
6
4
0
5
6
153
126
28
158.6319018405
129.9069767442
29.6470588235
10
3
6
6
198
179
24
213.3786407767
189.8186813187
28.1379310345
8
3
5
16
194
168
24
216.0663507109
187.9322033898
27.75
17
9
8
24
245
216
29
266.4741035857
234.7397260274
31.71875
6
3
3
22
214
168
24
234.7400881057
188.511627907
24.7272727273
13
4
9
22
Cases by destination
200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009
201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010
201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011
201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012
201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013
201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014
201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015
201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016
201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017
201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018
Asia
Algeria
Afghanistan
Brazil
Bolivia
Cambodia
Columbia
Dom.Rep
Ecuador
FNG
Guatemala
Haiti
Honduras
India
Indonesia
Laos
Malaysia
Myanmar
Nepal
Nicaragua
Pakistan
Peru
Philippines
PNG
Sri Lanka
Thailand
Timor L'Est
Vanuatu
Venezuela
Southamerica
Number of imported cases
1
2
1
1
5
2
1
1
1
1
1
2
9
2
1
1
2
2
4
2
1
1
1
1
1
1
1
1
3
1
2
1
1
1
2
1
1
1
2
1
1
1
1
1
1
2
1
1
1
1
2
4
2
2
1
1
1
1
1
3
1
2
1
1
1
1
1
1
3
4
1
2
1
1
Travel destination all
677178
802167
728161
668169
776173
1177346
1285393
1195329
1227323
1167288
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Unknown destination
Traval Destination Unknown incl
2009200920092009200920092009200920092009200920092009200920092009200920092009
2010201020102010201020102010201020102010201020102010201020102010201020102010
2011201120112011201120112011201120112011201120112011201120112011201120112011
2012201220122012201220122012201220122012201220122012201220122012201220122012
2013201320132013201320132013201320132013201320132013201320132013201320132013
2014201420142014201420142014201420142014201420142014201420142014201420142014
2015201520152015201520152015201520152015201520152015201520152015201520152015
2016201620162016201620162016201620162016201620162016201620162016201620162016
2017201720172017201720172017201720172017201720172017201720172017201720172017
2018201820182018201820182018201820182018201820182018201820182018201820182018
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Number of imported Cases
677
802
728
668
776
1177
1285
1195
1227
1167
Arbeitsblatt
YearTOTAL Imported casesImmigratedTraveller_totalPf/k/u allPv/o/m allTravel_Buis_unknownVFRALLall pfkuall pvomTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaPercentage (totalPercentage PfkuPercentage PvomUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from non_AfricaPf/k/u allPv/o/m allUnknown destinationPf/k/u of unknownsPv/o/m of unknownsAll possible imported cases from non_AfricaPf/k/u allPv/o/m allAsiaAlgeriaAfghanistanBrazilBoliviaCambodiaColumbiaDom.RepEcuadorFNGGuatemalaHaitiHondurasIndiaIndonesiaLaosMalaysiaMyanmarNepalNicaraguaPakistanPeruPhilippinesPNGSri LankaThailandTimor L'EstVanuatuVenezuelaSouthamericaUnknownTOTALvisits of more than one countryDEUTSCHLANDTraveller_totalPf/k/u allPv/o/m allALLall pluall pvomTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaPercentage (totalPercentage PfkuPercentage PvomUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from NON_AfricaPf/k/u all_possible_Non_AfricaPv/o/m_all_possible_NonAfricaUnknown destinationPf/k/u of unknownsPv/o/m of unknownsD+CHYearTraveller_totalPf/k/u allPv/o/m allTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from non_AfricaPf/k/u allPv/o/m allUnknown destinationPf/k/u of unknownsPv/o/m of unknownsPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_Africa
2006142539271224412539-25252006
20071819372931433111935*red marked-19192007
200814203419412522034-20202008
20091701915112922151807112610719111101108894532221213312212156912647311187102522340281212115211112541*red marked5264451033733206534431243929866141122254854346829822833412313411135153125382009677574125455413531631432761855680441431154143459184517814741919
201019021169137328584154125291391182190947214112153129231578106281111689151233019111292115306335491044814167944340354929713140129358353257381325833212485017331521332520108026861365825217515414057366618053203313592566254216714528928
2011189241651343179861541252914212319929866109115213220122108234101132111192231112122421111125*red marked5634621234133378936633346899914133124549945751474431114817116645591501253420117285961545084566514313266515887159653182173077870161134368911
20121493211796217047113932010791169598804311119417624522000062443110551111131413*red marked551428143386297105323284528496181381257461409596313531645027619901972165131382012668524164430375681421287572503756915572761939962176169134398614
2013159621381201262761321161012811659710050641134120640530500014066421046211161163854711447141572452412569699131601316612543621931641227192642516713242201377666712658052861166135774666368233217110303043117313644964
2014316147169133369673163129341531262894988264215913030103662180001036642167821112111616*red marked1008609429668450232641441213969847326156939675973062791942814316411235340159197201411777424657945672413321609511267273363712251431638511541346163199964
201543321122219334991232061822919817924969883151142131902883542171019361611524141011121111624106366442568647722363446118692973934818179982642265521637831729634812271377187202201512858574598326402103641928311968322936019422963449892576393198207937
2016315802351983711112421117732194168249295752220421618828179885252111910924215413013124221111132443*red marked96071626565552314858950597909719274186228636911196618511033431740972591305193117201611959143027836731212962062510798791468327593384239116351013292141229010
201735582273238351351382512193224521629989991211932662353263321910073322193282261211112229954804179653567105609554739398132812321089078683441332723020523641855301237742017122710422148547701023022501211561020114501635216234271225832325677946
201828132249193341261232271723321416824949873212112351892513496227100144922211352510113412112236*red marked918774165652546120627540100969918256225888376510825620411710383592826622845201811679671998417081242772469111895413338102911383049133728824946964
00
TOTAL CH2557710188815712949439451737144526716311406200949772142123201771.60250516281527.7950543982219.84271857441063967632810371511262725716593011370436001222817421217326362021151268929826822932.6789616865
0
15112922526445103
526445103
1285100
39631
Arbeitsblatt
00
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Year
Number of cases
Sheet2
Visited Country
Number of Cases
Sheet3
Asia
Algeria
Afghanistan
Brazil
Bolivia
Cambodia
Columbia
Dom.Rep
Ecuador
FNG
Guatemala
Haiti
Honduras
India
Indonesia
Laos
Malaysia
Myanmar
Nepal
Nicaragua
Pakistan
Peru
Philippines
PNG
Sri Lanka
Thailand
Timor L'Est
Vanuatu
Venezuela
Southamerica
Year
Number of cases
171
Pf/k/u of unknowns
Pv/o/m of unknowns
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Number of Cases
Traveller_total
Pf/k/u all
Pv/o/m all
Travel_Buis_unknown
VFR
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown destination
1
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Unknown destination
Number of Cases
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Number of imported cases
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Years
Number of imported cases
Total Imported Malaria Cases to Germany and Switzerland, 2009-2018
-
Imported Malaria Cases to Switzerland and Germany per 100 000 Travellers per Year
2009-2013 2014-2018versus
Pf/u= Plasmodium falciparum/knowlesi, unknownPv/o/m= Plasmodium vivax/ovale/malariae
Arrivals in destination countries, based on UNWTO statistics on arrivals to countries by nationality
Data on reported malaria cases data were collated from FOPH and RKI
-
Imported malaria cases and deaths, Switzerland, 2007 - 2019
39
Diagramm1
20072007
20082008
20092009
20102010
20112011
20122012
20132013
20142014
20152015
20162016
20172017
20182018
20192019
Malaria cases
Number of known deaths (reported to FOSP)
Year
164
2
185
3
170
0
190
0
189
2
149
1
159
1
317
1
432
2
315
0
354
2
285
0
286
1
dem BAG gemeldete Todesfälle
Datenbeschreibung:
Stand der Auswertung: 9.1.2020
alle sicheren Malaria-Fälle
Wohnland Schweiz, Fürstentum Liechtenstein oder Wohnland unbekannt oder immigriert
Tabelle mit den dem BAG bekannten Anzahl Todesfälle (gemäss Meldungen zum klinischen Befund für Malaria)
– hier bitte beachten, dass das BAG KEINE Todesursachenstatistik führt. Das Bundesamt für Statistik hingegen führt eine Todesursachenstatistik.
Die Anzahl Todesfälle, die unten in der Tabelle aufgeführt sind, kommt von der Meldung zum klinischen Befund.
Hier kann der Arzt angeben, ob der Patient gestorben ist. Es ist aber nicht sicher, an was der Patient gestorben ist und zudem ist die Statistik nicht vollständig.
Stirbt ein Patient nachdem die Meldung zum klinischen Befund bereits gemeldet wurde, wird der Todesfall dem BAG NICHT gemeldet.
FalljahrMalaria casesNumber of known deaths (reported to FOSP)
20071642
20081853
20091700
20101900
20111892
20121491
20131591
20143171
20154322
20163150
20173542
20182850
20192861
bitte für die Todesursachenstatistik das Bundesamt für Statistik anfragen.
dem BAG gemeldete Todesfälle
Malaria cases
Number of known deaths (reported to FOSP)
Year
-
40
Imported Malaria Cases to Switzerland2009 – 2019 (Migrants vs Travellers)
Diagramm1
20092009200920092009
20102010201020102010
20112011201120112011
20122012201220122012
20132013201320132013
20142014201420142014
20152015201520152015
20162016201620162016
20172017201720172017
20182018201820182018
20192019201920192019
Total
Migrants
Travellers (total)
Tourists (+ other/unknown)
VFR
Year
Number of imported cases
19
151
21
169
24
165
32
117
62
138
147
169
211
222
80
235
83
271
38
247
24
262
Travel destionation total
2009200920092009200920092009200920092009
2010201020102010201020102010201020102010
2011201120112011201120112011201120112011
2012201220122012201220122012201220122012
2013201320132013201320132013201320132013
2014201420142014201420142014201420142014
2015201520152015201520152015201520152015
2016201620162016201620162016201620162016
2017201720172017201720172017201720172017
2018201820182018201820182018201820182018
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown destination
111
15
6
9
25
139
15
7
8
15
142
12
2
10
11
107
6
2
4
4
128
4
0
5
6
153
10
3
6
6
198
8
3
5
16
194
17
9
8
24
243
6
3
3
22
212
13
4
9
22
Cases by destination
200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009
201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010
201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011
201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012
201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013
201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014
201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015
201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016
201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017
201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018
Asia
Algeria
Afghanistan
Brazil
Bolivia
Cambodia
Columbia
Dom.Rep
Ecuador
FNG
Guatemala
Haiti
Honduras
India
Indonesia
Laos
Malaysia
Myanmar
Nepal
Nicaragua
Pakistan
Peru
Philippines
PNG
Sri Lanka
Thailand
Timor L'Est
Vanuatu
Venezuela
Southamerica
Number of imported cases
1
2
1
1
5
2
1
1
1
1
1
2
9
2
1
1
2
2
4
2
1
1
1
1
1
1
1
1
3
1
2
1
1
1
2
1
1
1
2
1
1
1
1
1
1
2
1
1
1
1
2
4
2
2
1
1
1
1
1
3
1
2
1
1
1
1
1
1
3
4
1
2
1
1
Travel destination all
67745541353163.1283671646142.641355140226.7174089069618.1283671646555.641355140279.717408906944143114.87163283544.358644859814.282591093158.871632835418.358644859845.2825910931178
80258252175153.5306450306140.171755.4176061008735.5306450306661.1717580.417606100853203313.46935496944.828258.73897861266.469354969424.8282541.738978612167
72850845665143.0726392252132.37232047485.9512943825651.0726392252588.372320474870.95129438255965317.92736077481.627679525217.116621464576.92736077487.627679525270.1166214645161
66843037568141.857558806128.2014771377.4531986532571.857558806503.20147713775.453198653269155727.1424411945.79852286319.38095238196.14244119420.79852286376.380952381169
77658052861166.0814514572135.04578313256.6674698795746.0814514572663.045783132567.6674698795233216.91854854280.954216867510.333333333329.91854854283.954216867531.3333333333173
1177794567241331.8893868704159.726976744294.89372549021125.8893868704726.7269767442335.893725490237122514.11061312963.273023255816.486561866151.110613129615.273023255841.4865618661346
1285832640210363.8013813015191.54614463182.9052266321195.8013813015831.546144631292.90522663260194229.19861869856.453855368934.377764032889.198618698525.453855368976.3777640328393
1195783673121296.3335262834206.289755971125.44980879541079.3335262834879.2897559711146.449808795483275932.66647371667.710244028941.5675675676115.666473716634.7102440289100.5675675676329
1225852770102302.1881031015250.305863593512.24608686071154.18810310151020.3058635935114.246086860750163520.81189689855.694136406522.833630952470.811896898521.694136406557.8336309524323
1165839708124276.5295023858246.00613340158.9690309691115.5295023858954.0061334015132.96903096938102911.47049761422.99386659857.772727272749.470497614212.993866598536.7727272727288
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Unknown destination
Traval Destination Unknown incl
2009200920092009200920092009200920092009200920092009200920092009200920092009
2010201020102010201020102010201020102010201020102010201020102010201020102010
2011201120112011201120112011201120112011201120112011201120112011201120112011
2012201220122012201220122012201220122012201220122012201220122012201220122012
2013201320132013201320132013201320132013201320132013201320132013201320132013
2014201420142014201420142014201420142014201420142014201420142014201420142014
2015201520152015201520152015201520152015201520152015201520152015201520152015
2016201620162016201620162016201620162016201620162016201620162016201620162016
2017201720172017201720172017201720172017201720172017201720172017201720172017
2018201820182018201820182018201820182018201820182018201820182018201820182018
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Number of imported Cases
677
455
413
53
163.1283671646
142.6413551402
26.7174089069
618.1283671646
555.6413551402
79.7174089069
44
14
31
14.8716328354
4.3586448598
14.2825910931
58.8716328354
802
582
521
75
153.5306450306
140.17175
5.4176061008
735.5306450306
661.17175
80.4176061008
53
20
33
13.4693549694
4.82825
8.738978612
66.4693549694
728
508
456
65
143.0726392252
132.3723204748
5.9512943825
651.0726392252
588.3723204748
70.9512943825
59
6
53
17.9273607748
1.6276795252
17.1166214645
76.9273607748
668
430
375
68
141.857558806
128.201477137
7.4531986532
571.857558806
503.201477137
75.4531986532
69
15
57
27.142441194
5.798522863
19.380952381
96.142441194
776
580
528
61
166.0814514572
135.0457831325
6.6674698795
746.0814514572
663.0457831325
67.6674698795
23
3
21
6.9185485428
0.9542168675
10.3333333333
29.9185485428
1177
794
567
241
331.8893868704
159.7269767442
94.8937254902
1125.8893868704
726.7269767442
335.8937254902
37
12
25
14.1106131296
3.2730232558
16.4865618661
51.1106131296
1285
832
640
210
363.8013813015
191.546144631
82.905226632
1195.8013813015
831.546144631
292.905226632
60
19
42
29.1986186985
6.4538553689
34.3777640328
89.1986186985
1195
783
673
121
296.3335262834
206.2897559711
25.4498087954
1079.3335262834
879.2897559711
146.4498087954
83
27
59
32.6664737166
7.7102440289
41.5675675676
115.6664737166
1225
852
770
102
302.1881031015
250.3058635935
12.2460868607
1154.1881031015
1020.3058635935
114.2460868607
50
16
35
20.8118968985
5.6941364065
22.8336309524
70.8118968985
1165
839
708
124
276.5295023858
246.0061334015
8.969030969
1115.5295023858
954.0061334015
132.969030969
38
10
29
11.4704976142
2.9938665985
7.7727272727
49.4704976142
Arbeitsblatt
YearTOTAL Imported casesImmigratedTraveller_totalPf/k/u allPv/o/m allTravel_Buis_unknownVFRALLall pfkuall pvomTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaPercentage (totalPercentage PfkuPercentage PvomUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from non_AfricaPf/k/u allPv/o/m allUnknown destinationPf/k/u of unknownsPv/o/m of unknownsAll possible imported cases from non_AfricaPf/k/u allPv/o/m allAsiaAlgeriaAfghanistanBrazilBoliviaCambodiaColumbiaDom.RepEcuadorFNGGuatemalaHaitiHondurasIndiaIndonesiaLaosMalaysiaMyanmarNepalNicaraguaPakistanPeruPhilippinesPNGSri LankaThailandTimor L'EstVanuatuVenezuelaSouthamericaUnknownTOTALvisits of more than one countryDEUTSCHLANDTraveller_totalPf/k/u allPv/o/m allALLall pluall pvomTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaPercentage (totalPercentage PfkuPercentage PvomUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from NON_AfricaPf/k/u all_possible_Non_AfricaPv/o/m_all_possible_NonAfricaUnknown destinationPf/k/u of unknownsPv/o/m of unknownsD+CHYearTraveller_totalPf/k/u allPv/o/m allTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from non_AfricaPf/k/u allPv/o/m allUnknown destinationPf/k/u of unknownsPv/o/m of unknownsPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_Africa
2006142539271224412539-25252006
20071819372931433111935*red marked-19192007
200814203419412522034-20202008
20091701915112922151807112610719111101108894532221213312212156912647311187102522340281212115211112541*red marked5264451033733206534431243929866141122254854346829822833412313411135153125382009677574125455413531631432761855680441431154143459184517814741919
201019021169137328584154125291391182190947214112153129231578106281111689151233019111292115306335491044814167944340354929713140129358353257381325833212485017331521332520108026861365825217515414057366618053203313592566254216714528928
2011189241651343179861541252914212319929866109115213220122108234101132111192231112122421111125*red marked5634621234133378936633346899914133124549945751474431114817116645591501253420117285961545084566514313266515887159653182173077870161134368911
20121493211796217047113932010791169598804311119417624522000062443110551111131413*red marked551428143386297105323284528496181381257461409596313531645027619901972165131382012668524164430375681421287572503756915572761939962176169134398614
2013159621381201262761321161012811659710050641134120640530500014066421046211161163854711447141572452412569699131601316612543621931641227192642516713242201377666712658052861166135774666368233217110303043117313644964
2014316147169133369673163129341531262894988264215913030103662180001036642167821112111616*red marked1008609429668450232641441213969847326156939675973062791942814316411235340159197201411777424657945672413321609511267273363712251431638511541346163199964
201543321122219334991232061822919817924969883151142131902883542171019361611524141011121111624106366442568647722363446118692973934818179982642265521637831729634812271377187202201512858574598326402103641928311968322936019422963449892576393198207937
2016315802351983711112421117732194168249295752220421618828179885252111910924215413013124221111132443*red marked96071626565552314858950597909719274186228636911196618511033431740972591305193117201611959143027836731212962062510798791468327593384239116351013292141229010
201735483271238351341372492193224321629989991211932642353263321910073322193282261211112229954804179653567105609554739398132812321089078683441332723020523641855301237742017122510422148527701023022501211541020114501635216234271225832325677946
201828538247193341201272251723321216824949873212112331892513496227100144922211352510113412112236*red marked918774165652546120627540100969918256225888376510825620411710383592826622845201811659671998397081242772469111695413338102911383049133728824946964
201928624262123139
00
TOTAL CH284674121461571294105910871733144526716271406200949772142123201767.58708187831527.7950543982219.84271857441063967632810371511262725716593011370436001222817421217326362021151268929826822932.6798065
0
15112922526445103
10.818
228.8
354526445103
271
83
134
137
1285100
39631
Arbeitsblatt
00
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Year
Number of cases
Tabelle1
Visited Country
Number of Cases
Sheet2
Asia
Algeria
Afghanistan
Brazil
Bolivia
Cambodia
Columbia
Dom.Rep
Ecuador
FNG
Guatemala
Haiti
Honduras
India
Indonesia
Laos
Malaysia
Myanmar
Nepal
Nicaragua
Pakistan
Peru
Philippines
PNG
Sri Lanka
Thailand
Timor L'Est
Vanuatu
Venezuela
Southamerica
Year
Number of cases
Sheet3
171
Pf/k/u of unknowns
Pv/o/m of unknowns
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Number of Cases
Traveller_total
Pf/k/u all
Pv/o/m all
Travel_Buis_unknown
VFR
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown destination
1
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Unknown destination
Number of Cases
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Number of imported cases
Traveller_total
Pf/k/u all
Pv/o/m all
All possible imported cases from Africa
All possible imported cases from non_Africa
Years
Number of imported cases
Total Imported Malaria Cases to Germany and Switzerland, 2009-2018
YearTotalMigrantsTravellers (total)Tourists (+ other/unknown)VFR
2009170191518071
2010190211698584
2011189241657986
2012149321177047
2013159621386276
20143161471699673
201543321122299123
201631580235111124
201735483271134137
201828538247120127
201928624262123139
Total
Year
Number of imported cases
Total
Migrants
Travellers (total)
Tourists (+ other/unknown)
VFR
Year
Number of imported cases
-
Imported Malaria Cases, Switzerland, 2018
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
BrazilGuinea-Bissau
IraqLiberiaMalawi
Papua New GuineaZambiaSenegal
South AfricaVenezuela (Bolivarian Republic of)
Central African RepublicEquatorial Guinea
EthiopiaIndia
MadagascarRwanda
Sri LankaAfghanistan
GabonIndonesia
MozambiqueSierra Leone
SudanBeninKenya
UgandaUnited Republic of Tanzania
Burkina FasoGhanaGuineaEritreaCongo
TogoNigeria
UnknownCôte d’Ivoire
Cameroon
TOTAL N=285
TOURISTS = 120 (42%)VFR = 127 (45%)MIGRANTS = 38 (13%)
Veit, Data collected from FOSP Switzerland, 2019
-
Destination of imported cases to Switzerland2017 - 2019
43
-
Imported malaria cases to Switzerland + Germany, 2009-2018: Africa versus Non-African Countries
44Veit, data collected from FOSP Switzerland and Robert Koch Institut Germany, 2019
Diagramm1
20092009200920092009
20102010201020102010
20112011201120112011
20122012201220122012
20132013201320132013
20142014201420142014
20152015201520152015
20162016201620162016
20172017201720172017
20182018201820182018
Traveller_total
Pf/k/u all
Pv/o/m all
All possible imported cases from Africa
All possible imported cases from non_Africa
Years
Number of imported cases
677
618.1283671646
58.8716328354
802
735.5306450306
66.4693549694
728
651.0726392252
76.9273607748
668
571.857558806
96.142441194
776
746.0814514572
29.9185485428
1177
1125.8893868704
51.1106131296
1285
1195.8013813015
89.1986186985
1195
1079.3335262834
115.6664737166
1227
1156.1923271691
70.8076728309
1167
1117.5407016027
49.4592983973
Travel destionation total
2009200920092009200920092009200920092009
2010201020102010201020102010201020102010
2011201120112011201120112011201120112011
2012201220122012201220122012201220122012
2013201320132013201320132013201320132013
2014201420142014201420142014201420142014
2015201520152015201520152015201520152015
2016201620162016201620162016201620162016
2017201720172017201720172017201720172017
2018201820182018201820182018201820182018
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown destination
111
101
10
133.0238095238
121.7663551402
11.5789473684
15
6
9
25
139
118
21
152.538961039
129.328
23.1724137931
15
7
8
15
142
123
19
152.1428571429
131.856
20.3103448276
12
2
10
11
107
91
16
110.7876106195
93.935483871
16.8
6
2
4
4
128
116
5
133.8181818182
120
6
4
0
5
6
153
126
28
158.6319018405
129.9069767442
29.6470588235
10
3
6
6
198
179
24
213.3786407767
189.8186813187
28.1379310345
8
3
5
16
194
168
24
216.0663507109
187.9322033898
27.75
17
9
8
24
245
216
29
266.4741035857
234.7397260274
31.71875
6
3
3
22
214
168
24
234.7400881057
188.511627907
24.7272727273
13
4
9
22
Cases by destination
200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009200920092009
201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010201020102010
201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011201120112011
201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012201220122012
201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013201320132013
201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014201420142014
201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015201520152015
201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016201620162016
201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017201720172017
201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018201820182018
Asia
Algeria
Afghanistan
Brazil
Bolivia
Cambodia
Columbia
Dom.Rep
Ecuador
FNG
Guatemala
Haiti
Honduras
India
Indonesia
Laos
Malaysia
Myanmar
Nepal
Nicaragua
Pakistan
Peru
Philippines
PNG
Sri Lanka
Thailand
Timor L'Est
Vanuatu
Venezuela
Southamerica
Number of imported cases
1
2
1
1
5
2
1
1
1
1
1
2
9
2
1
1
2
2
4
2
1
1
1
1
1
1
1
1
3
1
2
1
1
1
2
1
1
1
2
1
1
1
1
1
1
2
1
1
1
1
2
4
2
2
1
1
1
1
1
3
1
2
1
1
1
1
1
1
3
4
1
2
1
1
Travel destination all
67745541353163.1283671646142.641355140226.7174089069618.1283671646555.641355140279.717408906944143114.87163283544.358644859814.282591093158.871632835418.358644859845.2825910931178
80258252175153.5306450306140.171755.4176061008735.5306450306661.1717580.417606100853203313.46935496944.828258.73897861266.469354969424.8282541.738978612167
72850845665143.0726392252132.37232047485.9512943825651.0726392252588.372320474870.95129438255965317.92736077481.627679525217.116621464576.92736077487.627679525270.1166214645161
66843037568141.857558806128.2014771377.4531986532571.857558806503.20147713775.453198653269155727.1424411945.79852286319.38095238196.14244119420.79852286376.380952381169
77658052861166.0814514572135.04578313256.6674698795746.0814514572663.045783132567.6674698795233216.91854854280.954216867510.333333333329.91854854283.954216867531.3333333333173
1177794567241331.8893868704159.726976744294.89372549021125.8893868704726.7269767442335.893725490237122514.11061312963.273023255816.486561866151.110613129615.273023255841.4865618661346
1285832640210363.8013813015191.54614463182.9052266321195.8013813015831.546144631292.90522663260194229.19861869856.453855368934.377764032889.198618698525.453855368976.3777640328393
1195783673121296.3335262834206.289755971125.44980879541079.3335262834879.2897559711146.449808795483275932.66647371667.710244028941.5675675676115.666473716634.7102440289100.5675675676329
1227854770102302.1923271691250.305863593512.24608686071156.19232716911020.3058635935114.246086860750163520.80767283095.694136406522.833630952470.807672830921.694136406557.8336309524323
1167841708124276.5407016027246.00613340158.9690309691117.5407016027954.0061334015132.96903096938102911.45929839732.99386659857.772727272749.459298397312.993866598536.7727272727288
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Unknown destination
Traval Destination Unknown incl
2009200920092009200920092009200920092009200920092009200920092009200920092009
2010201020102010201020102010201020102010201020102010201020102010201020102010
2011201120112011201120112011201120112011201120112011201120112011201120112011
2012201220122012201220122012201220122012201220122012201220122012201220122012
2013201320132013201320132013201320132013201320132013201320132013201320132013
2014201420142014201420142014201420142014201420142014201420142014201420142014
2015201520152015201520152015201520152015201520152015201520152015201520152015
2016201620162016201620162016201620162016201620162016201620162016201620162016
2017201720172017201720172017201720172017201720172017201720172017201720172017
2018201820182018201820182018201820182018201820182018201820182018201820182018
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from non_Africa
Number of imported Cases
677
455
413
53
163.1283671646
142.6413551402
26.7174089069
618.1283671646
555.6413551402
79.7174089069
44
14
31
14.8716328354
4.3586448598
14.2825910931
58.8716328354
802
582
521
75
153.5306450306
140.17175
5.4176061008
735.5306450306
661.17175
80.4176061008
53
20
33
13.4693549694
4.82825
8.738978612
66.4693549694
728
508
456
65
143.0726392252
132.3723204748
5.9512943825
651.0726392252
588.3723204748
70.9512943825
59
6
53
17.9273607748
1.6276795252
17.1166214645
76.9273607748
668
430
375
68
141.857558806
128.201477137
7.4531986532
571.857558806
503.201477137
75.4531986532
69
15
57
27.142441194
5.798522863
19.380952381
96.142441194
776
580
528
61
166.0814514572
135.0457831325
6.6674698795
746.0814514572
663.0457831325
67.6674698795
23
3
21
6.9185485428
0.9542168675
10.3333333333
29.9185485428
1177
794
567
241
331.8893868704
159.7269767442
94.8937254902
1125.8893868704
726.7269767442
335.8937254902
37
12
25
14.1106131296
3.2730232558
16.4865618661
51.1106131296
1285
832
640
210
363.8013813015
191.546144631
82.905226632
1195.8013813015
831.546144631
292.905226632
60
19
42
29.1986186985
6.4538553689
34.3777640328
89.1986186985
1195
783
673
121
296.3335262834
206.2897559711
25.4498087954
1079.3335262834
879.2897559711
146.4498087954
83
27
59
32.6664737166
7.7102440289
41.5675675676
115.6664737166
1227
854
770
102
302.1923271691
250.3058635935
12.2460868607
1156.1923271691
1020.3058635935
114.2460868607
50
16
35
20.8076728309
5.6941364065
22.8336309524
70.8076728309
1167
841
708
124
276.5407016027
246.0061334015
8.969030969
1117.5407016027
954.0061334015
132.969030969
38
10
29
11.4592983973
2.9938665985
7.7727272727
49.4592983973
Arbeitsblatt
YearTOTAL Imported casesImmigratedTraveller_totalPf/k/u allPv/o/m allTravel_Buis_unknownVFRALLall pfkuall pvomTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaPercentage (totalPercentage PfkuPercentage PvomUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from non_AfricaPf/k/u allPv/o/m allUnknown destinationPf/k/u of unknownsPv/o/m of unknownsAll possible imported cases from non_AfricaPf/k/u allPv/o/m allAsiaAlgeriaAfghanistanBrazilBoliviaCambodiaColumbiaDom.RepEcuadorFNGGuatemalaHaitiHondurasIndiaIndonesiaLaosMalaysiaMyanmarNepalNicaraguaPakistanPeruPhilippinesPNGSri LankaThailandTimor L'EstVanuatuVenezuelaSouthamericaUnknownTOTALvisits of more than one countryDEUTSCHLANDTraveller_totalPf/k/u allPv/o/m allALLall pluall pvomTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaPercentage (totalPercentage PfkuPercentage PvomUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from NON_AfricaPf/k/u all_possible_Non_AfricaPv/o/m_all_possible_NonAfricaUnknown destinationPf/k/u of unknownsPv/o/m of unknownsD+CHYearTraveller_totalPf/k/u allPv/o/m allTravel destionation Africa (total)Pf/k/u AfricaPv/o/m AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from AfricaPf/k/u all_possible_AfricaPv/o/m_all_possible_AfricaTravel destination outside of Africa (total)Pf/k/u non-AfricaPv/o/m non_AfricaUnknown totalUnknown pkuUnknown pvuAll possible imported cases from non_AfricaPf/k/u allPv/o/m allUnknown destinationPf/k/u of unknownsPv/o/m of unknownsPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_AfricaPercentage outside of Africa (total)Percentage Pf/k/u non-AfricaPv/o/m non_Africa
2006142539271224412539-25252006
20071819372931433111935*red marked-19192007
200814203419412522034-20202008
20091701915112922151807112610719111101108894532221213312212156912647311187102522340281212115211112541*red marked5264451033733206534431243929866141122254854346829822833412313411135153125382009677574125455413531631432761855680441431154143459184517814741919
201019021169137328584154125291391182190947214112153129231578106281111689151233019111292115306335491044814167944340354929713140129358353257381325833212485017331521332520108026861365825217515414057366618053203313592566254216714528928
2011189241651343179861541252914212319929866109115213220122108234101132111192231112122421111125*red marked5634621234133378936633346899914133124549945751474431114817116645591501253420117285961545084566514313266515887159653182173077870161134368911
20121493211796217047113932010791169598804311119417624522000062443110551111131413*red marked551428143386297105323284528496181381257461409596313531645027619901972165131382012668524164430375681421287572503756915572761939962176169134398614
2013159621381201262761321161012811659710050641134120640530500014066421046211161163854711447141572452412569699131601316612543621931641227192642516713242201377666712658052861166135774666368233217110303043117313644964
2014316147169133369673163129341531262894988264215913030103662180001036642167821112111616*red marked1008609429668450232641441213969847326156939675973062791942814316411235340159197201411777424657945672413321609511267273363712251431638511541346163199964
201543321122219334991232061822919817924969883151142131902883542171019361611524141011121111624106366442568647722363446118692973934818179982642265521637831729634812271377187202201512858574598326402103641928311968322936019422963449892576393198207937
2016315802351983711112421117732194168249295752220421618828179885252111910924215413013124221111132443*red marked96071626565552314858950597909719274186228636911196618511033431740972591305193117201611959143027836731212962062510798791468327593384239116351013292141229010
201735582273238351351382512193224521629989991211932662353263321910073322193282261211112229954804179653567105609554739398132812321089078683441332723020523641855301237742017122710422148547701023022501211561020114501635216234271225832325677946
201828132249193341261232271723321416824949873212112351892513496227100144922211352510113412112236*red marked918774165652546120627540100969918256225888376510825620411710383592826622845201811679671998417081242772469111895413338102911383049133728824946964
00
TOTAL CH2557710188815712949439451737144526716311406200949772142123201771.60250516281527.7950543982219.84271857441063967632810371511262725716593011370436001222817421217326362021151268929826822932.6789616865
0
15112922526445103
526445103
1285100
39631
Arbeitsblatt
00
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Year
Number of cases
Sheet2
Visited Country
Number of Cases
Sheet3
Asia
Algeria
Afghanistan
Brazil
Bolivia
Cambodia
Columbia
Dom.Rep
Ecuador
FNG
Guatemala
Haiti
Honduras
India
Indonesia
Laos
Malaysia
Myanmar
Nepal
Nicaragua
Pakistan
Peru
Philippines
PNG
Sri Lanka
Thailand
Timor L'Est
Vanuatu
Venezuela
Southamerica
Year
Number of cases
171
Pf/k/u of unknowns
Pv/o/m of unknowns
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Number of Cases
Traveller_total
Pf/k/u all
Pv/o/m all
Travel_Buis_unknown
VFR
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Pf/k/u non-Africa
Pv/o/m non_Africa
Unknown destination
1
Traveller_total
Pf/k/u all
Pv/o/m all
Travel destionation Africa (total)
Pf/k/u Africa
Pv/o/m Africa
Unknown total
Unknown pku
Unknown pvu
All possible imported cases from Africa
Pf/k/u all_possible_Africa
Pv/o/m_all_possible_Africa
Travel destination outside of Africa (total)
Unknown destination
Number of Cases
All possible imported cases from non_Africa
Pf/k/u all
Pv/o/m all
Number of imported cases
Traveller_total
Pf/k/u all
Pv/o/m all
All possible imported cases from Africa
All possible imported cases from non_Africa
Years
Number of imported cases
Total Imported Malaria Cases to Germany and Switzerland, 2009-2018
-
Imported malaria cases to Switzerland from non-African countries, 2009-2018
46
Dom.Rep (5)India (9)Indonesien (8)PNG (1) Timor L'est (1)Cambodia (1)Philippines (2)Laos (4)Thailand (3)Columbia (1)Pakistan (1)Haiti (1)Sri Lanka (1, 2018!)N=38
P.falciparum
Veit, Data collected from FOSP Switzerland, 2019
-
Imported malaria cases by country (non-Africa) 2007-2016, Germany
47
INDIEN PAKISTAN
Indonesien
Afghanistan
PNGBrasilien Dom.Rep
Unklare Destination
-
South- East Asia Region
• Region with most (70%) cases outside of Africa
• 98% of cases occur in India (58%) and Indonesia (30%), Myanmar (10%)
48WHO, WMR 2019
-
Malaria deaths, Switzerland, 1998 - 2017
49
Reported by «Bundesamt für Statistik», Neuchatel
-
Development of Malaria Prevention Strategies for
Travellers
Methodology of the Swiss Expert Commitee for Travel Medicine
(ECTM)
2019
-
53
Malaria prevention strategy 2019
micro-epidemiolog. approach
-
54
Definitions of malaria prevention strategies
Hatz et al., BAG Bulletin, 2016, adapted by Swiss ECTM, 2019
Malaria-risk
Strategy
Imported Malaria cases
CH, D, A
per year
Malaria cases in indigenouspolpulation
per year
HighMosquito bite prevention +
chemoprophylaxis (P)>10 / 100’000 >10 / 1’000
LowMosquito bite prevention
+SBET for risk situations (T*)
>1-10 / 100’000 >1-10 / 1’000
Minimal Mosquito bite prevention (M) ≤1 / 100’000 ≤1 / 1’000
None - -No cases within the last 3
years
-
Methodology of recommendation process
Definition that leads to revisiting a countries’ prevention strategy: • Change of any criteria in a country according to “definition of
malaria risk”• Change of imported malaria cases to A,D,CH
• Structuring all information • highlighting changes
• Risk Assessment for travellers
• World Malaria Reports, PAHO, CDC)• National guidelines• Systematic reviews/milestone papers• Other relevant epid, informations• Imported data to A, D, CH
1x/ year
General secret.
1x/ year
General secret.
-
Methodology of recommendation process
56
• Discussion/endorsement of propositions 1x/ year
1x/ year
ECTM recomm. group
General secret.
• Country list• Malaria world map/ maps by coutnry
FOPH Safetravel ®,Tropimed®
General secret.
-
75
CAMBODIA
Imported cases to A/CH/D:
1.2/100’000 travellers per year
AFI
AVI
AFI
AFI
AVIWMR 2018
Local data:Presumed/confirmed cases:2013: 24’1302014: 26’2782015: 33’9302016: 23’4922017: 36’932
Population at high risk(>1 case/1000): 4.8 M (2%)
Species (2017)P. falciparum: 58% P. vivax: 45%
WHO 2018: https://www.who.int/malaria/publications/world_malaria_report/en/,
WMR country profiles: https://www.who.int/malaria/publications/country-profiles/en/
AVI
WMR 2018
WMR 2016
WMR 2017
WMR 2016
WMR 2017
WMR 2018
-
Imported Malaria Cases to Switzerland and Germany per 100 000 Travellers per Year
2009-2013 2014-2018versus
Pf/u= Plasmodium falciparum/knowlesi, unknownPv/o/m= Plasmodium vivax/ovale/malariae
Arrivals in destination countries, based on UNWTO statistics on arrivals to countries by nationality
Data on reported malaria cases data were collated from FOPH and RKI
-
78
Preventionstrategy CAMBODIA
2019
2018
-
Indication to prescribe/ take with for stand-by emergency treatment (SBET) only for risk
situations if travelling to areas with low malaria risk
Stand-by emergency treatment (SBET)is rarely used (2.5%) In case of fever, SBET is rarely used (12.7%) Malaria is seldom the cause of fever If SBET is taken, it is used in a wrong way
Ferrara et al., 2018, Tan et al., 2019, Utzinger et al., 2019
Improvement of medical infrastructure in many regions
80
Systematic Reviews und Metaanalysis
Swiss ECTM and DTG 2019
-
83
Malaria prevention strategy 2019
-
Mosquito bite avoidance measuresMosquito bite avoidance
plus take SBET with
Mosquito biteavoidance
plus chemoprophylaxis
Regions withhigh malaria risk
Regions withminimal
malaria risk
1 For potential vulnerable persons (immunocompromised persons, children 65 years,persons with relevant chronic diseases travelling to regions with low malaria risks an individual riskassessment and strategy is recommended.If pregnant women cannot avoid travelling to regions with low malaria risk, mosquito bite avoidancemeasures plus chemoprophylaxix is recommended.
Regions with low malaria risk1
No or unclear access to a medical infrastructure within48 hours during of after the
stay
Access to a medicalinfrastructure within
48 hours during of after thestay
Strategies for travellers to malaria endemic regions
-
Immediately consult a doctor to rule out malaria
In case of fever (>37,5 °C) 7 days after a first stay in a region with low malaria risk:
SBET was recommended(no or unclear access to medical infrastructure
within 48h hours)
No SBET was recommended(access to medical infrastructure within 48h hours)
What should travellers do in case of fever during or after staying in regions with low malaria risk?
Do not take SBET
Fever is selflimitingwithin 24 hours and is
not recuring
Take SBET and
immediately consult a doctor to rule out
malaria
Fever lasting over 24 hours or in case of
recuring fever
-
86
Instructions in case of fever during or after a stay in malaria endemic area:
Information to ALL travellers visiting malaria endemic areas:
• take a thermometer with you!• in case of fever (>37,5 °C) 7 days after the first stay in a malaria endemic area immediately consult a doctorto rule out malaria
-
88
GREATER MEKONG REGION
-
89
South East Asia
CH: www.bag.admin.ch/malaria
D: www.dtg.org/aktuelles/mitteilungen-der-dtg/461-dtg-empfehlungen-2019-zu-reiseimpfungen-verfuegbar.html
http://www.bag.admin.ch/malariahttp://www.dtg.org/aktuelles/mitteilungen-der-dtg/461-dtg-empfehlungen-2019-zu-reiseimpfungen-verfuegbar.html
-
How many travellers are really visiting high malaria risk areas?
90
-
Different national malaria prevention strategies
Example India
91
CDC NaTHNaC CH- Germany
-
Different national malaria prevention strategies
Example India
92
Netherlands Belgium CH- Germany
-
93
• Different malaria risk assessment?• Different malaria recommendation development
methodology?• Different ‘culture’
• Different ‘culture’ between Europeans and Americans ?
• Risk perception?1.Real fear of malaria, but why not of drugs…?
• Legal consequences?• Other?
Different national recommendations: why?
-
94
Switzerland -Germany
Malaria Prevention
Strategy 2019
CH: www.bag.admin.ch/malaria
D: www.dtg.org/aktuelles/mitteilungen-der-dtg/461-dtg-empfehlungen-2019-zu-reiseimpfungen-verfuegbar.html
http://www.bag.admin.ch/malariahttp://www.dtg.org/aktuelles/mitteilungen-der-dtg/461-dtg-empfehlungen-2019-zu-reiseimpfungen-verfuegbar.html
-
Summary
• Global malaria morbidity and mortality has declined within decades
• Stagnation since 2014• Reemergency in some regions• Change of global malaria risk has conqesences for
travellers• Malaria prevention measures can vary within a
country (M vs CP)• National recommentation for travellers vary
101
-
CAMBODIA
THANK YOU
-
P. vivax Malaria
Scientific and medical history: P. vivax = benign disease
Several studies:• 20% of hospitalized patients with P. vivax meet WHO
criteria for severe and complicated malaria • First of all due to shock and sever jaundice• 20% require intensive care• Mortality due either infection in patients progressed to
severely ill states consistently occur at approximately equal rates
Park et al., 2019, Quispe 2014, Tjitra et al., 2008, Hwand et. al, 2014
103
-
104
-
Eastern Mediterranean Region
• Countries in elimination programe Iran, Saudi Arabia
• Zero indigenous cases for 3 years Oman
• Increase since 2010:
105
+ Yemen
-
West Pacific Region• Course on elimination by 2020: China, Malaysia, D.R. Korea
• Target of >40% reduction by 2020:
• Increase since 2010:
106
-
Methodology of recommendation process
107
• World Malaria Reports, PAHO, CDC)• National guidelines• Systematic reviews/milestone papers• Other relevant epid, informations• Imported data to A, D, CH
• Structuring all information • highlighting changes
1x/ year
1x/ year
General secretary
General secretary
• Risk Assessment for travellers is based on Local malaria cases by country (WMR, MoH) Parasite species (API for P. falciparum and P.vivax) Imported malaria cases by countries CH, D, A ( data MoH) Tourist arrivals as denominator (UNWTO) Season Host risk
1x/ year
Working group
Definition that leads to revisiting a countries’ prevention strategy: • Change of any criterion/a in a country according to `definition of
malaria risk´• Change of imported malaria cases to A,D,CH
-
Methodology of recommendation process
108
• Discussion/endorsement of propositions 1x/ year
1x/ year
ECTM recomm. group
General secretary
• Country list• Malaria world map/ maps by coutnry
FOPH Safetravel ® Tropimed®
General secretary
Olivia Veit, MD, MIH��OverviewSlide Number 3Slide Number 4Slide Number 8MalariaChanges of P. falciparum incidenceMalaria case incidence rate (cases per 1000 population at risk) by country, 2018Malaria EliminationSlide Number 20Slide Number 21Worldwide Malaria SituationWorldwide Malaria Situation�2010 - 2018Falciparum Malaria among cabincrew members, Dar es SalaamMalaria mortality worldwideEstimated malaria cases by WHO Region, 2017/2018Challenges of malaria control����Change of malaria risk and consequences for travellers���Imported malaria cases to Switzerland and Germany Imported malaria cases to Switzerland + Germany�2009 - 2018�Imported Malaria Cases to Switzerland and Germany �per 100 000 Travellers per Year� �Imported malaria cases and deaths, Switzerland, 2007 - 2019Slide Number 40Imported Malaria Cases, Switzerland, 2018Destination of imported cases to Switzerland�2017 - 2019Imported malaria cases to Switzerland + Germany, 2009-2018: Africa versus Non-African Countries�Imported malaria cases to Switzerland from non-African countries, 2009-2018�Imported malaria cases by country (non-Africa) 2007-2016, GermanySouth- East Asia RegionMalaria deaths, Switzerland, 1998 - 2017���Slide Number 53Slide Number 54Methodology of recommendation processMethodology of recommendation processCAMBODIA�Imported Malaria Cases to Switzerland and Germany �per 100 000 Travellers per Year� �Slide Number 78Indication to prescribe/ take with for stand-by emergency treatment (SBET) only for risk situations if travelling to areas with low malaria risk Slide Number 83Slide Number 84Slide Number 85Slide Number 86Slide Number 88Slide Number 89How many travellers are really visiting high malaria risk areas?Different national malaria prevention strategies��Example India�Different national malaria prevention strategies��Example India�Slide Number 93Slide Number 94SummaryCAMBODIAP. vivax MalariaSlide Number 104Eastern Mediterranean RegionWest Pacific RegionMethodology of recommendation processMethodology of recommendation process