Malaria Epidemiology & Prevention Strategies for ... › dokumente › swiss... · Factors contributing to control malaria Since 2000 estimated 663 Mio clinical cases averted. 21.

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

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

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


Pf/k/u Africa

Pv/o/m Africa





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


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


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown total

Unknown pku

Unknown pvu


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


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown total

Unknown pku

Unknown pvu


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


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


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


Pf/k/u Africa

Pv/o/m Africa





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown destination

1

Traveller_total

Pf/k/u all

Pv/o/m all


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Unknown destination

Number of Cases


Pf/k/u all

Pv/o/m all


Traveller_total

Pf/k/u all

Pv/o/m all


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown total

Unknown pku

Unknown pvu


Pf/k/u all

Pv/o/m all

Years



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


19

151

21

169

24

165

32

117

62

138

147

169

211

222

80

235

83

271

38

247

24

262


2009200920092009200920092009200920092009

2010201020102010201020102010201020102010

2011201120112011201120112011201120112011

2012201220122012201220122012201220122012

2013201320132013201320132013201320132013

2014201420142014201420142014201420142014

2015201520152015201520152015201520152015

2016201620162016201620162016201620162016

2017201720172017201720172017201720172017

2018201820182018201820182018201820182018


Pf/k/u Africa

Pv/o/m Africa





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


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


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


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


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown total

Unknown pku

Unknown pvu


Pf/k/u all

Pv/o/m all

Unknown destination


2009200920092009200920092009200920092009200920092009200920092009200920092009

2010201020102010201020102010201020102010201020102010201020102010201020102010

2011201120112011201120112011201120112011201120112011201120112011201120112011

2012201220122012201220122012201220122012201220122012201220122012201220122012

2013201320132013201320132013201320132013201320132013201320132013201320132013

2014201420142014201420142014201420142014201420142014201420142014201420142014

2015201520152015201520152015201520152015201520152015201520152015201520152015

2016201620162016201620162016201620162016201620162016201620162016201620162016

2017201720172017201720172017201720172017201720172017201720172017201720172017

2018201820182018201820182018201820182018201820182018201820182018201820182018

Traveller_total

Pf/k/u all

Pv/o/m all


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown total

Unknown pku

Unknown pvu



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


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


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


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


Pf/k/u Africa

Pv/o/m Africa





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown destination

1

Traveller_total

Pf/k/u all

Pv/o/m all


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Unknown destination

Number of Cases


Pf/k/u all

Pv/o/m all


Traveller_total

Pf/k/u all

Pv/o/m all



Years



YearTotalMigrantsTravellers (total)Tourists (+ other/unknown)VFR

2009170191518071

2010190211698584

2011189241657986

2012149321177047

2013159621386276

20143161471699673

201543321122299123

201631580235111124

201735483271134137

201828538247120127

201928624262123139

Total

Year


Total

Migrants

Travellers (total)

Tourists (+ other/unknown)

VFR

Year


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



Years


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


2009200920092009200920092009200920092009

2010201020102010201020102010201020102010

2011201120112011201120112011201120112011

2012201220122012201220122012201220122012

2013201320132013201320132013201320132013

2014201420142014201420142014201420142014

2015201520152015201520152015201520152015

2016201620162016201620162016201620162016

2017201720172017201720172017201720172017

2018201820182018201820182018201820182018


Pf/k/u Africa

Pv/o/m Africa





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


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


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


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


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown total

Unknown pku

Unknown pvu


Pf/k/u all

Pv/o/m all

Unknown destination


2009200920092009200920092009200920092009200920092009200920092009200920092009

2010201020102010201020102010201020102010201020102010201020102010201020102010

2011201120112011201120112011201120112011201120112011201120112011201120112011

2012201220122012201220122012201220122012201220122012201220122012201220122012

2013201320132013201320132013201320132013201320132013201320132013201320132013

2014201420142014201420142014201420142014201420142014201420142014201420142014

2015201520152015201520152015201520152015201520152015201520152015201520152015

2016201620162016201620162016201620162016201620162016201620162016201620162016

2017201720172017201720172017201720172017201720172017201720172017201720172017

2018201820182018201820182018201820182018201820182018201820182018201820182018

Traveller_total

Pf/k/u all

Pv/o/m all


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown total

Unknown pku

Unknown pvu



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


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


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


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


Pf/k/u Africa

Pv/o/m Africa





Pf/k/u non-Africa

Pv/o/m non_Africa

Unknown destination

1

Traveller_total

Pf/k/u all

Pv/o/m all


Pf/k/u Africa

Pv/o/m Africa

Unknown total

Unknown pku

Unknown pvu





Unknown destination

Number of Cases


Pf/k/u all

Pv/o/m all


Traveller_total

Pf/k/u all

Pv/o/m all



Years



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.


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

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


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


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

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