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Ten-year Experience with Imported Malaria in Bergamo, Italy.

Malaria infections have become an increasing public health problem in Europe, especially those imported into nonendemic areas. The transmission and diffusion of malaria has increased, especially over the last decade, due to changes in agricultural practices, vector resistance to insecticides, and most relevantly, increasing international travel and the resistance of these parasites to chemophrophylaxis. This study investigates the epidemiologic factors if imported malaria in an area of Italy, as related to international travel and prophylaxis by Italian immigrants who have revisited their country of origin. All cases (175) of imported malaria detected at the Laboratory of Microbiology of Ospedali Riuniti in Bergamo, Italy, between 1984 and 1993 were studied epidemiologically for the following variables: age, sex, and nationality; travel destination, length of stay, and date of return; and pathogen(s) detected, chemoprophylaxis used, and clinical symptoms exhibited. A high prevalence of Plasmodium falciparum was detected in more than three quarters of the cases with 91.4% of these travelers having visited African countries. Only two subjects had received adequate, correct prophylaxis. Fever, headache, and fatigue were experienced most often; however, in a few cases, blood, exchange transfusion, or treatment for splenomegaly were required. The results indicate that there is an emerging public health problem with immigrants who have resided in Italy for some time, revisited their country of origin, and consequently become infected with malaria, with specific prophylaxis not having been provided. This study emphasizes the importance of local epidemiologic studies, effective prophylaxis, and the need for those involved in the travel industry to promote specialized pretravel advice on a routine basis.