bs_bs_banner
doi:10.1111/jpc.12870
ORIGINAL ARTICLE
Malaria in Sydney, Australia: Lessons learned from case management Kelly A Thompson, Ben J Marais, Alison Kesson and David Isaacs The Children’s Hospital at Westmead and the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Aim: To evaluate the clinical presentation and profile of malaria cases diagnosed at a tertiary children’s hospital in Australia Methods: A retrospective file review of children diagnosed with malaria at the Children’s Hospital Westmead from 1 January 2000 to 31 December 2010. Results: During the 11-year study period, 40 children were diagnosed with malaria; 30 (75%) presented with fever; 14 (35%) complained of nausea, vomiting or abdominal pain; and eight (20%) were completely asymptomatic. The median time between arrival in Australia and malaria diagnosis was 32 (range 4–434) days. Sixteen (40%) were refugees from sub-Saharan Africa, six (15%) were immigrants from South-East Asia, and seven (18%) recently travelled to or visited friends and family in malaria-endemic areas. Most (68%) cases had Plasmodium falciparum; Plasmodium vivax was identified in four cases with exposures in India and Papua New Guinea; one had mixed P. falciparum and P. vivax infection. Conclusion: Malaria signs and symptoms were non-specific, with an absence of fever in a quarter of cases. Diagnostic vigilance is required in all children with potential malaria exposure in the preceding year. Asymptomatic parasitaemia should be considered in recent migrants from malaria-endemic areas. Key words:
chemoprophylaxis; child; malaria; refugee; travel.
What is already known on this topic
What this paper adds
1 Malaria is a major global epidemic. 2 Australia is non-endemic for malaria but harbours susceptible mosquito species. 3 Malaria is an important diagnosis to consider in international refugees from malaria-endemic areas or returned travellers with fever.
1 A quarter of malaria patients presented without fever. 2 Screening of asymptomatic refugee children from malariaendemic countries identified additional cases. 3 Asymptomatic parasitaemia should be treated, given uncertain disease risk and potential to infect local mosquito vectors.
Malaria continues to be a major public health concern despite recent declines in morbidity and mortality world-wide. Gains in malaria control remain fragile, and there is a need for continued prevention efforts that reflect the shifting populations most at risk for malaria,1 limiting the risk of emerging drug resistance2,3 and addressing climatic factors that may affect vector distribution.4,5 Australia was declared malaria free in 1981, but potential reservoirs of infection remain, given the presence of Anopheles mosquitoes in some sub-tropical regions. A localised outbreak of Plasmodium vivax infection was recorded in Queensland during recent years,6 and repeated outbreaks of Dengue fever in the same location7 highlight the lurking dangers posed by imported Correspondence: Ms Kelly A Thompson, The Children’s Hospital at Westmead and the Sydney Medical School, University of Sydney, 188/105 Bridge Road, Westmead, Sydney, NSW 2145, Australia. Fax: +61 2 9845 3421; email: [email protected] Conflict of interest: No conflict of interests to disclose. Accepted for publication 5 February 2015.
920
mosquito borne disease. The World Health Organization (WHO) emphasises the risk of malaria re-establishment in areas where it has been eradicated. The continued presence of effective vectors demands heightened vigilance of imported malaria cases and ongoing surveillance to exclude local transmission.8 In the absence of local transmission, only international travellers and recent immigrants from malaria-endemic areas are at risk.9,10 More than half a million Australian residents leave the country every month for short-term departures; five malariaendemic countries (China, India, Indonesia, Malaysia and Thailand) are included among the top 10 destinations for Australian travellers.11 Australia also participates in a United Nations humanitarian programme, which affords protection to international refugees, many from malaria-endemic countries.12 Additionally, the greatest disease burden is carried by children under 5 years of age who live in endemic areas. Given the mobility of the Australian population and the influx of foreign nationals, imported malaria remains a concern. However, very little is known about the frequency with which children in Sydney are diagnosed with malaria, their clinical profile and local management practices.13–16
Journal of Paediatrics and Child Health 51 (2015) 920–923 © 2015 The Authors Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
KA Thompson et al.
Methods We performed a retrospective chart review of all children (
doi:10.1111/jpc.12870
ORIGINAL ARTICLE
Malaria in Sydney, Australia: Lessons learned from case management Kelly A Thompson, Ben J Marais, Alison Kesson and David Isaacs The Children’s Hospital at Westmead and the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Aim: To evaluate the clinical presentation and profile of malaria cases diagnosed at a tertiary children’s hospital in Australia Methods: A retrospective file review of children diagnosed with malaria at the Children’s Hospital Westmead from 1 January 2000 to 31 December 2010. Results: During the 11-year study period, 40 children were diagnosed with malaria; 30 (75%) presented with fever; 14 (35%) complained of nausea, vomiting or abdominal pain; and eight (20%) were completely asymptomatic. The median time between arrival in Australia and malaria diagnosis was 32 (range 4–434) days. Sixteen (40%) were refugees from sub-Saharan Africa, six (15%) were immigrants from South-East Asia, and seven (18%) recently travelled to or visited friends and family in malaria-endemic areas. Most (68%) cases had Plasmodium falciparum; Plasmodium vivax was identified in four cases with exposures in India and Papua New Guinea; one had mixed P. falciparum and P. vivax infection. Conclusion: Malaria signs and symptoms were non-specific, with an absence of fever in a quarter of cases. Diagnostic vigilance is required in all children with potential malaria exposure in the preceding year. Asymptomatic parasitaemia should be considered in recent migrants from malaria-endemic areas. Key words:
chemoprophylaxis; child; malaria; refugee; travel.
What is already known on this topic
What this paper adds
1 Malaria is a major global epidemic. 2 Australia is non-endemic for malaria but harbours susceptible mosquito species. 3 Malaria is an important diagnosis to consider in international refugees from malaria-endemic areas or returned travellers with fever.
1 A quarter of malaria patients presented without fever. 2 Screening of asymptomatic refugee children from malariaendemic countries identified additional cases. 3 Asymptomatic parasitaemia should be treated, given uncertain disease risk and potential to infect local mosquito vectors.
Malaria continues to be a major public health concern despite recent declines in morbidity and mortality world-wide. Gains in malaria control remain fragile, and there is a need for continued prevention efforts that reflect the shifting populations most at risk for malaria,1 limiting the risk of emerging drug resistance2,3 and addressing climatic factors that may affect vector distribution.4,5 Australia was declared malaria free in 1981, but potential reservoirs of infection remain, given the presence of Anopheles mosquitoes in some sub-tropical regions. A localised outbreak of Plasmodium vivax infection was recorded in Queensland during recent years,6 and repeated outbreaks of Dengue fever in the same location7 highlight the lurking dangers posed by imported Correspondence: Ms Kelly A Thompson, The Children’s Hospital at Westmead and the Sydney Medical School, University of Sydney, 188/105 Bridge Road, Westmead, Sydney, NSW 2145, Australia. Fax: +61 2 9845 3421; email: [email protected] Conflict of interest: No conflict of interests to disclose. Accepted for publication 5 February 2015.
920
mosquito borne disease. The World Health Organization (WHO) emphasises the risk of malaria re-establishment in areas where it has been eradicated. The continued presence of effective vectors demands heightened vigilance of imported malaria cases and ongoing surveillance to exclude local transmission.8 In the absence of local transmission, only international travellers and recent immigrants from malaria-endemic areas are at risk.9,10 More than half a million Australian residents leave the country every month for short-term departures; five malariaendemic countries (China, India, Indonesia, Malaysia and Thailand) are included among the top 10 destinations for Australian travellers.11 Australia also participates in a United Nations humanitarian programme, which affords protection to international refugees, many from malaria-endemic countries.12 Additionally, the greatest disease burden is carried by children under 5 years of age who live in endemic areas. Given the mobility of the Australian population and the influx of foreign nationals, imported malaria remains a concern. However, very little is known about the frequency with which children in Sydney are diagnosed with malaria, their clinical profile and local management practices.13–16
Journal of Paediatrics and Child Health 51 (2015) 920–923 © 2015 The Authors Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
KA Thompson et al.
Methods We performed a retrospective chart review of all children (
