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C l u st e r o f i m p o rt e d m a l a r i a f r o m G a m b i a i n f i n l a n d – t r av e l l e r s d o n ot l i st e n to G i v e n a dv i C e K Valve (kirsi.valve@ktl.fi)1, E Ruotsalainen1, T Kärki1, E Pekkanen1, H Siikamäki21. National Public Health Institute, Department of Infectious Disease Epidemiology and Control, Helsinki, Finland2. Helsinki University Central Hospital, Division of Infectious Diseases, Department of Medicine, Helsinki, Finland Twelve Finnish tourists contracted falciparum malaria from Gambia prophylaxis for tropical Africa. One of them got the prescription in the period between 3 and 27 November 2008. The travellers from a physician and two of them used chloroquine - against came from different parts of Finland and all except one had booked professional advice - stored from a previous trip. Nine travellers the trip from the same travel agency. Ten of them had received did not use any chemoprophylaxis. One of them was prescribed information about the risk of malaria in Gambia and protection adequate prophylaxis but did not take it because of warnings about from mosquito bites but none of them had used adequate malaria side-effects he had read on the internet.
Ten of the patients had either received information on protection Twelve Finnish tourists contracted falciparum malaria from from mosquito bites from the travel agency or had found it on their Gambia in the period between 3 and 27 November 2008. Three own from various sources. There was wide variation, however, on of the patients needed intensive care due to complications. In all these cases there was a delay of at least four days in seeking The only travel agency organising package trips to Gambia takes approximately 5,000 Finns yearly to Gambia in the period Usually, between 20 and 30 cases of imported malaria are from mid-October to mid-April. The number of travellers has not diagnosed every year in Finland (population 5.3 million); most of increased in the last few years. The National Public Health Institute them are contracted in Africa. In 2007, three cases were imported informed clinical practitioners and sent out a press release about from Gambia. The cluster of twelve patients described here raises the situation on 14 November 2008, which has had wide media the total number in 2008 to 36 cases to date. coverage. The travel agency discontinued selling last-minute trips to Gambia immediately and has decided to sell trips no later than All twelve patients were thoroughly interviewed. The age two weeks prior to departure and to put extra effort into informing distribution was 27-66 years, seven patients were male and five were female. The travellers came from different parts of Finland, and they stayed in different tourist resorts in Gambia, approximately The number of Finnish travellers to this region of Africa has not 20 km from the capital city Banjul. One traveller resided in the increased in the last few years. Interestingly, there have been similar countryside for one month. The other patients stayed in Gambia clusters of falciparum malaria in travellers returning from Gambia also in other European countries; in total, more than 39 travellers were reported to TropNetEurop and GeoSentinel [1]. It is not clear, All except one had booked the trip from the same travel agency. if this increase in malaria cases is related to a higher malaria Five travellers had booked a last-minute trip (booking less than five activity in Gambia or to a decrease in compliance with protective days before departure). One had bought the trip ten days before, measures or in risk awareness among travellers purchasing last- and five more than three weeks before the departure. Booking minute package tours. In fact, a recently published analysis showed information for the last case was not available.
that the risk to acquire malaria in Gambia seems to have decreased significantly between 1999 and 2007 [2]. But this trend could have Ten of the patients had received information about the risk of been changed in 2008. According to unconfirmed information, the malaria in Gambia and knew that prophylaxis using anti-malarial rainy season has been longer than usual this year. drugs was recommended. Six travellers got the information from the travel agency, two from the internet, one had previous information Irrespective of what the reasons for this increase in travel-related and one was a healthcare professional. Two travellers had not been malaria are, this cluster demonstrates once again the need for informed about the risk of malaria; one of them had booked the adequate chemoprophylaxis and information on protection from trip by telephone, the other one on the internet. mosquito bites for all travellers to West-Africa. None of the patients had used adequate malaria chemoprophylaxis. Three patients had used chloroquine, which is not recommended E. Pekkanen has occasionally consulted GlaxoSmithKline and SBL vaccines.
EUROSURVEILL ANCE Vol . 13 · Issue 51 · 18 December 2008 · www.eurosurveillance.org 1. ProMED-mail. Malaria - Europe, USA, ex Gambia. Archive Number 20081201.3775. 1 December 2008. Available from: http://www.promedmail.org/pls/otn/f?p=2400:1001:::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000%2C74978 2. Ceesay SJ, Casals-Pascual C, Erskine J, Anya SE, Duah NO, Fulford AJ, et al. Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis. Lancet. 2008;372(9649):1545-54.
This article was published on 18 December 2008.
Citation style for this article: Valve K, Ruotsalainen E, Kärki T, Pekkanen E, Siikamäki H. Cluster of imported malaria from Gambia in Finland – travellers do not listen to given advice. Euro Surveill. 2008;13(51):pii=19068. Available online: http://www.
eurosurveillance.org/ViewArticle.aspx?ArticleId=19068 EUROSURVEILL ANCE Vol . 13 · Issue 51 · 18 December 2008 · www.eurosurveillance.org

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