Malaria epidemiological situation in Italy and evaluation of malaria incidence in Italian travelers

Background: Malaria was endemic throughout the country until it was eradica ted nearly 50 years ago, Since then, mainly imported malaria cases have bee n reported to the National Health Service, with an increasing trend. The ai m of this study was to present a detailed analysis of the current epidemiol ogical situation of malaria in Italy, and to make a first attempt to calcul ate the incidence of malaria in Italian international travelers. Methods: An archive of confirmed malaria cases is available at the Istituto Superiore di Sanita (ISS), the National Institute of Health of Italy, base d on the mandatory report system. Data from each case report reported to th e ISS from 1989 to 1997 have been analyzed. An evaluation of malaria incide nce in Italian travelers has been also performed for the same period, based on the statistics provided by the Ministry of Transport. Results: From 1989 to 1997, a total of 5.898 microscopically confirmed mala ria cases have been reported. Of these, 5,773 (97.9%) were imported cases, 106 cases (1.8%) were relapses of Plasmodium vivax or Plasmodium ovale infe ctions, and 19 cases (0.3%) occurred in subjects who had never been out of Italy. During the period of study, 55 deaths due to Plasmodium falciparum m alaria were reported, with a mean fatality rate of 1.2%. Malaria incidence in Italians who traveled to Africa was estimated to be 1.5/1000. These figu res appeared to be 10-20 and 30-40 times greater than that recorded in trav elers to Asia (0.11/1000) and Central-South America (0.04/1000) respectivel y. Conclusions: From 1989 to 1997 there has been a remarkable increase in the total number of imported malaria cases in Ita ly, which reached a peak of m ore than 800 cases/year in 1997 A constant increase in the number of cases affecting foreigners has been reported, while the cases among Italians have remained stable. From 1989 to 1997 the number of Italian intercontinental travelers has nearly doubled, but malaria incidence has remained quite stab le.