Imported Malaria in countries where malaria is not endemic A comparison of semi-immune and nonimmune travelers
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Imported Malaria in countries where malaria is not endemic A comparison of semi-immune and nonimmune travelers. / Mischlinger, Johannes; Rönnberg, Caroline; Álvarez-Martínez, Míriam J.; Bühler, Silja; Paul, Małgorzata; Schlagenhauf, Patricia; Petersen, Eskild; Ramharter, Michael.
In: CLIN MICROBIOL REV, Vol. 33, No. 2, e00104-19, 18.03.2020.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Imported Malaria in countries where malaria is not endemic A comparison of semi-immune and nonimmune travelers
AU - Mischlinger, Johannes
AU - Rönnberg, Caroline
AU - Álvarez-Martínez, Míriam J.
AU - Bühler, Silja
AU - Paul, Małgorzata
AU - Schlagenhauf, Patricia
AU - Petersen, Eskild
AU - Ramharter, Michael
N1 - Copyright © 2020 American Society for Microbiology.
PY - 2020/3/18
Y1 - 2020/3/18
N2 - The continuous increase in long-distance travel and recent large migratory movements have changed the epidemiological characteristics of imported malaria in countries where malaria is not endemic (here termed non-malaria-endemic countries). While malaria was primarily imported to nonendemic countries by returning travelers, the proportion of immigrants from malaria-endemic regions and travel-ers visiting friends and relatives (VFRs) in malaria-endemic countries has continued to increase. VFRs and immigrants from malaria-endemic countries now make up the majority of malaria patients in many nonendemic countries. Importantly, this group is characterized by various degrees of semi-immunity to malaria, resulting from repeated exposure to infection and a gradual decline of protection as a result of prolonged residence in non-malaria-endemic regions. Most studies indicate an effect of naturally acquired immunity in VFRs, leading to differences in the parasitological features, clinical manifestation, and odds for severe malaria and clinical complications between immune VFRs and nonimmune returning travelers. There are no valid data indicating evidence for differing algorithms for chemoprophylaxis or antimalarial treatment in semi-immune versus nonimmune malaria patients. So far, no robust biomarkers exist that properly reflect anti-parasite or clinical immunity. Until they are found, researchers should rigorously stratify their study results using surrogate markers, such as duration of time spent outside a malaria-endemic country.
AB - The continuous increase in long-distance travel and recent large migratory movements have changed the epidemiological characteristics of imported malaria in countries where malaria is not endemic (here termed non-malaria-endemic countries). While malaria was primarily imported to nonendemic countries by returning travelers, the proportion of immigrants from malaria-endemic regions and travel-ers visiting friends and relatives (VFRs) in malaria-endemic countries has continued to increase. VFRs and immigrants from malaria-endemic countries now make up the majority of malaria patients in many nonendemic countries. Importantly, this group is characterized by various degrees of semi-immunity to malaria, resulting from repeated exposure to infection and a gradual decline of protection as a result of prolonged residence in non-malaria-endemic regions. Most studies indicate an effect of naturally acquired immunity in VFRs, leading to differences in the parasitological features, clinical manifestation, and odds for severe malaria and clinical complications between immune VFRs and nonimmune returning travelers. There are no valid data indicating evidence for differing algorithms for chemoprophylaxis or antimalarial treatment in semi-immune versus nonimmune malaria patients. So far, no robust biomarkers exist that properly reflect anti-parasite or clinical immunity. Until they are found, researchers should rigorously stratify their study results using surrogate markers, such as duration of time spent outside a malaria-endemic country.
KW - Clinical characteristics
KW - Diagnosis
KW - Europe
KW - Imported
KW - Malaria
KW - Nonimmune
KW - Prophylaxis
KW - Semi-immune
KW - Treatment
KW - VFR
UR - http://www.scopus.com/inward/record.url?scp=85081680292&partnerID=8YFLogxK
U2 - 10.1128/CMR.00104-19
DO - 10.1128/CMR.00104-19
M3 - SCORING: Review article
C2 - 32161068
AN - SCOPUS:85081680292
VL - 33
JO - CLIN MICROBIOL REV
JF - CLIN MICROBIOL REV
SN - 0893-8512
IS - 2
M1 - e00104-19
ER -