Non-imported malaria in Italy: paradigmatic approaches and public health implications following an unusual cluster of cases in 2017.
Animals
Disease Outbreaks
/ statistics & numerical data
Female
Humans
Italy
/ epidemiology
Malaria
/ epidemiology
Malaria, Falciparum
/ epidemiology
Male
Mosquito Vectors
Plasmodium falciparum
/ isolation & purification
Plasmodium ovale
/ isolation & purification
Polymerase Chain Reaction
Population Surveillance
Anopheles labranchiae
Cryptic case
Genotyping
Hospital-acquired infection
Malaria vector
Non-imported malaria
Plasmodium falciparum
Plasmodium ovale spp.
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
05 Jun 2020
05 Jun 2020
Historique:
received:
27
08
2019
accepted:
21
04
2020
entrez:
7
6
2020
pubmed:
7
6
2020
medline:
11
11
2020
Statut:
epublish
Résumé
The European region achieved interruption of malaria transmission during the 1970s. Since then, malaria control programs were replaced by surveillance systems in order to prevent possible re-emergence of this disease. Sporadic cases of non-imported malaria were recorded in several European countries in the past decade and locally transmitted outbreaks of Plasmodium vivax, most probably supported by Anopheles sacharovi, have been repeatedly reported from Greece since 2009. The possibility of locally-transmitted malaria has been extensively studied in Italy where the former malaria vector An. labranchiae survived the control campaign which led to malaria elimination. In this study, we present paradigmatic cases that occurred during a 2017 unusual cluster, which caused strong concern in public opinion and were carefully investigated after the implementation of the updated malaria surveillance system. For suspected locally-transmitted malaria cases, alerts to Ministry of Health (MoH) and the National Institute of Health (ISS) were mandated by the Local Health Services (LHS). Epidemiological investigations on the transmission modes and the identification of possible infection's source were carried out by LHS, MoH and ISS. Entomological investigations were implemented locally for all suspected locally-transmitted cases that occurred in periods suitable to anopheline activity. Molecular diagnosis by nested-PCR for the five human Plasmodium species was performed to support microscopic diagnosis. In addition, genotyping of P. falciparum isolate was carried out to investigate putative sources of infection and transmission modalities. In 2017, a cluster of seven non-imported cases was recorded from August through October. Among them, P. ovale curtisi was responsible of one case whereas six cases were caused by P. falciparum. Two cases were proved to be nosocomial while the other five were recorded as cryptic at the end of epidemiological investigations. The epidemiological evidence shows that the locally acquired events are sporadic, often remain unresolved and classified as cryptic ones despite investigative efforts. The "cluster" of seven non-imported cases that occurred in 2017 in different regions of Italy therefore represents a conscious alert that should lead us to maintain a constant level of surveillance in a former malaria endemic country.
Sections du résumé
BACKGROUND
BACKGROUND
The European region achieved interruption of malaria transmission during the 1970s. Since then, malaria control programs were replaced by surveillance systems in order to prevent possible re-emergence of this disease. Sporadic cases of non-imported malaria were recorded in several European countries in the past decade and locally transmitted outbreaks of Plasmodium vivax, most probably supported by Anopheles sacharovi, have been repeatedly reported from Greece since 2009. The possibility of locally-transmitted malaria has been extensively studied in Italy where the former malaria vector An. labranchiae survived the control campaign which led to malaria elimination. In this study, we present paradigmatic cases that occurred during a 2017 unusual cluster, which caused strong concern in public opinion and were carefully investigated after the implementation of the updated malaria surveillance system.
METHODS
METHODS
For suspected locally-transmitted malaria cases, alerts to Ministry of Health (MoH) and the National Institute of Health (ISS) were mandated by the Local Health Services (LHS). Epidemiological investigations on the transmission modes and the identification of possible infection's source were carried out by LHS, MoH and ISS. Entomological investigations were implemented locally for all suspected locally-transmitted cases that occurred in periods suitable to anopheline activity. Molecular diagnosis by nested-PCR for the five human Plasmodium species was performed to support microscopic diagnosis. In addition, genotyping of P. falciparum isolate was carried out to investigate putative sources of infection and transmission modalities.
RESULTS
RESULTS
In 2017, a cluster of seven non-imported cases was recorded from August through October. Among them, P. ovale curtisi was responsible of one case whereas six cases were caused by P. falciparum. Two cases were proved to be nosocomial while the other five were recorded as cryptic at the end of epidemiological investigations.
CONCLUSIONS
CONCLUSIONS
The epidemiological evidence shows that the locally acquired events are sporadic, often remain unresolved and classified as cryptic ones despite investigative efforts. The "cluster" of seven non-imported cases that occurred in 2017 in different regions of Italy therefore represents a conscious alert that should lead us to maintain a constant level of surveillance in a former malaria endemic country.
Identifiants
pubmed: 32503526
doi: 10.1186/s12889-020-08748-9
pii: 10.1186/s12889-020-08748-9
pmc: PMC7275312
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
857Investigateurs
Silva Franchini
(S)
Marino Migazzi
(M)
Roberta Ferranti
(R)
Francesco Castelli
(F)
Lina Tomasoni
(L)
Annapaola Rizzoli
(A)
Daniele Arnoldi
(D)
Gioia Capelli
(G)
Fabrizio Montarsi
(F)
Simone Martini
(S)
Zeno Bisoffi
(Z)
Francesca Perandin
(F)
Chiara Piubelli
(C)
Zeno Pasquini
(Z)
Benedetta Canovari
(B)
Barbara Pieretti
(B)
Massimo Agostini
(M)
Giorgia Angeloni
(G)
Elisa Antognini
(E)
Stefano Gavaudan
(S)
Michele Conversano
(M)
Francesco Desiante
(F)
Rosita Cipriani
(R)
Roberta Cambria
(R)
Ettore Franco
(E)
Angelo Pellegrino
(A)
Giovanni Battista Buccoliero
(GB)
Maria Assunta Cafiero
(MA)
Donato Antonio Raele
(DA)
Domenico Galante
(D)
Pier Angela Ferrero
(PA)
Anna Bertorello
(A)
Paolo Roberto
(P)
Andrea Mosca
(A)
Sandra Roversi
(S)
Laura Gardenghi
(L)
Roberto Cagarelli
(R)
Giovanna Mattei
(G)
Claudio Gualanduzzi
(C)
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