Epidemiological update - indigenous Plasmodium falciparum malaria cases in the Apulia region, Italy
On 4 October 2017, Italy reported through the Early Warning and Response System (EWRS) the detection of four Plasmodium falciparum malaria cases in the Apulia region. Cases are 21 to 37-year-old men, originally from Africa. All stated that they had been in Italy for more than three months. Dates for onset of symptoms ranged from 20 to 27 September 2017. The cases are agricultural workers in Ginosa and Castellaneta. Malaria vectors such as Anopheles labranchiae and Anopheles superpictus are present in Italy.
The report of four Plasmodium falciparum malaria cases in Italy without travel history to malaria-endemic countries is unusual. The fact that all the cases had onset of symptoms within a week and all had been in Italy for more than three months suggests an indigenous transmission in Italy resulting from either a ‘suitcase’ event or an introduced malaria event.
On 20 September, ECDC published the rapid risk assessment ‘Multiple reports of locally-acquired malaria infections in the EU’. The conclusions of the rapid risk assessment remain valid. The risk of further spread of malaria in the EU is considered very low. At this time of the year, the risk of further transmission in connection with the cases is considered low. Epidemiological, parasitological and entomological investigations should provide evidence on the source of infection and should support further assessment of the risk for transmission.
The Italian authorities are investigating this event and ECDC is continuing to monitor the event through epidemic intelligence activities.
