(Imported) Malaria in Germany, 1993-2003.: Surveillance data of the Robert!Koch-Institut on epidemiologic patient characteristics, countries of infection and treatment

Background and objective: In Germany, malaria is a major imported disease. The national surveillance data from 1993 to 2003 were analysed to assess epidemiologic trends in imported malaria. Methods: Malaria is a notifiable disease in Germany. Laboratory and epidemiologic data are obtained for each malaria case in a standardised way and reported to the Robert Koch-Institut where the central database exists for statistical analysis. Results: From 1993 to 2003, a total of 9148 malaria cases were reported to the Robert Koch-Institut. The annual cases ranged from 598 (1993) to 1045 (2001). No clear trend over the years was observed. The proportion of malaria cases of German origin declined significantly over the years to 50% in 2003. The proportion of cases aged 40 to 49 years increased over time. However, in each year the highest malaria incidence was found in the age group 20 to 39 years. Case fatality decreased substantially in recent years. In about 25% of patients malaria diagnosis and treatment start were delayed. This is of great concern since 70 to 80% of all cases were caused by Plasmodium falciparum. In recent years atovaquone + proguanil as well as arthemether + lumefantrin were increasingly used for treatment (both combination therapies made up for 35% of treatments in 2003). Conclusions: Further improvements in counselling and adequate use of malaria prophylaxis in travelers and in timely malaria diagnosis and treatment are necessary.