Article Figures & Tables
Tables
- Table 1: Demographic characteristics of 437 returned travellers or new immigrants with 456 malaria diagnoses who presented to a CanTravNet site for care, 2004-2014*
Characteristic All cases
(456 diagnoses; 437 patients)Purpose of travel; no. (%)† Visiting friends and relatives§ (174 diagnoses; 169 patients) Business (77 diagnoses; 71 patients) Missionary, volunteer, research or aid work(73 diagnoses; 69 patients) Immigration
(62 diagnoses; 60 patients)Tourism
(54 diagnoses; 52 patientsOther‡
(16 diagnoses; 16 patients)Sex Male 278 (63.6) 101 (59.8) 62 (87.3) 38 (55.1) 39 (65.0) 26 (50.0) 12 (75.0) Female 159 (36.4) 68 (40.2) 9 (12.7) 31 (44.9) 21 (35.0) 26 (50.0) 4 (25.0) Age, yr, median (range) 33.5 (1-82) 37 (2-82) 42 (21-71) 28 (12-68) 22 (1-64) 39 (1-75) 22 (14-48) Children and adolescents (age < 18 yr) 27 (6.2) 10 (5.9) 0 (0) 1 (1.4) 14 (23.3) 1 (1.9) 1(6.3) Type of patient Inpatient 141 (32.3) 52 (30.8) 28 (39.4) 21 (30.4) 18 (30.0) 16 (30.8) 6 (37.5) Outpatient 296 (67.7) 117 (69.2) 43 (60.6) 48 (69.6) 42 (70.0) 36 (69.2) 10 (62.5) Travel duration, d, median (range) 35 (0-7256) 34 (0-884) 33 (0-1065) 61 (3-831) NA 19 (0-547) 90 (1-7256) Pretravel medical encounter Yes 131 (30.0) 29 (17.1) 39 (54.9) 39 (56.5) NA 16 (30.8) 6 (37.5) No 217 (49.7) 110 (65.1) 19 (26.8) 14 (20.3) NA 24 (46.2) 5 (31.3) Unknown 89 (20.4) 28 (16.6) 13 (18.3) 16 (23.2) NA 12 (23.1) 5 (31.3) Geographic region of exposure Sub-Saharan Africa 326 (74.6) 133 (78.7) 57 (80.3) 58 (84.1) 38 (63.3) 28 (53.8) 11 (68.8) South Central Asia 55 (12.6) 30 (17.8) 1 (1.4) 0 (0) 15 (25.0) 4 (7.7) 5 (31.2) South America 9 (2.1) 2 (1.2) 3 (4.2) 1 (1.4) 1 (1.7) 2 (3.8) 0 (0) Caribbean 9 (2.1) 1 (0.6) 1 (1.4) 2 (2.9) 0 (0) 5 (9.6) 0 (0) North Africa 10 (2.3) 1 (0.6) 1 (1.4) 3 (4.3) 4 (6.7) 1 (1.9) 0 (0) Southeast Asia 7 (1.6) 0 (0) 1 (1.4) 3 (4.3) 2 (3.3) 1 (1.9) 0 (0) Central America 8 (1.8) 1 (0.6) 1 (1.4) 1 (1.4) 0 (0) 5 (9.6) 0 (0) Oceania 4 (0.9) 0 (0) 1 (1.4) 0 (0) 0 (0) 3 (5.8) 0 (0) Unknown 10 (2.3) 1 (0.6) 5 (7.0) 1 (1.4) 0 (0) 3 (5.8) 0 (0) Birth country Canada 148 (33.9) 11 (6.5) 43 (60.6) 59 (85.5) 0 (0) 29 (55.8) 6 (37.5) Other 289 (66.1) 158 (93.5) 28 (39.4) 10 (14.5) 60 (100) 23 (44.2) 10 (62.5) Note: NA = not available.*The total cohort of travellers consisted of 18 870 travellers with a definitive travel-related diagnosis, 931 with a non-travel-related diagnosis, and 544 with a diagnosis for which relation to travel could not be ascertained. This analysis includes only those travellers with a final diagnosis of malaria, except where indicated otherwise.
†Unless otherwise specified.
‡Includes 15 cases in students and 1 case in military personnel.
§Among patients born outside of Canada, people who travelled for the purpose of visiting friends and relatives were defined as immigrants who were ethnically or racially distinct from the majority population in their current country of residence and who returned to their homeland to visit friends and relatives. This group also included children of foreign-born parents (i.e., second-generation immigrants) who returned to their parents' homeland to visit friends and relatives.
- Table 2: Most common diagnoses and source countries for malaria species in 456 malaria cases diagnosed at CanTravNet sites, 2004-2014
Diagnosis Total no. of malaria diagnoses in database No. (%) of malaria diagnoses* in travellers presenting with fever Three most common source countries Malaria 456 379 (83.1) Plasmodium falciparum 282 237 (84.0) Nigeria, Ghana, Ivory Coast (includes severe malaria) Severe (complicated) 26 23 (88.5) Plasmodium vivax 85 77 (90.6) India, Pakistan, Guyana Species unknown 39 22 (56.4) Burkina Faso, Sierra Leone Plasmodium ovale 21 18 (85.7) Nigeria, Ghana, Cameroon Plasmodium malariae 3 2 (66.7) Nigeria, Ghana, Cameroon *Percentages are calculated using corresponding total number of diagnoses in database as denominator. A returned traveller could present with more than 1 chief complaint and have more than 1 diagnosis.
- Table 3: Most common source countries by year of import for 456 cases of malaria among ill returned travellers and new immigrants evaluated at CanTravNet sites, 2004-2014
Year of import No. of diagnoses of malaria (no. travellers with malaria) Total no. of cases of malaria reported to the Public Health Agency of Canada10 Cases reported to the Public Health Agency of Canada seen at CanTravNet sites, % Most common source countries (no. of cases)* First Second Third† 2004‡ 4 (4) 375 4.3§ Afghanistan (1) Guatemala (1) Venezuela (1) 2005 10 (9) 365 2.7 Ghana (2) Guinea (2) - 2006 21 (20) 333 6.3 Nigeria (6) Ivory Coast (4) Mozambique (4) 2007 31 (28) 384 8.1 India (5) Ivory Coast (3) Cameroon (2), Nigeria (2) 2008 45 (42) 372 12.1 Kenya (5) Nigeria (5) - 2009 36 (35) 364 9.9 India (5) Ghana (4) - 2010 41 (40) 514 8.0 Cameroon (3) Ghana (3) Honduras (3), Nigeria (3) 2011 60 (58) 517 11.6 India (10) Ghana (7) Nigeria (6) 2012 64 (62) 477 13.4 India (7) Pakistan (6) Sierra Leone (5) 2013 95 (90) 489 19.4 Cameroon (12) Guinea (7) Nigeria (7) 2014¶ 49 (48) Unavailable Unavailable Benin (4) Ghana (4) - Total 456 (437) 4190 11.3 Nigeria (41) India (40) Ghana (32) *Country of exposure may be unknown or unattributable with multicountry itineraries.
†Not noted if more than 5-way tie for third place.
‡Data for Sept. 1, 2004, to Dec. 31, 2004.
§Extrapolated to 1 year.
¶Data for Jan. 1, 2014, to Aug. 31, 2014.
- Table 4: Cases of malaria by travel reason among 18 870 ill returned travellers presenting to a CanTravNet site, 2004-2014
Reason for travel Total no. of malaria diagnoses (no. of travellers) Type of malaria; no. of diagnoses Top 3 countries of exposure Received prophylaxis Plasmodium falciparum Severe malaria Plasmodium vivax Plasmodium ovale Species unknown Plasmodium malariae All
(n = 18 870)456 (437) 282 26 85 21 39 3 See Table 2 68* Tourism
(n = 8 136)54 (52) 29 4 16 2 3 0 Ghana, Uganda, Ivory Coast 8 Immigration (n = 4 967) 62 (60) 35 2 15 4 5 1 India, Nigeria, Liberia NA Visiting friends and relatives
(n = 1 966)174 (169) 117 5 38 7 7 0 Nigeria,
India, Cameroon28 Missionary, volunteer, research or aid work
(n = 1 656)73 (69) 42 7 5 5 13 1 Ghana,
Burkina Faso, Cameroon19 Business
(n = 1 643)77 (71) 51 7 7 3 8 1 Burkina Faso,
Ghana, Guinea7 Other†
(n = 498)16 (16) 8 1 4 0 3 0 India,
Benin, Burkina Faso, Tanzania2 Note: NA = not applicable.*Includes 5 travellers who either missed doses of doxycycline during travel or ran out of doxycycline before the end of travel.
†Includes 355 students, 122 military personnel and 21 people travelling for medical tourism.