A recent case in the Lake Fondi region reminds us that the potential for malaria transmission persists in Europe. In fact, sporadic reports of cryptic, airport- and locally-acquired malaria have appeared in the Italian literature in recent years. The following review of malaria in Italy was abstracted from GIDEON.

Historical background

• Malaria was eradicated from Sardinia during 1946 to 1950, through massive application (267 metric tons) of DDT.
• A single endemic case (Plasmodium vivax in Palma di Montechiaro, Sicily) was reported in 1956; with sporadic cases in the area of Palermo during 1962.
• The country was declared ‘malaria-free’ in 1970.
• A single case of autochthonous malaria (P. vivax) was reported in Maremma (Tuscany) in 1997 – Anopheles labranchiae was implicated as the vector.

Although disease rates have increased in recent years, imported malaria continues to be less common than in neighboring France and Switzerland.

Additional notes:
1. 411,000 cases of malaria were reported in 1949.
2. 74,641 cases were reported on Sardinia in 1946; 39,303 in 1947; 15,121 in 1948; 1,314 in 1949; 0 in 1950; 9 in 1951; 0 in 1952.
3. 1,087 cases of malaria were reported during 1973 to 1982; 5,843 during 1986 to 1996 (including 7 transfusion-related, 2 ‘airport malaria’ and 7 cryptic); 3,354 during 2002 to 2006 – 71.0% among foreigners.
4. 97.9% of cases reported during 1989 to 1997 were imported, 106 characterized as relapses and 19 acquired in Italy.
5. 407 cases of imported malaria among children ages 0 to 18 were reported during 1992 to 2002 – 82.3% due to Plasmodium falciparum.
6. 86% to 92% of cases are acquired in Africa (1995 to 2006)
7. 73.3% of malaria cases reported during 1986 to 1997 were caused by P. falciparum and 20% P. vivax.
8. P. falciparum accounted for 73.8% of cases during 1989 to 1997; 84% during 1999 to 2000; 84.6% during 2002 to 2006.
Individual years:
1998 – The rate of malaria among Italian tourists to Africa was 100 per 100,000, 10 per 100,000 to Asia, and 0.9 to Latin America.
2000 – The rate of malaria among Italian tourists to Africa was 70 per 100,000, 5 per 100,000 Asia and 2 per 100,000 Latin America.
2000 – A cluster of 22 Chinese immigrants with malaria was reported. 4 5
2001 – Included one case of nosocomial transmission.

No cases of ‘airport malaria’ were reported during 1994 to 1995.

17 cases of cryptic infection (all due to P. falciparum) were reported during 1986 to 1996.

Fatal cases:
1. One to seven fatal cases are reported most years (1971 to 2007) ; with a peak of 12 fatal cases in 1997.
2. During 1890 to 1900, 2,000 to 2,200 persons on Sardinia died each year of malaria.
3. Death rates for Italy / Sardinia per 100,000 population: 58 / 300 during 1887 to 1889; 59 / 298 during 1900 to 1902; 6 / 43 during 1912 to 1914.
4. 138 fatal cases were reported on Sardinia in 1939; 88 in 1940; 169 in 1946.

Vectors:
The potential vectors for Italy are Anopheles superpictus and An. labranchiae.
- An. atoparvus was once active in transmission, and is still present in Tuscany (Fucecchio and Cerbaie woodlands, Grosseto and Siena)
- An. sacharovi was previously found in Puglia and Sardina, but was absent as of 1994. – An. labranchiae is found in Tuscany (Grosseto Province and areas of intensive rice cultivation), Apulia (coastal plains of the Adriatic from Lesina lake to the Candelaro River), Calabria (Coastal plains of the Tirrenian and Ionian sides and the close hiterland) , Puglia, Sicily (rural coastal and hilly areas); and Sardinia (rural coastal and hilly areas).
- An superpictus is found in Calabria (Coastal plains of the Tirrenian and Ionian sides and the close hiterland), and Sicily (rural coastal and hilly areas).

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