A recent case of autochthonous infection in Huesca Province highlights the fact that malaria rates in Spain have increased dramatically since the 1960′s. See graph

Graph notes:
1. 461 cases were reported during 1973 to 1982; 1,707 during 1985 to 1994.
2. Plasmodium falciparum accounted for 59.6% of cases reported during 1989 to 1995, with a case/fatality rate of 1.91% among patients infected with this species.
3. P. falciparum accounted for 62.6% of cases reported during 1996 to 1999.
4. No cases of ‘airport malaria’ were reported during 1994 to 1995.
Individual years:
1994 – 69.02% imported from Africa. 115 of these reported from Madrid and 74 from Cataluna.
1995 – 228 from Africa. 89 were from Equatorial Guinea).
1996 – 117 from Madrid and Cataluna. 143 from Africa (51 from Equatorial Guinea).
1997 – 181 from Madrid and Cataluna. 208 from Africa (61 from Equatorial Guinea).
1998 – 219 from Madrid and Cataluna. 271 from Africa (104 from Equatorial Guinea).
1999 – 219 from Madrid and Cataluna. 229 from Africa (65 from Equatorial Guinea).

The following background data are abstracted from references 1 and 2.

Malaria was extremely common in Spain during the first decades of the twentieth century, with 293,000 cases and 1,278 deaths reported during the late 1930′s to early 1940′s. The last confirmed indigenous cases were reported during the 1950′s, and Spain was certified “malaria-free” by WHO in September 1964.

Autochthonous or Introduced malaria:
1978 – A case of introduced malaria was reported (a nurse who had been in contact with a malaria patient).
1984 – An outbreak of 4 cases was reported among injecting drug users in Madrid in 1984. A similar outbreak (2 IDU in Cataluna) was reported in 1986.
1987 – A case of transfusion-related malaria was reported in Valencia.
1991 – An outbreak (43 cases from transfused blood and 11 from plasma) of ‘introduced malaria’ was reported.
1998 – Spain’s last case of introduced malaria (from Mauritania) was reported in the Canary Islands in 1998.

Prevalence surveys:
3.8% of asymptomatic immigrants referred to a tropical medical unit (Madrid, 1989 to 2008)

Vectors:
The local potential vectors are Anopheles atroparvus (throughout) and An. messeae (in the north).
- An. labranchiae, once a common vector, is not longer found in Spain.

References:
1. Berger SA. Infectious Diseases of Spain, 511 pp, 2,036 refs. Gideon e-book series, 2010.
2. Berger SA. Malaria: Global Status, 370 pp, 1,609 refs. Gideon e-book series, 2010.

Although increasing numbers of malaria cases have been reported in Ireland in recent years, disease rates for Northern Ireland and the United Kingdom as a whole have actually declined. [1,2]

References:
1. Berger SA. Infectious Diseases of Ireland and Northern Ireland, 2010. Gideon e-book series, 437 pp. http://www.gideononline.com/ebooks/country/infectious-diseases-of-ireland-and-northern-ireland/
2. Berger SA. Malaria: Global Status, 2010. Gideon e-boon series, 378 pp. http://www.gideononline.com/ebooks/disease/malaria-global-status/

Although autochthonous cases continue to be reported, malaria rates in Georgia and surrounding countries have decreased considerably since 1999. With the exception of Russia, all of the countries which border Georgia had reported higher rates in recent years.

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.

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ProMED recently quoted GIDEON in a post about Malaria in India:

According to information available on the Global Infectious Disease and Epidemiology Network (GIDEON)

Two-thirds of all cases are reported from Gujarat, Karnatka, Madhya Pradesh, Orissa, Uttar Pradesh and Punjab.
- Orissa, Assam & Maharashtra account for 80 percent of all _plasmodium falciparum_ malaria.
- Malaria is reported nationwide, including Delhi and Bombay; but not in Hichal Pradesh, Jammu & Sikkim, isolated coastal areas around Western Ghats, Andaman and Nicobar Islands. Transmission begins with the onset of the Monsoon seasonb in mid-June.
- _P. vivax_ predominates until August, with _P. falciparum_ infection rising to a peak in September.
- There is no risk for malaria at altitudes above 2000 meters.

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