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DEATHS CAUSED BY MALARIA IN SWITZERLAND 1988–2002

Despite sophisticated intensive medicine, between one and three malaria-associated deaths occur annually in Switzerland. In this retrospective study, 33 deaths (25 men and 8 women) caused by falciparum malaria reported in Switzerland from 1988 to 2002 were analyzed. The case fatality ratio (CFR) for the falciparum infections for the 15-year period was 1.2%, with a peak of 2.2% in 1991. Sub-Saharan Africa was the source of all the imported fatal infections. Non-immune Europeans had a significantly higher case fatality ratio than the non-Europeans (1.7% versus 0.2%; P < 0.001). Careless use or non-use of prophylaxis, sometimes because of physicians giving unsatisfactory pre-travel advice, and initially missed diagnosis post-travel were factors that contributed to the development of severe infections leading to death. Travelers should be sensitized to the risk of malaria by well-informed general practitioners. Updated information is readily available (www.safetravel.ch). Regarding diagnosis and treatment, greater physician awareness of the disease is needed, and expert advice should be sought without hesitation. Rapid malaria tests may be a useful diagnostic adjunct in centers where microscopic expertise is lacking. Falciparum malaria in a non-immune patient is an emergency requiring immediate treatment.

Received June 16, 2005. Accepted for publication July 19, 2006.

Acknowledgments: The authors thank the physicians and hospitals who provided detailed clinical data for this study, Prof. Christoph Hatz for productive cross-reading, and Dr. Lehky-Hagen for contributions to this work. We are indebted to Simone Graf, from the SFOPH, for contributions that were central to this manuscript.

^* Address correspondence to Patricia Schlagenhauf, WHO CC for Travellers’ Health, Division of Epidemiology and Communicable Diseases, Institute for Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland. E-mail: pat{at}ifspm.unizh.ch

Authors’ addresses: Daniel Christen, WHO CC for Travellers’ Health, Division of Epidemiology and Communicable Diseases, Institute for Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland, Telephone: 41-44-6344630, E-mail: christendaniel{at}gmx.net. Robert Steffen, WHO CC for Travellers’ Health, Division of Epidemiology and Communicable Diseases, Institute for Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland, Telephone: 41-44-6344620, Fax: 41-44-6344984, E-mail: roste{at}ofspm.unizh.ch. Patricia Schlagenhauf, WHO CC for Travellers’ Health, Division of Epidemiology and Communicable Diseases, Institute for Social and Preventive Medicine, University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland, Telephone: 41-44-6344630, E-mail: pat{at}ifspm.unizh.ch.

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