Migration and malaria in europe

Begoña Monge-Maillo, Rogelio López-Vélez, Begoña Monge-Maillo, Rogelio López-Vélez

Abstract

The proportion of imported malaria cases due to immigrants in Europe has increased during the lasts decades, with higher rates associated with settled immigrants who travel to visit friends and relatives (VFRs) in their country of origin. Cases are mainly due to P. falciparum and Sub-Saharan Africa is the most common origin. Clinically, malaria in immigrants is characterised by a mild clinical presentation including asymptomatic or delayed malaria cases and low parasitic levels. These characteristics may be explained by a semi-immunity acquired after long periods of time exposed to stable malaria transmission. Malaria cases among immigrants, even asymptomatic patients with sub-microscopic parasitemia, could increase the risk of transmission and cause the reintroduction of malaria in certain areas that have adequate vectors and climate conditions. Moreover, imported malaria cases in immigrants can also play an important role in the non-vector transmission out of endemic areas, through blood transfusions, organ transplantation or congenital transmission or occupational exposures. Consequently, outside of endemic areas, malaria screening should be carried out among recently arrived immigrants coming from malaria endemic countries. The aim of screening is to reduce the risk of clinical malaria in the individual as well as to prevent autochthonous transmission of malaria in areas where it has been eradicated.

Figures

Fig 1
Fig 1
Imported malaria cases in Europe. Data from WHO Regional Office for Europe.

References

    1. World health organization. World malaria report 2010. Available at:
    1. European Commission. Eurostat. Katya Vasileva. Population and social conditions. 2011;34 Available at: .
    1. Sabatinelli G, Ejov M, Joergensen P. Malaria in the WHO European region 1971–1999. Euro Surveill. 2001;6:61–65.
    1. World Health Organization Regional Office for Europe. Centralized information system for infectious diseases (CISID) Available at: .
    1. Odolini S, Parola P, Gkrania-Klotsas E, Caumes E, Schlagenhauf P, López-Vélez R, Burchard GD, Santos-O’Connor F, Weld L, von Sonnenburg F, Field V, de Vries P, Jensenius M, Loutan L, Castelli F. Travel-related imported infections in europe, EuroTravNet 2009. Clin Microbiol Infect. 2011
    1. van Rijckevorsel GG, Sonder GJ, Geskus RB, Wetsteyn JC, Ligthelm RJ, Visser LG, Keuter M, van Genderen PJ, van den Hoek A. Declining incidence of imported malaria in the netherlands, 2000–2007. Malar J. 2010;9:300. doi: 10.1186/1475-2875-9-300. doi: 10.1186/1475-2875-9-300.
    1. Behrens RH, Carroll B, Smith V, Alexander N. Declining incidence of malaria imported into the UK from west africa. Malar J. 2008;7:235. doi: 10.1186/1475-2875-7-235.
    1. Jelinek T, Schulte C, Behrens R, Grobusch MP, Coulaud JP, Bisoffi Z, Matteelli A, Clerinx J, Corachán M, Puente S, Gjørup I, Harms G, Kollaritsch H, Kotlowski A, Björkmann A, Delmont JP, Knobloch J, Nielsen LN, Cuadros J, Hatz C, Beran J, Schmid ML, Schulze M, Lopez-Velez R, Fleischer K, Kapaun A, McWhinney P, Kern P, Atougia J, Fry G, da Cunha S, Boecken G. Imported falciparum malaria in Europe: Sentinel surveillance data from the European network on surveillance of imported infectious diseases. Clin Infect Dis. 2002;34:572–576. doi: 10.1086/338235.
    1. Romi R, Sabatinelli G, Majori G. Malaria epidemiological situation in italy and evaluation of malaria incidence in italian travelers. J Travel Med. 2001;8:6–11. doi: 10.2310/7060.2001.5140.
    1. Mascarello M, Gobbi F, Angheben A, Concia E, Marocco S, Anselmi M, Monteiro G, Rossanese A, Bisoffi Z. Imported malaria in immigrants to italy: A changing pattern observed in north eastern italy. J Travel Med. 2009;16:317–321. doi: 10.1111/j.1708-8305.2009.00321.x.
    1. Foca A, Barreca GS, Barbieri V, Matera G, Liberto MC, De Rosa M. Fourteen-year experience with imported malaria. Infez Med. 2004;12:186–192.
    1. Millet JP, Garcia de Olalla P, Carrillo-Santisteve P, Gascón J, Trevino B, Munoz J, Gómez I, Prat J, Cabezos J, González Cordón A, Caylà JA. Imported malaria in a cosmopolitan european city: A mirror image of the world epidemiological situation. Malar J. 2008;7:56. doi: 10.1186/1475-2875-7-56.
    1. Rojo-Marcos G, Cuadros-Gonzalez J, Gete-Garcia L, Prieto-Rios B, Arcos-Pereda P. Imported malaria in a general hospital in Madrid. Enferm Infecc Microbiol Clin. 2007;25:168–171. doi: 10.1157/13099367.
    1. Driessen GJ, Pereira RR, Brabin BJ, Hartwig NG. Imported malaria in children: A national surveillance in the Netherlands and a review of European studies. Eur J Public Health. 2008;18:184–188. doi: 10.1093/eurpub/ckm101.
    1. Mascarello M, Allegranzi B, Angheben A, Anselmi M, Concia E, Laganà S, Manzoli L, Marocco S, Monteiro G, Bisoffi Z. Imported malaria in adults and children: Epidemiological and clinical characteristics of 380 consecutive cases observed in verona, italy. J Travel Med. 2008;15:229–236. doi: 10.1111/j.1708-8305.2008.00204.x.
    1. Ladhani S, Aibara RJ, Riordan FA, Shingadia D. Imported malaria in children: A review of clinical studies. Lancet Infect Dis. 2007;7:349–357. doi: 10.1016/S1473-3099(07)70110-X.
    1. Bacaner N, Stauffer B, Boulware DR, Walker PF, Keystone JS. Travel medicine considerations for North American immigrants visiting friends and relatives. JAMA. 2004;291:2856–2864. doi: 10.1001/jama.291.23.2856.
    1. Angell SY, Behrens RH. Risk assessment and disease prevention in travelers visiting friends and relatives. Infect Dis Clin North Am. 2005;19:49–65. doi: 10.1016/j.idc.2004.11.001.
    1. Angell SY, Cetron MS. Health disparities among travelers visiting friends and relatives abroad. Ann Intern Med. 2005;142:67–72.
    1. Leder K, Tong S, Weld L, Kain KC, Wilder-Smith A, von Sonnenburg F, Black J, Brown GV, Torresi J GeoSentinel Surveillance Network. Illness in travelers visiting friends and relatives: A review of the GeoSentinel surveillance network. Clin Infect Dis. 2006;43:1185–1193. doi: 10.1086/507893.
    1. Smith AD, Bradley DJ, Smith V, Blaze M, Behrens RH, Chiodini PL, Whitty CJ. Imported malaria and high risk groups: Observational study using UK surveillance data 1987–2006. BMJ. 2008;337:a120. doi: 10.1136/bmj.a120.
    1. Angell SY, Behrens RH. Risk assessment and disease prevention in travelers visiting friends and relatives. Infect Dis Clin North Am. 2005;19:49–65. doi: 10.1016/j.idc.2004.11.001.
    1. Fulford M, Keystone JS. Health risks associated with visiting friends and relatives in developing countries. Curr Infect Dis Rep. 2005;7:48–53. doi: 10.1007/s11908-005-0023-z.
    1. Muentener P, Schlagenhauf P, Steffen R. Imported malaria 1985–95. Trends and perspectives. Bull World Health Organ. 1999;77:560–566.
    1. Monge-Maillo B, Jiménez BC, Pérez-Molina JA, Norman F, Navarro M, Pérez-Ayala A, Herrero JM, Zamarrón P, López-Vélez R. Imported infectious diseases in mobile populations, spain. Emerg Infect Dis. 2009;15:1745–1752.
    1. Marangi M, Di Tullio R, Mens PF, Martinelli D, Fazio V, Angarano G, Schallig HD, Giangaspero A, Scotto G. Prevalence of plasmodium spp. in malaria asymptomatic african migrants assessed by nucleic acid sequence based amplification. Malar J. 2009;8:12. doi: 10.1186/1475-2875-8-12.
    1. Ndao M, Bandyayera E, Kokoskin E, Gyorkos TW, MacLean JD, Ward BJ. Comparison of blood smear, antigen detection, and nested-PCR methods for screening refugees from regions where malaria is endemic after a malaria outbreak in quebec, canada. J Clin Microbiol. 2004;42:2694–2700. doi: 10.1128/JCM.42.6.2694-2700.2004.
    1. Cherian S, Fagan JM, Thambiran A, Geddes J, Burgner D. Severe plasmodium falciparum malaria in refugee children despite reported predeparture antimalarial treatment. Med J Aust. 2006;185:611.
    1. Maroushek SR, Aguilar EF, Stauffer W, Abd-Alla MD. Malaria among refugee children at arrival in the united states. Pediatr Infect Dis J. 2005;24:450–452. doi: 10.1097/01.inf.0000160948.22407.0d.
    1. Alves FP, Durlacher RR, Menezes MJ, Krieger H, Silva LH, Camargo EP. High prevalence of asymptomatic plasmodium vivax and plasmodium falciparum infections in native amazonian populations. Am J Trop Med Hyg. 2002;66:641–648.
    1. Cucunuba ZM, Guerra AP, Rahirant SJ, Rivera JA, Cortes LJ, Nicholls RS. Asymptomatic plasmodium spp. infection in Tierralta, Colombia. Mem Inst Oswaldo Cruz. 2008;103:668–673. doi: 10.1590/S0074-02762008000700007.
    1. Sheikh M, Pal A, Wang S, MacIntyre CR, Wood NJ, Isaacs D, Gunasekera H, Raman S, Hale K, Howell A. The epidemiology of health conditions of newly arrived refugee children: A review of patients attending a specialist health clinic in Sydney. J Paediatr Child Health. 2009;45:509–513. doi: 10.1111/j.1440-1754.2009.01550.x.
    1. Martin JA, Mak DB. Changing faces: A review of infectious disease screening of refugees by the migrant health unit, western Australia in 2003 and 2004. Med J Aust. 2006;185:607–610.
    1. Tiong AC, Patel MS, Gardiner J, Ryan R, Linton KS, Walker KA, Scopel J, Biggs BA. Health issues in newly arrived African refugees attending general practice clinics in Melbourne. Med J Aust. 2006;185:602–606.
    1. Krajden S, Panisko DM, Tobe B, Yang J, Keystone JS. Prolonged infection with plasmodium falciparum in a semi-immune patient. Trans R Soc Trop Med Hyg. 1991;85:731–732. doi: 10.1016/0035-9203(91)90434-Z.
    1. Greenwood T, Vikerfors T, Sjoberg M, Skeppner G, Farnert A. Febrile plasmodium falciparum malaria 4 years after exposure in a man with sickle cell disease. Clin Infect Dis. 2008;47:e39–41. doi: 10.1086/590250.
    1. Szmitko PE, Kohn ML, Simor AE. Plasmodium falciparum malaria occurring 8 years after leaving an endemic area. Diagn Microbiol Infect Dis. 2009;63:105–107. doi: 10.1016/j.diagmicrobio.2008.08.017.
    1. D’Ortenzio E, Godineau N, Fontanet A, Houze S, Bouchaud O, Matheron S, Le Bras J. Prolonged plasmodium falciparum infection in immigrants, Paris. Emerg Infect Dis. 2008;14:323–326. doi: 10.3201/eid1402.061475.
    1. Revel MP, Datry A, Saint Raimond A, Lenoir G, Danis M, Gentilini M. Plasmodium falciparum malaria after three years in a non-endemic area. Trans R Soc Trop Med Hyg. 1988;82:832. doi: 10.1016/0035-9203(88)90008-9.
    1. Theunissen C, Janssens P, Demulder A, Nouboussié D, Van-Esbroeck M, Van-Gompel A, Van-Denende J. Falciparum malaria in patient 9 years after leaving malaria-endemic area. Emerg Infect Dis. 2009;15:115–116. doi: 10.3201/eid1501.080909.
    1. Males S, Gaye O, Garcia A. Long-term asymptomatic carriage of plasmodium falciparum protects from malaria attacks: A prospective study among Senegalese children. Clin Infect Dis. 2008;46:516–522. doi: 10.1086/526529.
    1. Reyburn H, Mbatia R, Drakeley C, Bruce J, Carneiro I, Olomi R, Cox J, Nkya WM, Lemnge M, Greenwood BM, Riley EM. Association of transmission intensity and age with clinical manifestations and case fatality of severe plasmodium falciparum malaria. JAMA. 2005;293:1461–1470. doi: 10.1001/jama.293.12.1461.
    1. Struik SS, Riley EM. Does malaria suffer from lack of memory? Immunol Rev. 2004;201:268–290. doi: 10.1111/j.0105-2896.2004.00181.x.
    1. Langhorne J, Ndungu FM, Sponaas AM, Marsh K. Immunity to malaria: More questions than answers. Nat Immunol. 2008;9:725–732. doi: 10.1038/ni.f.205.
    1. Bouchaud O, Cot M, Kony S, Durand R, Schiemann R, Ralaimazava P, Coulaud JP, Le Bras J, Deloron P. Do African immigrants living in France have long-term malarial immunity? Am J Trop Med Hyg. 2005;72:21–25.
    1. Chougnet C, Deloron P, Savel J. Persistence of cellular and humoral response to synthetic peptides from defined plasmodium falciparum antigens. Ann Trop Med Parasitol. 1991;85:357–363.
    1. Deloron P, Chougnet C. Is immunity to malaria really short-lived? Parasitol Today. 1992;8:375–378. doi: 10.1016/0169-4758(92)90174-Z.
    1. Lindo JF, Bryce JH, Ducasse MB, Howitt C, Barrett DM, Lorenzo Morales J, Ord R, Burke M, Chiodini PL, Sutherland CJ. Plasmodium malariae in Haitian refugees, Jamaica. Emerg Infect Dis. 2007;13:931–933.
    1. MMWR. Morbidity and mortality weekly report JID - 7802429.0922. Malaria--great exuma, bahamas, may–june 2006.
    1. Schneider P, Bousema JT, Gouagna LC, Otieno S, van de Vegte-Bolmer M, Omar SA, Sauerwein RW. Submicroscopic plasmodium falciparum gametocyte densities frequently result in mosquito infection. Am J Trop Med Hyg. 2007;76:470–474.
    1. Bruneel F, Thellier M, Eloy O, Mazier D, Boulard G, Danis M, Bédos JP. Transfusion-transmitted malaria. Intensive Care Med. 2004;30:1851–1852. doi: 10.1007/s00134-004-2366-6.
    1. Menichetti F, Bindi ML, Tascini C, Urbani L, Biancofiore G, Doria R, Esposito M, Mozzo R, Catalano G, Filipponi F. Fever, mental impairment, acute anemia, and renal failure in patient undergoing orthotopic liver transplantation: Posttransplantation malaria. Liver Transpl. 2006;12:674–676. doi: 10.1002/lt.20730.
    1. Kitchen AD, Barbara JA, Hewitt PE. Documented cases of post-transfusion malaria occurring in england: A review in relation to current and proposed donor-selection guidelines. Vox Sang. 2005;89:77–80. doi: 10.1111/j.1423-0410.2005.00661.x.
    1. Scuracchio P, Vieira SD, Dourado DA, Bueno LM, Colella R, Ramos-Sanchez EM, Lima GF, Inoue J, Sanchez MC, Di Santi SM. Transfusion-transmitted malaria: Case report of asymptomatic donor harboring plasmodium malariae. Rev Inst Med Trop Sao Paulo. 2011;53:55–59. doi: 10.1590/S0036-46652011000100010.
    1. Hung CC, Chang SC, Chen YC, Yen TS, Hsieh WC. Plasmodium vivax infection in a renal transplant recipient: Report of a case. J Formos Med Assoc. 1994;93:888–889.
    1. Einollahi B. Plasmodium falciparum infection transmitted by living kidney donation: A case report from Iran. Ann Transplant. 2008;13:75–78.
    1. Babinet J, Gay F, Bustos D, Dubarry M, Jaulmes D, Nguyen L, Gentilini M. Transmission of plasmodium falciparum by heart transplant. BMJ. 1991;303:1515–1516. doi: 10.1136/bmj.303.6816.1515.
    1. Chiche L, Lesage A, Duhamel C, Salame E, Malet M, Samba D, Segol P, Treilhaud M. Posttransplant malaria: First case of transmission of plasmodium falciparum from a white multiorgan donor to four recipients. Transplantation. 2003;75:166–168. doi: 10.1097/00007890-200301150-00031.
    1. Crafa F, Gugenheim J, Fabiani P, Di Marzo L, Militerno G, Iovine L, Goubaux B, Mouiel J. Possible transmission of malaria by liver transplantation. Transplant Proc. 1991;23:2664.
    1. Seth AK, Puri P, Chandra A, Dutta V, Naidu S, Saha A. Mixed plasmodium falciparum and plasmodium vivax malaria in orthotopic liver transplant recipient. Transplantation. 2009;88:288. doi: 10.1097/TP.0b013e3181acc314.
    1. Fischer L, Sterneck M, Claus M, Costard-Jäckle A, Fleischer B, Herbst H, Rogiers X, Broelsch CE. Transmission of malaria tertiana by multi-organ donation. Clin Transplant. 1999;13:491–495. doi: 10.1034/j.1399-0012.1999.130609.x.
    1. Hagmann S, Khanna K, Niazi M, Purswani M, Robins EB. Congenital malaria, an important differential diagnosis to consider when evaluating febrile infants of immigrant mothers. Pediatr Emerg Care. 2007;23:326–329. doi: 10.1097/01.pec.0000270164.78238.7d.
    1. European centre for disease prevention and control. Epidemiological update: Malaria in Greece. Nov, 2011. Available at: .
    1. Danis K, Baka A, Lenglet A, Van Bortel W, Terzaki I, Tseroni M, Detsis M, Papanikolaou E, Balaska A, Gewehr S, Dougas G, Sideroglou T, Economopoulou A, Vakalis N, Tsiodras S, Bonovas S, Kremastinou J. Autochthonous plasmodium vivax malaria in greece, 2011. Euro Surveill. 2011;16:19993.
    1. Santa-Olalla Peralta P, Vazquez-Torres MC, Latorre-Fandos E, Mairal-Claver P, Cortina-Solano P, Puy-Azón A, Adiego Sancho B, Leitmeyer K, Lucientes-Curdi J, Sierra-Moros MJ. First autochthonous malaria case due to plasmodium vivax since eradication, Spain, October 2010. Euro Surveill. 2010;15:19684.
    1. Rogers DJ, Randolph SE. The global spread of malaria in a future, warmer world. Science. 2000;289:1763–1766.
    1. CDC. Recommendations for Pre-departure Presumptive Treatment and Directed Treatment for Malaria for all Refugees from Sub Saharan Africa to United States. Atlanta, GA: US Department of Health and Human Service, CDC; 2010. Available at: .
    1. Murray RJ, Davis JS, Burgner DP Australasian Society for Infectious Diseases Refugee Health Guidelines Writing Group. Hansen-Knarhoi M, Krause V, Biggs BA, Lemoh C, Benson J, Cherian S, Buttery J, Paxton G. The Australasian society for infectious diseases guidelines for the diagnosis, management and prevention of infections in recently arrived refugees: An abridged outline. Med J Aust. 2009;190:421–425.
    1. Monge-Maillo B, Lopez-Velez R. Is screening for malaria necessary among asymptomatic refugees and immigrants coming from endemic countries? Expert Rev Anti Infect Ther. 2011;9:521–524. doi: 10.1586/eri.11.37.
    1. Ohrt C, O'Meara WP, Remich S, McEvoy P, Ogutu B, Mtalib R, Odera JS. Pilot assessment of the sensitivity of the malaria thin film. Malar J. 2008;7:22. doi: 10.1186/1475-2875-7-22.
    1. Babiker HA, Schneider P. Application of molecular methods for monitoring transmission stages of malaria parasites. Biomed Mater. 2008;3:034007. doi: 10.1088/1748-6041/3/3/034007.
    1. Okell LC, Ghani AC, Lyons E, Drakeley CJ. Submicroscopic infection in plasmodium falciparum-endemic populations: A systematic review and meta-analysis. J Infect Dis. 2009;200:1509–1517. doi: 10.1086/644781.
    1. Stauffer WM, Newberry AM, Cartwright CP, Rosenblatt JE, Hanson KL, Sloan L, Tsukayama DT, Taylor C, Juni BA. Evaluation of malaria screening in newly arrived refugees to the united states by microscopy and rapid antigen capture enzyme assay. Pediatr Infect Dis J. 2006;25:948–950. doi: 10.1097/01.inf.0000235747.28644.6f.
    1. Sama W, Killeen G, Smith T. Estimating the duration of plasmodium falciparum infection from trials of indoor residual spraying. Am J Trop Med Hyg. 2004;70:625–634.
    1. Espinosa-Vega E, Martin-Sanchez AM, Elcuaz-Romano R, Hernandez-Febles M, Molina-Cabrillana J, Perez-Arellano JL. Malaria in paradise: Characterization of imported cases in gran canaria island 1993–2006. J Travel Med. 2011;18:165–172. doi: 10.1111/j.1708-8305.2011.00503.x.
    1. Antinori S, Cigardi B, Galimberti L, Orlando G, Schifanella L, Milazzo L, Viola A, Giuliani G, Ridolfo A, Corbellino M. Diagnosis and therapy for hospitalized imported malaria in adults in Italy. J Travel Med. 2011;18:379–385. doi: 10.1111/j.1708-8305.2011.00554.x.
    1. Garcia-Villarrubia M, Millet JP, de Olalla PG, Gascón J, Fumadó Vi, Prat JG, Trevino B, Pinazo MJ, Cabezos J, Munoz J, Zarzuela F, Caylà JA. Epidemiology of imported malaria among children and young adults in Barcelona 1990–2008. Malar J. 2011;10:347. doi: 10.1186/1475-2875-10-347.
    1. Arnáez J, Roa MA, Albert L, Cogollos R, Rubio JM, Villares R, Alarabe A, Cervera A, López-Vélez R. Imported malaria in children: A comparative study between recent immigrants and immigrant travelers (VFRs) J Travel Med. 2010;17:221–227. doi: 10.1111/j.1708-8305.2010.00416.x.
    1. Rey S, Zuza I, Martinez-Mondejar B, Rubio JM, Merino FJ. Imported malaria in an area in southern madrid, 2005–2008. Malar J. 2010;9:290. doi: 10.1186/1475-2875-9-290.
    1. Guedes S, Siikamaki H, Kantele A, Lyytikainen O. Imported malaria in finland 1995 to 2008: An overview of surveillance, travel trends, and antimalarial drug sales. J Travel Med. 2010;17:400–404. doi: 10.1111/j.1708-8305.2010.00456.x.
    1. Martinez-Baylach J, Cabot Dalmau A, Garcia Rodriguez L, Sauca G. Imported malaria: Clinical and epidemiological review of an emerging disease. An Pediatr (Barc) 2007;67:199–205.
    1. Spinazzola F, Nicastri E, Vlassi C, Ghirga P, De Marco M, Pittalis S, Paglia MG, Ferrari C, Narciso P. Imported malaria at Italy's national institute for infectious diseases Lazzaro Spallanzani, 1984–2003. Eur J Clin Microbiol Infect Dis. 2007;26:175–179. doi: 10.1007/s10096-007-0266-8.
    1. Williams JP, Chitre M, Sharland M. Increasing plasmodium falciparum malaria in southwest london: A 25 year observational study. Arch Dis Child. 2002;86:428–430. doi: 10.1136/adc.86.6.428.
    1. Baas MC, Wetsteyn JC, van Gool T. Patterns of imported malaria at the academic medical center, amsterdam, the netherlands. J Travel Med. 2006;13:2–7. doi: 10.1111/j.1708-8305.2006.00003.x.
    1. Chalumeau M, Holvoet L, Chéron G, Minodier P, Foix-L'Hélias L, Ovetchkine P, Moulin F, Nouyrigat V, Bréart G, Gendrel D. Delay in diagnosis of imported plasmodium falciparum malaria in children. Eur J Clin Microbiol Infect Dis. 2006;25:186–189. doi: 10.1007/s10096-006-0105-3.
    1. Ladhani S, El Bashir H, Patel VS, Shingadia D. Childhood malaria in east london. Pediatr Infect Dis J. 2003;22:814–819. doi: 10.1097/01.inf.0000086401.13592.79.
    1. Huerga H, Lopez-Velez R. Infectious diseases in sub-saharan african immigrant children in madrid, spain. Pediatr Infect Dis J. 2002;21:830–834. doi: 10.1097/00006454-200209000-00009.
    1. Huerga H, Lopez-Velez R. Imported malaria in immigrant and travelling children in madrid. Eur J Clin Microbiol Infect Dis. 2001;20:591–593. doi: 10.1007/s100960100558.
    1. Matteelli A, Volonterio A, Gulletta M, Galimberti L, Maroccolo S, Gaiera G, Giani G, Rossi M, Dorigoni N, Bellina L, Orlando G, Bisoffi Z, Castelli F. Malaria in illegal Chinese immigrants, Italy. Emerg Infect Dis. 2001;7:1055–1058. doi: 10.3201/eid0706.010628.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi