Last Updated: 17/12/2024
The importance of an active case detection programme for malaria among migrants from malaria endemic countries: The Greek experience in a receptive and vulnerable area
Objectives
The aim of this study is to describe the active case detection (ACD) program implemented during 2012–2017 in the receptive and vulnerable Evrotas area in Greece, which is a developed malaria free country, to present the results including the achievement of surveillance indicators, and discuss the challenges in its implementation.
In October 2011, following an outbreak of 36 locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases.
The total number of migrants who were screened for malaria symptoms for the years 2012-2017 was 5057 with 84,169 fever screenings conducted, while 2288 Rapid Diagnostic Tests (RDT) and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reported in 2012 and 2015, respectively. Sensitivity of the PACD program ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness between diagnosis and treatment initiation was 0 h.
The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction.
Each migrant was visited at home every 7-15 days to screen for malaria symptoms, and performing RDTs and blood smears on symptomatic patients. A “suspected malaria case” was defined as any person with documented temperature ≥37.0 ◦C, or history/complaints of fever and/or other malaria-compatible symptoms (headache, fatigue, myalgia) in the previous 7–15 days.
The PACD program was evaluated according to the following indicators, adapted from the WHO guidance on Malaria Elimination:
– Number/proportion of locally acquired malaria cases exposed in Evrotas
– Sensitivity: Number/proportion of imported malaria cases detected through PACD
– Median time from onset of symptoms (fever) to first contact with the health system (target 24–48 h)
– Median time from first contact with the health system to malaria testing (target < 12 h)
– Median time from onset of symptoms (fever) to diagnosis (target: 24–48 h)
– Median time from diagnosis to treatment onset (target < 12 h)
Jan 2012 — Dec 2017
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