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Int. J. Environ. Res. Public Health 2014, 11(6), 5651-5664; doi:10.3390/ijerph110605651

The Epidemiology of Imported Malaria in Taiwan between 2002–2013: The Importance of Sensitive Surveillance and Implications for Pre-Travel Medical Advice

1 Department of Family Medicine, Da-Chien General Hospital, Miaoli 350, Taiwan 2 General Education Center, Ta Tung University, Taipei 111, Taiwan 3 Division of Surveillance, Centers for Disease Control, Taipei 104, Taiwan 4 School of Public Health, National Defense Medical Center, National Defense University, Taipei 117, Taiwan 5 Department of Occupational Medicine, Tainan Municipal Hospital, Tainan 701, Taiwan 6 Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
* Author to whom correspondence should be addressed.
Received: 13 March 2014 / Revised: 8 May 2014 / Accepted: 20 May 2014 / Published: 27 May 2014
(This article belongs to the Special Issue Epidemiology, Prevention and Control of Malaria)
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The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20–5.74). The reproductive number under control (Rc) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan.
Keywords: malaria; travel medicine; immigrant; imported case malaria; travel medicine; immigrant; imported case
This is an open access article distributed under the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Chen, S.-C.; Chang, H.-L.; Chen, K.-T. The Epidemiology of Imported Malaria in Taiwan between 2002–2013: The Importance of Sensitive Surveillance and Implications for Pre-Travel Medical Advice. Int. J. Environ. Res. Public Health 2014, 11, 5651-5664.

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