Eritrean and Sudanese migrants presenting with malaria in Israel

In Israel, a malaria-free country, we have noticed lately an increase of hospital admissions with malaria, parallel to the rise in the number of Eritrean and Sudanese migrants. Eritrea and Sudan are malaria-endemic countries; Plasmodium falciparum accounts for 85-90% and Plasmodium vivax accounts for 10-15% of malaria species in these areas. We aimed to describe the features of malaria in this migrant population by conducting a retrospective descriptive study of Eritrean and Sudanese migrants admitted with malaria during 1/2009-4/2010. Patient files were reviewed for demographics, clinical data, laboratory tests, treatment and outcome. 101 patients (mean age 24.9 (SD 5.6) years; 86.1% males) with malaria were identified. 87.1% were infected with P. vivax, 6% with P. falciparum, and 6.9% had both. All presented with pyrexia. None had respiratory or cerebral complications. Mean length of hospitalization was 2.49 (SD 1.5) days. No treatment failures or complications were observed. We conclude that in countries with waves of migrants from malaria-endemic areas, onset of fever should raise suspicion of malaria. Contrary to the known dominance of P. falciparum among malaria species in Eritrea and Sudan, the vast majority of migrants presented with P. vivax. The region of P. vivax acquisition remains unclear.