Malaria--a disease that refuses to die but continues to kill.

404 Previously an endemic area for malaria, Israel was declared malaria free about 50 years ago. The same holds true for other western countries, including those in the northern hemisphere, almost all having been endemic areas of malaria and that succeeded in eradicating the disease in the 20th century. Yet, today, these countries are encountering an increasing number of imported malaria cases due to extensive travel and migration. Most of the cases seen in western countries are people coming from sub-Saharan Africa – where malaria is the predominant disease. The most prevalent species of malaria in sub-Saharan Africa is Plasmodium falciparum, the lethal malaria pathogen. Each year there are about 2 million cases of death in Africa due to falciparum malaria, usually among children who lack immunity. The other common species of malaria, vivax malaria, can cause significant morbidity but rarely causes severe or lethal disease; however, prevention of vivax malaria is much more complicated [1]. The number of imported malaria cases is alarming. In Europe there are about 7,000–8,000 reported cases annually, but the true estimation is 30,000 cases annually [2]. In the United States there are about 1,400 reported cases annually [3], and in Israel there are 60–100 imported cases annually [4]. Among falciparum malaria cases, about 10% will be severe, and among these, 20% will likely be fatal. In the industrialized countries, including Israel, cases of mortality from malaria occur every year, despite the fact that falciparum malaria can be prevented. Moreover, timely diagnosis and treatment can prevent complications and mortality. In this issue of IMAJ, Ben-Ami and colleagues present data on Israeli travelers who acquired malaria in a resort area in Mombassa, Kenya [5]. Their data show that malaria was acquired in Mombassa after less than 2 weeks stay in a good hotel in a coastal resort area, and that the patients were older than the usual travelers to the tropics since the purpose of travel was recreation and leisure rather than an adventure. Ninety percent of the group did not take recommended prophylaxis. This report illustrates several important issues for Israel as well as for the international travel industry. The general perception of the population is that a short stay in a resort hotel is not associated with risk of acquiring malaria. However, it must be stressed that it is not the type of travel but rather the destination that is the risk factor. Malaria …