Epidemiological and clinical characteristics of imported malaria and their associated presentations and outcomes at a major hospital in Al Ain, United Arab Emirates: 2012–2017

B ackground:

Following the United Arab Emirates’ (UAE) successful elimination of indigenous malaria transmission in 2007, travel-associated malaria has continued to exert significant pressure on local healthcare services.
Methods:
Electronic medical records of all patients seen with laboratory confirmed malaria at a major tertiary hospital in Al Ain in the period from 01 October 2012 through 30 September 2017 were reviewed retrospectively. Epidemiology, clinical features, and outcomes of imported malaria were examined.
Results:
In total, 809 patients were treated for one or more malaria episodes during the study period. Of these, 79.6% (644/809) patients presented with Plasmodium vivax and 20.4% (165/809) patients with P. falciparum infections. The median age at first presentation was 28 years (IQR 23–40). The majority of patients were males (93.3%, 755/809); and were originally from the Indian subcontinent (89.3%, 722/809). The Indian subcontinent was the most frequent travel destination (82.6%, 299/362). Chemoprophylaxis uptake was poor (1%, 2/185). The interval between arrival from abroad and hospital presentation was short for P. falciparum (median 11 days, IQR 7–21, n=131) but longer for P. vivax (median 120 days, IQR 21–210, n=217). July–September was the peak season of presentation (43.1%, 349/809). The median P. falciparum parasitaemia was 0.4% (IQR 0.1–1.1, n=141); and >2% parasitaemia was recorded in 14.2% (20/141) of these patients. Most malaria patients were managed on ambulatory basis: 73.6% (474/644) for P. vivax and 18.8% (31/165) for P. falciparum. Four patients with P. falciparum and three patients with P. vivax required critical care admission. No deaths were recorded.

Conclusions:Malaria awareness and access to prevention tools should be scaled up among UAE’s expatriate community, especially those from the Indian subcontinent.