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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Really malaria-free Europe?
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Vol. 36. Issue 4.
Pages 251-252 (April 2018)
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Vol. 36. Issue 4.
Pages 251-252 (April 2018)
Scientific letter
DOI: 10.1016/j.eimce.2017.07.002
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Really malaria-free Europe?
¿Es real una Europa libre de malaria?
Aitor Olasoa,
Corresponding author

Corresponding author.
, María F. López-Ballerob
a Instituto de Salud Pública de Navarra, Pamplona, Spain
b Hospital San Juan de Dios, Pamplona, Spain
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Tables (1)
Table 1. Reported total malaria cases and autochthonous malaria cases in Greece, 2009–2017.
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Concerning the past World Malaria Day1 on 25th April 2017, with the message “Malaria prevention works: let's close the gap” and its special focus on prevention gaps in access to proven malaria control tools, we consider this moment opportune to comment upon the current status of autochthonous (indigenous) malaria in Greece2 and the recent consideration3 by WHO of malaria-free area of the WHO European Region. This WHO European region includes all European countries (“Europe”), but also others like Turkey, Russian Federation, Israel or Tajikistan.

On 2015, WHO declared the European region to become the first malaria-free region globally, and this situation has been included on the World Malaria Report 2016.3 The numbers of malaria (indigenous) cases in the European region decreased from 90,712 in 1995 to zero cases in 2015, according to this report. This amazing goal was achieved joining different pillars such as vector control, malaria surveillance, cross-border cooperation or research and development. Staying malaria-free will not be an easy task and should involve political commitment, sustained vigilance and different resources as explained in the report.

In this report,3 WHO has considered that countries with 3 consecutive years of zero autochthonous (indigenous) cases of malaria are considered to have eliminated malaria. One of the key targets is Preventing re-establishment of malaria in all countries that are malaria-free, being one near-term milestone along the way to track for 2020, as part of the WHO Global Technical Strategy1 for malaria 2016–2030, adopted in 2015.

Four1 surrounding “Mediterranean” countries such are Morocco, Egypt, Turkey and Syria were endemic for malaria in 2000 and are no longer endemic in 2016. The same situation occurred for some countries of the WHO European region: Turkey, Georgia, Azerbaijan, Armenia, Kirgizstan, Tajikistan, Turkmenistan and Uzbekistan.

Within the WHO European region, only one country, Tajikistan,1 has not yet 3 consecutive years of zero indigenous cases (its last case being reported in July 2014).

Nevertheless, we have not found any reference to the local4 outbreak of autochthonous Plasmodium vivax malaria in Laconia on 2009 and 2010 and the existing situation2,5 of “autochthonous malaria cases in Greece”.

Table 1 shows the number of autochthonous cases on period 2009–2015 and the last 4 years separately 2014, 2015, 2016 and 2017 (up to 18th May), and the percentage of autochthonous malaria cases against total malaria cases in Greece during each study period included.

Table 1.

Reported total malaria cases and autochthonous malaria cases in Greece, 2009–2017.

Total reported casesYear
2009–20152  20145  20155  20164  20174,b 
Autochthonous malaria cases  82a 
Total reported cases  3504  38  79  83 
Autochthonous cases/total (%)  23.43%  0%  7.5%  6%  25% 

None cases reported on 2014.


Data up to 18 May 2017.

During the period 2009–2015, the percentage between autochthonous cases/total cases was above 20%. The tendency showed from 2013 was going relatively well (decreasing), although far from zero cases in last 3 consecutives years, with zero cases only in 2014, 6 cases and 5 cases in 2015 and 2016 respectively. Percentage remained below 8%.

However, this 2017 shows higher percentage of autochthonous cases (>20%) compared with last 2 years and, similar to the period 2009–2015. Overall, only 2 autochthonous cases out of 8 total malaria cases is a good achievement in terms of quantity, yet, strictly speaking, the “quality” measured on percentage has around turned and has quadrupled in the last year.

This percentage points out again autochthonous malaria to be unresolved. In any case, since the local4 outbreak of autochthonous P. vivax malaria started on 2009, there was only one year with zero cases (2014) and the situation seems to be continuous along the way.

In conclusion, it can be said that autochthonous malaria remains active in Greece and, we have doubts on whether these cases neither have been included into the Malaria Report 2016 nor had been considered on the declaration of malaria-free area of the European region. We consider that the situation in Greece needs further monitoring and measures against malaria being upfront of priorities.

Authors contributions

Conceived the idea of the report: AO. Extracted and analyzed data: AO, MFLB, TF, JA. Wrote the paper: AO. All authors have seen and approved the final manuscript.

World Health Organisation. World malaria day. Available from: http://www.who.int/mediacentre/news/releases/2017/world-malaria-day/en/ [accessed 11.07.17].
Olaso A, Ramos JM, López-Ballero MF, Olaso I. Malaria in Europe: Follow-up of autochthonous malaria in Greece and new risks. Enferm Infecc Microbiol Clin. 2016;11:3 Available from: https://doi.org/10.1016/j.eimc.2016.11.003 Medline: https://www.ncbi.nlm.nih.gov/pubmed/27979435.
World Health Organisation.
World malaria report 2016.
WHO Press, (2016),
P. Andriopoulos, A. Economopoulou, G. Spanakos, G. Assimakopoulos.
A local outbreak of autochthonous Plasmodium vivax malaria in Laconia, Greece—a re-emerging infection in the southern borders of Europe?.
Int J Infect Dis, 11 (2013), pp. e125-e128
Hellenic Center for Disease Control & Prevention (HCDCP). Epidemiological surveillance report. Malaria in Greece (up to 18.05.2017). Available from: http://www.keelpno.gr/Portals/0/%CE%91%CF%81%CF%87%CE%B5%CE%AF%CE%B1/%CE%95%CE%BB%CE%BF%CE%BD%CE%BF%CF%83%CE%AF%CE%B1/2017/Malaria_report_GR_18-5-2017.pdf [accessed 11.07.17].
Copyright © 2017. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
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