Airport/seaport and autochthonous malaria in Europe from 1969 to 2022: A systematic review

Background In the context of this paper, airport/seaport malaria denotes the accidental relocation by air or sea of a malaria infected mosquito to Europe, a non-endemic area, the survival of the transported mosquito and subsequent blood meal and infection of a local person. Autochthonous malaria refers to locally transmitted cases of malaria in Europe.Methods The systematic review followed PRISMA guidelines and was registered on PROSPERO (CRD42023444243). PubMed and Ovid MEDLINE electronic databases as well as EMBASE, Scopus and CINAHL were searched for eligible papers. The selection process followed strict inclusion and exclusion criteria.Results We included 68 papers describing 115 cases of airport, seaport or autochthonous malaria in Europe, with a total of 68 airport/seaport malaria cases and 47 autochthonous malaria cases. France, Germany, Italy and Spain reported both types of malaria cases. Cases of airport/seaport malaria only were reported from Belgium, Luxembourg, Switzerland and the United Kingdom. Cases of autochthonous malaria only were reported from Greece, Malta and the Netherlands. The case fatality rates for airport/seaport malaria were 13.24 % and for autochthonous malaria 2.13 % respectively.Conclusion The importance of airport/seaport and autochthonous malaria is related to the frequently delayed or missed diagnosis, leading to high case fatality rates. Rising temperature may facilitate the importation and proliferation of competent Anopheles vectors. Increased human migration and travel with malaria parasite carriage may contribute to the reemergence of autochthonous malaria in Europe.