Increasing imported malaria in children and adults in Tuscany, Italy, (2000 to 2017): A retrospective analysis.

Background: Updated data regarding the epidemiology of imported malaria in Italy are needed. The aim of this study is to evaluate trends in incidence and associated lethality of malaria episodes and to consider if there has been an increase in paediatric cases in the region of Tuscany. Methods: All malaria cases diagnosed from 2000 to 2017 in 31 Tuscan hospitals were retrospectively identified. Epidemiological data regarding hospitalization rates and lethality for malaria in paediatric and adult population were described. Results: Among the 1102 retrieved cases of malaria (134 children and 968 adults). Plasmodium falciparum was the most commonly reported species (67%). The overall hospitalization rate was of 1.69 cases per 100,000 population/year. Hospitalization rate in the total population decreased from 2000 to 2009 (p < 0.01) and increased from 2009 to 2017 (p < 0.01), similar trends were observed in adults and children. However, in 2010-2017, the cumulative child group incidence of 1.78 per 100,000 surpassed that of the adult group of 1.53 per 100,000 (p < 0.01). Fifteen deaths occurred, all of them in adults, giving a crude lethality rate of 1.36%. Conclusions: In Tuscany, malaria is still a health concern in terms of both morbidity and mortality. Educational actions and pre-travel advice must be promoted.