© International Society of Travel Medicine 2022. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com Journal of Travel Medicine, 2022, 1–6 https://doi.org/10.1093/jtm/taac083 Original Article Original Article Trends in imported malaria during the COVID-19 pandemic, Spain (+Redivi Collaborative Network) Francesca F. Norman , MBBS 1, *, Begoña Treviño-Maruri, PhD 2 , José Manuel Ruiz Giardín, MD 3 , Beatriz Gullón-Peña, BSc 1 , Fernando Salvador, PhD 4 , Nuria Serre, PhD 2 , Marta Díaz-Menéndez , PhD 5 , Eva Calabuig, MD 6 , Azucena Rodriguez-Guardado, MD 7 , Itxaso Lombide, MD 8 , Ana Pérez-Ayala, PhD 9 , Diego Torrús, PhD 10 , Josune Goikoetxea, MD 11 , Magdalena García-Rodriguez, MD 12 , Jose A Pérez-Molina , PhD 1 , and for the +Redivi Study Group 1 National Referral Unit for Tropical Diseases, Infectious Diseases Department. Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain, 2 Unitat de Medicina Tropical y Salut Internacional Vall d’Hebron-Drassanes, Vall d’Hebron University Hospital, PROSICS Barcelona, Spain, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain, 3 Fuenlabrada University Hospital, Madrid, Spain, 4 Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Spain, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain, 5 National Referral Centre for Imported Tropical Diseases, Hospital Universitario La Paz-Carlos III, Madrid, Spain, 6 La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain, 7 Asturias Central University Hospital, Oviedo, Spain, 8 Basurto University Hospital, Bilbao, Spain, 9 12 de Octubre University Hospital, Madrid, Spain, 10 Alicante General University Hospital, Alicante, Spain, 11 Cruces University Hospital, Barakaldo, Bilbao, Spain and 12 Valencia General University Hospital, Valencia, Spain *To whom correspondence should be addressed. Email: ffnorman@gmail.com Submitted 19 April 2022; Revised 8 July 2022; Editorial Decision 13 July 2022; Accepted 13 July 2022 Abstract Introduction: The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date. Methods: Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. polymerase chain reaction) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed. Results: In total, 1751 cases of malaria (1751/26601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (interquartile range: 27–44.7) years and most occurred in visiting friends and relatives (VFR)-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to Plasmodium falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (P < 0.001) (attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to Plasmodium falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively). Conclusions: After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with Downloaded from https://academic.oup.com/jtm/advance-article/doi/10.1093/jtm/taac083/6649393 by guest on 04 August 2022