Early ReportMalaria in Maremma, Italy
Introduction
For centuries, malaria was endemic in several marshy regions of Italy. Maremma (Grosseto), a coastal plain in Tuscany, central Italy, was one of those areas. Now, 2 centuries after the marshes were drained, it still remains one of the less densely populated regions in Italy. 1997 was the 100th anniversary of the end of the estatatura: a local custom which, every summer, saw the migration of people from villages in the plain to villages in the hills, to escape the mosquitoes plagued the plains during the summer. In spite of drainage, which was carried out all over the country, malaria was still common at the beginning of World War II; 411 000 cases were reported in Italy in 1949. A national malaria-eradication programme was started in 1947, and the last endemic case of Plasmodium vivax infection was reported from Sicily in 1956. In November, 1970, the WHO officially declared Italy malaria-free.
Until eradication, the main malaria vectors in Italy were Anopheles labranchiae Falleroni, An sacharovi Favre, and Ae superpictus Grassi.1 In Maremma, the vector species was An labranchiae. As a result of the eradication campaign, anopheline mosquitoes disappeared or were greatly reduced in numbers. Over the past few decades, however, they have recolonised many of their previous habitats. Areas of central and southern Italy in which former malaria vectors are back to substantial densities have been identified.2 In Grosseto An labranchiae is now the dominant species.2, 3
Since 1970, only imported and occasional cryptic cases of malaria have occurred in Italy: 5012 in the 11 years 1986 to 1996.4, 5 Of these, 17 occurred in people with no history of travel to malarious regions: P falciparum was the cause of all of them.17 Each was investigated by the Istituto Superiore di Sanità in Rome, and appeared to be due to transfusion of infected blood (seven cases); syringe-exchange between drug addicts (one); and inadvertent carriage of infected tropical mosquitoes by aeroplanes and containers (nine).
Section snippets
Patient and methods
On Aug 7, 1997, a 62-year-old woman who had had an intermittent high fever since July 30 was admitted to the Internal Medicine Unit of Grosseto Hospital. She had not travelled out of the country, nor had any of her family. She had not received any blood or blood products or used intravenous drugs. She lived in a sparsely populated rural area. The nearest international airport (Pisa) was 150 km away. On Aug 13, microscopy of her blood showed heavy parasitaemia with P vivax (10 200 parasites/μL;
Results
An Indian family of a 7-year-old girl, her 29-year-old father, and 34-year-old mother, living about 500 m away from the patient were the only non-indigenous inhabitants of the region. No one else living or working in the area had ever visited a malaria-endemic country. The father had lived in Italy since 1992. He had made two short trips to India, and was back in Italy from the last in January, 1996. He was, and had been, in good health. The mother came to Italy from the Punjab in India with
Discussion
Due to the persistence of anopheline vectors, most Mediterranean countries from which malaria has been eradicated are susceptible to the reintroduction of the disease. We had already drawn the Italian health authorities' attention to the risk of malaria reintroduction in Italy, as the number of imported cases rose from 33 per year in 1966–70, to 782 in 1993–96.4 Entomological surveys demonstrate that high densities of An labranchiae are again present in Maremma (Grosseto), mainly in areas of
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