1. What is this study about?

Odyssean malaria is caused by malaria parasite-infected mosquitoes that have inadvertently travelled to non-malarious areas via various means of transport (sea, air, rail, road). A person/s bitten by such a mosquito may result in a case/s of malaria in the absence of travel to an endemic area. This study summarises odyssean malaria outbreak investigations in South Africa from 2014 to 2023.

 2. Why does this matter?

Malaria transmission in South Africa is restricted to low-altitude border regions of Limpopo, Mpumalanga, and KwaZulu-Natal provinces. Local acquisition of malaria outside of these areas is unexpected, often leading to delayed diagnosis, complications and death. Alerting the public and health-care workers in non-endemic provinces about the existence of this form of malaria is key to improving patient outcomes.

 3. What drew your interest in this area of research?

A similar previous study was conducted between 2007 and 2013. I was interested in understanding the clinical, entomological and epidemiological changes that may have occurred over the past ten years.

 4. What was your role in the study?

I led the study design, data analysis and writing of the manuscript.

 5. Why should people read this article?

The article raises awareness about malaria in South Africa in general, and the entity of odyssean malaria in particular. Odyssean malaria is an unusual but recurrent entity in our country and will remain a risk in South Africa’s non-endemic provinces until malaria is eliminated in the region. Although these cases are rare, our findings emphasise the need to think about malaria in febrile patients with unexplained fever and thrombocytopenia (low platelet count), even in the absence of a travel history.

6. What impact do you hope this study will have on public health policy and access to healthcare?

A multidisciplinary team is essential for the comprehensive investigation of clinical and public health aspects of odyssean malaria outbreaks. Delayed diagnosis and treatment of odyssean malaria can lead to severe and sometimes fatal complications. It is therefore crucial to investigate and review cases of this type of malaria to raise awareness among clinicians and the general public.

Any patient with a febrile illness in whom a diagnosis is not apparent, especially if there is an accompanying thrombocytopenia, should alert the healthcare worker to the possibility of malaria. Point-of-care (rapid diagnostic) malaria tests should be more widely utilised when routine laboratory microscopy diagnosis is delayed or not available, such as in primary health clinics (provided users are appropriately trained). Inexperience in recognising and managing clinically severe malaria contributes to mortality, and patients should be managed at the highest level of care available.

Dr Charlotte Sriruttan-Nel is a Senior Pathologist at the Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.

For a more in-depth look into this interesting study, download the full article below.