Malaria: 11‐Year Experience With Imported Cases at a German University Hospital and Epidemiological Trends Amid the COVID‐19 Pandemic

Background By the mid‐20th century, Europe eradicated endemic malaria. However, the significance of imported infections in nonendemic regions is growing. These cases often constitute the majority, can sustain transmission, trigger relapses, and increase mortality in these areas. Methods We conducted a retrospective, single‐center study of patients with malaria treated at the University Hospital Regensburg located in the State of Bavaria, Germany, between 2012 and 2023. Our single‐center epidemiological data were analyzed in the context of the COVID‐19 pandemic and compared with overall data from Bavaria, Germany, and Europe. Results Fifty‐eight patients with malaria were treated at a German university hospital. The median age at diagnosis was 37.5 years, with 65% of patients being male. A total of 31.6% of the patients required intensive care. This study revealed a survival rate of 98%. Only 17% had taken malaria prophylaxis, and Plasmodium falciparum was the causative agent in 96% of cases. The primary laboratory abnormality was thrombocytopenia. Germany reports a significant number of imported malaria cases annually. North Rhine‐Westphalia is the most affected region. The COVID‐19 pandemic impacted global malaria epidemiology, leading to a drastic decrease in malaria cases across Europe, including Germany. Conclusion Imported malaria remains rare in Europe. However, severe cases still occur, often requiring intensive care and resulting in high morbidity or even death. The diagnosis and management of malaria in nonendemic settings present a clinical challenge, and the delayed diagnosis is responsible for preventable deaths.