Malaria outbreak in a malaria-free region in Omen 1998: unknown impact of civil war in Africa

Beginning in April 1998, the surveillance system in Dhofar region, Oman, detected malaria cases among individuals who had no risk factors for the acquisition of malaria. An investigation was conducted to describe the outbreak and to identify its possible causes. A malaria case was defined as an unexplained fever (>38 degreesC) in a resident of the Dhofar region from April to September 1998. The investigation consisted of enhanced passive case detection, active case finding through contact screening, mass blood survey and school survey. Also an entomological survey was conducted and meteorological data was reviewed. Over a period of seven months, 1279 patients with fever were examined for malaria parasites. Sixty-five cases were positive; 60 (92%) males and 5 (8%) females. Cases occurred in all age groups (range: 2-63 years, median 25 years). Most cases were among illegal Somali immigrants (28, 43%) followed by Omanis (20, 31%). Out of the 2323 slides collected from the community and 2487 from school children, 21 slides were positive. All of them were from illegal immigrants. The entomological survey detected three vectors, previously found in the region: A. d'thali, A. sergenti and A. stephensi. Although the region is classified as a malaria-free region, it has the potential for malaria introduction. This outbreak most likely occurred due to the influx of hundreds of illegal Somali immigrants due to the civil war into the Dhofar region, providing a sufficient number of gametocyte carriers for local anopheline mosquitoes to feed on.