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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 5
| Issue : 4 | Page : 158-161 |
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Malaria in illegal immigrants in Southern Libya
Fadwa J Mahanay1, Abdulla M Bashein2, Abdulnasser A EI-Buni2, Almabrouk Sheebah3, Badereddin B Annajar4
1 Department of Biology, Faculty of Education, University of Tripoli; National Center for Disease Control, Tripoli, Libya
2 National Center for Disease Control, University of Tripoli; Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Tripoli, Tripoli, Libya
3 National Center for Disease Control, University of Tripoli, Tripoli, Libya
4 National Center for Disease Control, University of Tripoli; Department of Public Health, Faculty of Medical Technology, University of Tripoli, Tripoli, Libya
| Date of Submission | 09-Oct-2021 |
| Date of Acceptance | 12-Nov-2021 |
| Date of Web Publication | 28-Feb-2022 |
Correspondence Address:
Dr. Abdulla M Bashein
Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Tripoli
Libya
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ljms.ljms_58_21
Background and Aims: The risk of malaria re-introduction to Libya is increasing due to immigration to Libya from sub-Saharan countries where malaria is endemic. This study was conducted to investigate the prevalence of malaria-positive cases among illegal immigrants in the southern region of Libya. Materials and Methods: Three hundred and three illegal immigrants, with a mean age of 25.78 ± 5.92 years, from 12 different countries were included. An enzyme-linked immunosorbent assay was used to detect the presence of serum malaria antibodies. Results: One hundred and ninety-five (64.36%) of the participants tested positive for malaria antibodies. One hundred and seventy-two of the positive cases arrived in Libya within 1–10 months. The highest number of positive cases (70) came from Ghana, followed by (40) from Niger and (39) from Bangladesh. Conclusion: Illegal immigration issue should be treated urgently, combined by increasing the surveillance activities of infectious diseases to prevent malaria re-introduction to Libya.
Keywords: Illegal immigration, Libya, malaria
How to cite this article:
Mahanay FJ, Bashein AM, EI-Buni AA, Sheebah A, Annajar BB. Malaria in illegal immigrants in Southern Libya. Libyan J Med Sci 2021;5:158-61 |
| Introduction | |  |
Malaria is one of the most prevalent vector-borne diseases worldwide. More than 2 billion people (40% of the world's population) live in areas where malaria is endemic. According to the World Health Organization's (WHO) latest estimates, 228 million cases occurred globally in 2018, resulting in 405,000 deaths. Most cases (93%) were reported from the WHO African region.[1] The burden is heaviest in the WHO African region, where an estimated 90% of all malaria deaths occur, and in children aged under 5 years, who account for 78% of all deaths.[2] Malaria in endemic disease areas with explosive epidemics in many parts of Africa is probably caused by many factors, including rapidly spreading resistance to antimalarial drugs, resistance to insecticides, climatic changes, and population movement.[3],[4],[5] In the last decade, the prevalence of malaria has been escalating at an alarming rate, especially in Africa, and the cases account for approximately 90% of malaria cases in the world. In Africa, some countries in the North have achieved malaria elimination in the last 30 years, Libya in 1973, Tunisia in 1979, and Morocco in 2010.[6],[7],[8]
Outside the endemic areas, imported clinical malaria is a well-known disease; in 2019, more than 8600 imported malaria cases were reported in immigrants and travelers in European Union countries.[9] Recently, illegal immigration dramatically increased toward European Union countries through Libya and other North African countries.[10] Many of the illegal immigrants may carry infectious diseases, including malaria, that are prevalent in their countries of origin or prevalent in the migration route countries.[11],[12]
The aim of this prospective, observational, multicenter study was to assess the prevalence of malaria in illegal immigrants living in immigrants centers in a nonendemic area in southern Libya.
| Materials and Methods | | |
Participants
Blood specimens were collected randomly from 303 individual illegal immigrants residing in the illegal immigrants' centers in Sebha, Brak Al-Shati, and Bergen. All of the participants were males. Those immigrants came from countries in the sub-Saharan Africa and South-East Asia to use Libyan territories as a transit route to Europe. Informed consent was obtained from the participants, and the ethics approval was obtained from the Ethics Committee of the National Center for Disease Control (NCDC).
Specimens collection
Four milliliters of venous whole blood from each participant was drawn into ethylenediaminetetraacetic acid tubes. The tubes were immediately centrifuged at 3000 rpm for 10 min and the plasma was collected in 1.5 ml Eppendorf tubes and stored at −20°C until used. The plasma was transported to the laboratory of the NCDC in Tripoli within a week.
All samples were tested for the presence of malaria parasite antibodies by enzyme-linked immunosorbent assay (ELISA) technique within 1 h of the arrival of the samples to the parasitology laboratory at NCDC.
Malaria diagnosis using enzyme-linked immunosorbent assay technique
All specimens were tested with the ELx50 ELISA device (BioTek Instruments Inc., Vermont, USA) using the DiaMed ELISA test kit which has a clinical sensitivity of 84.2% and clinical specificity of 99.6%. The DiaMed ELISA malaria antibody test is based on the binding of anti-Plasmodium antibodies present in a plasma sample to antigens immobilized on 96-well plates. The antigens are a mixture of a total extract of cultured Plasmodium falciparum and recombinant Plasmodium vivax antigens.[13] The test was performed as recommended by the manufacturer.
| Results | | |
Participants' age ranged from 11 to 42 years. The mean age was 25.78 ± 5.92 years.
Of the participants, 195 individuals (64.4%) tested positive for malaria antibodies. Of those, 175 (89.7%) positive samples were from Brak Al-Shati center, 15 (7.7%) positive samples were from Sebha center, and 5 (2.6%) positive samples were from Bergan center [Table 1]. | Table 1: The incidence of malaria infection according to immigrants' center
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All of the participating individuals were males, 2.06% aged <18 years, while 97.94% aged 19 years and above at the time of consultation. Our results showed that the most prevalent infected participants were at age 20 years with 37 positive samples (18.9%) and the highest infection percentage was seen in the age category of 18–30 years with 154 positive samples (78.9%).
Most tested illegal immigrants have arrived relatively recently to the country, as shown in [Table 2]; however, some of them have been living in the country for a year or more. Interestingly, one positive case arrived to Libya before 36 months.
Most of the participating illegal immigrants came from countries in the sub-Saharan Africa and Asia [Table 3], including 120 (39.6%) of them were citizens of Ghana, followed by 49 (16.2%) from Niger. The lowest number came from Nigeria and Eritrea with one case (0.3%) from each and 49 (16.1%) were Asiatic citizens from Bangladesh. | Table 3: Distribution of the positive cases according to the country of origin
Click here to view |
Regarding malaria-positive cases, overall, 64.35% of the cases were positive. Fifteen (100%) of those who came from Chad were positive, followed by 40 (81.64%) of immigrants from Niger, 8 (80%) from Somalia, and 39 (79.59%) of immigrants from Bangladesh. However, there were no positive cases came from Guinea, Eritrea, Cameron, or from Nigeria.
| Discussion | | |
Although Libya is already declared malaria-free country, it is still at risk of malaria spread through a continuing influx of illegal immigrants.[6],[8] which will increase the burden on the Libyan health services institutions. This is the first study in recent decades to investigate the prevalence of malaria among the illegal immigrants in Libya for the confirmation of their malaria infection. Our results indicate that the prevalence of malaria among the illegal immigrants of the studied sample is evidently high. This result was expected, as most of the participants come from countries infested with high malaria prevalence. This suggests that if the illegal immigration continuous, malaria might spread again in Libya and might become endemic because the female anopheles mosquito is present in Libya.[14] From 1973 to 1980, there were no new cases reported. However, in September 1980, an outbreak of malaria vivax occurred in the coastal city of Zuara, involving 18 subjects and is believed to have been introduced by migrant workers.[8],[15] Furthermore, new cases of Libyans infected with malaria have been detected on December 2015 in Al-Disa district in Brak Al-Shati in the southwest of Libya. The cases included two pregnant women and their sons-in-law.[6] The NCDC reaffirmed that the epidemiological investigation on the two cases proved that they had not traveled abroad and did not undergo blood transfusion prior to the infection. It suggested that the presence of illegal immigrants from different African countries might be the source of the infection.[6]
Moreover, this further confirms that the risk of re-introducing malaria to northern areas such as Tripoli is likely. However, this result might not reflect the real magnitude of the imported malaria in Libya.
Of the 195 positively tested, included immigrants from Ghana, Niger, Bangladesh, Chad, Mali, Somalia, Sudan, and two were from the Gambia. It is well known that these countries are highly endemic with malaria.[1],[2] This result is similar to the results previously reported in Europe.[10]
Plasmodium infection prompts the production of plasmodium-specific antibodies, particularly of the IgM and IgG isotypes and to a lesser extent IgA. Antibodies are produced 1–14 days postinfection to all four Plasmodium species.[16],[17] Serological studies showed that antibody titers decline sharply after recovery from primary infection and fade within about a year.[13],[16],[18],[19] Detection of malaria parasite-specific antibodies is thus considered as a marker of recent exposure to Plasmodium. Specific antibody titers are directly proportional to the intensity and duration of the infection. When used to evaluate past or current malaria infections, serological methods are more sensitive than direct examinations. However, in the acute phase of the first infection, the antibody titers are independent of the start of infection variations in blood parasites levels in blood.[13],[16] This explains why the infection rate is higher among illegal immigrants who arrived to Libya within 1–10 months with 172 positive samples (88.2%). However, we detected one positive case who arrived to Libya before 36 months. This case may have got infected in the immigrants' center in Libya.
Regarding the distribution among age groups, the result revealed that the adult age group 18–30 years is the highest infected group with 154 positive cases (78.9%). This may be due to the fact that this is the most preferred age by employers and this is why they leave their countries.[20],[21]
Fifty-five of the positive patients presented with symptoms such as fever and just 11 immigrants said that they receive treatment for malaria. Those who do not receive treatment represent a potential source of infection.
The main limitation of this study was that the communication with the participants was extremely difficult, as none of them could speak some English or Arabic language. Even when translators were used, information was incomplete and incoherent because of fear of deportation.
| Conclusion | | |
This study confirms that the prevalence of malaria among illegal immigrants is relatively high. However, illegal immigrants, particularly those crossing the southern borders from highly malaria-endemic countries, may impose a high risk of re-introducing malaria to the southern regions of the country followed by northern areas and may cross the Mediterranean to southern Europe. The results also give a good reason for including malaria tests for immigrants. The use of malaria antibody test for malaria detection in this study was proved to be practical and reliable.
Acknowledgments
The authors would like to thank the National Center for Disease Control (NCDC) in Tripoli, Libya, for the support received.
Financial support and sponsorship
This work was supported by the National Center for Disease Control (NCDC) in Tripoli, Libya.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | |
| 2. | White NJ, Pukrittayakamee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM. Malaria. Lancet (London, England) 2014;383:723-35.  |
| 3. | Yunta C, Hemmings K, Stevenson B, Koekemoer LL, Matambo T, Pignatelli P, et al. Cross-resistance profiles of malaria mosquito P450s associated with pyrethroid resistance against WHO insecticides. Pestic Biochem Physiol 2019;161:61-7. |
| 4. | Plowe CV. The evolution of drug-resistant malaria. Trans R Soc Trop Med Hyg 2009;103 Suppl 1:S11-4. |
| 5. | Mischlinger J, Rönnberg C, Álvarez-Martínez MJ, Bühler S, Paul M, Schlagenhauf P, et al. Imported malaria in countries where malaria is not endemic: A comparison of semi-immune and nonimmune travelers. Clin Microbiol Rev 2020;33:e00104-19. |
| 6. | Hamid NM, Abdalla AM, Aldlouli AZ, AlMaki AA, Mansour AM, Abdulnabi A, et al. Prevalence of malaria infection in Fezzan region. J Med Sci 2018;13:1-3. |
| 7. | Snow RW, Marsh K. Malaria in Africa: Progress and prospects in the decade since the Abuja Declaration. Lancet 2010;376:137-9. |
| 8. | Snow RW, Amratia P, Kabaria CW, Noor AM, Marsh K. The changing limits and incidence of malaria in Africa: 1939-2009. Adv Parasitol 2012;78:169-262. |
| 9. | European Centre for Disease Prevention and Control. Surveillance Atlas of Infectious Diseases. Solna: European Centre for Disease Prevention and Control; 2019. Available from: http://atlas.ecdc.europa.eu/public/index.aspx. [Last accessed on 2021 Nov 01]. |
| 10. | Kassar H, Marzouk D, Anwar WA, Lakhoua C, Hemminki K, Khyatti M. Emigration flows from North Africa to Europe. Eur J Public Health 2014;24 Suppl 1:2-5. |
| 11. | Salas-Coronas J, Cabezas-Fernández MT, Lozano-Serrano AB, Soriano-Pérez MJ, Vázquez-Villegas J, Cuenca-Gómez JÁ. Newly arrived african migrants to Spain: Epidemiology and burden of disease. Am J Trop Med Hyg 2018;98:319-25. |
| 12. | Khyatti M, Trimbitas RD, Zouheir Y, Benani A, El Messaoudi MD, Hemminki K. Infectious diseases in North Africa and North African immigrants to Europe. Eur J Public Health 2014;24 Suppl 1:47-56. |
| 13. | Doderer C, Heschung A, Guntz P, Cazenave JP, Hansmann Y, Senegas A, et al. A new ELISA kit which uses a combination of Plasmodium falciparum extract and recombinant Plasmodium vivax antigens as an alternative to IFAT for detection of malaria antibodies. Malar J 2007;6:19. |
| 14. | Ramsdale CD. Anopheles mosquitoes and imported malaria in Libya. Mosq Syst 1990;22:34-40. |
| 15. | Gebreel AO, Gilles HM, Prescott JE. Studies on the sero-epidemiology of endemic diseases in Libya, IV. Malaria. Ann Trop Med Parasitol 1985;79:341-7. |
| 16. | Park CG, Chwae YJ, Kim JI, Lee JH, Hur GM, Jeon BH, et al. Serologic responses of Korean soldiers serving in malaria-endemic areas during a recent outbreak of Plasmodium vivax. Am J Trop Med Hyg 2000;62:720-5. |
| 17. | Contreras CE, Pance A, Marcano N, González N, Bianco N. Detection of specific antibodies to Plasmodium falciparum in blood bank donors from malaria-endemic and non-endemic areas of Venezuela. Am J Trop Med Hyg 1999;60:948-53. |
| 18. | Cavanagh DR, Elhassan IM, Roper C, Robinson VJ, Giha H, Holder AA, et al. A longitudinal study of type-specific antibody responses to Plasmodium falciparum merozoite surface protein-1 in an area of unstable malaria in Sudan. J Immunol 1998;161:347-59. |
| 19. | Perraut R, Varela ML, Loucoubar C, Niass O, Sidibé A, Tall A, et al. Serological signatures of declining exposure following intensification of integrated malaria control in two rural Senegalese communities. PLoS One 2017;12:e0179146. |
| 20. | Bisoffi Z, Matteelli A, Aquilini D, Guaraldi G, Magnani G, Orlando G, et al. Malaria clusters among illegal Chinese immigrants to Europe through Africa. Emerg Infect Dis 2003;9:1177-8. |
| 21. | Matteelli A, Volonterio A, Gulletta M, Galimberti L, Maroccolo S, Gaiera G, et al. Malaria in illegal Chinese immigrants, Italy. Emerg Infect Dis 2001;7:1055-8. |
[Table 1], [Table 2], [Table 3]
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