An outbreak of malaria at Frankfurt Airport this summer has raised alarm, with eight people known to have contracted the disease in the vicinity since July; three of them have died. Those affected are mostly employees of the airport operator Fraport. The cases have prompted concerns about the spread of a disease typically associated with tropical regions.

The Frankfurt Public Health Department believes the outbreak is due to "airport malaria," which occurs when a female Anopheles mosquito carrying the malaria parasite travels by aircraft from a country where the disease is common to one where it is not, bites a person, and infects their red blood cells. "We are dealing with a very rare occurrence, not a new frequent disease in Germany," said Achim Hörauf, director of the Institute for Medical Microbiology, Immunology and Parasitology at Bonn's University Hospital (UKB), in a press release.

The last documented case of airport malaria in Germany before the current ones was in 2023, according to the Epidemiologisches Bulletin of the Robert Koch Institute (RKI). Normally, those with the disease in Germany were infected elsewhere and brought it back during a long-haul trip. However, a mosquito can make its way to Germany as a "stowaway" if trapped in a suitcase or clothing. Hörauf noted that under certain circumstances, it might survive in warmer areas of an airport.

According to a UKB press release, the cases in Frankfurt involve malaria tropica, considered the most dangerous and potentially life-threatening form. To contract the disease, a person must be bitten by a female Anopheles mosquito infected with the Plasmodium falciparum parasite. This pathogen passes to the human and attacks red blood cells. "Simply put, it can lead to many small blockages in the blood vessels," explained Hörauf. "Depending on which organ is affected, various serious complications can arise."

Fluid can accumulate in the lungs, or neurological damage can result if the blood vessels of the brain are affected. Acute kidney failure is also possible. About 20% of those affected die if the disease is left untreated. "If a diagnosis is made in time, there can be targeted treatment," Hörauf said. "If the disease is overlooked, however, it can very quickly take a severe turn."

At first, symptoms are not specific, resembling those of the flu: sudden high fever, chills, headaches, and muscle pain. Nausea, vomiting, and diarrhea are also possible. The Frankfurt Public Health Department has advised anybody who lives or works near Frankfurt Airport to seek medical attention immediately if they experience any such symptoms. Rapid diagnostic tests can provide evidence of malaria in human blood, and a blood test can confirm this. The RKI says treatment should take place at a hospital with expertise in tropical medicine.

As summer comes to an end and temperatures cool in Germany, particularly at night, conditions are becoming less favorable for mosquitoes and malaria parasites. However, experts warn that there could still be other cases of malaria in Germany despite the cooler weather. Plasmodium falciparum has an incubation period of seven to 15 days, so more than two weeks can pass between a mosquito transmitting malaria and the onset of symptoms. According to Hörauf, the biggest challenge is to ensure that people think malaria could be a possibility even if they have not traveled abroad.

Source: www.dw.com