Analysis of Trends in International Travel and the Impact on Domestic Malaria, United States, 2000-2009 Open Access

Abstract

Malaria has been eliminated from the United States, yet approximately 1,500 people are diagnosed with the disease in the US every year after having traveled to malaria endemic countries; particularly travel from West Africa. Worldwide travel is increasing and infectious diseases are being spread due to both the greater numbers of international travelers and the decreased time that it takes to cross borders and continents. This analysis used poisson regression to examine trends in cases of malaria imported into the United States in relation to changes in global travel. Data on imported malaria cases were taken from CDC's National Malaria Surveillance System (NMSS). The years of NMSS data that were utilized were from 2000 to 2009; after exclusion the dataset included 11,025 cases of malaria. Worldwide travel data came from the United Nations World Tourism Organization (UNWTO). The analysis did not support travel being a primary influence on the increase of imported cases that the United States has seen in recent years. Holding all other variables constant, the rate of malaria in the US would decrease by 0.1% with every increase in 100,000 travelers entering the US. However, the rate of malaria in the US attributable to travel to West Africa was 9.15 times higher than the rate of malaria in the US attributable to the referent group of Central Africa, which suggests that interventions targeted towards travelers to West Africa may still be very helpful towards the goal of lowering the number of imported cases into the United States.

Table of Contents

CHAPTER I. 3

CHAPTER II. 10

METHODS. 12

Data sources. 12

Analysis. 14

RESULTS. 15

DISCUSSION. 18

CHAPTER III. 22

APPENDICES. 24

REFERENCES. 27

TABLES. 30

FIGURES. 38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Malaria Poisson
Committee Chair / Thesis Advisor	McNabb, Scott JN, Emory University
Committee Members	Cullen, Karen, Centers for Disease Control and Prevention
Partnering Agencies	CDC

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