{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:10:45Z","timestamp":1790453445700,"version":"4.1.0"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T00:00:00Z","timestamp":1728604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-003970"],"award-info":[{"award-number":["INV-003970"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006506","name":"Minist\u00e9rio da Sa\u00fade","doi-asserted-by":"publisher","award":["443148\/2019-8"],"award-info":[{"award-number":["443148\/2019-8"]}],"id":[{"id":"10.13039\/501100006506","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Malaria is a global health challenge, and international efforts are underway to alleviate its impact by 2035. Within the 249 million global cases, 0.6 million occur in the Americas, mainly in Venezuela, Brazil, and Colombia. Considering Brazil\u2019s geographical proximity to malaria-endemic countries in South America, this study objective is to analyze the epidemiological characteristics and time trends of imported malaria cases in Brazil from 2007 to 2022, discussing their influence on the elimination process. This is an ecological time-series study that analyses malaria imported cases (infected in other countries) notified in Brazil, from 2007 to 2022. Brazil\u2019s Ministry of Health data were used. Descriptive statistics were employed to analyze sociodemographic and spatial patterns, while the impact of the Covid-19 pandemic on imported malaria trends was assessed using Prais-Winsten regression methods. In the study period there was a total of 109,914 imported cases (2.6% of Brazil\u2019s total malaria burden). There was an annual reduction of 515.3 cases (p = 0.001) prior to the Covid-19 pandemic. During the pandemics there was an overall reduction of -3,301.8 cases (p = 0.001). In the Amazon region<jats:italic>P<\/jats:italic>.<jats:italic>vivax<\/jats:italic>imported infections predominated, whereas in the extra-Amazon region<jats:italic>P<\/jats:italic>.<jats:italic>falciparum<\/jats:italic>imported infections were more prevalent. Most imported cases were males (67.8%), of Black ethnicity (47.5%), with incomplete primary education (45.1%), aged 20\u201339 (61.1%), and primarily gold miners (54.0%). Most cases are from French Guiana (31.7%), Venezuela (30.0%), and Guyana (17.9%). African nations, notably Angola and Nigeria, were primary sources of imported cases to the extra-Amazon region. The imported cases flux, predominantly from Latin America, threatens Brazil\u2019s elimination goals by potentially reintroducing the disease into previously cleared areas and sustaining the transmission in endemic areas. Strengthening epidemiological surveillance at the borders and fostering international cooperation are imperative steps in addressing this challenge.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003822","type":"journal-article","created":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T17:28:12Z","timestamp":1728667692000},"page":"e0003822","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Brazil towards malaria elimination: A time-series analysis of imported cases from 2007 to 2022"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-8742","authenticated-orcid":true,"given":"Klauss Kleydmann Sabino","family":"Garcia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7412-9390","authenticated-orcid":true,"given":"Gabriel Z.","family":"Laporta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyi","family":"Soremekun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Bottomley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Amaral","family":"Abrah\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilberto Gilmar","family":"Moresco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Drakeley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anielle de Pina","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2208-0294","authenticated-orcid":true,"given":"Andr\u00e9 M.","family":"Siqueira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,10,11]]},"reference":[{"key":"pgph.0003822.ref001","volume-title":"World malaria report 2023","author":"WHO","year":"2023"},{"key":"pgph.0003822.ref002","volume-title":"Microorganisms","author":"J Talapko","year":"2019"},{"issue":"suppl 1","key":"pgph.0003822.ref003","doi-asserted-by":"crossref","first-page":"i15","DOI":"10.1093\/inthealth\/ihw002","article-title":"Leaving no one behind: a neglected tropical disease indicator and tracers for the Sustainable Development Goals: Box 1.","volume":"8","author":"C Fitzpatrick","year":"2016","journal-title":"Int Health."},{"issue":"6","key":"pgph.0003822.ref004","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1590\/0074-02760150041","article-title":"A historical perspective on malaria control in Brazil","volume":"110","author":"SM Griffing","year":"2015","journal-title":"Mem Inst Oswaldo Cruz"},{"key":"pgph.0003822.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/1240962","article-title":"Severe Malaria Associated with Plasmodium falciparum and P. vivax among Children in Pawe Hospital, Northwest Ethiopia","volume":"2016","author":"G Geleta","year":"2016","journal-title":"Malar Res Treat."},{"key":"pgph.0003822.ref006","first-page":"57","article-title":"Malaria Situation in Latin America and the Caribbean: Residual and Resurgent Transmission and Challenges for Control and Elimination.","author":"MU Ferreira","year":"2019"},{"key":"pgph.0003822.ref007","volume-title":"Epidemiological Report\u2013Malaria 2021","author":"Brazil","year":"2021"},{"key":"pgph.0003822.ref008","volume-title":"Malaria in Brazil: an overview [Internet].","author":"J Oliveira-Ferreira","year":"2010"},{"issue":"1","key":"pgph.0003822.ref009","article-title":"Malaria time series in the extra-Amazon region of Brazil: epidemiological scenario and a two-year prediction model.","volume":"21","author":"KKS Garcia","year":"2022","journal-title":"Malar J."},{"issue":"1","key":"pgph.0003822.ref010","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s12936-021-03668-4","article-title":"Cross-border malaria in Northern Brazil.","volume":"20","author":"NJ Arisco","year":"2021","journal-title":"Malar J."},{"issue":"5","key":"pgph.0003822.ref011","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.trstmh.2009.12.010","article-title":"Epidemiology and control of frontier malaria in Brazil: Lessons from community-based studies in rural Amazonia","volume":"104","author":"NS da Silva","year":"2010","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pgph.0003822.ref012","unstructured":"WHO. Disease Surveillance for Malaria Control: An Operational Manual. Geneva, Switzerland. 2012."},{"key":"pgph.0003822.ref013","unstructured":"WHO. Global technical strategy for malaria 2016\u20132030. Geneva, Switzerland. 2021. Available at: https:\/\/www.who.int\/publications\/i\/item\/9789240031357; 2015."},{"key":"pgph.0003822.ref014","unstructured":"Datasus. TABNET DATASUS. Avaiable at: https:\/\/datasus.saude.gov.br\/informacoes-de-saude-tabnet\/."},{"key":"pgph.0003822.ref015","volume-title":"Vienna ARF for SC","author":"R Core Team","year":"2023"},{"key":"pgph.0003822.ref016","article-title":"Trend estimators and serial correlation","author":"SJ Prais","year":"1954","journal-title":"Cowles Commission discussion paper Stat No. 383, Chicago"},{"issue":"8","key":"pgph.0003822.ref017","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1002\/sim.9669","article-title":"In praise of Prais\u2010Winsten: An evaluation of methods used to account for autocorrelation in interrupted time series.","volume":"42","author":"C Bottomley","year":"2023","journal-title":"Stat Med."},{"issue":"3","key":"pgph.0003822.ref018","doi-asserted-by":"crossref","first-page":"565","DOI":"10.5123\/S1679-49742015000300024","volume":"24","author":"JLF Antunes","year":"2015","journal-title":"Using time series analysis in epidemiological studies Epidemiologia e Servi\u00e7os de Sa\u00fade"},{"issue":"1","key":"pgph.0003822.ref019","doi-asserted-by":"crossref","DOI":"10.1515\/em-2018-0010","article-title":"Analysing Interrupted Time Series with a Control.","volume":"8","author":"C Bottomley","year":"2019","journal-title":"Epidemiol Methods."},{"key":"pgph.0003822.ref020","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial.","volume":"dyw098","author":"J Lopez Bernal","year":"2016","journal-title":"Int J Epidemiol."},{"issue":"9","key":"pgph.0003822.ref021","doi-asserted-by":"crossref","first-page":"247","DOI":"10.3390\/tropicalmed7090247","article-title":"Impact of Covid-19 on Tuberculosis Indicators in Brazil: A Time Series and Spatial Analysis Study","volume":"7","author":"TZ Berra","year":"2022","journal-title":"Trop Med Infect Dis"},{"issue":"5","key":"pgph.0003822.ref022","doi-asserted-by":"crossref","first-page":"e052407","DOI":"10.1136\/bmjopen-2021-052407","article-title":"Continuity of community-based healthcare provision during Covid-19: a multicountry interrupted time series analysis.","volume":"12","author":"M Ballard","year":"2022","journal-title":"BMJ Open."},{"key":"pgph.0003822.ref023","article-title":"QGIS Geographic Information System.","author":"QGIS","journal-title":"QGIS Association. Version 2.18."},{"issue":"4","key":"pgph.0003822.ref024","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.jinf.2021.07.017","article-title":"Public health effects of travel-related policies on the Covid-19 pandemic: A mixed-methods systematic review","volume":"83","author":"L Bou-Karroum","year":"2021","journal-title":"Journal of Infection"},{"issue":"5","key":"pgph.0003822.ref025","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1590\/0074-0276140228","article-title":"Malaria in Brazil: what happens outside the Amazonian endemic region","volume":"109","author":"A de Pina-Costa","year":"2014","journal-title":"Mem Inst Oswaldo Cruz"},{"issue":"4","key":"pgph.0003822.ref026","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/cc2183","article-title":"Clinical review: Severe malaria.","volume":"7","author":"A Trampuz","year":"2003","journal-title":"Crit Care"},{"key":"pgph.0003822.ref027","article-title":"Fever in the returning traveler.","author":"D Paquet","year":"2022","journal-title":"Dtsch Arztebl Int."},{"key":"pgph.0003822.ref028","volume-title":"Epidemiological Report\u2013Malaria 2020","author":"Brazil","year":"2020"},{"key":"pgph.0003822.ref029","volume-title":"National Malaria Elimination Plan","author":"Brazil","year":"2022","edition":"1"},{"key":"pgph.0003822.ref030","unstructured":"Observat\u00f3rio das Migra\u00e7\u00f5es Internacionais. DataMigra BI panel [Online]. Available at: https:\/\/app.powerbi.com\/view?r=eyJrIjoiNDFiODhmMjUtNmRiNy00MWMzLThjOTAtZTdlZGZjZmViZjg1IiwidCI6ImVjMzU5YmExLTYzMGItNGQyYi1iODMzLWM4ZTZkNDhmODA1OSJ9&pageName=ReportSection9b3637a54858b0741fea. Accessed at: May 18, 2024."},{"issue":"5","key":"pgph.0003822.ref031","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1016\/S1473-3099(18)30757-6","article-title":"Venezuela\u2019s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region","volume":"19","author":"ME Grillet","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pgph.0003822.ref032","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12936-022-04141-6","article-title":"Changing transmission dynamics among migrant, indigenous and mining populations in a malaria hotspot in Northern Brazil: 2016 to 2020.","volume":"21","author":"EA Wetzler","year":"2022","journal-title":"Malar J."},{"issue":"1","key":"pgph.0003822.ref033","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1186\/s12936-022-04381-6","article-title":"Gold miners augment malaria transmission in indigenous territories of Roraima state, Brazil.","volume":"21","author":"J de Aguiar Barros","year":"2022","journal-title":"Malar J.Nov 29"},{"issue":"21","key":"pgph.0003822.ref034","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1001\/jama.1997.03550210070041","article-title":"Cycles of malaria associated with El Ni\u00f1o in Venezuela","volume":"278","author":"MJ Bouma","year":"1997","journal-title":"JAMA"},{"issue":"11","key":"pgph.0003822.ref035","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1111\/tmi.12776","article-title":"El Ni\u00f1o\u2010based malaria epidemic warning for Oromia, Ethiopia, from August 2016 to July 2017.","volume":"21","author":"MJ Bouma","year":"2016","journal-title":"Tropical Medicine & International Health."},{"issue":"1","key":"pgph.0003822.ref036","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s12936-017-1779-y","article-title":"El Ni\u00f1o Southern Oscillation as an early warning tool for malaria outbreaks in India.","volume":"16","author":"RC Dhiman","year":"2017","journal-title":"Malar J."},{"issue":"1","key":"pgph.0003822.ref037","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s40249-022-00945-5","article-title":"Reaching the malaria elimination goal in Brazil: a spatial analysis and time-series study.","volume":"11","author":"GZ Laporta","year":"2022","journal-title":"Infect Dis Poverty."},{"issue":"1","key":"pgph.0003822.ref038","doi-asserted-by":"crossref","first-page":"17982","DOI":"10.1038\/s41598-022-22590-6","article-title":"Imported malaria definition and minimum data for surveillance.","volume":"12","author":"NJ Arisco","year":"2022","journal-title":"Sci Rep."},{"issue":"2","key":"pgph.0003822.ref039","article-title":"Malaria in the borders between Brazil and French Guiana: social and environmental health determinants and their influence on the permanence of the disease.","volume":"29","author":"SM Gomes M do","year":"2020","journal-title":"Sa\u00fade e Sociedade."},{"issue":"1","key":"pgph.0003822.ref040","doi-asserted-by":"crossref","first-page":"6058","DOI":"10.1038\/s41598-022-09819-0","article-title":"Cross-border malaria drivers and risk factors on the Brazil\u2013Venezuela border between 2016 and 2018.","volume":"12","author":"K Wangdi","year":"2022","journal-title":"Sci Rep."},{"key":"pgph.0003822.ref041","doi-asserted-by":"crossref","DOI":"10.1590\/0074-02760200043","article-title":"The impact of imported malaria by gold miners in Roraima: characterizing the spatial dynamics of autochthonous and imported malaria in an urban region of Boa Vista","volume":"115","author":"J Louzada","year":"2020","journal-title":"Mem Inst Oswaldo Cruz"},{"issue":"44","key":"pgph.0003822.ref042","doi-asserted-by":"crossref","first-page":"22212","DOI":"10.1073\/pnas.1905315116","article-title":"Amazon deforestation drives malaria transmission, and malaria burden reduces forest clearing","volume":"116","author":"AJ MacDonald","year":"2019","journal-title":"Proc Natl Acad Sci USA"},{"key":"pgph.0003822.ref043","doi-asserted-by":"crossref","first-page":"105533","DOI":"10.1016\/j.worlddev.2021.105533","article-title":"The COVID-19 crisis and Amazonia\u2019s indigenous people: Implications for conservation and global health.","volume":"145","author":"AY Vittor","year":"2021","journal-title":"World Dev."},{"issue":"3","key":"pgph.0003822.ref044","doi-asserted-by":"crossref","DOI":"10.1093\/jtm\/taad164","article-title":"Imported malaria into Australia: surveillance insights and opportunities.","volume":"31","author":"A Sohail","year":"2024","journal-title":"J Travel Med."},{"key":"pgph.0003822.ref045","article-title":"Malaria cases in China acquired through international travel, 2013\u20132022.","author":"Y Zhu","year":"2024","journal-title":"J Travel Med."},{"key":"pgph.0003822.ref046","doi-asserted-by":"crossref","first-page":"e002002024","DOI":"10.1590\/0037-8682-0551-2023","article-title":"Malaria in areas under mining activity in the Amazon: A review.","volume":"57","author":"PST Amaral","year":"2024","journal-title":"Rev Soc Bras Med Trop"},{"issue":"5\u20136","key":"pgph.0003822.ref047","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.tmaid.2012.09.006","article-title":"Knowledge and practice of malaria prophylaxis among travel medicine consultants in Greece.","volume":"10","author":"A Pavli","year":"2012","journal-title":"Travel Med Infect Dis."},{"issue":"5","key":"pgph.0003822.ref048","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1179\/acb.2001.042","article-title":"Implementation of pretravel advice: good for malaria, bad for diarrhea.","volume":"56","author":"WE Peetermans","year":"2001","journal-title":"Acta Clin Belg."},{"issue":"1","key":"pgph.0003822.ref049","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12936-017-1713-3","article-title":"Pre-travel malaria chemoprophylaxis counselling in a public travel medicine clinic in S\u00e3o Paulo, Brazil.","volume":"16","author":"SS Chaves T do","year":"2017","journal-title":"Malar J."},{"issue":"3","key":"pgph.0003822.ref050","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.idc.2012.05.003","article-title":"Malaria Prevention in Travelers.","volume":"26","author":"B Genton","year":"2012","journal-title":"Infect Dis Clin North Am."},{"issue":"1","key":"pgph.0003822.ref051","doi-asserted-by":"crossref","first-page":"E60","DOI":"10.9778\/cmajo.20190070","article-title":"Risk of malaria associated with travel to malaria-endemic areas to visit friends and relatives: a population-based case\u2013control study.","volume":"8","author":"DH Marasinghe","year":"2020","journal-title":"CMAJ Open."},{"key":"pgph.0003822.ref052","first-page":"64","article-title":"Malaria at international borders: challenges for elimination on the remote Brazil-Peru border.","author":"M Palma-Cuero","year":"2022","journal-title":"Rev Inst Med Trop Sao 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