Odyssean malaria: Tshwane, Gauteng Province and Swartruggens, North West Province

22 March 2017

The National Institute for Communicable Diseases (NICD) was notified of two persons with malaria from Doornpoort, a suburb in the northern part of the City of Tshwane, and two patients from Swartruggens in the North West Province. None of these people had travelled to a known malaria transmission area. Unfortunately three of the patients passed away due to late diagnosis which resulted in complications of malaria. An investigation of the residences and environs in Tshwane and Swartruggens was carried out,  no anopheles mosquito adults or larvae were found. The evidence available therefore suggests that these cases did not result from local transmission in Tshwane and Swartruggens. There is no link between the cases in Tshwane and those in Swartruggens. There have been no further malaria cases confirmed in these areas.

These are isolated incidents of Odyssean or taxi malaria and do not represent an expansion in the malaria transmission areas in South Africa but rather follow translocation of an infected malaria mosquito from a malaria area.  These are very uncommon events - most mosquitoes would in fact not survive the journey. A few cases of  so-called ‘Odyssean’ malaria or ‘mini-bus’ or ‘suitcase’ malaria are confirmed mainly in Gauteng Province each year and coincide with the seasonal increase in malaria cases in the usual malaria transmission areas from January to April. 

All healthcare practitioners are encouraged to consider malaria as a differential diagnosis in all patients presenting with unexplained fever (>38°C) and flu-like illness especially in the presence of a change in the level of consciousness and/ or progressive jaundice even in the absence of a travel history to a malaria-endemic region.