Historical evolution of the epidemiology of Malaria in Spain and Europe. Future perspectives.

Background: Malaria is a disease caused by a parasite of the Plasmodium species transmitted by anopheline mosquitoes that was officially eradicated in Spain in 1964 and in Europe in the 1970s through a combination of implementation of health programs with drug therapy, insecticide spraying and environmental engineering. Since then, the disease has been imported to the continent by international travelers and immigrants from endemic regions.

Methods: Diverse medical articles in English and Spanish language, guides and official reports from International Health Organisms were selected, as well as the official WHO (World Health Organization) website (accessing its reports for the years 2023 and 2024) and ECDC (European Centre for Disease Prevention and Control) website with its annual epidemiological reports. The searches were clearly focused on providing answers to the main objective, which is to offer a historical, past and current description of epidemiology in Spain and Europe, and as secondary objectives, to consider how migratory and population movements, as well as climate change, may influence a new disease scenario and how we can anticipate the problems that will arise from this situations.

Results: Nowadays there are a high number of imported cases, with autochthonous transmission in Europe being extremely infrequent, probably because of early diagnosis and treatment enabled by efficient healthcare systems. It is speculated that the current changing climatic conditions with warm temperatures and adequate humidity could favor the proliferation of anopheline mosquitoes and thus malaria transmission in several areas of southern Europe. In addition, the continuing massive influx of refugees and migrants from endemic areas could contribute to the creation of a reservoir of infectious parasites.

Conclusion: Although the disease potential in Europe is currently low, especially in the northern and western parts of the Continent, strengthening disease awareness and maintaining strong public health infrastructures for surveillance and vector control are of utmost importance to avoid the possibility of malaria transmission and re-emergence in the most vulnerable areas of Europe.