5 g/dL), acidemia, and repeated generalized convulsions, requiring critical care attention. Although comorbidity was present in this case, P. vivax may produce severe malaria mainly due to severe anemia, in a rate similar to the one we show in our study.31 Increasing Cobimetinib manufacturer evidence that P. vivax is not always a benign parasite, which can cause severe malaria,

even death,38–42 coupled with the emergence of drug resistant strains could pose a serious threat to global control of malaria. The mortality rate was similar to those referred in other studies.1,2,8,9,12,25 Six of the seven deaths occurred in foreign sailors who arrived on the island through the harbor. Severe and complicated malaria among them was highly present. Unfortunately, this group of patients has been poorly characterized in former studies.8 There are different reasons that could help to explain a higher lethality in these individuals: difficulties for health attention out at sea, with consequent diagnosis and treatment delay, and language barriers that impede detailed anamnesis. In our opinion, burden of malaria in sailors arriving in Gran Canaria is higher than we show here. An unknown number of malaria cases are treated in private sanitary centers, which do not usually declare the infection, even though malaria is a

notifiable disease to health authorities in Spain. African immigration to the Canary Islands is notably increasing. Often, Y-27632 concentration the Canary Islands are the first stop on their way to other European countries. During the last years, some of these immigrants are arriving crowded on boats called “pateras” or “cayucos.” Malaria diagnosis has not been a frequent finding in these people when they arrived;

however, we described seven cases, six of them in 2006. Malaria in travelers is a preventable disease, if adequate measures are taken. Adherence to chemoprophylaxis in travelers to endemic countries here described is similar oxyclozanide to that referred to by other authors,24 but there is also notable variability according to the different studies.2,18,23,24 Furthermore, it is possible that many of the cases ignored the need to have chemoprophylaxis during the journey. None of the patients who traveled to endemic regions to VFR were declared to have had any chemoprophylaxis. This fact heightens the necessity to encourage the use of preventive measures and chemoprophylaxis in VFR.29,36 We hope that travel health consulting at hospitals in Gran Canaria Island and availability of better antimalarial drugs for chemoprophylaxis will help to improve chemoprophylaxis adherence in travelers. Data on patients diagnosed from 2007 has not been made available for detailed investigation. To follow the trends and evaluate preventable measures that could be taken, notification of cases to the public health system is essential. The authors state that they have no conflicts of interest.