Airport malaria in Germany remains infrequent

Eight people are known to have contracted malaria in the vicinity of Frankfurt Airport in central Germany since July; three of them have died. Those affected are mostly employees of the airport operator Fraport.

The Frankfurt Public Health Department believes the outbreak is due to "airport malaria," which occurs when a female Anopheles mosquito carrying the malaria parasite travels by aircraft to a country where the disease is not common from one where it is, bites a person and infects their red blood cells. 

"We are dealing with a very rare occurrence, not a new frequent disease in Germany," said Achim Hörauf, the director of the Institute for Medical Microbiology, Immunology and Parasitology at Bonn's University Hospital (UKB), in a press release.

Several die from rare 'airport malaria' in Germany

Airport malaria is very infrequent

The last documented case of airport malaria in Germany before the current ones was in 2023, according to the Epidemiologisches Bulletin of the Robert Koch Institute (RKI), an online journal that regularly provides information on infectious diseases and public health.

Normally, those with the disease in Germany were infected elsewhere and brought it back during a long-haul trip.

But a mosquito can make its way to Germany as a "stowaway" if it was trapped in a suitcase or in clothing. Hörauf said that under certain circumstances, it might be able to survive in warmer areas of an airport.

Frankfurt cases are of dangerous malaria tropica

According to a UKB press release, the cases in Frankfurt involve malaria tropica, which is considered to be the most dangerous and potentially life-threatening form of malaria.

To contract the disease, a person needs to be bitten by a female anopheles mosquito infected with the Plasmodium falciparum parasite. This pathogen passes to the human and then attacks the red blood vessels.

"Simply put, it can lead to many small blockages in the blood vessels," explained Hörauf. "Depending on which organ is affected, various serious complications can arise."

Fluid can accumulate in the lungs, or neurological damage can result if the blood vessels of the brain are affected. Acute kidney failure is also possible. About 20% of those affected die if the disease is left untreated.

"If a diagnosis is made in time, there can be targeted treatment," Hörauf said. "If the disease is overlooked, however, it can very quickly take a severe turn."

At first, symptoms are not specific, resembling those of the flu: sudden high fever, chills, headaches and muscle pain. Nausea, vomiting and diarrhea are also possible.

Frankfurt authorities tell public to seek advice in case of symptoms

The Frankfurt Public Health Department has advised anybody who lives or works near Frankfurt Airport to seek medical attention immediately if they experience any such symptoms.

Rapid diagnostic tests can provide evidence of malaria in human blood and then a blood test can help to confirm this. The RKI says treatment should take place at a hospital, which has expertise in tropical medicine.

As summer comes to an end and temperatures cool in Germany, particularly at night, the conditions are becoming less favorable for mosquitoes and malaria parasites.

However, experts warn that there could still be other cases of malaria in Germany despite the cooler weather. Plasmodium falciparum has an incubation period of seven to 15 days, so more than two weeks can pass between a mosquito transmitting malaria to somebody by biting them and the onset of symptoms. According to Hörauf, the biggest challenge is to ensure that people think malaria could be a possibility even if they have not traveled abroad.