Abstract
Background
Exposure of blood to malaria parasites can lead to infection even in the absence of the anopheles mosquito vector. During a stay in a healthcare facility, accidental inoculation of the skin with blood from a malaria patient might occur, referred to as nosocomial malaria transmission.
Methods
Between 2007 and 2021, we identified six autochthonous malaria cases that occurred in six different French hospitals, originating from nosocomial transmission and imported malaria patients being the infection source. Four cases were observed during the COVID-19 pandemic. The genetic relatedness between source and nosocomial infections was evaluated by genome-wide short tandem repeats (STRs) and single-nucleotide polymorphisms (SNPs).
Results
None of the patients with autochthonous malaria had travel history to an endemic area nor had been transfused. For each case, both the source and recipient patients stayed a few hours in the same ward. After diagnosis, autochthonous cases were treated with antimalarials and all recovered except one. Genetically, each pair of matched source/nosocomial parasite infections showed less than 1% of different genome-wide STRs, and less than 6.9% (<1.5% for monoclonal infections) of different SNPs. Similar levels of genetic differences were obtained for parasite DNA samples that were independently sequenced twice as references of identical infections. Parasite phylogenomic results were consistent with travel information reported by the source patients.
Conclusions
Our study demonstrates that genomics analyses may resolve nosocomial malaria transmissions, despite the uncertainty regarding the modes of contamination. Nosocomial transmission of potentially life-threatening parasites should be taken into consideration in settings or occasions where compliance with universal precautions is not rigorous.
Keywords: malaria, nosocomial, autochthonous, short tandem repeat, single-nucleotide polymorphism, next-generation sequencing
Contributor Information
Romain Coppée, Université Paris Cité and Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France.
Véronique Sarrasin, Centre National de Référence du Paludisme, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France; Université Paris Cité, IRD, MERIT, F-75006 Paris, France.
Rizwana Zaffaroulah, Centre National de Référence du Paludisme, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France.
Azza Bouzayene, Centre National de Référence du Paludisme, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France.
Marc Thellier, Centre National de Référence du Paludisme, AP-HP, GHU Pitié-Salpêtrière, F-75013 Paris, France.
Harold Noël, Infectious diseases division, Santé Publique France, F-91410 Saint Maurice, France.
Jérôme Clain, Centre National de Référence du Paludisme, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France; Université Paris Cité, IRD, MERIT, F-75006 Paris, France.
Sandrine Houzé, Centre National de Référence du Paludisme, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France; Université Paris Cité, IRD, MERIT, F-75006 Paris, France.
the Investigation Study Group:
Sophie Abgrall, Ulviyya Alizada, Nicolas Argy, Blandine Benet, Françoise Botterel, Laura Bouetard, François Braun, Oriane Broustal, Sophie Brun, Clementine Calba, Anaïs Chosidow, Charles Damoisel, Nathalie De suremain, Robin Dhote, Virginie Eclache-saudreau, Odile Fenneteau, Julie Figoni, Guillemette Fremont-goudot, Agnès Gaudichon, Sebastien Gette, Laura Guigui, Christelle Hamon, Raya Harich, Antoine Hautcoeur, Stéphane Jaureguiberry, Valentin Joste, Eric Kendjo, Siham Khouadhria, Margaux Lepainteur, Anaïs Leleu, Mathieu Llorens, Mathie Lorrot, Anthony Marteau, Isabelle Poujol de molliens, Valérie Quermelin, Lydia Raineri di szatmary, Laurie Renaudin, Simon Riviere, Céline Robert, Loïc Simon, Jean yves Siries, Santa Soualah, Arnaud Tarantola, Fanny Tastet, Dorothée Vignes, Aurélien Zhu-soubise, and Fouzia Zouiti
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