Our data showed no increasing Nintedanib in vivo trend in malaria cases, except for a peak in the number of cases in the last quarter of 2008 due to a cluster of Finnish travelers to the Gambia.18 None of the travelers had used adequate prophylaxis. Additional information on malaria surveillance in Finland showed that in 79% of the 271 malaria cases diagnosed during 2000 to 2008, travelers had used no malaria prophylaxis or had taken it irregularly (H. Siikamäki, unpublished results). Interestingly, the increased travel to malaria-endemic countries was not followed by an increase in the numbers of imported malaria cases. These data may be at least partly explained by the fact that the increase in the number

of trips was mostly to areas with limited risk. On the other hand, it may also reflect a change in epidemiology and a decreasing malaria risk in endemic areas, consistent with the reports of Behrens and colleagues19 from West Africa and Latin America20 and of Schmid and colleagues21 from India. Approximately 40% of the malaria cases occurred

among foreign-born individuals, most frequently among persons born in AFR or SEAR, which were also the two most common regions of infection. This is in line with a recent report showing that in Europe immigrants accounted for 50% of the total number of malaria cases,22 and, as in other studies,2,23,24 persons VFR accounted see more for almost 90% of the cases among foreign-born individuals. In our study, children constituted more than one quarter of the total number of cases among foreign-born individuals. VFR and second-generation VFR are known to be at increased risk for malaria.23,25,26 Probable

Unoprostone reasons are poor knowledge of malaria transmission and prevention27 and misconceptions of lifelong immunity.28 We considered that acquiring the infection in the region of birth was an indicator of being a VFR, but we did not have information on individual countries, and, therefore, misclassification bias might exist. Additional information for the 112 malaria cases diagnosed during 2001 to 2009 shows that 25% of all cases were VFR, 17% recently arrived immigrants, and 6% foreign visitors (H. Siikamäki, unpublished results). The surveillance system in Finland could be improved. Important information, such as country of birth and residence, destination and reason for travel, time of travel, and use of chemoprophylaxis, has been collected in the additional register, but is missing in the main register and should be linked to it. To be able to use travel data for surveillance, data storage and collection from partner institutions should be (re)organized and information on individual countries made available. International airport surveys collecting data on countries of destination19 and places from which trips are bought (travel agency, web resources) could give accurate information for planning and targeting pre-travel advice.