Airport malaria at Frankfurt airport: once again!

Airport malaria Baggage malaria Odyssean malaria Plasmodium falciparumThe ongoing investigation of a malaria cluster with 2 deaths among baggage handlers at Frankfurt Airport, Germany [1,2], has renewed attention to the so-called "airport or baggage" malaria, which is one of the possible modes of malaria acquisition outside endemic areas (Table 1).At the time of writing, September 19th, 2026, media reports indicate that 2 more people who lived in Frankfurt but did not work at the airport have been infected with Plasmodium falciparum malaria, and one has died, bringing the current tally to 3 deaths (https://www .20min.ch/story/flughafenmalaria-dritter-malariatoter-in-frankfurt-a nwohner-sollen-sich-schuetzen-103634996).Unrecognized airport malaria was initially observed in 1969 in two people who were diagnosed with obscure autochthonous cases of Plasmodium falciparum malaria in the Brittany Finistère Department (France).However, a subsequent investigation concluded that an imported mosquito probably infected them because they lived near the Le Bourget International Airport and were classified as the first cases of airport malaria [3].Since then, airport and baggage malaria (included under the umbrella term "Odyssean malaria") have been extensively reviewed [4][5][6][7].Most airport malaria cases were reported at major hub airports in France, Belgium, and Germany (Table 2), with Charles de Gaulle (Paris), Brussels, and Frankfurt am Main airports in Europe among the top five destination airports from sub-Saharan Africa, and among those most frequently involved in such cases [6].However, it is particularly regrettable to see that from 2019, three clusters of airport malaria (including the most recent one) have been observed at Frankfurt airport, with 11 workers involved who were diagnosed with severe P. falciparum malaria in six cases, eventually responsible for two deaths (CFR 18.2%) [8,9].Interestingly, a mathematical modeling study showed that using insecticides at the airport and in aircraft (a process known as "disinsection") can reduce the cumulative number of infected airport personnel to 0 [10].The World Health Organization (WHO) provided recommendations for aircraft disinsection methods and procedures, but this issue has been debated because of possible human toxicity, although a systematic review on the risks and utility of aircraft spraying found only limited evidence of human toxicity [11][12][13][14][15][16].