Italian prosecutors have opened a manslaughter inquiry into the death of a four-year-old girl who was killed by malaria amid fears she may have contracted the disease from a reused needle at a hospital.
Sofia Zago had not travelled to any at-risk countries having spent her summer with her family in Italy’s Veneto region, which like all of Europe is typically malaria-free.
When she got home, she was admitted for diabetes treatment to the paediatric department of the Santa Chiara hospital, which was also treating a family that had contracted malaria during a trip to Burkina Faso.
Experts are exploring whether the disease was passed from the family to Sofia via a mosquito bite, while prosecutors in Trento are investigating whether the girl could have caught it from a re-used needle at the hospital.
The death of Sofia Zago, pictured here with her family, has baffled doctors as she had never travelled to a risk-prone country
Sofia developed a fever after returning home from the family holiday in Bibione, a seaside resort on the Adriatic coast near Venice.
As her condition deteriorated, she was taken to a hospital in the northern city of Trento.
Within an hour, she had slipped into a coma and was diagnosed with malaria.
The child was then then transferred to intensive care at a hospital in Brescia which treats tropical diseases, but they were unable to save her and she died on Sunday night.
The girl had never travelled to a country classified as at-risk, raising questions about how she contracted the disease.
An expert suspects climate change may be to blame for the first-home grown case in 55 years.
The hospital has said it uses only disposable, single-use needles.
Both the family and Sofia were suffering from the same type of malaria – plasmodium falciparum – but experts were trying to determine whether they were affected by the same strain.
The tragic youngster’s autopsy is scheduled for today and different strains would rule out contamination in the hospital.
Only some types of mosquito, called anopheline, are able to transmit the disease from person to person.
Sofia came into contact with two children at the Trento hospital who had caught malaria during a trip to Africa.
Only certain species of mosquitoes of the Anopheles genus – and only females of those species – can transmit malaria
Her death has puzzled doctors because, while some types of mosquito are able to transmit the disease from person to person, they are not native to Italy.
‘I’ve never seen a case like it, it’s a mystery. It shouldn’t have been possible for her to get malaria,’ said Claudio Paternoster, head of the infectious diseases department at the Trento’s Santa Chiara Hospital, where Sofia was first treated.
‘But only some types of mosquito are able to transmit the disease from person to person, and they don’t exist in Italy,’ she said.
While there are a few cases of malaria in Italy a year, ‘they are so-called ‘suitcase’ cases, where someone has brought an infected mosquito back with them from Africa,’ he explained.
Colin Sutherland, a professor of Parasitology at the London School of Hygiene & Tropical Medicine, said: ‘There are still anopheline mosquitoes in parts of Italy that can transmit malaria, but these would be unlikely to be found as far north as Trentino.
‘There are also recorded cases of mosquitoes from malaria-endemic countries making it to Europe and transmitting the disease during a hot summer. This could reach Europe in either in the body of an aircraft, or items of luggage.’
But Massimo Galli, vice-president of the Italian Society of Infectious Diseases, said a so-called suitcase mosquito was unlikely in this case as the family did not travel directly from Africa to the hospital with their luggage.
He admitted that the case was a mystery, saying ‘we need to consider the improbable, the almost-impossible’.
Trento’s health service said traps laid in the hospital after Sofia’s death found no anopheline mosquitos – though as the disease has an incubation period of up to 20 days, the offending mosquito could have come and gone.
Sofia was initially thought to have pharyngitis before doctors realised Saturday that it was malaria and she was transferred to intensive care, but her condition deteriorated rapidly and she died early on Monday.
The family which had travelled to Burkina Faso – a mother, a teenage son and two small children – recovered.
Malaria was rife in Italy in the 19th century, particularly in the centre, south and islands.
But after mass draining of marshlands and the widespread use of the medicine quinine, the country was declared malaria-free in 1962.
With global climate change, the potential for the reappearance of malaria in countries where it was previously eradicated exists, but is relatively small.
According to the World Health Organization, there were 212 million cases of malaria worldwide in 2015, and 429,000 deaths. Ninety percent of malaria cases and deaths occur in Africa, with children under five most at risk.
Climate change could be to blame for the tragic four-year-old’s death in Italy
Malaria was rife in Italy in the 19th century, particularly in the centre, south and islands.
But after mass draining of marshlands and the widespread use of the medicine quinine, by 1962 the country was declared malaria-free.
Since then, most recorded cases have been linked to tourists who returned from countries where it is common.
Dr Paternoster said he had not seen a single case of ‘indigenous malaria’ during his 30-year career.
He speculated that climate change may be to blame.
‘It was a very hot summer and with climate change we cannot rule out the adaptation of some species [of mosquito] or the re-introduction of others which could transmit the disease,’ the Italian newspaper Corriere della Sera quoted him as saying.
The country’s Ministry of Health confirmed that it has dispatched a team of experts to investigate how the girl contracted the disease.
And on Tuesday, the World Health Organization (WHO) hosted a meeting in Moscow to discuss how to keep Europe free of the disease. No cases of home-grown malaria were reported in Europe in 2015.
The United Nations agency says Italy could be vulnerable to a return of malaria if mosquitoes are not properly controlled.
According to WHO, there were 212 million cases of malaria worldwide in 2015, and 429,000 deaths.
Ninety per cent of malaria cases and deaths occur in Africa. Children under five are most at risk.