FAQ on Airport Malaria

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1. How do malaria cases occur near airports?

Even in malaria free regions, isolated cases of airport malaria and baggage malaria can occur near airports. In both situations, an infected female Anopheles mosquito is transported from an endemic region to a malaria free region. The two situations differ in how the mosquito arrives and where it bites.

Airport malaria: The infected mosquito arrives on an aircraft and bites a person at or near an airport. Those affected are often airport staff or local residents. This is a form of locally acquired malaria, also known as autochthonous malaria, because the infection occurs locally and is not acquired during travel to an endemic region.

Baggage malaria: The infected mosquito arrives in passenger baggage or freight. Infection may occur after the mosquito emerges from the baggage and bites a person. This may happen some distance from the airport. Baggage malaria is more closely associated with the transport of the vector in baggage or freight than with direct exposure on the airport apron or in the terminal. According to a systematic review, 32 such cases have been reported in Europe to date.

2. How does the chain of transmission work in imported malaria?

Several conditions must be met for malaria to be introduced:

1. An infected mosquito enters the aircraft: Mosquitoes may be transported in the cabin, the cargo hold, baggage, freight or other concealed areas of the aircraft.
2. The mosquito and the parasite survive the flight: Some mosquitoes can survive long haul flights and evade insect control measures. This is particularly possible if they are resistant to the insecticides used on aircraft or if the insecticides do not reach everywhere;
3. The parasite develops into its infective stage inside the mosquito: After a mosquito has acquired parasites from an infected person, the parasites must develop into their infective stage before they can be transmitted during a later bite. This process takes approximately 10 to 14 days inside the mosquito. The mosquito may already carry the infective stage when it enters the aircraft, or the parasite may reach this stage after the mosquito has arrived.
4. The infectious mosquito bites a person near the airport: Cases then occur on the premises of, or in the vicinity of, international airports, particularly amongst airport staff or local residents.

3. What increases the likelihood of transmission in imported malaria?

The direct introduction of infected mosquitoes through air travel is the main mechanism. Local conditions around airports may allow mosquitoes to survive for a short period and bite after their arrival. Climatic and environmental conditions also play a role. Gaps in control measures on aircraft or insecticide resistance may allow mosquitoes to survive despite these measures.

4. Who is particularly at risk of imported malaria?

Staff working on runways or opening containers, cabin and security staff, passengers and residents living near the airport, people who do not live too far from the airport, and travellers who open their luggage at home if there are infected mosquitoes there.

5. How else can infection occur?

Infection during a flight or at a stopover is very rare and is not considered airport malaria. In this situation, the traveller becomes infected during the flight or stopover, rather than after arriving near an airport. This therefore represents a different transmission situation.

6. How high is the risk of malaria transmission when an infected person arrives?

The risk of secondary transmission is generally very low in a malaria free region, but it is not zero. The situation becomes relevant only if the person who has arrived carries infective stages of the parasite, competent Anopheles vectors are present, meaning mosquitoes that are capable of transmitting malaria parasites, and local conditions support mosquito survival and further spread.

7. How many Anopheles species occur in Germany, and how many can transmit malaria parasites?

Seven Anopheles species have been recorded in Germany. Five species have either been shown to be capable of transmitting malaria parasites or are suspected of having this ability. These include species from the Anopheles maculipennis complex and Anopheles plumbeus.

8. How often has airport malaria been reported in Germany and Europe?

Imported malaria has rarely been reported in Germany. So far, the cases have been isolated incidents. A European systematic review published in 2024 counted nine cases of airport malaria in Germany among 145 cases of airport or baggage malaria reported in Europe up to January 2024. This places Germany among the European countries with the highest number of reported cases.

In Germany, two cases of airport associated falciparum malaria occurred in Frankfurt in 2019. Three further airport associated cases occurred in Frankfurt in 2022. Since July 2026, eight additional cases have occurred near Frankfurt Airport. Approximately half of all cases of airport malaria in Europe occurred in outbreaks involving between two and six cases per cluster.

Since 2015, the Robert Koch Institute has recorded 19 malaria cases that were probably acquired in Germany, according to Epidemiological Bulletin 38/2026. These include:

• Two cases involving transmission in hospitals.

• One case of baggage malaria.

• One case of congenital mother to child transmission.

• One case with an unclear route of transmission.

• Fourteen cases of possible airport malaria, including two cases in 2019, three cases in 2022, one case in 2023 and eight cases in 2026.

All cases of airport malaria were associated with Frankfurt Airport.

Frankfurt Airport is the only German airport explicitly identified in the sources reviewed as a location where airport malaria cases occurred. Two cases were reported there in October 2019. A separate cluster involving three cases occurred at Frankfurt Airport in 2022.

9. How far can Anopheles mosquitoes fly?

Anopheles mosquitoes usually fly only short distances. Their flight range varies depending on the mosquito species and environmental conditions.

For many Anopheles mosquitoes, a range of approximately 1 to 2 km is assumed. Several studies identify 2 km as the maximum flight distance for most Anopheles species. Other sources describe a typical daily movement range of only a few hundred metres for Anopheles gambiae and Anopheles arabiensis. A broader review concludes that most adult Anopheles mosquitoes normally do not fly more than 3 to 5 km from their place of origin or release.

Wind may carry mosquitoes over greater distances. In 2020, a case of illness probably caused by airport malaria was observed approximately 5 km from the airport.

10. How often does a female Anopheles mosquito bite?

A female Anopheles mosquito normally bites approximately once during each gonotrophic cycle, meaning the cycle of blood feeding and egg development. Many modelling scenarios assume that this cycle lasts between 2 and 4 days.

If the blood meal is not sufficient because the mosquito is disturbed or driven away, it may attempt to bite again, potentially biting another person. This corresponds to an average of approximately 0.25 to 0.5 bites per day, depending on the species and environmental conditions.

Some species bite more than once during the same cycle. The actual frequency may therefore be higher than the simple assumption of one blood meal per cycle.

11. How long do Anopheles mosquitoes live?

In the wild, Anopheles mosquitoes may live for approximately one week. Under laboratory conditions, they may live for more than one month.

Female Anopheles mosquitoes live considerably longer than males. Under favourable conditions, females may live for approximately 10 to 30 days in the wild and for several months under controlled laboratory conditions. Male Anopheles mosquitoes have a much shorter lifespan of approximately 10 days or less.

The lifespan of adult mosquitoes varies between Anopheles species. It is strongly influenced by temperature, humidity and nutrition.

12. Which insecticides are used on aircraft?

Specific insecticides are used in accordance with international aviation guidelines. The International Civil Aviation Organization, ICAO, and the World Health Organization, WHO, recommend the following active ingredients for aircraft disinsection:

• Pyrethroids, such as permethrin and deltamethrin. These are synthetic insecticides that affect the nervous system of insects.

• Organophosphates, such as malathion. These are phosphorus compounds with a neurotoxic effect on arthropods.

• Neonicotinoids. These are newer active ingredients with selective toxicity towards insects.

• Dichlorvos. This is an organophosphate insecticide used in some regions.

Spray disinsection is carried out either during the flight or on the ground. The insecticide aerosol is distributed throughout the aircraft cabin. The procedure takes place in empty cabins or after passengers have disembarked to ensure their safety.

During residual treatment, long acting insecticides are applied to surfaces that insects commonly visit, such as door frames and luggage compartments.

13. Which Anopheles species are involved in airport or baggage malaria?

The case reports on airport and baggage malaria do not name any Anopheles species. They merely indicate that an infected Anopheles mosquito was transported in baggage or goods.

A European review published in 2024 classified 32 cases as baggage malaria. However, the available extract does not list the mosquito species involved in these cases.

A later discussion of baggage malaria also refers to an infectious mosquito transported in baggage or goods without naming a species. Earlier reviews likewise mention vectors transported in baggage, but the available text does not identify them at species level.

14. Further information

World Health Organzation (WHO)

European Centre for Disease Prevention and Control

Robert Koch-Institut 

Malaria research at BNITM

Malaria is a key research focus at the Bernhard Nocht Institute for Tropical Medicine (BNITM). Research spans from fundamental molecular mechanisms to clinical and global health questions:

• Parasite biology and life cycle of Plasmodium falciparum
• Immune response and vaccine development
• Clinical research on diagnostics and treatment  
• Epidemiology and disease control
• Vector research on Anopheles mosquitoes
• Data analysis and modelling: use of bioinformatics and computational methods to analyse large datasets, model infection dynamics and predict patterns of spread

Relevant research groups:

Basic research / Cell biology

Department of Cellular Parasitology

RG Malaria Cell Biology

Junior Research Group Molecular Parasitology

Immunology

RG Host-Parasite-Interaction

RG Protozoa Immunology

Junior Research Group Malaria B Cell Immunolology

Vektorforschung zu Anopheles-Mücken

Lab Group Heitmann

Arthropod breeding

Klinische Forschung

Department of Clinical Research

Lab Group Groger

Lab Group Zoleko Manego

Lab Group Mischlinger

Epidemiologie

Department of Infectious Disease Epidemiology

Lab Group Applied Epidemiology and Biostatistics

Computational Sciences

Computational Infection Biology Department

Lab Group Bachmann