Malaria Home > Past Malaria Features > Health-Care Providers: Consider Malaria as Cause of Illness in Refugees from Malarious Countries

Health-Care Providers: Consider Malaria as Cause of Illness in Refugees from Malarious Countries

A recent report of malaria cases in Burundian refugees recently arrived from Tanzania highlights the need for health-care providers to be vigilant regarding the possibility of malaria among refugees from malarious countries.

"Imported" Malaria in the United States

Recent immigrants and refugees make up on average about 10% of the approximately 1,500 malaria cases brought into the United States each year. In addition to the threat the illness poses to the people themselves, imported cases make it possible for malaria to start circulating once again in the United States (malaria was eliminated by the early 1950s). Anopheline mosquitoes that are capable of transmitting malaria are found in the 48 contiguous states and US territories.

Malaria in Burundian Refugees

A recently released report in CDC’s August 15 MMWR describes three cases of Plasmodium falciparum malaria and two cases of Plasmodium ovale malaria during June 27, 2007–October 15, 2007 in King County, Washington, in Burundian refugees who recently arrived in the United States from two refugee camps in Tanzania, where they had been living after fleeing in 1972 from ethnic violence in their homeland. Some of the refugees had been displaced many times; most had always lived in exile.

Among 1,805 Burundian refugees from Tanzania who resettled to 34 states from May 4 to July 7, 2007, 29 malaria cases were identified in 12 states, including Washington. Of the 29 persons with malaria, most (82%) were hospitalized; no one died.

Up to 70,000 refugees are resettled to the United States annually, often from areas with endemic malaria.

Refugees' Care Prior to Departure and Once in the United States

CDC recommends that refugees from sub-Saharan Africa be given presumptive treatment for malaria (with an artemisinin-containing combination treatment), as well as other illnesses, before departure or during domestic refugee medical screening after arrival.¹

Many U.S. health-care providers may not be familiar with recommended malaria treatment regimens. For example, one of the five patients described in the report did not receive adequate treatment for severe infection with P. falciparum. Instead, she received oral atovaquone-proguanil, which would have been appropriate for uncomplicated malaria. The recommended regimens for severe infection with P. falciparum include either intravenous quinidine or artesunate. The latter is available from CDC via an investigational new drug protocol (PDF – 71 KB).

Health-care providers in the United States caring for refugee populations resettling from malarial regions should remain aware of the possibility of malaria in these groups regardless of prior treatment.

CDC Resources for Health-Care Providers

For health-care providers needing assistance with diagnosis or management of suspected cases of malaria,

• CDC Malaria Hotline: Call 770-488-7788 (M-F, 8am-4:30pm, EST). Emergency consultation after hours: Call: 770-488-7100 and request to speak with a CDC Malaria Branch clinician.
• E-mail nciddpdmalaria@cdc.gov
• CDC Malaria web site information on diagnosis and treatment: http://www.cdc.gov/malaria/diagnosis_treatment/index.htm

1. Stauffer WM, et al. Pre-departure and Post-arrival Management of P. falciparum Malaria in Refugees Relocating from Sub-Saharan Africa to the United States
   Am J Trop Med Hyg 2008 79: 141-146.

Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.