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Preventing Malaria Deaths In The United States

Practically all malaria deaths in the United States are preventable, if travelers and healthcare providers take appropriate measures.

Every year, nearly 1,500 cases of malaria are reported in the United States. Most of these cases occur in U.S. residents who become infected while traveling abroad. Up to ten of these malaria patients will die each year. However, practically all these deaths are preventable.

An article (180 KB/10 pages) recently published in the journal Annals of Internal Medicine reviews 123 malaria deaths that occurred in returning U.S. travelers, between 1963 and 2001. According to the article, the majority of deaths (105, or 85.4%) were considered preventable. (Ann Intern Med. 2004;141:547-555)

Red blood cells, some of which are infected with Plasmodium falciparum malaria parasites (arrows). Plasmodium falciparum was responsible for most (92.7%) of the malaria deaths in U.S. travelers during the period 1963-2001.

For 83 (79.0%) of these 105 patients who died, the person’s own decisions may have contributed to an unfavorable outcome. Such decisions included:

• failure to take chemoprophylaxis (= antimalarial pills for preventing malaria)
• failure to adhere to the prescribed chemoprophylaxis regimen
• failure to seek medical attention promptly (within 2 days) once symptoms occurred.

For 70 (66.7%) of these 105 patients who died, medical errors may have contributed to the fatal outcome; such errors included:

• failure to prescribe the correct chemoprophylaxis regimen
• failure to diagnose malaria upon the patient’s first visit
• failure to start treatment promptly upon diagnosis
• treatment with an antimalarial drug inappropriate for the infecting type of malaria, or for the region where the malaria infection was acquired.

Missed Opportunities for Preventing Malaria Deaths in U.S. Travelers (from Ann Intern Med. 2004;141:547-555)

To prevent malaria deaths in U.S. travelers:

• Travelers to malaria risk areas should seek pre-travel advice from their healthcare providers, 4-6 weeks before departure, about how to protect themselves against malaria.
• Travelers should take their antimalarial pills as prescribed, before, during, and after their travel.
• Travelers should avoid mosquito bites between dusk and dawn during their travel, by using personal protection measures.
• Travelers should plan in advance what they would do in case of illness abroad or after return to the United States; this includes reporting promptly any symptoms, together with their history of travel to a malaria risk area, to healthcare providers.
• Healthcare providers are encouraged to consult CDC resources on malaria risk areas and recommended chemoprophylaxis regimens when offering pre-travel advice.
• Healthcare providers should always exclude malaria in a febrile patient, by taking a travel history and obtaining a malaria blood smear for all cases of suspected malaria.
• Healthcare providers should view malaria as a medical emergency that requires immediate (and correct) diagnosis and treatment.
• Health care providers are encouraged to use CDC resources for malaria management advice. These include a Malaria Hotline (770-488-7788) which provides access to CDC malaria experts 24 hours a day, 365 days a year; and Web-based, continuously updated information for clinicians on diagnosis and treatment of malaria.