foodconsumer.org: Malaria Acquired in Haiti --- 2010

Malaria Acquired in Haiti --- 2010
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admin on 03/06/2010 19:00:00
 
MORBIDITY AND MORTALITY WEEKLY REPORT (MMWR)
WEEKLY
March 5, 2010 / 59(08);217-219
On January 12, 2010, a 7.0 magnitude earthquake struck Haiti, which borders the
Dominican Republic on the island of Hispaniola. The earthquake's epicenter was
10 miles west of the Haiti capital city of Port-au-Prince (estimated population:
2 million). According to the Haitian government, approximately 200,000 persons
were killed, and 500,000 were left homeless (1). Malaria caused by Plasmodium
falciparum infection is endemic in Haiti, and the principal mosquito vector is
Anopheles albimanus, which frequently bites outdoors. Thus, displaced persons
living outdoors or in temporary shelters and thousands of emergency responders
in Haiti are at substantial risk for malaria. During January 12 --February 25,
CDC received reports of 11 laboratory-confirmed cases of P. falciparum malaria
acquired in Haiti. Patients included seven U.S. residents who were emergency
responders, three Haitian residents, and one U.S. traveler. This report
summarizes the 11 cases and provides chemoprophylactic and additional preventive
recommendations to minimize the risk for acquiring malaria for persons traveling
to Haiti.
Of the seven emergency responders, six were U.S. military personnel. Among the
six, four cases were uncomplicated and treated locally in Haiti. Two other
patients were moderately to seriously ill and transferred to the United States
for intensive care; one required intubation and mechanical ventilation for acute
respiratory distress syndrome. All are expected to make a full recovery.
All six military personnel had been provided oral chemoprophylaxis with
doxycycline before departure from the United States and personal protective
equipment (e.g., insect repellent and insecticide-treated netting and uniforms)
after arrival in Haiti. Of the 11 total patients, chemoprophylaxis was indicated
for the seven emergency responders and the lone U.S. traveler. Six of these
eight patients (including the two hospitalized military personnel) reported
nonadherence to the recommended malaria medication regimen. Adherence status was
unknown for the remaining two patients.
Three cases occurred in Haitian residents who traveled to the United States,
including one Haitian adoptee. The number of U.S. malaria cases imported from
Haiti likely is underestimated because typically not all cases are reported to
CDC.
REPORTED BY
K Mung, MD, B Renamy, MSc, Pan American Health Organization. JF Vely, MD, R
Magloire MD, Ministry of Public Health and Population, Haiti. N Wells, MD, US
Navy Medical Corps, J Ferguson, DO, US Army Medical Corps. D Townes, MD, M
McMorrow, MD, K Tan, MD, B Divine, L Slutsker, MD, Malaria Br, Div of Parasitic
Diseases, Center for Global Health, CDC.
EDITORIAL NOTE
In 2008, a total of 1,298 cases of malaria in the United States were reported
provisionally to CDC, and 527 (40.6%) were caused by P. falciparum; all but two
of the malaria cases were imported (CDC, unpublished data, 2009). Most imported
cases are in travelers returning to the United States from areas in Africa,
Asia, and the Americas where malaria transmission is known to occur (2). Of the
four Plasmodium species that routinely infect humans (P. falciparum, P. vivax,
P. malariae, and P. ovale), P. falciparum causes the most severe disease and
highest mortality and is the predominant species in Haiti (3,4). Information
regarding the incidence of malaria in Haiti is limited. Historically, malaria
transmission peaks in Haiti after the two rainy seasons, with a primary peak
during November--January and a secondary peak during May--June. Although each
year Haiti reports approximately 30,000 confirmed cases of malaria to the Pan
American Health Organization, as many as 200,000 cases might occur annually. One
population-based survey in 2006 in the Artibonite Valley, located 75 miles north
of Port-au-Prince, found an overall prevalence of P. falciparum infection of
3.1% (14.2% in febrile and 2.1% in nonfebrile persons) (4).
Prompt diagnosis and treatment of malaria as well as chemoprophylaxis when
appropriate are critical. Recommendations for antimalarials for treatment and
prevention are based on information on parasite drug susceptibility for a
specific geographic setting. In Haiti, the first-line treatment for malaria is
chloroquine. No evidence exists of clinical failure of chloroquine treatment in
persons with P. falciparum infection acquired in Hispaniola, nor has chloroquine
prophylaxis failure been documented in travelers. However, one published study
found five of 79 (6.3%) P. falciparum isolates collected in the Artibonite
Valley in Haiti in 2006 and 2007 carried a mutation associated with parasite
resistance to chloroquine (5). Although the findings do not serve as a basis for
prophylaxis and treatment policy change, they do point out the need for
heightened awareness of potential failure of chloroquine treatment or
prophylaxis in persons in Haiti or returning from Haiti.
Persons traveling to Haiti should receive chemoprophylaxis with one of the
following medications: atovaquone-proguanil, chloroquine, doxycycline, or
mefloquine (6). If preventive medications are started