Malaria in the U.S. – Do we need to be concerned?
The CDC recently issued an alert after locally acquired malaria cases were identified in Florida and Texas. Malaria is a mosquito-borne disease carried by certain species of mosquitoes, but what exactly does it do and how do you know if you have it? Helmut Albrecht, MD, answered these questions and more.
What is malaria?
“Malaria is an incredibly common disease around the world,” Dr. Albrecht said. “There are about 250 million cases of malaria a year and there are probably many more that go undiagnosed. Malaria causes more than half a million deaths a year.”
What are the symptoms of malaria?
Symptoms of malaria include fever, chills, headache, muscle pain and severe fatigue. It’s possible to also have gastrointestinal and neurological symptoms. Left untreated, malaria can progress to a life-threatening disease that leads to kidney failure, seizures and a lack of responsiveness or coma.
Who’s most at risk for severe symptoms from malaria?
Although most people recover from the disease, it can be much more serious if you’re infected with a more severe strain of malaria or if you’re a pregnant woman, a non-immune traveler or a child under five years of age.
“Not only are pregnant women at risk, but death of the unborn is also common with severe malaria,” Dr. Albrecht said.
Has malaria been found in the U.S. before?
“We typically have about 2,000 cases a year in the U.S.,” said Dr. Albrecht, “but virtually all of those are imported, which means somebody traveled to Sub-Saharan Africa, was infected with malaria and then ended up here in one of our emergency rooms. It’s common enough that we are quite well prepared for it.”
What’s different about these more recent cases is the fact that they’ve been acquired locally, meaning there has been no travel into a malaria area and malaria was discovered more than 10 miles away from an airport.
“So, not a mosquito that made it onto a plane,” Dr. Albrecht said. “Instead, an infected person comes here, gets bitten by a local mosquito and this mosquito then bites somebody else and creates a local chain of transmission, which is very different from cases that are acquired abroad and imported here.”
Local outbreaks are not new, however. “Even these local transmission outbreaks are something we used to see fairly often between 1957 and 2003,” Dr. Albrecht said. “The last one was in Palm Beach County in 2003, but there have not been prolonged outbreaks.”
The strain that was recently discovered in the U.S. is called Plasmodium vivax. “It can cause severe disease, but it’s not nearly as deadly or threatening as other strains,” Dr. Albrecht said. “We have good treatments that can be provided easily and usually in the outpatient setting.”
Should we be concerned about malaria?
Dr. Albrecht said we should be aware, but not concerned. The CDC has raised an alert so we can react appropriately and prevent malaria from spreading in our local mosquito population.
“We can go through our treatment algorithms and ask patients to include Florida and Texas, and probably other southern states, in their travel history,” he said. “We can make sure that we have enough rapid tests on hand, as well as enough malaria medicines for severe cases.”
He said they can also adjust the treatment according to the strain of malaria. “The treatment for this strain is different because it stays dormant in the liver of patients. There’s a standard treatment, but it’s a little different.”
What should you do if you think you might have malaria?
The likelihood of getting malaria is relatively low. But if you’ve had an exposure – say you’ve been in Sarasota, Florida, for two weeks and you’re having severe symptoms – call your family medicine doctor first.
Dr. Albrecht said to look for fever that comes and goes every three to four days, where you feel sicker and develop a significant fever spike.
“If you don’t have significant muscle pain, headaches and fever, it’s fine to sit it out and see if it’s something else,” he said. “This illness is typically not subtle, so you’ll know if it’s something to be concerned about.”
If you have no symptoms, however, don’t go to the emergency room to be tested as there is no test for malaria in asymptomatic patients.
Can malaria be prevented?
Like West Nile virus, which is also transmitted by mosquitoes, malaria can be prevented by avoiding mosquitos and using repellent with DEET. Other prevention tips include:
- Remove standing water from around your house.
- Avoid going outside during cooler times of the day. “Mosquitoes can’t find humans when it’s hotter outside than our body temperature is, so in the evening and in the early morning you need to protect yourself,” Dr. Albrecht said.
- Wear long sleeves and pants when outside.
- Make sure the screens in your house are functional. “These particular mosquitoes do not do well in houses as much as the ones that transmit West Nile, so it’s not as much of a threat that this becomes an ongoing problem as it is for other mosquitoes,” he added.
Is there a vaccine for malaria?
There’s no vaccine available in the U.S. for the plasmodium vivax strain. There are several vaccines in development and some available in Africa, but not for this strain.
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