Most US malaria deaths preventable: CDC

A new study finds that most malaria deaths among U.S. travelers between 1963 and 2001 were preventable.

The study is published in the Oct. 5, 2004, issue of Annals of Internal Medicine, a peer-reviewed medical journal published in Philadelphia by the American College of Physicians.

Although indigenous transmission of malaria was eradicated from the United States in the late 1940s, every year about 1,500 malaria cases occur in the United States. Most infections occur in people who travel abroad, and one of every 100 U.S. travelers with diagnosed malaria die. Researchers at the Centers for Disease Control and Prevention (CDC) reviewed records of U.S. travelers who died of malaria between 1963 and 2001. Of 123 deaths, most (105 people or 85.4 percent) were considered preventable.

For 83 of these, the patient’s own actions may have contributed to death. The factors that contributed to death included not taking necessary preventive medicines; not following the prescribed regimen for the medications, or not seeking medical attention promptly (within two days) when symptoms occurred. For 70 of the 105 deaths (66.7 percent), medical errors may have contributed to the deaths. Among these errors were clinicians not prescribing the correct preventive medicines; not diagnosing malaria when the patient first reported symptoms; not beginning treatment promptly after diagnosis, or not treating the patient with the appropriate antimalarial drug.

Robert D. Newman, MD, MPH, lead author of the CDC study says, “Health care providers need to know that the CDC has expanded resources available that provide critical up-to-date information regarding prevention and treatment of malaria.”

Dr. Newman encourages travelers and physicians providing pre-travel advice to access the CDC Travelers’ Health Web site at http://www.cdc.gov/travel. This resource emphasizes the importance of taking preventive drugs appropriate to the area of travel; describes other measures to protect against malaria; and guides travelers through developing a plan for illness, abroad or after return to the United States, including reporting any symptoms and travel history to physicians promptly.

Dr. Newman urges physicians to take a travel history in a febrile patient, obtain a blood film for suspected malaria, and use malaria management advice available through the CDC Malaria Hotline (770-488-7788), which provides access to CDC malaria experts 24 hours a day, 365 days a year. Continuously updated information for health providers on treatment of malaria is also available online at http://www.cdc.gov/malaria.

Another critical element of managing a patient with malaria is access to the proper treatment drug. Dr. Newman notes that “Hospitals must have intravenous quinidine gluconate on hospital formulary because it is the only drug currently approved and available in the United States for treating severe malaria.”