On June 26, the US Centers for Disease Control and Prevention (CDC) issued a health advisory after cases of malaria were reported in Texas and Florida. These cases, one in Texas and four in Florida, have made headlines as they are the first cases of malaria originating within the United States since 2003. The CDC highlights that although the US was once a malaria-endemic country, the disease was eliminated in 1951.
The individual in Florida resides in Sarasota County while the person in Texas is an outdoor worker from Cameron County. While there are approximately 2,000 cases of severe malaria diagnosed in the US each year, most are acquired through travel to malaria-endemic countries. The diagnosis of five cases of malaria within the US is considered a medical emergency, and the CDC urges anyone with symptoms to seek urgent evaluation. Fortunately, all affected individuals have been treated and have since recovered.
This unusual spread of malaria within the US has prompted the CDC to call for states to issue public health alerts. The CDC also emphasizes measures to prevent mosquito bites, such as avoiding being outside during peak mosquito activity times and using EPA-registered repellents on the body and permethrin on clothing. The use of window screens and mosquito netting while sleeping is also recommended.
Malaria is a potentially fatal disease caused by the transmission of a parasite through the bite of an Anopheles mosquito. The disease can be caused by any of the five known species of the Plasmodium parasite: P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi. Worldwide, more than 240 million people are affected by malaria each year, leading to approximately 625,000 deaths, primarily among children.
Symptoms of malaria typically appear 10 to 30 days after the mosquito bite and resemble flu-like symptoms, including fever, chills, headache, body aches, nausea, and vomiting. If left untreated, malaria can become life-threatening, causing neurological symptoms, anemia, acute respiratory distress syndrome, and kidney damage. Laboratory abnormalities may include low red blood cell counts, low platelet levels, elevated bilirubin, and elevated liver enzymes.
Historically, quinine, chloroquine (CQ), and hydroxychloroquine (HCQ) have been used for the prevention and treatment of malaria. The introduction of HCQ in 1955 provided a less toxic alternative to CQ. Interestingly, both CQ and HCQ have been found to disrupt the replication of various viruses, including coronaviruses, raising the possibility of their use in prophylaxis and treatment of COVID-19.
Despite the proven safety and efficacy of HCQ, there has been resistance to its use for COVID-19 prevention, with claims of insufficient evidence and safety concerns. This resistance is unfounded, as HCQ has been widely prescribed in the US for various indications, with over 486 million prescriptions written between 2013 and 2020.
Since the emergence of drug-resistant strains of P. falciparum, artemisinin-based combination therapy (ACT) has become the standard treatment for malaria. Derived from the Chinese herb “qing hao,” artemisinin-based drugs act rapidly to clear parasites from the blood, while a slower-acting antimalarial drug is used to eliminate remaining parasites over three days of treatment. ACT has been successful in reducing malaria-related morbidity and mortality across Africa.
The World Health Organization (WHO) released new guidelines in June 2022 for the treatment of malaria, emphasizing the use of artemisinin-based combination therapies. These guidelines outline recommended drugs, protocols, and dosages for malaria treatment.
While discussing the recent outbreaks of malaria in Texas and Florida, it is worth considering the potential reasons for these occurrences. One of the affected individuals, Christopher Shingler in Texas, is a National Guard member stationed near the Texas-Mexico border. It is possible that he acquired the disease from one of the illegal immigrants crossing the southern border.
Malaria spreads through the bites of infected mosquitoes, and individuals traveling from malaria-endemic regions may carry the parasite. As such, increased scrutiny and appropriate preventive measures should be implemented to address the re-emergence of malaria within the US.
In conclusion, the recent cases of malaria originating within the US have raised concerns and prompted the CDC to issue a health advisory. Preventive measures, including mosquito bite protection, are crucial in reducing the transmission of malaria. Continued surveillance and prompt diagnosis and treatment of malaria cases are essential to prevent further spread and mitigate the impact of this potentially deadly disease.