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RAPID MALARIA SCREENING AND TARGETED TREATMENT OF UNITED STATES–BOUND MONTAGNARD REFUGEES FROM CAMBODIA IN 2002

In 2002, a group of Montagnard refugees living in Cambodia was accepted for resettlement in the United States. Pre-departure malaria screening and targeted treatment was conducted to prevent morbidity, and minimize the potential for local malaria transmission post-arrival. We screened 902 of 906 refugees using rapid diagnostic tests (RDTs), microscopy, and polymerase chain reaction (PCR) analysis. Twelve (1.3%) RDT results were positive and 28 (3.1%) were indeterminate. Microscopy confirmed Plasmodium species in two of the positive RDT and one of the indeterminate results. Among a random 10% sample of negative RDT results (n = 86), none were positive by microscopy. The PCR confirmed the two microscopically (and RDT) positive specimens. The PCR result was negative for all other specimens tested. Eighteen (2.0%) refugees were treated with antimalarials. The RDTs were useful in this setting, facilitating timely, sensitive diagnosis and targeted treatment. Evaluations to determine the most appropriate interventions in other refugee settings should include cost-effectiveness analyses of alternative strategies.

Received June 10, 2004. Accepted for publication December 9, 2004.

Acknowledgments: We are very grateful to the local staff and staff of the IOM office in Phnom Penh for their assistance with the implementation of this screening and treatment program. At the CDC, Division of Parasitic Diseases laboratory We thank J. Pieniazek, Maniphet V. Xayavong, Stephanie P. Johnston, and Susanne P. Wahlquist (Division of Parasitic Diseases, CDC) for their assistance with specimen evaluation and technical support.

Financial support: This malaria strategy was supported by CDC and the International Organization for Migration.

Disclaimer: Use of trade names and commercial sources is for identification only and does not imply endorsement by CDC or the U.S. Department of Health and Human Services.

Disclosure: None of the authors has any conflicts of interest.

Authors’ addresses: Louise M. Causer, John R. MacArthur, and Peter B. Bloland, Malaria Branch, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, NE, Atlanta, GA 30341, Telephone: 770-488-7755, Fax: 770-488-4206. Henry S. Bishop, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Mailstop F-36, 4770 Buford Highway, NE, Atlanta, GA 30341, Telephone: 770-488-4474, Fax: 770-488-3115. Donald J. Sharp, Elaine W. Flagg, J. Jina Shah, Susan A. Maloney, and Martin S. Cetron, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Mailstop E-03, Executive Park 57, Atlanta, GA 30333, Telephone: 404-498-1600, Fax: 404-498-1633. Jaime F. Calderon and, Vincent Keane, International Organization for Migration, No 46, Street 310, Chamcar Mon, PO Box 435, Phnom Penh, Cambodia, Telephone: 855-23-216-532, Fax: 855-23-216-423.

Reprint requests: Louise M.Causer, Malaria Branch, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488 7782, Fax: 770-488 4206, E-mail: lsc6{at}cdc.gov.

^* Field microscopy results called suspicious were considered to be positive for the purpose of prescribing treatment in this setting.

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