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Plasmodium infection, often sub-clinical, is common in migrating sub-Saharan refugee populations. Refugees who subsequently develop clinical malaria suffer illness and exact a cost on state and local health care facilities. Untreated infection is also of public health concern because of the potential for local transmission. In response to increasing numbers of refugees originating in sub-Saharan Africa guidelines for the management of malaria in refugees migrating to the United States have been broadened and updated. The guidelines are based on available evidence-based literature and recent public health experience. These guidelines were critically reviewed, assessed, and approved by multiple National and State entities as well as outside experts. These consensus guidelines recommend that sub-Saharan African refugees relocating to the United States receive presumptive treatment of P. falciparum malaria before departure or during the domestic refugee medical screening after arrival. Presumptive therapy is not currently recommended for either non-falciparum malaria or for refugees relocating from areas outside sub-Saharan Africa.
Received November 21, 2007. Accepted for publication April 4, 2008.
Acknowledgments: We thank Zanju Wang for assistance with the figures, Drs. Monica Parise and Greg Armstrong for review of the early recommendations, and Dr. Paul Arguin and Ava Nevin for review of the manuscript. We also thank our Federal and State Partners for close collaboration: Office of Refugee Resettlement Refugee Medical Screening Protocol Workgroup on Domestic Medical Screening.
* Address correspondence to William M. Stauffer, University of Minnesota, Department of Medicine, Division of Infectious Diseases and International Medicine, Department of Pediatrics, Infectious Diseases, School of Public Health, Division of Epidemiology and Community Health, 420 Delaware Street SE, Mayo Building D407, MMC 250, Minneapolis, MN 55455. E-mail: stauf005{at}umn.edu
Authors’ addresses: William M. Stauffer, University of Minnesota, Department of Medicine, Division of Infectious Diseases and International Medicine Department of Pediatrics, Infectious Diseases School of Public Health, Division of Epidemiology and Community Health, 420 Delaware Street SE, Mayo Building D407, MMC 250, Minneapolis, MN 55455, Tel: 612-624-9996, Pager: 612-899-7538, Fax: 612-624-4410, E-mail: stauf005{at}umn.edu. Michelle Weinberg and Martin S. Cetron, Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 1600 Clifton Road, Atlanta, GA 30333, E-mails: mpw5{at}cdc.gov and mzc4{at}cdc.gov. Robert D. Newman, Centers for Disease Control and Prevention, Malaria Branch, 4770 Buford Highway NE, Mail-stop F-22, Atlanta, GA 30341, Tel: 770-488-7559, Fax: 770-488-4206, E-mail: rnewman{at}cdc.gov. Louise M. Causer, Centers for Disease Control and Prevention, Malaria Branch, Division of Parasititc Diseases, 4770 Buford Highway NE, Mail-stop F-22, Atlanta, GA 30341, E-mail: Lcauser{at}nchecr.unsw.edu.au. Mary J. Hamel, KEMRI/CDC Research Station, Unit 64112, APO, AE 09831, Tel: +254-722-772-616, E-mail: Mhamel{at}ke.cdc.gov. Laurence Slutsker, Centers for Disease Control and Prevention, Malaria Branch, Division of Parasitic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Coordinating Center for Infectious Diseases, 1600 Clifton Road, Mail-stop F-22, Atlanta, GA 30333, Tel: 770-488-7789, Fax: 770-488-4206, E-mail: lms5{at}cdc.gov.
Reprint requests: William M. Stauffer, MD, MSPH, DTMH, University of Minnesota, Department of Medicine, Division of Infectious Diseases and International Medicine Department of Pediatrics, Infectious Diseases School of Public Health, Division of Epidemiology and Community Health, 420 Delaware Street SE, Mayo Building D407, MMC 250, Minneapolis, MN 55455, Tel: 612-624-9996, Pager: 612-899-7538, Fax: 612-624-4410, E-mail: stauf005{at}umn.edu.
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