Presumptive Treatment to Reduce Imported Malaria among Refugees from East Africa Resettling in the United States

Christina R. Phares Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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Bryan K. Kapella Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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Annelise C. Doney Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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Paul M. Arguin Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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Michael Green Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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Leul Mekonnen Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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Aleksander Galev Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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Michelle Weinberg Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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William M. Stauffer Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, and Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; International Organization for Migration, Dar es Salaam, Tanzania; Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota

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During May 4, 2007–February 29, 2008, the United States resettled 6,159 refugees from Tanzania. Refugees received pre-departure antimalarial treatment with sulfadoxine-pyrimethamine (SP), partially supervised (three/six doses) artemether-lumefantrine (AL), or fully supervised AL. Thirty-nine malaria cases were detected. Disease incidence was 15.5/1,000 in the SP group and 3.2/1,000 in the partially supervised AL group (relative change = –79%, 95% confidence interval = –56% to –90%). Incidence was 1.3/1,000 refugees in the fully supervised AL group (relative change = –92% compared with SP group; 95% confidence interval = –66% to –98%). Among 39 cases, 28 (72%) were in refugees < 15 years of age. Time between arrival and symptom onset (median = 14 days, range = 3–46 days) did not differ by group. Thirty-two (82%) persons were hospitalized, 4 (10%) had severe manifestations, and 9 (27%) had parasitemias > 5% (range = < 0.1–18%). Pre-departure presumptive treatment with an effective drug is associated with decreased disease among refugees.

Author Notes

*Address correspondence to William M. Stauffer, Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Mayo D407, MMC 250, 420 Delaware Street SE, Minneapolis, MN 55455. E-mail: stauf005@umn.edu

Financial support: This study was supported by the Centers for Disease Control and Prevention.

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

Authors' addresses: Christina R. Phares, Annelise C. Doney, and Michelle Weinberg, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: cphares@cdc.gov, adoney@cdc.gov, and mweinberg@cdc.gov. Bryan K. Kapella,Centers for Disease Control and Prevention, U.S. Embassy Annex, Hanoi, Vietnam, E-mail: kapellabk@vn.cdc.gov. Paul M. Arguin and Michael Green, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: parguin@cdc.gov and mdg4@cdc.gov. Leul Mekonnen, International Organization for Migration, Addis Ababa, Ethiopia, E-mail: lmekonnen@iom.int. Aleksandar Galev, International Organization for Migration, Nairobi, Kenya, E-mail: agalev@iom.int. William M. Stauffer, Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, E-mail: stauf005@umn.edu.

  • 1.

    US Department of Homeland Security, 2009. 2009 Yearbook of Immigration Statistics. Available at: http://www.dhs.gov/files/statistics/publications/yearbook.shtm. Accessed March 1, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Boggild AK, Parise ME, Lewis LS, Kain KC, 2007. Atovaquone-proguanil: report from the CDC expert meeting on malaria chemoprophylaxis (II). Am J Trop Med Hyg 76: 208223.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Green MD, Nettey H, Villalva Rojas O, Pamanivong C, Khounsaknalath L, Grande Ortiz M, Newton PN, Fernandez FM, Vongsack L, Manolin O, 2007. Use of refractometry and colorimetry as field methods to rapidly assess antimalarial drug quality. J Pharm Biomed Anal 43: 105110.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Eriksen J, Mwankusye S, Mduma S, Veiga MI, Kitua A, Tomson G, Petzold MG, Swedberg G, Gustafsson LL, Warsame M, 2008. Antimalarial resistance and DHFR/DHPS genotypes of Plasmodium falciparum three years after introduction of sulfadoxine-pyrimethamine and amodiaquine in rural Tanzania. Trans R Soc Trop Med Hyg 102: 137142.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Mugittu K, Abdulla S, Falk N, Masanja H, Felger I, Mshinda H, Beck HP, Genton B, 2005. Efficacy of sulfadoxine-pyrimethamine in Tanzania after two years as first-line drug for uncomplicated malaria: assessment protocol and implication for treatment policy strategies. Malar J 4: 55.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    World Health Organization, 2010. WHO List of Prequalified Medicinal Products. Available at: http://apps.who.int/prequal/. Accessed March 1, 2011.

  • 7.

    Makanga M, Premji Z, Falade C, Karbwang J, Mueller EA, Andriano K, Hunt P, De Palacios PI, 2006. Efficacy and safety of the six-dose regimen of artemether-lumefantrine in pediatrics with uncomplicated Plasmodium falciparum malaria: a pooled analysis of individual patient data. Am J Trop Med Hyg 74: 991998.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Piola P, Fogg C, Bajunirwe F, Biraro S, Grandesso F, Ruzagira E, Babigumira J, Kigozi I, Kiguli J, Kyomuhendo J, Ferradini L, Taylor W, Checchi F, Guthmann JP, 2005. Supervised versus unsupervised intake of six-dose artemether-lumefantrine for treatment of acute, uncomplicated Plasmodium falciparum malaria in Mbarara, Uganda: a randomised trial. Lancet 365: 14671473.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Novartis, 2004. Monograph: Coartem. Third edition. Available at: http://www.smi-voyage-sante.com/docs/KitsPaluComposants/Coartem_monographie.pdf. Accessed March 1, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    White NJ, van Vugt M, Ezzet F, 1999. Clinical pharmacokinetics and pharmacodynamics and pharmacodynamics of artemether-lumefantrine. Clin Pharmacokinet 37: 105125.

  • 11.

    Ahmed R, Bowen J, O'Donnell W, 2004. Cultural competence and language interpreter services in Minnesota: results of a needs assessment survey administered to physician members of the Minnesota Medical Association. Minn Med 87: 4042.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Derose KP, Escarce JJ, Lurie N, 2007. Immigrants and health care: sources of vulnerability. Health Aff (Millwood) 26: 12581268.

  • 13.

    Garrett CR, Treichel CJ, Ohmans P, 1998. Barriers to health care for immigrants and nonimmigrants: a comparative study. Minn Med 81: 5255.

  • 14.

    Weiss R, 2005. Improving care for immigrants. Health Prog 86: 1112.

  • 15.

    Newman RD, Parise ME, Barber AM, Steketee RW, 2004. Malaria-related deaths among U.S. travelers, 1963–2001. Ann Intern Med 141: 547555.

  • 16.

    Collinet-Adler S, Stauffer WM, Boulware DR, Larsen KL, Rogers TB, Williams DN, 2007. Financial implications of refugee malaria: the impact of pre-departure presumptive treatment with anti-malarial drugs. Am J Trop Med Hyg 77: 458463.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Martens P, Hall L, 2000. Malaria on the move: human population movement and malaria transmission. Emerg Infect Dis 6: 103109.

  • 18.

    Zucker JR, 1996. Changing patterns of autochthonous malaria transmission in the United States: a review of recent outbreaks. Emerg Infect Dis 2: 3743.

  • 19.

    Darsie RF, Ward RA, 2005. Identification and Geographical Distribution of the Mosquitoes of North America, North of Mexico. Gainesville, FL: University Press of Florida.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Filler SJ, MacArthur JR, Parise M, Wirtz R, Eliades MJ, Dasilva A, Steketee R, 2006. Locally acquired mosquito-transmitted malaria: a guide for investigations in the United States. MMWR Recomm Rep 55: 19.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Maroushek SR, Aguilar EF, Stauffer W, Abd-Alla MD, 2005. Malaria among refugee children at arrival in the United States. Pediatr Infect Dis J 24: 450452.

  • 22.

    Ndao M, Bandyayera E, Kokoskin E, Gyorkos TW, MacLean JD, Ward BJ, 2004. Comparison of blood smear, antigen detection, and nested-PCR methods for screening refugees from regions where malaria is endemic after a malaria outbreak in Quebec, Canada. J Clin Microbiol 42: 26942700.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Stauffer WM, Newberry AM, Cartwright CP, Rosenblatt JE, Hanson KL, Sloan L, Tsukayama DT, Taylor C, Juni BA, 2006. Evaluation of malaria screening in newly arrived refugees to the United States by microscopy and rapid antigen capture enzyme assay. Pediatr Infect Dis J 25: 948950.

    • PubMed
    • Search Google Scholar
    • Export Citation
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