The Centers for Disease Control and Prevention (CDC) has issued a health advisory regarding the emergence of several locally acquired malaria cases in Florida and Texas. This marks the first time in 20 years that cases of malaria acquired within the United States have been detected. A total of five cases have been identified so far, with four in Florida and one in Texas, all occurring in the past two months. The fact that these individuals were infected within the U.S. has raised concerns among health officials, as local infections of this kind have not been seen since 2003.
Prior to the COVID-19 pandemic, the U.S. already recorded around 2,000 cases of malaria annually. However, those cases were typically found in individuals who had traveled to regions where malaria transmission is more common. The recent cases in Florida and Texas, acquired locally, indicate that mosquitoes within the U.S. have acquired the parasite and are spreading it.
While effective treatments and mitigation strategies against malaria are available in the U.S., the emergence of these cases has raised concerns about a potential larger issue. Malaria was once widespread in the U.S., but efforts such as the National Malaria Eradication Program in the 1940s and 1950s successfully eliminated the disease as an endemic condition.
Malaria is considered a serious medical emergency by the CDC, particularly for children under five and pregnant women, as it can be fatal. Symptoms can range from mild to life-threatening, with flu-like symptoms and potential complications such as an enlarged spleen, enlarged liver, or mild jaundice.
A prominent symptom of malaria is the “malaria attack,” which lasts for six to ten hours and is characterized by three stages: chills and shivering, fever, headache, vomiting, and potentially seizures in children, and a sweating stage. Patients experience these attacks cyclically throughout their infection.
The recent cases in the U.S. have been caused by the parasite P. vivax, which is transmitted by two species of mosquitoes found in the country. John Adams, a professor at the University of South Florida College of Public Health, expressed concerns about the potential for the spread of these cases, as some strains of P. vivax can be non-virulent, leading individuals to be infected without realizing it.
It takes approximately 10 to 15 days for the P. vivax parasite to develop and become transmissible within a mosquito, making the spread of malaria less immediately noticeable. Chloroquine, an anti-malaria drug, is effective against P. vivax infections; however, cases associated with this parasite may require additional treatment, such as the drug primaquine, to target the dormant parasite in the liver.
Treatment with primaquine comes with its own issues, as it can have toxic side effects such as fatigue, weak pulse, skin and eye discoloration, seizures, confusion, and blurred vision. It should also not be administered to individuals with G6PD deficiency, a genetic condition that can lead to anemia.
The recent infections have been attributed to increased international travel during the summer season. The presence of standing water due to hurricane season may have also contributed to mosquito breeding. There are concerns that these malaria cases could indicate the spread of other mosquito-borne diseases, such as dengue, the Zika virus, West Nile virus, and the Chikungunya virus.
To combat malaria, efforts can include using helicopters and airplanes to spray insecticides and kill adult mosquitoes and larvae. All counties in Florida have mosquito abatement districts aimed at controlling mosquito populations and preventing disease. Individuals can also protect themselves by wearing clothing treated with permethrin, a synthetic repellent and insecticide, and using standard mosquito repellents.
Clinicians have been advised by the CDC to consider malaria when treating patients with an unknown origin fever, regardless of recent international travel. Obtaining a travel history from patients is also recommended.
In conclusion, the emergence of locally acquired malaria cases in Florida and Texas has raised concerns among health officials. Efforts are underway to control mosquito populations, treat infected individuals, and raise awareness about the symptoms and transmission of malaria. Vigilance is crucial in preventing the further spread of this disease within the United States.
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