Local Malaria Cases Prompt CDC Monitoring and Hypervigilance

On June 26, 2023, the United States Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory prompted by local cases in Florida and Texas. The organization is monitoring the disease’s spread and stressing hypervigilance.

The advisory identifies locally acquired cases, emphasizes concerns about disease spread linked to international travel, and encourages the development of a rapid treatment access plan.

According to the CDC, the locally acquired malaria cases were Plasmodium vivax malaria, acquired through mosquito transmission. The organization notes that the four cases in Florida were in patients near Sarasota County. The Florida Department of Health issued its own state-wide advisory.

In addition, one Texas resident in Cameron County has been diagnosed with the condition, spurring further investigations into the disease and its potential spread. These cases mark the first locally acquired cases in the US since eight were identified in Palm Beach County, FL, in 2003.

Malaria symptoms typically appear 7–30 days after infection; however, some patients do not develop symptoms for up to a year. Uncomplicated malaria is characterized by a 6–10 hour malaria attack divided into three stages:

• Cold stage
• Hot stage
• Sweating stage

Symptoms may include fever, chills, sweat, headaches, nausea, vomiting, body aches, and malaise. Some rare cases of uncomplicated anemia may cause weakness, an enlarged spleen, mild jaundice, liver enlargement, and an increased respiratory rate.

Severe malaria can lead to organ failure or potentially fatal effects. Severe malaria can cause abnormal behavior, impaired consciousness, seizures, coma, anemia, hemoglobinuria, acute respiratory distress syndrome, abnormal blood coagulation, low blood pressure, acute kidney injury, hyper-parasitemia, and metabolic acidosis.

Prompt diagnosis and treatment of malaria can minimize the risk of severe and potentially fatal infection or complications. Providers are urged to consider travel history and the risk of malaria when treating patients and order tests when indicated. The CDC recommends diagnosis with microscopic examination and a rapid diagnostic test (RDT), such as BinaxNOW.

Providers should treat with artemether-–lumefantrine; however, atovaquone-–proguanil can be used, and cases contracted outside of Papua New Guinea or Indonesia should first be treated with chloroquine.

The CDC notes, “IV artesunate is the first-line drug for treatment of severe malaria in the United States. Artesunate for Injection is approved by the FDA for treating severe malaria and is commercially available.”