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Locally Acquired Malaria Cases Detected in Florida and Texas: A Rare Occurrence in the US After Two Decades

The US Centers for Disease Control and Prevention (CDC) has issued a notable alert to clinicians regarding locally acquired cases of malaria in Florida and Texas. Over the past two months, four cases have been identified in Florida and one in Texas. This marks the first time in 20 years that malaria has been transmitted within the United States, according to the CDC.

Understanding Malaria

Malaria is a potentially life-threatening disease transmitted by mosquitoes carrying the malaria parasite. While thousands of Americans fall ill with malaria each year, the majority of cases are acquired outside the United States, particularly in the African region, where about 95% of infections occur. This has led to limited familiarity with the disease among the American population.

What is Malaria?

Malaria is a curable disease with life-threatening potential. Humans usually contract it when bitten by mosquitoes carrying the malaria parasite. However, the disease can also be transmitted through infected blood during transfusions or organ transplants, as well as from a pregnant mother to her fetus. Malaria is most prevalent in warm countries, especially those with tropical climates. In 2021, approximately 247 million cases of malaria and 619,000 deaths were reported worldwide, as per the World Health Organization (WHO).

Recent Malaria Cases in the United States:

The locally acquired cases in Florida and Texas involve the Plasmodium vivax strain, which typically causes less severe illness compared to the P. falciparum strain. However, P. vivax can lead to relapsing disease as it can remain dormant in the liver and resurface months or even years later. Prompt diagnosis and treatment are crucial in such cases.

What are the Symptoms of Malaria

Malaria symptoms resemble those of the flu, including fever, chills, headaches, muscle aches, fatigue, nausea, and vomiting. In severe cases, individuals may experience abnormal bleeding, jaundice, and breathing difficulties. Symptoms usually appear 10 to 15 days after infection, but they can manifest earlier or much later, even up to a year after infection. Failure to treat malaria adequately can result in kidney failure, seizures, coma, and death. Certain vulnerable groups, such as children under 5, pregnant individuals, older adults, and those with weakened immune systems, are at higher risk.

Malaria Transmission: Which Mosquito Causes Malaria?

Malaria is not spread through casual contact between individuals. It is a vector-borne disease, meaning it is transmitted through another organism, specifically the Anopheles mosquito. The mosquito must first bite an infected person and then bite another individual to spread the infection. Malaria cannot be contracted through breathing the same air or sharing utensils with an infected person, nor is it sexually transmitted. However, transmission can occur through blood transfusions or sharing needles with an infected person.

The Diagnosis and Treatment

Malaria is diagnosed through a blood test that examines the presence of the Plasmodium parasite under a microscope. Early diagnosis is crucial as it allows for timely treatment, which is vital in preventing the progression to severe disease. The treatment for malaria depends on the specific type of Plasmodium detected in the individual and any associated characteristics. Various medications are available, and CDC guidelines dictate tailored treatment regimens. Severe malaria often requires injectable medications, while less severe cases can be treated with oral medication. It is important to initiate treatment promptly, which is why the CDC has issued an alert to ensure clinicians are vigilant and equipped with the necessary diagnostic and treatment resources.

Where was Malaria Detected in the United States Recently?

Florida’s Sarasota County and Texas’s Cameron County have reported the locally transmitted malaria cases. The CDC emphasizes that there is no evidence linking the cases in these two states, although they are the first instances of local transmission in the United States since 2003. Some of the affected individuals spent prolonged periods outdoors. All patients have received treatment and are showing signs of improvement.

Does International Travel have any Influence on Malaria.

Malaria outbreaks were common in the United States until the late 1940s when the disease ceased to be a major public health concern. Since then, the majority of cases have been among travelers returning from abroad. Before the COVID-19 pandemic, an estimated 2,000 malaria cases were recorded annually among individuals who had recently traveled internationally, with five to ten deaths occurring as a result. As international travel is expected to return to pre-pandemic levels, the number of infections acquired abroad and imported into the United States may increase accordingly.

Are there Vaccines Available?

Locally Acquired Malaria Cases Detected in Florida and Texas: A Rare Occurrence in the US After Two Decades
Locally Acquired Malaria Cases Detected in Florida and Texas: A Rare Occurrence in the US After Two Decades

In 2021, the World Health Organization recommended the widespread use of the first and only malaria vaccine, known as RTS,S/AS01 or Mosquirix, in sub-Saharan Africa and other regions with moderate to high malaria transmission. This vaccine has shown a 30% reduction in severe and fatal malaria cases. Although other promising vaccine candidates are being tested worldwide, the development process has been slow. Therefore, while efforts continue, the availability of a highly effective malaria vaccine remains uncertain.

Does Climate Change Relate to the Spread of Malaria?

Malaria is more prevalent in warm climates, and certain Anopheles mosquitoes have expanded their ranges in ways consistent with climate change. However, it is challenging to determine the direct link between the recent US cases and climate change. The southern United States already had a climate suitable for malaria transmission. Nevertheless, climate change may indirectly contribute to these cases by increasing the disease’s prevalence in regions where Americans frequently travel, leading to more imported cases and subsequent transmission within the United States.

What are the Risks of Contracting Malaria?

For individuals living in the United States who do not travel to malaria-endemic areas, the risk of contracting malaria is extremely low. While the five locally transmitted cases in Florida and Texas warrant attention from public health officials and clinicians, there is no cause for general concern among the public. It is important for everyone to actively reduce mosquito populations and take precautions to prevent mosquito bites whenever possible. Travelers to areas with local malaria transmission should take appropriate preventive measures, including potentially using prophylactic medications, and remain vigilant for symptoms upon return. Those residing in warm climates and experiencing unexplained fever should consult their healthcare providers.

By staying informed and taking necessary precautions, individuals can effectively mitigate the risk of malaria within the United States.


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