The holiday season, with its increase in travel, is a good time to remind clinicians and hospitals that all recent travelers to malaria-endemic regions presenting with fever should be tested for malaria. This was the focus of an alert the Pennsylvania Department of Health (DOH) sent out on Dec. 9, 2015.
The alert included that:
- Early signs and symptoms of malaria (which may include fever, headaches, muscle pains, nausea, or vomiting) are non-specific.
- The experience in the past year of evaluation of febrile illness in travelers from Ebola-affected countries in West Africa, where malaria is endemic, has highlighted the importance of diagnosing or ruling out malaria. The Center for Disease Control and Prevention’s (CDC) Malaria Diagnosis webpage has guidance and tools to assist clinicians with evaluation of patients for malaria.
- Asking about recent travel and obtaining a thorough travel history is essential; a table of malaria risk by country is available on the CDC’s website.
- DOH recommends that patients presenting with fever and recent history of travel to a malaria-endemic country be tested immediately for malaria using blood smears. The use of rapid antigen tests does not eliminate the need for malaria microscopy; both positive and negative rapid tests should be confirmed by blood smear examination.
- Health care providers needing assistance with diagnosis or management of suspected cases of malaria should call the CDC Malaria Hotline: 770-488-7788 or 855-856-4713 toll-free (M-F, 9 a.m.-5p.m., ET). For emergency consultation after hours, call 770-488-7100 and request to speak with a CDC Malaria Branch clinician.
- Laboratories needing assistance with evaluating smears for parasites should contact DOH’s Bureau of Laboratories or visit CDC’s DPDx website. Digital images may be uploaded for review by CDC laboratorians.
- So that more may be learned about the emergence and spread of malaria drug resistance, the CDC is now requesting the submission of Plasmodium-positive whole blood samples from all malaria patients for drug resistance testing. Please send stained slides and EDTA blood tubes to DOH’s Bureau of Laboratories, who will ship the specimens to the CDC. A Bureau of Laboratories Specimen Submission Form must accompany the specimens and include information on the patient’s travel history and drug therapy.
- Malaria is a reportable disease in Pennsylvania. All cases of confirmed or suspected malaria should be reported via PA-NEDSS or as otherwise instructed by your local health jurisdiction. Health care providers who do not have a PA-NEDSS account may request one by emailing PA-NEDSS@pa.gov. In addition, the CDC Malaria Case Report Form is available on the CDC’s website.