Transmission of Malaria in Resort Areas --- Dominican Republic, 2004

Main Category: Public Health
Article Date: 07 Jan 2005 - 22:00 PDT

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Malaria is caused by any of four Plasmodium parasites carried by Anopheles mosquitoes and usually is transmitted by the bite of an infective female Anopheles. In rural areas of the Dominican Republic, P. falciparum malaria is endemic, with the highest risk in the far western region of the country, and prophylactic medication with chloroquine is recommended for incoming travelers.

Conversely, urban and resort areas in the Dominican Republic have been considered nonmalarious, and prophylactic medication has not been recommended for persons traveling to these areas (1).

However, since November 2004, CDC has received reports of three malaria cases in U.S. travelers returning from areas in La Altagracia and Duarte provinces previously considered nonmalarious. An additional 14 cases of malaria in La Altagracia Province, in the far eastern region of the country, have been reported in European and Canadian travelers.

This report describes three of these 17 malaria cases and summarizes the overall investigation, which led to expansion of CDC recommendations for chloroquine prophylaxis to include all of La Altagracia and Duarte provinces.

Case Reports

Case 1.

During the third week of November 2004, a woman aged 47 years was admitted to an intensive care unit (ICU) in the United States with multisystem organ failure, including acute respiratory distress syndrome and renal failure. She had a 6-day history of fever, chills, abdominal pain, headache, nausea, and vomiting that began 24--36 hours after returning from a 1-week vacation to a resort in Punta Cana in La Altagracia Province.

The patient had been examined twice by a health-care provider in an outpatient setting and sent home. Two days before hospital admission, she had jaundice. On admission, the patient had P. falciparum malaria on blood smear (35% parasitemia), anemia (hemoglobin: 10.4 g/dL [normal: 12--18 g/dL]), leukocytosis (white blood cell count: 35,000/µL [normal: 5,000--10,000/µL]), severe thrombocytopenia (platelet count: 5,000/µL [normal: 130,000--400,000 /µL]), and was obtunded. The patient was started on intravenous quinidine gluconate, and the parasitemia cleared in 2 days.

On the fifth day of hospitalization, the quinidine was discontinued, and the patient was placed on doxycycline. The patient underwent hemodialysis for renal failure; she improved and was discharged to a rehabilitation center, where she remained as of December 30, 2004. Her husband reported that they had stayed at an all-inclusive resort in Punta Cana during their entire week in the Dominican Republic and did not travel to other areas. In addition, the patient had not traveled to any other malarious areas nor received any blood transfusions during the preceding year…….. CONTINUES…………CDC MMWR

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