title: Presumptive treatment to reduce imported malaria among refugees from east Africa resettling in the United States.
abstract: During May 4, 2007-February 29, 2008, the United States resettled 6,159 refugees from Tanzania. Refugees received pre-departure antimalarial treatment with sulfadoxine-pyrimethamine (SP), partially supervised (three/six doses) artemether-lumefantrine (AL), or fully supervised AL. Thirty-nine malaria cases were detected. Disease incidence was 15.5/1,000 in the SP group and 3.2/1,000 in the partially supervised AL group (relative change = -79%, 95% confidence interval = -56% to -90%). Incidence was 1.3/1,000 refugees in the fully supervised AL group (relative change = -92% compared with SP group; 95% confidence interval = -66% to -98%). Among 39 cases, 28 (72%) were in refugees < 15 years of age. Time between arrival and symptom onset (median = 14 days, range = 3-46 days) did not differ by group. Thirty-two (82%) persons were hospitalized, 4 (10%) had severe manifestations, and 9 (27%) had parasitemias > 5% (range = < 0.1-18%). Pre-departure presumptive treatment with an effective drug is associated with decreased disease among refugees.
authors: Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, USA. cphares@cdc.gov
authors: Christina R
authors: CR
authors: Phares
authors: Bryan K
authors: BK
authors: Kapella
authors: Annelise C
authors: AC
authors: Doney
authors: Paul M
authors: PM
authors: Arguin
authors: Michael
authors: M
authors: Green
authors: Leul
authors: L
authors: Mekonnen
authors: Aleksander
authors: A
authors: Galev
authors: Michelle
authors: M
authors: Weinberg
authors: William M
authors: WM
authors: Stauffer
mesh_terms: D000293:Adolescent; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D005449:Fluorenes / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000078102:Lumefantrine; D008288:Malaria / Q000517:prevention & control*; D011739:Pyrimethamine / Q000627:therapeutic use*; D012036:Refugees; D013413:Sulfadoxine / Q000627:therapeutic use*; D013636:Tanzania / Q000208:ethnology; D014481:United States
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D000077549:Artemether; D000078102:Lumefantrine; D011739:Pyrimethamine