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Domestic refugee health guidelines; malaria
  • Published Date:
    November 13, 2012
Filetype[PDF-4.14 MB]


Details:
  • Corporate Authors:
    National Center for Emerging and Zoonotic Infectious Diseases (U.S.), Division of Global Migration and Quarantine.
  • Description:
    Summary and background -- Recommendations for pre-departure presumptive and directed treatment for P. falciparum Infection for refugees from sub-Saharan Africa -- Recommendations for post-arrival presumptive and directed treatment for malaria for refugees from sub-Saharan Africa -- Precautions and contraindications to presumptive treatment -- Refugees from other regions -- Strategies to prevent non-falciparum malaria in newly arriving refugees.

    Each year 50-70,000 refugees are accepted for resettlement to the United States. Refugees from sub-Saharan Africa account for an increasing proportion of these newly arriving refugees and now constitute more than a third of new arrivals. The proportion of newly arriving refugees who originate in Africa has climbed from 9%, in 1998 to 39% in 2005. This shift in population has been accompanied by changing patterns of infection and illness in newly arriving refugees. Because of its potential virulence and dynamic epidemiology, including its high prevalence, malaria has emerged as a disease of particular concern in this population. Each year 50-70,000 refugees are accepted for resettlement to the United States. Refugees from sub-Saharan Africa account for an increasing proportion of these newly arriving refugees and now constitute more than a third of new arrivals. The proportion of newly arriving refugees who originate in Africa has climbed from 9%, in 1998 to 39% in 2005. This shift in population has been accompanied by changing patterns of infection and illness in newly arriving refugees. Because of its potential virulence and dynamic epidemiology, including its high prevalence, malaria has emerged as a disease of particular concern in this population. Malaria was endemic in most of the continental United States and much of Europe into the 20th century. Most of the continental United States has Anopheles mosquitoes (particularly An. quadramaculatus and An. freeborni) which are competent vectors under favorable conditions. Local U.S. vector-borne transmission has resulted in 156 known malaria cases in 63 U.S. outbreaks over the past 50 years. In addition, more than 1000 cases of malaria are reported annually in the U.S. with migration playing an important role in the importation of these cases. In endemic areas, malaria has historically plagued displaced populations, and this situation continues in many contemporary refugee camps. Refugees are often not included in the host country's national health programs, which may lead to higher rates of many diseases, including malaria and other parasitic infections.

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