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Do I need malaria prevention meds on my trip to Florida?

Infectious Diseases

A: No, at at this time you should just try to avoid mosquito bites. 🦟Preventive medications for malaria are not recommended for travel in the United States right now, but stay tuned on this evolving situation!

On June 26, 2023, the Florida Department of Health issued a health alert after identifying a small cluster of four malaria infections that were acquired locally–that is, people caught malaria in Florida. So far, seven people who caught the disease have been identified near Sarasota, Florida, and one (apparently unrelated) case has been identified in Cameron County, TX.

Though the United States sees around 2,000 cases of malaria a year, they are almost always cases that someone got while traveling abroad. Malaria is extremely common globally, infecting 250-300 million people every year and killing more than a million, many of them young children. It’s arguably the largest public health issue in the world. But U.S. cases in people who *haven’t* traveled? That’s big news. The U.S. does not have endemic malaria and has not seen a case acquired locally in twenty years.

Malaria is an infection caused by a single-celled parasite in the plasmodium genus. This summer’s cases have all been Plasmodium vivax, one of four types that infect humans. Transmission happens when an infected mosquito bites a person. The parasite enters the victim’s blood and replicates in the liver and red blood cells. When another mosquito bites the infected person, later on, that mosquito can carry the disease to another person. (It’s called vector transmission, nerds. 🤓)

It usually takes 10-30 days for symptoms to appear, but sometimes much longer. 🚨Malaria is a medical emergency. 🚨 If you have symptoms like fever, chills, headache, muscle pain, and/or fatigue and you’ve been in an area with known malaria (Florida, Texas, or anywhere else in the world), go to an emergency room immediately and tell them about your travel history. Malaria is treatable but serious. Especially for kids.

That said, don’t freak out.

The chance of you getting bitten by an infected mosquito is incredibly small, even if you live in one of the affected areas. One expert even said you’re more likely to get struck by lightning 🌩️ (see the Stat News article below).

Although some medications can prevent malaria infection (called malaria prophylaxis), they’re not easy to take, and they aren’t recommended for people inside the U.S. right now. The risk of getting malaria is too low to be worth it. The new game-changing malaria vaccine targets a different type of malaria (P. falciparum) and is not available in the U.S. It is currently being administered to children in parts of Africa with *a lot* of malaria, with 150 million kids vaccinated so far.

The best strategy for now is to try to avoid mosquito bites. Here’s how:

✅ The mosquito that carries malaria likes to bite in the late evening and night, so one simple step is to stay inside during those peak feeding times.
✅ You can also use an EPA-registered mosquito repellent like DEET.
✅ Cover your skin by wearing long pants and long-sleeved shirts.
✅ Patch any holes in your window screens. Duct tape makes a serviceable temporary patch.
✅ Make sure your yard isn’t a mosquito breeding zone by dumping out any standing water at least weekly, even small amounts such as in garden tools, gutters, and children’s toys.

Why is malaria happening now after 20 years? Will it become more common in the U.S. as warm-weather mosquito habitat expands? Will other mosquito-borne diseases start breaking out? Will prophylaxis be recommended for travel to the Southern US at some point in the future? 🔮 🔮 We don’t know. Time will tell.

For now, the bottom line is to try to avoid getting bitten.

Read more here:

CDC – Locally Acquired Malaria Cases Identified in the United States

Mayo Clinic on Malaria

AFP Journal – Prevention of Malaria in Travelers

STAT News – Malaria cases in Florida and Texas: Here’s what you need to know

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