Grandparents, aunts, uncles and cousins all eagerly awaited the first face-to-face encounter with their little American relative. The 2-year-old couldn't appreciate all the work involved in planning the long trip to India and the much-anticipated four-month visit, but his parents really were doing a great job.
They had arranged for passports and plane tickets and were now working their way down the medical checklist. The boy had already received immunizations against typhoid and hepatitis A.
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All that remained was to fill a prescription for mefloquine, an anti-malaria pill, which is started two weeks prior to travel, then taken weekly during travel and for four weeks following the return home. A smart move since malaria, a potentially deadly disease spread by infected nighttime-biting Anopheles mosquitoes, is common in the region the family planned to visit.
Officials at the World Health Organization note that nonimmune individuals from malaria-free countries who travel to high-risk areas are particularly vulnerable to malarial disease. Individuals who have lived for years in malaria-endemic areas can develop partial protection and are then less likely to develop severe malaria, but are never completely immune to the disease.
While the U.S. is not considered a high-risk malaria zone, internationally the parasitic disease is responsible for between 600,000 to 1.2 million deaths per year. Most of these deaths occur in the pediatric population of Africa where, according to WHO estimates, a child dies every minute due to malaria. The encouraging news is that malaria's worldwide mortality rate has dropped by more that 25 percent since the year 2000.
Five species of the Plasmodium parasite are known to cause malarial disease in humans. In the American Academy of Pediatrics Red Book Online, infectious disease specialists describe the clinical manifestations of the two most common of these parasitic species.
Malarial infection with the more deadly of the two species, P. falciparum, causes multiple life-threatening conditions including cerebral malaria, hypoglycemia, renal failure, respiratory failure and metabolic acidosis, severe anemia, and vascular collapse and shock.
The second common Plasmodium species, P. vivax, causes anemia, enlargement of the spleen with possible rupture, and the potential for three to five years of additional relapsing malarial disease.
Fortunately, anti-malarial drugs are available. Rapid identification of the Plasmodium species through stained blood films and prompt treatment of the patient can be lifesaving.
Since it's always preferable to prevent disease rather than treat complications, AAP experts advise that families heading to malaria-endemic areas start prophylactic medications prior to travel. While traveling, protective clothing, mosquito repellents (with DEET, picaridin, oil of lemon eucalyptus, or IR3535), insecticide-treated mosquito netting and screened in-housing are all recommended.
The AAP reports that malaria risk is highest for travelers to sub-Saharan Africa, Papua New Guinea, the Solomon Islands and Vanuatu. Risk of malaria is intermediate on the Indian subcontinent and low in most of Southeast Asia and Latin America.
Parents should visit www.cdc.gov/travel to determine the risk of malaria and other infectious disease in the geographic area their family plans to visit. Also, hospital-based or free-standing travel clinics often have access to international vaccinations not commonly stocked in pediatric offices and can provide up-to-date advice to help keep families safe and healthy during their travel adventures.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.