MALARIA: HOT OFF THE CDC PRESS

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ECH, M.D.

Guest
MOST RECENT UPDATE FROM THE CENTERS FOR DISEASE CONTROL ATLANTA REGARDING MALARIA AND THE DOMINICAN REPUBLIC:

7 JANUARY 2000

Notice

Dominican Republic - Revised Malaria Recommendations

CDC has recommended malaria prophylaxis for travelers to rural areas in the Dominican Republic but not for travel to resorts. There has been a recent observed increase in malaria cases in the Dominican Republic, including a localized outbreak in the Altagracia Province (principally in the Bavaro Beach area) in the southeastern part of the country, which has included some cases in tourists who have stayed in resorts in this area. The risk to tourists appears to be quite low, but as a precautionary measure we are expanding our recommendations to include chloroquine prophylaxis for travelers to resorts in the Altagracia Province, particularly those that travel to the Bavaro Beach area. The Ministry of Health in the Dominican Republic has implemented malaria control measures including intensified surveillance, prompt case management, and intensive mosquito control activities in response to the increase in malaria activity in the province. CDC will continue to monitor the situation and provide updates on these recommendations.
 
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Karen

Guest
What is the treatment if one acquires Malaria? Is there any major side effect from the prevention treatment? I like to be cautious, but most medications tend to affect me more than others. For example, I hallucinated while wearing a seasick patch. :) Karen
 
E

ECH, M.D.

Guest
Re: MALARIA: TREATMENT QUESTIONS

This is not an easy question to answer. First you must understand there are four offending protozoa that cause malaria; Plasmodium falciparum, P. ovale, P. vivax, P. malariae. Chloroquin is the drug of choice in all except for Plasmodium falciparum malaria that is resistant to Chloroquin. The Plasmodium falciparum species that is resistant to Chloroquin has only been found in South American and Africa and not the Dominican Republic. In the Plasmodium falciparum that is resistant to Chloroquin, the drug of choice is quinine sulfate. Prognosis: Untreated vivax, ovale, or malariae subspecies spontaneously in 10 to 30 days but may recur at variable intervals. The prognosis becomes less favorable if intercurrent infection supervenes or if the patient was in poor general health when the attack began. Rapid treatment of uncomplicated malaria produces excellent results. Untreated falciparum malaria may have a case fatality rate as high as 20%. Patients with malaria gradually develop immunity that considerably modifies the clinical course. This immunity has a degree of strain specificity. Vaccines are still experimental. Various other antimalarials are available in areas outside the USA, but many of these drugs or drug combinations have been associated with either decreased antimalarial efficacy or unacceptable toxicities. Because P. falciparum and P. malariae parasites do not have a persistent hepatic (extraerythrocytic) phase, the disease is cured once the acute attack is adequately treated as outlined. In P. vivax and P. ovale, malaria, the exocrythrocytic parasites must be eradicated to prevent relapse. Primaquine phosphate taken orally for 14 days accomplishes this in most infections acquired in Latin America and Africa. Note: Primaquine has serious side effects and should not be given to pregnant women.

CHLOROQUINE alone is used to prevent malaria for travelers going to specific geographical regions such as North Africa, the Caribbean, Temperate South America, most of Central America, and part of the Middle East. In these regions CHLOROQUINE is still effective in preventing malaria. CHLOROQUINE is often marketed in the United States under the brand name Aralen?. The adult dosage is 500 mg (salt) once a week. This drug should be taken one week before entering a malarious area, weekly while there, and weekly for 4 weeks after leaving the malarious area. Rare side effects to CHLOROQUINE include upset stomach, headache, dizziness, blurred vision, and itching. Generally these effects do not require the drug to be discontinued. Did not mean for my answers to ramble so......sorry!
 
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Susanne

Guest
Malaria warning from Denmark

The Danish equivalent of CDC, Seruminstituttet, yesterday changed it's recommendations about Malaria precautions and the Dominican Republic.

All people that are going to stay close to the border of Haiti or in rural parts of the Dominican Republic are still adviced to take Chloroquine. But now that recommendation has been extended to the whole of the Altagracia Province, including the Punta Cana-area.

Regards, Susanne
 
E

ECH, M.D.

Guest
Re: Malaria warning from Denmark

GOOD GRIEF SUSANNE! How on Earth do you pronounce "Seruminstituttet" realizing that it has 5 (five, count them) "t's" in the word!!!!
 
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Susanne

Guest
Re: Malaria warning from Denmark - language lesson

I sympathize with your frustration! Linguists have declared Danish one of the most difficult languages to learn, due to an overwhelming amount of "impossible" vowel sounds.

"Seruminstituttet" is not as hard as it looks, though. Try to pronounce each syllable like this: See-rum-in-stee-too-ted" - say it really fast - and you will be close enough. Good luck!

The Danish favourite to confuse poor foreigners is "r?dgr?d med fl?de", which is an old country pudding. Don't even try this one. My English husband is only now, after 14 years here, getting a grasp of it, and he is very good with languages.

Regards, Susanne
 
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Karen

Guest
Re: MALARIA: TREATMENT QUESTIONS

Thanks for the reply. I would be curious to know what percentage of travelers headed for the DR have been innoculated. My other alternative is to douse myself with deet and hope I don't grow a third eye! Karen