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November 2007

Congenital Malaria in the United States: A Review of Cases From 1966 to 2005

Author Affiliations

Author Affiliations: Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.

Arch Pediatr Adolesc Med. 2007;161(11):1062-1067. doi:10.1001/archpedi.161.11.1062

Objectives  To provide an updated review and examine any trends among congenital malaria cases that might help guide diagnosis, treatment, and public health recommendations.

Design  Retrospective case series.

Setting  United States.

Participants  We reviewed all cases of congenital malaria reported to the US National Malaria Surveillance System between January 1, 1966, and December 31, 2004, including 1 unpublished case from 2005, encompassing all years for which data were collected and available.

Main Exposures  Maternal characteristics, including travel history, and malaria treatment.

Main Outcome Measure  Characteristics of congenitally acquired cases of malaria.

Results  For the 81 cases of congenital malaria reported in the United States in the past 40 years, the predominant infecting species was Plasmodium vivax (81%). Most mothers (96%) were foreign born, and 55 of 65 women (85%), for whom time of most recent exposure was known, were exposed 1 year or less before delivery. A common error in the treatment of infants with congenital malaria was the unnecessary administration of primaquine phosphate for P vivax infection.

Conclusions  Health care professionals should have heightened vigilance for malaria in pregnant women who have emigrated from or traveled to malaria-endemic areas within the past year, as well as in their offspring. Such women with episodes of fever during pregnancy should have a blood film to test for malaria performed promptly and should be treated appropriately. Treatment of a mother does not negate the need for heightened vigilance in her newborn. Health care professionals should be aware that congenital P vivax malaria does not need to be treated with primaquine.