Travelers of a certain age might remember Annie Awful, a cartoon character and public information campaign that ran in the 1940s to drive awareness of malaria.
"She's a thief and a killer. She stops at nothing," warned the cartoon.
By all accounts, the public information campaign worked. Malaria had become largely eradicated in the United States by the early 1950s.
So why do nearly 1,500 Americans continue to be hospitalized from the disease every year? According to a new study released by the American Journal of Tropical Medicine and Hygiene, nearly all malaria patients in the U.S. are travelers that brought the disease home with them from affected countries. What's more, the disease could have easily been prevented had travelers taken the proper precautions before their trip.
"It appears more and more Americans are traveling to areas where malaria is common and many of them are not taking preventive measures, such as using anti-malarial preventive medications and mosquito repellents, even though they are very effective at preventing infections," said Diana Khuu, PhD, MPH, a scientist at the University of California, Los Angeles, who co-authored the study.
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Over the 15-year spanning from 2000 to 2014, more than 22,000 Americans were hospitalized due to malaria-related illnesses. Nearly 5,000 of them were diagnosed with severe malaria, which can create such complications as renal failure, coma or acute respiratory distress. Of these, 182 patients died. During that same period, malaria-related illnesses cost patients more than a half billion dollars in healthcare costs.
According to the study, malaria hospitalizations were more common in the U.S. than any other travel-related illness. Dengue fever, for example, which is generally contracted in parts of Mexico, Puerto Rico and Latin America, generated about 259 hospitalizations a year compared with the 1,489 for malaria.
The study also suggests indicates that the number of people contracting malaria is actually closer to 2,100 Americans per year since not all people with the disease will seek treatment at a hospital.
Additionally, the study also found "sporadic" instances of "locally-acquired" malaria, which researchers believe were caused by a domestic mosquito that either fed on an infected traveler or by an overseas mosquito that hitched a ride back to the U.S.
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As more travelers return with the disease, there is a greater "risk of malaria re-establishing itself in the U.S.," according to Dr. Khuu.
"Hospitalizations in the United States from malaria remind us that we live in an interconnected world," said Patricia F. Walker, MD, DTM&H, FASTMH, president of the American Society of Tropical Medicine and Hygiene. "For this reason, the U.S. must continue to invest in tropical medicine research efforts and programs, even for diseases like malaria that we don't think of as American diseases."
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