August 12th, 2013 6:47 am ET - Stefanie Steele, RN, MPH, CPH, CDC Division of Parasitic Diseases and Malaria
Since 2007, managing the CDC Malaria Hotline has been a large part of my job as a health educator in the Division of Parasitic Diseases and Malaria at CDC. It’s wonderfully fulfilling because it gives me the opportunity to talk directly with the public to share information that can help them avoid malaria infection when they travel. I can hear the public’s concerns and misconceptions about malaria and work to address them in our educational materials.
On average the Hotline handles 6,000 calls a year from mostly the public and healthcare providers—the vast majority are from within the United States.
The public’s primary concern is whether malaria occurs in the area they plan to visit and if so, what they can do to protect themselves. Sometimes people who have returned ill from their travel call to ask if their symptoms might be malaria. Fortunately, in the U.S. there are well-qualified healthcare providers, clinics, hospitals, and labs available most everywhere, as well as CDC prevention information I can direct them to.
Some callers are U.S. healthcare providers who want to know which antimalarial drug to prescribe to prevent malaria for a patient who is planning travel—the recommendation varies by area, but fortunately very effective drugs are available for prevention no matter which area they plan to visit.
Clinicians who call the hotline about diagnosing or managing a confirmed or suspected case of malaria in a returned traveler are connected to a Malaria Branch expert—a service that is available 24/7/365. As our Malaria Branch experts can testify, calls in the middle of the night are a common occurrence.
But what happens when the caller to the hotline is a U.S. resident already traveling abroad who becomes ill with what could be malaria? Each year, the hotline handles dozens of these calls. Those most concerning to me are young people traveling in a malarious area who become ill. Some are away for a school semester or cultural exchange program, or as a missionary or other volunteer on a project bringing aid to an impoverished community. Sometimes it’s the concerned parent calling on behalf of an ill teenager or young adult child who has limited access to a telephone or the Internet where they are traveling. At other times it’s the young person on the other end of the line whose voice often conveys how sick they are feeling and their fears about being so sick while far away from home.
Regardless of who is calling, I try to allay their fears and reassure them that it is possible to obtain adequate treatment for malaria even in a country with a poor healthcare infrastructure. However, locating a reputable healthcare provider can be more complicated.
The typical scenario is that they are in a very poor country where access to even basic health care is limited—something they may not have given much thought to until they became ill. In addition, cultural and language barriers can compound the situation.
Some callers tell a story of becoming ill within two or three days of arrival at their destination and being told by a local healthcare provider they consulted that they have malaria, which is highly improbable given the short period of time between their arrival and when their symptoms occurred. Another scenario is the caller traveling with a group who all became ill at the same time. They are then told they all acquired malaria infection—also unlikely to be the case, especially for those on an appropriate antimalarial drug to prevent malaria.
Of great concern to me as well are treatments many of these young people report they have taken. These treatments may include a drug known to be ineffective against the type of malaria in the area they are traveling, and some have reported they were given injections of some unknown drug. This is also troubling because of the possibility that contaminated needles might be used in these instances.
I have also been told by more than a few callers that a local healthcare provider advised them to stop taking their antimalarial drug because it was not effective for the country where they were traveling—which is often not true. Still others want to know whether it’s okay, while still symptomatic, to hop on the next commercial flight back to the States for treatment. I tell them this is not a wise thing to do for someone who might have malaria because the disease can sometimes rapidly become severe and they would not be able to get medical attention at 30,000 feet.
These are some of the most challenging calls to the hotline because of the seriousness of malaria, which should be treated as a medical emergency. However, there are no 24 hour medical services in many of the places where these young travelers find themselves when they suddenly fall ill. They may have to contend with counterfeit or substandard drugs being prescribed, or poorly trained healthcare workers and laboratorians, not to mention relying on the same scarce resources the local residents must use when they become ill.
My advice to the traveler who becomes ill abroad? See a reputable healthcare provider as soon as possible. It’s important to know whether it really is malaria and if not, to get appropriate diagnostics and treatment for whatever else the illness might be. I tell them to contact the U.S. embassy or consulate in their host country to ask for a clinician recommendation or to call a family member in the United States themselves and ask the family to do this for them. A U.S. consular officer can assist in locating medical services and informing family or friends (see Travel.State.Gov). I also tell callers that in some countries they may need to travel to the capital or a major city to access better care. Medical evacuation is another option but can be pricey and works out best if evacuation insurance was purchased in advance.
The good news is that malaria is largely a preventable disease. Preventing malaria infection involves a bit of pretravel planning and is best done at least 4-6 weeks before the trip. By far the most important step is to see a healthcare provider, preferably a specialist in travel/tropical medicine, and to follow the dosage and timing recommendations for their antimalarial drug if prescribed. The CDC Malaria website as well as the hotline (855-856-4713) is available to help figure out the appropriate drug for the destination.
It’s also helpful to identify a reputable health care provider or clinic/hospital in the host country before travel for any type of medical emergency, such as a suspected malaria infection. Two professional organizations of travel medicine specialists, the International Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene, have clinic directories on their websites for locating a travel medicine specialist member in many countries. Travelers should also consider emergency medical evacuation insurance and possibly travelers insurance, especially for travelers who will be outside the U.S. for an extended period of time. (Read more about Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance.)
The CDC Malaria Hotline (855-856-4713) operates Monday through Friday from 9-5 pm Eastern Standard Time for both clinicians and the traveling public. Healthcare providers needing assistance with diagnosis or management of suspected cases of malaria after hours can call the CDC Emergency Operations Center at 770-488-7100 and request to speak with a CDC Malaria Branch expert.