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Prevention of Malaria

Stephen L. Hoffman, MD, DTMH
JAMA. 1991;265(3):398-399. doi:10.1001/jama.1991.03460030104039.
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In 1990, the World Health Organization estimated that 2.1 billion people live in malarious areas of the world and that 270 million people develop new malaria infections each year.1 Although transmission of malaria was interrupted in the United States in the early 1950s, it is still a major concern to the 7 million Americans who visit countries with malaria every year.

Several years ago I was asked to consult on a patient with cerebral malaria. The patient had visited Kenya (East Africa) on safari several weeks earlier and had not taken chemoprophylaxis. Eight days before I saw him he developed fever and headache, and 2 days later he presented to an emergency department with the chief complaint, "I have malaria." The malaria smear was reported as negative (review revealed low parasitemia). The physician prescribed an antipyretic and follow-up in 2 days if his condition did not improve. Three days


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