Correspondence
Malaria in New Jersey
N Engl J Med 1994; 331:1454-1455November 24, 1994
- Article
To the Editor:
Brook and colleagues (July 7 issue)1 describe two cases of Plasmodium vivax malaria apparently acquired locally in New Jersey. This is of course a remarkable occurrence, and the hypothesis that the malarial parasite was transmitted locally requires careful critical evaluation. It is surprising that the authors did not consider the possibility that infected mosquitoes were imported into nonmalarial areas by airplanes (“airport malaria”2) or even in the baggage of passengers (“baggage malaria”3). These mechanisms may explain apparently unexplainable occurrences of malaria in temperate countries. It would be interesting to know whether the patients described by Brook et al. resided near an international airport or, if not, whether anyone in the patients' neighborhoods had returned from an infected area immediately before the patients presented with malaria.
3 ReferencesGeoff Gill, M.D.
Walton Hospital, Liverpool L9 1AE, United Kingdom1
Brook JH ,Genese CA ,Bloland PB ,Zucker JR ,Spitalny KC . Malaria probably locally acquired in New Jersey. N Engl J Med 1994;331:22-23
Full Text | Web of Science | Medline2
Isaacson M . Airport malaria: a review. Bull World Health Organ 1989;67:737-743
Web of Science | Medline3
Castelli F ,Caligaris S ,Matteelli A ,Chiodera A ,Carosi G ,Fausti G . “Baggage malaria” in Italy: cryptic malaria explained? Trans R Soc Trop Med Hyg 1993;87:394-394
CrossRef | Web of Science | Medline
To the Editor:
The 29-year-old woman described by Brook et al. was under the care of my colleagues and me when I was assistant professor of clinical medicine in the Department of Hematology and Oncology, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine. The case report incorrectly states that the Centers for Disease Control and Prevention (CDC) made the diagnosis of malaria in this patient. Our fellow at the time, Julianne C. Wilkins, D.O., insisted that the blood smear was consistent with P. vivax infection, added primaquine to the therapy, and sent the slides to the CDC for confirmation of the diagnosis. The CDC confirmed the diagnosis of malaria and asked Dr. Wilkins to defer writing about this unusual case, because the CDC was collecting data on a series of such patients.
Michael B. Dabrow, D.O.
Lankenau Hospital, Wynnewood, PA 19096Author/Editor Response
The authors reply:
To the Editor: We thank Dr. Gill for suggesting the possibility that the two cases of malaria were caused by infected mosquitoes that were imported by aircraft from an area where malaria is endemic. We evaluated this possibility during the investigation. The residence in each case was more than 15 air miles from the nearest international airport, a much longer distance than that in any reported case of airport-related malaria, no one associated with either patient had spent any time at or near an airport. In addition, there are very few international flights from areas of endemic malaria to airports in Philadelphia or New York without a change of equipment at another airport overseas. The few direct flights arrive from cities where there is no transmission of malaria.
The suggestion that infected mosquitoes may have been imported in baggage is interesting. This hypothesis was developed to explain the apparent transmission of malaria during the winter in Italy, but it was not confirmed. In the reported cases, competent vectors and favorable weather conditions were recorded in the area. No one involved in either case was visited by anyone arriving from an area where malaria is endemic, nor were the patients aware of any close neighbors who had visited such an area.
We apologize for any misunderstanding that may have occurred with regard to the publication of this report. The correspondence we received and a review of the hospital records are consistent with the information reported in our article. There were no plans for the CDC to report on a case series, and no one was discouraged from publishing any report. The initiative to publish this report came from the New Jersey Department of Health, and the CDC supported the effort.
John H. Brook, M.D., M.P.H.
New Jersey Department of Health, Trenton, NJ 08625Peter B. Bloland, D.V.M., M.P.V.M.
Jane R. Zucker, M.D.
Centers for Disease Control and Prevention, Shamblee, GA 30341
