Malaria Resurfaces in North America

By ALPA Staff

When traveling overseas to certain tropical and subtropical zones, airline pilots may be at risk for malaria infection. This insidious disease, spread by mosquitoes carrying the plasmodium parasite, is particularly prevalent in the central regions of Africa and certain island chains in the Pacific Ocean. However, for the first time in 20 years, cases of malaria have been contracted on U.S. soil. Reports of infection have been confirmed this summer in both Florida and Texas.

According to the U.S. Centers for Disease Control and Prevention (CDC), “Usually, people get malaria by being bitten by an infective female Anopheles mosquito.” Symptoms include fever, chills, fatigue, headache, coughing and breathing problems, diarrhea, nausea, and vomiting. These symptoms usually occur seven to 30 days after infection and, if left untreated, can lead to kidney failure, seizure, coma, and even death.

On average, approximately 2,000 cases of malaria are reported in the United States and 400 cases in Canada each year. In these instances, infected individuals travel to North America where they spread the disease by being bitten by mosquitos that then bite others.

While the CDC has issued a nationwide advisory about the possibility of local malaria transmission, the agency has concluded that the risk remains low. Even so, any case of malaria should be considered a medical emergency, and those infected should seek immediate treatment. Dr. Monica Parise, director of the division of parasitic diseases and malaria for the CDC’s Center for Global Health, advised, “It starts out mild, but it can progress to a very severe disease and death if it’s not promptly treated.” Consequently, it’s important for flight crews to be vigilant, given the recent rebound in international travel, which could be contributing to the spread of this and other insect-borne diseases.

The CDC was established in 1946, in part, to address the spread of malaria in the United States at that time. Nearly 15,000 cases were reported the following year. The agency was intentionally positioned in Atlanta, Ga., because the southeastern region of the country had the highest concentration of cases.

A National Malaria Eradication Program was soon launched, which included draining and removing mosquito breeding sites and spraying insecticides. By 1949, the country was declared free of malaria as a significant public-health problem. However, cases of the disease have continued to appear with the growth of international commerce and travel.

Pilots flying to locales where malaria is widespread may want to take measures to protect themselves. The CDC provides lists of locations in the world where malaria transmission is widespread and medications available for prevention.

Your aviation medical examiner (AME) or primary care provider should decide on the best drug for you, if any, based on your travel plans, medical history, age, drug allergies, pregnancy status, and other factors. AMEs will know if specific medications have recommendations or limitations.

Be mindful that some antimalarial drugs need to be started well in advance of traveling to be effective. In addition, airlines typically recommend certain medications if a flight crew is scheduled to travel to a malaria hotspot.

Most antimalarial medications are allowed for pilots after a ground test period without side effects. However, mefloquine (Larium) isn’t allowed because of possible neuropsychiatric side effects. Use of mefloquine disqualifies a pilot for four weeks after the last dose and requires AME clearance according to the FAA. Transport Canada doesn’t have a published policy on malaria medications, but taking similar precautions is encouraged.

The CDC is quick to point out, “No antimalarial drug is 100 percent protective and must be combined with the use of personal protective measures.” These include insect repellent, long-sleeve shirts, long pants, and sleeping in a mosquito-free setting when possible. At home, check your yard to ensure there’s no standing water, which can attract these insects.

Have Questions?

ALPA pilots from both the U.S. and Canada with questions about malaria or malaria medications may contact Aviation Medical Advisory Service (AMAS), ALPA’s Aeromedical Office, to confidentially speak to one of its aerospace medicine physicians about health and medical certification issues. The office hours are Monday–Friday 8:30 a.m. to 4:00 p.m., mountain time. Additional information is available on the AMAS website. These services are available to all ALPA members at no charge.

This article was originally published in the August 2023 issue of Air Line Pilot.

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