Malaria in Kingston, Jamaica

Update: January 29, 2007

The Public Health Agency of Canada (PHAC) continues to monitor an outbreak of malaria in Jamaica. As of January 28, 2007, the Jamaican Ministry of Health has reported 273 confirmed cases of malaria with the majority occurring in Kingston. Eleven of the cases have been reported in the adjacent parish of St. Catherine, three cases have been reported in St. Thomas parish, and a single case has been reported in the parish of Clarendon. Although, one case has been reported in a US resident who traveled to Kingston in November 2006, no cases have been reported among Canadian travellers to date. All confirmed cases were caused by infection with Plasmodium falciparum. No deaths have occurred and there is no evidence of chloroquine resistance among treated cases. PHAC is temporarily recommending chemoprophylaxis and personal protective measures to prevent malaria in persons staying overnight in Kingston, Jamaica - please refer to ‘Recommendations' below). [map]

The Jamaican Ministry of Health is implementing intensive measures to control and contain the outbreak: early case detection, diagnosis, and prompt treatment; mosquito control including insecticide spraying and source reduction; and health education of the local population.

Malaria is not endemic to Jamaica.  Except for a small number of imported cases each year, Jamaica had been malaria free for the last 41 years. However, Jamaica is susceptible to the reintroduction of local transmission of this disease given its tropical climate, the presence of the mosquito that is capable of transmitting the disease, and its proximity to countries with endemic malaria.

Technical assistance is being provided by the Pan American Health Organization (PAHO) and the Caribbean Epidemiology Center (CAREC).  The US Centers for Disease Control and Prevention (CDC) is assisting by strengthening laboratory diagnostic capacity.

Source: Pan American Health Organization, Jamaican Ministry of Health, US Centers for Disease Control and Prevention (CDC)

Malaria is an acute flu-like illness caused by one of four species of parasite of the genus Plasmodium; Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae. Infection with P. falciparum malaria can be fatal.

The disease is most commonly transmitted to humans through the bite of an infected female Anopheles mosquito - a dusk-to-dawn biter.

Consult with your health care provider or travel health clinic before travelling to better understand your health risks and to learn what personal preventative measures you may need while travelling.

Recommendations

Given the current localized malaria activity in Jamaica and until further notice, the Public Health Agency of Canada recommends antimalarial prophylaxis (medication) and the use of personal insect protective measures against mosquito bites (between dusk and dawn) for Canadian travellers who may stay overnight in Kingston, Jamaica.

How to prevent malaria infection

Two important measures can help you prevent malaria infection: avoiding mosquito bites and using effective anti-malarial medications.

1. Personal Protective Measures to Prevent Mosquito Bites
Comprehensive information on mosquito-bite avoidance is detailed in CATMAT's “Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers”.

2. Antimalarial Medication (Prophylaxis)

Chloroquine is the malaria drug of choice for Jamaica. However, atovaquone / proguanil (malarone), doxycycline and mefloquine are equally effective as chloroquine and readily available.

Antimalarial medications decrease the risk of developing symptomatic malaria. However, they do not provide 100% protection against the disease. Your individual need for antimalarial medications should be discussed with your physician or travel medicine professional several weeks before travel.

If your physician or travel medicine clinic prescribes an antimalarial medication, it is important that you take it as directed in order to maximize the protective effect. Each drug has its own dosing regime that should be strictly followed. Because of the incubation period of the disease, these medications must be taken both before, during, and after travel.

Travellers are reminded to complete their prescribed regimen of prophylaxis on their return. Except for atovaquone/proguanil which must be taken for one week after returning from a malaria-endemic area, chloroquine, doxycyline and mefloquine must be taken for four weeks after returning from a malaria-endemic area.

All travellers to an area where malaria occurs, regardless of whether or not they have taken malaria prophylaxis, must understand that any fever should be immediately followed up with a medical consultation to rule out malaria.

As a reminder...

The Public Health Agency of Canada routinely recommends that Canadian international travellers consult their personal physician or a travel clinic prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication, and personal protective measures.

The Public Health Agency of Canada recommends, as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been.

For additional information on malaria

• The Committee to Advise on Tropical Medicine and Travel (CATMAT) produces evidence based statements and guidelines. For maps of malaria-endemic areas and other information about malaria, visit CATMAT's Canadian recommendations for the prevention and treatment of malaria among international travellers as published in the Canada Communicable Disease Report - Supplement (Vol. 30, June 2004).
• Malaria - Frequently Asked Questions