Public Health Response to the First Locally Acquired Malaria Outbreaks in the US in 20 Years.

IF 9.7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Timothy N DeVita, Andrea M Morrison, Danielle Stanek, Michael Drennon, Elizabeth Sarney, Wade Brennan, Kelly Tomson, Carina Blackmore, Kelly Broussard, Monique Duwell, David Blythe, Laura Rothfeldt, Theresa Dulski, Keith Blount, Savanna Ledford, Dawn Blackburn, Erika Wallender, Joel L N Barratt, Brian H Raphael, Audrey E Lenhart, Alison D Ridpath, Kimberly E Mace, Seymour G Williams, Charles B Beard, Monica E Parise, Peter D McElroy
{"title":"Public Health Response to the First Locally Acquired Malaria Outbreaks in the US in 20 Years.","authors":"Timothy N DeVita, Andrea M Morrison, Danielle Stanek, Michael Drennon, Elizabeth Sarney, Wade Brennan, Kelly Tomson, Carina Blackmore, Kelly Broussard, Monique Duwell, David Blythe, Laura Rothfeldt, Theresa Dulski, Keith Blount, Savanna Ledford, Dawn Blackburn, Erika Wallender, Joel L N Barratt, Brian H Raphael, Audrey E Lenhart, Alison D Ridpath, Kimberly E Mace, Seymour G Williams, Charles B Beard, Monica E Parise, Peter D McElroy","doi":"10.1001/jamanetworkopen.2025.35719","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>In 2023, the US reported 10 locally acquired mosquito-transmitted malaria cases of 4 genetic lineages in 4 states, the first such outbreaks detected in 20 years and the largest in 35 years.</p><p><strong>Objective: </strong>To present the investigations, interventions, and challenges in the public health response to the malaria outbreaks and provide recommendations for future outbreaks.</p><p><strong>Design, setting, and participants: </strong>This qualitative study was an interdisciplinary public health response to the locally acquired malaria outbreaks in May to December 2023 and included case investigations, enhanced case finding, polymerase chain reaction analysis of captured Anopheles spp mosquitoes for Plasmodium spp parasites, and novel targeted amplicon sequencing of Plasmodium spp in patient blood samples. Public health interventions included incident command activation, clinician outreach, community awareness, and vector control. Patient data were acquired through public health surveillance as part of National Notifiable Disease Surveillance.</p><p><strong>Exposure: </strong>Plasmodium vivax-infected and Plasmodium falciparum-infected Anopheles spp mosquitoes.</p><p><strong>Main outcomes and measures: </strong>Confirmed malaria infection via blood film microscopy and polymerase chain reaction, presence of Plasmodium spp in Anopheles spp mosquitoes, and genetic markers associated with an endemic region of origin and parasite strain relatedness via targeted amplicon sequencing.</p><p><strong>Results: </strong>The study included 10 patients (mean [SD] age of 39.5 [15.0] years; 7 male [70%]) from Florida, Texas, Maryland, and Arkansas with locally acquired mosquito-transmitted malaria and 783 Anopheles spp mosquitoes across 4 states. No patient had a recent history of international travel or blood-borne exposures. Outbreak cases had epidemiologic links within but not across state lines. P vivax was detected in 3 Anopheles crucians in Florida. Sequencing data showed that all Florida P vivax cases shared the same Plasmodium strain. The Texas and Arkansas P vivax cases were genetically distinct from each other and from Florida's cases. All 9 P vivax strains had genetic signatures that were consistent with Central and South American origin. Maryland's P falciparum parasites were consistent with African origin. The outbreaks were contained.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study of locally transmitted malaria, outbreaks remained contained to individual counties, with Florida's P vivax cases linked to a single strain distinct from those in other states. Sustained Plasmodium spp transmission is unlikely in the US, though increases in global travel and migration, population, temperatures, and persistence of Anopheles spp vectors may increase risk for locally acquired malaria. Clinicians should prescribe chemoprophylaxis for patients traveling to endemic regions, ensure timely diagnosis and treatment, and facilitate public health reporting. Researching US Anopheles spp ecology and control methods while accelerating efforts to reduce malaria globally could mitigate future risk.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535719"},"PeriodicalIF":9.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501801/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA Network Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamanetworkopen.2025.35719","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Importance: In 2023, the US reported 10 locally acquired mosquito-transmitted malaria cases of 4 genetic lineages in 4 states, the first such outbreaks detected in 20 years and the largest in 35 years.

Objective: To present the investigations, interventions, and challenges in the public health response to the malaria outbreaks and provide recommendations for future outbreaks.

Design, setting, and participants: This qualitative study was an interdisciplinary public health response to the locally acquired malaria outbreaks in May to December 2023 and included case investigations, enhanced case finding, polymerase chain reaction analysis of captured Anopheles spp mosquitoes for Plasmodium spp parasites, and novel targeted amplicon sequencing of Plasmodium spp in patient blood samples. Public health interventions included incident command activation, clinician outreach, community awareness, and vector control. Patient data were acquired through public health surveillance as part of National Notifiable Disease Surveillance.

Exposure: Plasmodium vivax-infected and Plasmodium falciparum-infected Anopheles spp mosquitoes.

Main outcomes and measures: Confirmed malaria infection via blood film microscopy and polymerase chain reaction, presence of Plasmodium spp in Anopheles spp mosquitoes, and genetic markers associated with an endemic region of origin and parasite strain relatedness via targeted amplicon sequencing.

Results: The study included 10 patients (mean [SD] age of 39.5 [15.0] years; 7 male [70%]) from Florida, Texas, Maryland, and Arkansas with locally acquired mosquito-transmitted malaria and 783 Anopheles spp mosquitoes across 4 states. No patient had a recent history of international travel or blood-borne exposures. Outbreak cases had epidemiologic links within but not across state lines. P vivax was detected in 3 Anopheles crucians in Florida. Sequencing data showed that all Florida P vivax cases shared the same Plasmodium strain. The Texas and Arkansas P vivax cases were genetically distinct from each other and from Florida's cases. All 9 P vivax strains had genetic signatures that were consistent with Central and South American origin. Maryland's P falciparum parasites were consistent with African origin. The outbreaks were contained.

Conclusions and relevance: In this qualitative study of locally transmitted malaria, outbreaks remained contained to individual counties, with Florida's P vivax cases linked to a single strain distinct from those in other states. Sustained Plasmodium spp transmission is unlikely in the US, though increases in global travel and migration, population, temperatures, and persistence of Anopheles spp vectors may increase risk for locally acquired malaria. Clinicians should prescribe chemoprophylaxis for patients traveling to endemic regions, ensure timely diagnosis and treatment, and facilitate public health reporting. Researching US Anopheles spp ecology and control methods while accelerating efforts to reduce malaria globally could mitigate future risk.

公共卫生部门对美国20年来首次本地获得性疟疾爆发的反应。
重要性:2023年,美国报告了4个州的4种遗传谱系的10例本地获得性蚊子传播疟疾病例,这是20年来首次发现此类疫情,也是35年来最大的疫情。目的:介绍公共卫生应对疟疾疫情的调查、干预措施及面临的挑战,为今后的疫情防控提供建议。设计、环境和参与者:本定性研究是针对2023年5月至12月当地获得性疟疾暴发的跨学科公共卫生响应,包括病例调查、强化病例发现、捕获的按蚊疟原虫疟原虫的聚合酶链反应分析,以及患者血液样本中疟原虫的新型靶向扩增子测序。公共卫生干预措施包括事件指挥激活、临床医生外展、社区意识和病媒控制。作为国家应呈报疾病监测的一部分,通过公共卫生监测获得患者数据。接触:感染间日疟原虫和感染恶性疟原虫的按蚊。主要结果和措施:通过血膜显微镜和聚合酶链反应确认疟疾感染,在按蚊中存在疟原虫,通过靶向扩增子测序与流行区域起源和寄生虫菌株相关性相关的遗传标记。结果:本研究纳入来自佛罗里达州、德克萨斯州、马里兰州和阿肯色州的10例当地获得性蚊媒疟疾患者(平均年龄39.5[15.0]岁,男性7例[70%])和4个州的783只按蚊。无患者近期有国际旅行史或血源性接触史。暴发病例在州内有流行病学联系,但没有跨州联系。在佛罗里达州3只按蚊中检出间日疟。测序数据显示,所有佛罗里达州间日疟原虫病例都具有相同的疟原虫菌株。德克萨斯州和阿肯色州的间日疟原虫病例在基因上彼此不同,也与佛罗里达州的病例不同。所有9株间日疟原虫的遗传特征均与中南美洲起源一致。马里兰州的恶性疟原虫与非洲起源一致。疫情得到了控制。结论和相关性:在这一地方性传播疟疾的定性研究中,疫情仍然被控制在个别县,佛罗里达州的间日疟病例与其他州不同的单一菌株有关。尽管全球旅行和迁徙的增加、人口数量的增加、温度的升高以及按蚊媒介的持续存在可能增加当地获得性疟疾的风险,但疟原虫在美国不太可能持续传播。临床医生应对前往流行地区的患者开具化学预防处方,确保及时诊断和治疗,并促进公共卫生报告。研究美国按蚊的生态学和控制方法,同时加快全球减少疟疾的努力,可以减轻未来的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信