Synopsis for July 20, 2001

MMWR articles are embargoed until 4 p.m. EST Thursday.

1. Malaria Fatalities Following Inappropriate Malaria Chemoprophylaxis — United States, 2001
2. Evaluation of a Regional Program to Prevent Mother-Infant HIV Transmission — Thailand, 1998–2000
3. Hantavirus Pulmonary Syndrome — Vermont, 2000

Synopsis for July 20, 2001

Malaria Fatalities Following Inappropriate Malaria Chemoprophylaxis — United States, 2001

Malaria remains a serious but preventable health threat to U.S. travelers abroad.

Two U.S. citizens have died in 2001 after taking chloroquine alone or in combination with proguanil for malaria prophylaxis in countries with known chloroquine-resistant Plasmodium falciparum malaria. Chloroquine resistance is extremely widespread, and now affects sub-Saharan Africa, Southeast Asia, the Indian subcontinent, and large areas of South America. CDC does not recommend chloroquine-containing drug therapy for prevention regimens to persons who travel to areas with known chloroquine-resistant P. falciparum malaria. Safe and effective alternative drug therapy regimens exist for travelers to these regions. Therefore, all travelers to international destinations should seek the advice of a health care provider regarding the need for malaria drug therapy for prevention and the selection of an appropriate medication. This report names those appropriate drugs.

Evaluation of a Regional Program to Prevent Mother-Infant HIV Transmission — Thailand, 1998–2000

Program successfully prevents mother-to-infant HIV transmission in Thailand.

Most of the world’s 600,000 annual HIV infections among infants occur in developing countries. This report summarizes the results of a large pilot program conducted in Northeastern Thailand to prevent mother-to-infant HIV transmission through HIV counseling and voluntary testing of pregnant women and the provision of short-course zidovudine (AZT) therapy to HIV-infected pregnant women. The program, conducted in 1998-2000, resulted in 86% of 122,000 pregnant women accepting HIV testing and 69% of 922 HIV-infected women receiving prophylaxis to reduce mother-to-infant HIV transmission. Additionally, infant formula use was nearly universal among HIV-infected women to prevent HIV transmission through breast-feeding. The risk of mother-to-infant HIV transmission was estimated to be approximately 10%, which is similar to the results from clinical trials, and a substantial reduction from the risk of 30% or more, which occurs in the absence of interventions. This program demonstrates that it is feasible to implement programs to prevent mother-to-infant HIV transmission on a large scale in a developing country.

Hantavirus Pulmonary Syndrome — Vermont, 2000

Hantavirus infection, though rare, can occur anywhere in the U.S. if the appropriate rodent vectors are present.

This report describes the first case of hantavirus pulmonary syndrome (HPS) infection in New England. Only 5% of confirmed cases of HPS have occurred east of the Mississippi River. Hantavirus infection, though rare, can be acquired in Vermont/New England after exposure to rodents and rodent droppings. The case-patient in this report had cleaned a mouse nest from a woodpile, observed mice in his basement, and trapped mice under kitchen counters, during the 2 months preceding his illness and subsequent hospitalization. Individuals should take the necessary precautions to decrease their risk of exposure to rodents. Physicians should consider hantavirus when treating an otherwise healthy patient who develops symptoms consistent with HPS.

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