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Notes from the Field: Malaria Imported from West Africa by Flight Crews --- Florida and Pennsylvania, 2010

On September 15, 2010, CDC notified the Florida and Pennsylvania departments of health of four Plasmodium falciparum--associated malaria cases among employees of a single commercial airline. All four employees had traveled to Accra, Ghana, during August 25--September 2, 2010, two of whom were on the same flight. Their duration of stay in Accra ranged from 48 to 80 hours. All had stayed at the same hotel and spent time outdoors near the swimming pool, in restaurants without air conditioning, and in other locations during the evening and night.

Two cases were in female flight attendants aged 20--40 years, and two cases were in male pilots aged 40--60 years. All had fever, headache, nausea, vomiting, and diarrhea approximately 2 weeks after their most recent exposure in Accra. Three of the four received diagnoses of acute P. falciparum--associated malaria on the basis of trophozoites observed on microscopic examination of thin and thick blood films. Malaria was diagnosed for one patient by blood smear, but the species (P. falciparum) was determined by positive polymerase chain reaction. One flight attendant was hospitalized for treatment, recovered uneventfully, and was discharged after 2 days. The two pilots and the other flight attendant were severely ill, were hospitalized, and required intravenous treatment. Both pilots had respiratory distress and required intubation. All recovered and were discharged after 6--15 days with diagnoses of acute malaria infection and acute respiratory failure for the pilots.

None of the four airline workers had used antimalarial chemoprophylaxis, despite company-paid atovaquone-proguanil (Malarone, GlaxoSmithKline) being an element of this airline's malaria prevention strategy. All reported having used insect repellent most of the time. Accra is recognized as a high-risk area for malaria transmission (1). CDC advises travelers to West Africa, an area of intense transmission, to use chemoprophylaxis as well as to take measures to avoid mosquito bites, because even brief exposure can result in transmission (2). Travelers to malaria-endemic countries, even for brief periods, should be aware of the risk for malaria and of prevention measures that can be taken.

Reported by

D Stanek, DVM, C Blackmore, DVM, PhD, Florida Dept of Health. V Dato, MD, Pennsylvania Dept of Health. B Martin, Delta Air Lines, Atlanta, Georgia. P Arguin, MD, Center for Global Health; P Kozarsky, MD, National Center for Preparedness, Detection, and Control of Infectious Diseases; D Bensyl, PhD, Scientific Education and Professional Development Program Office; M Selent, DVM, VM Beau De Rochars, MD, EIS officers, CDC.


  1. CDC. Malaria surveillance---United States, 2008. MMWR 2010;59(No. SS-7).
  2. CDC. Health information for travelers. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at Accessed October 27, 2010.

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