Perspective Pre-departure and Post-arrival Management of P. falciparum Malaria in Refugees Relocating from Sub-Saharan Africa to the United States

Abstract. Plasmodium infection, often sub-clinical, is common in migrating sub-Saharan refugee populations. Refu-gees who subsequently develop clinical malaria suffer illness and exact a cost on state and local health care facilities. Untreated infection is also of public health concern because of the potential for local transmission. In response to increasing numbers of refugees originating in sub-Saharan Africa guidelines for the management of malaria in refugees migrating to the United States have been broadened and updated. The guidelines are based on available evidence-based literature and recent public health experience. These guidelines were critically reviewed, assessed, and approved by multiple National and State entities as well as outside experts. These consensus guidelines recommend that sub-Saharan African refugees relocating to the United States receive presumptive treatment of P. falciparum malaria before depar-ture or during the domestic refugee medical screening after arrival. Presumptive therapy is not currently recommended for either non-falciparum malaria or for refugees relocating from areas outside sub-Saharan Africa. FORMULATION OF RECOMMENDATIONS The recommendations in this document provide revised guidance for presumptive treatment of asymptomatic/sub-clinical Plasmodium infection in refugees relocating to the United States and should replace those issued in 1999. Thes