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Infectious diseases are a problem in every part of the world, and a common, yet deadly, example is malaria. Malaria was once a major medical issue in the Southern United States; in fact, a 1933 survey found that up to thirty percent of local populations in the Tennessee River Valley were affected. The disease was also common in WWII war zones. Malaria became such a concern that the CDC (back then, it stood for “Communicable Disease Center”) was established primarily to combat it.

Note: (Now, it stands for “Centers for Disease Control and Prevention.”)

The CDC and the health agencies of thirteen Southeastern states instituted the National Malaria Eradication Program in 1947. By the end of 1949, over 4,650,000 homes were sprayed with insecticide.

This had an immediate effect. In 1947, 15,000 new cases were reported. The next year, it was down to 2,000. By the end of the year after that, malaria was considered eradicated in the United States. This public health miracle happened through the widespread implementation of insecticides, drainage programs, and the installation of door and window screens.

In recent weeks, six cases of malaria have been reported in Florida’s Sarasota county, and one in Cameron county, Texas. They represent the first documented cases of local transmission in twenty years, when eight cases were reported in Palm Beach, Florida. That doesn’t mean that Americans can’t get malaria abroad. In 2018, close to 1,800 cases of travel-related malaria were identified in returning travelers, seven of which died of the infection.

This is a drop in the bucket compared to the damage done yearly worldwide by malaria. The CDC reports that, in one recent year, an estimated 247 million cases were diagnosed with 619,000 deaths, mostly in children in sub-Saharan Africa. Given this fact, it’s important to identify threats early and take action to prevent outbreaks.


Malaria is a disease caused by a parasite in the genus Plasmodium. Several types can cause the disease, but Plasmodium falciparum is most likely to cause severe infections.

Malaria is usually transmitted by a bite from a specific species of mosquito known as Anopheles that carries the parasite. Only the females bite, and they must have previously taken a blood meal from an infected person to harbor the parasite. The organism lives in the saliva of the mosquito and is injected into each future victim during a bite.

Once in a human, the malaria parasite lives in red blood cells, leaving open a number of ways in which the disease can be spread:

  • Blood transfusions
  • Needle Sharing
  • Organ transplants
  • From mother to fetus

Other than these specific avenues, malaria is not considered contagious from person to person. It isn’t airborne like colds, flus, and COVID. It isn’t passed along by sexual contact.


It’s important to recognize the signs and symptoms of malaria, just as it’s important to diagnose any disease early in the process.

Expect to see symptoms begin about 10 days after an infected mosquito bite; in some cases, however, symptoms may be delayed up to a year. This is because Plasmodium falciparum can remain dormant in the liver for a time. You see physical signs of sickness once it invades red blood cells. There may be a cycle of inactivity followed by active phases known as “relapses.” Relapses tend to worsen over time and may be separated by weeks, months, or even years.

Symptoms of malaria include:

  • Fever and chills
  • Headache
  • Muscle aches
  • Fatigue
  • Nausea and vomiting
  • Diarrhea
  • Confusion

The organism that causes malaria sometimes destroys so many blood cells that anemia ensues. In some cases, skin and eyes turn yellow (“jaundice”). If ignored, organ failure, seizures, coma, and death may occur.

Diagnosis isn’t difficult if you have a microscope. The Plasmodium parasites can be identified in a drop of blood.


The conventional wisdom put forth by many experts points to warmer temperatures caused by climate change. Hotter weather and increased rainfall, indeed, could lead to wider spread of malaria and other tropical diseases. Mosquitoes breed best in the heat (as long as there’s a water source to lay eggs) and are rendered inactive by cold.

Others suggest that the recent cases, which seem to have been caused by a type of Plasmodium (P. vivax) that causes less severe symptoms, may not have been recognized as being signs of malaria by the victims until they had a relapse.

Note: (Despite having less severe symptoms, the CDC considers any case of malaria a medical emergency which must be treated immediately.)

Perhaps, the malaria cases in Texas and Florida may have been discovered because COVID has raised people’s awareness regarding flu-like illnesses. Those who are feeling sick may be more likely to present to their medical provider, only to find they have malaria instead of COVID.

An alternative hypothesis you won’t hear about is the possibility that immigrants crossing the border, many of whom come from countries where malaria is common, may be carrying the parasite. If carriers get bitten by mosquitoes after they arrive in the United States, the now-infected mosquitoes transmit the disease locally. This may not only be true of malaria, but of other mosquito-borne illnesses or respiratory diseases like tuberculosis.


Quinine sulphate bottle, 1880.  Science Museum, London. 

Malaria cases here might even become more severe in nature in the U.S. than in places where it’s common. U.S. citizens have essentially no immunity to malaria due to lack of exposure. Rapid treatment is important to nip the infection in the bud.

For P. Falciparum infections acquired in areas without chloroquine-resistant strains, which include parts of Central America, Haiti, and the Dominican Republic, treatment is with oral chloroquine or, alternatively, hydroxychloroquine.

Quinine sulfate in addition to doxycycline is an option in cases which were acquired in other areas where chloroquine resistance is common. A number of other drugs have been used with some degree of success.


— If you can’t help but travel in regions where anopheles mosquitoes live, you might consider taking medicine that offers protection against Plasmodium organisms. Begin the course of treatment a few days before, and both during and for a week after your trip. Examples include:

  • Atovaquone/Proguanil
  • Chloroquine
  • Doxycycline
  • Mefloquine
  • Primaquine
  • Tafenoquine

The exact dosing varies, dependent on the drug.

— Preventing mosquito bites will prevent malaria. Use Environmental Protection Agency (EPA)-approved insect repellents. The ones below are considered safe and effective for all adults, including pregnant/breastfeeding women.

  • DEET
  • Picaridin
  • IR3535
  • Oil of lemon eucalyptus
  • Para-menthane-diol (PMD)
  • 2-undecanone

Apply repellents after, not before, applying sunscreen.

—Wear long-sleeved shirts and long pants, preferably treated with 0.5% permethrin. Permethrin is an insecticide that kills or repels insects like mosquitoes and sand flies. Treated clothing (which is available commercially) provides protection, even after multiple washes. Do not use permethrin products directly on skin.

—Keep mosquitoes out of your residence. Air conditioning and window/door screens will decrease your exposure. Mosquito netting is also available for your bed. Choose one that’s compact, rectangular, has 156 holes per square inch, long enough to tuck under the mattress, and permethrin-treated. A white net would provide a background that allows you to better see mosquitoes.

—Strategies for children include:

  • Long sleeves and pants.
  • Netting to cover baby carriers.
  • Using insect repellent.

Avoid applying repellent to the child’s hands, eyes, or mouth. Spray onto your hands and then apply to the child’s face. Do not use products containing oil of lemon eucalyptus or para-menthane-diol (PMD) on children under 3 years old.

Some plants naturally repel mosquitoes, like citronella, rosemary, lavender, mint, basil, sage, and bee balm. Each grows in its own zone, so find the one that can thrive in yours.

Likely, you’ll won’t be able to completely prevent a mosquito bite here and there. If you’re bitten, don’t scratch the area as it could cause an infected wound. Wash the area with soap and water; then, apply an anti-itch or antihistamine ointment or cream as needed.

There’s no reason to believe a major outbreak of malaria will hit the U.S., but the family medic should know about the disease. Early diagnosis, treatment, and prevention will decrease a patient’s chance of long-term illness or worse.

Joe Alton MD

Hey, don’t forget to check out our entire line of quality medical kits at Also, our Book Excellence Award-winning 700-page SURVIVAL MEDICINE HANDBOOK: THE ESSENTIAL GUIDE FOR WHEN HELP IS NOT ON THE WAY is now available in black and white on Amazon and in color and color spiral-bound versions at

Hey, don’t forget to check out our entire line of quality medical kits and individual supplies at Also, our Book Excellence Award-winning 700-page SURVIVAL MEDICINE HANDBOOK: THE ESSENTIAL GUIDE FOR WHEN HELP IS NOT ON THE WAY is now available in black and white on Amazon and in color and color spiral-bound versions at

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