Congenital malaria in the United States: a review of cases from 1966 to 2005.

OBJECTIVES: To provide an updated review and examine any trends among congenital malaria cases that might help guide diagnosis, treatment, and public health recommendations.
DESIGN: Retrospective case series.
SETTING: United States. PARTICIPANTS: We reviewed all cases of congenital malaria reported to the US National Malaria Surveillance System between January 1, 1966, and December 31, 2004, including 1 unpublished case from 2005, encompassing all years for which data were collected and available. MAIN EXPOSURES: Maternal characteristics, including travel history, and malaria treatment. Main Outcome Measure Characteristics of congenitally acquired cases of malaria.
RESULTS: For the 81 cases of congenital malaria reported in the United States in the past 40 years, the predominant infecting species was Plasmodium vivax (81%). Most mothers (96%) were foreign born, and 55 of 65 women (85%), for whom time of most recent exposure was known, were exposed 1 year or less before delivery. A common error in the treatment of infants with congenital malaria was the unnecessary administration of primaquine phosphate for P vivax infection.
CONCLUSIONS: Health care professionals should have heightened vigilance for malaria in pregnant women who have emigrated from or traveled to malaria-endemic areas within the past year, as well as in their offspring. Such women with episodes of fever during pregnancy should have a blood film to test for malaria performed promptly and should be treated appropriately. Treatment of a mother does not negate the need for heightened vigilance in her newborn. Health care professionals should be aware that congenital P vivax malaria does not need to be treated with primaquine.