Recent trends in the importation of malaria caused by Plasmodium falciparum into the United States from Africa.

National malaria surveillance data were reviewed in an analysis of the epidemiological impact of the transmission of chloroquine-resistant Plasmodium falciparum in Africa on malaria in the United States. Between 1975 and 1983, P. falciparum infections acquired by U.S. citizens who visited East Africa, especially Kenya, increased 21-fold. Estimated attack rates for P. falciparum per 100,000 U.S. travelers to Kenya rose from 21.2 cases in 1977 to 83.3 cases in 1982, a rise suggesting that the increase in imported malaria was not due to increased travel. The percentage of reported cases in U.S. citizens with P. falciparum infections acquired in East Africa who indicated having used chloroquine prophylaxis increased from 22.2% in 1978 to 75.8% in 1983; in contrast, no change in the reported use of chloroquine prophylaxis was observed in those infected in West Africa during the same period. These results suggest that chloroquine can no longer be considered a highly effective drug for prevention of malaria caused by P. falciparum in U.S. travelers to East Africa.