Rapid Malaria Screening and Targeted Treatment of United States–bound Montagnard Refugees From Cambodia in 2002

Abstract

In 2002, a group of Montagnard refugees living in Cambodia was accepted for resettlement in the United States. Pre-departure malaria screening and targeted treatment was conducted to prevent morbidity, and minimize the potential for local malaria transmission post-arrival. We screened 902 of 906 refugees using rapid diagnostic tests (RDTs), microscopy, and polymerase chain reaction (PCR) analysis. Twelve (1.3%) RDT results were positive and 28 (3.1%) were indeterminate. Microscopy confirmed Plasmodium species in two of the positive RDT and one of the indeterminate results. Among a random 10% sample of negative RDT results (n = 86), none were positive by microscopy. The PCR confirmed the two microscopically (and RDT) positive specimens. The PCR result was negative for all other specimens tested. Eighteen (2.0%) refugees were treated with antimalarials. The RDTs were useful in this setting, facilitating timely, sensitive diagnosis and targeted treatment. Evaluations to determine the most appropriate interventions in other refugee settings should include cost-effectiveness analyses of alternative strategies.

Post-Arrival Screening for Malaria in Asymptomatic Refugees Using Real-Time PCR

“…Dramatic increases in sensitivity were observed with PCR, which detected two times as many infections as the OptiMAL Rapid Detection Tests (RDTs) and 25% more than microscopy. 5 Similar problems with sensitivity were reported in the study by Stauffer and others 31 using the Binax NOW ICT kit, whereas poor specificity and positive predictive values of RDTs in this population were described by Causer and others 32 using the OptiMAL kit. These issues with the performance of diagnostic tests within semi-immune, asymptomatic populations suggest that the prevalence of Plasmodium infections may have been underestimated in studies that used microscopy or RDTs for screening.…”

Dispensary level pilot implementation of rapid diagnostic tests: an evaluation of RDT acceptance and usage by providers and patients – Tanzania, 2005

“…The type of training that was provided to the dispensary level staff was, in all likelihood, more extensive than what could be provided during a national roll-out of RDTs. Although it has been suggested that novice technicians can competently use RDTs with minimal training[ 17 , 25 ], it was observed in this study that closer supervision, particularly during the first week, was needed in order to assure the health care workers that their techniques were appropriate. Comments continued up to the eighth week that more training and supervision was needed.…”

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

“…Currently, no refugee populations relocating to the United States from regions other than sub-Saharan African are from areas of hyper-or holoendemic malaria. Therefore, refugee populations relocating from other areas, except under special circumstances, 23,24 do not currently receive presumptive malaria treatment.…”