IMPORTED MALARIA IN MONTAGNARD REFUGEES SETTLING IN NORTH-CAROLINA - IMPLICATIONS FOR PREVENTION AND CONTROL

In the winter of 1992, some 402 Southeast Asian refugees were resettle d in North Carolina. They received very limited medical screening befo re immigration and many arrived in the United States with significant health problems, including several tropical infectious diseases. These refugees had lived for many years in remote areas along the Vietnam-C ambodia border, where there is intense transmission of malaria, includ ing Plasmodium falciparum resistance to most antimalarial drugs availa ble in the United States. Of 322 refugees screened after arrival in No rth Carolina, 187 (58%) were infected. 33% with P. falciparum, 23.5% w ith P. vivax, 23.5% with P. malariae, and 2.1% with P. ovale. Most inf ected persons were asymptomatic and infections with multiple species w ere common. Because of the documented high infection prevalence and th e probable presence of many subpatent infections, all nonpregnant refu gees were treated with halofantrine; those with P. vivax or P. ovale i nfections were given primaquine as well. This group accounted for the largest cluster of malaria cases reported ill the United States in the last 50 years. Their rapid relocation, with minimal medical screening prior to arrival, resulted in a significant burden to the refugees an d to the health-care system. Coordination between immigration agencies , the public health community, and medical workers in communities wher e the refugees are settled is critical for U.S.-based management of im ported tropical diseases.