Malaria deaths in visitors to Canada and in Canadian travellers: a case series

Abstract

Over the last decade there has been a marked increase in case of drug-resistant and severe malaria in Canadian travellers. We report 7 deaths due to falciparum malaria that occurred in Canada or in Canadian travellers. Risks for malaria infection include inappropriate recommendations for malaria prevention by health care providers and lack of knowledge about or adherence to appropriate recommendations by the travelling public. Risks for death include delays in seeking medical attention, delays in diagnosis and inadequate care by Canadian physicians and hospitals, and lack of access to parenteral therapy for severe malaria. Malaria infections and deaths are preventable. Better education of health care providers and travellers about the risks of malaria and appropriate prevention and treatment measures may decrease this unnecessary burden on the Canadian health care system.

Fig. 1: World map showing areas where malaria is endemic, according to type of drug resistance, if any. This map is meant only as a visual aid, not as a definitive source of information about malarial endemicity. Additional important details about antimalarial drugs and country-specific malaria risk are available from Health Canada,¹³ the Centers for Disease Control and Prevention,¹⁴ the World Health Organization¹⁵ and Kain.¹⁹