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

Kevin C. Kain^*, Douglas W. MacPherson, Tim Kelton, Jay S. Keystone^*, Jack Mendelson and J. Dick MacLean^¶

From the *Tropical Diseases Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ont.; the Department of Pathology and Molecular Medicine, Hamilton Regional Laboratory Medicine Program and McMaster University, Hamilton, Ont.; the Missionary Health Institute, Toronto, Ont.; Sir Mortimer B. Davis – Jewish General Hospital, Montreal, Que.; and ¶McGill University Centre for Tropical Disease, Montreal General Hospital, Montreal, Que.

Abstract

Over the last decade there has been a marked increase in cases 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.

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