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Jamaica: Don't blame Haitians for malaria, fight it!

By Dr Dabor Reisiere

Tuesday, December 12, 2006

In the December 2 issue of the Observer, it was inferred that Haitians could have caused the malaria outbreak in Jamaica. As a doctor with knowledge in tropical medicine, I was surprised to read such comments in Jamaica's number 1 morning daily.

I was also surprised to read Dr Kenneth Baugh's statement, "It is now suspected that individuals (Haitians) may have escaped attention and mingled with other communities, thereby leading to local infections."

Dr Baugh is probably right as an Opposition spokesman on health, but wrong as a professor of clinical parasitology, because as I know, this disease is caused by the protozoan Plasmodium falciparum with approximatively 90 per cent acquired in sub-Saharan Africa, not in Haiti which is part of the Caribbean, In contrast, 70 per cent of cases of malaria due to Plasmodium vivax are acquired in Asia or Latin America.

Four species are transmitted through the bite of an infected female anopheles (Plasmodium falciparum, Vivax, Ovale and malariae).

Malaria can be also transmitted via blood transfusion, congenitally between mother and foetus. Those forms of infections are rare. I have never seen them in my experience.

Malaria remains a public health problem, accounting for 3.5 million deaths. In France, 5000 to 6,000 cases are diagnosed each year with 20 to 25 deaths. All are classified as imported malaria which is an infection acquired in an endemic country (sub-Saharan Africa) and treated in France. Plasmodium falciparum is accounted for in 80 per cent of cases. The largest patient group includes African, long-term residents in France coming back from vacation in their native country, or in non-immunised adults, with or without chemoprophylaxis.

In most of the Caribbean, malaria was eradicated more than 50 years ago - it is still in two countries, Haiti and the Dominican Republic (Zone 1 , WHO classification). Really, now, how can one make such a statement with regard to Haitians and malaria in Jamaica? I disagree with the statement as it has no scientific evidence.

Instead of accusing Haitians, it will be more understanding to think and rethink more about prevention of airport malaria. There is a high possibility of exposure to bites from infected imported anopheles mosquitoes. Haiti is a country with intellectual women and men. Just imagine their thoughts when they read such a statement. That's not fair.

Neither is it good for the image of the first independent country in the West Indies. Talking like that is reminding the Haitian people about a statement on HIV/AIDS, made in 1981 in a medical journal by a group of doctors seeking to be famous, saying that the Human Immuno-deficiency Virus was coming from Haiti.

Today, 39.5 million people are infected. Are they Haitians?

The problem of the Haitian people is also the Jamaican one. Remember, we are one people and remember that Haiti helped Jamaica in the past - by its participation in independence, with medical doctors and food, etc.

Haiti is a member of Caricom . This country needs to be treated similar to other members. The Haitian people are not asking for anything else but dignity and respect.

Imported malaria is not a new topic. In France, each year, we have to deal with a large number of cases of imported malaria. Most of them are people who visit family and friends when they go abroad or are simply tourists. For that same reason, vaccines and chemoprophylactic regimens are highly recommended before departure. In the United States 800 cases of imported malaria are diagnosed each year in people who visit family and friends abroad.

In 1999, D Lusina et al reported four cases (observational) of "airport malaria" in Paris. The affected airport was Roissy Charles de Gaulle. The four cases were found in the environs of the airport.

Anopheles surveillance

In Europe, especially in France, there is Eurosurveillance to track airport malaria and imported malaria.

Preparations should include infection-control plans for the rapid influx of malaria infection into health-care facilities, access to anti-malarial stockpiles, and supportive care equipment. More tropical and travel medicine specialists are needed to diagnose and to evaluate those travel-associated illnesses in Jamaica.

Don't blame Haitian refugees, do what you have to do for the well-being of your country.

We are all refugees.

For information regarding travel-associated illnesses, readers may wish to go to the following websites:

http: //WWW.istm.org/geosentinel/main.html

http://www.tropnet;net)

Dr Dabor Reisiere is emergency and intensive care physician in the Department of Medical and Toxicological Intensive Care Unit, Hôpital Lariboisière, Paris, France.

dreisiere@invivo.edu