Almost 1 million Canadians travel annually to malaria endemic areas, with several hundred cases reported each year.[1] Travelers who visit friends and relatives (VFRs) are well known to be at increased risk for malaria.[2, 3] Anecdotally, cases of malaria at Winnipeg Children’s Hospital (WCH) appeared to be increasing over time. The aim of this study was to review the aspects of malaria at WCH in both travelers and immigrants, and to identify possible gaps in management. Charts for all cases of malaria buy Olaparib in children (≤18 years), identified by ICD-9 code and hematology lab record review

and confirmed by positive thick or thin smears, as reviewed by a hematopathologist, presenting to WCH from January PARP phosphorylation 1, 1989,

to December 31, 2008, were retrospectively reviewed. Data were collected by way of a collection tool. Our hospital is the only tertiary pediatric center for the province of Manitoba, northwestern Ontario, eastern Saskatchewan, and southern Nunavut. There are an estimated 50,000 outpatient visits to the emergency department (ED) per year. Data were analyzed using Microsoft Excel (Microsoft, Seattle, WA, USA). The review was approved by the University of Manitoba Bannatyne Research Ethics Board. Statistical comparisons were done using Fisher’s exact test. From 1989 to 2008, 38 cases of pediatric malaria were identified in patients presenting to WCH. The mean age of cases was 8.4 ± 4.6 years, and 50% were male. Most cases occurred in older Astemizole children, with 24 cases (63%) > 6 years of age. On average, two cases of malaria were identified per year. Twelve cases occurred in pediatric travelers from malaria non-endemic areas (11 from Canada,

1 from UK), 11 of which were among VFRs (children born in Canada or overseas, returning to family’s nation of origin to visit friends and relatives). Six VFRs traveled to India, and five to sub-Saharan Africa. One child traveled to the Solomon Islands with family on business. The mean time from date of return to Canada to diagnosis was 123.3 days. The remaining 26 cases occurred among new immigrants and refugees, with a mean time from arrival in Canada to diagnosis of 92.3 days. Only 4 immigrants emigrated from India or Pakistan, while 22 emigrated from sub-Saharan Africa (Nigeria and Mozambique most commonly). All but two (93%) of the immigrant/refugee cases presented from 2000 onwards, whereas only four (33%) of the travel-related cases occurred in the same time period (Figure 1). From the traveler’s group, information about pre-travel counseling was available for 10 patients of whom 6 consulted a clinician prior to travel, none via a travel clinic. Only one child was prescribed appropriate malarial prophylaxis for the area of travel, and the parents of that child forgot to administer it overseas (two cases not specified, one given nothing, two given chloroquine inappropriately).