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Medical Access to Artesunate or Quinine for Malaria Treatment Streamlined in Canada through the Canadian Malaria Network (CMN)
Canadian Malaria Network (CMN)
Malaria continues to be a major cause of death worldwide and is the principal life-threatening infection facing Canadian travellers in malaria-endemic areas. Severe P. falciparum malaria infections may have a mortality rate of 20% or higher. Patients require immediate hospitalization and urgent, intensive medical management, including parenteral malaria therapy. Severe malaria is not a common disease in Canada, with an average of 14 cases per year (range 8-20 cases annually from 2001-2008). However, these cases are dispersed across the country, and attest to the need for distribution of these scarce antimalarial drugs for treatment of severe malaria across the country.
Artesunate,the preferred medication for the treatment of severe and cerebral malaria due to P. falciparum, and quinine, a possible alternative when artesunate is contraindicated, are only available in Canada through Health Canada's Special Access Program
, a program that allows practitioners to request access to drugs that are unavailable for sale in Canada. Although quinidine is available and is equally efficacious in treating malaria, it has a risk of life-threatening cardiotoxicity and an associated requirement for cardiac monitoring.
The Canadian Malaria Network was created in collaboration with Health Canada's Special Access Program and the Public Health Agency of Canada due to the potential for adverse outcomes associated with delays in acquiring parenteral malaria therapy. The Canadian Malaria Network (CMN) is established in 11 medical centres across Canada and maintains and facilitates rapid access to strategically-located supplies of intravenous artesunate and quinine for the treatment of severe P. falciparum. In addition, each of the participating centers has a designated physician with experience in treating malaria who is willing to assist and provide guidance in the management of malaria infections. These life-saving drugs are available 24 hours per day by contacting the pharmacies listed below. After-hours assistance can be obtained by contacting the infectious disease consultant on call at the respective center. Each Centre provides surveillance data to Health Canada on all malaria cases treated with these drugs.
Once a request is made to any of the designated CMN centres for either parenteral artesunate or quinine, the attending physician will receive the following via courier delivery:
- treatment dose
- information on treatment and chemotherapy for severe falciparum malaria
- forms to be completed for the collection of surveillance data (Forms A & B).
The attending physician will be asked to complete and send to the CMN National Coordinator the forms at the time of access/ request of intravenous artesuate or quinine (Form A) and at discharge/end of malaria therapy (Form B). The information collected on these forms is vital to inform policy for distribution of these drugs, and required by the organizations supplying these drugs for notification of any drug related adverse event.
Note: Fever occurring in a traveller within three months of returning from a malaria-endemic area is a medical emergency and should be investigated urgently with thick and thin blood films for malaria.
Table 1: Criteria for Severe Falciparum Malaria
EITHER
|
Adapted from: Severe and complicated malaria, 2nd ed. Trans Roy Soc Trop Med Hyg 1990;84(Suppl 2). |
Contact Information
The following hospital Centers across Canada have been identified as participants in the Canadian Malaria Network (CMN ).
To obtain artesunate or quinine, please contact the listed pharmacy in your area. The designated physician for each Center can be used as a resource for any questions you may have with regard to the treatment of malaria.
For after-hours assistance please contact the infectious disease consultant on call at the respective center.
Canadian Malarial Network Coordinators
| National Program Coordinator | National Pharmacy Coordinator | |
Name: |
Dr. Anne E. McCarthy | Kim Lamont, R. Ph. Tech. |
Address: |
Director of Tropical Medicine and International Health Clinic Division of Infectious Diseases Ottawa Hospital (General Campus) 501 Smyth Road, Ottawa, ON K1H 8L6 |
Pharmacy Department Ottawa Hospital (General Campus) 501 Smyth Road Ottawa ON K1H 8L6 |
Phone #: |
(613) 737-8184 | (613) 737-8899 ext. 72276 |
Fax #: |
(613) 737-8682 | (613) 737-8891 |
E-Mail: |
amccarthy@ottawahospital.on.ca |
Canadian Malaria Network Centres, by province
British Columbia |Alberta |Saskatchewan |Manitoba |Ontario |Quebec |Nova Scotia |Newfoundland |
| British Columbia | ||
|---|---|---|
|
Designated Physician |
Designated Pharmacist |
Name: |
Dr. William Bowie |
Dr. Tim Lau, Pharmacist et |
Address: |
Division of Infectious Diseases |
Pharmaceutical Sciences |
Phone: |
(604) 875-4147 or (604) 875-4111 (ID physician on call) |
(604) 875-4111, ext. 63361 or |
Fax: |
(604) 875-4013 |
(604) 875-5267 |
Email: |
||
Satellite Site |
1. Vancouver Island Health Authority, Royal Jubilee Hospital, Tammy Larkin, |
|
| Alberta | ||
| Designated Physician | Designated Pharmacist | |
| Name | Dr. Stan Houston | Wilson Cheng, Pharmacist |
| Address | 2E4.12 WC Mackenzie Health Sciences Ctr. University of Alberta Edmonton, AB T6G 2B7 |
University of Alberta Hospital Pharmacy WMC OG1, 8440-112 Street Edmonton, AB T6G 2B7 |
| Phone | (780) 407-8035 | (780) 407-1586 |
| Fax | (780) 407-7137 | (780) 407-8848 |
| shouston@ualberta.ca | wilson.cheng@albertahealthservices.ca | |
| Satellite Site | 1. Stanton Territorial Health Authority, Pharmacy, Cheryl Cooper Phone: (867) 669-4165 |
|
| Name | Dr. Susan M. Kuhn | Leah Boulter (Drug Information Pharmacist) |
| Address | Alberta Children's Hospital 2888 Shaganappi Tr NW Calgary, AB T3B 6A8 |
Alberta Children's Hospital 2888 Shaganappi Tr NW Calgary, AB T3B 6A8 |
| Phone | (403) 955-7553 | (403) 955-2999 (or 7204) |
| Fax | (403) 955-3045 | (403) 955-2719 |
| susan.kuhn @calgaryhealthregion.ca |
leah.boulter@calgaryhealthregion.ca | |
| Saskatchewan | ||
| Designated Physician | Designated Pharmacist | |
| Name | Dr. Karen McClean | Christina Swiatecki, Pharmacist |
| Address | Division of Infectious Diseases Royal University Hospital 103 Hospital Drive Saskatoon, SK S7N 0W8 |
Royal University Hospital Pharmacy 103 Hospital Drive Saskatoon, SK S7N 0W8 |
| Phone | (604) 875-4147 or (604) 875-4111 (ID Physician On Call) |
(604) 875-4111 or local 63361 or local 61571 |
| Fax | (306) 655-1000 (hospital locating) |
(306) 655-2279 |
| karen.mcclean@usask.ca | christina.swiatecki @saskatoonhealthregion.ca |
|
| Satellite Site | Regina | |
| Manitoba | ||
| Designated Physician | Designated Pharmacist | |
| Name | Dr. Pierre Plourde, Medical Officer of Health | Luke McKenzie, Pharmacist |
| Address | Winnipeg Regional Health Authority 490 Hargrave Street Winnipeg MB R3A 0X7 |
St-Boniface Gen. Hosp. Pharmacy 409 Avenue Taché Winnipeg MB R2H 2A6 |
| Phone | (204) 940-1683 or (204) 237-2053 (ID on call Physician) |
(204) 237- 2166 |
| Fax | (204) 956-4494 | (204) 237-2165 |
| pplourde@wrha.mb.ca | lmckenzie@sbgh.mb.ca | |
| Ontario | ||
| Designated Physician | Designated Pharmacist | |
| Name | Dr. Kevin C. Kain | Tamara Rumsey, C. Ph. Tech. |
| Address | Toronto General Hospital 200 Elizabeth Street Eaton North 13-214 Toronto ON M5G 2C4 |
Toronto General Hospital University Health Network 200 Elizabeth Street. ENB-310 Toronto ON M5G 2C4 |
| Phone | (416) 340-3535 | (416) 340-4800 ext. 3499 |
| Fax | (416) 595-5826 | (416) 340-3685 |
| kevin.kain@uhn.on.ca | tamara.rumsey@uhn.on.ca | |
| Name | Dr. Anne E. McCarthy | Kim Lamont, R. Ph. Tech. |
| Address | Director of Tropical Medicine and International Health Clinic Division of Infectious Diseases Ottawa Hospital (General Campus) 501 Smyth Road Ottawa ON K1H 8L6 |
Pharmacy Department Ottawa Hospital (General Campus) 501 Smyth Road Ottawa ON K1H 8L6 |
| Phone | (613) 737-8184 | (613) 737-8899 ext. 72276 |
| Fax | (604) 875-4013 | (604) 875-5267 |
| amccarthy@ottawahospital.on.ca | klamont@toh.on.ca | |
| Satellite Site | 1. Ottawa Hospital (Civic Campus), Candace Teakles Phone: (613)737-8899 ext.16642 2. Children's Hospital of Eastern Ontario (CHEO), Mary Malcomson Phone: (613) 737-222 3. Kingston General Hospital, Susan McKenna, Phone: (613) 549-6666 ext. 6286 (alternate: Chris Gray ext. 3654) 4. Hull Hospital (CSSS Gatineau), Alain Parenteau Phone: (819) 595-6006 5. Thunder Bay Regional Health Science Centre, Jeff Chan Phone: (807) 684-6327 6. North Bay General Hospital, Patti Euler Phone: (705) 474-8600 ext. 2098 |
|
| Name | Dr. Shariq Haider | Gita Sobhi, Pharmacist |
| Address | Microbiology & Infectious Diseases Room 3V51B McMaster University Medical Centre 1200 Main Street West Hamilton ON L6M 3Z8 |
McMaster University Pharmacy 1200 Main Street W Hamilton ON L8S 4J9 |
| Phone | (905) 521-2100 ext. 26287 after hours: (905) 521-5030 pager 8020 |
(905) 521-2100 ext. 73447 |
| Fax | (905) 521-4971 | |
| haider@univmail.cis.mcmaster.ca | sobhi@hhsc.ca | |
| Quebec | ||
| Designated Physician | Designated Pharmacist | |
| Name | Dr. Louise Côté | Luc Bergeron, Msc, Pharmacist |
| Address | Microbiology & Infectious Diseases Centre hospitalier universitaire de Québec Pavillon CHUL 2705, boul. Laurier, PL S-413 Sainte-Foy PQ G1V 4G2 |
Département de pharmacie Centre hospitalier universitaire de Québec Pavillon CHUL 2705, boul. Laurier, R-1720 Sainte-Foy PQ G1V 4G2 |
| Phone | (418) 656-4141 ext. 7882 | (418) 656-4141 ext. 47916 |
| Fax | (418) 654-2147 | (418) 654-2775 |
| micro.pchul@chuq.ulaval.ca | luc.bergeron@chuq.qc.ca | |
| Name | Dr. Brian Ward | Denise Kalyvas, Pharmacist |
| Address | The Montreal General Hospital 1650 Cedar Avenue Room D7-153 Montreal PQ H3G 1A4 |
The Montreal General Hospital - Pharmacy 1650 Cedar Avenue Room C1-200 Montreal PQ H3G 1A4 |
| Phone | (514) 921-6953 or (514) 934-8075 (hospital locating) |
(514) 934-1934 ext. 44933 |
| Fax | (514) 934-8347 | |
| brian.ward@mcgill.ca | denise.kalyvas@muhc.mcgill.ca | |
| Satellite Site | 1. Jewish General Hospital (Montreal), Caroline Robitaille Phone: (514) 340-8222 ext 2825 2. Fleurimont Hospital (Sherbrooke), Sylvie Cloutier Email: pharmaciecrc@chus.ssss.gouv.qc.ca 3. Amos |
|
| Nova Scotia | ||
| Designated Physician | Designated Pharmacist | |
| Name | Dr. David Haldane | Patti Gallant, Pharmacy Research Technician |
| Address | Microbiology Laboratory Mackenzie Building VG Site, QE II HSC 5788 University Avenue Halifax NS B1H 1V8 |
Pharmacy Department Attn: Patti Gallant, Rm #2042 VG Site, QE II HSC 1276 South Park St. Halifax NS B3H 2Y9 |
| Phone | (902) 473-6624 | (902) 473-6601 |
| Fax | (902) 473-4432 | (902) 473-1606 |
| david.haldane@cdha.nshealth.ca | patrice.gallant@cdha.nshealth.ca | |
| Newfoundland | ||
| Designated Physician | Designated Pharmacist | |
| Name | Dr. Chau Nguyen | Frank Pinsent, Pharmacist |
| Address | Division of Infectious Diseases, General Hospital The Health Care Corporation 300 Prince Philip Drive St. John's NL A1B 3V6 |
Department of Pharmacy Health Science Centre 300 Prince Philip Drive St. John's NL A1B 3V6 |
| Phone | (709) 777-8437 | (709) 777-6455 |
| Fax | (709) 777-7655 | (709) 777-8120 |
| eskinner@mun.ca | hcc.pinf@hccsj.nf.ca | |
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