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CHICAGO -- Nearly 40 U.S. Army Rangers returning from Afghanistan in 2002 may have contracted malaria because of inadequate use of preventive measures, according to a study in the Jan. 12 issue of JAMA.
War and conflict have had a long historical partnership with malarial outbreaks, according to background information in the article. Disruptions in healthcare infrastructure, maneuvering of numerous military personnel, and exposure of individuals with nominal or no immunity all bring about an increased risk for the disease. Throughout history, disease and nonbattle injuries have caused more casualties than combat action among military personnel, with malaria having a significant impact on many military operations.
U.S. Army soldiers operating in endemic regions are directed to consume antimalaria chemoprophylaxis and use personal protective measures, including minimizing exposed skin through proper wear of the uniform and use of bed nets, impregnating uniforms and bed nets with permethrin, and frequently applying topical insect repellent (33 percent diethyltoluamide [DEET]) to exposed skin.
Russ S. Kotwal, MD, MPH, of the Naval Operational Medicine Institute, Pensacola, Fla., and colleagues conducted a study to determine the extent of malaria in U.S. Army personnel deployed to a combat zone. The unit studied was the 725-man ranger task force that deployed to eastern Afghanistan between June and September 2002.
The researchers found that a total of 38 patients were infected with malaria, yielding an attack rate of 52.4 cases per 1,000 soldiers. Diagnosis was confirmed a median of 233 days (range, 1-339 days) after return from the malaria endemic region, with additional laboratory findings noting anemia and thrombocytopenia (a blood disease).
From an anonymous postdeployment survey of 72 percent (521/725) of the task force, the self-reported compliance rate was 52 percent for weekly chemoprophylaxis, 41 percent for terminal (postdeployment) chemoprophylaxis, 31 percent for both weekly and terminal chemoprophylaxis, 82 percent for treating uniforms with permethrin, and 29 percent for application of insect repellent.
"A major cause of malaria prophylaxis failure is patient nonadherence to prescribed treatment. Providing continuous education about the need to comply with prophylaxis medications and having leaders directly observe therapy and enforce personal protective measures may help safeguard soldiers from vector-borne disease. Additionally, U.S. military and civilian clinicians need to consider malaria in the differential diagnosis for military personnel who return from a malaria-endemic region and present with fever or an otherwise indistinct illness," the authors write.