An Outbreak of Malaria in US Army Rangers Returning From Afghanistan

Kotwal, Russ S.

doi:10.1001/jama.293.2.212

Cited by 98 publications

(82 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, the two large outbreaks of malaria in MSMs had occurred quite remotely from the time of this survey (2002 and 2003). 6,7 Although the numbers are small, one-time weekly medication dosing did not improve compliance over daily dosing (38% versus 61%).…”

Section: Discussionmentioning

confidence: 98%

“…Distractions were the primary reason for non-compliance. 7 The work by Newton and others 8 surveyed Marines concerning compliance with chemoprophylaxis when returning from Somalia with malaria and found 56% compliance. The work by Barrett and others 9 reported 30% compliance in soldiers returning from Vietnam.…”

Section: Discussionmentioning

confidence: 99%

“…Those surveys were conducted with troops who had contracted the disease or members of their units contracted the disease, possibly affecting the outcome of the surveys. [6][7][8][9] This report of compliance of healthy MSMs with malaria chemoprophylaxis in Afghanistan, including MSM reasons for non-compliance and the effect of daily versus weekly dosing, is the first of its kind.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Compliance with Antimalaria Chemoprophylaxis in a Combat Zone

Brisson¹,

Brisson²

2012

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. Compliance with malaria chemoprophylaxis by military service members (MSMs) is notoriously low, ranging from 30% to 56%. Our objective was to determine the rate of compliance and reasons for non-compliance with malaria chemoprophylaxis among healthy US MSMs in Afghanistan. An eight-question, anonymous online survey was used to collect data regarding the compliance of healthy MSMs with malaria chemoprophylaxis. E-mail surveys were sent to 1,200 MSMs; 528 (44%) MSMs completed the survey. One-time daily doxycycline was the most commonly prescribed chemoprophylaxis (90%); 60% (N = 318) responded that they were compliant with their chemoprophylaxis as prescribed, whereas 40% (N = 221) indicated that they were not compliant. Compliance with daily dosing was 61% and weekly dosing was 38%. The most common reasons for non-compliance were gastrointestinal effects (39%), forgetfulness (31%), and low perception of risk (24%). Malaria chemoprophylaxis compliance by healthy MSMs in Afghanistan is poor. Side effects, forgetfulness, and lack of education are contributing factors. Commanders bear the primary responsibility for the health of their soldiers, and the individual MSM bears personal responsibility; however, additional public health interventions could possibly have a positive impact on prevention.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Compliance with Antimalaria Chemoprophylaxis in a Combat Zone

Brisson¹,

Brisson²

2012

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…20,26,27 Primaquine is a longtterm medication (usually 14 days), and low compliance can be a problem. 28 To increase compliance, the ROK military requires that all soldiers take antimalarial drugs under direct supervision and sign a drug administration checklist. In adt t dition, to reduce late primary attacks occurring after retirement, all soldiers who were stationed in risk areas and retiring during the malaria risk period receive primaquine prophylaxis before retirement.…”

Section: Discussionmentioning

confidence: 99%

Chemoprophylaxis and the epidemiological characteristics of re-emergent P. vivax malaria in the Republic of Korea

Kim

Shin

Yong

et al. 2006

Bull World Health Organ

View full text Add to dashboard Cite

Objective In the Republic of Korea (ROK), soldiers stationed where there is a risk of contracting malaria have received antimalarial chemoprophylaxis since 1997. However, chemoprophylaxis may facilitate the development of drug resistance, and late primary attacks in individuals who have received chemoprophylaxis are becoming more frequent. We investigated the association between chemoprophylaxis and the epidemiological characteristics and effectiveness of treatment for re-emergent Plasmodium vivax malaria, using a nationwide malaria database. Methods Among soldiers at risk of malaria between 1999 and 2001, we reviewed all P. vivax malaria cases (1158) that occurred before 31 December 2003. Early and late primary attacks were defined as cases occurring < 2 or > 2 months after the last day of exposure to risk of malaria, respectively. Findings Of these cases, 634 (72.0%) had received chemoprophylaxis, and 324 (28.0%) had not. Cases occurred mostly in summer, with a peak in July-August. Stratification by chemoprophylaxis history revealed different times to onset. Early primary attacks were more prevalent in the group not receiving chemoprophylaxis, while in the group receiving chemoprophylaxis most cases were late primary attacks. Of the latter, 312 out of 461 (67.7%) did not take primaquine regularly. After treatment of the first attack, 14 (1.2%) of 1158 were re-treated; all re-treated cases were cured using the same doses and regimen used for the first treatment. Conclusion In ROK, the increase in late primary episodes of re-emergent P. vivax malaria is associated with the use of antimalarial chemoprophylaxis.Bulletin of the World Health Organization 2006;84:827-834.Voir page 833 le résumé en français. En la página 833 figura un resumen en español. IntroductionPlasmodium vivax, the causative agent of vivax malaria, has been endemic in the Republic of Korea (ROK) for cent t turies. The number of cases of endemic malaria began to decline in the 1960s, partly due to increased socioeconomic development, increased use of agricult t tural pesticides, and the efforts of the National Malaria Eradication Service. These factors contributed to the eradicat t tion of malaria in the ROK, resulting in the declaration by WHO in 1979 that the country was malariatfree. 1 In 1993, one case of malaria attributed to autot chthonous transmission was detected near the demilitarized zone (DMZ) that separates ROK (south) from the Democratic People's Republic of Korea (north).2 Since 1993, the number of malaria cases has increased exponentially, particularly among soldiers based near the DMZ. [1][2][3][4][5] Chemoprophylaxis and the epidemiological characteristics of re-emergent P. vivax malaria in the Republic of Korea In ROK, healthy males aged over 18 years serve 26 months of mandat t tory military duty; most are stationed throughout their service near the DMZ, where the risk of malaria is highest. After finishing their military duty, the soldiers return from these risk areas to areas with little or no malaria. To reduce the occurren...

show abstract

“…In 2002, 38 U.S. Army Rangers were infected with Plasmodium vivax malaria (52.4 cases per 1,000 persons), and were diagnosed a median of 233 days after return from deployment to eastern Afghanistan. 7 In 2012, three cases of P. vivax malaria were diagnosed among members of an Army unit who had returned from deployment to Afghanistan approximately seven months earlier. 10 The extended duration after return from a malaria-endemic area to diagnosis suggests that improved compliance and/or appropriate prescriptions of primaquine may have prevented these cases.…”

mentioning

confidence: 99%

Compliance with Antimalarial Chemoprophylaxis Recommendations for Wounded United States Military Personnel Admitted to a Military Treatment Facility

Rini

Weintrob

Tribble

et al. 2014

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malariaendemic countries. However, limited information is available on compliance with chemoprophylaxis among trauma patients during hospitalization and after discharge. Therefore, we assessed antimalarial primary chemoprophylaxis and presumptive antirelapse therapy (primaquine) compliance among wounded United States military personnel after medical evacuation from Afghanistan (June 2009-August 2011) to Landstuhl Regional Medical Center in Landstuhl, Germany, and then to three U.S. military hospitals. Among admissions at Landstuhl Regional Medical Center, 74% of 2,540 patients were prescribed primary chemoprophylaxis and 1% were prescribed primaquine. After transfer of 1,331 patients to U.S. hospitals, 93% received primary chemoprophylaxis and 33% received primaquine. Of 751 trauma patients with available post-admission data, 42% received primary chemoprophylaxis for four weeks, 33% received primaquine for 14 days, and 17% received both. These antimalarial chemoprophylaxis prescription rates suggest that improved protocols to continue malaria chemoprophylaxis in accordance with force protection guidelines are needed.During the past decade, United States military personnel have been deployed to Afghanistan, where malaria remains a serious health threat. Approximately 77% of the Afghan population resides in areas at risk of disease transmission, which results in an estimated annual average of 77,000 cases per year.

show abstract

An Outbreak of Malaria in US Army Rangers Returning From Afghanistan

Cited by 98 publications

References 24 publications

Compliance with Antimalaria Chemoprophylaxis in a Combat Zone

Compliance with Antimalaria Chemoprophylaxis in a Combat Zone

Chemoprophylaxis and the epidemiological characteristics of re-emergent P. vivax malaria in the Republic of Korea

Compliance with Antimalarial Chemoprophylaxis Recommendations for Wounded United States Military Personnel Admitted to a Military Treatment Facility

Contact Info

Product

Resources

About