Compliance with Antimalaria Chemoprophylaxis in a Combat Zone

Brisson, Michael; Brisson, Paul

doi:10.4269/ajtmh.2012.11-0511

Cited by 37 publications

(33 citation statements)

References 10 publications

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“…Approximately one third of the 2013 cases among military personnel were acquired in Afghanistan. Adherence among those military personnel who reported taking any chemoprophylaxis was 22% in 2012 and was 17% in 2013.This is substantially lower than the reported adherence by U.S. service members overall (range: 49%-100%) (50,51). Reasons for these differences might include overreporting of adherence among the survey respondents and missing information on chemoprophylaxis adherence reported to NMSS or AFHSC.…”

Section: Discussioncontrasting

confidence: 43%

Malaria Surveillance — United States, 2013

Cullen¹,

Mace²,

Arguin³

2016

MMWR Surveill. Summ.

102

110

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Problem/Condition: Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is also occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers.Period Covered: This report summarizes cases in persons with onset of illness in 2013 and summarizes trends during previous years.Description of System: Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are mandated to be reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducted antimalarial drug resistance marker testing on blood samples submitted to CDC by health care providers or local/state health departments. Data from these reporting systems serve as the basis for this report.Results: CDC received 1,727 reported cases of malaria, including two congenital cases, with an onset of symptoms in 2013 among persons in the United States. The total number of cases represents a 2% increase from the 1,687 cases reported for 2012. Plasmodium falciparum, P. vivax, P. malariae, and P. ovale were identified in 61%, 14%, 3%, and 4% of cases, respectively. Forty (2%) patients were infected by two species. The infecting species was unreported or undetermined in 17% of cases. Polymerase chain reaction testing determined or corrected the species for 85 of the 137 (62%) samples evaluated for drug resistance marker testing. Of the 904 patients who reported purpose of travel, 635 (70%) were visiting friends or relatives (VFR). Among the 961 cases in U.S. civilians for whom information on chemoprophylaxis use and travel region was known, 42 (4%) patients reported that they had initiated and adhered to a chemoprophylaxis drug regimen recommended by CDC for the regions to which they had traveled. Thirty-six cases were reported in pregnant women, none of whom had adhered to chemoprophylaxis. Among all reported cases, approximately 270 (16%) were classified as severe illnesses in 2013. Of these, 10 persons with malaria died in 2013, the highest number since 2001. In 2013, a total of 137 blood samples submitted to CDC were tested for molecular markers associated with antimalarial drug resistance. Of the 100 P. falciparum-positive samples, 95 were tested for pyrimethamine resistance: 88 (93%) had genetic polymor...

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Section: Discussioncontrasting

confidence: 43%

Malaria Surveillance — United States, 2013

Cullen¹,

Mace²,

Arguin³

2016

MMWR Surveill. Summ.

102

110

View full text Add to dashboard Cite

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“…Self-reported compliance with antimalarial medications among military personnel was found to be 60% among a group of Afghanistan deployers, and in one report, self-reported compliance for mefloquine (48.5%) was much lower than for doxycycline (78.4%) and other antimalarials. 38,39 However, other studies have found that compliance with mefloquine is higher than with doxycycline (American Soldiers: 80% versus 60%; Turkish troops: 61% versus 56%; Australian travelers: 78% versus 68%). [40][41][42] However, how compliance is defined is important in interpreting these findings.…”

Section: Discussionmentioning

confidence: 97%

Neuropsychiatric Outcomes After Mefloquine Exposure Among U.S. Military Service Members

Eick-Cost

Rohrbeck

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Mefloquine was widely prescribed to U.S. military service members until 2009 when use was limited to personnel with contraindications to doxycycline and no contraindications to mefloquine. The need to estimate the occurrence of neuropsychiatric outcomes (NPOs) in service members prescribed mefloquine warranted a comprehensive evaluation of this issue. Active component service members filling a prescription for mefloquine, doxycycline, or atovaquone/proguanil (A/P) between January 1, 2008 and June 30, 2013, were included in the analysis. The risk of developing incident NPOs and the risk of subsequent NPOs among subjects with a history of the condition were assessed. A total of 367,840 individuals were evaluated (36,538 received mefloquine, 318,421 received doxycycline, and 12,881 received A/P). Among deployed individuals prescribed mefloquine, an increased risk of incident anxiety was seen when compared with doxycycline recipients (incidence rate ratio [IRR] = 1.12 [1.01-1.24]). Among nondeployed mefloquine recipients, an increased risk of posttraumatic stress disorder (PTSD) was seen when compared with A/P recipients (IRR = 1.83 [1. 07-3.14]). An increased risk of tinnitus was seen for both deployed and nondeployed mefloquine recipients compared with A/P recipients (IRR = 1.81 [1.18-2.79]), 1.51 (1.13-2.03), respectively). Six percent of the mefloquine cohort had an NPO in the year before receiving mefloquine. When comparing individuals with a prior neuropsychiatric history to those without, the ratio of relative risks for adjustment disorder, anxiety, insomnia, and PTSD were higher (not statistically significant) for mefloquine compared with doxycycline. These findings emphasize the continued need for physicians prescribing mefloquine to conduct contraindication screening.

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“…2,3,[7][8][9]16 Overall rates of side effects were comparable between doxycycline and MQ, reported by roughly 30% of respondents to both drugs. Neuropsychiatric reactions, manifested largely as "vivid dreams," were the primary side effects seen here with MQ, reported by more than 20% of respondents.…”

Section: Discussionmentioning

confidence: 90%

“…Prior studies of deployed soldiers have demonstrated poor compliance with daily doxycycline prophylaxis. [7][8][9][10][11][12] Although most efficacy trials of DH and DM have shown comparable rates of GI toxicity, AE withdrawals, and noncompliance, it is important to realize that most of the safety and tolerability data are from trials powered for efficacy, not tolerability. 13 Differences in study design, end points, assessment methods, and length of follow-up complicate the comparison of the safety and tolerability of the different dosage forms of doxycycline (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Safety, Tolerability, and Compliance with Long-Term Antimalarial Chemoprophylaxis in American Soldiers in Afghanistan

Saunders¹,

Garges²,

Manning³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Long-term antimalarial chemoprophylaxis is currently used by deployed U.S. military personnel. Previous small, short-term efficacy studies have shown variable rates of side effects among patients taking various forms of chemoprophylaxis, though reliable safety and tolerability data on long-term use are limited. We conducted a survey of troops returning to Fort Drum, NY following a 12-month deployment to Operation Enduring Freedom, Afghanistan from 2006 to 2007. Of the 2,351 respondents, 95% reported taking at least one form of prophylaxis during their deployment, and 90% were deployed for > 10 months. Compliance with daily doxycycline was poor (60%) compared with 80% with weekly mefloquine (MQ). Adverse events (AEs) were reported by approximately 30% with both MQ and doxycycline, with 10% discontinuing doxycycline compared with 4% of MQ users. Only 6% and 31% of soldiers reported use of bed nets and skin repellents, respectively. Compliance with long-term malaria prophylaxis was poor, and there were substantial tolerability issues based on these anonymous survey results, though fewer with MQ than doxycycline. Given few long-term antimalarial chemoprophylaxis options, there is an unmet medical need for new antimalarials safe for long-term use.

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Compliance with Antimalaria Chemoprophylaxis in a Combat Zone

Cited by 37 publications

References 10 publications

Malaria Surveillance — United States, 2013

Malaria Surveillance — United States, 2013

Neuropsychiatric Outcomes After Mefloquine Exposure Among U.S. Military Service Members

Safety, Tolerability, and Compliance with Long-Term Antimalarial Chemoprophylaxis in American Soldiers in Afghanistan

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