Malaria control and chemoprophylaxis policy in the Republic of Korea Armed Forces for the previous 20 years (1997–2016)

Abstract

BackgroundVivax malaria reemerged along the Demilitarized Zone (DMZ), Republic of Korea (ROK), in 1993. While it was hypothesized that vivax malaria would spread throughout the peninsula, nearly all cases were due to exposure near the DMZ. To reduce spillover of vivax malaria to the civilian community, the ROK Ministry of National Defense (MND) initiated malaria prevention policies including a large-scale chemoprophylaxis programme in malaria high-risk areas in 1997. The present study investigated the overall changes in the incidence of malaria among ROK soldiers and the mass chemoprophylaxis program from 1997 to 2016.ResultsPeak numbers of vivax malaria were reported in 2000, with most cases reported near the DMZ, before declining to the current levels. To combat the rapid increase in the number of malaria cases and its expansion throughout the ROK, the MND implemented mosquito control and personal protection programmes. The MND also implemented a large-scale vivax malaria chemoprophylaxis programme using hydroxychloroquine (400 mg weekly) in 1997, and primaquine (15 mg × 14 days) as terminal chemoprophylaxis in 2001. Additionally, an improved medical system enabled the rapid detection and treatment of malaria to reduce morbidity and decrease transmission of malaria from humans to mosquitoes. Following the full implementation of these programmes, the incidence of vivax malaria declined in both ROK Armed Forces and civilian populations. Subsequently, several changes in the ROK Armed Forces chemoprophylaxis programme were implemented, including the reduction of the period of hydroxychloroquine prophylaxis by 2 months (2008) and other changes in the chemoprophylaxis policy, e.g., only ROK Armed Forces personnel in moderate risk groups received terminal primaquine chemoprophylaxis (2011), and in 2016, the discontinuation of terminal primaquine chemoprophylaxis in moderate-risk area.ConclusionsThe resurgence of vivax malaria in the ROK Armed Forces personnel near the DMZ was successfully suppressed through the implementation of a mass malaria chemoprophylaxis programme initiated by the MND in 1997, as well as several other factors that may have contributed to the reduction of malaria transmission since 2000. Given the current malaria situation in the ROK and North Korea, it is necessary to reevaluate the ROK Armed Forces and civilian malaria control policies.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2449-4) contains supplementary material, which is available to authorized users.

Increasing Malaria Parasite Clearance Time after Chloroquine Therapy, South Korea, 2000–2016

“…First, the trend of increased PCT and FCT in South Korea might be ascribed to decreased P. vivax susceptibility to chloroquine that could be seen before the emergence of WHO-recognized drug resistance. Mass chemoprophylaxis of military personnel with hydroxychloroquine started in 1997 in South Korea ( 3 , 6 ). However, mass chemoprophylaxis with poor compliance to recommended dosing among the patients increased the possibility of chloroquine-resistant strains of P. vivax emerging .…”

“…After P. vivax reemerged after being eliminated in South Korea in the late 1970s, it mainly occurred in soldiers or veterans stationed in the demilitarized zone between North Korea and South Korea. Because of this focus, mass chloroquine chemoprophylaxis has been administered in place for soldiers working in high-risk areas since 1997 ( 2 , 3 ). However, there is concern that mass chemoprophylaxis might lead to reduced chloroquine susceptibility ( 2 ).…”

Four Times of Relapse of Plasmodium vivax Malaria Despite Primaquine Treatment in a Patient with Impaired Cytochrome P450 2D6 Function

“…His body weight was 52 kg, and he was treated with chloroquine (total 21.7 mg/kg) and primaquine (15 mg for 14 days). Since very low prevalence of Glucose-6-phosphate dehydrogenase (G6PD) deficiency in Koreans [7], G6PD deficiency test was not performed. Fever was cleared within 4 day and disappearance of the asexual stage parasitemia was confirmed by Giemsa-stained blood smear 5 days after chloroquine treatment.…”

<p>Flattening the Risk: Pre-Exposure Prophylaxis for COVID-19</p>

“…26,27 This extraordinary property has allowed the medication to be used for decades as weekly prophylaxis for malaria. 28,29 Although HCQ-resistant malaria has eventually developed in parts of the world, the benefit of the medication is still recognized in terms of low cost, ease of use and limited side effects in areas with susceptible disease. [29][30][31] Malaria prophylaxis with HCQ may contribute in part to the reportedly low rate of COVID-19 infection seen so far in sub-Saharan Africa.…”