Malaria notifications in the Australian Defence Force from 1998 to 2007

Elmes, Nathan J.

doi:10.1016/j.inhe.2010.03.001

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…PART is commonly used as an intervention measure to reduce the incidence of vivax relapses after leaving endemic countries and after relapse. The recommended dose of primaquine used in PART for the ADF was 22.5 mg daily for 14 days (before April 2000) and 30 mg daily for 14 days after April 2000 [15]. However, despite using PART relapsing vivax malaria in returning personnel is common.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite using PART relapsing vivax malaria in returning personnel is common. Within ADF personnel the median period between departing the endemic countries (PNG, East Timor and Solomon Islands) and having a primary presentation of P. vivax malaria was 86 days (range 1–505 days) [15]. Almost all cases were considered relapses resulted from hypnozoite activation since most personnel had their primary infection 3 weeks and after their return without further visits to endemic areas.…”

Section: Discussionmentioning

confidence: 99%

“…Relapses of P. vivax malaria in military personnel after returning home are common. In Australian Defence Force (ADF) personnel deployed to East Timor, over 400 cases of relapsing vivax malaria were documented in returned troops despite receiving PART [15]. A number of relapsing P. vivax infections were also documented in personnel returning from Bougainville, PNG [31].…”

Section: Introductionmentioning

confidence: 99%

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Cytochrome P450 2D6 profiles and their relationship with outcomes of primaquine anti-relapse therapy in Australian Defence Force personnel deployed to Papua New Guinea and East Timor

Chen¹,

Dowd²,

Gatton

et al. 2019

Malar J

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Background Primaquine, an 8-aminoquinoline with anti-hypnozoite activity against Plasmodium vivax , is metabolized by human cytochrome P450 2D6 (CYP2D6) to its active metabolite. Human CYP2D6 activities may influence the metabolism of primaquine and the risk of experiencing Plasmodium relapses following primaquine anti-relapse therapies (PART). In this study, the CYP2D6 profile and its relationship with outcomes of PART in Australian Defence Force (ADF) personnel is retrospectively investigated. Methods Genomic DNA was isolated from stored and de-identified serum or blood samples from ADF personnel deployed on peacekeeping duties to Papua New Guinea (PNG) (1999) and East Timor (1999–2000) who received PART before returning to Australia and after experiencing relapses. CYP2D6 allelic type was determined by PCR and Sanger sequencing. CYP2D6 allele frequency, predicted phenotypes and activity scores were compared among personnel who did not experience P. vivax (ADF-NR, n = 48) and those who experience at least one (ADF-R, n = 109) relapse, as well as between those who experienced 1 (n = 79), 2 (n = 21) and 3–5 (n = 9) relapses within the ADF-R group. Results 16 CYP2D6 alleles were observed in 157 ADF personnel. Alleles *1, *4, *2 and *41 were major alleles (> 5%). The CYP2D6 allele frequency profile in the ADF-NR group matched that of a European population. There was an increased proportion of non-functional CYP2D6 alleles in the ADF-R group compared to the European population and ADF-NR group. However, frequencies of predicted CYP2D6 phenotype and activity score were not different between the ADF-R and ADF-NR groups, nor among sub-groups experiencing multiple relapses within the ADF-R group. Conclusions CYP2D6 phenotype or activity score based on the allele classification was not a major contributor to P. vivax relapse in this ADF cohort. Other factors such as adherence and/or parasite tolerance to primaquine are likely contributing factors to P. vivax relapses in this cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cytochrome P450 2D6 profiles and their relationship with outcomes of primaquine anti-relapse therapy in Australian Defence Force personnel deployed to Papua New Guinea and East Timor

Chen¹,

Dowd²,

Gatton

et al. 2019

Malar J

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“…The number of New Zealand residents who traveled overseas as VFRs increased from 26,721 in 1999to 46,183 in 2011(Statistics NZ 2012, and VFRs are likely to continue to be an important group of travelers at risk of malaria. Malaria is known to be a significant problem for military personnel due to the high exposure risk of their activities (Porter 2006, Elmes 2010. Factors associated with malaria risk in military personnel include compliance to chemoprophylaxis and other preventive measures, side effects from medications, perception of susceptibility to mosquito bites and malaria risk, lack of preventative medicine support, involvement in night operations, location of platoon positions, and general compliance within the group (Anonymous 2001, Peragallo et al 2002, Kitchener et al 2003, Resseguier et al 2010.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Surveillance for Informing Pretravel Medical Advice: Imported Malaria in New Zealand 1997–2009

Lau

Weinstein

Slaney

2014

Vector-Borne and Zoonotic Diseases

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Malaria has never been endemic in New Zealand, and all cases have been diagnosed in international travelers. In this paper, we describe malaria cases reported from 1997 to 2009 and discuss epidemiological changes compared to a previous report from 1980 to 1992. From 1997 to 2009, 666 malaria infections were reported, with 410 cases (61.6%) in travelers aged 20-39 and 133 (20%) in military personnel. Infections were caused by Plasmodium vivax in 436 cases (72.7%) and Plasmodium falciparum in 163 (27.2%). In the 533 civilians, common countries of infection were Papua New Guinea (24.4%), India (18.6%), the Solomon Islands (8.8%), and Indonesia (6.1%). Most common regions of malaria acquisition for civilians were Papua New Guinea and Western Pacific (39.8%), Africa (24.7%), Indian subcontinent (19.5%), and Southeast Asia (13.6%). Compared to a previous report of malaria in New Zealand from 1980 to 1992, regions of malaria acquisition have changed significantly, with a lower percentage of cases acquired from Papua New Guinea and Western Pacific (from 59.2% to 39.3%), and a higher percentage from Africa (from 8.6% to 21.3%). The ethnic groups affected also differ significantly between the two surveillance periods, with a reduction in the percentage of cases reported in Caucasians (from 80.8 to 45.9%) and an increase in cases in Indians (from 7.0 to 15.7%), Papua New Guineans and Pacific Islanders (from 5.2 to 16.9%), other Asians (from 2.3 to 5.6%), and Africans (from 0 to 8.5%). Common locations of malaria infection have evolved over time and probably reflect changing travel patterns of New Zealanders and the origins of visitors and immigrants. Therefore, local surveillance is important for informing pretravel advice by identifying vulnerable groups and common destinations for malaria infection, so that special attention on malaria prevention can be focused on travelers who are at highest risk. Ongoing surveillance is also essential for monitoring the evolving epidemiology of imported malaria over time.

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“…In the case of drug trials, further reference was made to the applicable international standard for good clinical practice, mandated under the relevant Australian legislation [ 95 ]. One limitation of this review is that actual RBA relating to mefloquine use in the ADF is not publicly available; however ADF malaria policy [ 3 ] and published papers on the drug's historical use in the organisation [ 2 , 3 , 15 , 85 – 88 ] provide sufficient insight to inform this analysis in that the risk of neuropsychiatric adverse effects is cited as a reason for limiting the drug's use.…”

Section: Methodsmentioning

confidence: 99%

Malaria Prevention, Mefloquine Neurotoxicity, Neuropsychiatric Illness, and Risk-Benefit Analysis in the Australian Defence Force

McCarthy¹

2015

Journal of Parasitology Research

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The Australian Defence Force (ADF) has used mefloquine for malaria chemoprophylaxis since 1990. Mefloquine has been found to be a plausible cause of a chronic central nervous system toxicity syndrome and a confounding factor in the diagnosis of existing neuropsychiatric illnesses prevalent in the ADF such as posttraumatic stress disorder and traumatic brain injury. Overall health risks appear to have been mitigated by restricting the drug's use; however serious risks were realised when significant numbers of ADF personnel were subjected to clinical trials involving the drug. The full extent of the exposure, health impacts for affected individuals, and consequences for ADF health management including mental health are not yet known, but mefloquine may have caused or aggravated neuropsychiatric illness in large numbers of patients who were subsequently misdiagnosed and mistreated or otherwise failed to receive proper care. Findings in relation to chronic mefloquine neurotoxicity were foreseeable, but this eventuality appears not to have been considered during risk-benefit analyses. Thorough analysis by the ADF would have identified this long-term risk as well as other qualitative risk factors. Historical exposure of ADF personnel to mefloquine neurotoxicity now also necessitates ongoing risk monitoring and management in the overall context of broader health policies.

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Malaria notifications in the Australian Defence Force from 1998 to 2007

Cited by 5 publications

References 20 publications

Cytochrome P450 2D6 profiles and their relationship with outcomes of primaquine anti-relapse therapy in Australian Defence Force personnel deployed to Papua New Guinea and East Timor

Cytochrome P450 2D6 profiles and their relationship with outcomes of primaquine anti-relapse therapy in Australian Defence Force personnel deployed to Papua New Guinea and East Timor

The Importance of Surveillance for Informing Pretravel Medical Advice: Imported Malaria in New Zealand 1997–2009

Malaria Prevention, Mefloquine Neurotoxicity, Neuropsychiatric Illness, and Risk-Benefit Analysis in the Australian Defence Force

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