Malaria among United States troops in Somalia.
OBJECTIVE
United States military personnel deployed to Somalia were at risk for malaria, including chloroquine-resistant Plasmodium falciparum malaria. This report details laboratory, clinical, preventive, and therapeutic aspects of malaria in this cohort.


METHODS
The study took place in US military field hospitals in Somalia, with US troops deployed to Somalia between December 1992 and May 1993. Centralized clinical care and country-wide disease surveillance facilitated standardized laboratory diagnosis, clinical records, epidemiologic studies, and assessment of chemoprophylactic efficacy.


RESULTS
Forty-eight cases of malaria occurred among US troops while in Somalia; 41 of these cases were P falciparum. Risk factors associated with malaria included: noncompliance with recommended chemoprophylaxis (odds ratio [OR] 2.4); failure to use bed nets (OR 2.6); and failure to keep sleeves rolled down (OR 2.2). Some patients developed malaria in spite of mefloquine (n = 8) or doxycycline (n = 5) levels of compatible with chemoprophylactic compliance. Five mefloquine failures had both serum levels > or = 650 ng/mL and metabolite:mefloquine ratios over 2, indicating chemoprophylactic failure. All cases were successfully treated, including 1 patient who developed cerebral malaria.


CONCLUSIONS
P falciparum malaria attack rates were substantial in the first several weeks of Operation Restore Hope. While most cases occurred because of noncompliance with personal protective measures or chemoprophylaxis, both mefloquine and doxycycline chemoprophylactic failures occurred. Military or civilian travelers to East Africa must be scrupulous in their attention to both chemoprophylaxis and personal protection measures.
Wallace
M R
MR
Department of Internal Medicine (Infectious Diseases Division), Naval Medical Center, San Diego 92134-5000 USA.
Sharp
T W
TW
Smoak
B
B
Iriye
C
C
Rozmajzl
P
P
Thornton
S A
SA
Batchelor
R
R
Magill
A J
AJ
Lobel
H O
HO
Longer
C F
CF
Burans
J P
JP
D000900:Anti-Bacterial Agents / Q000097:blood / Q000627:therapeutic use; D000962:Antimalarials / Q000097:blood / Q000627:therapeutic use; D018890:Chemoprevention; D002738:Chloroquine / Q000627:therapeutic use; D003020:Clothing; D015331:Cohort Studies; D004318:Doxycycline / Q000097:blood / Q000627:therapeutic use; D004351:Drug Resistance; D006801:Humans; D016779:Malaria, Cerebral / Q000175:diagnosis / Q000188:drug therapy; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D008297:Male; D015767:Mefloquine / Q000097:blood / Q000627:therapeutic use; D008889:Military Personnel; D011159:Population Surveillance; D011446:Prospective Studies; D011482:Protective Devices; D011739:Pyrimethamine / Q000627:therapeutic use; D011803:Quinine / Q000627:therapeutic use; D012307:Risk Factors; D012998:Somalia; D013413:Sulfadoxine / Q000627:therapeutic use; D017211:Treatment Failure; D016312:Treatment Refusal; D014481:United States
D000900:Anti-Bacterial Agents; D000962:Antimalarials; D013413:Sulfadoxine; D002738:Chloroquine; D011803:Quinine; D004318:Doxycycline; D015767:Mefloquine; D011739:Pyrimethamine