title: Malaria in the Republic of Korea, 1993-2007. Variables related to re-emergence and persistence of Plasmodium vivax among Korean populations and U.S. forces in Korea.
abstract: Malaria was eradicated and the Republic of Korea (ROK) declared "malaria free" in 1979. However, in 1993, a temperate strain of vivax malaria, expressing both latent and nonlatent disease populations, re-emerged near the demilitarized zone (DMZ), rapidly spread to civilian sectors near the DMZ, and increased exponentially in ROK military, veteran, and civilian populations through 1998. Malaria among all ROK populations decreased 5-fold from a high of 4142 cases in 2000 to a low of 826 cases in 2004, before increasing again to 2180 cases by 2007. Each malaria case in the ROK is reported in the metropolitan area/province where the diagnosis is made, which may be at some distance from the area where infection occurred. Therefore, it is difficult to ascertain transmission sites since approximately 60% of vivax malaria in Korea is latent with symptoms occurring >1 month to 24 months after infection. A review of case diagnosis for civilian, veteran, and military populations shows that nearly all malaria south of Gyeonggi and Gangwon Provinces is the result of veterans exposed in malaria high-risk areas along the DMZ and returning to their hometowns where they later develop malaria. Thus, malaria currently remains localized near the DMZ with limited transmission in provinces south of Seoul and has not spread throughout Korea as previously hypothesized. This report describes the reemergence of vivax malaria cases in civilian and military ROK populations and U.S. military personnel and assesses variables related to its transmission and geographic distribution.
authors.affiliation: Fifth Medical Detachment, 168th Multifunctional Medical Battalion, Unit 15247, APO AP 96205-5247.
authors.forename: Heung-Chul
authors.initials: HC
authors.lastname: Kim
authors.forename: Laura A
authors.initials: LA
authors.lastname: Pacha
authors.forename: Won-Ja
authors.initials: WJ
authors.lastname: Lee
authors.forename: Jong-Koo
authors.initials: JK
authors.lastname: Lee
authors.forename: Joel C
authors.initials: JC
authors.lastname: Gaydos
authors.forename: William J
authors.initials: WJ
authors.lastname: Sames
authors.forename: Hee-Choon S
authors.initials: HC
authors.lastname: Lee
authors.forename: Kent
authors.initials: K
authors.lastname: Bradley
authors.forename: Gi-Gon
authors.initials: GG
authors.lastname: Jeung
authors.forename: Steven K
authors.initials: SK
authors.lastname: Tobler
authors.forename: Terry A
authors.initials: TA
authors.lastname: Klein
mesh_terms: D000818:Animals; D004196:Disease Outbreaks; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D008887:Military Medicine / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000706:statistics & numerical data*; D010966:Plasmodium vivax; D012307:Risk Factors; D014481:United States / Q000453:epidemiology