title: An outbreak of Plasmodium falciparum malaria in U.S. Marines deployed to Liberia.
abstract: In 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent, 5 (12%) used permethrin-treated clothing, and none used bed netting. Adherence with weekly mefloquine (MQ) was reported by 23 (55%). However, only 4 (10%) had serum MQ levels high enough to correlate with protection (> 794 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 3.79). Tablets collected from Marines met USP identity and dissolution specifications for MQ. Testing failed to identify P. falciparum isolates with MQ resistance. This outbreak resulted from under use of personal protective measures and inadequate adherence with chemophrophylaxis. It is essential that all international travelers make malaria prevention measures a priority, especially when embarking to regions of the world with high transmission intensity such as west Africa..
authors.affiliation: Infectious Diseases Department, National Naval Medical Center, Bethesda, MD, USA. timothy.whitman@med.navy.mil
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Whitman
authors.forename: Philip E
authors.initials: PE
authors.lastname: Coyne
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Magill
authors.forename: David L
authors.initials: DL
authors.lastname: Blazes
authors.forename: Michael D
authors.initials: MD
authors.lastname: Green
authors.forename: Wilbur K
authors.initials: WK
authors.lastname: Milhous
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Burgess
authors.forename: Daniel
authors.initials: D
authors.lastname: Freilich
authors.forename: Sybil A
authors.initials: SA
authors.lastname: Tasker
authors.forename: Ramzy G
authors.initials: RG
authors.lastname: Azar
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Endy
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Clagett
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Deye
authors.forename: G Dennis
authors.initials: GD
authors.lastname: Shanks
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Martin
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000494:pharmacology; D004196:Disease Outbreaks; D006801:Humans; D007302:Insect Repellents / Q000008:administration & dosage / Q000494:pharmacology; D007988:Liberia / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology*; D008297:Male; D015767:Mefloquine / Q000008:administration & dosage / Q000627:therapeutic use; D008889:Military Personnel; D009032:Mosquito Control; D057147:Mosquito Nets; D010349:Patient Compliance; D010963:Plasmodium falciparum / Q000187:drug effects; D011481:Protective Clothing; D014481:United States; D055815:Young Adult
chemical_list: D000962:Antimalarials; D007302:Insect Repellents; D015767:Mefloquine