Importation of chloroquine-resistant Plasmodium falciparum by Guatemalan peacekeepers returning from the Democratic Republic of the Congo.
BACKGROUND
Malaria elimination is being pursued in five of seven Central American countries. Military personnel returning from peacekeeping missions in sub-Saharan Africa could import chloroquine-resistant Plasmodium falciparum, posing a threat to elimination and to the continued efficacy of first-line chloroquine (CQ) treatment in these countries. This report describes the importation of P. falciparum from among 150 Guatemalan army special forces and support staff who spent ten months on a United Nations' peacekeeping mission in the Democratic Republic of the Congo (DRC) in 2010.


METHODS
Investigators reviewed patients' medical charts and interviewed members of the contingent to identify malaria cases and risk factors for malaria acquisition. Clinical specimens were tested for malaria; isolated parasites were characterized molecularly for CQ resistance.


RESULTS
Investigators identified 12 cases (8%) of laboratory-confirmed P. falciparum infection within the contingent; one case was from a soldier infected with a CQ-resistant pfcrt genotype resulting in his death. None of the contingent used an insecticide-treated bed net (ITN) or completely adhered to malaria chemoprophylaxis while in the DRC.


CONCLUSIONS
This report highlights the need to promote use of malaria prevention measures, in particular ITNs and chemoprophylaxis, among peacekeepers stationed in malaria-endemic areas. Countries attempting to eliminate malaria should consider appropriate methods to screen peacekeepers returning from endemic areas for malaria infections. Cases of malaria in travellers, immigrants and soldiers returning to Central America from countries with CQ-resistant malaria should be assumed to be carry resistant parasites and receive appropriate anti-malarial therapy to prevent severe disease and death.
International Emerging Infections Program, US Centers for Disease Control and Prevention Regional Office for Central America and Panama, 18 Avenida 11-95 zona 15, Vista Hermosa III, 01015 Guatemala, Guatemala. pcjuliao@gmail.com.
Patricia C
PC
Juliao
Silvia
S
Sosa
Luis D
LD
Gonzalez
Norma
N
Padilla
Lucia
L
Ortiz
Ira
I
Goldman
Venkatachalam
V
Udhayakumar
Kim A
KA
Lindblade
D000328:Adult; D000962:Antimalarials / Q000494:pharmacology*; D002738:Chloroquine / Q000494:pharmacology*; D015023:Democratic Republic of the Congo; D004351:Drug Resistance; D006166:Guatemala; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000302:isolation & purification*; D014195:Travel; D055815:Young Adult
D000962:Antimalarials; D002738:Chloroquine