An Outbreak of Plasmodium falciparum Malaria in U.S. Marines Deployed to Liberia
NAVAL MEDICAL RESEARCH INST BETHESDA MD INFECTIOUS DISEASE DEPT
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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 ngmL, and 9 22 had evidence of steady-state kinetics MQ carboxy metaboliteMQ 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 chemo-phrophylaxis. 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.
- Medicine and Medical Research
- Military Forces and Organizations