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August 3, 1994

Malaria in US Marines Returning From Somalia

Author Affiliations

From the Department of Internal Medicine, Infectious Disease Division, and the Department of Clinical Investigation, Naval Medical Center, San Diego, Calif (Drs Newton, Wallace, Kennedy and Oldfield); the Department of Internal Medicine, Naval Hospital, Camp Pendleton, Calif (Dr Schnepf); and the Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Parasitic Diseases, Atlanta, Ga (Dr Lobel). Dr Newton is now with the Naval Medical Center, Portsmouth, Va. Dr Kennedy is now with The Lexington (Ky) Clinic. Dr Oldfield is now with Eastern Virginia Medical School, Norfolk.

JAMA. 1994;272(5):397-399. doi:10.1001/jama.1994.03520050077034

Objective.  —To identify malaria in US Marines returning from Somalia and to determine their compliance with chemoprophylaxis.

Design.  —Case series.

Setting.  —The US Navy health care system.

Patients.  —Consecutive sample of 106 US Marines diagnosed with malaria after returning from Somalia in 1993.

Main Outcome Measures.  —Identification of the incidence and clinical features of imported malaria. Determination of compliance with chemoprophylaxis in this cohort.

Results.  —As of December 20,1993, there were 112 cases of imported malaria in 106 US Marine Corps personnel returning from Somalia. Plasmodium vivax accounted for 97 (87%) of 112 malaria cases, and Plasmodium falciparum accounted for eight (7%) of 112 cases. Mixed infection with P vivax and Pfalciparumwas noted in six (5%) of 112 cases, and a single case of Plasmodium malariae was identified. Patients with P falciparum malaria were diagnosed a mean of 20.9 days (range, 1 to 82 days) after returning to the United States compared with 91.8 days (range, 7 to 228 days) for P vivax infection (P<.0001). The self-reported chemoprophylaxis compliance rate was 56%; however, only 45 (50%) of 90 patients were given an optimal chemoprophylaxis regimen.

Conclusions.  —Noncompliance with personal protective measures and chemoprophylaxis contributed to the largest outbreak of imported malaria in US military personnel since the Vietnam conflict. Since military personnel frequently go on leave after deployment, health care providers throughout the United States must be aware of the presence of imported malaria from Somalia.(JAMA. 1994;272:397-399)