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March 8, 1995

Malaria in Somalia: Lessons in Prevention

Author Affiliations

Navy Environmental & Preventive Medicine Unit No. 5 San Diego, Calif
San Diego State University San Diego, Calif
First Marine Expeditionary Force Camp Pendleton, Calif

JAMA. 1995;273(10):774-775. doi:10.1001/jama.1995.03520340028022

To the Editor.  —In the article assessing malaria in US Marines returning from Somalia by Dr Newton and colleagues,1 important issues regarding prevention may be obscured by their finding that 50% of patients were administered suboptimal chemoprophylaxis.The Navy Environmental and Preventive Medicine Unit No. 5 identified 132 cases of Somalia-related malaria in 128 marines. Ninety-seven individuals were interviewed. Plasmodium vivax accounted for 82 (65.1%) of 126 diagnoses, 34 (27.0%) were Plasmodium falciparum, eight (6.3%) were mixed, and two (1.6%) were unspeciated.Malaria exposure had been anticipated2 and preparations made. Appropriate prescribing is published in the widely distributed Navy Medical Department Guide to Malaria Prevention and Control.3 For doxycycline, 89 (89.9%) of 99 prescriptions were appropriate, as were 81 (92.0%) of 88 primaquine prescriptions. For mefloquine, 59 (71.1%) of 83 were appropriate. The other 24 (28.9%) included many that failed to overlap doxycycline and mefloquine by 1

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