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
Ledbetter E, Shallow S, Hanson KR. Malaria in Somalia: Lessons in Prevention. JAMA. 1995;273(10):774-775. doi:10.1001/jama.1995.03520340028022