An outbreak of Plasmodium falciparum malaria in U.S. Marines deployed to Liberia.

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 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 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 chemophrophylaxis. 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..

[1]  O. Ogbu,et al.  Lassa fever in West African sub-region: an overview. , 2007, Journal of vector borne diseases.

[2]  W. D. Porter Imported malaria and conflict: 50 years of experience in the U.S. Military. , 2006, Military medicine.

[3]  D. Freilich,et al.  Rapid diagnostic test for Plasmodium falciparum in 32 Marines medically evacuated from Liberia with a febrile illness. , 2005, Annals of internal medicine.

[4]  S. Hay,et al.  The global distribution of clinical episodes of Plasmodium falciparum malaria , 2005, Nature.

[5]  R. Kotwal,et al.  An outbreak of malaria in US Army Rangers returning from Afghanistan. , 2005, JAMA.

[6]  A. Tegnell,et al.  Bichat guidelines for the clinical management of haemorrhagic fever viruses and bioterrorism-related haemorrhagic fever viruses. , 2004, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[7]  M. Rowland,et al.  DEET mosquito repellent provides personal protection against malaria: a household randomized trial in an Afghan refugee camp in Pakistan , 2004, Tropical medicine & international health : TM & IH.

[8]  S. Krishna,et al.  The pfmdr1 Gene Is Associated with a Multidrug-Resistant Phenotype in Plasmodium falciparumfrom the Western Border of Thailand , 1999, Antimicrobial Agents and Chemotherapy.

[9]  M. Green,et al.  Improved validated assay for the determination of mefloquine and its carboxy metabolite in plasma, serum and whole blood using solid-phase extraction and high-performance liquid chromatography. , 1999, Journal of chromatography. B, Biomedical sciences and applications.

[10]  H. Lobel,et al.  Monitoring for mefloquine-resistant Plasmodium falciparum in Africa: implications for travelers' health. , 1998, The American journal of tropical medicine and hygiene.

[11]  H. Lobel,et al.  Comparison of whole blood and serum levels of mefloquine and its carboxylic acid metabolite. , 1997, The American journal of tropical medicine and hygiene.

[12]  M. C. Thomson,et al.  Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme , 1995, The Lancet.

[13]  R. Baric,et al.  A strong association between mefloquine and halofantrine resistance and amplification, overexpression, and mutation in the P-glycoprotein gene homolog (pfmdr) of Plasmodium falciparum in vitro. , 1994, The American journal of tropical medicine and hygiene.

[14]  M. Wallace,et al.  Malaria in US Marines returning from Somalia. , 1994, JAMA.

[15]  E. Boudreau,et al.  Tolerability of prophylactic Lariam regimens. , 1993, Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft fur Technische Zusammenarbeit.

[16]  H. Lobel,et al.  Long-term malaria prophylaxis with weekly mefloquine , 1993, The Lancet.

[17]  C. Beadle,et al.  History of malaria in the United States Naval Forces at war: World War I through the Vietnam conflict. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  C. Raccurt,et al.  Failure of falciparum malaria prophylaxis by mefloquine in travelers from West Africa. , 1991, The American journal of tropical medicine and hygiene.

[19]  P. Phillips-Howard,et al.  Risk of malaria in British residents returning from malarious areas. , 1990, BMJ.

[20]  N. Weatherly,et al.  Plasmodium falciparum: cloning by single-erythrocyte micromanipulation and heterogeneity in vitro. , 1988, Experimental parasitology.

[21]  W. Milhous,et al.  REDUCED IN-VITRO SUSCEPTIBILITY TO MEFLOQUINE IN WEST AFRICAN ISOLATES OF PLASMODIUM FALCIPARUM , 1987, The Lancet.

[22]  P. Jahrling,et al.  EARLY DIAGNOSIS OF HUMAN LASSA FEVER BY ELISA DETECTION OF ANTIGEN AND ANTIBODY , 1985, The Lancet.

[23]  P. Jahrling,et al.  Detection of Lassa virus antigens and Lassa virus-specific immunoglobulins G and M by enzyme-linked immunosorbent assay , 1984, Journal of clinical microbiology.

[24]  J. Haynes,et al.  Quantitative assessment of antimalarial activity in vitro by a semiautomated microdilution technique , 1979, Antimicrobial Agents and Chemotherapy.

[25]  I. Slotki,et al.  ACUTE-ON-CHRONIC RENAL FAILURE PRECIPITATED BY CLOFIBRATE , 1976, The Lancet.

[26]  A. Buoniconti,et al.  The royal commission and London. , 1968, Lancet.

[27]  P. Bartelloni,et al.  Combined therapy for chloroquine-resistant, Plasmodium falciparum infection. Concurrent use of long-acting sulphormethoxine and pyrimethamine. , 1967, JAMA.

[28]  S. Stricker Medical Schools in England and Germany , 1870, Nature.

[29]  Organización Mundial de la Salud World malaria report 2009 , 2009 .

[30]  P. Atkinson,et al.  Opinion — tropical infectious diseases: Urbanization, malaria transmission and disease burden in Africa , 2005, Nature Reviews Microbiology.

[31]  Weltgesundheitsorganisation World malaria report , 2005 .

[32]  F. Pagés,et al.  [Malaria in military personnel: the case of the Ivory Coast in 2002-2003]. , 2003, Medecine tropicale : revue du Corps de sante colonial.

[33]  J. Tuck,et al.  A malaria outbreak following a British military deployment to Sierra Leone. , 2003, The Journal of infection.

[34]  Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. , 2000, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[35]  N. White Why is it that antimalarial drug treatments do not always work? , 1998, Annals of tropical medicine and parasitology.

[36]  M. Wallace,et al.  Malaria among United States troops in Somalia. , 1996, The American journal of medicine.

[37]  Update: management of patients with suspected viral hemorrhagic fever--United States. , 1995, MMWR. Morbidity and mortality weekly report.

[38]  W. Slim Defeat into Victory , 1956 .