War and conflict have had a long historical partnership with malarial outbreaks, according to background information in the article. Disruptions in health care infrastructure, maneuvering of numerous military personnel, and exposure of individuals with nominal or no immunity all bring about an increased risk for the disease. Throughout history, disease and nonbattle injuries have caused more casualties than combat action among military personnel, with malaria having a significant impact on many military operations.

U.S. Army soldiers operating in endemic regions are directed to consume antimalaria chemoprophylaxis and use personal protective measures, including minimizing exposed skin through proper wear of the uniform and use of bed nets, impregnating uniforms and bed nets with permethrin, and frequently applying topical insect repellent (33 percent diethyltoluamide [DEET]) to exposed skin.

Russ S. Kotwal, M.D., M.P.H., of the Naval Operational Medicine Institute, Pensacola, Fla., and colleagues conducted a study to determine the extent of malaria in U.S. Army personnel deployed to a combat zone. The unit studied was the 725-man Ranger Task Force that deployed to eastern Afghanistan between June and September 2002.

The researchers found that a total of 38 patients were infected with malaria, yielding an attack rate of 52.4 cases per 1,000 soldiers. Diagnosis was confirmed a median of 233 days (range, 1-339 days) after return from the malaria endemic region, with additional laboratory findings noting anemia and thrombocytopenia (a blood disease).

From an anonymous postdeployment survey of 72 percent (521/725) of the task force, the self-reported compliance rate was 52 percent for weekly chemoprophylaxis, 41 percent for termin
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Contact: Ann Ham
410-436-2088
JAMA and Archives Journals
11-Jan-2005