Malaria: A Serious Threat to our Military

[sgmgrumpy]

http://www.nwc.navy.mil/press/Review...s/art4-w05.pdf

THE MOSQUITO CAN BE MORE DANGEROUS THAN THE MORTAR ROUND

We must be prepared to meet malaria by training as strict and earnest
as that against enemy troops. We must be as practiced in our weapons
against it as we are with a rifle.

FIELD MARSHAL VISCOUNT SIR ARCHIBALD WAVELL

The malaria threat is tied to the rate of transmission, and in most cases the transmission rate depends on the local mosquito population.During operations in sub-Saharan Africa, where mosquitoes are very effective malaria “vectors,” malaria infection rates among unprotected troops may be expected to approach 100 percent, and if the infected soldiers are American,without prior exposure to tropical diseases, a high percentage will likely suffer acute infections and experience life-threatening complications that require immediate medical evacuation. These realities could easily render a U.S. military force ineffective without a combat engagement ever taking place.

Briefings on Malaria Outbreaks with JTF Liberia

http://www-nehc.med.navy.mil/downloa...JTFMalaria.pdf

http://www-nehc.med.navy.mil/Downloa..._IDC_20020.ppt

[Stan]

Mornin' SGM !
Having worked in Sub-Sahara for nearly 10 straight years with 7 countries of accreditation, I can substantiate your post and quote 110 percent. I am however perplexed that the US Military would send a JTF in without reading at least the DoD Foreign Clearance Guide, and better yet the US Embassy's web site for that particular country.

The FCG contains information derived and updated annually by members in country, including US Military. The Embassy web sites are more "State-sanctioned info" but also contain substantial medical-related info for the common traveler.

Zäire's mosquito population carry Falciparum malaria (contracting it equated to a medical emergency requiring hospitalization).

In early 84 prior to anti-terrorism courses at Bragg and our MTTs deployment to Kinshasa, Zäire, the base physician gave us our first two doses of Chloroquine together with some tiny little tablets to keep our livers from going south. He was adamant that not less than two weeks on Chloroquine prior to entering Africa. He also went into grave detail about Chloroquine side-effects. Paranoia being the worst. "You could go crazy, but you won't die from malaria" he said. I felt better already

Now that I think about, even the aircrews from the 437th in Charleston and the 438th out of McGuire that frequented our little hole every two weeks were on Chloroquine.

The other side-effects ?
They include blood donation and liver problems. You actually carry the malaria around with you for up to 5 years and during that time, nobody wants your blood or your liver (except the others that were with you there ).

Regards, Stan

[carl]

This is a big problem in the civilian NGO world also. My organization has had multiple people go down with malaria in the two years I have been here. Few of those who got infected were on any kind of preventative medication.

The biggest reason for this is people just refuse to view disease as a real threat. We come from places where there are no serious infectious diseases and what maladies we do get are treated with some bed rest and chicken soup. People do not really believe there are places with diseases that WILL KILL YOU unless you try hard to avoid them.

Parent organizations are guilty in that they don't really believe it either and don't put the stress on the matter that they should. This results in the people who arecoming out consulting with each other and talking each other into doing nothing with tales of "liver damage" and "it really isn't that bad."

I would like to see each person formally briefed by a physician who will look each man in the eye and say "you can die!"; and then briefing them on the what to do and how to do it. Fear does well in concentrating the mind (thank you to whoever I stole that quote from).

The first thing I do when a new person shows up is to ask whether they are taking anything to prevent malaria. If yes, I am pleased. If they say no, I do my best to scare them into taking something. Sometimes it works.

[Stan]

Good points Carl !
BTW, the Chloroquine didn't get my liver.
On the other hand, the thousands of Simbas didn't hurt

[nichols]

The Peace Corps Doc from Nigeria had all of us switch over to mefloquine about 6 months into our 18 month tour after plasmodium falciparum bug became resistant to chloroquine. The meth dreams were something else...

In a small detachment it was easy to keep track and make sure that the Marines took the prescribed prophylaxis, in larger line units, it was difficult but not impossible.

Our biggest problems in Central Africa, Middle East or Central America was the various forms of gardia.

[sgmgrumpy]

Stan, agree with you 100%. Those evening BUBs were not a fun time during Liberia. I think we learned a huge lesson off of that one. What works in Gulf Region does not work in sub-sahara Africa. We seem to have a better handle on it now since units have access to MTBs for almost every country.


Hard for alot of soldiers to understand it is 100% preventable.

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

An outbreak of malaria in US Army Rangers returning from Afghanistan.
Kotwal RS, Wenzel RB, Sterling RA, Porter WD, Jordan NN, Petruccelli BP.
Army-Navy Aerospace Medicine Residency, Naval Operational Medicine Institute, Pensacola, Fla 32508, USA

CONTEXT: With numerous US military personnel currently deployed throughout the world, military and civilian health care professionals may encounter imported malaria from this population. OBJECTIVE: To identify malaria in US Army personnel deployed to a combat zone. DESIGN, SETTING, AND PATIENTS: Case series in the US Army health care system. A total of 38 cases of malaria were identified in a 725-man Ranger Task Force that deployed to eastern Afghanistan between June and September 2002. MAIN OUTCOME MEASURES: Identification of malaria cases and soldiers' self-report of compliance with antimalarial measures. RESULTS: A total of 38 patients were infected with Plasmodium vivax, yielding an attack rate of 52.4 cases per 1000 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. One case was complicated with acute respiratory distress syndrome during the patient's primary attack and a spontaneous pneumothorax during relapse. This case accounted for 1 of 2 relapse cases in the study population. From an anonymous postdeployment survey of 72% (521/725) of the task force, the self-reported compliance rate was 52% for weekly chemoprophylaxis, 41% for terminal (postdeployment) chemoprophylaxis, 31% for both weekly and terminal chemoprophylaxis, 82% for treating uniforms with permethrin, and 29% for application of insect repellent. CONCLUSIONS: Delayed clinical presentation can occur with P vivax. Symptoms are often vague, but malaria should be included in the differential diagnosis for soldiers returning from an endemic region. Suboptimal compliance with preventive measures can result in a malaria outbreak.

[Stan]

SGM,
That's nothing more than a darn shame.
Our EOD elements have deployed on 6 rotations to Afghanistan without one incident. Our Rescue Team's paramedic checked the CDC site and ordered the prescriptions for 65 of us. "Take these" he said.

Later our Disaster Relief Team would go to provide relief to the Tsunami victims. Same story, take this and don't stop.

Hey Nichols,
I would agree 100 percent, easy to control a small MTT or detachment, but an entire company may play hell.

Perhaps better we didn't have access to mefloquine in the early 80's. I think I would rather be crazy with a failing liver

Regards, Stan