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reading 4 - BRIEF REPORT An Outbreak of Malaria in US Army...

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BRIEF REPORT An Outbreak of Malaria in US Army Rangers Returning From Afghanistan Russ S. Kotwal, MD, MPH Robert B. Wenzel, MD Raymond A. Sterling, PA-C, MPAS William D. Porter, MD, MPH Nikki N. Jordan, MPH Bruno P. Petruccelli, MD, MPH W AR AND CONFLICT HAVE had a long historical partnership with ma- larial outbreaks. 1-7 Dis- ruptions in health care infrastructure, displacement and cross-border move- ment of civilian populations, invasion and maneuver of numerous military personnel, and exposure of individu- als with nominal or no immunity all bring about an increased risk for the dis- ease. Throughout history, disease and nonbattle injuries have caused more ca- sualties than combat action among mili- tary personnel, with malaria having a significant impact on many military op- erations. 6-8 Since 1995, military clinicians have reported an average of 42 cases of ma- laria per year in US soldiers, 9 with the majority of these cases acquired while serving in the Republic of Korea. Al- though this incidence rate and the epi- demiological pattern have been rela- tively stable over the past decade, outbreaks associated with an increase in the number of military troops de- ployed to malarial areas have oc- curred and may continue to account for an increase in malaria cases imported into the United States. 10 Malaria is endemic to more than 100 countries and territories worldwide and is predominantly found in the tropic and subtropic regions. More than 90% of malaria cases occur on the African continent, with the remainder concen- trated in parts of the Pacific, Latin America, and Asia. 11,12 Most US soldiers currently deployed in war zones are in Afghanistan or Iraq where malaria transmission is seasonal and varies geographically. While Plas- modium vivax historically accounts for 80% to 90% of indigenous cases in Af- ghanistan and 95% of cases in Iraq, with Plasmodium falciparum causing the ma- jority of the remaining cases, 13,14 these numbers are likely to be inaccurate due to unreliable reporting in recent years from these war-torn areas. The US Army directs soldiers oper- ating in these areas to consume anti- malaria chemoprophylaxis and use per- sonal protective measures, to include minimizing exposed skin through Author Affiliations: Army-Navy Aerospace Medicine Residency, Naval Operational Medicine Institute, Pen- sacola, Fla (Dr Kotwal); Department of Preventive Medi- cine, University of Texas Medical Branch, Galveston (Dr Kotwal); Department of Military and Emergency Medi- cine, Uniformed Services University of the Health Sci- ences, Bethesda, Md (Drs Kotwal and Wenzel); Regi- mental Surgeon (Dr Wenzel) and Battalion Physician Assistant (Mr Sterling), 75th Ranger Regiment, Fort Ben- ning, Ga; Division Preventive Medicine Officer, 1st Cavalry Division, Fort Hood, Tex (Dr Porter); and Epi- demiology and Disease Surveillance, US Army Center for Health Promotion and Preventive Medicine, Aber- deen Proving Ground, Md (Ms Jordan and Dr Petruc- celli). Dr Kotwal was formerly Battalion Surgeon, 75th Ranger Regiment, Fort Benning, Ga.
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