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More than 80 U.S. military personnel contracted malaria last year despite all the medications and precautions made available to the forces, according to a recent Pentagon study.

Complacency seems to be the main reason, said Dr. (Col.) Peter Weina, a board-certified infectious diseases physician and chairman of the Defense Department’s severe malaria program.

"Unfortunately, we are all human and all fallible, and as such, we don’t either take our meds on schedule — or at all — and we are horrible at doing personal protective measures," said Weina, who has worked with malaria since 1977. "We have to be right 100 percent of the time; the mosquito — or malaria parasite — only has to be right once.

"Every U.S. troop believes they are John Wayne and indestructible. … None believe that a little mosquito will take them down when they are facing Taliban, roadside bombs and bullets every day. So they forget or ignore the advice of the docs and get malaria," Weina said.

In 2008, 83 troops were diagnosed or reported to have malaria, according to a review in the January edition of the Defense Department’s Medical Surveillance Monthly Report. More than two-thirds were caused by infections likely acquired in Afghanistan, it stated.

Of the 83 recorded cases, 55 were contracted in Central Asia and the Middle East and 22 contracted in "unknown" locations. One was contracted in Korea, three in Africa, two in Central or South America, the report stated.

The report noted a dramatic decrease in cases reported out of South Korea, where most cases were contracted before 2004.

"The most significant finding of this summary relates to the decline in cases from Korea. From the mid-1990s through 2004, most cases of malaria among U.S. military members were due to P. vivax infections acquired near the demilitarized zone in Korea," the report says.

The decline is attributed to U.S. military prevention policies and control programs such as eliminating breeding sites. No cases were reported in 2008 from troops stationed in Korea, though one case was considered "Korea-acquired" from soldier who traveled to Korea in 2007, the report stated.

Four species are capable of infecting humans and causing clinically significant illnesses: Plasmodium falciparum, which is the most deadly; Plasmodium viavax, the most common; Plasmodium ovale, and Plasmodium malariae.

Failure to take anti-malaria medicine can land a member in trouble, a Pentagon spokesman said.

"An order to follow requirements for medical countermeasures to disease threats (subject to medical exemptions or any other rules for exceptions) is the same as any other lawful military order," said Cmdr. Jeffrey Gordon. He did not have answers to questions such as what is the punishment, or how many troops might have been penalized for disobeying the order.

Early symptoms include headaches, feeling of weakness and exhaustion, achy bones, loss of appetite, desire to stretch or yawn, and nausea and vomiting.

"We get sick with a prodrome (early symptoms) that looks like the flu, or a stomach ache, or just feeling a little under the weather," said Weina, who works at the Division of Experimental Therapeutics at Walter Reed Army Institute of Research in Washington, D.C. "Rarely do we see the classic fever chill cycle, but eventually, if not treated, it can often be fatal in ‘non-immunes’ like we in the U.S. are."

People who live in endemic countries and are constantly exposed to the parasite develop a semi-immunity to it, he said. "People who do not grow up and live with this are non-immune and get sick, and even can die, from seemingly low level infections."

During the review’s seven-year surveillance period, cases stemming from Afghanistan were reported every month of the year. Cases typically increased during the spring, plateaued in the summer, and declined in the fall, according to the four-page review.

With the U.S. Navy sending warships and sailors to the African continent as part of Africa Partnership Station’s ongoing teaching mission with African nations, the service is ratcheting up its precautions.

"Sub-Saharan Africa is considered endemic for malaria and all … personnel are required to follow preventive medicine guidelines which include prescription anti-malarial medications," said Capt. Mark Malakooti, Naval Forces Europe-Africa Preventive Medicine Officer. "Personnel are also educated on prevention measures such as the use of DEET on exposed skin and proper wear of permethrin-treated uniforms, especially during periods of increased insect activity."

Malaria cases in 2008 were reported from more than 30 medical facilities, with Landstuhl Regional Medical Center in Germany reporting the largest number at 15.

The best way to safeguard against contracting the disease is with personal protective measures, such as taking medications and using repellent such as DEET, Permethrin-treated uniforms, and mosquito netting on beds and cots, Weina said.


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