Colonel Mark M. Fukuda, MD, is the assistant chief and program director for malaria surveillance of the Global Emerging Infections Surveillance & Response System division at the Armed Forces Health Surveillance Center.
The potential impact of malaria on military populations is highlighted by General Douglas MacArthur, who in referring to malaria’s impact on World War II forces, famously lamented: “This will be a long war, if for every division I have facing the enemy, I must count on a second division in the hospital with malaria, and a third division convalescing from this debilitating disease”.1 Today’s deployment patterns, though different from those of MacArthur’s time, continue to pose the threat of malaria to members of U.S. armed forces.
This issue of the Medical Surveillance Monthly Report (MSMR) reports the latest trends in malaria among U.S. military members. Of particular note, the 91 cases of malaria that were considered acquired in Afghanistan in 2011 was the highest number recorded among U.S. military members serving in that country in the last nine years; moreover, the Afghanistan-acquired cases constituted 73 percent of all documented malaria cases last year. Unfortunately, after ten years of U.S. military presence in Afghanistan, and despite the availability of effective prevention measures and a long organizational history of fighting the disease, malaria remains a threat to U.S. forces and their operations in Afghanistan.
The U.S. military’s persistent and perhaps worsening malaria experience in Afghanistan is not inevitable. Foreign militaries’ recent experiences in malaria endemic settings have shown that malaria burdens can be reduced to negligible levels by the consistent application of proper control measures. Of note, during a series of Swedish military deployments to Liberia from 2004 to 2006, no cases of Plasmodium falciparum malaria were reported among the 1,170 soldiers whose total malaria exposure spanned approximately 7,000 person-months.2 According to the report, all soldiers were instructed prior to deployment to use a DEET-containing repellent and bed nets. In addition, the use of anti-malarial drugs to prevent the disease, such as mefloquine or atovoquone-proguanil (Malarone®), was “encouraged” by both command and health personnel and “soldiers took their tablets together and at the same time of the day.”