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The epidemiology of malaria among U.S. government personnel attached to diplomatic posts has not been reported. We reviewed malaria surveillance reports on persons with onset of symptoms between January 1988 and December 2004. Among 684 slide-proven cases, the median age was 36 years. There were 565 (82.6%) cases of Plasmodium falciparum malaria and 56 (8.2%) of P. vivax malaria. A total of 89.9% were infected in Africa and 5.8% were infected in Asia; 95% of the P. falciparum cases originated in sub-Saharan Africa. One-fourth of all cases were reported in 1990–1991. The average annual incidence (per 1,000 personnel) of Plasmodium between 1995 and 1999 was highest in west Africa (8.96), followed by central Africa (8.08), and east Africa (4.27). No or irregular chemoprophylaxis was reported by 58.5%. Among those who indicated regular prophylaxis, 78% took regimens no longer considered adequate. In sub-Saharan Africa, cases were reported in every month. There were three deaths. Prevention of malaria among U.S. Government employees attached to diplomatic posts should particularly focus on those serving in sub-Saharan Africa and malarious areas of Asia.
Received August 11, 2006. Accepted for publication October 2, 2006.
Acknowledgments: We thank Dr. Cedric Dumont (Director, Office of Medical Services, U.S. Department of State) for initiating the study, the medical technologists in Washington who reviewed the malaria slides, the technologists at overseas diplomatic posts who prepared and interpreted the malaria slides under field conditions, the medical providers who complete the case report forms and send the slides and reports for review, Dr. Robert Burney (Chief, Quality Improvement, U.S. Department of State) for support of monthly health unit reports from which the numbers of persons at post in 2002 are derived, the Department of Epidemiology and Biostatistics, The George Washington University (Washington, DC), Dr. Virginia Foster and Ann Goldman for their assistance.
Financial support: This study was supported by the United States Government. The American Society of Tropical Medicine and Hygiene (ASTMH) and the American Committee on Clinical Tropical Medicine and Travelers’ Health (ACCTMTH) assisted with publication expenses.
Disclaimer: The opinions expressed herein are those of the authors and are not to be construed as official nor necessarily represent the views or official policies of the Department of State or U.S. Government.
Disclosure: Martin Wolfe is a consultant for GlaxoSmithKline, the makers of atovaquone and proguanil (Malarone®). This statement is made in the interest of full disclosure and not because the author considers this to be a conflict of interest.
* Address correspondence to Joe P. Bryan, 1421 Mayflower Drive, McLean, VA 2210. E-mail: joe.p.bryan{at}earthlink.net
Authors’ addresses: Priya Joy Rathnam, U.S. Food and Drug Administration, Silver Spring, MD 20903. Joe P. Bryan, 1421 Mayflower Drive, McLean, VA 22101 Telephone: 703-356-8450, E-mail: joe.p.bryan{at}earthlink.net. Martin Wolfe, Traveler’s Medical Service, 2141 K Street, NW, Suite 408, Washington, DC 20037, Telephone: 202-466-8109.
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