An Outbreak of Plasmodium falciparum Malaria in U.S. Marines Deployed to Liberia

Timothy J. Whitman Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Philip E. Coyne Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Alan J. Magill Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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David L. Blazes Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Michael D. Green Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Wilbur K. Milhous Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Timothy H. Burgess Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Daniel Freilich Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Sybil A. Tasker Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Ramzy G. Azar Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Timothy P. Endy Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Christopher D. Clagett Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Gregory A. Deye Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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G. Dennis Shanks Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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Gregory J. Martin Infectious Diseases Department, National Naval Medical Center, Bethesda, Maryland; Walter Reed Army Institute of Research, Silver Spring, Maryland; Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; College of Public Health, University of South Florida, Tampa, Florida; Naval Medical Research Center, Silver Spring, Maryland; Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York; U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples, Italy; Australian Army Malaria Institute, Gallipoli Barracks, Australia

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DOI:
https://doi.org/10.4269/ajtmh.2010.09-0774
Volume/Issue:
Volume 83: Issue 2
Page(s):
258–265
Restricted access
Get Permissions
In 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent, 5 (12%) used permethrin-treated clothing, and none used bed netting. Adherence with weekly mefloquine (MQ) was reported by 23 (55%). However, only 4 (10%) had serum MQ levels high enough to correlate with protection (> 794 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 3.79). Tablets collected from Marines met USP identity and dissolution specifications for MQ. Testing failed to identify P. falciparum isolates with MQ resistance. This outbreak resulted from under use of personal protective measures and inadequate adherence with chemophrophylaxis. It is essential that all international travelers make malaria prevention measures a priority, especially when embarking to regions of the world with high transmission intensity such as west Africa.

“Good doctors are of no use without good discipline. More than half the battle against disease is not fought by doctors, but by regimental officers. It is they who see that the daily dose of mepacrine (anti-malarial chemoprophylactic drug used in WW II) is taken…if mepacrine was not taken, I sacked the commander. I only had to sack three; by then the rest had got my meaning.”

—Lieutenant General William Slim (1891–1970), Burma Campaign, 1943

Author Notes

*Address correspondence to Timothy J. Whitman, Infectious Diseases Department, Division of Medicine, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889. E-mail: timothy.whitman@med.navy.mil

Disclosure: None of the authors have any potential conflicts of interest.

Authors' addresses: Timothy J. Whitman, David L. Blazes, Sybil A. Tasker, and Ramzy G. Azar, Infectious Diseases Department, Division of Medicine, National Naval Medical Center, Bethesda, MD. Alan J. Magill, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD. Philip E. Coyne and Gregory J. Martin, Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, MD. Michael D. Green, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Wilber K. Milhous, College of Public Health, University of South Florida, Tampa, FL. Timothy H. Burgess and Daniel Freilich, Naval Medical Research Center, Silver Spring, MD. Timothy P. Endy, Infectious Diseases Division, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY. Christopher D. Clagett, U.S. Navy Environmental and Preventive Medicine Unit Seven, Naples Italy. Gregory A. Deye, Walter Reed Army Institute of Research, Silver Spring, MD. G. Dennis Shanks, Army Malaria Institute, Gallipoli Barracks, Enoggera, Brisbane, Queensland, Australia.

Copyright:
Copyright © 2010 by The American Society of Tropical Medicine and Hygiene 2010
Received:
19 Dec 2009
|
Accepted:
23 Apr 2010
|
Published Online:
05 Aug 2010
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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