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Safety, Tolerability, and Compliance with Long-Term Antimalarial Chemoprophylaxis in American Soldiers in Afghanistan

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  • Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Walter Reed Army Institute of Research, Silver Spring, Maryland; University of Maryland School of Medicine, Baltimore, Maryland; 10th Mountain Division, Fort Drum, New York; Bill and Melinda Gates Foundation, Seattle, Washington

Long-term antimalarial chemoprophylaxis is currently used by deployed U.S. military personnel. Previous small, short-term efficacy studies have shown variable rates of side effects among patients taking various forms of chemoprophylaxis, though reliable safety and tolerability data on long-term use are limited. We conducted a survey of troops returning to Fort Drum, NY following a 12-month deployment to Operation Enduring Freedom, Afghanistan from 2006 to 2007. Of the 2,351 respondents, 95% reported taking at least one form of prophylaxis during their deployment, and 90% were deployed for > 10 months. Compliance with daily doxycycline was poor (60%) compared with 80% with weekly mefloquine (MQ). Adverse events (AEs) were reported by approximately 30% with both MQ and doxycycline, with 10% discontinuing doxycycline compared with 4% of MQ users. Only 6% and 31% of soldiers reported use of bed nets and skin repellents, respectively. Compliance with long-term malaria prophylaxis was poor, and there were substantial tolerability issues based on these anonymous survey results, though fewer with MQ than doxycycline. Given few long-term antimalarial chemoprophylaxis options, there is an unmet medical need for new antimalarials safe for long-term use.

Author Notes

* Address correspondence to David L. Saunders, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail: david.saunders@afrims.org

Authors' addresses: David L. Saunders and Jessica E. Manning, USAMC-Armed Forces Research Institute of Medical Sciences (AFRIMS), Immunology and Medicine, APO, E-mails: david.saunders@afrims.org and jessica.manning.gst@afrims.org. Eric Garges and Kent Bennett, Walter Reed Army Institute of Research, Preventive Medicine, Silver Spring, MD, E-mails: eric.c.garges.mil@mail.mil and kb128793@hotmail.com. Sarah Schaffer, University of Maryland School of Medicine, Baltimore, MD, E-mail: sarah.schaffer@som.umaryland.edu. Andrew J. Kosmowski, 10th Mountain Division, Division Surgeon, Fort Drum, NY, E-mail: andrew.kosmowski@fcer.com. Alan J. Magill, Bill and Melinda Gates Foundation, Malaria, Seattle, WA, E-mail: alan.magill@gatesfoundation.org.

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