Kim Heung-Chul, Pacha Laura A, Lee Won-Ja, Lee Jong-Koo, Gaydos Joel C, Sames William J, Lee Hee-Choon S, Bradley Kent, Jeung Gi-Gon, Tobler Steven K, Klein Terry A
Fifth Medical Detachment, 168th Multifunctional Medical Battalion, Unit 15247, APO AP 96205-5247.
Mil Med. 2009 Jul;174(7):762-9. doi: 10.7205/milmed-d-01-6208.
Malaria was eradicated and the Republic of Korea (ROK) declared "malaria free" in 1979. However, in 1993, a temperate strain of vivax malaria, expressing both latent and nonlatent disease populations, re-emerged near the demilitarized zone (DMZ), rapidly spread to civilian sectors near the DMZ, and increased exponentially in ROK military, veteran, and civilian populations through 1998. Malaria among all ROK populations decreased 5-fold from a high of 4142 cases in 2000 to a low of 826 cases in 2004, before increasing again to 2180 cases by 2007. Each malaria case in the ROK is reported in the metropolitan area/province where the diagnosis is made, which may be at some distance from the area where infection occurred. Therefore, it is difficult to ascertain transmission sites since approximately 60% of vivax malaria in Korea is latent with symptoms occurring >1 month to 24 months after infection. A review of case diagnosis for civilian, veteran, and military populations shows that nearly all malaria south of Gyeonggi and Gangwon Provinces is the result of veterans exposed in malaria high-risk areas along the DMZ and returning to their hometowns where they later develop malaria. Thus, malaria currently remains localized near the DMZ with limited transmission in provinces south of Seoul and has not spread throughout Korea as previously hypothesized. This report describes the reemergence of vivax malaria cases in civilian and military ROK populations and U.S. military personnel and assesses variables related to its transmission and geographic distribution.
疟疾已被根除，大韩民国（韩国）于1979年宣布“无疟疾”。然而，1993年，一种间日疟原虫的温带菌株出现，同时存在潜伏性和非潜伏性疾病群体，在非军事区（DMZ）附近重新出现，迅速蔓延到DMZ附近的平民区，并在1998年之前在韩国军队、退伍军人和平民人口中呈指数增长。韩国所有人群中的疟疾发病率从2000年的4142例高位下降了5倍，至2004年的826例低位，然后在2007年再次增至2180例。韩国的每一例疟疾病例都在做出诊断的大都市地区/省份进行报告，而该地区可能与感染发生地有一定距离。因此，由于韩国约60%的间日疟原虫是潜伏性的，症状在感染后1个月至24个月出现，所以很难确定传播地点。对平民、退伍军人和军队人群的病例诊断进行回顾显示，京畿道和江原道以南几乎所有的疟疾都是退伍军人在DMZ沿线疟疾高风险地区接触后，回到家乡后发病的结果。因此，目前疟疾仍局限于DMZ附近，在首尔以南省份的传播有限，并未如之前所假设的那样在韩国全境传播。本报告描述了韩国平民和军队人群以及美国军事人员中间日疟原虫病例的再次出现，并评估了与其传播和地理分布相关的变量。
