Malaria in US Marines returning from Somalia.

OBJECTIVE

To identify malaria in US Marines returning from Somalia and to determine their compliance with chemoprophylaxis.

DESIGN

Case series.

SETTING

The US Navy health care system.

PATIENTS

Consecutive sample of 106 US Marines diagnosed with malaria after returning from Somalia in 1993.

MAIN OUTCOME MEASURES

Identification of the incidence and clinical features of imported malaria. Determination of compliance with chemoprophylaxis in this cohort.

RESULTS

As of December 20, 1993, there were 112 cases of imported malaria in 106 US Marine Corps personnel returning from Somalia. Plasmodium vivax accounted for 97 (87%) of 112 malaria cases, and Plasmodium falciparum accounted for eight (7%) of 112 cases. Mixed infection with P vivax and P falciparum was noted in six (5%) of 112 cases, and a single case of Plasmodium malariae was identified. Patients with P falciparum malaria were diagnosed a mean of 20.9 days (range, 1 to 82 days) after returning to the United States compared with 91.8 days (range, 7 to 228 days) for P vivax infection (P < .0001). The self-reported chemoprophylaxis compliance rate was 56%; however, only 45 (50%) of 90 patients were given an optimal chemoprophylaxis regimen.

CONCLUSIONS

Noncompliance with personal protective measures and chemoprophylaxis contributed to the largest outbreak of imported malaria in US military personnel since the Vietnam conflict. Since military personnel frequently go on leave after deployment, health care providers throughout the United States must be aware of the presence of imported malaria from Somalia.