Malaria in Iraq, Afgh, and Horn of Africa

[Sacamuelas]

Deployed Troops Step Up Anti-Malarial Protections
By Donna Miles
American Forces Press Service

WASHINGTON, April 8, 2004 -- It's peak mosquito season in Iraq, and U.S troops deployed in support of Operation Iraqi Freedom are taking steps to protect themselves against malaria.

The high-risk season for malaria in Iraq runs from April 1 through Nov. 1, according to Army Col. Fredric Plotkin, preventive medicine and force health protection officer for U.S. Central Command headquarters at MacDill Air Force Base, Fla. The highest-risk areas are in the northern, eastern and southeastern provinces, Plotkin said. Baghdad and much of western Iraq are malaria-free.

The high-risk period for malaria in Afghanistan runs from March through November, and malaria is a high risk year-round in the Horn of Africa.

Service members in high-risk areas are required to take anti-malarial medication. The type of drug prescribed varies depending on the region, based on the malarial strain present, Plotkin said.

Chloroquine, the drug most commonly prescribed to service members in Iraq, requires only a weekly 500-milligram tablet and has fewer side effects than other anti-malarial drugs, Plotkin said.

Other anti-malarial drugs frequently used by deployed U.S. service members are mefloquine and doxycycline. These drugs generally are used in areas where malaria is resistant to chloroquine or for service members who can't take chloroquine.

Although U.S. Central Command issues general guidelines about how anti-malarial drugs are prescribed, Plotkin said unit surgeons on the ground are authorized to tailor these guidelines based on local conditions.

Use of anti-malarial drugs continues for four extra weeks after the exposure to malaria, Plotkin said, to ensure that malaria parasites are cleared from the blood. In addition, service members take primaquine for two weeks to kill any malaria parasites in the liver, he said, adding that a blood test is required before primaquine is prescribed.

Anti-malarial drugs serve as a second line of defense in the event that other protective measures fail, Plotkin said.

These measures include using an insect repellent containing DEET (diethylmethyltoluamide) on exposed skin, blousing pants into boots, wearing sleeves down, treating uniforms with permethrin and sleeping under a permethrin-treated bed net, he said.

These measures also protect service members against other insect-borne diseases, such as leishmaniasis, for which anti-malarial drugs are not effective, Plotkin said.

According to an Army message issued to the field in November, no cases of malaria have been reported among coalition troops in Iraq, and encountering a strain of malaria that is resistant to chloroquine is considered to be unlikely in Iraq.

Malaria is a major health problem in tropical climates, with an estimated 500 million new cases causing at least 1 million deaths every year. Malaria usually is fatal in only the very old, very young and those with weakened immune systems, officials said.

Symptoms of malaria include a slow-rising fever that lasts several days, followed by shaking chills and rapidly increased temperature. Victims often feel malaise and suffer headache, nausea and profuse sweating. Plotkin said the cycle of chills, fever and sweating typically repeats itself every one to three days.

Plotkin said malarial symptoms may appear long after a service member has redeployed from the affected region. For this reason, he said, service members are counseled to advise their doctors that they served in an area where malaria was present if they develop a flu-like illness within a year or so after redeploying.

[ktek01]

Good timely information, thanks for posting that.

[Gypsy]

Originally posted by Sacamuelas
Deployed Troops Step Up Anti-Malarial Protections
By Donna Miles
American Forces Press Service

WASHINGTON, April 8, 2004 -- It's peak mosquito season in Iraq, and U.S troops deployed in support of Operation Iraqi Freedom are taking steps to protect themselves against malaria.

I have a question. A popular item people have sent overseas is that Skin So Soft product by Avon which is seemingly effective in preventing mosquito bites. Does anyone have real experience with this or would it be better to find DEET products to send over this summer?

Thanks in advance.

[ktek01]

I would go with DEET. Skin So Soft uses oil of citronela, not DEET.

[Gypsy]

Thanks ktek!

[lrd]

Marine Corps to add insect repellant to utilities
Submitted by: MCB Quantico
Story Identification #: 2004929153954
Story by Sgt. Salju K. Thomas

http://www.usmc.mil/marinelink/mcn20...E?opendocument

[SRT31B]

Bringing up an old one i know...

OK, so its finally about that time. 2 weeks to redeployment and we are all doing our PDHA crap. We all got issued more Doxy and 2 weeks worth of Primaquine. Since I haven't really dealt with this stuff before, I wanted to get some advice from the guys who have before I answer all my guys' questions (that they obviously couldn't ask the doc when they did the interview... )

A few of the joes have been told that while they're on the Primaquine they can't drink. Is this true, or just something they're putting out to mess with everyone?

Second, if the Doxy is just a malaria prophylaxis, and the Primaquine is the actual med that gets rid of it, is it really necessary to continue to take the Doxy for 4 additional weeks (even though we've only got 2 weeks worth of Primaquine to kill it)?

Thanks in advance guys. For those staying here, stay safe and get home soon.

Bull

[jasonglh]

Doxycycline is an anti-infective and will help you with all those STD's too.

Primaquine prevents a relapse of malaria. From the first article in this thread:

In addition, service members take primaquine for two weeks to kill any malaria parasites in the liver

Both are metabolized in the liver so if you had and impaired liver function then you really don't need to be drinking. In my drug book there is no specific warning for alcohol but.....taking 2 drugs hard on the liver and boozing isn't such a great idea.

just my .02

[SRT31B]

Thanks, I'll pass on the "good news."

I'm sure everyone will be thrilled when they get the word that they're on dry status for 2 weeks once we hit the ground... Better safe than sorry though I guess.

I should be too busy rucking and running to be getting tanked anyway.

[Irish_Army01]

The Irish Defence Forces uses Larium as our anti-malaria Drug..I've heard a few stories from mates serving in Liberia about some side effects..

Some of our Guys extend their deployment's from 6 months to 9 months.,which is AFAIK the longest you can take larium with out a break.

[Doczilla]

Originally Posted by Gypsy

I have a question. A popular item people have sent overseas is that Skin So Soft product by Avon which is seemingly effective in preventing mosquito bites. Does anyone have real experience with this or would it be better to find DEET products to send over this summer?

Thanks in advance.

I'd heard about this several years ago as well. This was evaluated in a study from the NEJM in 2002. There is SOME protection from the Skin-So-Soft, but not for long. The mean duration of protection was about 22 min, with range from 10-60 min in this "arm in a cage" study. A field study found them about equal (except with a certain mosquito species), and not enough study has been done to sort out this discrepancy. Citronella oils also have been examined in other studies, with even worse results. The fact is that for what's commercially available, DEET is the best you can get. Concentrations greater than 26% didn't yield any better results and led to greater skin irritation. Products such as Deep Woods Off! and variations of Cutter, as well as myriad other brands, have the 26% concentration. This is what I would send.

'zilla

[Gypsy]

Thanks for the additional information Doczilla!

[Doczilla]

The primaquine kills malaria at a certain point in it's life cycle in recurrent (chronic) infections where the malaria hides in the liver. The doxy is needed to eradicate any current infection in its active state in the blood cells, where the primaquine is ineffective.

Originally Posted by SRT31B

A few of the joes have been told that while they're on the Primaquine they can't drink. Is this true, or just something they're putting out to mess with everyone?

Primaquine is metabolized in the liver to produce an active metabolite to fight the disease. Liver impairment, through alcohol or other injury, could potentially decrease the effectiveness of the medication, in theory leaving the soldier unprotected.

Doxycycline is also metabolized by the liver, and is known to increase liver enzymes with prolonged treatment. Does this signal liver damage? Maybe, but I wouldn't want to give the liver the additional insult of alcohol while taking it.

You did the right thing to advise your guys not to drink until they finish the meds.

To be sure, I ran this by our ICU pharmacist, who didn't come up with anything else in his databases as far as interactions.

'zilla

[SRT31B]

Thanks for the info.

[Lothar]

Gents,

I took Doxycycline while I was downrange the second time and don't remember any ill effects. I took one everyday. You just have to remember to take it. Doxy can make your skin sensitive to sunlight. One of our guys didnt take his at all and came down with Malaria. He got very ill and had to medevaced to BAF from the field.

The first time over I took the Larium on Malaria Monday. I experienced some wacko dreams...one of the side effects.

IMHO...take the Doxy if you can. When you get home take the Primaquine and don't booze it up.

Jus my .02