CHEMOPROPHYLAXIS IN US NAVAL AIRCREW TRANSITING MALARIA ENDEMIC AREAS

Background: The role of chemoprophylaxis in aircrew transiting malaria endemic regions has been, and remains, a point of controversy. The re cent emergence of multi-drug resistant parasites and pesticide-resista nt mosquitoes have made malaria prevention and control even more chall enging and complex. The primary purpose was to review the efficacy of chemoprophylaxis (as compared with no chemoprophylaxis) in U.S. Naval aircrew traveling to malaria endemic areas for short periods of time o n a frequent, infrequent, or isolated basis. A secondary purpose was t o generate chemoprophylaxis guidelines based on the outcomes of this r eview. Methods:A comprehensive MEDLINE database search was performed f or the interval from January 1966 to April 1997. Additional resources were obtained from references cited in relevant journal articles, mono graphs, textbooks, and U. S. government publications. Pertinent U. S. Navy publications were also reviewed. Selection criteria were develope d and applied to the data. Results: The investigation railed to identi fy any analytic studies that met selection criteria regarding the effi cacy of chemoprophylaxis in U.S. Naval aircrew or aircrew surrogates t ransiting malaria endemic areas. The data were therefore used to quali tatively assess the risks/benefits of chemoprophylaxis and generate ch emoprophylaxis guidelines. Based on the results of this review, the de cision to prescribe chemoprophylaxis was strongly dependent on the fol lowing risk factors: a) geographic region; b) transmission risk; c) du ration of nighttime exposure; and d) aircrew, aircraft, and mission pr ofiles. Conclusions: Studies of adequate analytic design are needed to delineate the role of chemoprophylaxis in aircrew transiting malaria endemic areas and to validate the chemoprophylaxis guidelines suggeste d in this review.