MALARIA IN US MARINES RETURNING FROM SOMALIA

Objective.-To identify malaria in US Marines returning from Somalia an d to determine their compliance with chemoprophylaxis. Design.-Case se ries. Setting.-The US Navy health care system. Patients.-Consecutive s ample of 106 US Marines diagnosed with malaria after returning from So malia 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, 199 3, there were 112 cases of imported malaria in 106 US Marine Corps per sonnel 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 no ted in six (5%) of 112 cases, and a single case of Plasmodium malariae was identified. Patients with P falciparum malaria were diagnosed a m ean of 20.9 days (range, 1 to 82 days) after returning to the United S tates compared with 91.8 days (range, 7 to 228 days) for P vivax infec tion (P<.0001). The self-reported chemoprophylaxis compliance rate was 56%; however, only 45 (50%) of 90 patients were given an optimal chem oprophylaxis regimen. Conclusions.-Noncompliance with personal protect ive measures and chemoprophylaxis contributed to the largest outbreak of imported malaria in US military personnel since the Vietnam conflic t. Since military personnel frequently go on leave after deployment, h ealth care providers throughout the United States must be aware of the presence of imported malaria from Somalia.