Malaria in the Military

November 11th is Veteran’s Day in the United States. Over the years soldiers have been vulnerable to malaria. During the U.S. Civil War 150 years ago over 14,000 Union troops are estimated to have died from malaria. While death estimates were not available for the Confederates, it was thought that over 40,000 malaria cases occurred in an 18-month period in the middle of the war.

nyt-mali-7a.jpgToday places like Afghanistan and the Horn of Africa pose a malaria threat to troops, so there is malaria prophylaxis for soldiers. Sometimes the prevention itself poses problems. “The Army has dropped Lariam — the drug linked to side effects including suicidal tendencies, anxiety, aggression and paranoia,” and now prefers doxycycline for people who may react to mefloquine.

The military takes malaria seriously now. The Walter Reed Army Institute of Research (WRAIR) puts a priority on malaria research since, “Malaria remains highly relevant to the military because of its prevalence, variety (there are four species that infect humans), debilitating nature, potential lethality, and tendency to become resistant to drugs. No organization in the world has WRAIR’s experience in the complete spectrum of malaria research.”

WRAIR’s “Work on a vaccine is also progressing. Advanced molecular, genetic, and biomedical technologies are now being employed to produce candidate malaria vaccines. Field trials of these candidate pharmaceuticals are an essential part of the program and are underway in Thailand and Kenya.”

The military of all nations are at risk when they serve in malaria endemic areas. For example, a Philippine soldier “succumbed to malaria on 23 October 2008 while serving as a military observer with the U.N. Mission in Sudan.”

Another concern of malaria in the military is the potential for soldiers who contract malaria for spreading it to other countries or bringing it home. It was reported that Soviet soldiers serving in Afghanistan some years ago brought the disease back to republics in the Caucasus and Central Asia. Though this particular spread could be controlled, not all situations may be so fortunate.

Today a variety of injury and mental health problems may overwhelm the effects of malaria on soldiers. Still, soldiers are at risk. For example in 2002, “38 cases of malaria were identifiedin a 725-man Ranger Task Force that deployed to eastern Afghanistan.” Also over a 6-year span the Defense Medical Surveillance System reported 423 cases of malaria including Plasmodium vivax, P. falciparum, P. ovale, and P. malaria. A big challenge is the inability of health systems in non-endemic countries to treat and save lives of soldiers who return home with the disease.

There are basically two lessons from this issue. First malaria control must recognize that soldiers who may not be immune when they enter a malaria endemic war zone are at risk of malaria death. Secondly, as a mobile population soldiers have the potential for reintroducing malaria to areas where it may have been eliminated. War kills people; malaria kills people – when soldiers are infected a double dose of death potentially occurs

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