An outbreak of Plasmodium falciparum malaria in U.S. marines deployed to Liberia

Timothy J. Whitman; Philip E. Coyne; Alan J. Magill; David L. Blazes; Michael D. Green; Wilbur K. Milhous; Timothy H. Burgess; Daniel Freilich; Sybil A. Tasker; Ramzy G. Azar; Timothy P. Endy; Christopher D. Clagett; Gregory A. Deye; G. Dennis Shanks; Gregory J. Martin

doi:10.4269/ajtmh.2010.09-0774

An outbreak of Plasmodium falciparum malaria in U.S. marines deployed to Liberia

Timothy J. Whitman, Philip E. Coyne, Alan J. Magill, David L. Blazes, Michael D. Green, Wilbur K. Milhous, Timothy H. Burgess, Daniel Freilich, Sybil A. Tasker, Ramzy G. Azar, Timothy P. Endy, Christopher D. Clagett, Gregory A. Deye, G. Dennis Shanks, Gregory J. Martin

Infectious Disease Clinical Research Program (IDCRP)

Research output: Contribution to journal › Article › peer-review

59 Scopus citations

Abstract

In 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent, 5 (12%) used permethrin-treated clothing, and none used bed netting. Adherence with weekly mefloquine (MQ) was reported by 23 (55%). However, only 4 (10%) had serum MQ levels high enough to correlate with protection (> 794 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 3.79). Tablets collected from Marines met USP identity and dissolution specifications for MQ. Testing failed to identify P. falciparum isolates with MQ resistance. This outbreak resulted from under use of personal protective measures and inadequate adherence with chemophrophylaxis. It is essential that all international travelers make malaria prevention measures a priority, especially when embarking to regions of the world with high transmission intensity such as west Africa.

Original language	English
Pages (from-to)	258-265
Number of pages	8
Journal	American Journal of Tropical Medicine and Hygiene
Volume	83
Issue number	2
DOIs	https://doi.org/10.4269/ajtmh.2010.09-0774
State	Published - Aug 2010

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Whitman, T. J., Coyne, P. E., Magill, A. J., Blazes, D. L., Green, M. D., Milhous, W. K., Burgess, T. H., Freilich, D., Tasker, S. A., Azar, R. G., Endy, T. P., Clagett, C. D., Deye, G. A., Shanks, G. D., & Martin, G. J. (2010). An outbreak of Plasmodium falciparum malaria in U.S. marines deployed to Liberia. American Journal of Tropical Medicine and Hygiene, 83(2), 258-265. https://doi.org/10.4269/ajtmh.2010.09-0774

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title = "An outbreak of Plasmodium falciparum malaria in U.S. marines deployed to Liberia",

abstract = "In 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent, 5 (12%) used permethrin-treated clothing, and none used bed netting. Adherence with weekly mefloquine (MQ) was reported by 23 (55%). However, only 4 (10%) had serum MQ levels high enough to correlate with protection (> 794 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 3.79). Tablets collected from Marines met USP identity and dissolution specifications for MQ. Testing failed to identify P. falciparum isolates with MQ resistance. This outbreak resulted from under use of personal protective measures and inadequate adherence with chemophrophylaxis. It is essential that all international travelers make malaria prevention measures a priority, especially when embarking to regions of the world with high transmission intensity such as west Africa.",

author = "Whitman, {Timothy J.} and Coyne, {Philip E.} and Magill, {Alan J.} and Blazes, {David L.} and Green, {Michael D.} and Milhous, {Wilbur K.} and Burgess, {Timothy H.} and Daniel Freilich and Tasker, {Sybil A.} and Azar, {Ramzy G.} and Endy, {Timothy P.} and Clagett, {Christopher D.} and Deye, {Gregory A.} and Shanks, {G. Dennis} and Martin, {Gregory J.}",

year = "2010",

month = aug,

doi = "10.4269/ajtmh.2010.09-0774",

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journal = "American Journal of Tropical Medicine and Hygiene",

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Whitman, TJ, Coyne, PE, Magill, AJ, Blazes, DL, Green, MD, Milhous, WK, Burgess, TH, Freilich, D, Tasker, SA, Azar, RG, Endy, TP, Clagett, CD, Deye, GA, Shanks, GD & Martin, GJ 2010, 'An outbreak of Plasmodium falciparum malaria in U.S. marines deployed to Liberia', American Journal of Tropical Medicine and Hygiene, vol. 83, no. 2, pp. 258-265. https://doi.org/10.4269/ajtmh.2010.09-0774

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AU - Whitman, Timothy J.

AU - Coyne, Philip E.

AU - Magill, Alan J.

AU - Blazes, David L.

AU - Green, Michael D.

AU - Milhous, Wilbur K.

AU - Burgess, Timothy H.

AU - Freilich, Daniel

AU - Tasker, Sybil A.

AU - Azar, Ramzy G.

AU - Endy, Timothy P.

AU - Clagett, Christopher D.

AU - Deye, Gregory A.

AU - Shanks, G. Dennis

AU - Martin, Gregory J.

PY - 2010/8

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N2 - In 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent, 5 (12%) used permethrin-treated clothing, and none used bed netting. Adherence with weekly mefloquine (MQ) was reported by 23 (55%). However, only 4 (10%) had serum MQ levels high enough to correlate with protection (> 794 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 3.79). Tablets collected from Marines met USP identity and dissolution specifications for MQ. Testing failed to identify P. falciparum isolates with MQ resistance. This outbreak resulted from under use of personal protective measures and inadequate adherence with chemophrophylaxis. It is essential that all international travelers make malaria prevention measures a priority, especially when embarking to regions of the world with high transmission intensity such as west Africa.

AB - In 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent, 5 (12%) used permethrin-treated clothing, and none used bed netting. Adherence with weekly mefloquine (MQ) was reported by 23 (55%). However, only 4 (10%) had serum MQ levels high enough to correlate with protection (> 794 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 3.79). Tablets collected from Marines met USP identity and dissolution specifications for MQ. Testing failed to identify P. falciparum isolates with MQ resistance. This outbreak resulted from under use of personal protective measures and inadequate adherence with chemophrophylaxis. It is essential that all international travelers make malaria prevention measures a priority, especially when embarking to regions of the world with high transmission intensity such as west Africa.

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An outbreak of Plasmodium falciparum malaria in U.S. marines deployed to Liberia

Abstract

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