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Malaria cases up among soldiers in Afghanistan

Cases of the mosquito-borne disease malaria, which military doctors say are preventable, have struck U.S. troops in Afghanistan at the highest rate there in nine years.

According to a report published by the Armed Forces Health Surveillance Center last month, 124 cases appeared among American troops in 2011. Of those, 91 — nearly three out of four — were diagnosed in Afghanistan.

The number of cases in Afghanistan is proportionately higher than the number of cases acquired in the tropical regions of Africa and Haiti, where U.S. troops provided assistance following the 2010 earthquake.

In 2011, malaria diagnoses among U.S. troops were highest in the Army, the largest ground force.

“Unfortunately, after 10 years of U.S. military presence in Afghanistan, and despite the availability of effective prevention measures and a long organizational history of fighting the disease, malaria remains a threat to U.S. forces and their operations in Afghanistan,” Col. Mark Fukuda, a doctor with the Armed Forces Health Surveillance Center’s malaria surveillance program, wrote in a commentary that accompanied the report.

Malaria accounted for the deaths of 1.2 million people worldwide, many of them African children, according to a recent study published in The Lancet. The number of such deaths has decreased since 2004, in part because of targeted health aid.

Of the 124 cases in the U.S. military, 24 were linked to Africa, four to South Korea, and five were of unknown origin. No U.S. service members have died from malaria, according to AFHSC.

Possible reasons for the jump in reported cases include the 30,000 troops who arrived in Afghanistan in 2011 and an improved capacity for reporting and diagnosing malaria, the AFHSC report said.

Lt. Col. Laura Pacha, of the U.S. Army Public Health Command’s disease epidemiology program, said that in spite of malaria’s association with the tropics, infections do occur in temperate climates such as those of Afghanistan and Korea.

“We used to have it in the United States as well, until we eradicated it,” she said.

Fukuda wrote that malaria and other infectious diseases can be prevented with the combination of the right anti-malarial drugs, the use of DEET-based repellent, proper wear of Permethrin-treated uniforms and the use of bed nets.

Such measures are not only required but could “make a crucial difference — in enhancing military operational effectiveness and saving lives,” he wrote.

Between 2004 and 2006, while deployed to Liberia as part of an international peacekeeping force, Swedish troops suffered no malaria cases, Fukuda wrote. Soldiers were instructed to use DEET-based repellent and mosquito nets; and soldiers took anti-malaria tablets together at the same time every day.

By contrast, Fukuda wrote, U.S. troops in Liberia took their anti-malarials on the “honor system,” had no bed nets and their use of insect repellent was low. Thirty-six percent of the U.S. troops were diagnosed with malaria infections.

In November, the Army dropped the anti-malarial drug mefloquine. Users had complained the pill caused psychiatric symptoms ranging from nightmares, depression and paranoia to auditory hallucinations and mental breakdowns.

Pacha said soldiers are exposed to predeployment training and posters that caution soldiers to take preventative measures.

She suggested soldiers wear their Permethrin-treated uniforms with sleeves down and pant legs tucked in; coat exposed skin with DEET-based repellents; use their medication as prescribed and avoid going out at dawn and dusk, when mosquitoes are biting the most.

“No single method is 100 percent,” Pacha said. “You really do have to implement the full spectrum of prevention measures.”

The Associated Press contributed to this report.