Doctors should be on the lookout for malaria in military personnel who return from a malaria-endemic region with fever or other “indistinct” illness, military physicians are advising.

Dr. Russ S. Kotwal, of the Naval Operational Medicine Institute in Pensacola, Florida, and colleagues report that 38 soldiers from a 725-man Ranger Task Force were diagnosed with malaria up to 11 months after returning from deployment in eastern Afghanistan between June and September 2002.

Kotwal’s group reports in this week’s Journal of the American Medical Association that the outbreak occurred despite the fact that the soldiers were put on a malaria prevention regimen that included weekly mefloquine tablets starting 2 week before deployment through 4 weeks after deployment, plus daily primaquine tablets for the first 2 weeks after deployment.

The results of an anonymous compliance survey, however, showed that only 52 percent of respondents complied fully with the weekly regimen, 41 percent complied with termination treatment, and 31 percent reported full compliance with both regimens.

More than half of the respondents reported difficulty keeping up with pills, and many believed there was not a mosquito problem.

While most of the soldiers wore uniforms treated with permethrin, only 29 percent used insect repellent.

“Providing continuous education about the need to comply with (preventive) medications and having leaders directly observe therapy and enforce personal protective measures” may be needed to safeguard soldiers from insect-borne diseases, Kotwal and his team suggest.

SOURCE: Journal of the American Medical Association, January 12, 2005.