Abstract
BackgroundMalaria elimination is being pursued in five of seven Central American countries. Military personnel returning from peacekeeping missions in sub-Saharan Africa could import chloroquine-resistant Plasmodium falciparum, posing a threat to elimination and to the continued efficacy of first-line chloroquine (CQ) treatment in these countries. This report describes the importation of P. falciparum from among 150 Guatemalan army special forces and support staff who spent ten months on a United Nations’ peacekeeping mission in the Democratic Republic of the Congo (DRC) in 2010.MethodsInvestigators reviewed patients’ medical charts and interviewed members of the contingent to identify malaria cases and risk factors for malaria acquisition. Clinical specimens were tested for malaria; isolated parasites were characterized molecularly for CQ resistance.ResultsInvestigators identified 12 cases (8%) of laboratory-confirmed P. falciparum infection within the contingent; one case was from a soldier infected with a CQ-resistant pfcrt genotype resulting in his death. None of the contingent used an insecticide-treated bed net (ITN) or completely adhered to malaria chemoprophylaxis while in the DRC.ConclusionThis report highlights the need to promote use of malaria prevention measures, in particular ITNs and chemoprophylaxis, among peacekeepers stationed in malaria-endemic areas. Countries attempting to eliminate malaria should consider appropriate methods to screen peacekeepers returning from endemic areas for malaria infections. Cases of malaria in travellers, immigrants and soldiers returning to Central America from countries with CQ-resistant malaria should be assumed to be carry resistant parasites and receive appropriate anti-malarial therapy to prevent severe disease and death.
Highlights
Malaria elimination is being pursued in five of seven Central American countries
Civilian travellers and migrants are the populations most often considered as sources of imported malaria cases to non-endemic countries, military personnel returning from deployment to malaria-endemic areas contribute to malaria importation [5]
There are seven United Nations (UN) peacekeeping missions in Africa, and six of these are in malaria-endemic countries; Central American soldiers participate in all of these missions [6]
Summary
Military personnel returning from peacekeeping missions in sub-Saharan Africa could import chloroquine-resistant Plasmodium falciparum, posing a threat to elimination and to the continued efficacy of first-line chloroquine (CQ) treatment in these countries. Central America has seen a significant decrease in malaria transmission in the last decade; all seven countries (Belize, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama) have experienced >50% decline in the number of confirmed cases between 2000 and 2010 [1]. There are seven UN peacekeeping missions in Africa, and six of these are in malaria-endemic countries; Central American soldiers participate in all of these missions [6]. Due to the large number of soldiers and frequency of deployment, UN peacekeepers could serve as a significant source of malaria imported into Central America
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