Deployed servicemembers step up anti-malarial protections Published April 9, 2004 By Donna Miles American Forces Press Service WASHINGTON (AFPN) -- It is peak mosquito season in Iraq, and U.S. servicemembers deployed supporting Operation Iraqi Freedom are taking steps to protect themselves against malaria.The high-risk season for malaria runs April to November, said Army Col. Fredric Plotkin, preventive medicine and force health protection officer for U.S. Central Command at MacDill Air Force Base, Fla. The highest-risk areas are in the northern, eastern and southeastern provinces, he said. Baghdad and much of western Iraq are malaria-free.The high-risk period in Afghanistan runs March through November, and malaria is a high risk yearlong in the Horn of Africa.Servicemembers in high-risk areas are required to take anti-malarial medication. The medication prescribed varies depending on the region, based on the malarial strain present, Colonel Plotkin said.Chloroquine, the medication most commonly prescribed in Iraq, requires only a weekly 500-milligram tablet and has fewer side effects than other anti-malarial drugs, Colonel Plotkin said.Other medications frequently used by deployed servicemembers are mefloquine and doxycycline. They generally are used in areas where malaria is resistant to chloroquine or for servicemembers who cannot take chloroquine.Although U.S. Central Command officials issue general guidelines about how anti-malarial medications are prescribed, Colonel Plotkin said unit surgeons on the ground are authorized to tailor these guidelines based on local conditions.People use the medication for four extra weeks after the exposure to malaria to ensure that malaria parasites are cleared from the blood, Colonel Plotkin said. In addition, servicemembers take primaquine for two weeks to kill any malaria parasites in the liver, he said. A blood test is required before primaquine is prescribed.The prescriptions serve as a second line of defense in the event that other protective measures fail, Colonel Plotkin said.These measures include using an insect repellent containing DEET on exposed skin, blousing pants into boots, wearing sleeves down, treating uniforms with permethrin and sleeping under a permethrin-treated bed net, he said.These measures also protect servicemembers against other insect-borne diseases, such as leishmaniasis, for which anti-malarial medications are not effective, Colonel Plotkin said.Army officials said in November, encountering a strain of malaria resistant to chloroquine is unlikely in Iraq.Malaria is a major health problem in tropical climates, with an estimated 500 million new cases causing at least 1 million deaths every year. Malaria usually is fatal in only the very old, very young people and those with weak immune systems, officials said.Symptoms of malaria include a slow-rising fever lasting several days, followed by shaking chills and rapidly increasing temperature. Victims often feel malaise and suffer from headache, nausea and profuse sweating. The cycle of chills, fever and sweating typically repeats itself every one to three days, Colonel Plotkin said.Malarial symptoms may appear long after a servicemember leaves an affected region, he said. For this reason, servicemembers should advise their doctors they served in an area where malaria was present if they develop a flu-like illness within a year of returning, Colonel Plotkin said.