WEDNESDAY, Jan 12, 2005 (HealthDayNews) --Malaria, an old bug from past wars, is cropping up again in the U.S. military.

Some Army Rangers coming back from duty in Afghanistan have the disease, and medical experts cite the same reason that may have caused malarial cases to occur with most veterans from previous wars: Soldiers simply don't stick with their regimen of medications to suppress the disease.

The study authors conclude that doctors need to think of the possibility of malaria when certain symptoms appear in soldiers returning from service in areas of the world where malaria is endemic.

Malaria continues to be a worldwide scourge. "Of single diseases, it is the third top killer in the world," said Dr. Joseph M. Vinetz, a malaria expert and a professor of medicine at the University of California San Diego. "There is no vaccine for malaria," he added, and not nearly enough is being done to eradicate the disease. "There is limited support for the important research that needs to be done," he said.

To prevent catching malaria, soldiers serving in regions where malaria is endemic are instructed to take antimalaria medicine. In World War II, quinine was among the first drugs used, usually to counteract the disease after a soldier had become ill. In Vietnam, chloroquine, a quinine derivative, was given in pill form for the GI to take once a week to prevent getting the disease.

Today's soldiers are also supposed to use personal protection, such as minimizing skin exposure and using bed nets and insect repellent.

In their study, the research team collected data on 725 U.S. Army Rangers sent to eastern Afghanistan between June and September 2002. Among these subjects, 38 developed malaria. The diagnosis of malaria was made within one to 339 days after they returned from Afghanistan, according to the report in the Jan. 12 issue of the Journal of the American Medical Association.

When the researchers asked how many of the soldiers maintained their regimen of medication, they found that only 52 percent took it while in Afghanistan, and only 41 percent continued their treatment after returning. In addition, only 29 percent used insect repellent while in Afghanistan.

"A major cause of malaria prophylaxis [prevention] failure is patient nonadherence to prescribed treatment," the researchers wrote.

"Providing continuous education about the need to comply with prophylaxis medications and having leaders directly observe therapy and enforce personal protective measures may help safeguard soldiers from vector-borne disease," the authors concluded.

And for those military men and women who return home from where malaria is prevalent, the study strongly suggests that physicians look to malaria as a possible cause of an unexplained fever or other "indistinct" illness.

"This failure to follow personal protective measures is not an uncommon occurrence," said Dr. Diane E. Griffin, chairwoman of the Department of Molecular Microbiology and Immunology at Johns Hopkins School of Medicine.

Griffin pointed out that when U.S. Marines spent several days in Liberia in 2003, there was an outbreak of malaria among them and several died. "It turned out that they didn't do all the things we know you can do to prevent infection," she said.

Fortunately for these soldiers serving in Afghanistan, they were exposed to the vivax strain of malaria, which is not fatal, Griffin said.

This is not only a problem for soldiers, Griffin said, but also for tourists who travel to areas where malaria is present. "It is really hard to have people continue prophylaxis, particularly when they get home," she noted.

Physicians need to be alert to the possibility of malaria, Griffin said. "Just because the person was supposed to take prophylaxis, and was in a situation where it was being provided, doesn't mean that they don't have malaria," she added.

More information

The U.S. Centers for Disease Control and Prevention can tell you more about malaria.

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