Dataset Information

Malaria control and chemoprophylaxis policy in the Republic of Korea Armed Forces for the previous 20 years (1997-2016).

ABSTRACT: Vivax malaria reemerged along the Demilitarized Zone (DMZ), Republic of Korea (ROK), in 1993. While it was hypothesized that vivax malaria would spread throughout the peninsula, nearly all cases were due to exposure near the DMZ. To reduce spillover of vivax malaria to the civilian community, the ROK Ministry of National Defense (MND) initiated malaria prevention policies including a large-scale chemoprophylaxis programme in malaria high-risk areas in 1997. The present study investigated the overall changes in the incidence of malaria among ROK soldiers and the mass chemoprophylaxis program from 1997 to 2016.Peak numbers of vivax malaria were reported in 2000, with most cases reported near the DMZ, before declining to the current levels. To combat the rapid increase in the number of malaria cases and its expansion throughout the ROK, the MND implemented mosquito control and personal protection programmes. The MND also implemented a large-scale vivax malaria chemoprophylaxis programme using hydroxychloroquine (400 mg weekly) in 1997, and primaquine (15 mg?×?14 days) as terminal chemoprophylaxis in 2001. Additionally, an improved medical system enabled the rapid detection and treatment of malaria to reduce morbidity and decrease transmission of malaria from humans to mosquitoes. Following the full implementation of these programmes, the incidence of vivax malaria declined in both ROK Armed Forces and civilian populations. Subsequently, several changes in the ROK Armed Forces chemoprophylaxis programme were implemented, including the reduction of the period of hydroxychloroquine prophylaxis by 2 months (2008) and other changes in the chemoprophylaxis policy, e.g., only ROK Armed Forces personnel in moderate risk groups received terminal primaquine chemoprophylaxis (2011), and in 2016, the discontinuation of terminal primaquine chemoprophylaxis in moderate-risk area.The resurgence of vivax malaria in the ROK Armed Forces personnel near the DMZ was successfully suppressed through the implementation of a mass malaria chemoprophylaxis programme initiated by the MND in 1997, as well as several other factors that may have contributed to the reduction of malaria transmission since 2000. Given the current malaria situation in the ROK and North Korea, it is necessary to reevaluate the ROK Armed Forces and civilian malaria control policies.

SUBMITTER: Im JH

PROVIDER: S-EPMC6094909 | biostudies-other | 2018 Aug

REPOSITORIES: biostudies-other

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Malaria control and chemoprophylaxis policy in the Republic of Korea Armed Forces for the previous 20 years (1997-2016).

Im Jae Hyoung JH Huh Kyungmin K Yoon Chang-Gyo CG Woo Hyeongtaek H Lee Jin-Soo JS Chung Moon-Hyun MH Klein Terry A TA Jung Jaehun J

Malaria journal 20180815 1

<h4>Background</h4>Vivax malaria reemerged along the Demilitarized Zone (DMZ), Republic of Korea (ROK), in 1993. While it was hypothesized that vivax malaria would spread throughout the peninsula, nearly all cases were due to exposure near the DMZ. To reduce spillover of vivax malaria to the civilian community, the ROK Ministry of National Defense (MND) initiated malaria prevention policies including a large-scale chemoprophylaxis programme in malaria high-risk areas in 1997. The present study i ...[more]

PMID: 30111314

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Project description:BackgroundAs a result of the reintroduction of malaria in the Republic of Korea (ROK) in 1993 and the threat to military and civilian populations, the Korea Military National Defense (MND) increased emphasis on vector control in 2012 at ROK Army (ROKA) installations located near the DMZ, while decreasing chemoprophylaxis, fearing potential drug resistance. Mosquito surveillance demonstrated a need for continuous monitoring of disease patterns among ROKA soldiers and vector malaria infection rates to ensure positive outcomes.MethodsAnopheles spp. were collected from May-October at three ROKA installations in three locations near the DMZ. Each of the areas included one installation <2 km and two installations 11-12 km from the DMZ in Paju and Yeoncheon counties, Gyeonggi Province. Anopheles spp. were identified by polymerase chain reaction (PCR) techniques and then assayed for the presence of vivax malaria sporozoites. The ROK MND reported vivax malaria patients monthly to Korea Centers for Disease Control and Prevention. Correlations for the incidence of Plasmodium vivax patients and infected Anopheles species were analysed using the Wilcoxon rank sum test, Pearson correlation test and liner regression analysis.ResultsA total of 4282 Anopheles spp. were collected. Anopheles kleini (69.5 %) was the most commonly collected, followed by Anopheles pullus (17.3 %), Anopheles belenrae (4.5 %), Anopheles sineroides (4.2 %), Anopheles sinensis sensu stricto (2.7 %), and Anopheles lesteri (1.9 %). Overall, 21 malaria patients were reported by the ROK MND. The monthly incidence of the malaria patients correlated with the monthly number of Plasmodium vivax sporozoite positive Anopheles spp. The monthly numbers of An. kleini demonstrated the highest correlations to the numbers of ROKA malaria patients throughout the mosquito season (P < 0.01). Anopheles spp. positive for P. vivax and malaria patients at ROKA installations located <2 km from the DMZ were higher than for ROKA installations located 11-12 km from DMZ.ConclusionThe number of Anopheles spp. positive for P. vivax sporozoites correlated with the monthly number of malaria cases and exposure of ROKA soldiers from May-October to P. vivax malaria infections. Malaria vector surveillance and vector control is warranted as part of an effective malaria management program at ROKA installations located near DMZ.

Dataset Information

Malaria control and chemoprophylaxis policy in the Republic of Korea Armed Forces for the previous 20 years (1997-2016).

Publications

Malaria control and chemoprophylaxis policy in the Republic of Korea Armed Forces for the previous 20 years (1997-2016).

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