Importation of chloroquine-resistant Plasmodium falciparum by Guatemalan peacekeepers returning from the Democratic Republic of the Congo

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.

A seven-year surveillance of epidemiology of malaria reveals travel and gender are the key drivers of dispersion of drug resistant genotypes in Kenya

“…This is an implication that other factors contribute to CQR. Literature shows that irrational use of drugs (Nsubuga et al, 2011) gender dimensions (WHO, 2007), travel (Juliao et al, 2013), number of parasites exposed to a drug, the drug concentration to which the parasites are exposed, and the simultaneous presence of other antimalarials in the blood to which the parasite is not resistant influence the emergence and spread of drug resistant malaria parasites (WHO, 2018). These multiple factors argue for deployment of integrated research for effective malaria control.…”

Peer Review #1 of "A seven-year surveillance of epidemiology of malaria reveals travel and gender are the key drivers of dispersion of drug resistant genotypes in Kenya (v0.1)"

“…This is an implication that other factors contribute to CQR. Literature shows that irrational use of drugs (Nsubuga et al, 2011) gender dimensions (WHO, 2007), travel (Juliao et al, 2013), number of parasites exposed to a drug, the drug concentration to which the parasites are exposed, and the simultaneous presence of other antimalarials in the blood to which the parasite is not resistant influence the emergence and spread of drug resistant malaria parasites (WHO, 2018). These Manuscript to be reviewed approaches, collaboration -across disciplines, sectors and regions -, multi-stakeholder engagement, and sensitivity to social equity (Wiese, 2012).…”

Fighting fire with fire: mass antimalarial drug administrations in an era of antimalarial resistance

“…Additional CQ-resistant P. falciparum genotypes have been detected in South America more recently [27]. These strains are thought to be most likely imported from Asia and Africa [28].…”