Malaria Prevention Measures in Coalition Troops in Afghanistan

Abstract

1 found that treatment with statins was associated with regression of coronary atherosclerosis (assessed by intravascular ultrasonography) when low-density lipoprotein cholesterol (LDL-C) was substantially reduced and high-density lipoprotein cholesterol (HDL-C) was increased by more than 7.5%. The authors state that it remains to be determined whether these changes translate to improved clinical outcomes because the small increases in HDL-C observed during statin therapy have never been shown to correlate with clinical outcome.However, in a post hoc analysis of the secondary coronary heart disease prevention Greek Atorvastatin Coronary Heart Disease Evaluation (GREACE) Study, the composite end point of all vascular events was found to be partly determined by the extent of atorvastatin-induced HDL-C increase in the structured care group compared with usual care. 2 This was in the setting of achieving an LDL-C level of 100 mg/dL (2.59 mmol/L) in 95% of patients in the structured care group (a 46% decrease in LDL-C from baseline values). After multiple regression analysis, the beneficial effect associated with HDL-C increase was independent of the LDL-C reduction (hazard ratio for each 4 mg/dL [0.10 mmol/L] increase in HDL-C, 0.85; 95% confidence interval, 0.76-0.94; P = .002). 2 A relatively small increase in HDL-C (mean, 7%) observed during 3 years of statin treatment was associated with clinical event reduction, supporting the findings of Nicholls et al. 1

Compliance with Antimalaria Chemoprophylaxis in a Combat Zone

“…A report 24 in 2006 indicated that the US government provides "treated uniforms" and "repellant" as part of its non-drug malaria prevention measures to troops deployed to Afghanistan. Also, survey information concerning MSMs participation in DOT programs would also have provided additional insight into compliance.…”

Risk Assessment and Prevention of Malaria Among Italian Troops in Afghanistan, 2002 to 2011

“…1 Suppressive chemoprophylaxis was implemented by most of the ISAF forces, and mefloquine was the generally preferred agent. 2 This Figure 1 Afghanistan provinces can be clustered into three groups with different risk levels of malaria. 3 The risk is, however, far from being homogeneous within each province; transmission occurs mainly in river valleys where rice fields are common.…”

Anti-Malarial Chemoprophylaxis Following Evacuation from Afghanistan

“…Contrary to this a retrospective study of personnel deployed to Iraq showed that 81% of those offered AMC accepted it [7]. There have been several reported cases of non-UK soldiers returning from Afghanistan who have become infected with Plasmodium Vivax [8,9], which if untreated could cause significant morbidity and occasionally lead to death [10,11]. Although we are unable to report on the malaria infection rate in UK forces that have deployed to Afghanistan, and we are unaware of malarial infection in the casualties included in this investigation, we believe that it may be appropriate to re-evaluate whether a country wide antimalarial prescription is necessary.…”