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Malaria Prophylaxis Vietnam


Steady progress in the reduction of malaria in Vietnam had been possible through vigorous command emphasis, improved preventive regimens, and increased control measures. A major change in the chloroquine-primaquine chemoprophylaxis program was instituted with Change 1 to USARV Regulation 40-4. This change stipulated that units in high-risk areas were to take daily dapsone tablets in addition to weekly chloroquine - primaquine tablets as chemoprophylaxis against Plasmodium falciparum, the malarial parasite responsible for nearly 98 percent of infections occurring among troops. The command surgeon notified field commanders to enforce this change when manpower losses due to infections with P. falciparum were greater than 20 cases per 1,000 per annum per major unit.

The Wilson-Edeson test, adopted by the 172d Preventive Medicine Unit, to measure the amount of chloroquinc in urine, was rapid and convenient for field use. This test helped field commanders evaluate objectively each unit`s malaria chernoprophylaxis program and resulted in a dramatic drop in the malaria rate in the units tested. Since slightly more than 80 percent of all cases of malaria occurred in combat units, it was the responsibility of field commanders to provide consistent and continuous command emphasis on preventive measures. In addition to chloroquine-primaquine and dapsone chemoprophylaxis, personal protective measures to control malaria were stressed. Skin repellents, aerosol insecticide dispensers, bednets, and headnets were in general use by field units. Combat units in remote forward areas received repellents and aerosol dispensers routinely.

For personnel departing Vietnam, commanders were urged to insure that the malaria chemoprophylaxis records of all returnees were reviewed as soon as possible after arrival at their new duty station to make certain that each returnee had signed a `malaria debriefing` statement. This procedure was recommended to prevent manpower loss and to limit the spread of malaria from infected soldiers to susceptible persons in the United States and other areas. Those individuals who had not completed the 8-week chloroquine-primaquine course and the 28-day dapsone course were to be given sufficient tablets to complete the malaria chemoprophylaxis course they were on in Vietnam.

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