There are currently no vaccines to protect against contracting malaria, although research is ongoing. All military personnel who serve in malaria endemic areas should be informed of the nature of the risks of malaria and measures to counter them. Reducing the risk of malaria infection depends on personal protection against mosquito bites and chemoprophylactic medications. The choice of malaria chemoprophylaxis is based on the type of malaria parasite, drug resistance in specific locations, and any allergic or other reaction to the medication or job-related restrictions. Prophylactic medications include chloroquine, doxycycline, atovaquone/proguanil, mefloquine, and primaquine.
Military Malaria-Related Chemoprophylaxis Guidance
Malaria chemoprophylaxis is administered under command authority and ensuring compliance is a command responsibility. Guidance can be found in the following documents:
- HA Policy 13-002 Guidance on Medications for Prophylaxis of Malaria, April 15, 2013
- DoD Health Affairs policy which provides the following guidance for malaria chemoprophylaxis: “Chloroquine is the drug of choice for areas with no chloroquine-resistant malaria. In areas with chloroquine-resistant malaria, either atovaquone-proguanil or doxycycline is acceptable as first-line prophylactic medications. Mefloquine should be reserved for individuals with intolerance or contraindications to both first-line medications. Before using mefloquine for prophylaxis, care should be taken to identify any contraindications on an individual basis and ensure the U.S. Food and Drug Administration (FDA)-required patient information handouts are available for distribution.”
- ASD(HA) Memorandum, Policy Memorandum on the Use of Mefloquine (Lariam®) as Malaria Prophylaxis, September 4, 2009
- Take Your Pill Before, During & After Deployment Malaria Tip Card, Army Public Health Center, April 2015
In July 2013, the FDA issued an FDA Drug Safety Communication "advising the public about strengthened and updated warnings regarding neurologic and psychiatric side effects associated with the antimalarial drug mefloquine hydrochloride. A boxed warning, the most serious kind of warning about these potential problems, has been added to the drug label. FDA has revised the patient Medication Guide dispensed with each prescription and wallet card to include this information and the possibility that the neurologic side effects may persist or become permanent." Additional information can be found on the Mefloquine Drug Label, Revised June 2013.
Personal Protective Measures
Precautions to help prevent being bitten by mosquitoes can be found in the following resources:
- Falciparum Malaria Just the Facts, Army Public Health Center Fact Sheet 18-073-0216, February 2016
- DoD Insect Repellent System Web page, Army Public Health Center
- Protection Against Mosquitoes, Ticks, and Other Arthropods, CDC Health Information for International Travel (commonly called the Yellow Book), 2016