[Antimalarial chemoprophylaxis in the French army: development from 1986 to 2001]

In 1999, almost 25,000 French soldiers were deployed in malaria transmission areas. With an incidence of 4.5 p. 100 men.year, malaria infection remains a serious problem requiring priority status for control in military personnel. Epidemiological surveillance provides data necessary to assess morbidity due to malaria, monitor changing patterns of Plasmodium falciparum drug-sensitivity, and evaluate the efficacy of malaria control measures. In 1990, the French army replaced chemoprophylaxis using chloroquine alone with combination treatment using a single capsule containing 100 mg of chloroquine base and 200 mg of proguanil chlorhydrate. This measure in association with the use deltamethrine impregnated bed-nets led to a significant decrease in incidence. However a comeback was observed from 1993 to 1997. Since 1995, the effectiveness of the chloroquine-proguanil combination has diminished mainly in the stable malaria areas. In response to increasing Plasmodium falciparum resistance to chloroquine-proguanil chemoprophylaxis, it was necessary to find an alternative. Two studies carried out among French soldiers in Sub-Saharian Africa between 1996 and 1998 demonstrated that a daily dose 100 mg doxycycline was more effective than the chloroquine-proguanil combination. In addition the 1998 study showed that doxycycline monohydrate in the form of a multiparticle tablet was better tolerated. In 2001 four drugs are used for malaria chemoprophylaxis in the army personnel, i.e., chloroquine and proguanil in combination, mefloquine, and doxycycline, depending on location and duration of mission. The chloroquine-proguanil combination is used in countries with chloroquine-resistant strains, e.g., Chad and Senegal. Mefloquine and doxycycline are used in countries with chloroquine-resistant strains. Due to increasing resistance, it will be necessary to evaluate other drugs or antipaludian combinations.