Chemoprophylaxis in US Naval aircrew transiting malaria endemic areas

The role of chemoprophylaxis in aircrew transiting malaria endemic regions has been, and remains, a point of controversy. The recent emergence of multi-drug resistant parasites and pesticide-resistant mosquitoes have made malaria prevention and control even more challenging and complex. The primary purpose was to review the efficacy of chemoprophylaxis (as compared with no chemoprophylaxis) in U.S. Naval aircrew traveling to malaria endemic areas for short periods of time on a frequent, infrequent, or isolated basis. A secondary purpose was to generate chemoprophylaxis guidelines based on the outcomes of this review.

A comprehensive MEDLINE database search was performed for the interval from January 1966 to April 1997. Additional resources were obtained from references cited in relevant journal articles, monographs, textbooks, and U. S. government publications. Pertinent U. S. Navy publications were also reviewed. Selection criteria were developed and applied to the data.

The investigation failed to identify any analytic studies that met selection criteria regarding the efficacy of chemoprophylaxis in U.S. Naval aircrew or aircrew surrogates transiting malaria endemic areas. The data were therefore used to qualitatively assess the risks/benefits of chemoprophylaxis and generate chemoprophylaxis guidelines. Based on the results of this review, the decision to prescribe chemoprophylaxis was strongly dependent on the following risk factors: a) geographic region; b) transmission risk; c) duration of nighttime exposure; and d) aircrew, aircraft, and mission profiles.

Studies of adequate analytic design are needed to delineate the role of chemoprophylaxis in aircrew transiting malaria endemic areas and to validate the chemoprophylaxis guidelines suggested in this review.