Malaria is seasonally endemic in Afghanistan and Iraq, and soldiers
returning to the United States may import malaria. Kotwal and colleagues investigated
a malaria outbreak among a 725-man Army Ranger Task Force deployed to Afghanistan
in 2002. They identified 38 cases of malaria, often associated with vague
symptoms and diagnosed a mean of 233 days after the soldiers’ return
to the United States. The authors also documented poor compliance with preventive
measures, including chemoprophylaxis, use of insect repellent, and application
of permethrin on uniforms.