Chemoprophylaxis

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through the use of oral medications. Factors which affect the choice of chemoprophylaxis

include geographic area of travel; types of malaria endemic to the area of travel; malaria drug

resistance; characteristics of traveler (e.g. age, sex, drug sensitivities) and availability of

medical care. Current information concerning malaria chemoprophylaxis, the location of

malaria endemic areas, and the use of chemoprophylaxis in special situations (pregnancy,

pediatrics, etc.) can be obtained from the Centers for Disease Control and Prevention's (CDC)

Malaria Hot Line at (404) 332-4555. Enclosure (1) provides NSNs and procurement

information for the medications discussed below. All Coast Guard health care providers shall

be cognizant of the specifics of malaria chemoprophylaxis and the product information for

these medications prior to prescribing them.

CHEMOPROPHYLAXIS FOR PERSONNEL DEPLOYING TO AREAS WITH

MALARIA SENSITIVE TO CHLOROQUINE PHOSPHATE:

(1)

Chloroquine phosphate 500 mg (300 mg base) once weekly (at the same time)

starting two weeks prior to malaria exposure, and continuing through four weeks

post exposure.

(2)

Terminal prophylaxis with primaquine 45 mg once weekly for eight weeks should

be used following long-term exposure in ovale or vivax malaria areas only. (Long-

term exposure definition varies by the malaria-risk area and the living conditions of

personnel assigned. Consult CDC for recommendations for situation specific long-

term terminal prophylaxis.)

(3)

Individuals with G-6-PD deficiency should receive terminal prophylaxis with

primaquine but should be monitored with a base line hematocrit and subsequent

hematocrits every two weeks. If hemolysis occurs, should be discontinued and the

individual counseled about malaria symptoms.

(4)

If primaquine is unavailable, these individuals should be carefully counseled and

informed to seek medical treatment if malaria signs or symptoms occur.

CHEMOPROPHYLAXIS FOR PERSONNEL DEPLOYING TO CHLOROQUINE-

RESISTANT MALARIA AREAS:

(1)

Doxycycline 100 mg once daily starting two days prior to malaria exposure,

continued daily throughout exposure, and for four weeks post exposure.