6%), and 30 following the return to France (attack rate of 52%)

6%), and 30 following the return to France (attack rate of 5.2%). The following results only concern the 30 imported cases, which occurred between February 13 and May 14, 2006 (Figure 1). The median interval between return date and diagnosis was 21 days (range = 0–88d). Twenty of the episodes (66.6%) occurred within 4 weeks after returning home. Mean age of the cases was 28 years (range = 21–45 y). A large majority of these imported cases

was due to P. falciparum (83.3%). Other cases were due to Plasmodium ovale (two cases), Plasmodium Malariae (two cases), and Plasmodium Vivax (one case). No case with co-parasitism was observed. The average interval between onset of symptoms and the initial consultation was 3.5 days and reached 10 days for two subjects. Three subjects presented a serious form according to World Health Organization BIBW2992 order criteria.1 The episode with

the most serious complications involved a man aged 30 who had been Tanespimycin datasheet presented a cerebral malaria 18 days after return, and had been developed sequelae with poor prognosis. Exposure to the risk of developing a malaria episode was estimated at 2,012 person-months (PM) (575 × 3.5 mo) in Ivory Coast and at 575 PM after returning home, or a total of 2,587 PM. Incidence rate was 4.5 per 1,000 PM during the period spent in Ivory Coast and 34.8 per 1,000 PM during the month following the return. Post-return incidence rate was particularly higher among subjects who served in the Man–Danane–Daloa triangle (65.8 per 1,000 PM vs 28.6 in Abidjan and 24.0 in Bouake). Therefore,

the risk of malaria episode during the month following the return was higher than during the period spent in Ivory Coast [hazard ratio (HR) = 7.7, P < 10−5], and particularly among subjects who had been served in the Man–Danane–Daloa triangle (HR = 14.6, p < 10−5). Hence, these soldiers seemed to be particularly exposed to risk due to some field missions conducted in January and February, MG-132 manufacturer during which prophylactic measures appeared to had been insufficiently applied (some nights without net, lack of supervision of chemoprophylaxis) given the operational context. The two last months of stay in Ivory Coast were yet marked by low rainfall. According to the data on the declaration forms, 55% (11/20) of subjects who developed a malaria episode during the first 4 weeks following return at home admitted to not having taken their chemoprophylaxis regularly (forgotten more than once) in the 8 days preceding diagnosis; that is, the minimal incubation period of malaria. Information concerning compliance with vector control measures in the operation theater was available for 20 subjects: 95% had used insecticide-treated combat uniforms, 85% had used bed nets, and 60% had used skin repellents. This investigation raised the clear predominance of P.

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