Malaria in Viet Nam

An enemy even stealthier than the Viet Cong is putting more and more American servicemen out of action in Viet Nam and into hospitals. Relatively few cases of malaria have been con tracted so far by U.S. troops, but the number has been increasing steadily as the rainy season has encouraged the multiplication of mosquitoes. And the increase will continue as men are deployed into the forest hills. Most of the troops in the current buildup of forces are fresh from nonmalarious areas and have no resistance to the disease. Tertian Fevers. Until the Viet Cong stepped up its activities, the antimalaria campaign had been one of the most successful of the U.S. Operations Mission's efforts in South Viet Nam. With ten American advisers and 5,000 Vietnamese workers, USOM had spent $14 million, sprayed more than 10 million pounds of DDT, and slashed both the incidence of malaria and resulting deaths among the Vietnamese. But last year the Viet Cong terrorists began to take aim at the malaria fighters; since then, at least twelve have been killed and 58 are missing. Upland malaria is the more dangerous variety. On the coastal plains, three out of four cases are of the "benign tertian" variety caused by the parasite Plasmodium vivax, and only one case out of four is "malignant tertian," caused by Plasmodium falciparum. In the hills, the proportions are reversed. Falciparum malaria usually does not last as long as the vivax form--only weeks or months, instead of years--but it is far more disabling while it lasts, and if untreated may cause death. No American serviceman goes untreated. Military discipline requires that all take chloroquine (best-known U.S. trade name: Aralen) twice a week as a preventive. If a man is bitten by malarial mosquitoes and develops the disease despite all precautions, he is put in a hospital and given more intensive chloroquine treatment, sometimes with the addition of quinine. Refractory Strain. Malaria parasites have complex life cycles that differ with different species. Antimalarial drugs work by attacking the parasites when they are most accessible and vulnerable, usually in the bloodstream. In theory, a man who is taking his chloroquine regularly should not get malaria. But just as some bacteria have become resistant to penicillin, so have some falciparum parasites developed enough resistance to chloroquine to be labeled "refractory" by Army medics. Most servicemen hospitalized for malaria are out in a week or ten days. Relapses may occur whenever a recovered patient's resistance is lowered--especially if he is wounded and loses much blood.

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