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Plasmodium vivax Malaria: Status in the Republic of Korea Following Reemergence

Jae-Won Park1, Gyo Jun2, Joon-Sup Yeom3
The Korean Journal of Parasitology 2009;47(Suppl):S39-S50.
Published online: October 26, 2009

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Corresponding author (jw.moses.park@gmail.com)
• Received: September 18, 2009   • Revised: September 28, 2009   • Accepted: September 28, 2009

Copyright © 2009 by The Korean Society for Parasitology

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Plasmodium vivax Malaria: Status in the Republic of Korea Following Reemergence
Korean J Parasitol. 2009;47(Suppl):S39  Published online October 26, 2009
DOI: https://doi.org/10.3347/kjp.2009.47.S.S39
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Plasmodium vivax Malaria: Status in the Republic of Korea Following Reemergence
Korean J Parasitol. 2009;47(Suppl):S39  Published online October 26, 2009
DOI: https://doi.org/10.3347/kjp.2009.47.S.S39
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Plasmodium vivax Malaria: Status in the Republic of Korea Following Reemergence
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Fig. 1 Proportion of P. vivax malaria ROK patients after reemergence. Data are from references [7-10].
Fig. 2 Distribution of reported P. vivax malaria cases among ROK military personnel and civilians in malaria-risk areas during 1993-2007. Data and figures are from references [7-10]. (a) Administrative boundaries of the malaria-risk areas in ROK. DMZ represents the Demilitarized Zone. (b) Annual malaria cases among military personnel (left panels) and civilians (right panels). Large dots represent 100 cases, medium dots 10 cases, and small dots 1 case. The asterisk in the 1993 military personnel map represents the first case.Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003].
Fig. 2 Distribution of reported P. vivax malaria cases among ROK military personnel and civilians in malaria-risk areas during 1993-2007. Data and figures are from references [7-10]. (a) Administrative boundaries of the malaria-risk areas in ROK. DMZ represents the Demilitarized Zone. (b) Annual malaria cases among military personnel (left panels) and civilians (right panels). Large dots represent 100 cases, medium dots 10 cases, and small dots 1 case. The asterisk in the 1993 military personnel map represents the first case.Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003].
Fig. 2 Distribution of reported P. vivax malaria cases among ROK military personnel and civilians in malaria-risk areas during 1993-2007. Data and figures are from references [7-10]. (a) Administrative boundaries of the malaria-risk areas in ROK. DMZ represents the Demilitarized Zone. (b) Annual malaria cases among military personnel (left panels) and civilians (right panels). Large dots represent 100 cases, medium dots 10 cases, and small dots 1 case. The asterisk in the 1993 military personnel map represents the first case.Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 73, 604-608, 2005; 76, 865-868, 2007].
Fig. 2 Distribution of reported P. vivax malaria cases among ROK military personnel and civilians in malaria-risk areas during 1993-2007. Data and figures are from references [7-10]. (a) Administrative boundaries of the malaria-risk areas in ROK. DMZ represents the Demilitarized Zone. (b) Annual malaria cases among military personnel (left panels) and civilians (right panels). Large dots represent 100 cases, medium dots 10 cases, and small dots 1 case. The asterisk in the 1993 military personnel map represents the first case.Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 81, 605-610, 2009].
Fig. 3 Number of P. vivax malaria cases of civilians, reported at 10-day intervals, 1999-2007, ROK. Data and figures are from references [7-10]. Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003; 73, 604-608, 2005; 76, 865-868, 2007; 81, 605-610, 2009].
Fig. 4 Date of diagnosis for ROK military personnel without previous exposure to malaria the preceding year. The y-axis of each graph represents the number of patients. Data and figure are from reference [7].Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003].
Fig. 5 Number of the first late primary attack cases of P. vivax malaria among veterans discharged from the military between May, 2003 and April, 2006, during 2 consecutive malaria-transmission seasons after their discharge. Data and figure are from reference [10].Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 81, 605-610, 2009].
Fig. 6 Ten-day incident cases of malaria involving soldiers and civilians in ROK, January 1999 through December 2002. Arrows represent the starting point of chemoprophylaxis in each year. Data and figures are from reference [16].Copyright © The Korean Academy of Medical Sciences [Journal of Korean Medical Science, 20, 707-712, 2005].
Fig. 7 Comparison of the actual plasma concentrations of HCQ in 61 soldier patients infected with malaria parasites despite chemoprophylaxis for longer than 4 weeks to the simulated plasma time-concentration profiles of HCQ after oral administration of HCQ sulfate with a prophylactic dose of 400 mg/week. Data and figure are from reference [17].Copyright © American Society for Microbiology [Antimicrobial Agents and Chemotherapy, 53, 1468-1475, 2009]
Fig. 8 Official report of annual incidence of P. vivax malaria in DPRK. Data and figure are from reference [20].Copyright © Ajou Institute of Korean Unification and Health Care, [Korean Unification and Health Care, 6, 31-58, 2007]
Fig. 9 Monthly incidence of P. vivax malaria in DPRK, January 2001 through December 2002. Data and figure are from reference [20].Copyright © Ajou Institute of Korean Unification and Health Care, [Korean Unification and Health Care, 6, 31-58, 2007].

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Plasmodium vivax Malaria: Status in the Republic of Korea Following Reemergence
Year Soldiers Veteransa Civiliansb Total 1993 1 0 0 1 1994 18 1 2 21 1995 88 12 7 107 1996 287 25 46 358 1997 1,155 207 361 1,723 1998 1,655 1,127 1,148 3,930 1999 1,085 996 1,541 3,622 2000 1,288 1,273 1,581 4,142 2001 673 754 1,111 2,538 2002 425 470 866 1,761 2003 282 278 606 1,166 2004 159 248 457 864 2005 231 321 759 1,311 2006 311 431 1,277 2,019 2007 446 462 1,295 2,203
Total 8,104 6,605 11,057 25,766 Year Number of soldiers 1997 15,981 1998 37,529 1999 61,772 2000 Over 90,000 2001 Over 110,000 2002 Over 140,000 2003 Over 160,000 2004 Over 190,000 2005 About 200,000 2006 About 200,000 2007 About 200,000 Year 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Annual military cases (a) 1 18 88 287 1,155 1,655 1,085 1,288 673 425 Annual cases in areas of highest prevalence (b) 1 14 85 267 1,048 1,474 785 876 398 239 Annual total cases (c) 1 21 107 358 1,723 3,930 3,622 4,142 2,538 1,761 % (b/a) 100 77.8 96.6 93.0 90.7 89.1 72.4 68.0 59.1 56.2 % (a/c) 100 85.7 82.2 80.2 67.0 42.1 30.0 31.1 26.5 24.1 Year 1997 1998 1999 2000 Unit A 33 (5.5) 0 (0) 6 (1) 0 (0) Unit B 6 (0.85) 28 (4) 4 (0.57) 1 (0.14) Relative risk (95% CIa) 6.42b (2. 71-15.21) 0.00b (0.00-0.20) 1.75 (0.50-6.17) 0 (0.00-20.21) Efficacy of prophylaxisc (95% CI) N/A 100% (NAd) N/A N/A Unit C 9 (1.8) 5 (1) 3 (0.6) 5 (1) Unit D 1 (0.28) 6 (1.71) 16 (4.57) 4 (1.14) Relative risk (95% CI) 6.30 (0.80-49.50) 0.58 (0.18-1.90) 0.13b (0.04-0.45) 0.88 (0.24-3.24) Efficacy of prophylaxisc (95% CI) N/A N/A 80% (75-83) N/A Unit E 8 (1.33) 1 (0.16) 4 (0.66) 8 (1.33) Unit F 4 (1.14) 8 (2.28) 13 (3.71) 26 (7.42) Relative risk (95% CI) 1.17 (0.35-3.85) 0.07b (0.07-0.58) 0.18b (0.06-0.55) 0.18b (0.08-0.39) Efficacy of prophylaxisc (95% CI) 92% (91-94) 80% (78-85) 80% (77-86) Status of chemoprophylaxis Year
Total 2005
2006
2007
No. of patients (%) No. of patients (%) No. of patients (%) No. of patients (%) Regulara 48 (25.0) 63 (30.1) 76 (18.4) 187 (23.0) Irregularb 116 (60.4) 130 (62.2) 294 (71.2) 540 (66.3) Nonec 28 (14.6) 16 (7.7) 43 (10.4) 87 (10.7) Total 192 (100) 209 (100) 413 (100) 814 (100) Patient Hospital (Location) Period of HCQ administration Plasma concentration of HCQa (ng/mL) Parasite density before/aftera HCQ treatment (parasites/μL) Regimen for complete cure A I (Goyang) July 30 - August 1, 2003 165 3,500/300 Additional administration of HCQ B II (Seoul) July 25 - 27, 2007 150 3,800/440 Quinine sulfate/doxycycline Province/metropolitan city Number of city/county/district (A) Number of malaria-prevalent city/county/district (B) B/A (%) Pyeongyang city 23 15 65.2 South pyeongan province 23 16 70.0 North pyeongan province 25 21 84.0 Jagang province 18 0 0 South hwanghae province 20 20 100 North hwanghae province 16 16 100 Gangwon province 17 17 100 South hamgyeong province 26 14 53.8 North hamgyeong province 23 7 30.4 Ryanggang province 12 0 0 Gaeseong city 4 4 100 Nampo city 6 6 100 Total 213 136 63.8
Table 1. Annual incidence of Plasmodium vivax malaria among the Republic of Korea Army military personnel, veterans and civilians

Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003; 73, 604-608, 2005; 76, 865-868, 2007; 81, 605-610, 2009].

Data are from references [7-10].

Veterans include soldiers who were retired or discharged from the military for ≤ 2 years and previously assigned to a malaria-risk area.

Civilians include veterans who were discharged from the military for > 2 years.

Table 2. Number of the ROK Army soldiers provided hydroxychloroquine/primaquine chemoprophylaxisa, 1997-2007

Copyright © The Korean Academy of Medical Sciences [Journal of Korean Medical Science, 20, 707-712, 2005].

Part of data is from reference [16].

Chemoprophylaxis was initiated in mid-June in 1997, in early June during 1998 to 2000, and has been initiated in mid-May since 2001. Chemoprophylaxis has been composed of hydroxychloroquine sulfate administration of 400 mg/week for 20 weeks, followed by anti-relapse presumptive therapy with primaquine phosphate of 15 mg/day for 14 days.

Table 3. Proportion of the total ROK military cases and annual military malaria cases in areas of highest prevalence (Paju, Yeoncheon, and Cheolwon Counties) compared to the total number of annual malaria cases reported by the Korea Centers for Disease Control and Prevention

Copyright © The Korean Academy of Medical Sciences [Journal of Korean Medical Science, 20, 707-712, 2005].

Data are from reference [16].

Table 4. Number and percent (%) of malaria cases of paired units located near the DMZ, 1997-2000

Copyright © The Korean Academy of Medical Sciences [Journal of Korean Medical Science, 20, 707-712, 2005].

Data are from reference [16], with underline denoting units that were provided chemoprophylaxis during the particular year.

The comparison of malaria incidence between groups was tested by Mantel-Haenszel χ2-test.

95% CI = 95% confidence interval.

P-value < 0.01.

Efficacy of prophylaxis = 1-[(rate of disease among the chloroquine/primaquine treatment group)/ (rate of disease among the control group)].

NA = not applicable.

Table 5. Compliance of military personnel patients to chemoprophylaxis with hydroxychloroquine and primaquine in ROK, 2005-2007

Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 81, 605-610, 2009].

Data are from reference [10].

Note: Of the 987 military personnel patients during 2005-2007, those answered the survey are included in this table.

Regular administration of both drugs.

Irregular administration of either of the drugs.

Chemoprophylaxis was not performed for this group.

Table 6. Demographic and clinical characteristics of 2 patients infected with P. vivax who were unsuccessfully treated with the conventional HCQ regimen, ROK

Copyright © The American Society of Tropical Medicine and Hygiene, [American Journal of Tropical Medicine and Hygiene, 80, 215-217, 2009].

Data are from reference [18].

Measured 24 hr after completion of HCQ treatment.

Table 7. Geographical distribution of P. vivax malaria in DPRK, 2002-2003

Copyright © Ajou Institute of Korean Unification and Health Care [Korean Unification and Health Care, 6, 31-58, 2007].

Data are from reference [20].

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