Ivory Coast is, since 1998, the main country where French military personnel is contaminated.2 In addition, P. falciparum is the predominant plasmodial strain involved in

cases, whether locally or imported. It is responsible for serious forms of imported malaria, which occurred often after poorly followed or inappropriate antimalarial chemoprophylaxis, and is a consequence of a delayed treatment.3,4 This risk appears high among military personnel because during their leaves, a break in the treatment chain can occur: subjects do not always automatically consult a civil practitioner and tend to delay consultation.5 It is known that the KU-60019 work environment of military personnel, which implies some stress and operational imperatives not always suitable for application of prophylactic measures,

increases the risk of malaria transmission. However, another major cause that can be advanced concerning this outbreak is poor compliance with antimalarial post-return chemoprophylaxis among military personnel who, since they go on leave as soon as they return to France, are no longer under any supervision. Hence, epidemiologic surveillance data among the entire French military personnel in Ivory Coast reported since 1998 a decrease in malaria incidence during missions and since 2004, an annual incidence rate higher after return than during mission’s time.2 Incidence rate observed on the operation theater in our study is much lower than the global incidence rate observed among entire forces in Ivory Coast in 2006 (4.5 selleckchem vs 28.0 per 1,000), which could reflect a relatively good application of prophylactic measures on theater despite operational context. However, Reverse transcriptase post-return incidence among Man–Danane–Daloa triangle soldiers in our study was slightly higher than that observed among entire forces in 2006 (65.8 vs 53.5 per 1,000). Moreover, this imported malaria outbreak did not occur during the usual season of high incidence (June and July)

according to French military surveillance data.2,6 Another study, involving American soldiers after returning from Somalia in 1993, gave a 50% proportion of noncompliance with doxycycline.7 Our level of proper compliance, revealed by questioning, is probably under-evaluated because of dissimulation on the part of questioned subjects. That hypothesis is supported by a study conducted in 2006 among French troops, based on measured plasma concentrations of doxycycline, which showed a 63.4% rate of noncompliance.8 Recommendations issued following the investigation called for improving compliance with chemoprophylaxis and inciting servicepersons to consult a doctor rapidly if they develop a fever after returning from an area where malaria is endemic.