PLoS Medicine
(Accessed 9 May 2015)
http://www.plosmedicine.org/

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Essay
Screening and Treating UN Peacekeepers to Prevent the Introduction of Artemisinin-Resistant Malaria into Africa
Stan Houston, Adam Houston
Published: May 5, 2015
DOI: 10.1371/journal.pmed.1001822
Summary Points
:: The Haitian cholera epidemic provides a tragic demonstration of the potential for United Nations peacekeepers to introduce serious disease into vulnerable populations.
:: Resistance to artemisinin derivatives, now the global standard therapy for falciparum malaria, has emerged and is spreading in Southeast Asia.
:: UN peacekeeping troops from Southeast Asia are frequently deployed in sub-Saharan Africa.
:: These circumstances entail a high risk of introducing artemisinin resistance into the populations most affected by malaria, with potentially disastrous consequences for malaria treatment and control in sub-Saharan Africa.
:: The UN has a responsibility to prevent such an outcome; selective predeployment screening and treatment of UN peacekeeping troops is feasible and urgently needed.
Introduction: The Precedent of Cholera in Haiti
In the aftermath of the massive earthquake that devastated Haiti in 2010, an ongoing epidemic of cholera introduced by United Nations peacekeepers has resulted in over 730,000 cases and over 8,700 deaths—the largest single-country cholera epidemic in nearly a century [1,2]. This disaster should serve as an urgent warning about the potential for introduction by UN troops of other serious infectious diseases into the vulnerable populations they were sent to protect. Indeed, the UN has recently agreed to avoid rotation of African troops to Haiti because of concern about the introduction of Ebola [3]. But the tragedy in Haiti pales in comparison to the scale of long-term impact on malaria morbidity, mortality, and control programs that would result from the introduction of artemisinin-resistance into sub-Saharan Africa, where 85% of the world’s falciparum malaria cases and over 90% of all malaria deaths now occur [4]. This threat demands urgent action, in particular on the part of the UN…