[see also:
Malaria re-emerges - Korea 970126214442
Malaria re-emerges - Korea (02) 970129120151]

Date: Tue, 11 Nov 97 07:53:23 -0600
From: Dr. J. J. Karwacki

The 19 SEP 97 (#38) WHO Weekly Epidemiological Report contained a report on
the world malaria situation as of 1994.

It did not, however, mention that beginning about that time there has been
a re-emergence of _Plasmodium vivax_ malaria in the northern region of the
Republic of South Korea (ROK). Cases have approximately tripled each year
since the initial few in 1993. This year well over a thousand cases were
[reported]. South Korea was thought to have been malaria-free for the past
15 years.

The focus of the spread is along the Demilitarized Zone with North Korea.
Although there has been speculation in the South Korean press about North
Korean involvement, there is certainly no proof of such. The vector
mosquito's flight range is unlikely to allow it to naturally transit the
DMZ and bring the infection from the North. Due to the isolation of the
North, almost nothing is known about the status of malaria transmission
north of the DMZ. [Reader assistance is sought if any such information is
available.]

For physicians in the USA, this outbreak has already spawned a few cases of
the long-incubation variety of [malaria caused by] _P. vivax_ [which is]
known to
inhabit temperate areas. American soldiers stationed along the DMZ have
presented with malaria 7-9 months after their exposure in Korea after
having returned to the US. So far the few dozen cases of malaria in US
soldiers have been quickly diagnosed and treated with chloroquine. It is
unlikely that any tourists or business travelers to the Republic of Korea
(ROK) will be at risk for malaria since the affected area is generally
out-of-bounds to the traveler.
However, for purposes of rapid and accurate diagnosis, it behooves medical
personnel to be aware that:

1. there is malaria in the ROK;
2. there have been cases that presented months after the exposure;
3. all cases are chloroquine sensitive.