Running Head: THE EFFECTS OF MALARIA ON VIETNAM VETERANS 1

The Effects of Malaria on Vietnam War Veterans

Allie G. Cannon
Auburn University
THE EFFECTS OF MALARIA ON VIETNAM VETERANS 2

Abstract
Malaria is a problem that exists throughout history, over continents, and over the lives of

Vietnam veterans. The main issue with malaria is that while there are effective treatments in

place, there is no way to completely eliminate the disease due to the prevalence of anopheles

mosquitoes in tropical environments, asymptomatic infected individuals, increasingly resistant

strains, and lack of preventive measures such as bed nets in areas of high risk. Malaria has also

posed problems for militaries throughout history. During the Vietnam War, an entire three-

battalion organization was rendered ineffective by malaria and the United States government

even saw fit to spray insecticide over the forest of Central Vietnam to kill anopheles mosquitoes

in Operation FLYSWATTER. Malaria also causes neuropsychiatric problems far later in life for

survivors of cerebral malaria during the Vietnam War. This evidence suggests that healthcare

professionals ought to focus on both the elimination of malaria and the aid of older adults

suffering from delayed symptoms such as seizures, personality changes, and depression. Many of

these problems could be solved by the incorporation of anticonvulsant medications into veterans

treatment.
Keywords: malaria, mosquitoes, military, Vietnam War, veterans, cerebral malaria,

neuropsychiatric effects
THE EFFECTS OF MALARIA ON VIETNAM VETERANS 3

The Effects of Malaria on Vietnam War Veterans

Although malaria, a blood disease caused by anopheles mosquitoes, is on the decline

worldwide, the disease still kills 2,000 people per day and is still affecting Vietnam War veterans

to this day (White et al., 2014). This disease not only pertains to African communities, where

more than 85% of cases occur, but also to Vietnam Veterans, military strategists, and to those

living in Central Vietnam (White et al., 2014). The purpose of this paper is to discuss the

different ways in which malaria has affected and continues to mark the history of humanity and

to call for greater focus on the elimination of the disease and treatment of the delayed

neuropsychiatric effects.
The Epidemiology, Pathology, Prevention, and Treatment of Malaria
Malaria is a parasitic disease of the blood that occurs when an infected anopheles

mosquito bites another human and spreads microscopic sporozoites to the new host. These

sporozoites then invade and infect red blood cells of the host. Because malaria is spread

primarily by mosquitoes, the biggest factor in malaria expansion is the density, longevity, biting

habits, and efficiency of anopheles mosquitoes (White et al., 2014). These mosquitoes thrive in

tropical environments, placing Africa and much of Central Asia at risk. In one study,

Epidemiology of forest malaria in Central Vietnam: The hidden parasite reservoir, researchers

realized that the greatest risk factors for malaria were location, age, and absence of bed nets. This

study also discovered that there is a high population of asymptomatic malaria carriers living in

Central Vietnam. This, along with factors such as seasonal migrations and drug resistance, is

contributing to the countrys inability to eliminate the disease (Thanh et al., 2015). Since the

disease is so difficult to eliminate, focus has been primarily placed on prevention through

vaccination, vector control, and chemoprophylaxis. While vector control through insecticide

treated mosquito nets is considered crucial to the fight against malaria, anopheles mosquitoes

exposure to these insecticides is increasing resistance in the mosquito and making prevention
THE EFFECTS OF MALARIA ON VIETNAM VETERANS 4

more difficult. Chemoprophylaxis is generally used for people travelling to malaria hotspots and

will fight blood infections coming from the liver (White et al., 2014). To treat severe malaria,

intravenous or intramuscular artesunate is the drug of choice worldwide because it significantly

reduces mortality in both Asia and Africa. For less severe falciparum malaria, arteminisin

combination treatment is the most effective (White et al., 2014). Along with symptoms such as

fever, headache, fatigue, and nausea, malaria can also cause several other problems such as

cerebral malaria, acidosis, pulmonary edema, and anemia. Because these pathological changes

are so deadly, it is extremely important for health care providers to be able to quickly screen and

diagnose for malaria. The most effective test is the thick and thin blood film microscopy

examination, but also widely used is the specific antibody based rapid diagnostic test for

falciparum malaria (White et al., 2014). Despite all of these measures to prevent, diagnose, and

treat malaria, this disease continues to ravage Africa and Central Asia.
Issues with Malaria in Wartime
Throughout history, soldiers have had to fight wars while simultaneously fighting

malaria, and the results have been disastrous for militaries worldwide. During the Vietnam War,

the spread of malaria was so severe that the American government had to take several actions to

fight the disease that soldiers actually wanted to contract in order to avoid combat. But during

the Vietnam War it was both P. falciparum and P. vivax malaria affecting soldiers rather than

merely the less severe P. vivax, thus causing more severe reactions to the disease and debilitating

the U.S. Army (Beadle and Hoffman, 1993). One unit became so affected by the disease that

over 50% of the 2,000 men in the organization became ill, thus rendering the group combat

ineffective (Hembree, 1980). The U.S. army thus decided to implement Operation

FLYSWATTER to reduce American casualties. In light of the fact that 10,000 Americans became

casualties to malaria during the first two years of war in Vietnam, the American army decided to
THE EFFECTS OF MALARIA ON VIETNAM VETERANS 5

reconfigure a RANCH HAND UC-123 defoliation aircraft [] to spray the insecticide

malathion as part of a test program to reduce mosquitoes in South Vietnam (Cecil and Young,

2008). This effort to kill anopheles mosquitoes proves how detrimental these bugs were to the

United States Army during the Vietnam War, however the effects of malaria continue to affect

some veterans to this day.

Neuropsychiatric Effects of Malaria on Vietnam Vets
One disastrous outcome of the P. falciparum form of malaria in Vietnam veterans was

cerebral malaria, which occurs when parasitized erythrocytes cut off blood flow to the brain

(White et al., 2014). Research has since suggested that cerebral malaria can cause

neuropsychiatric changes in affected individuals, such as depression, personality change, and

seizures (Varney, Roberts, Springer, Connell, and Wood, 1997). In this study, veterans that

suffered from cerebral malaria were tested for these neuropsychiatric effects against veterans

who had suffered trauma, but not malaria. The study proved that cerebral malaria survivors

suffered from complex partial seizure symptoms, depression, subjective distress and suggests

that the 250,000 cerebral malaria survivors of the Vietnam War may benefit from anticonvulsant

medication (Varney et al., 1997). This simple change in treatment may drastically change the

lives of affected veterans and relieve their neuropsychiatric symptoms.

Summary
With malarias death toll rising and its lingering symptoms for Vietnam War veterans, it is

clear that health care professionals need to address elimination, prevention, and long term

treatment tactics for malaria. Entire wars have been shaped by the effects of this one disease, and

it is time for both malaria to be eliminated and for veterans to receive the treatment they need.
THE EFFECTS OF MALARIA ON VIETNAM VETERANS 6

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