U.S. forces on standby but not deployed. Nonetheless, the malaria threat was present. Where possible, malaria casualty data are included. Notably, since the Vietnam War, U.S. military actions abroad have (with the exception of the Iraqi operations) been increasingly smaller, shorter, more intense and in geographic areas with significant malaria threats (Tables 2-1 and 2-2). To use a preventive medicine phrase, the malaria problem is most often “local and focal,” as was the experience for U.S. Marines in Liberia in 2003.

Prior to World War II, malaria caused significant morbidity and mortality in the American Civil War and Spanish-American War and threatened U.S. strategic interests in Panama. At the end of World War I malaria was a problem in U.S. troops at home that were garrisoned and training in southern states. During this period the U.S. Army Medical Department distinguished itself through the leadership of three remarkable individuals: MAJ George Sternberg, MAJ Walter Reed, and MAJ William Gorgas. Their combined successes (especially Gorgas in Panama) led to today’s U.S. military operational malaria strategy: control, prevent, and treat (Ockenhouse et al., 2005).

During World War II this basic malaria strategy was put to the test of global warfare. Unfortunately, vector control has limited application on the rapidly changing battlefield (although the introduction of dichlorodiphenyltrichloroethane [DDT] in 1944 was a late success [Harper et al., 1947]). Treatment was problematic given the shortage of quinine that