Army Malaria Institute - Its Evolution And Achievements. Fourth Decade (1st Half): 1995-2000

During the 1995-2000 quinquennium, the Army Malaria Research Unit (AMRU) was re-named the Australian Army Malaria Institute (AMI) and re-located from Sydney to a modern purpose-built facility in Brisbane. Its international recognition as a centre of excellence for malaria research was further enhanced by the establishment of a molecular parasitology laboratory to investigate drug resistance. During this period AMI deployed outbreak management teams in response to the hundreds of soldiers who suffered from malaria in Bougainville and Timor Leste due to inadequate personal protection and chemoprophylactic measures. Between 10-20% of affected soldiers experienced their first attack of falciparum or vivax malaria overseas for failing to comply with doxycycline prophylaxis or, possibly, for taking doxycycline which had been degraded by exposure to adverse environmental conditions. By contrast, 80-90% of primary episodes of malaria did not occur until after return to Australia, simply because the 14-day post-exposure primaquine course was either ineffective in eradicating residual liver stages of Plasmodium vivax or had not been taken as prescribed. Field studies with tafenoquine, a slowly-eliminated analogue of primaquine, indicated that this drug might eventually replace primaquine and even prevent malaria while overseas. In a further field study, atovaquone/proguanil (Malarone (R)) proved to be just as effective as doxycycline, suggesting that it could be used as an alternative drug for malaria prophylaxis. Laboratory-based studies with Mannich base, artemisinin, and third-generation antifolate compounds provided further evidence of their potential value for the control of drugresistant falciparum malaria. Progress was also made in evaluating drug resistance and diagnostic procedures and in identifying molecular markers of parasite resistance to antimalarial drugs, such as atovaquone. Two novel insect repellents and a self-erecting low-profile bednet provided good protection against mosquito bites. Surveys on the distribution and speciation of anopheline mosquitoes in Papua New Guinea were extended to another five provinces and, whilst DNA analysis was still in progress, early findings indicated a marked diversity of genotypes in anopheline species. Towards the end of the quinquennium, AMI became involved in efforts to provide Australian Defence Force personnel with better protection against other mosquito-borne diseases, such as Ross River virus, dengue and Japanese encephalitis.