Malaria Outbreak Blamed on Troops Failure to Take Drug in Liberia Cited

[thedrifter]

Malaria Outbreak Blamed on Troops
Failure to Take Drug in Liberia Cited
By David Brown
Washington Post Staff Writer
Saturday, October 18, 2003; Page A20


The large outbreak of malaria among Marines who spent time ashore in the West African nation of Liberia in the summer was apparently caused by a nearly wholesale failure of the troops to follow protective measures, and in particular not taking a once-a-week malaria-preventing drug.

Blood samples taken from the 26th Marine Expeditionary Unit right after malaria was diagnosed in several troops in early September showed that only 5 percent had been regularly taking the recommended drug, mefloquine. Only 12 percent wore uniforms properly treated with the insecticide permethrin. Only 27 percent reported using the time-released insect repellant issued to them. And none slept under insecticide-treated mosquito nets.

The findings were presented this week in closed briefings to the House and Senate Armed Services committees.

"It is difficult to get these young Marines, who are willing to charge a machine gun nest, to be worried about a mosquito," said Cmdr. David L. McMillan, a Navy physician involved in the investigation. "It is much more difficult than we believe it should be."

Out of 290 people who went ashore in Liberia, even briefly, from ships waiting off the Atlantic coast, 80 contracted malaria -- an "attack rate" of 28 percent. Of the 157 troops who spent at least one night ashore, 69 became infected -- an attack rate of 44 percent.

In all, 44 were ill enough with falciparum malaria -- the most serious of the three types of the disease -- to be evacuated to Europe or the United States. No one died, although several developed cerebral malaria -- an infection of the brain -- that required them to be on mechanical ventilators in intensive-care units.

In addition to Marines from the expeditionary force, the victims included seven in the Navy, two Marine embassy guards, an Army soldier and a civilian.

McMillan said a team of military and civilian epidemiologists, infectious disease physicians and preventive medicine specialists who met on Oct. 9 to review the episode concluded that better education about the risk of malaria is the best way to prevent future outbreaks. The group did not think that requiring unit commanders to directly observe people taking their medicine -- a strategy employed with great success in civilian tuberculosis treatment -- would be practical or necessary.

Liberia and neighboring areas in West Africa have some of the most intense malaria transmission in the world. By one estimate, there is a 50 percent chance that a person who takes no protective measures will be infected within a month. Most of the troops from the expeditionary unit who stayed ashore were there for about two weeks.

Mefloquine, sold under the trade name Lariam, sometimes causes vivid dreams and insomnia, and in a few cases appears to affect mood. After several soldiers who returned from Afghanistan two years ago committed murder or suicide, rumors circulated attributing the violence to mefloquine. Further investigation refuted that idea.

McMillan said that when investigators asked the 41 people treated at the National Naval Medical Center in Bethesda whether they were afraid mefloquine might have psychological effects, none said he or she was. Complacency appeared to be the main reason people did not take it.

"They had been given the same series of recommendations as for Afghanistan, Djibouti and Iraq. Nobody was having any problems" when they did not closely follow the malaria-prevention orders there, he said. In Liberia, however, the risk of contracting malaria is about 1,000 times higher than in the Persian Gulf or in Central Asia.

Blood samples from 133 Marines were tested for mefloquine levels at the Centers for Disease Control and Prevention, in Atlanta. Seventy percent contained breakdown products of the drug, which is evidence that some amount of the medicine had been taken in the preceding month. Only 14 percent had levels high enough to be protective at the time. Only 5 percent of the samples indicated that the medicine had been taken every week.

Logistical problems were responsible for some of the other failures. For example, the unit ordered the permethrin dipping solution for its uniforms but did not get it before it left the United States, McMillan said. Instead, it received spray cans of the insecticide, which was used to treat the desert-camouflage uniforms the troops wore early in the deployment. In Liberia, they wore woodland-camouflage uniforms, and only 12 percent of the troops treated those.

Permethrin-treated sleeping nets -- a low-tech item whose use has been shown to dramatically lower malaria mortality in West Africa -- were not even taken ashore, McMillan said. The Liberia excursion was a "man-portable mission" in which each individual carried everything he needed. The nets require four poles, and ideally a cot, to be used correctly.

In addition, many troops were apparently reluctant to use the long-acting insect repellant containing DEET issued to them because it made them feel greasy in hot weather.

Tests by the Food and Drug Administration and by the Walter Reed Army Institute of Research showed that the mefloquine tablets the Marines used were potent and that the malaria parasite was not resistant to the drug.


© 2003 The Washington Post Company

http://www.washingtonpost.com/wp-dyn...2003Oct17.html


Sempers,

Roger

[tferg78]

All I have to say is thats crap, I served with the Security forces at the embassy. Those mosquitos were motivated and would attack you even with the best repellent. That entire country is messed up and will take a lot to repair. In our unit every Marine took their pills and we still had people get Malaria, it wasn't the troops.

[thedrifter]

tferg78


Thanks for setting the story straight........

Sempers,

Roger