September 10, 2003 - Washington Post: Failed Safeguards Are Blamed For Marines' Malaria Outbreak

Peace Corps Online: Peace Corps News: Headlines: Peace Corps Headlines - 2003: September 2003 Peace Corps Headlines: September 10, 2003 - Washington Post: Failed Safeguards Are Blamed For Marines' Malaria Outbreak

By Admin1 (admin) on Friday, September 12, 2003 - 11:24 pm: Edit Post

Failed Safeguards Are Blamed For Marines' Malaria Outbreak





Read and comment on this story from the Washington Post that despite extensive preventive measures, most of the more than 200 Marines who spent time ashore in Liberia last month apparently contracted malaria, with about 43 of them ill enough to be hospitalized. The patients, members of the 26th Marine Expeditionary Unit except for several Navy medical corpsmen, were taking mefloquine (sold as Lariam), a standard drug used to prevent and treat malaria. West Africa is not known to be an area with high rates of mefloquine-resistant disease, although occasional cases have been reported there. U.S. troops in West Africa have since switched to an alternative medication, doxycycline.

This is the most intensive outbreak of malaria in the U.S. armed services in recent memory and the largest number of cases among Marines since the deployment to Somalia a decade ago. All of the cases were caused by Plasmodium falciparum, one of three types of malaria parasite and by far the most dangerous. No one has died in the outbreak, but two patients in the Bethesda intensive care unit have cerebral malaria, the most feared form of the disease, with a fatality rate of about 20 percent. They are conscious, improving and expected to recover fully, said Lt. Cmdr. David L. Blazes, an infectious-diseases physician treating them.

Peter B. Bloland, a malaria epidemiologist at the Centers for Disease Control and Prevention, said there are only a few possible explanations for the outbreak. "The possibilities include inadequate absorption [of the drug into the bloodstream], people not taking it correctly, poor drug quality or actual resistance" to the drug in the microbes, he said. The experience of Peace Corps volunteers in West Africa, who live in areas of intense malaria transmission for long periods of time, suggests that mefloquine-resistant infections are rare there, he added. "Based on what we know about failures of prophylaxis in Africa, I think the most common explanation is inadequate blood levels [of the preventive drug] for some reason," he said.

Read the story at:


Failed Safeguards Are Blamed For Marines' Malaria Outbreak*

* This link was active on the date it was posted. PCOL is not responsible for broken links which may have changed.



Failed Safeguards Are Blamed For Marines' Malaria Outbreak

By David Brown

Washington Post Staff Writer

Wednesday, September 10, 2003; Page A16

Despite extensive preventive measures, most of the more than 200 Marines who spent time ashore in Liberia last month apparently contracted malaria, with about 43 of them ill enough to be hospitalized.

The malaria outbreak amounts to a stunning failure of standard protections against a disease that the American military is unusually keen to prevent in troops deployed to the tropics. So many Marines became sick in such a short time that Navy physicians for a while doubted the illnesses could all be because of the mosquito-borne infection.

Although the malaria diagnosis has been confirmed in only 15 percent of the troops, they and their officers report that nearly all who spent the two weeks ashore reported at least mild symptoms typical of malaria. Navy physicians and epidemiologists investigating the outbreak believe most of the onshore troops may have been infected.

"We are extremely, extremely concerned about this," said Capt. Gregory J. Martin, a physician at National Naval Medical Center in Bethesda, where all but two patients are being treated. The concern is shared not only by the military's infectious diseases and preventive medicine specialists but by combat commanders, he said.

The outbreak occurred even though the troops were taking a drug to prevent the disease, were instructed to use insect repellents and were wearing uniforms treated with long-acting insecticides.

How the Marines became infected despite these measures is uncertain, although failure of the drug to reach adequate concentrations in the troops' bloodstreams is a leading hypothesis.

The patients, members of the 26th Marine Expeditionary Unit except for several Navy medical corpsmen, were taking mefloquine (sold as Lariam), a standard drug used to prevent and treat malaria. West Africa is not known to be an area with high rates of mefloquine-resistant disease, although occasional cases have been reported there. U.S. troops in West Africa have since switched to an alternative medication, doxycycline.

This is the most intensive outbreak of malaria in the U.S. armed services in recent memory and the largest number of cases among Marines since the deployment to Somalia a decade ago. All of the cases were caused by Plasmodium falciparum, one of three types of malaria parasite and by far the most dangerous.

The number of malaria cases in the armed services in recent years was not available yesterday. The Army, which has the most, reported 57 cases last year, 52 in 2001 and 55 in 2000.

Thirty-one patients arrived at the Bethesda hospital Sunday and 10 yesterday morning. Two others are being treated at the Army hospital in Landstuhl, Germany.

No one has died in the outbreak, but two patients in the Bethesda intensive care unit have cerebral malaria, the most feared form of the disease, with a fatality rate of about 20 percent. They are conscious, improving and expected to recover fully, said Lt. Cmdr. David L. Blazes, an infectious-diseases physician treating them.

Members of the Marine unit, normally stationed at Camp Lejeune, N.C., went ashore Aug. 12-14 and returned to their two ships 10 to 12 days later. Soon afterward, many reported common symptoms of malaria, including headache, pain behind the eyes and muscle aches accompanied by cyclical fevers.

Malaria is normally diagnosed by using a microscope to look for malaria parasites inside red blood cells. Many of the Marines received diagnoses aboard ship that way. In some of the 43 people -- 40 Marines and three sailors -- no parasites were seen, probably because the infection was partially treated by the mefloquine, but "virtually everyone had classical symptoms" of the disease, Blazes said.

About 30 patients who arrived at Bethesda on Sunday were put in a separate unit because physicians feared some might have some other disease; malaria rarely shows up in sudden, severe outbreaks. The possibilities included Lassa fever, which is caused by a virus; leptospirosis, caused by a bacterium; or infections arising from bacteria-like microbes called rickettsia.

"It was hard to believe that you could have almost all of a group that large develop symptoms over a four- to five-day period and have it be malaria," Martin said.

Blood samples were sent to the Army's infectious diseases laboratory at Fort Detrick in Frederick, and within 12 hours those infections were ruled out.

Nearly all the Marines said they had taken their once-a-week mefloquine pills; a few said they had missed a dose or two. Many had been taking it since June.

Normally, a case of malaria is considered severe if more than 3 percent of red blood cells are infected with the parasite. Several of the Marines, including one who reported never missing a dose of mefloquine, had more than 10 percent of their cells infected.

Peter B. Bloland, a malaria epidemiologist at the Centers for Disease Control and Prevention, said there are only a few possible explanations for the outbreak.

"The possibilities include inadequate absorption [of the drug into the bloodstream], people not taking it correctly, poor drug quality or actual resistance" to the drug in the microbes, he said. The experience of Peace Corps volunteers in West Africa, who live in areas of intense malaria transmission for long periods of time, suggests that mefloquine-resistant infections are rare there, he added.

"Based on what we know about failures of prophylaxis in Africa, I think the most common explanation is inadequate blood levels [of the preventive drug] for some reason," he said.

About 120 samples of blood taken from the Marines shortly before they became ill will be sent to CDC to measure mefloquine levels.

© 2003 The Washington Post Company
August 5, 2003 - This is Malaria





We have read on some PCV listservs that some volunteers stop taking their anti-malarial medication because of the side-effects. These volunteers are putting themselves at risk for a terrible disease. Read and comment on this story from the London Evening Standard on an overseas traveler who stopped taking her anti-malarial medication and the consequences. Read the story at:

I was so seduced by my dream trip that I felt I was invincible*

* This link was active on the date it was posted. PCOL is not responsible for broken links which may have changed.



I was so seduced by my dream trip that I felt I was invincible

Aug 5, 2003 - Evening Standard; London

Author(s): Bonnie Estridge

THE expression on my mother's face when she met me in the isolation unit at Heathrow said it all. I weighed only a little over six stone [84 pounds], my skin was yellow, and I was so delirious and dehydrated that I'd been taken from the plane in a wheelchair. My dream holiday had turned into a nightmare - and it was my fault.

Five years ago, just before I turned 30, my friend Mark and I decided to go backpacking in India, which we had always longed to do. We had saved enough money to go for six months and when we left, in June, we'd had every injection possible to guard against tropical diseases, and started our anti-malarial pills, as instructed, two weeks before leaving.

We had been given two types of pills; proguanil, to take weekly, and chloroquine, to take daily. Yet, by our second day in Delhi, both of us were feeling ill. Like most backpackers, we suffered from the "runs", but it was the nausea - a side-effect of anti-malarial drugs - that took the edge off our thrill at being in India.

Mark stopped taking his pills soon after we arrived because he felt so sick, but I was determined to keep going. I didn't want to get malaria.

After four weeks, however, I felt differently. We met other travellers and it seemed that I was the only one taking her pills like a good girl.

Everyone kept telling me that they were fine and I would be, too. Did I want to spoil my holiday by feeling sick all the time? In the end, I was convinced, and felt so much better for giving them up. The fact that we all had loads of mosquito bites didn't bother us; we were having such a great time, we felt invincible.

By October, we had been from Rajasthan to Bombay, Calcutta and Goa, ending up in Kerala - the southernmost point of India.

Although I'd stopped feeling sick I had become very weak; it had happened so gradually, I hardly noticed.

But by the time we reached Kerala I was exhausted, freezing - even when temperatures reached more than 100 degrees - and vomiting a lot. Having loved the local food, it now repulsed me - just the thought of eating made me throw up. I craved something plain such as toast and Marmite.

We were staying in a lovely beach hut in a heavenly place, yet all I could do was drag myself a few yards down the sand and lie there shivering. This caused friction between Mark and me because he wanted to explore while I refused to do anything.

After two weeks I suddenly felt desperate to get back to Delhi. I had lost more than two stone [28 pounds] in weight (I normally weigh nine-and-a- half stone [133 pounds]), I had no energy, felt sick all the time and wanted my mother.

Everything seemed hazy.

Eventually we agreed to travel to Delhi by bus and train - it took six days and was horrific. The transport was crowded, every smell made me vomit and there were no public lavatories. When at last we reached Delhi we treated ourselves to a smart hotel.

I started having uncontrollable fits of shivering and sweating, so violent that they made my body go rigid. I had a raging thirst but couldn't even sip a glass of water because my teeth were chattering so much my mouth wouldn't open. We saw various doctors, none of whom mentioned malaria. They simply handed out pills or medicine which they said would "cure" me.

Mark was now anxious to get me home, but in my delirious state I kept saying that I couldn't leave until I'd brought presents for my family and friends.

After a couple of days and yet another episode of me refusing to leave without presents, Mark stormed out. I was scared because I felt so ill, and rang the hotel reception babbling incoherently.

I have no recollection of how I ended up on a table in a shabby back room of a shop - I think I was taken there by a hotel receptionist - but when I saw medical instruments in a Fairy liquid bottle with the top chopped off and a doctor coming towards me with a syringe saying "you need an injection", I screamed.

Suddenly the door burst open and Mark came in like Superman, scooped me up and carried me back to the hotel. He had booked the plane tickets, but couldn't get us on the same flight. The next day he saw me on to the plane.

By now I weighed little more than six stone [84 pounds]. I was terrified I would have another of the shaking fits and wouldn't be allowed to board. I was frantic to see my mum.

I sent a fax saying: "Please meet me - don't worry, I have a bit of a cold."

On the flight I had a horrifying shaking bout. I came round and the three seats next to me had been cleared. I was lying across them, desperate for water. A woman passenger sat down, put my head on her lap and stroked my hair.

She seemed like an angel. As we landed, I heard an announcement asking for the person in seat 17b to make themselves known. I remember thinking, "I wonder what they've done?"

Slowly I realised they meant me. I was carried from the cabin. When my mother saw me, all she could say was "Look at you, you're yellow". She looked terribly distraught.

At the Hospital for Tropical Diseases, close to Heathrow my red blood cells were so depleted that it was almost impossible for the nurses to take enough blood for tests. But, eventually, it was confirmed: I had malaria. Strange though it may sound, it hadn't even occurred to me.

I was asked whether I had taken anti-malaria drugs; I felt so stupid and naive. No one reprimanded me, but I got the impression that they were used to seeing backpackers in similar circumstances. Over the next week, I started to recover; the less hazy I became, the more foolish I felt. It took me three months at home in Buckinghamshire to recover fully. I was very, very lucky as I had no kidney or liver damage.

I still cannot believe that I took such a risk. My message is: don't listen to anyone who tells you not to bother taking anti- malaria drugs. I did, and I nearly paid for it with my life.

Interview by Bonnie Estridge

The doctor's orders you can't afford to ignore YOU can contract malaria by being bitten by an infected mosquito.

Depending on where you are travelling to, your doctor may prescribe anti-malarial drugs such as chloroquine, proguanil, chloroquine plus proguanil, mefloquine, maloprim plus chloroquine and doxycycline.

There is controversy over mefloquine, tradename Lariam. A study by the London School of Hygiene and Tropical Medicine showed that one in 140 people will experience psychological side-effects; it should not be taken by those who suffer from depression, fits or seizures.

For further information, visit www.24DrTravel.com




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This story has been posted in the following forums: : Headlines; Safety and Security of Volunteers; Lariam; COS - Liberia

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