Doctors probe malaria cases among Marines in Liberia

Forty-three patients have been evacuated from their ships off the West African shore to hospitals in Germany and the United States, 13 confirmed with one of the most common types of the mosquito-borne illness, falciparum, said Capt. Greg Martin of the National Naval Medical Center in Bethesda, Md.

The 43 represent almost 20% of 225 Marines and Navy personnel who went ashore last month. Officials are closely watching the rest, an unknown number of whom also are reported to have complained of symptoms, Martin said.

"There are a lot of questions about this," he told a press conference Tuesday in the Washington suburb of Bethesda, to where most were taken. He said doctors are uneasy because the cases represent "an incredibly high attack rate" among those deployed.

Doctors are looking into three possibilities, he said: That type of malaria has become resistant to the drug the Marines have been taking; troops didn't take it correctly; the drug had gone bad or there was a flaw in its manufacture.

All going ashore are being switched to another antimalarial in case resistance is the problem, doctors said.

In addition to the confirmed cases, seven Marines tested positive in initial blood tests but have not been confirmed as having the disease, officials said.

Five are of the cases are serious, including two patients with cerebral malaria, but all are expected to recover, said Lt. Cmdr. David Blazes, who is caring for those brought to Bethesda.

Martin said the Marines and sailors started taking the antimalarial drug mefloquine in late June or early July in a regimen that requires troops to begin dosing two weeks in advance of a deployment, then take the drug once a week thereafter for a month until they have been out of the risk area for a month.

The military also gives troops a repellent cream containing DEET and mosquito netting.

The 40 Marines and three naval officers who fell ill went ashore in Liberia from the amphibious assault ship USS Iwo Jima and the amphibious landing dock USS Carter Hall, said Lt. Cmdr. Chito Peppler, a spokesman at the Bethesda center.

Col. Jay DeFrank, a Defense Department spokesman, said the Marines, members of the 26th Marine Expeditionary Unit based at Camp Lejeune, N.C., were in Liberia in mid-August as part of a U.S. quick-reaction force of about 150 troops. They operated from an airport outside Monrovia, the capital, for about 10 days.

Others went back and forth from the ships to land, sometimes for as little as a couple of hours at a time.

Doctors said they are asking the patients whether they took their drugs faithfully, whether they slept inside or out at night and other pertinent questions.

Forty-one of the patients were taken to Bethesda and two to the Landstuhl Regional Medical Center in Germany in the medical evacuations that began over the weekend.

Because malaria is spread by mosquitoes, it presented no communicable disease risk to the other Marines and Navy men aboard the ships outside the affected area.

Other officials said that as a precaution, movements of Marines ashore in Liberia from the Iwo Jima and two other U.S. Navy ships off the Liberian coast were being limited for the time being.

About 136 American troops still are ashore in Liberia, mostly Marines providing security at the U.S. Embassy in Monrovia. The Iwo Jima and two other ships off the coast carry about 2,200 Marines and about 2,500 sailors.

Malaria is transmitted by mosquitos, which breed in stagnant water and tall grass.

The disease infects 300 million people a year — and kills at least 1 million — in Africa and elsewhere and has become increasingly resistant to drugs, according to the World Health Organization and the United Nations Children's Fund, UNICEF. Some 3,000 African children die every day from it, the United Nations said in a report early this year.

About 800 American civilians come home with malaria each year from trips abroad, according to the Centers for Disease Control and Prevention.

The malaria parasite has developed resistance to the old standby drug, chloroquine, in most of the world, rendering that drug largely useless and leaving only mefloquine and two others.

Large areas of Central and South America, the Dominican Republic and Haiti, the Indian subcontinent, Southeast Asia, the Middle East, and Oceania also are considered malaria-risk areas, according to the CDC.

World Health Organization on malaria: http://www.who.int/health_topics/malaria/en/