Breaking News and Commentary
Marines in Liberia contract malaria
Military doctors speculate that failed chemoprophylaxis might be to blame for an outbreak of malaria
October 2003
Military doctors are baffled as to the cause of a malaria outbreak among soldiers who served in Liberia in mid- to late August
To date, at least 44 servicemen from the 26th Marine Expeditionary Unit based in Camp Lejune, N.C. – including 40 Marines, three embedded Navy sailors and one Army soldier – have experienced “malaria-like symptoms,” defense officials announced. Twelve of the soldiers have been definitively diagnosed with falciparum malaria.
The servicemen were part of a 200-man force operating in Liberia for varying times in August, Lt. Dan Hetlage, a Pentagon spokesman for the Navy said in a statement. The soldiers had previously served aboard two Navy ships, the Iwo Jima and the Carter Hall.
Since falling ill, several of the soldiers have been evacuated from the area and are being treated at the National Naval Medical Center in Bethesda, Md., while some remain at Landstuhl Army Regional Medical Center in Germany. At least two of the affected soldiers have been diagnosed with cerebral malaria.
There was initial concern that the soldiers had fallen ill with something other than malaria since the U.S. military regularly distributes malaria prophylaxis to soldiers being deployed to endemic areas. Soldiers in the 26th Marine Expeditionary Unit were given mefloquine (Lariam, Roche), and most of the soldiers claimed to be adherent to their prophylaxis regimens, defense officials said.
However, many of the soldiers became ill so rapidly, displaying symptoms that could be consistent with a host of other conditions, that military doctors initially suspected an outbreak of Lassa fever or Ebola virus. Blood testing confirmed malaria in the 12 soldiers, and the remaining soldiers displayed signs and symptoms consistent with malaria, including muscle aches, high fever, anemia and diarrhea.
Military epidemiologists and infectious disease experts now want to know the cause of the outbreak. Blood tests are now being conducted to see if the soldiers had contracted mefloquine-resistant malaria, which is not endemic to West Africa but has been reported in the past. Experts are also looking at whether soldiers actually adhered to their prophylactic regimens or whether there were problems with the potency of the pills, rendering them ineffective against the mosquito-borne disease.
After the outbreak, soldiers in the area were switched to prophylactic regimens using doxycycline to gain additional protection against malaria.
At this writing, the 26th Marine Expeditionary Unit is deployed to Liberia to assist the ECOMIL, the peacekeeping arm of the Economic Community of West African States, or ECOWAS. The soldiers first hit land between Aug. 12 and 14 and established positions at the Roberts International Airport and the Free Port of Monrovia “to facilitate the resumption of humanitarian relief efforts for the people of Liberia,” according to the unit’s Web site
The U.S. military is vigilant in supplying chemoprophylaxis to soldiers and preventing infectious diseases. However, occasional outbreaks of infectious diseases have been reported. Earlier this year, 100 soldiers contracted pneumonia while serving in Southwest Asia – Iraq, Kuwait, Qatar, Uzbekistan and Djibouti – though military officials would not call it an outbreak because the rates were consistent with background rates.
“The rates of pneumonia among personnel deployed to Southwest Asia in the past six months are consistent with what we would have expected and we have data that strongly support that,” William Winkenwerder, MD, assistant secretary of defense for health affairs said in a press briefing on Sept. 9.
Several hundred thousands of service members served in Southwest Asia between March and August, the time of the pneumonia cases, Windenwerder added.
The occurrence of the last malaria outbreak among U.S. soldiers is not clear at this time, but at least 100 soldiers contracted vivax malaria while on operations in Somalia in the early 1990s.
There are still approximately 140 service members on the ground in Liberia, another 180 in nearby Senegal and roughly 2,200 Marines and 1,900 sailors on ships in the area, officials said.
Copyright 2003, SLACK Incorporated. This information is to be used for educational and research purposes only.
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