Officials Say Malarial Marines Didn't Take Medication Properly

[thedrifter]

Officials Say Malarial Marines Didn't Take Medication Properly
By DONALD G. McNEIL Jr.

Published: December 5, 2003


PHILADELPHIA, Dec. 4 ? The 53 marines sickened by malaria after 12 days in Liberia in August caught the disease because they did not take their pills properly, Navy officials said on Thursday at a conference on tropical diseases.

Although many of the marines swore to Navy doctors that they had religiously taken their weekly mefloquine pills, blood levels showed that they had not, a Navy spokesman said. The three sickest marines, who nearly died of brain and lung complications, had almost undetectable levels.

"The reality was that it just fell by the wayside," said Lt. Cmdr. Tim Whitman, an infectious-disease specialist at the National Naval Medical Center in Bethesda, Md., who spoke to the annual conference of the American Society of Tropical Medicine and Hygiene. "These men had been in Iraq and Djibouti; if they'd gotten away with not taking their mefloquine there, they assumed they'd get away with not taking it here."

Dangerous strains of malaria are far more common in Liberia than in dry desert regions like Iraq and Djibouti, which is on the Red Sea.

In an anonymous survey of the men, in which they were asked whether they avoided their mefloquine pills because of side effects like stomach pains and nightmares, "overwhelmingly, the reason was `I forgot,' " Commander Whitman said.

They first lied either out of confusion or for fear of getting in trouble, he said. Only one sergeant said his unit had someone watch each man take his weekly pill.

Blood tests on the 80 marines who did not get sick suggested that many of them had merely been lucky: not one had the high and stable levels of mefloquine that doctors consider adequately protective.

The marines, who were rushed into Liberia on Aug. 12 to protect American citizens and the United States Embassy during fighting in the capital, Monrovia, also did not sleep under mosquito nets. The insecticide-treated nets are troublesome because they are considered hazardous material aboard ship.

Tests on the mefloquine pills in the marines' pockets ? a generic version of a drug better-known by its prescription name, Lariam ? showed that they were "within specs" for potency, Commander Whitman added. It was initially suspected that the pills might have been weak or expired.

In the confusion after 53 of the 133 marines became ill, they were first misdiagnosed as having dysentery because so many initially had diarrhea. The chief medical officer on the Iwo Jima had been trained in pediatrics, not tropical diseases, Commander Whitman said.

Dr. Gregory J. Martin, a Navy captain who led the military team that cared for the marines at Bethesda, said the lesson of the episode "went like a shot" to the top levels of the Department of Defense.

But Commander Whitman seemed slightly more cynical.

"The hard lessons are learned over and over and over again, in Somalia and Vietnam and World War II," he said, adding jokingly, "This will go to the top of the list after fuel and bullets and everything else."

http://www.nytimes.com/2003/12/05/n...&partner=GOOGLE


Sempers,

Roger