Re: malaria drugs
- I can't think of a more critical high priority within Gabon than
lessening the incidents of malaria. The previous article points out
what can happen when precautions are not taken and the article on the
Gates' donations is a good step in the right direction.
Where I live, Palm Beach County, Florida, just this year, we have had
eight incidents of malaria infection. Malaria knows no boundaries and
can spread rapidly.
Recent study of malaria and pregnant women in Gabon:
--- In email@example.com, jonathonwithano
> Failed Safeguards Are Blamed For Marines' Malaria Outbreakall
> 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
> 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
> 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
> 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
> 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
> "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
- Regab, the national beer of Gabon, claims 4.5% alcohol. You never
know how much alcohol is really in each bottle. That is always a
surprise. Kronenbourg was the beer we drank in Gabon back in the
60's since Regab wasn't brewed until the late 70's. I did down more
than a few Regabs when I returned to Gabon in June 2002. Anyone want
to share some Regab stories?
- Scientists accuse international agencies of approving useless
Eds: SUBS 4th graf, `At least ...' to CORRECT spelling of
By EMMA ROSS
AP Medical Writer
LONDON (AP) The World Health Organization and other aid
agencies are undermining the battle against malaria by funding
cheaper and less-effective drugs, contributing to tens of
thousands of deaths of children in Africa, researchers asserted.
The scientists, writing in The Lancet medical journal, accused
WHO and the Global Fund for AIDS, Tuberculosis and Malaria of
promoting programs that use the wrong drugs because they are
a tenth the cost of better medicines.
Both agencies defended their positions, saying they cannot
dictate countries' drug policies and that many are changing to
the new drugs.
At least 1 million people, most of them children, die every year
from malaria. One reason propelling the deadly mosquito-borne
epidemic is that the bug has become immune to the
conventional drugs, chloroquine and
Newer drugs, known as artemisinin-class combination therapy,
or ACT, are considered the best treatment in areas where
resistance has become widespread.
In the Lancet, health scholar Amir Attaran from the
London-based Royal Institute of International Affairs and
colleagues from Africa, Asia and Europe cited many examples
where the old drugs were funded for countries with
Many malaria programs are financed by the Global Fund for
AIDS, Malaria and Tuberculosis, set up in 2002 to channel
money into fighting the three diseases in the developing world.
"Most African countries reluctantly cling to chloroquine,
sulfadoxine-pyrimethamine, or the insignificantly better
combination of (them) because ACT is 10 times more
expensive, and therefore unaffordable to them," the scientists
say in the Lancet paper.
"When those same countries seek financial aid from the Global
Fund to purchase ACT, they are forcefully pressured out of it by
governments such as the U.S.A.," the scientists said.
The U.S. Department of Health and Human Services said in a
statement that it "has never pressured any nation to use the
drugs cited in the article as less effective, in place of the more
expensive ACT drugs."
The experts cited Kenya, where drug-resistant malaria is
widespread. The Global Fund rejected an application to fund a
$102 million malaria program based on the new drugs, but later
approved one using two older drugs that cost $33 million.
Vinand Nantulya, senior adviser to the executive director of the
Global Fund, said Kenya's original application was rejected
because its strategy was not clear enough.
However, Attaran said the Global Fund had also agreed to
finance a combination of the two old drugs in Uganda and
Ethiopia, a pairing WHO describes as "not recommended."
Attaran and his colleagues said the funding of the wrong drugs
is "indefensible." The practice "at least wastes precious
international aid money and at most kills patients who have
The scientists estimate tens of thousands of children die every
year as a direct result of getting the wrong drugs.
WHO spokesman Iain Simpson said the agency's approval of
Global Fund proposals does not constitute a full technical
review. He said WHO officials might have signed off on
something that is in line with a country's drug policy, even if the
policy is outdated.
"It's not up to us to advise the Global Fund on how to spend their
money," or to dictate a country's policy on malaria treatment,
Simpson said. "It is up to us to assist countries in making sure
that they have the right drug policy and we believe that we're
doing that. A number of countries have changed their drug policy
over the last couple of years and we would advise others to do
But Attaran rejected that explanation.
"When countries request the wrong medicines, WHO signs off
on those applications and that's the bottom line," he said. "They
are saying they are happy to support the wrong medicine."
The Global Fund said it plans, together with WHO, to submit a
rebuttal to the Lancet article.
Nantulya of the Global Fund acknowledged some countries use
old drugs that should be using the new ones.
"At the time they made their proposals, the countries' drug
policies were based on what they could afford. They didn't know
the data on resistance," he said.
Proposals that involve the old drugs do get rejected, he added,
citing Nigeria as an example.
In addition, money is not tied to specific drugs and countries can
switch to the new drugs during a program without having to
reapply to the Global Fund, he said.
Nantulya said the Global Fund is now advising countries to shift
to the new drugs. "We don't think there is a crisis, because
countries that want to change are changing," he said.
- By Maggie Fox, Health and Science Correspondent
WASHINGTON (Reuters) - The deadly Ebola virus, which emerged
mysteriously from African forests, probably attacks people who
butcher and eat infected animals, researchers said on Thursday.
The virus, which most recently killed 29 people in the Congo
Republic, seems to break out when people slaughter chimpanzees,
gorillas and small antelopes called duikers, the scientists said.
"Humans and duikers scavenging for meat probably became infected by
contact with dead apes," they wrote in their report, published in
Friday's issue of the journal Science.
"Almost all human Ebola outbreaks in Gabon and the Republic of Congo
have been linked to the handling of dead animals by villagers or
hunters, and increased animal mortality always preceded the first
human cases," added the international team of researchers, led by
Eric Leroy of the Development Research Institute in Gabon.
They said health workers may be able to get a warning of Ebola
outbreaks when large numbers of dead animals start appearing in
Ebola first appeared in 1976 and causes a particularly frightening
and deadly form of hemorrhagic fever. Patients die of shock but may
bleed internally and externally.
Depending on the strain of virus, it kills between 50 and 90 percent
Leroy and colleagues studied several outbreaks in central Africa and
said villagers, and they themselves, found many dead animals just
around the time of an outbreak.
They also found that great apes such as chimps and gorillas could be
infected, although the original source of the virus remains unknown.
"The human outbreaks consisted of multiple simultaneous epidemics
caused by different viral strains, and each epidemic resulted from
the handling of a distinct gorilla, chimpanzee or duiker carcass,"
"These animal populations declined markedly during human Ebola
outbreaks, apparently as a result of Ebola infection. Recovered
carcasses were infected by a variety of Ebola strains, suggesting
that Ebola outbreaks in great apes result from multiple virus
introductions from the natural host."
This natural host, or reservoir, is likely to be an animal that is
not made ill by the virus, scientists say.
EBOLA ANOTHER BLOW TO ENDANGERED GORILLAS
Gorillas in particular have been hard-hit by Ebola, the researchers
noted. Along with poaching and habitat loss, this could lead to their
extinction in western Central Africa, they said.
Many people in Africa depend on apes and monkeys -- known as bush
meat -- for food. But some governments are trying to discourage the
practice because many apes are endangered.
And other viruses, including the HIV virus that causes AIDS, are
believed to have come from chimps and other close relatives of
"Now we know that the virus doesn't 'spread' as much as it spills
over from many sources in the forest," said Dr. William Karesh of the
New York-based Wildlife Conservation Society, who worked on the
Karesh, Leroy and colleagues found that one outbreak between October
2001 and May 2003 was caused by eight viral strains originating from