100 years of fighting malaria in the ADF

[bob10]

100 years of fighting killer bites

MALARIA and how to deal with it has preoccupied the ADF since World War I.
According to the World Health Organisation, more than half the world's population is at risk of this potentially fatal disease spread by female anopheles mosquitoes, known as vectors.
Malarial cases were reported in the AN&MEF in Rabaul in 1914, at Gallipoli and particularly the Desert Mounted Corps in Palestine where 100 deaths were attributed to the disease.
Malaria was endemic in parts of Australia, particularly Far North Queensland where it was not declared eradicated until 1981.
At the start of the Pacific war, 90 per cent of quinine supplies came from the Dutch East Indies, then under Japanese threat, so the Australian Army established a malarial research unit to discover alternate prophylaxes in Cairns, where malaria remained ?endemic.
Malarial prevention has ?always been a combination of controlling the vector, ?guarding against bites when vectors were most active and a regimen of suppressive medicines in affected areas followed by an eradication regimen on departure.

Atabrine became the suppressant of choice though suspicious Diggers spread rumours it made them impotent as it also coloured their complexions yellow.
Many chose to risk infection rather than the supposed side effects.
The malarial plasmodium parasite lives in the human liver so choosing a suitable prophylaxis has always been a balance between effective prevention while minimising potential liver damage.
The malarial research unit, disbanded in 1946, was again raised in 1967 at Sydney University to counter the disease in Borneo and Vietnam.
The drug of choice then was paludrin, one tablet per day consumed under supervision though typically those in malarial areas including PNG were advised to take two.
A weekly dose of chloroquine later replaced paludrin until its efficacy was reduced by resistant malarial strains.
Malarial areas including barracks and married quarters were subject to regular fogging via two-stroke engines which delivered a mix of carbon monoxide and insecticide at dusk and dawn supposedly as vectors rose and settled.

Malarial incidence decreased but there were ?inevitably other adverse health and environmental implications, particularly from the widespread use of insecticide DDT.
It's fair to say control of anti-malarial drugs and their administration were haphazardly supervised, apart from notations in roll books which were more often used for disciplinary than medical purposes.
As malarial parasites developed resistance to widely used prophylaxes, new drugs and regimes were tried, often on a 'suck it and see? methodology rather than properly supervised trials.

In recent years the drugs of choice have been doxycycline, malarone and mefloquine, the latter distributed under the tradename Larium.
Larium has well documented side effects, including vivid dreams, sleep disturbance, disorientation, depression or anxiety.
It is not recommended for those with a history of ?psychiatric disorders.
Not all these were recognised when it was first recommended for use and it is possible some veterans 'diagnosed with extreme PTSD were instead suffering from untreatable mefloquine -toxicity.
It could explain otherwise inexplicable behaviour and some adverse outcomes including deaths.

[bob10]

Shades of Agent Orange.

WA former soldier fears anti-malarial Army drug trial caused permanent brain injury - ABC News (Australian Broadcasting Corporation)

[bob10]

http://cdn.newsapi.com.au/image/v1/9...a9cc?width=650

East Timor veteran Scott McCormick was sent back to Australia after he had a psychotic reaction to mefloquine, but his records show that he was not given a medical assessment upon arriving home.

Claims by war veterans of serious mental health damage caused by antimalarial drug trials have been supported by Defence's own medical ethics committee, which said it had not been made aware of dangerous side-effects and that the risk of 'depression and psychosis caused considerable concern?.

More than 2500 ADF members were used in trials of two antimalarial drugs about 15 years ago even though one drug, tafenoquine, has never been approved for public use in Australia and a second, mefloquine, can cause permanent brain damage among other mental health impacts.

The minutes show that Australian Defence Medical Ethics Committee approved the trials despite having serious concerns, and that some adverse reactions were not recorded.

?This protocol caused considerable debate when it became apparent that mefloquine had potentially serious side effects of which ADMEC had been previously unaware. In particular, CNS [central nervous system] side effects of depression and psychosis caused considerable concern to Committee, especially were they to occur in deployed troops,? the February 2001 minutes reveal.

A senior medical officer told the committee that the trial was 'scientifically necessary? and that adverse reactions normally occur after four doses of mefloquine, which are taken prior to deploying overseas.

Mefloquine, which is branded as Lariam and is still available in Australia, was given to about 1300 troops deployed to East Timor in 2001 and 2002. Numerous troops have told The Australian that they were compelled by their commanding officer to take it, but Defence strongly denies this.

ADMEC said in August 2002 that the ?apparent high incidence of adverse events was of concern to the committee?.

The ADF has consistently claimed that ADMEC approved all the trials, but the minutes show that the committee was also alarmed by them.

East Timor veteran Scott McCormick was sent back to Australia after he had a psychotic reaction to mefloquine, but his records show that he was not given a medical assessment upon arriving home.

Mr McCormick believes he is one of the 16 per cent participants recorded as having withdrawn from the trial, rather than showing an adverse reaction to the drug mefloquine. A very substantial 6.5 per cent are recorded as having been adversely affected.

Mr McCormick, 34, started suffering from anxiety and sleep disturbances after receiving the first three doses over nine days ? more than double the recommended dose. He now suffers from depression and has been awarded a Totally and Permanently Incapacitated (TPI) pension by the Department of Veterans Affairs.

During the trial in 2001, he scrawled on a survey form that he was suffering from anxiety, tiredness and sleep disorders, including bad dreams.

?I was 20, I barely knew what anxiety was but I knew I was feeling it. For me to indicate I was suffering anxiety it must have been something pretty serious and I couldn't find the column for basket case,? he said.

He has now been diagnosed with depression and has taken five different antidepressants which have not worked. He says that his mental health problems make it difficult to work.

?I struggle to concentrate. I have learning difficulties and get extremely fatigued. I am concerned about the neuro toxic nature of this drug. I believe it may have done permanent damage,? he says.

Mr McCormick recently pressed the Army Malaria Institute, which was responsible for the trials, to give him his records.

The file has a page that is blank except for the words ?RTA Questionnaire Missing?, which refers to his return to Australia assessment.

Another Timor veteran who took part in the trial says he suffers from vertigo and has bowel problems linked to a series of digestive disorders.

A decade ago, up to 400 veterans had planned to mount a class action against the Defence Department but this was dropped after the government changed the law to limit its liability.

Major Stuart McCarthy, whose mental health has been affected by mefloquine, said the minutes 'reinforce the need for an urgent judicial inquiry into what appears to be extensive criminal conduct on the part of numerous senior ADF officials over many years?.

Dr Remington Nevin, a former US army medical officer, said he found it troubling that by the time ADMEC had reviewed the tafenoquine and mefloquine trials, some had in fact already been completed.

Dr Nevin, who now lectures at Johns Hopkins University, says the information on the consent forms downplayed the risks of mefloquine and was misleading.

The Defence Minister Senator Marise Payne declined to answer The Australian's questions and instead referred them to Defence media.

Labor's veterans affairs spokesman David Feeney said there should be a review of the way the ADF prescribes drugs and treatment to members so that practices are ?both clear and ethical?.

?It is unacceptable for there to be the perception, let alone the reality, that ADF personnel are being prescribed drugs that have not been adequately tested and are not yet available to the general public for the purposes of testing them,? he added.

[rovercare]

I was on Doxy whilst in a malarious area, although took enough to pass urine test as I don't wish to take this stuff daily, guys on malarone for severely knocked about!....better off catching malaria I reckon and treating it

Atleast then you can become semi-immune

Mosses kill the most people on the planet estimated at like 25+ million/annum

[austastar]

Hi,
The RAAF used to spray Dieldrin around at Butterworth in the late 60s.

Bit of a worry, but I don't think it affected me.

Cheers

[bob10]

RAN personnel serving on ships in the Vietnam conflict had their drinking water contaminated with agent orange, It carried over during the process of distillation. We were drinking it. The report;

[ame]http://www.dva.gov.au/sites/default/files/files/consultation%20and%20grants/healthstudies/nrcet.pdf[/ame]

[ame]http://www.dva.gov.au/sites/default/files/files/consultation%20and%20grants/healthstudies/nrcet.pdf[/ame]

[bob10]

The Australian report was used by US veterans & their advocates.


2 HISTORICAL BACKGROUND | Blue Water Navy Vietnam Veterans and Agent Orange Exposure | The National Academies Press

[squizzyhunter]

I know a girl who had to be physically restrained on the flight to indo from taking Larium. I mate I traced with worked in the Congo as a midwife( straight out if uni course that was non health related and was delivering baby's after 2 days of training, this was 15 yrs ago though). His girlfriend was given what was supposed to be only x1 week dose of Larium ( I haven't heard of this before) but she mistakenly took them daily.... She lost her hair and was in and out of psychiatric care since. I can't believe Larium is still prescribed....

[juddy]

When I first spent 4 months in Asia I took Larry ( Larium ) did very strange things to my mind. doxycycline used for other things too makes me sick as a dog, just leaves malarone. Which I have had and was ok.





n recent years the drugs of choice have been doxycycline, malarone and mefloquine, the latter distributed under the tradename Larium.
Larium has well documented side effects, including vivid dreams, sleep disturbance, disorientation, depression or anxiety.
It is not recommended for those with a history of ?psychiatric disorders.
Not all these were recognised when it was first recommended for use and it is possible some veterans 'diagnosed with extreme PTSD were instead suffering from untreatable mefloquine -toxicity.
It could explain otherwise inexplicable behaviour and some adverse outcomes including deaths.
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