Broader Implications of Malaria Outbreak in U.S. Soldiers Deployed in Haiti

A U.S. military spokesman in Haiti reported today that six American soldiers involved in the aid mission have come down with malaria, one of whom was evacuated for treatment, the others are recovering, and scheduled to return to their duties.

The malaria outbreak is bigger, and more complicated than that admitted, according to a very knowledgeable epidemiologist who was one of the few individuals who had "got it right" during the initial phases of the AIDS epidemic, and who has particular expertise in insect-borne diseases. In a discussion today, he reported that 16 U.S. soldiers in the Haitian deployment have contracted malaria, and two of them have died; one from respiratory failure, the other from swelling of the brain. In all 16 cases, the strain has been identified as falciparum malaria, which is the strain that is most common in Haiti.

However, we have to assume that what we are seeing is a new, far more virulent strain of the admittedly dangerous falciparum strain. All U.S. military personnel deployed to Haiti are given doxycycline, an antibiotic the Army uses as a malarial preventive, 48 hours before their deployment, with an additional 90-day supply (the pills are supposed to be taken daily), as recommended by Federal health guidelines and military protocol.

Admittedly, not all soldiers take their pills, and even if taken as directed, the pills are not 100% effective. But, that's why the Centers for Disease Control and Prevention and military protocols call for a layered approach, reducing risk several ways.

Troops going into malarial regions are supposed to have their uniforms treated with permethrin, an insecticide that's sprayed on the uniforms, which then must air-dry. They are also supposed to apply another repellent, DEET, to exposed skin several times a day, and to use chemically treated bed nets. But, largely as a result of spending cuts, those measures also are not always taken, or are done sporadically.

A Fort Bragg spokesman (most of those affected are members of the 82nd Airborne) consulted, said he didn't know whether units had treated uniforms, but said, "they should have." He said he did know that they had shipped containers and containers of bed nets to Haiti for use by the 10,000 troops who were part of the initial deployment. As to whether they got their nets, "I can't speak to that," he said.

However, our contact spoke to one of the doctors on site who was involved in the initial diagnoses, and he said that the units never received their bed nets, and he saw little use of either insecticide.

There have also been a number of reported cases of leptospirosis, a bacterial disease caused by exposure to the urine of infected animals, often in contaminated water. But, leptospirosis is also prevented by taking doxycycline, so the fact that U.S. troops are contracting the infection DESPITE the fact that they're taking prophylactic drugs, similarly indicated that we're seeing a more virulent, drug resistant strain.

The overall implications of this should be clear. And, although it does require an immediate change in the recommended protocols for U.S. personnel, it is going to be very difficult to come up with one that is 100% effective. Also, if this is occurring in a population with relatively high herd immunity, who are ALSO being given prophylactic medication, the impact on the Haitian population, a group whose immunity was severely compromised BEFORE the earthquake, could wipe them out.

And, if we have learned anything at all from the AIDS epidemic, the overall potential for a biological holocaust, with a reach far beyond the immediate and secondary target regions, is real and potentially catastrophic.