The Quinism Foundation Calls on the Peace Corps to Deprioritize Use of Mefloquine and Investigate Claims of Misuse

Recent Media Reports Have Highlighted the Plight of Peace Corps Volunteers Left Permanently Disabled from the Antimalarial Drug

WHITE RIVER JUNCTION, VT. (PRWEB) DECEMBER 12, 2018

The Quinism Foundation has sent correspondence to Kathy A. Butler, Inspector General of the Peace Corps, calling for an investigation into claims of permanent disability resulting from the misuse of the antimalarial drug mefloquine.

“Recent media reports have highlighted the plight of several Returned Peace Corps Volunteers (RPCVs) who claim, based on supporting medical documentation, to have been left permanently disabled as a result of their use of mefloquine while in the Peace Corps,” wrote Remington Nevin, MD, MPH, DrPH, executive director of The Quinism Foundation. “We are calling for your office to investigate the circumstances of these specific claims, and to investigate the circumstances of broader claims of harm arising from the apparent misuse of mefloquine among Peace Corps Volunteers (PCVs).”

Dr. Nevin noted that since the licensing of mefloquine in 1989, physicians have been warned that the onset of certain psychiatric symptoms requires the drug’s immediate discontinuation.

“In many cases, the apparent misuse of mefloquine has occurred as a result of what appears to be inadequate consideration of and respect for guidance in the U.S. Food and Drug Administration (FDA)-approved product labelling,” wrote Dr. Nevin. “For example, in one case highlighted in recent media reports, a Peace Corps Medical Officer (PCMO) apparently failed to follow warnings to discontinue a PCVs use of mefloquine, and prescribe an alternative antimalarial, at the reported onset of psychiatric symptoms. We are concerned that this example of misuse of the drug is evidence of a broader systematic neglect of FDA-approved guidance, and constitutes mismanagement within the Peace Corps Office of Medical Services (OMS).”

Dr. Nevin described cases highlighted in a series of investigative reports on WUSA9 [1], where PCVs developed symptoms of anxiety while taking mefloquine, but were not instructed to discontinue the drug. These volunteers subsequently developed disabling brain and brainstem injuries attributed by medical professionals to mefloquine.

“Interviewed recently by WUSA9 in response to these cases, Peace Corps OMS epidemiologist Dr. Kyle Petersen noted his opinion that, ‘judging by what was available on the market at that time, Peace Corps did the best job they could’,” wrote Dr. Nevin.

“In our opinion, PCMOs under the management of the Peace Corps OMS very clearly failed to do ‘the best job they could’, in that they neglected to adequately consider and respect guidance in the FDA-approved product labelling for the use of the drug.”

Dr. Nevin noted that the U.S. military has all but prohibited use of mefloquine, restricting its use to a ‘drug of last resort’, with the drug now comprising less than 1% of new antimalarial prescriptions. Other militaries, including those of Canada, Germany, France, Australia, and the United Kingdom, have similarly deprioritized mefloquine in favor of safer and better-tolerated daily antimalarial drugs.

“Peace Corps OMS epidemiologist Dr. Kyle Petersen, when asked about the Peace Corps’ continued use of mefloquine despite the U.S. military’s near-complete ban on its use, suggested that while ‘the military does have missions in tropical countries’, that this is akin to ‘comparing apples and oranges’,” wrote Dr. Nevin. “Dr. Petersen was apparently suggesting that the Peace Corps’ mission of sending its PCVs to highly malaria-endemic areas, such as sub-Saharan Africa, was somehow unique, and justified the Peace Corps’ continued use of the drug.”

However, Dr. Nevin noted that according to U.S. military figures, U.S. Africa Command (AFRICOM) has over 7,200 military personnel in Africa, most serving for prolonged periods in areas of high malaria endemicity in sub-Saharan areas. Yet since as early as 2011, AFRICOM policy has specifically declared the daily drug atovaquone-proguanil as its drug of choice for deployments to such ‘high transmission areas’ [2], in stark contrast to then-current Peace Corps policy which favored mefloquine’s continued use.

“The U.S. military policy of ‘last resort’ use of mefloquine remained in place during the Ebola crisis of 2014, during the large-scale deployment of thousands of U.S. military personnel to highly malaria- endemic areas of Liberia during Operation United Assistance. This deployment saw almost no use of mefloquine, with atovaquone-proguanil declared the drug of choice for the deployment [3],” wrote Dr. Nevin.

Dr. Nevin noted that the effectiveness of this policy was demonstrated when, following the deployment, only a handful of U.S. military personnel were found to have contracted malaria [4], in sharp contrast to the experience a decade earlier, when 44 out of 225 U.S. military personnel serving in Liberia, and relying on mefloquine, had to be evacuated for suspicion of malaria [5].

Dr. Nevin also noted that a growing number of international civilian travel advisory bodies, for example, that of France, now also specifically deprioritize mefloquine in place of safer and better-tolerated prophylactic antimalarials, including for travel to sub-Saharan Africa [6].

“Our group has asked the Centers for Disease Control (CDC) to update its recommendations for use of mefloquine among U.S. travelers accordingly [7],” wrote Dr. Nevin.

“In 2013, after the FDA issued its U.S. FDA drug safety communication, Dr. Barry Simon, then serving as medical director of the Peace Corps, asked in an email to a colleague, ‘can we still get away with using mefloquine?’”

“The Quinism Foundation believes that after five years of failed policy of continued use of mefloquine, the answer to this question is a resounding ‘no’,” wrote Dr. Nevin, “and that the Peace Corps must now align its policies with the risk-reduction practices of the U.S. military in formally deprioritizing use of mefloquine for the prevention of malaria, including among PCVs in sub-Saharan Africa and other highly malaria-endemic areas.”

About The Quinism Foundation

The Quinism Foundation, founded in January 2018, in White River Junction, Vermont, promotes and supports education and research on quinism, the family of medical disorders caused by exposure to quinoline drugs, including mefloquine and tafenoquine.

Dr. Nevin is a board-certified occupational medicine and preventive medicine physician and former U.S. Army medical officer and epidemiologist. He is author of more than 30 scientific publications on malaria and the quinoline antimalarials, including “A serious nightmare: psychiatric and neurologic adverse reactions to mefloquine are serious adverse reactions,” published in the journal Pharmacology Research & Perspectives (http://dx.doi.org/10.1002/prp2.328).

1. McCarren, Andrea. Former Peace Corps volunteers: Malaria meds caused devastating side effects. https://www.wusa9.com/article/news/former-peace-corps-volunteers-malaria-meds-caused-devastating-side-effects/65-610736352. November 10, 2018.

2. U.S. Africa Command. USAFRICOM Command Notice (ACN) 4200.02 Change 2 to Africa Command Manual (ACM) 4200.03 Force Health Protection Procedures for Deployment and Travel (Malaria Chemoprophylais). September 22, 2011.

3. Woods M. Biggest threat to US troops in Liberia is malaria, not Ebola. Defense Video and Imagery Distribution System. http://www.dvidshub.net/news/149258/biggest-threat-us-troops-liberia-malaria-not-ebola. December 3, 2014.

4. Kime P. Troops get malaria during Ebola deployment. Military Times. http://www.militarytimes.com/story/military/benefits/health-care/2015/04/23/us-military-ebola-deployment-malaria/26236769. April 23, 2015.

5. Whitman TJ, Coyne PE, Magill AJ, et al. An outbreak of Plasmodium falciparum malaria in U.S. Marines deployed to Liberia. The American journal of tropical medicine and hygiene. 2010;83(2):258-265.

6. Camus D, Chidiac C. [Health recommendations for travellers, 2018 (for health professionals)]. Bulletin Epidemiologue Hebdomadaire. http://invs.santepubliquefrance.fr/content/download/147167/535751/version/62/file/Recommandations_voyageurs_2018.pdf. May 25, 2018.

7. The Quinism Foundation. The Quinism Foundation Calls on the CDC to Update its Malaria Prevention Recommendations to Reflect Important FDA Safety Warnings for Tafenoquine and Mefloquine. https://quinism.org/press-releases/the-quinism-foundation-calls-on-the-cdc-to-update-its-malaria-prevention-recommendations-to-reflect-important-fda-safety-warnings-for-tafenoquine-and-mefloquine. August 14, 2018.