Martin Ferris (Kerry North, Sinn Fein)
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Question 24: To ask the Minister for Defence if Officers were issued a different anti-malaria drug to soldiers of other ranks; if Naval Service or Air Corps personnel who served overseas in Africa were issued with Lariam or another anti-malaria drug and if so the reason for same [37990/10]

Brian O'Shea (Waterford, Labour)
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Question 25: To ask the Minister for Defence if his attention has been drawn to the fact that the US army stopped administering the anti-malaria drug Lariam in February 2009; and if he will make a statement on the matter. [38085/10]

Martin Ferris (Kerry North, Sinn Fein)
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Question 37: To ask the Minister for Defence if he is willing to meet former soldiers who can show that they have suffered adverse effects from taking the anti-malaria drug Lariam, including mood swings, depression, suicidal tendencies, damage to the central nervous system and suicide [37995/10]

Arthur Morgan (Louth, Sinn Fein)
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Question 40: To ask the Minister for Defence if his attention has been drawn to the fact that upwards of 50 serving and non-serving soldiers are presenting with ongoing side-effects from their taking of the anti-malaria drug Lariam when on overseas duty in Africa with the Irish army; and if he will make a statement on the matter. [37991/10]

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Question 43: To ask the Minister for Defence the number of soldiers since 2000 who have been administered the drug Lariam prior and during missions overseas; when the Army Medical Corps become aware of severe side-effects of the drug and the fact that other armies no longer issued it as a anti-malaria drug or that it is the drug of last choice for armies; and if soldiers should have been instructed before being issued with the drug to discontinue taking the drug if they experienced any of those side-effects and report to sick bay and if they should have been warned of side-effects and precautions on the manufacturers instructions [37989/10]

Arthur Morgan (Louth, Sinn Fein)
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Question 46: To ask the Minister for Defence if he will set up a panel of medical experts to inspect all the soldiers who have served in Africa in the last ten years to ensure they are not suffering the side-effects of the anti-malaria drug Lariam; and to recommend the medical action that needs to be taken to alleviate the effects among those who have been adversely affected by the drug [37993/10]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 47: To ask the Minister for Defence the reason it is only prior to departure on overseas missions that soldiers undergo full medical checks and if he see the logic of asking the military authorities to carry out a full medical check on return from such missions to ensure the soldiers are in full fitness and that any medical complications associated with overseas operations can be identified and addressed; and if he will make a statement on the matter. [37992/10]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 52: To ask the Minister for Defence the number of soldiers who have served overseas in Africa in the past ten years; the number of suicides in the army each year for the past 20 years; the number of these for each year who had served overseas in Africa; the steps that have been taken to help those in the army with suicidal tendencies; and if he will instruct the military authorities to ensure that full toxicology tests are carried out on all serving and non-serving soldiers who may commit suicide in the future to establish the Lariam toxicity if any [37994/10]

Tommy Broughan (Dublin North East, Independent)
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Question 53: To ask the Minister for Defence if members of the Defence Forces who are prescribed Lariam are made aware of the side effects of this drug; and if he will make a statement on the matter. [38087/10]

Tony Killeen (Clare, Fianna Fail)
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I propose to take Questions Nos. 24, 25, 37, 40, 43, 46, 47, 52 and 53 together.

I am advised by the Military authorities that a total of 5,885 deployments to Africa have taken place since 1 January 2000, involving 4,127 personnel. In the period since 1 January 2000 the anti-malarial prophylactic agent for those who have served in Central Africa was and is Lariam.

I am further advised by the Military authorities that since 1 January 1990, a total of 336 Permanent Defence Force personnel have died in service. Of these, 18 personnel had served in overseas missions in continental Africa. The specific cause of death of personnel is not recorded on individual personal files.

The Military authorities have further advised that the main anti-malaria agents available to it are Chloroquine, Malarone, Doxycycline and Lariam. The choice of drug is based on the mission and not on the rank of the individual.

The Defence Forces consider Larium to be the most effective anti-malaria drug for the type of malaria our troops were exposed to in Chad and Central African Republic.

Lariam is authorised for use by the Irish Medicines Board (IMB) which is the statutory regulatory body charged with regulating the use of medicines, to ensure the quality, safety and efficacy of medicines available in Ireland. Lariam was first authorised for use by the IMB in 1989. While certain risks associated with the use of the drug were highlighted in Drug Safety Newsletters in 1996 and 2003, it remained of the view that the benefit / risk factor profile for the product remained acceptable. The Board continues to review the safety of this and all medicines on an ongoing basis and updates the product information as appropriate.

In the case of each of the other three anti-malaria products I referred to earlier, there are specific reasons as to why they are not suitable for use by the Defence Forces in sub-Saharan Africa and I will now set these out -

- Chloroquine is no longer of use because of the development of widespread resistance;

- Doxycycline has to be taken in the absence of dairy products and it can produce sun-sensitivity skin rashes in some patients. This is particularly significant when used in very sunny climes. For this reason it is not recommended for first line use by the Defence Forces in sub-Saharan Africa;

- Malarone is unsuitable for use as it is licensed for no more than 28 days continuous use in a malarious area by the IMB. In this context this prophylactic agent is only suitable for use where the overseas deployment does not exceed 28 days.

All personnel volunteering for service overseas are initially screened for medical suitability and fitness. Fitness to serve overseas is defined by Medical Classification Code. Personnel who do not achieve the specific Code are deemed to be 'medically unfit' for overseas service. This automatically excludes personnel from overseas service with conditions such as depression, anxiety, pregnancy, neurodegenerative disorders etc which, as indicated by the IMB, are more likely to precipitate serious adverse reactions to Lariam.

In the case of overseas missions to malarious areas, the medical screening involves an assessment of the individual's suitability to be prescribed the selected anti-malarial agent in line with current Irish Medical Board guidelines. This typically involves review of the patient's previous experience, if any, with the medication. The patient's medical history is also screened for those conditions which have been identified as precipitating serious side effects in association with the medication. In addition, blood tests are carried out to ensure that the liver is healthy as liver disease is an accepted contraindication to the use of Lariam.

It is the policy of the Defence Forces Medical Corps that those patients who are found suitable for Lariam should commence their medication three – four weeks in advance of their travel. The purpose of this precaution is two-fold - while it allows a slow buildup of the medication in the bloodstream, it also permits assessment by the patient of their individual reaction to the medication while still in Ireland. During this 'probationary' period the patient can consult with a Medical Officer (MO) over any adverse reaction, minor or major. Some minor reactions may be transient but if persistent, or troublesome, the patient will be deemed to have 'sensitivity' to the medication and will be found not medically suitable for the mission.

All overseas missions provide a medical service for participants. In the case of large Irish units serving with the UN etc. the primary care may be provided by the Medical Corps. Where the Medical Corps provides the primary care service, and where the Medical Officer (MO) forms the opinion that the patient has developed a 'sensitivity' to Lariam while overseas, the patient will be advised to cease taking the medication, substitute it with a 'second-line' agent, and the patient will be monitored to ensure symptoms subside. Appropriate 'anti-symptomatic' medication may be required in the interim and appropriate restrictions will be placed on duties.

Furthermore, all personnel, symptomatic or otherwise, are reviewed at their repatriation medical and advised on the further medical management of any medical problems which may have arisen while overseas.

The Defence Forces have advised me that as of August 2010, three members of the Defence Forces had been treated for serious symptomatology which may have been caused or contributed to by Lariam, although there is nothing conclusive in this regard. I am advised by the military authorities that all these personnel have made a full recovery, and that their cases have been reported to the Irish Medicines Board. In addition, the Defence Forces psychiatrist reports a further cohort of seven personnel with less dramatic symptomatology, and these remain under review. Again there is no conclusive evidence that the use of Lariam was a factor in any of these cases.

The Defence Forces take all necessary precautions in assessing the suitability of personnel before prescribing Larium in accordance with the prescribing instructions and information provided by the Irish Medicines Board. Personnel are screened both before and after deployments and all necessary actions are taken to ensure that those with contraindications to Larium use are deemed unsuitable for overseas service and are not prescribed the medication.

It is my understanding that the US Forces stopped using the Lariam due to concerns about inadvertent prescribing of the drug to soldiers who should not take it. In this regard, I am advised that the US authorities undertook mass administration of mefloquine (the generic name for Lariam) for soldiers serving in areas subject to malaria. The Defence Forces do not mass prescribe but rather follow all the instructions issued by the IMB in order to fully screen out personnel who may potentially have an adverse reaction to the medication.

Finally, I am assured by the military authorities that that they are fully satisfied with the arrangements currently in place in relation to all aspects of the administration of Lariam as an anti-malaria drug to Defence Forces personnel. Consequently, I have no plans to set up a panel of medical experts to inspect all the soldiers who have served in Africa in the last ten years. Equally, I have no plans to meet any individuals in this regard.