A Zoonotic Disease Summary for Public Health Personnel in the United States Army

Approved for public release, distribution unlimited

This issue contains information about Army tick and mosquito testing, animal-disease cases, rabies animal testing, and human zoonotic disease cases diagnosed at Army and Joint Base (JB) military treatment facilities (MTFs) and their designated catchment areas.

Male “brown dog tick”, Rhipicephalus sanguineus. Photo courtesy of Centers for Disease Control and Prevention (CDC).

2 Executive Summary

3 Human- Disease Summary

5 Human- Notable Disease Events

6 Animal- Rabies

9 Animal- Veterinary Surveillance

10 Vector- Mosquito Surveillance

13 Vector- Tick Surveillance

22 Focus On- Leishmaniasis in

Humans

23 References

24 Appendices

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2

Human Disease

Executive Summary

The top 4 zoonotic diseases captured in veterinary records are tick-borne; use of animal preventives should be emphasized.

There were 325 records of zoonotic disease captured in the Remote Online Veterinary Record (ROVR) in 2016. Of diseases monitored in this report, Lyme borreliosis (47%) and ehrlichiosis (33%) were the most commonly identified, followed by babesiosis (7%), anaplasmosis (6%), trypanosomiasis (3%), RMSF (2%), leishmaniasis, and leptospirosis (both 1%). All records were for canines: 76% pets and 24% working dogs. No cases of Yersinia, Q fever, or West Nile virus (WNV) disease were identified.

Rabies among feral and domestic animals remains problematic in many countries. The United States continues to see rabid animals despite prevention efforts. Rabies testing of animal specimens by Army labs indicates that some Army personnel may encounter rabies-positive animals. Veterinarians should continue to emphasize rabies vaccination for domestic animals.

Rabies: In 2016, 3,235 rabies-positive animal samples were reported from 33 U.S. states, the majority from wild animals (91%). Raccoons were the most frequently identified infected species (35%), followed by bats (28%) and skunks (19%). There were 116 animal specimens associated with 70 human exposures tested for rabies by Army labs; 9% (10/116) of specimens were positive; 1% (1/116) were indeterminate. Public Health Command (PHC)-Europe tested 13 of the animal samples, nearly half from U.S. Army Central Command (CENTCOM) (46%); 2 specimens from Afghanistan tested positive; no other samples from Europe or CENTCOM were indeterminate or positive. Installations from PHC-Pacific, PHC-Central, and PHC-Atlantic submitted 103 samples associated with 65 human exposures to the Department of Defense (DoD) Food Analysis and Diagnostic Laboratory; 8 samples were positive (4 from Arizona, 1 from Texas, 1 from New York, 1 from California, and 1 from Delaware), and 1 was indeterminate.

The most frequently identified zoonotic diseases among Army Active Duty (AD) and beneficiaries are tick-borne (e.g. Lyme disease and Rocky Mountain Spotted Fever (RMSF)), and most of these cases occurred in Eastern and Northeastern states. These findings are consistent with the distribution of cases in the general U.S. population.

Zoonotic Diseases as a Proportion of Reportable Medical Events: In 2016, zoonotic diseases comprised 6% (158/2,445) of all Reportable Medical Events (RMEs), excluding sexually transmitted infections (STIs). Zoonotic disease reports among Army AD Service members (SMs) comprised 3% (63/2,445) of all non-STI RMEs and 4% (95/2,445) among AD beneficiaries.

Most Common Zoonosis: Borreliosis, which includes Lyme disease, continued to be the most frequently reported zoonotic RME, comprising 80% of all reported zoonotic events. Borreliosis was also the most commonly coded zoonotic diagnosis in medical records, making up 70% (418/693) of zoonotic diseases identified.

A total of 5,067 mosquito pools from military installations in the United States were tested for WNV in 2016; all positive pools were Culex spp. Overall, 2% (83/4,445) of Culex spp. pools were WNV-positive. In PHC-Atlantic, 2% (65/2791) pools tested positive; 2% (17/1,013) pools in PHC-Central tested positive; and 3% (1/31) of Culex spp. mosquito pools in PHC-Pacific were positive.

In 2016, 4,189 ticks were tested by Public Health Command (PHC) laboratories and the DoD Tick Test Kit Program at the U.S. Army Public Health Center (APHC). Of the 1,020 Ixodes spp. that were tested, 280 (27%) were positive for Borrelia burgdorferi, the Lyme disease pathogen. Of 2,677 Amblyomma americanum ticks tested for Ehrlichia chaffeensis, 27 ticks (1%) were positive.

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Vector Surveillance

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Human Disease Summary: U.S. Army Reportable Medical Events

Zoonotic Diseases in DoD Beneficiaries from Army and Joint Army Installations in DRSi, 2016

Two tick-borne diseases (Lyme disease and RMSF) comprised the majority (92%, 145/158) of all zoonotic disease records in DRSi in 2016; Lyme disease alone makes up 80% (127/158) of records. Of 127 Lyme disease cases, 47 Army AD SMs, 65 AD beneficiaries, and 15 non-AD Army were reported: 51 cases from PHC-Atlantic (40%, 51/127), 27 from PHC-Central (21%), 16 from PHC-Europe (13%), 8 from PHC-Pacific (6%), and 25 from unspecified locations (20%). The majority of RMSF cases were reported from PHC-Atlantic (83%, 15/18); PHC-Central reported 6% (1/18) of cases, and 11% (2/18) were reported from unspecified locations. PHC-Pacific and PHC-Europe did not report any RMSF cases.

The leishmaniasis patient had a history of travel to Guyana, the Q fever patient had a history of travel to Somalia, Yemen, and Djibouti, and the Japanese encephalitis virus patient had a history of travel to the Republic of Korea.

Excluding STIs, 2,445 RME records with a date of diagnosis in calendar year 2016 were entered into the Disease Reporting System-internet (DRSi). Of these, 6.5% (158/2,445) were for zoonotic diseases: 63 AD SMs (including Cadets and Recruits) and 95 AD beneficiaries (family members, retirees, civilians).

Of the 158 zoonotic cases, 29 were Army cases reported from non-Army locations: 25 Lyme disease, 2 RMSF, 1 chikungunya fever, and 1 Q fever.

BEN: Active Duty Beneficiary (non-Service Member); USMA: United States Military Academy; USAG: United States Army Garrison; JBSA: Joint Base San Antonio.

BrucellosisJapanese

EncephalitisLeishmaniasis Q Fever

AD AD BEN AD BEN BEN AD AD AD BEN AD BEN

Ft. Rucker AL 1 2 4

Ft. Benning * Ft. Stewart GA 1 1 1 1

Ft. Campbell * Ft. Knox KY 3 1 1 4 2

Aberdeen Proving Ground * Ft.

Detrick * Ft. Meade * Walter

Reed NMMC

MD 1 6 15

Ft. Bragg NC 5 1

Ft. Drum * West Point USMA NY 5 2

Ft. Belvoir * Ft. Lee * JB Myer-

Henderson HallVA 2 10 1

1 16 35 1 1 0 1 0 7 8 0 0

Ft. Carson CO 2

Ft. Riley KS 2 4

Ft. Polk LA 1 1

Ft. Leonard Wood MO 1

Ft. Sil l OK 1

Ft. Bliss * Ft. Hood * JBSA-Ft.

Sam HoustonTX 10 6 2 2 1

0 16 11 0 2 0 0 0 0 1 2 1

Ft. Wainwright AK 1

Camp Zama JP 1 1

USAG Yongsan KO 1 1

Ft. Lewis WA 3 2

0 5 3 0 0 1 0 0 0 0 0 1

USAG Ansbach * USAG Bavaria *

USAG Rheinland-Pfalz * USAG

Stuttgart

GM 5 10

USAG Vicenza IT 1

0 5 11 0 0 0 0 0 0 0 0 0

OTHER Non-Army Non-Army 8 17 1 1 2

1 50 77 1 4 1 1 1 7 11 2 2TOTAL

Rocky Mountain

Spotted FeverTrichinosis

PACIFIC

PACIFIC TOTAL

EUROPE

EUROPE TOTAL

Borreliosis

(Lyme Disease)

Chikungunya

Fever

ATLANTIC

ATLANTIC TOTAL

CENTRAL

CENTRAL TOTAL

Region and Location

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Human Disease Summary: U.S. Army Location Medical Data Zoonotic Disease Cases in DoD Beneficiaries Identified from Medical Visit Data in M2, 2016

Inpatient and outpatient medical records from Army and JB MTFs, and purchased-care records from beneficiaries residing within these catchment areas were reviewed for zoonotic disease diagnoses codes. Modified Armed Forces Health Surveillance Board (AFHSB) case definitions and incident rules were applied to identify new cases. Verification of diagnoses via chart review was not performed. Cases listed in this section may not meet RME reporting guidelines, leading to higher case counts than reported elsewhere.

During 2016, 643 newly diagnosed zoonotic diseases were identified in M2. Most cases were identified from Army or JB MTFs (59.1%), with the remainder identified from medical claims submitted from beneficiaries in these catchment areas; 126 (19.6%) zoonotic diseas-es were diagnosed among AD SMs.

Borreliosis (including Lyme disease) was the most common zoonosis diagnosed in 2016 (60.8%, 391/643). Spotted fever rickettsiosis (including cases due to Rickettsia rickettsia and R. parkeri) was the second most common zoonosis identified (15.1%, 97/643), followed by babesiosis (6.5%, 46/643).

The majority of diseases (70%) were diagnosed in PHC-A, followed by PHC-C (18.4%), and PHC-E (7.5%).

Although not included in the data shown, there were 217 rabies exposures: 155 in PHC-Atlantic (71.4%), 55 in PHC-Central (25.4%), 4 in PHC-Pacific (1.8%), and 3 in PHC-Europe (1.4%). AD SMs accounted for 64 exposures (29.5%, 64/217).

¥ Cases due to Ehrlichia ewingii or E. chaffeensis; ⱡ Cases due to Rickettsia rickettsii or R. parkeri; # Cases of cutaneous and visceral leishmaniasis. Diseases with <5 cases excluded: Eastern equine encephalitis (n=1; 1 non-AD), Hantavirus (n=2; 1 AD, 1 non-AD), St. Louis encephalitis (n=4; 4 non-AD), WNV (n=2; 2 non-AD). *Cases extracted from purchased-care records are grouped with locations near the corresponding catchment area.

AD BEN AD BEN AD BEN AD BEN AD BEN AD BEN AD BEN AD BEN AD BEN

Ft. Rucker AL 1 1 2

Redstone Arsenal AL 1 1 2

Ft. Benning GA 1 4 1 2 1 1 1 2

Ft. Gordon GA 1 3 1 1 1

Ft. Stewart GA 1 7 1 2

Ft. Campbell KY 9 8 2 3 4

Ft. Knox KY 2 2 1 1 8

Aberdeen Proving Ground MD 1 6

Ft. Detrick MD 1 1 3 1 1

Ft. Meade MD 1 10 1

Walter Reed National Military

Medical CenterMD 2 3 5 51 3 13 5 2 6

Ft. Bragg NC 5 22 1 2 5 3 16 2 1

Ft. Dix NJ 1 2

Ft. Drum NY 4 4 1 1

West Point NY 4 7 4 28 1 3

Carlisle Barracks PA 1 1 16

New Cumberland PA 1 3 1

Ft. Jackson SC 4 2

Ft. Belvoir VA 1 11 1 43 1 1 1 1 1 1 3 7 2

Ft. Eustis VA 1 5 1 1 3

Ft. Lee VA 3 2

Ft. Myer VA 2 4

7 27 43 225 1 4 3 12 17 10 4 7 14 56 0 4 1 2

Ft. Huachuca AZ 3

Ft. Carson CO 4 1 8 2 2

Ft. Leavenworth KS 2 7

Ft. Riley KS 1 1 7 1

Ft. Polk LA 1 5 1

Ft. Leonard Wood MO 1 4 1 1 10

Ft. Sil l OK 4 2 1 1 2

Ft. Bliss TX 1 4 1 1 1

Ft. Hood TX 2 3 1 1 1 2 1 3 2 1

Ft. Sam Houston TX 1 11 1 1 2 3 1

0 6 13 54 0 4 1 0 0 3 1 4 5 21 0 0 3 3

Camp Humphreys SK 1

Ft. Lewis WA 1 2 6 1 1 3

Ft. Richardson AK 1 1

Ft. Shafter HI 7 1

Ft. Wainwright AK 1

Presidio Of Monterey CA 1

Schofield Barracks HI 1 1

Yongsan Garrison SK 1

0 2 5 16 1 1 0 0 0 4 0 0 0 0 0 0 0 1

USAG Benelux BE 2

USAG Bavaria GM 2 8 8

USAG Rheinland-Pfalz GM 1 7 1 1

USAG Stuttgart GM 11 1 2

USAG Wiesbaden GM 1 2

USAG Vicenza IT 1

0 0 4 31 1 0 0 0 0 0 0 0 0 1 1 10 0 0

7 35 65 326 3 9 4 12 17 17 5 11 19 78 1 14 4 6

EUROPE TOTAL

Borreliosis

(Lyme Disease)Q Fever

Spotted Fever

Rickettsiosesⱡ

Tick-borne

EncephalitisTrichinosisBabesiosis Brucellosis Ehrlichiosis¥

Leish-

maniasis#Region and Location State

TOTAL

ATLANTIC

CENTRAL

PACIFIC

EUROPE

ATLANTIC TOTAL

CENTRAL TOTAL

PACIFIC TOTAL

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Human Disease Summary: Notable Disease Events

Yellow Fever

Yellow fever is a viral hemorrhagic disease transmitted by infected Aedes and Haemogogus mosquitoes, which can live and breed in wild, domestic, and semi-domestic settings.

Yellow fever is endemic to parts of 34 countries in Africa and 13 countries in Central and South America.1

Yellow fever can be transported between countries by travelers. Approximately 84,000-170,000 cases and 60,000 deaths due to yellow fever are reported annually.

Monkeys are the primary animal reservoir for yellow fever, with mosquitos transmitting the virus to other monkeys and to humans. When infected humans introduce the virus into heavily populated areas with high mosquito density, urban yellow fever epidemics can occur, spreading person to person through mosquitos.1

Outlook: Yellow fever outbreaks can re-emerge in endemic areas at any time. Outbreaks are especially dangerous in areas with low

vaccination coverage, which could facilitate the rapid spread of disease.3

Areas such as South and Central America face the extra burden of combatting multiple outbreaks simultaneously, as yellow fever outbreaks can occur concurrently with Zika virus, chikungunya, and dengue outbreaks.3

There is no specific treatment or cure available for yellow fever. Mosquito control measures such as using insect repellent, wearing protective clothing, and getting vaccinated remain the best steps to prevent yellow fever virus infection.

Yellow Fever, 2016

Summary: Both humans and monkeys serve as important reservoirs for yellow fever, meaning that outbreaks can occur in both jungle and urban environments. Yellow fever remains a global human health threat, especially in urban areas where people have little or no immunity due to lack of vaccination.

Vaccination is the most important means of preventing yellow fever, but the yellow fever vaccine is in limited supply worldwide. Stockpiles of this vaccine are managed through the International Coordinating Group (ICG), which releases vaccines when certain emergency requirements are met.4

Mosquito control can help decrease the risk for urban yellow fever outbreaks.1

Prevention and Clinical Considerations

2016 Yellow Fever Outbreaks

In 2016, yellow fever outbreaks were reported in Angola, Uganda, and the Democratic Republic of the Congo (DRC).2

In Angola and the DRC, 884 cases were laboratory confirmed, with 121 deaths (case fatality rate: 13.7%) from 5 December 2015 to 20 October 2016.

In response to this outbreak, the World Health Organization (WHO) sent more than 30 million vaccine doses to Angola, the DRC, and Uganda.

Aedes aegypti mosquito, a vector of the yellow fever-causing Flavivirus, taking a blood meal. Photo courtesy of CDC.

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Animal Disease Summary: State Rabies Testing

*Only states that conduct and report rabies testing data are shown. Note: Numbers represent positive cases for each animal type in each state. Data was collected from publicly available reports.

For all or part of 2016, 33 states had publicly available animal rabies data listing species of animal tested. Only one state published total number of positives, and 15 did not publish data. Hawaii is rabies-free.

A total of 3,235 animals tested positive for rabies in 2016 in the United States.

The number of animals tested was not available. States that report more positives may be performing more tests.

Pennsylvania reported the most positive results (12.5%, 404/3,235).

Among known animal types, most positives were from wild animals (91.4%, 2,956/3,235).

Raccoons were the most commonly identified rabid animal, making up 35.1% of all positive results. Bats are the only animal represented in all 33 states’ data. Different species of bats were tested, depending on the area, but species in-formation was not always published. Bats are the second most commonly identified rabid animal, making up 28.4% of all positive results.

Skunks (19%) and foxes (6.8%) were the next most commonly reported positive animals, followed by felines (5.6%), other/unknown animals (4.5%), and canines (0.6%). Mammals tested in the ‘Other’ category include: cattle, ground-hogs, horses, bobcats, rodents, rabbits, goats, coyotes, sheep, opossum, and deer.

U.S. Annual Rabies Data Summary, 2016

Other

Feline CanineOther

DomesticTotal Bat Skunk Fox Raccoon

Other

WildTotal Unknown

Alabama 12/31/2016 0 1 0 1 15 0 12 48 1 76 0 77

Arizona 12/31/2016 1 0 1 2 72 70 5 3 150 0 152

Arkansas 12/31/2016 0 0 1 1 7 15 0 0 0 22 0 23

California 12/1/2016 2 1 0 3 142 22 8 0 0 172 0 175

Colorado 12/31/2016 0 0 3 3 58 25 0 0 2 85 0 88

Connecticut 12/31/2016 7 0 0 7 16 15 5 44 4 84 0 91

Delaware 12/31/2016 1 0 1 2 1 0 0 2 0 3 0 5

Florida 12/31/2016 4 0 2 6 13 0 6 31 3 53 0 59

Idaho 12/31/2016 0 0 0 0 15 0 0 0 0 15 0 15

Illinois 12/31/2016 1 0 0 1 62 0 0 0 0 62 0 63

Iowa 12/31/2016 1 3 2 6 12 1 0 0 0 13 0 19

Kansas 12/31/2016 4 1 6 11 6 33 1 0 1 41 0 52

Maine 12/31/2016 2 0 1 3 8 19 0 32 4 63 0 66

Maryland 12/31/2016 27 0 1 28 104 26 17 154 6 307 0 335

Massachusetts 12/31/2016 5 0 0 5 21 44 11 55 5 136 0 141

Michigan 11/29/2016 0 0 0 0 35 4 0 0 0 39 0 39

Minnesota 12/31/2016 2 0 5 7 36 10 1 0 0 47 0 54

Missouri 12/24/2016 1 1 1 3 17 5 0 0 0 22 0 25

Montana 09/14/2016 0 0 0 0 10 0 0 0 0 10 0 10

Nebraska 12/31/2016 0 0 1 1 11 4 0 0 0 15 0 16

New Hampshire 12/31/2016 0 0 0 0 4 6 5 6 2 23 0 23

New Jersey 12/31/2016 24 1 0 25 59 25 9 137 7 237 0 262

New Mexico 12/31/2016 0 0 0 0 0 4 0 0 0 4 0 4

New York 5/31/2016 6 0 5 11 10 69 11 98 4 192 0 203

North Carolina 12/31/2016 10 2 4 16 26 38 51 117 3 235 0 251

North Dakota 5/31/2016 1 1 7 9 0 7 0 0 0 7 0 16

Ohio 12/31/2016 0 0 0 0 36 0 0 0 5 41 0 41

Oregon 11/14/2016 0 0 0 0 14 0 0 0 0 14 0 14

Pennsylvania 12/31/2016 49 2 14 65 67 50 32 177 13 339 0 404

South Carolina 12/31/2016 6 4 1 11 10 18 11 43 1 83 0 94

Vermont 12/31/2016 1 0 2 3 9 10 5 21 0 45 0 48

Virginia 12/31/2016 25 4 17 46 16 90 27 158 5 296 0 342

West Virginia 12/31/2016 2 0 1 3 6 5 3 11 0 25 0 28

182 21 76 279 918 615 220 1,134 69 2956 0 3235

Total

TOTAL

State* Data up toDomestic Wild

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Animal Disease Summary: Army Rabies Testing

Laboratory Sciences Animal Rabies Testing, 2016

Rabies animal testing increased in 2016 compared to 2015. The proportion of specimens testing indeterminate and positive was stable in both years (6-9%).

Rabies-positive samples were identified in 2 stray animals from Afghanistan and 8 wild animals from across the U.S.

Note: Only states/countries that submitted specimens are included.

*Central Command: Afghanistan, Kuwait. Europe: Germany, Italy. Pacific: Japan, WA, CA (excluding 29 Palms).

**DFA: Direct Fluorescent Antibody

Overall, the number of samples submitted from 2015 to 2016 were very similar. From 2014 to 2015, a large decrease in samples tested occurred due to a reduction in the number of samples submitted from Afghanistan. However, the number of samples that tested DFA-positive or indeterminate has remained stable from 2014-2016.

As the majority of samples submitted in 2016 were from CONUS installations, the species of animals testing positive/indeterminate in 2016 (bats, stray dogs, stray cats, skunks, and raccoons) reflect several animal types known to be at higher risk of rabies infection in the United States.

Two DoD laboratory facilities perform rabies testing on animal samples: the PHC-Europe Laboratory Sciences in Germa-ny and the DoD Food Analysis and Diagnostics Laboratory (FADL) in Texas.

In 2016, 116 total animal specimens associated with 70 human exposures were submitted for rabies testing; 115 sam-ples were tested (1 was unable to be tested due to sample quality issues and was deemed an ‘indeterminate’ result).

Ten samples (9%) tested Direct Fluorescent Antibody (DFA)-positive; 1 sample was DFA-indeterminate (1%).

Overall 23 more animal samples were submitted for testing in 2016 compared to 2015. The proportion of samples testing DFA-positive or indeterminate were fairly stable from 2015 to 2016: roughly 6% of samples were DFA-positive in 2015, compared to 9% in 2016.

0

1

2

3

4

Bat Canine Skunk Raccoon Feline Fox Oppossum

Nu

mb

er

DFA-Positive and Indeterminate Rabies Results, by Species 2015-2016

2015 Positive 2015 Indeterminate 2016 Positive 2016 Indeterminate

No. % No. %

Central Command 6 3 0 0 2 33

Europe 6 2 0 0 0 0

Unknown 1 0 0 0 0 0

Pacific 13 7 0 0 1 8

Central 61 44 0 0 5 8

Atlantic 29 14 1 3 2 7

116 70 1 1 10 9

DFA-PositiveDFA**-Indeterminate

FADL

TOTAL

Testing OrganizationSubmitting Location

Region*No. Tested

No. Human

Exposures

Europe

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Animal Disease Summary: Army Rabies Testing Rabies Testing by PHC-Europe Laboratory Sciences, 2016

In 2016, PHC-Europe Laboratory Sciences tested 13 total samples for rabies: four canines, five bats, and four felines. Four canine samples and four feline samples were from stray animals. A total of five human exposures were associated with the nine tested samples.

All samples were tested by DFA, the gold standard. Two samples (15%) tested positive.

Five samples were also tested using polymerase chain reaction (PCR); all were negative. Of all of the samples, virus isolation via Mouse Neuroblastoma Antibody (MNA) testing was not performed.

All samples that originated from Europe tested negative. The only positive DFA samples were from Afghanistan.

*NAMRU-3: Naval Medical Re-search Unit - No. 3 HKIA: Hamid Karzai International Airport AFB: Air Force Base **Indeterminate abbreviated “Indet.” ***Mouse Neuroblastoma Cells.

U.S. military installations in PHCs-Atlantic, Central, and Pacific submitted 103 samples to the DoD FADL for ra-bies testing in 2016. Specimens were associated with 65 human exposures. The number of specimens submitted in 2016 increased from the number submitted in 2015.

One sample was DFA-indeterminate. The sample was unable to be tested due to sample quality issues or other issues that precluded testing and was deemed ‘indeterminate’ results.

Eight samples were DFA-positive: 1 bat and 3 skunks from Arizona, 1 bat from Texas, 1 fox from New York, 1 bat from California, and 1 bat from Delaware. Overall, 8% of specimens tested by the FADL were positive for rabies. Three humans were exposed to a positive bat in Arizona.

Rabies post-exposure human vaccination should be dis-continued if tests of the involved animal are rabies-negative5.

For detailed location information on DoD animal rabies testing, see Appendix A on page 24.

Rabies Testing by the FADL, 2016

Summary: Rabies remains a threat in stray animals in Afghanistan. Of only 3 samples tested, 2 were rabies positive.

Rabies in wild animals in the United States remains a threat; rabies was identified in three different wild animal species.

Canine 7 8 0 0

Fox 1 0 0 0 1 100

Oppossum 1 0 1 100 0

Bat 6 2 0 1 17

Feline 5 2 0 0

Racoon 6 1 0 0

Rat/Mouse 1 1 0 0

Woodchuck 2 0 0 0

TOTAL 29 14 1 3 2 7

Bat 34 13 0 2 6

Canine 10 14 0 0

Deer 1 0 0 0

Feline 6 8 0 0

Pocket gopher 1 1 0 0

Racoon 4 8 0 0

Skunk 5 0 0 3 60

TOTAL 61 44 0 5 8

Bat 1 0 0 1 100

Canine 5 2 0 0

Coyote 1 1 0 0

Feline 5 4 0 0

Rabbit 1 0 0 0

TOTAL 13 7 0 1 8

103 65 1 1 8 8TOTAL

Pacific

DFA-Positive

No. %

Atlantic

Central

Region Species Tested No. Tested

No.

Human

Exposures

No. DFA-Indeterminate

No. %

No. % No. %

NAMRU-3 Egypt Feline 1 0 0 0 0 0 0 Y

Canine 1 0 0 1 1 0 0 N

Feline 1 2 0 0 0 0 0 Y

HKIA, Kabul Canine 1 1 0 1 1 0 0 N

Kaiserslautern Bat 5 1 0 0 0 0 0 N

Spangdahlem AFB Feline 1 1 0 0 0 0 0 Y

Camp Arifjan Kuwait Canine 1 0 0 0 0 0 0 Y

NSA Bahrain Bahrain Feline 1 0 0 0 0 0 0 Y

Unknown Unknown Canine 1 0 0 0 0 0 0 N

13 5 0 2 15 0 0TOTAL

Germany

No. DFA-

Indet.**

DFA-Positive MNA*** Indet. PCR

Performe

d (Y/N)

AfghanistanBagram

CountryLocation* Species No. TestedNo.

Human

Exposures

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Animal Disease Summary: Veterinary Surveillance

Zoonotic Diseases Identified in U.S .Army Veterinary Medical Records in ROVR

Summary: The most common zoonotic diagnoses reported in the Remote Online Veterinary Record (ROVR) in 2015 and 2016 were borreliosis and ehrlichiosis, both tick-borne diseases. Most diagnoses in 2016 were among privately owned animals (246). No zoonotic diseases in species other than canines were identified.

The most common zoonoses diagnosed in 2016 were borreliosis (47%, 152/325) and ehrlichiosis (33%, 106/325). Most of the borreliosis cases (34%, 112/325) were identified at veterinary treatment facilities (VTFs) in the PHC-Atlantic region.

PHC-Atlantic: There were 184 zoonotic diagnoses in 2016, compared to 280 in 2015. Of the 184 diagnoses, 61% (112/184) were Lyme borreliosis. This proportion is fairly similar to the 2015 proportion of 53%. The remaining 39% identified were ehrlichiosis (26%), anaplasmosis (9%), RMSF (2%), babesiosis (1%), leishmaniasis (1%), and leptospirosis (1%).

PHC-Central: Of 107 zoonoses, 41% were ehrlichiosis and 24% were Lyme borreliosis. In 2015, the two most common diagnoses were ehrlichiosis and Lyme borreliosis. All (11) of the trypanosomiasis diagnoses were identified in PHC-Central. The majority of RMSF cases (63%, 5/8) were also identified in this region.

PHC-Pacific: 13 zoonoses were identified in 2016; whereas, in 2015, 38 zoonotic diagnoses were identified. The most common zoonotic diagnosis in 2016 was Lyme borreliosis (54%, 7/13), and the most common zoonotic diagnosis in 2015 was ehrlichiosis (46%).

PHC-Europe: 21 zoonoses were diagnosed in 2016, compared to 10 diagnoses in 2015. The most common zoonotic diagnosis was ehrlichiosis (37%), followed by Lyme borreliosis (33%).

Military Working Dog, Source: APHC

*GOA: Government-Owned Animal **POA: Privately Owned Animal.

*Diagnoses may represent exposure (positive serology) and not necessarily clinical disease. Animals diagnosed in one region may have been exposed elsewhere (see Appendix B on page 25 for diagnosis locations).

187

37

22

159

33

414

6

152

20 22

106

4 28 11

0

20

40

60

80

100

120

140

160

180

200

Num

ber o

f Cas

esSelected Zoonotic Disease Diagnoses* Recorded in

ROVR, 2015-2016

2015

2016

Babesiosis Leishmaniasis Leptospirosis Trypanosomiasis

GOA* POA** GOA GOA POA GOA POA POA POA GOA POA GOA

Atlantic 2 15 2 2 110 12 36 1 1 2 1 0

Central 1 19 12 14 7 37 1 5 11

Pacific 1 3 4 1 4

Europe 2 7 9 3

Total 2 18 22 17 135 20 86 4 2 7 1 11

Disease Total 22 4 2 11

RegionAnaplasmosis Borreliosis Ehrlichiosis RMSF

20 152 106 8

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Vector Surveillance: Mosquito Summary-West Nile Virus and Other Pathogens

Military Mosquito Pool Testing for WNV in the United States, 2016

The most common mosquito type tested for WNV was Culex spp. 94% of mosquitoes tested were Culex spp., followed by Aedes spp. (5%), Culiseta spp. (<1%), and Anopheles spp. (<1%).

Most of the pools were collected and tested by PHC-Atlantic (55%, 2791/5067), followed by PHC-Central (32%, 1631/5067), PHC-Europe (12%, 610/5067), and PHC-Pacific (1%, 35/5067).

All WNV-positive pools contained Culex spp. mosquitoes. No other mosquito types tested positive in 2015 or 2016.

For detailed location information on military mosquito testing, see Appendix C on page 26.

The majority of positive pools identified were located in the PHC-Atlantic region; 65 pools (78%, 65/83) tested positive for WNV; 62% of the positive pools in PHC-Atlantic were collected during Morbidity and Mortality Weekly Report (MMWR) weeks 33 and 34 in August 2016.

Most of the mosquitoes submitted for testing by PHC-Atlantic were collected in Washington, D.C. (19,370), and this area also had the most WNV-positive pools (56), accounting for 86% of the WNV-positive pools in PHC-Atlantic.

PHC-Central and PHC-Pacific regions had the greatest diversity of mosquito types tested, including Culex spp., Aedes spp., Anopheles spp., and Culiseta spp. All of the Culiseta spp. mosquitoes were collected by PHC-Pacific (282).

5.24%0.04%

94.15%

0.57%

Mosquitoes Tested for WNV by Genera, 2016

Aedes

Anopheles

Culex

Culiseta

Military Mosquito Testing for Other Pathogens, 2016

PHC-Atlantic tested 7,401 mosquitoes for chikungunya, dengue, and Zika viruses, and all were negative.

PHC-Central tested 2,567 mosquitoes for chikungunya and Zika viruses, and all were negative.

PHC-Pacific tested 5,271 mosquitoes for chikungunya virus, 5,372 mosquitoes for dengue virus, 6,385 mosquitoes for Zika virus, and 3,167 mosquitoes for Japanese encephalitis virus. All specimens tested negative for these diseases.

PHC-Europe tested 81 mosquitoes from Djibouti for select viral and protozoan pathogens; all samples were negative. In 2015, 259 arthropod specimens were tested; none were positive. The plasmodium spp. protozoan is the malaria pathogen.

*Mosquitoes may be tested for more than one pathogen; e.g., Aedes spp. mosquitoes tested for chikungunya virus may also be tested for dengue virus.

Anopheles spp. Culex spp.

Chikungunya

virusDengue virus Zika virus Plasmodium spp.

Japanese

encephalitis

Virus

Atlantic 7401 7401 7401

Central 2567 2567

Pacific 5271 5372 6385 3167

Europe 1 1 80

TOTAL 15240 12774 16353 80 3167

Aedes spp.

Region

No. Mosquitoes Tested*

RegionNo. Pools

Tested

No.

Mosquitoes

Tested

No. Pools

Positive

Atlantic 2791 29979 65

Central 1631 18241 17

Pacific 35 475 1

Europe 610 715 0

TOTAL 5067 49410 83

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Vector Surveillance: Mosquito Summary-West Nile Virus Results

Military Mosquito Testing for WNV in the United States, 2016

In 2016, 49,410 mosquitoes were collected and tested for WNV by military assets.

Four mosquito genera were tested for WNV, the majority of which were Culex spp. (94%, 46,521/49,410).

More mosquito pools were tested for WNV in 2016 compared to 2015 (5,067 pools v. 1,964 pools, respectively). However, more pools tested positive for WNV in 2015 than 2016 (111 v. 83, respectively).

The majority of military WNV testing efforts in the eastern part of the United States in 2016 were centered on the Washington, D.C. area (65%, 19,370/29,979).

In the southern part of the United States in 2016, military WNV mosquito testing focused on installations in Texas, specifically Lackland AFB, Randolph AFB, Ft. Bliss, Ft. Hood, Camp Bullis, JBSA-Ft. Sam Houston, Corpus Christi Army Depot/Air Station, and the Red River Army Depot.

All maps were produced by the Army Public Health Center’s Geographic Information System Office, Information Management Division.

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Vector Surveillance: Mosquito Summary-WNV Results

The highest minimum infection rate (MIR) was observed at Beale AFB (MIR=142.9 infected female Culex spp. mosquitoes per 1,000 females tested). However, low numbers of mosquitoes were tested (<10), so this MIR is unlikely to be statistical-ly significant.

The next highest MIRs were observed at the Naval Support Center (MIR=13.0) and the U.S. Naval Observatory (MIR=11.7), which are both in the D.C./Maryland/Virginia (DMV) area. However, the state with the overall highest MIR was New York (MIR=6.1). In contrast, an overall MIR of 0.4 was observed in Louisiana and Georgia and 0.8 in Kentucky. In 2015, Wash-ington, D.C. had an overall MIR of 9.0 versus 2.9 in 2016.

With over 5,000 Culex spp. mosquitoes tested, Ft. Hood, Texas had a yearly WNV MIR of 2.4. Ft. Bliss, Texas had a yearly MIR of 1.1.

Altus AFB, California had a yearly MIR of 8.7 with 1 positive mosquito pool identified. One positive WNV mosquito pool was identified from Ft. Polk, Louisiana (MIR=0.4).

All WNV-positive pools were Culex spp. mosquitoes. No other mosquito types tested positive in 2015 or 2016.

*Although other mosquito species were tested, the map above only illustrates Culex spp. testing and does not include testing at outside Continental United States locations.

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Vector Surveillance: Tick Summary Tick Collecting by Genus, Collection Method, and Testing Entity, 2016

In 2016, a total of 4189 ticks were tested by PHC laboratories and the DoD Human Tick Test Kit Program (HTTKP) for select pathogens.

The HTTKP exclusively tests ticks removed from humans. The regional laboratories tested ticks collected from the environment (e.g., tick drags), removed from animals (wild and domestic), and humans.

The majority of ticks (64%) tested in 2016 were Amblyomma americanum. Since tick type (species) determines pathogen testing; the majority of pathogens tested for were of the Ehrlichia genera (Ehrlichia chaffeensis, E. ewingii and the novel pathogen Panola Mountain Ehrlichia (PME)).

* Tick origin may differ from tick testing location (e.g., ticks collected in Africa may have been tested by PHC-Europe laboratory.) ** Ticks may be tested for more than one pathogen (e.g., I. pacificus ticks tested for A. phagocytophilum may also be tested for Borrelia spp.) ***Tick-borne encephalitis Virus (TBEV)

64.05%

11.58%

24.35%

0.02% (Rhipicephalus)

2016 Tick Testing by Tick Genus

Amblyomma

Dermacentor

Ixodes

Rhipicephalus

OCONUS Origin Tick Testing Results, 2016

Tick samples from three countries in Europe were tested by PHC-Europe in 2016. Less testing occurred in 2016 than in 2015. In 2015, seven countries in Europe, Africa, and Asia were tested by PHC-Europe and PHC-Atlantic.

2% (3/182) of ticks from Germany tested positive for Anaplasma phagocytophilum, and 2% of ticks from Germany (3/128) were positive for Ehrlichia spp.

1 of 4 ticks from Belgium tested Borrelia spp. positive and 4% (6/166) of ticks from Germany were Borrelia spp. positive.

No ticks tested positive for TBEV.

*(IP): Infection Prevalence is calculated when ticks are not pooled for testing, the formula is: IP=[number positive

No.

Tested

No. Pos

(IP)*

No.

Tested

No. Pos

(IP)

No.

Tested

No. Pos

(IP)

Belgium 4 0 4 0 4 0

Germany 182 3 (1.6) 182 3 (1.6) 182 0

Italy 1 0

Europe

TBEV

Region Country

A. phagocytophilum Borrelia spp.

Anaplasma Babesia Viruses

A. phago-

cytophilum

B.

microti

E.

chaffeensis

E.

ewingiiPME

B.

spp.

B.

burgdorferi

B.

miyamotoi

R.

andeanae

R.

parkeri

R.

rickettsiiTBEV***

Collection Method Testing Region*

Animal (wild & domestic) Atlantic 184 184 140 140 184 184 1 3

Animal (domestic) Europe 89 89 89

Environment Atlantic 361 361 85 85 361 361 3

Environment Europe 1 1 1

Environment Pacific 13

Human Europe 96 96 96

Human HTTKP 289 289 2452 2452 2452 289 5 5 467

1020 834 2677 2677 2452 186 834 545 5 6 486 186TOTAL

Ehrlichia Borrelia Rickettsia

Number of Ticks Tested**

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Vector Surveillance: Tick Summary Anaplasmosis Pathogen Identified in Ticks by Submitting Installation in the United States, 2016

In 2016, continental U.S. (CONUS) military laboratories received and individually tested 834 Ixodes spp. ticks (scapularis and pacificus) for the bacteria Anaplasma phagocytophilum - the pathogen that causes human granulocytic anaplasmosis.

A total of 71 infected with A. phagocytophilum were identified; 37 positive ticks were collected from the environment, 21 ticks were removed from deer, and 13 ticks were removed from humans and submitted to the HTTKP. In 2015, 65 ticks infected with A. phagocytophilum were identified.

14 Ixodes ticks were co-infected with A. phagocytophilum and Borrelia burgforeri, and 1 Ixodes tick was co-infected with A. phagocytophilum, B. burgdorferi, and B. miyamotoi. 9 co-infected ticks were collected from the environment at Ft. Drum, New York and 6 were submitted to the HTTKP.

The infection prevalence (IP) of A. phagocytophilum ranged from 2% at Aberdeen Proving Ground, Maryland to 50% from tick samples from Naval Weapons Station Earle, New Jersey*.

The three areas with the highest IP were Naval Weapons Station Earle, New Jersey* (50%), Adelphi Laboratories, Maryland (32%), and JB McGuire-Dix-Lakehurst, N* (29%).

=

*Low numbers of ticks were tested at this location (n<10)

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Vector Surveillance: Tick Summary Lyme Disease Pathogen Identified in Ticks by Submitting Installation in the United States, 2016

In 2016, CONUS military laboratories received and individually tested 834 Ixodes spp. ticks (scapularis and pacificus) for the bacteria Borrelia burgdorferi, the pathogen that causes Lyme disease.

A total of 280 ticks infected with B. burgdorferi were identified; 184 ticks were collected from the environment, 82 were removed from humans and submitted to the HTTKP, and 14 were removed from deer. In 2015, 254 ticks infected with B. burgdorferi were identified.

28 Ixodes ticks were co-infected with B. burgdorferi and B. miyamotoi. 21 co-infected ticks were collected from the environment at Ft. Drum, New York, 1 co-infected tick was removed from a deer at Blossom Point Field Test Facility, Maryland, and 6 were submitted to the HTTKP.

The IP of B. burgdorferi ranged from 7% at Blossom Point Field Test Facility, Maryland to 100% from tick samples from Bolling AFB, D.C.*.

The two areas with the highest IP were Bolling AFB, D.C. * (100%) and Ft. Drum, New York* (67%).

*Low numbers of ticks were tested at this location (n<10)

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Vector Surveillance: Tick Summary Human Monocytic Ehrlichiosis Pathogen Identified in Ticks by Submitting Installation in the United States, 2016

In 2016, CONUS military laboratories received and individually tested 2,677 Amblyomma americanum ticks for the bacteria Ehrlichia chaffeensis, the pathogen that causes ehrlichiosis.

A total of 27 ticks infected with E. chaffeensis were identified; 23 positive ticks were removed from humans and submitted to the HTTKP, 2 were removed from a horse, 1 was removed from a deer, and 1 was collected from the environment. In 2016, 32 ticks and 1 pool infected with E. chaffeensis were identified.

The IP of E. chaffeensis ranged from 1% at Aberdeen Proving Ground, Maryland; Ft. Knox, Kentucky; and Wendell H. Ford Regional Training Center (WHFRTC) to 100% from tick samples from Ft. Stewart, Georgia*.

The two areas with the highest IP were Ft. Stewart, Georgia* (100%) and JB Andrews, Maryland (4%).

*Low numbers of ticks were tested at this location (n<10)

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Vector Surveillance: Tick Summary Panola Mountain Ehrlichiosis Pathogen Identified in Ticks by Submitting Installation in the United States, 2016

In 2016, CONUS military laboratories received and individually tested 2,452 Amblyomma spp. ticks for Panola Mountain Ehrlichia (PME).

A total of 25 ticks infected with PME were identified; all positive ticks were removed from humans and submitted to the HTTKP.

The IP of PME ranged from 1% at Aberdeen Proving Ground, Maryland and Ft. Knox, Kentucky to 33% at Ft. Bragg, North Carolina*.

*Low numbers of ticks were tested at this location (n<10)

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Vector Surveillance: Tick Summary Spotted Fever Group Rickettsioses Identified in Ticks by Submitting Installation in the U.S., 2016

In 2016, CONUS military laboratories received and individually tested 485 Dermacentor spp. ticks, 1 Rhipichepalus sanguineus tick, and 6 Amblyomma maculatum ticks for various spotted fever group rickettsioses (Rickettsia andeanea, R. parkeri, and R. rickettsii).‡

1 A. maculatum tick was infected with R. parkeri and the tick was removed from a human.

The infection prevalence (IP) of R. parkeri was 33% at Ft. Campbell, Kentucky*.

‡All ticks were not tested for all pathogens. *Low numbers of ticks were tested at this location (n<10)

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Vector Surveillance: Tick Summary Anaplasmosis Pathogen Identified in Ticks by Submitting Installation in Europe, 2016

In 2016, military laboratories in Europe received and individually tested 186 Ixodes ricinus ticks for the bacteria Anaplasma phagocytophilum, the pathogen that causes human granulocytic anaplasmosis.

A total of 3 ticks infected with A. phagocytophilum were identified; 2 positive ticks were removed from an unidentified domestic animal and 1 tick was removed from a human.

The infection prevalence (IP) of A. phagocytophilum ranged from 5% at Stuttgart Army Health Clinic (AHC), Germany to 10% at Ansbach VTF, Germany.

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Vector Surveillance: Tick Summary Borrelia Species Pathogenic Organisms Identified in Ticks by Submitting Installation in Europe, 2016

In 2016, military laboratories in Europe received and individually tested 186 Ixodes ricinus ticks for Borrelia species pathogenic organisms.

A total of 3 ticks infected with Borrelia spp. were identified; 2 positive ticks were removed from an unidentified domestic animal, and 1 tick was removed from a human.

The IP of Borrelia spp. ranged from 4% at Ramstein Air Base (AB), Germany to 10% at Ansbach VTF, Germany.

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Vector Surveillance: Tick Summary

Department of Defense Human Tick Test Kit Program, 2016

In 2016, 3,213 ticks removed from humans in the United States were submitted to the DoD Human Tick Test Kit Program (an increase of 95 ticks compared to 2015). The majority of ticks were submitted from states in PHC-Atlantic in the eastern United States.

The majority of all ticks tested (58%) were submitted from Ft. Knox, Kentucky.

The proportion of Ixodes scapularis which tested positive for the Lyme disease pathogen Borrelia burgdorferi (29%) in 2016 was similar to the proportion positive in 2015 (31%).

In 2016, 1 out of 5 (20%) of the Amblyomma maculatum tested for Rickettsia parkeri were positive. In comparison, 1 out of 16 (6%) A. maculatum tested in 2014 were infected.

No ticks infected with R. rickettsii were identified in 2016, 2015, or 2014.

IP is calculated when ticks are not pooled for testing. The formula is: IP=[number positive ticks]/[number ticks tested]*100 ᵟ Dermacentor andersoni ¥ Dermacentor variabilis † Panola Mountain Ehrlichia ⱡ Rhipicephalus sanguineus

Babesia Borrelia Babesia Borrelia Rickettsia

microti burgdorferi microti burgdorferi E. ewingii PME† andeanae

StateNo.

Tested

No. Pos

(IP)*No. Pos (IP) No. Pos (IP)

No.

Tested

No. Pos

(IP)*

No. Pos

(IP)*No. Pos (IP)*

No.

Tested

No. Pos

(IP)No. Pos (IP)

No. Pos

(IP)

No. Pos

(IP)

No.

Tested

No. Pos

(IP)

No.

Tested

No. Pos

(IP)

No.

Tested

No. Pos

(IP)

No.

Tested

No. Pos

(IP)

No. Pos

(IP)

AL 1 0 0 0 10 0 0 4 0 1 0

AR 5 0 0 0 1 0

CA 3 0 0 0 4 0

CO 1 0

CT 48 2 (4.2) 4 (8.3) 15 (31.25) 11 0

DC 1 0 0 1 (100) 7 0 0 0 1 0

DE 15 0 0 0 9 0

FL 3 0 0 0 1 0 0 0 2 0

GA 1 0 0 0 1 1 (100) 0 0

IL 1 0 0 0 2 0

IN 1 0 0 0 1 0

KS 1 0 0 0 40 1 (2.5) 0 1 (2.5) 11 0

KY 5 0 0 0 1757 15 (0.9) 16 (0.9) 18 (1.0) 190 0 3 0 1 (33.3)

MA 18 1 (5.6) 0 4 (22.2) 10 0

MD 69 1 (1.4) 0 18 (26.1) 211 2 (0.9) 4 (1.9) 2 (0.9) 91 0

ME 9 0 2 (22.2) 4 (44.4) 8 0

MN 12 0 0 1 (8.3) 1 0

MO 18 0 0 0 4 0

NC 9 0 0 1 (11.1) 1 0

NJ 14 4 (28.6) 0 6 (42.9) 103 2 (1.9) 3 (2.9) 0 13 0

NY 3 0 1 (33.3) 2 (66.7)

OK 4 0 0 0 1 0 0

PA 53 1 (1.9) 2 (3.8) 19 (35.8) 6 0 0 0 25 0

RI 26 3 (11.5) 1 (3.8) 7 (26.9) 2 0 0 0 24 0

SC 7 0 0 0

TX 5 0 0 0 1 0

VA 14 0 0 2 (14.3) 250 2 (0.8) 0 3 (1.2) 0 22 0

WA 1 0

WI 7 1 (14.3) 1 (14.3) 3 (42.9) 29 0

Rickettsia

parkeriphagocytophilum E. chaffeensis

Rickettsia

andeanae

Rickettsia

rickettsii

Ixodes scapularis D. variabilis ¥Ixodes pacificus Amblyomma americanum A. maculatumR. sanguineusⱡD. andersoni ᵟ

Anaplasma Rickettsia

rickettsii

EhrlichiaAnaplasma

phagocytopilum

Rickettsia

rickettsii

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Focus On: Leishmaniasis in Humans

Background: Leishmania protozoan parasites are transmitted by the bite of infected female phlebotomine sand flies.7

Each year, there are an estimated 700,000 to 1 million new cases of leishmaniasis worldwide, leading to 20,000 to 30,000 deaths.7

Most cases of leishmaniasis occur in Asia, the Middle East, Africa, Southern Europe, Mexico, Central America, and South

America.8 Within the United States, occasional cases of cutaneous leishmaniasis have been acquired in Texas and Oklahoma, along

with cases imported from around the world.8

Clinical Features and Epidemiology: Leishmaniasis can manifest in 3 forms: cutaneous, visceral, and mucocutaneous. Cutaneous leishmaniasis is the most

common form of the disease and causes a sore to form on the skin’s surface several weeks or months after the bite. Visceral leishmaniasis can develop within months or years after the sand fly bite and can cause life-threatening damage to internal organs.9

There are about 20 species of disease-causing Leishmania parasites, spread by about 30 different species of phlebotomine sand flies. The flies are most active from dusk to dawn.8

Infected animals, including rodents and dogs, act as reservoirs for the parasite, maintaining the cycle by transmitting the parasite to uninfectedsand flies when bitten. The parasites require both mammal and sand fly host stages in order to complete their life cycle. In some areas, leishmaniasis transmission is anthroponotic, meaning the disease is spread from humans to flies and back to humans, without an animal intermediary.10

Outlook: Protection from sand fly bites is

the best way to prevent infection, as no vaccines or drugs are available to prevent infection.

Common methods used to

prevent mosquito bites, such as wearing long pants and shirts, using insect repellents, and sleeping in well-screened areas or under bed nets can all help prevent sand fly bites.11

Leishmaniasis transmission through animal and human vectors

Phlebotomus papatasi sand fly, which is re-sponsible for the spread of Leishmaniasis.

These sand flies are about one third the size of typical mosquitos.

Photo courtesy of CDC.

Leishmaniasis can cause cutaneous skin

lesions as seen here. Photo courtesy of CDC.

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State Animal Rabies Testing

References: Data Sources

For this report, zoonotic diseases are defined as diseases with an animal host or reservoir that can be transmitted to a human. RME case reports and medical encounters were queried as suggested in the 2012 and 2017 Armed Forces RME Guidelines and Case Definitions. Modifications were applied such that only medical encounters with any of the defining diag-noses in the first four diagnostic positions were considered a case as opposed to any diagnostic position. This modification reduces the selection of potential chronic disease events. More information on these rules can be found here: https://www.health.mil/Military-Health-Topics/Health-Readiness/Armed-Forces-Health-Surveillance-Branch/Epidemiology-and-Analysis/Surveillance-Case-Definitions.

M2 is a web-based data repository that contains select information on MTF medical records, personnel data, ancillary care records, and Tricare insurance claims for non-MTF care. M2 was queried based on zoonotic disease International Classifica-tion of Diseases, 9th Edition (ICD-9) and ICD-10 codes as referenced in the 2012 and 2017 Armed Forces RME Guidelines and Case Definitions. ICD codes listed in the first four diagnostic fields were used to select inpatient and outpatient medical en-counters from the year of interest based on the encounter date in M2. Direct-care records from Army and Joint Base MTFs and purchased-care records from non-MTFs in their designated catchment areas were included. Historic medical data for the prior 5 years were also reviewed to exclude chronic or previously diagnosed infections.

DRSi is a Web-based application developed by the Navy and Marine Corps Public Health Center (NMCPHC) that all Services use to monitor RMEs. Cases that meet RME case definitions are entered into DRSi by individuals at MTFs. These medical event reports are reviewed by the APHC Disease Epidemiology Division for completeness and accuracy. For this report, only RME records that are considered final with a case status of confirmed or probable are included; records were queried using date of diagnosis.

ROVR is a secure application that electronically stores and transmits elements of Army veterinary clinical encounters at all levels of care for animals owned by the government (all agencies) or DoD Families. Deployment of ROVR began in January 2014, and full DoD-wide implementation at all VTFs occurred in May 2014. ROVR has a searchable database that is populated by medical entries from patient medical encounters. ROVR was queried for select zoonotic diseases for all species by a veterinarian, and results were sent to the APHC Disease Epidemiology Division.

U.S. Army Public Health Center Entomological Sciences Division

The Entomological Sciences Division of the Environmental Health Sciences & Engineering Directorate at the APHC and Labor-atory Sciences at each PHC (Europe, Pacific, Atlantic, Central) completed all of the vector surveillance testing (mosquito, tick, etc.) and U.S. Army installation-related rabies specimen testing. Each PHC collates the results from their area of responsibility for the calendar year and sends the data to the APHC Disease Epidemiology Division.

Case Definitions and Incidence Rules Used for Human Zoonotic Disease Surveillance

The Military Health System Management Analysis and Reporting Tool (M2)

Disease Reporting System-internet (DRSi)

Each U.S. state is responsible for animal rabies testing and publishing results. APHC personnel query each state’s official Web site to identify animal rabies testing information. All information is compiled and summarized.

Remote Online Veterinary Record (ROVR)

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Appendix A: Animal Rabies Testing by the DoD Food Analysis & Diagnostics Laboratory (FADL)

Testing by State or Country of Submission and Animal Species, 2016

NAS: Naval Air Station; NB: Naval Base; NSB: Naval Submarine Base.

TABLE CONTINUED ON NEXT PAGE

Region Submitting LocationState/

CountrySpecies

No.

Tested

No.

Human

Exposures

No. DFA-

Indeterminate

% DFA-

Indeterminate

No. DFA-

Positive

% DFA-

Positive

Feline 1 0 0 0 0 0

AL Total 1 0 0 0 0 0

Bat 1 0 0 0 0 0

CT Total 1 0 0 0 0 0

Bat 1 0 0 0 1 100

DE Total 1 0 0 0 1 100

Canine 1 1 0 0 0 0

FL Total 1 1 0 0 0 0

Canine 3 4 0 0 0 0

Raccoon 2 0 0 0 0 0

GA Total 5 4 0 0 0 0

Bat 1 1 0 0 0 0

Raccoon 1 1 0 0 0 0

Feline 3 1 0 0 0 0

KY Total 5 3 0 0 0 0

Canine 1 1 0 0 0 0

NC Total 1 1 0 0 0 0

Bat 1 1 0 0 0 0

Fox 1 0 0 0 1 100

Raccoon 3 0 0 0 0 0

Ground Hog 1 0 0 0 0 0

Woodchuck 1 0 0 0 0 0

Oppossum 1 0 1 100 0 0

NY Total 8 1 1 13 1 13

Rat/Mouse 1 1 0 0 0 0

OH Total 1 1 0 0 0 0

Canine 2 1 0 0 0 0

Bat 2 0 0 0 0 0

VA Total 4 1 0 0 0 0

Feline 1 1 0 0 0 0

Cuba Total 1 1 0 0 0 0

FLNAS Jacksonville

VA

NYWest Point USMA

OHWright Patterson AFB

Ft. Bragg NCAtlantic

KYFt. Campbell ● Ft. Knox

ALFt. Rucker

CTNSB New London

GAFt. Stewart ● Ft. Gordon

DEDover AFB

Ft. Belvoir ● Ft. Eustis

Guantanamo Bay NB Cuba

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Appendix A: Animal Rabies Testing by the DoD Food Analysis & Diagnostics Laboratory (FADL), Continued

Testing by State or Country of Submission and Animal Species, 2016

*Twentynine Palms is located in PHC-Central. The other two installations in California that submitted samples are part of PHC-Pacific.

Region Submitting LocationState/

CountrySpecies

No.

Tested

No.

Human

Exposures

No. DFA-

Indeterminate

% DFA-

Indeterminate

No. DFA-

Positive

% DFA-

Positive

Pocket Gopher 1 1 0 0 0 0

Bat 2 3 0 0 1 50

Skunk 5 0 0 0 3 60

AZ Total 8 4 0 0 4 50

Canine 1 1 0 0 0 0

Raccoon 1 0 0 0 0 0

CO Total 2 1 0 0 0 0

Feline 2 5 0 0 0 0

Bat 3 4 0 0 0 0

Raccoon 2 6 0 0 0 0

KS Total 7 15 0 0 0 0

Canine 1 1 0 0 0 0

LA Total 1 1 0 0 0 0

Feline 2 2 0 0 0 0

Raccoon 1 2 0 0 0 0

MO Total 3 4 0 0 0 0

Canine 1 0 0 0 0 0

NM Total 1 0 0 0 0 0

Canine 1 7 0 0 0 0

OK Total 1 7 0 0 0 0

Canine 6 5 0 0 0 0

Feline 2 1 0 0 0 0

Bat 29 6 0 0 1 0

Deer 1 0 0 0 0 0

TX Total 38 12 0 0 1 3

Feline 2 1 0 0 0 0

Canine 1 0 0 0 0 0

Rabbit 1 0 0 0 0 0

Bat 1 0 0 0 1 100

CA Total 5 1 0 0 1 20

Canine 1 2 0 0 0 0

Coyote 1 1 0 0 0 0

WA Total 2 3 0 0 0 0

Canine 3 1 0 0 0 0

Feline 2 2 0 0 0 0

Japan Total 5 3 0 0 0 0

Feline 1 1 0 0 0 0

South Korea Total 1 1 0 0 0 0

OVERALL TOTAL 103 65 1 1 8 8

Ft. Polk LA

Ft. Leonard Wood

AZFt. Huachuca

Central

Pacific

MO

KSFt. Leavenworth ● Ft. Riley

COFt. Carson

South

KoreaOsan AFB

JB Lewis-McChord

NMHolloman AFB

CACamp Pendleton ● Ft. Irwin

Twentynine Palms*

Okinawa Branch Services ●

Misawa AFBJapan

Ft. Sill OK

Ft. Hood ● JBSA-Ft. Sam

Houston ● JBSA-Lackland ●

Devine

TX

WA

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Appendix B: Veterinary Surveillance Zoonotic Diseases at U.S. Army VTFs Identified in ROVR, 2016

JRB: Joint Reserve Base; MCAS: Marine Corps Air Station; MCB: Marine Corps Base; NS: Naval Station.

Babesiosis Leishmaniasis Leptospirosis Trypanosomiasis

GOA POA GOA GOA POA GOA POA POA POA GOA POA GOA

Ft. Rucker * Redstone Arsenal AL 1 1 1

NSB New London CT 1

Dover AFB DE 1

Macdill AFB FL 1

Ft. Benning * Ft. Gordon * Ft. Stewart GA 1 3 2 1

Naval Station Great Lakes IL 3 2 1

Ft. Campbell KY 3

Hanscom AFB MA 1 25 1

Aberdeen Provgin Ground * Ft. Meade MD 5 1 14 1 8

Ft. Bragg * MCAS Cherry Point * MCB Camp

Lejeune NC 5 5 9 1

Ft. Dix NJ 1 2 1 1

Ft. Drum * West Point NY 8 49 5

Wright-Patterson AFB OH 2

Carlisle Barracks PA 1 2

NS Newport RI 2

Ft. Belvoir * Ft. Eustis * MCB Quantico VA 1 1 1 5 3 1

ATLANTIC TOTAL 2 15 2 2 110 12 36 1 1 2 1 0

Little Rock AFB AR 1

Davis-Monthan AFB AZ 3

Ft. Carson CO 1 1

Mountain Home AFB ID 1

Ft. Riley KS 1 1 4 5

Ft. Leonard Wood * Whiteman AFB MO 2 1 1 13

Minot AFB ND 1 3

Holloman AFB * Kirtland AFB NM 2 8

Ft. Sil l * Tinker AFB OK 2

Lackland AFB * Ft. Bliss * Ft. Hood * NAS Ft.

Worth JRB TX 18 10 5 5 2 1 4 11

CENTRAL TOTAL 0 1 19 12 14 7 37 0 1 5 0 11

Ft. Wainwright AK 1 1

MCAS Miramir * MCB Camp Pendleton * NAS

Lemoore CA 1 3 3

NB Guam GU 1

Kadena AB JP 1

JB Lewis-McChord * NB Kitsap-Bangor WA 2

PACIFIC TOTAL 0 0 1 3 4 1 4 0 0 0 0 0

USAG Ansbach * Incirl ik AB * USAG

Spangdahlem AB * USAG Stuttgart * USAG

Vilseck

GM 2 7 9 1

USAG Vicenza IT 2

EUROPE TOTAL 0 2 0 0 7 0 9 3 0 0 0 0

2 18 22 17 135 20 86 4 2 7 1 11

22 4 2 11TOTAL BY DISEASE STATUS 20

Ehrlichiosis RMSFState/

Country

Atlantic

152

Anaplasmosis BorreliosisRegion Location

106 8

Europe

Central

Pacific

TOTAL BY ANIMAL STATUS

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Appendix C: Mosquito Testing

Military Mosquito Testing for WNV by Mosquito Genera and Testing Region, 2016

Region Genus

No.

Mosquitoes

Tested

No. Pools

Tested

No. Pools

Positive

Culex 29979 2791 65

Region Total 29979 2791 65

Aedes 2567 598 0

Culex 15392 1013 17

Culiseta 282 20 0

Region Total 18241 1631 17

Aedes 22 2 0

Anopheles 18 2 0

Culex 435 31 1

Region Total 475 35 1

Culex 715 610 0

Region Total 715 610 0

Aedes 2589 600 0

Anopheles 18 2 0

Culex 46521 4445 83

Culiseta 282 20 0

TOTAL 49410 5067 83

PHC-Atlantic

PHC-Central

PHC-Pacific

PHC-Europe

Total

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U.S. Army Public Health Command Zoonotic Disease Summary

Disease Epidemiology Program Resources: Epidemiology Training: http://phc.amedd.army.mil/topics/healthsurv/de/Pages/Epi-TechTraining.aspx DRSi Resources: http://phc.amedd.army.mil/topics/healthsurv/de/Pages/DRSiResources.aspx Resource Materials: http://phc.amedd.army.mil/topics/healthsurv/de/Pages/ResourceMaterials.aspx

Suggested Citation: Disease Epidemiology Division. US Army Zoonotic Disease Report, 2016. Army Public Health Center; 2017.