Vector Borne Disease and Vector Control in Essential Areas of Focus for US Military Personnel

Shalamar GeorgiaWalden UniversityPUBH 8165, Summer 2012

Vector Borne Disease What is it?

Disease that results from an infection transmitted to humans or animals by blood feeding arthropods. (Mims, 2004)

Vector Borne Disease Multiple types of microorganisms can be

transmitted as a vector borne disease

microbiologyonline.org.uk

microscopesblog.comprettyprotozoa.tumblr.com

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Vectors of Disease

cdvr.ucr.edu

infectionlandscapes.org

kaieteurnewsonline.compestcontrolrx.com

raywilsonbirdphotography.co.uk

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Vector borne Disease Globally

http://www.who.int/whr/2004/en/.

Countries of the Middle East Bahrain Cyprus Iran Iraq Israel Jordan Kuwait Lebanon Oman

Saudi Arabia Syria Turkey United Arab

Emirates Yemen

Conditions Affecting Disease Geography, climate and the culture

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Diseases Profiles in the Middle East Within the Middle East there are two

distinct types of Vector Borne Disease Short Incubation –These are diseases with

incubation periods of less than 15 days Long incubation – these are diseases with

incubation periods that are longer than 15 days.

Short Incubation Period Disease These are diseases with 15 days or less of

required incubation that could be important to military personnel and are present in the Middle East Malaria Dengue Typhus Relapsing Fever (both Mite and Tick borne)

Malaria Found in Iran, Iraq, Israel, Oman, Saudi Arabia,

United Arab Emirates and Yemen (DPMIAC, 1999)

There IS drug resistant malaria present in these countries!!!

Vector is the mosquito Agent is Plasmoduim spp Treatment available Anti Malaria medication

available as for prophylaxis

Eastern Hemisphere wwwnc.cdc.gov

PREVENTION Netting for beds (

Impoinvil et al., 2007)

Drugs Mosquito Spraying No stagnant Water

malariasite.com

Dengue Fever Also called

Breakbone Fever Mosquito Vector Caused by Dengue Hemorrhagic Virus Present in ALL Middle Eastern Countries

(DPMIAC, 1999) Large outbreak in Saudi Arabia in 1995 (CDC,

2004). Frequent ‘Carrier’ Cases

http://www.healthmap.org/dengue/index.php

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Prevention Use mosquito replant Spraying of vector breeding grounds

and habitat (Impoinvil et al., 2007) Protective clothing Avoid activity at high activity time frame

denguedisease.blogspot.com

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Typhus Caused by the

bacterium Rickettsia prowasekii

Vector is the human body louse Pediculus humanaus

Sudden onset can include fever, rash.

Disease can last 3 weeks sciencedirect.com

Prevention Examination of clothing and body Avoid contact with bedding and clothing

of persons suspected to have louse Frequently wash clothing and bedding

where louse is suspected Most recent outbreaks have been in

Lebanon, Tel Aviv and Israel (DPMIAC, 1999)

http://sprojects.mmi.mcgill.ca/tropmed/disease/typhus/geo.htm

Relapsing Fever (Louse and Tick Borne) Two forms (Mims et al., 2004)

Louse Borne Caused by spirochete Borrelia recurrentis;

vector P. humanus Tick borne

Caused by spirochete Borrelia recurrentis; vector tick of the genus Orithodoros

Disease found in Iran, Iraq, Israel, Jordan, Syria, Saudi Arabia and Yemen (Safdie et al., 2010)

Prevention Between 1-10 relapses of disease (tick

borne disease usually lasts longer) (Safdie et al., 2010)

Proper clothing can assist in not acquiring infected ticks (Safdie et al., 2010)

Proper hygiene can prevent body louse Frequent washing of clothes and

bedding of infected personnel

Long Incubation Period Disease These are diseases with more than15

days of required incubation that could be important to military personnel and are present in the Middle East Leishmaniasis Schistosomiasis Bancroftian Filariasis

Schistosomiasis Caused by the blood

trematodes in the genus Schistosoma

Vector is the Snail Acute disease symptoms occur

2-8 weeks after infection and include fever, headache, diarrhea, vomiting and blood in the urine. (Mims, 2004)

Disease is present in Saudi arabia, Yemen, Oman, Lebanon, Syria, Iraq and Iran

http://dpd.cdc.gov/dpdx/html/Schistosomiasis.htm

http://www.nejm.org/doi/full/10.1056/NEJMicm0803551

Prevention Prevention of disease is most easily

controlled by avoiding fresh water areas where snails may be present WHO recommends assuming that all

freshwater in endemic areas be considered infected and avoided

Insect repellant with DEET has been shown to be effective

IF exposed, clean skin with rubbing alcohol

Most official military uniforms (BDU and ACUs) can offer resistance when worn appropriately (pants tucked in boots) (DPMIAC, 1999)

Prevalence of vector is higher during the day

Do not step on or crush snails found Most prevention methods focus on

removal of the snail host population using chemicals

http://relief.unboundmedicine.com/relief/ub/view/cdc-yellow-book/204110/all/Schistosomiasis

http://www.modernguidetohealth.com/conditions-diseases/schistosomiasis-symptoms-treatment-and-prevention.html

Leishmaniasis Caused by the protozoan from

the genus Leishmania Vector is the sand fly (Genus

Phlebotomus) Symptoms include skin and

soft tissue lesions, fever, anemia, enlarged liver and/or spleen and increased weakness

Visercal Leishmaniasis can have a 95% mortality rate when left untreated.

Diagnosis is difficult and treatment is long and expensive. The treatment drug is not registered within the US.

http://dpd.cdc.gov/dpdx/html/Leishmaniasis.htm

missinglink.ucsf.edu

Prevention Normal mosquito netting will

allow passage of sand flies, so smaller mesh must be used (Impoinvil et al., 2007)

Sticky paper traps can be used to catch the flies and should be placed near plants and/or vegetables. They should also be placed around burrows, rocks and crevices and construction debris

http://www.who.int/leishmaniasis/burden/hiv_coinfection/burden_hiv_coinfection/en/index.html

commons.wikimedia.org

Bancroftian Filariasis Caused by the nematode

Wuchereria bancrofti Spread through a mosquito vector After 8-12 months of incubation

microlarvae are released. Females will continue to reproduce for 15-18 years (DPMIAC, 1999)

Infected individuals are usually asymptomatic in early infection (Mims et al., 2004)

Swelling of the lymphatic glands occurs and will obstruct flow in legs and genitalia (elephantiasis)

http://dpd.cdc.gov/dpdx/HTML/Frames/A-F/Filariasis/body_Filariasis_w_bancrofti.htm

http://www.thailabonline.com/sec8filariasis.htm

Prevention Occurs in Iran, Oman,

Yemen and Saudi Arabia Reduction of the mosquito

population is the easiest way to prevent disease occurrence (El-Setouhy et al., 2007), (Impoinvil et al., 2007) Spraying of aerosols during

periods of high activity (evening)

Spray both indoors and outdoors

Wear protective clothing

http://www.neglecteddiseases.gov/target_diseases/lymphatic_filariasis/index.html

http://www.kimayahealthcare.com/AilmentDetail.aspx?AilmentID=366&AboutID=1

Conclusion Many factors can influence vector borne

disease The Middle East is a diverse location

both geographically and culturally While disease is prevalent in these

countries, standard preventative measures can be used to prevent disease

Our troops should be educated on basic precautions when entering an endemic area that cover both the ecological and cultural risk factors

Thank You References:

Defense Pest Management Information Analysis Center. (1999). Regional Disease Vector Ecology Profile: The Middle East. Walter Reed Army Medical Center. Washington DC.

J.B. Derbyshire. (2002). The eradication of glanders in Canada. Can Vet J. 2002. 43(9). 722-726

World Health Organization. (2004). World Health Report. Retrieved July 17, 2012 from http://www.who.int/whr/2004/en/.

Mims, C., Dockekrell, HM., Goering, RV., Roit, I., Wakelin, D., Auckerman, M. (2004). Medical Microbiology 3rd Edition. Mosby Publishing.

El-Setouhy, M., Abd Elaziz, K. M., Helmy, H., Farid, H. A., Kamal, H. A., Ramzy, R. M. R., . . . Weil, G. J. (2007). The Effect of Compliance on the Impact of Mass Drug Administration for Elimination of Lymphatic Filariasis in Egypt. The American Journal of Tropical Medicine and Hygiene, 77(6), 1069-1073.

Hotez, P. J., Savioli, L., & Fenwick, A. (2012). Neglected Tropical Diseases of the Middle East and North Africa: Review of Their Prevalence, Distribution, and Opportunities for Control. PLoS Negl Trop Dis, 6(2), e1475. doi: 10.1371/journal.pntd.0001475

Impoinvil, D. E., Ahmad, S., Troyo, A., Keating, J., Githeko, A. K., Mbogo, C. M., . . . Beier, J. C. (2007). Comparison of mosquito control programs in seven urban sites in Africa, the Middle East, and the Americas. Health policy (Amsterdam, Netherlands), 83(2), 196-212.

Safdie, G., Farrah, I. Y., Yahia, R., Marva, E., Wilamowski, A., Sawalha, S. S., . . . Fishman, Y. (2010). Molecular Characterization of Borrelia persica, the Agent of Tick Borne Relapsing Fever in Israel and the Palestinian Authority. PLoS ONE, 5(11), e14105. doi: 10.1371/journal.pone.0014105