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

Vector Borne Disease and Vector Control in Essential Areas of Focus for US Military Personnel . Shalamar Georgia Walden University PUBH 8165, Summer 2012. Vector Borne Disease. What is it?

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

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  1. Vector Borne Disease and Vector Control in Essential Areas of Focus for US Military Personnel Shalamar Georgia Walden University PUBH 8165, Summer 2012

  2. Vector Borne Disease • What is it? • Disease that results from an infection transmitted to humans or animals by blood feeding arthropods. (Mims, 2004)

  3. Vector Borne Disease • Multiple types of microorganisms can be transmitted as a vector borne disease microbiologyonline.org.uk ehagroup.com prettyprotozoa.tumblr.com microscopesblog.com

  4. Vectors of Disease raywilsonbirdphotography.co.uk cdvr.ucr.edu infectionlandscapes.org publichealth.lacounty.gov kaieteurnewsonline.com pestcontrolrx.com

  5. Vector borne Disease Globally http://www.who.int/whr/2004/en/.

  6. Countries of the Middle East • Bahrain • Cyprus • Iran • Iraq • Israel • Jordan • Kuwait • Lebanon • Oman • Saudi Arabia • Syria • Turkey • United Arab Emirates • Yemen

  7. Conditions Affecting Disease • Geography, climate and the culture habibtoumi.com rmc4peace.com msnbc.msn.com

  8. 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.

  9. 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)

  10. 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 Plasmoduimspp • Treatment available • Anti Malaria medication available as for prophylaxis Eastern Hemisphere wwwnc.cdc.gov

  11. PREVENTION • Netting for beds (Impoinvil et al., 2007) • Drugs • Mosquito Spraying • No stagnant Water malariasite.com

  12. 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 afaq.wordpress.com

  13. Prevention • Use mosquito replant • Spraying of vector breeding grounds and habitat (Impoinvil et al., 2007) • Protective clothing • Avoid activity at high activity time frame vusolutions.com denguedisease.blogspot.com

  14. Typhus • Caused by the bacterium Rickettsia prowasekii • Vector is the human body louse Pediculushumanaus • Sudden onset can include fever, rash. • Disease can last 3 weeks sciencedirect.com

  15. 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

  16. Relapsing Fever (Louse and Tick Borne) • Two forms (Mims et al., 2004) • Louse Borne • Caused by spirochete Borreliarecurrentis; vector P. humanus • Tick borne • Caused by spirochete Borreliarecurrentis; vector tick of the genus Orithodoros • Disease found in Iran, Iraq, Israel, Jordan, Syria, Saudi Arabia and Yemen (Safdie et al., 2010)

  17. 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

  18. 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 • BancroftianFilariasis

  19. 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://www.nejm.org/doi/full/10.1056/NEJMicm0803551 http://dpd.cdc.gov/dpdx/html/Schistosomiasis.htm

  20. 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

  21. 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 • VisercalLeishmaniasis 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. missinglink.ucsf.edu http://dpd.cdc.gov/dpdx/html/Leishmaniasis.htm

  22. 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

  23. BancroftianFilariasis • Caused by the nematode Wuchereriabancrofti • 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://www.thailabonline.com/sec8filariasis.htm http://dpd.cdc.gov/dpdx/HTML/Frames/ A-F/Filariasis/body_Filariasis_w_bancrofti.htm

  24. 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

  25. 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

  26. 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., AbdElaziz, 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. PLoSNegl 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 Borreliapersica, the Agent of Tick Borne Relapsing Fever in Israel and the Palestinian Authority. PLoS ONE, 5(11), e14105. doi: 10.1371/journal.pone.0014105

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