Impact of Phlebotomine Sand Flies on U.S. Military Operations at Tallil Air Base, Iraq: 1. Background, Military Situation, and Development of a "Leishmaniasis Control Program"

Abstract

One of the most signiÞcant modern day efforts to prevent and control an arthropodborne disease during a military deployment occurred when a team of U.S. military entomologists led efforts to characterize, prevent, and control leishmaniasis at Tallil Air Base (TAB), Iraq, during Operation Iraqi Freedom. Soon after arriving at TAB on 22 March 2003, military entomologists determined that 1) high numbers of sand ßies were present at TAB, 2) individual soldiers were receiving many sand ßy bites in a single night, and 3) Leishmania parasites were present in 1.5% of the female sand ßies as determined using a real-time (ßuorogenic) Leishmania-generic polymerase chain reaction assay. The rapid determination that leishmaniasis was a speciÞc threat in this area allowed for the establishment of a comprehensive Leishmaniasis Control Program (LCP) over 5 mo before the Þrst case of leishmaniasis was conÞrmed in a U.S. soldier deployed to Iraq. The LCP had four components: 1) risk assessment, 2) enhancement of use of personal protective measures by all personnel at TAB, 3) vector and reservoir control, and 4) education of military personnel about sand ßies and leishmaniasis. The establishment of the LCP at TAB before the onset of any human disease conclusively demonstrated that entomologists can play a critical role during military deployments. KEY WORDS sand ßies, leishmaniasis, Iraq, surveillance, controlIn this article, we provide an overview of the general situation that the U.S. Military encountered at Tallil Air Base (TAB), Iraq, in March 2003 and discuss the factors that led to the establishment of a Leishmaniasis Control Program (LCP) at TAB. We also describe each of the four main components of the LCP (vector surveillance, personal protective measures [PPM], sand ßy and reservoir control, and soldier education). Although brief summaries of this program have been published separately (Coleman et al. 2004;2005), we believe that it is important to provide a comprehensive overview of one of the most signiÞcant modern day efforts to prevent and control an arthropod-borne disease during a military deployment. Although much of this article relies on anecdote, we believe that this information has both scientiÞc as well as historical value. In the series of articles to follow, we will provide detailed results about the speciÞc components of the program, including: 1) the general biology of phlebotomine sand ßies at TAB, 2) our evaluation of a variety of surveillance devices for the collection of sand ßies, 3) the impact of environmental conditions on sand ßy activity, 4) the efÞcacy of a variety of area spray measures on sand ßy abundance, 5) the efÞcacy of a variety of residual spray measures on sand ßy abundance, 6) testing of sand ßy populations for the presence of Leishmania parasites and the genetics of Leishmania parasites isolated from sand ßies, 7) our evaluation of PPM as a means of protecting soldiers from sand ßy bites, and 8) our overall evaluation of the risk of leishmaniasis at TAB and the efÞcacy of the ...

The biology and control of leishmaniasis vectors

“…The risk of cutaneous leishmaniasis for American military personnel early in the conflict prompted intensive vector control efforts. [39] Nine different insecticides, including organophosphates, pyrethroids and a carbamate, were used as residual sprays, space sprays and dustings for animal burrows. Despite the use of a wide spectrum of techniques and chemicals, the program appeared to have limited success in reducing sand fly populations.…”

“…As mentioned earlier, these sprays had disappointing effects in the U.S. military cantonments of Iraq. [39] Likewise, DDT and malathion fogs in Sudan were not effective in reducing sand fly populations, the results being both small and short-lived. [44] Nevertheless, interior fogs are still a part of some programs and can provide temporary relief from insect bites.…”

The Role of the United States Military in the Development of Vector Control Products, Including Insect Repellents, Insecticides, and Bed Nets

“…There is concern that asymptomatic latent leishmaniasis infection could be occurring in deployed troops that might cause subsequent disease in service members who later become immunosuppressed because of other diseases. Due to their small size and the fact that not enough is known about their biology, sand flies are difficult to control; to date, the use of air-conditioned quarters by service members in Iraq has proven to be the only effective countermeasure (Coleman et al 2006, Sanders et al 2005. Scrub typhus, a potentially life-threatening disease caused by Orientia tsutsugamushi bacteria that is transmitted to humans via bites from infected chiggers, has also impacted U.S. troops, particularly those engaged in jungle warfare in the Far East in World War II and the Vietnam War.…”

“…A comparison of the SS-LP bed net with the Australian Defence Force (ADF) mosquito bed net found that both bed nets provided greater than 97.9% protection compared to unprotected personnel (Frances et al 2003), and the insecticide-untreated SS-LP bed net provided better night-time protection than the untreated ADF bed net. However, the small dimensions can provoke claustrophobia and the fine mesh of the SS-LP bed net limits air flow, which can cause overheating and noncompliance in hot climates (Coleman et al 2006).…”

Evaluation of a metofluthrin fan vaporizer device against phlebotomine sand flies (Diptera: Psychodidae) in a cutaneous leishmaniasis focus in the Judean Desert, Israel

“…No cases of L. major were reported, though the vector (P. papatasi) is a nuisance pest in the area (Schnur et al 2004, Orshan et al 2010. Conventional methods for outdoor sand fly control (e.g., residual and ULV spraying) are not only expensive and harmful to the environment, but they have also been proven ineffective in harsh desert conditions (Coleman et al 2006, Orshan et al 2006). The inconvenience posed by the nightly use of topical repellents has facilitated the search for alternative vector control methods that protect people against sand fly bites.…”