Leishmaniasis: Military Significance and New Hope for Treatment

Ke, Kinnamon; Ea, Steck; Ps, Loizeaux; Ld, Hendricks; Vb, Waits; Wl, Chapman; Wl, Hanson

doi:10.1093/milmed/144.10.660

Cited by 14 publications

(1 citation statement)

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“…Historically, leishmaniasis has been a major cause of infectious disease morbidity among military personnel deployed to the Middle East (Kinnamon et al 1979, Cross et al 1996. During World War II, 1,000 Ð1,500 cases of cutaneous leishmaniasis (CL) and 50 Ð75 cases of visceral leishmaniasis (VL) occurred in allied forces in the Middle East (Most 1968).…”

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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"

Coleman¹,

Burkett

Putnam

et al. 2006

J Med Entomol

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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 ...

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