Middle East DVEP - Armed Forces Pest Management Board

hospitalized 2,088 patients with schistosomiasis. More importantly, the average numberof days lost per admission was 159, almost half a year per case. Over 1,500 cases ofacute infection due to S. japonicum were reported in US troops during the reinvasion ofLeyte in the Philippines. Allied and Axis troops deployed in the North African andMiddle East campaigns experienced high rates of infection. During the early 1950s,troops of the People’s Republic of China were training along the Yangtze River for anamphibious landing on Taiwan. However, the invasion had to be cancelled when 30,000to 50,000 cases of acute schistosomiasis, 10 to 15% of the invasion force, occurred. Bythe time the Chinese army recovered, the US had established the Taiwan DefenseCommand and had begun routine patrols of the Taiwan Strait. Schistosomiasis was rareamong US military personnel during the Vietnam War.Disease Distribution. Over 200 million persons are infected with schistosomiasisworldwide, causing serious acute and chronic morbidity. Schistosoma mansoni and S.haematobium are endemic in the Middle East and are considered a major public healthproblem. Current endemic areas in the region are illustrated in Figure 10.Iran: Low endemic levels of S. haematobium occur only in Khuzestan Province,primarily in areas around Ahvaz, Dasht Mishan, Dezful, Haft Tappeh, Hamidieh,Khorramshahr, Mian Ab, Sardasht, and Shushtar. During the 1990s, an infection rate of0.02% was reported in Khuzestan Province. Transmission is year-round, peaking fromMay through July and October through December.Iraq: Schistosoma haematobium is distributed along the entire Euphrates and Tigris (asfar north as Samarra) River system and tributaries, including urban areas. An isolatedfocus exists in the northern province of Ninawa in the area of Tall Kayft. Notransmission occurs south of Basrah because the delta waters are too saline for snailhosts. Incidence decreased during the 1980s due to control programs. Transmissionoccurs year-round, with increased risk from June through September.Jordan: The endemic status is unclear. Twenty-seven cases of urinary schistosomiasiswere reported during 1984 near Seil Al-Hasa, Al Karak Governorate. The Ministry ofHealth declared Jordan to be free of schistosomiasis in 1991. Potential snail hosts occurin foci along the Jordan Valley, East Ghor Canal, Zarqa River (including the King TalalDam reservoir), Yarmouk River, Lake Tiberius, and Jarash Spring. High infectionrates have been detected among migrant foreign workers and refugees from endemicareas.Kuwait: Transmission does not occur in Kuwait because of the absence of year-roundsurface water and snail intermediate hosts. Imported cases are frequently reported.Lebanon: Two cases reported in 1995 are believed to represent the first indigenoustransmission since 1969. Historically, foci of urinary schistosomiasis occurred in coastalareas between Tyre and Sidon.115