Middle East DVEP - Armed Forces Pest Management Board

VII. Other Diseases of Military Significance.A. Leptospirosis. (Weil disease, Canicola fever, Hemorrhagic jaundice, Mud fever,Swineherd disease)The spirochete bacterium Leptospira interrogans is the causative agent of this zoonoticdisease. More than 200 serovars of L. interrogans have been identified, and these havebeen classified into 23 serogroups based on serological relationships. Common clinicalfeatures are fever with sudden onset, headache, and severe muscle pain. Seriouscomplications can occur. The severity of leptospirosis varies greatly and is determined toa large extent by the infecting strain and health of the individual. In some areas ofenzootic leptospirosis, a majority of infections are mild or asymptomatic. The incubationperiod is 10 to 12 days after infection.Disease Distribution. Distribution is worldwide in urban and rural areas of bothdeveloped and developing countries. Leptospirosis is present in most countries of theMiddle East.Transmission Cycle(s). Numerous wild and domestic animals act as reservoirs, includingrodents, raccoons, deer, squirrels, swine, cattle, sheep, goats, horses, and dogs. Becauseof its prevalence in rodents and domestic animals, leptospirosis has been primarily anoccupational hazard to farmers, sewer workers, veterinarians, animal husbandry workers,and rice and sugarcane field workers. Leptospira infect the kidneys and are transmitted inthe urine of infected animals. Humans become infected through contact of skin or mucousmembranes with contaminated water, moist soil or vegetation. Leptospira survive only infresh water. Spirochetes are not shed in the saliva; therefore, animal bites are not a sourceof infection. Although infected humans shed Leptospira in urine, person-to-persontransmission is rare. Infection may occasionally occur by ingestion of food contaminatedwith urine from infected rats.Disease Prevention and Control. Control domestic rodents around living quarters andfood storage and preparation areas. Leptospira are readily killed by temperatures above60 o C, detergents, desiccation, and acidity. Good sanitation reduces the risk of infectionfrom commensal rodents. Troops should be educated about modes of transmission andinstructed to avoid swimming or wading in potentially contaminated waters. Vaccineshave been used effectively to protect workers in veterinary medicine, and immunizationhas also been used to protect against occupational exposure to specific serovars in Japan,China, Italy, Spain, France, and Israel. Short-term prophylaxis may be accomplished byadministration of antibiotics. Doxycycline was effective in Panama in preventingleptospirosis in military personnel.B. Hantaviral Disease. (Epidemic hemorrhagic fever, Korean hemorrhagic fever,Nephropathia epidemica, Hemorrhagic nephrosonephritis, Hemorrhagic fever with renalsyndrome (HFRS))Hantaviruses are a closely related group of zoonotic viruses that infect rodents. Theycause disease syndromes in humans that vary in severity but are characterized by abruptonset of fever, lower back pain, and varying degrees of hemorrhagic manifestations andrenal involvement. Severe illness is associated with Hantaan virus, primarily in Asia andthe Balkans. The case fatality rate is variable but is about 5% in Asia and somewhat130