Middle East DVEP - Armed Forces Pest Management Board

higher in the Balkans. Convalescence takes weeks to months. A less severe illnesscaused by Puumala virus and referred to as nephropathia epidemica predominates inEurope. Dobrava virus (Belgrade) has caused severe HFRS cases in several countries ofthe eastern Mediterranean.Military Impact and Historical Perspective. Prior to World War II, Japanese andSoviet authors described HFRS along the Amur River in Manchuria. In 1951, HFRS wasrecognized among United Nations troops in Korea and has been observed in both militarypersonnel and civilians since then. Hantaan virus disease is considered an emerginghealth problem in many areas of the world. In 1993, an outbreak of disease caused by anew hantavirus occurred in the USA, but the target organs were the lungs rather than thekidneys. Advanced diagnostic techniques have led to increasing recognition of newhantaviruses and hantaviral infections globally. The military threat of hantaviruses islimited in the Middle East, since they are probably enzootic only in Turkey.Disease Distribution. Hantaan virus claims 40,000 to 100,000 victims annually in China.South Korea has reported about 1,000 cases annually in recent years. Puumala viruscirculates in European countries, Russia west of the Ural Mountains, and the Balkans.During the 1990s, outbreaks of Dobrava virus have been reported from Albania, inneighboring Greece, and nearby Bosnia and Herzegovina. Enzootic foci likely existcountrywide in rural and semirural areas. Hantavirus may infect rodents in seaports thatare regularly visited by ships crewed by Asians from endemic areas.Transmission Cycle(s). Virus is present in the urine, feces and saliva of persistentlyinfected asymptomatic rodents. Aerosol transmission to humans from rodent excreta isthe presumed mode of infection. Hantaan virus is commonly associated with the fieldmouse, Apodemus agrarius, in open field or unforested habitats. The red bank vole,Clethrionomys glareolus, inhabits woodland or forest-steppe environments and is aprimary reservoir for Puumala virus. Dobrava virus has been isolated from the yellowneckedfield mouse, Apodemus flavicollis. The risk of transmission is highest in warmmonths when rodent reservoir populations are abundant. Military personnel are exposedto infection when working, digging or sleeping in fields infested by infected rodents.Disease Prevention and Control. Exclude or prevent rodent access to buildings. Storefood in rodent-proof containers or buildings. Disinfect rodent-contaminated areas withdisinfectant such as dilute bleach. Do not sweep or vacuum rodent-contaminated areas;use a wet mop moistened with disinfectant. Eliminate wild rodent reservoirs beforemilitary encampments are established in fields. Detailed information on surveillance andpersonal protective measures when working around potentially infected rodents can befound in TIM 40, Methods for Trapping and Sampling Small Mammals for VirologicTesting, and in TIM 41, Protection from Rodent-borne Diseases with special emphasis onoccupational esposure to hantavirus.131