Saudi Arabia: Malaria occurs in the southwestern part of the country in rural and urbanareas up to 2,000 m in the Tihama coastal region and the Asir highlands (Jizan, Asir, andAl Bahah Provinces). In the west (Makkah and Al Madinah Provinces) it is limited torural valley foci in the Hijaz Mountains. Malaria-free areas include the eastern, centraland northern provinces, and the urban areas of Jeddah, Mecca, Medina and Taif inwestern provinces. Nearly 90% of cases are caused by P. falciparum. Transmissionoccurs year-round, with a high incidence from October through April.Syria: Malaria is endemic at low levels in rural areas below 600 m. Urban centers andthe provinces of As Suwayda and Dayr az Zawr are malaria-free. Malaria transmission ishighest in the northern provinces bordering Turkey and Iraq. Plasmodium vivax accountsfor 56% of the cases.Turkey: Malaria cases are reported countrywide, but transmission is highest in southernand eastern Turkey, particularly the provinces along the Mediterranean coast fromAntalya eastward, Diyarbakir and Siirt Provinces, and the provinces bordering Syria,Iraq, and Iran. Transmission peaks in most areas during the summer months of Junethrough November. Outbreaks of P. vivax have increased more than tenfold since 1990due to reductions in vector control programs, population increases, and the ambitiousirrigation project in southeastern Turkey.United Arab Emirates: Malaria transmission occurs primarily north of the 25th parallel,including the east coast, Hajar mountain foothill regions, along the Gulf of Oman and theOman border, and the central plateau east of Dubayy. Transmission also occurs in AlAyn oasis. Most urban areas are malaria-free. Most cases of malaria are imported; lessthan 1% are indigenous.Yemen: Malaria transmission occurs in irrigated agricultural lands, wadis, and urbanlocales in coastal and foothill areas, including Socotra. Malaria risk is elevated in thesouthern governorates. Highest levels of transmission occur from October throughMarch. Approximately 90% of all cases are caused by P. falciparum, with P. vivax andP. malariae causing an equal percentage of the remainder.Bahrain, Cyprus, Israel, Jordan, Kuwait, Lebanon, and Qatar are considered malariafree,but imported cases are reported, and indigenous transmission may occasionallyoccur in areas where competent vectors are abundant. During the 1980s, Israel reportedover 2,000 cases of imported malaria, the vast majority in immigrants from Ethiopia. In1988, more than one-fifth of the imported cases were caused by chloroquine-resistant P.falciparum.Transmission Cycle(s). Humans are the only reservoir of human malaria. Nonhumanprimates are naturally infected by many Plasmodium species that can infect humans, butnatural transmission is rare. Female mosquitoes of the genus Anopheles are the exclusivevectors of human malaria. Plasmodium species undergo a complicated development inthe mosquito. When a female Anopheles ingests blood containing the sexual stages67
(gametocytes) of the parasite, male and female gametes unite to form a motile ookinetethat penetrates the mosquito’s stomach wall and encysts on the outer surface of themidgut. Thousands of sporozoites are eventually released, and some of these migrate tothe salivary glands. Infective sporozoites are subsequently injected into a human hostwhen the mosquito takes a blood meal (Figure 2). The time between ingestion ofgametocytes and liberation of sporozoites, ranging from 8 to 35 days, is dependent on thetemperature and the species of Plasmodium. Malaria parasites develop in the mosquitovector most efficiently when ambient air temperatures are between 25 and 30 o C.Parasite development is prolonged during cool seasons and at high altitudes, and mayexceed the life expectancy of the vector. Once infected, mosquitoes remain infective forlife. Vector competence is frequently higher with indigenous strains of malaria. Thisdecreases the likelihood that imported strains from migrants will become established.Vector Ecology Profiles.Worldwide, about 70 species of Anopheles transmit malaria to man, but of these onlyabout 40 are important. The distribution of malaria vectors in the <strong>Middle</strong> <strong>East</strong> region iscomplex. Primary malaria vectors are present throughout each country and includeAnopheles maculipennis, An. sacharovi, An. superpictus, An. pharoensis, An. sergentii,and An. arabiensis. Secondary vectors include An. claviger, An. culicifacies, An. d’thali,An. fluviatilis, An. multicolor, An. pulcherrimus, and An. stephensi. However, what arenormally primary vectors in most countries may be secondary vectors in other countries.The reverse may also be true, as is shown in the following list of the geographicdistribution of vectors, where the primary vectors are marked with an asterisk.Mosquitoes reported from the <strong>Middle</strong> <strong>East</strong> are listed in Appendix A.1. Vector ecologyprofiles of malaria vectors are summarized in Appendix B.1.Iran and Iraq: An. culicifacies*, An. maculipennis, An. sacharovi* (coastal and inlandareas), An. stephensi* (along the Persian Gulf and in the southeastern provinces), Ansuperpictus (central plateau), An. d’thali, and An. pulcherrimus*.Israel: An. sergentii*, An. superpictus*, An. sacharovi (northern Israel), An. claviger(scarce), and An. pharoensis (scarce).Lebanon: An. sacharovi* and An. sergentii.Oman: An. culicifacies* and An. stephensi.Saudi Arabia: An. arabiensis* (Asir District), An. fluviatilis, An. pharoensis, An.pulcherrimus, An. sergentii* (all areas except the east), An. stephensi* (urban areas,and in the east from Oman to Kuwait), and An. superpictus* (northern areas).Syria: An. claviger*, An. maculipennis, An. pulcherrimus, An. sacharovi, An. sergentii*,and An. superpictus*.Turkey: An. maculipennis, An. sacharovi*, An. sergentii, and An. superpictus.UAE: An. culicifacies and An. stephensi*.Yemen: An. arabiensis*, An. culicifacies, An. pharoensis, and An. sergentii*.68
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1. Table of ContentsI. Preface.....
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IX.Selected ReferencesA. Military P
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and spills have polluted sea- and l
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Sand fly fever is the most widespre
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VENOMOUS ANIMALSThere are 31 specie
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Middle East11
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Oman: Recognized foci of intestinal
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Female worms can deposit from 300 t
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Cercariae are killed by exposure fo
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123
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personnel moving into an endemic ar
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The biology of the Cx. pipiens comp
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Depending on the stage of developme
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higher in the Balkans. Convalescenc
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Scabies mites are very small, about
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exude serum, itch for several days,
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Eastern countries, including Cyprus
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also become attached to the cocoon
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sites of attack, and a favorite sit
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In the Middle East, the family Elap
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Table 2a. continuedBahrain Cyprus I
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Table 3. Plants That Cause Contact
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IX. Selected References.A. Military
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Bruce-Chwatt, L. J. 1985. In Essent
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Jacobson, R.L., Y. Schlein and E.R.
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Oldfield, E.C. III, M.R. Wallace, K
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Appendix A. Arthropod Species and t
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A.1. Mosquitoes continuedBahrain Cy
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A.2. Reported Distribution of Sand
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A.2. Sand flies continuedBahrain Cy
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A.3. Ticks continuedIXODIDAEBahrain
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A.3. Ticks continuedBahrain Cyprus
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A.4. Fleas continuedBahrain Cyprus
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A.4. Fleas continuedHYSTRICHOPSYLLI
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A.4. Fleas continuedBahrain Cyprus
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A.4. Fleas continuedBahrain Cyprus
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A.5. Reported Distribution of Scorp
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A.5. Scorpions continuedBahrain Cyp
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Appendix B. Vector Ecology Profiles
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Appendix B.2. Vector Ecology Profil
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B.2. Ticks continuedSpecies Geograp
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In recent years, synthetic pyrethro
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Published Reports of Insecticide Re
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Turkey.Calgar, S.S. 1991. An invest
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Appendix ESelected List of Identifi
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MammaliaHarrison, D.L. and P.J.J. B
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Appendix F: Personal Protective Mea
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Appendix GBioscience and State Depa
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8. Kuwait9. Lebanon10. Oman11. Qata
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Appendix H: Glossaryacaricide - a c
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zoonosis - An infectious disease of
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flies.11. Information on ticks and
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APPENDIX J METRIC CONVERSION TABLEM