Middle East DVEP - Armed Forces Pest Management Board

and bunkers can be treated with permethrin to control resting vectors. See Appendix Ffor more on personal protective measures.B. Sand fly Fever. (Papatasi fever, Three-day fever)Sand fly fever is caused by two distinct Phlebovirus serotypes, Naples and Sicilian. Thevirus produces an acute febrile illness lasting 2 to 4 days and is commonly accompaniedby headache and muscle pain. There is usually no mortality or significant complications.Most infections are acquired during childhood in endemic areas. The clinical disease inchildren is generally mild and results in lifelong immunity.Military Impact and Historical Perspective. Sand fly fever has been an importantcause of febrile disease during military operations since at least the Napoleonic Wars. In1909, an Austrian military commission first reported that an agent found in the blood ofinfected soldiers caused this fever, and that the vector was the sand fly. During WorldWar II, there were 19,000 cases of sand fly fever, with the highest incidence reported inthe Middle East Theater. Attack rates were 3 to 10% of all troops, although in some unitsthe attack rate exceeded 50%. In the Persian Gulf Command, attack rates were 50%higher than in the Middle East Theater and reached a peak of 235 cases per 1000 men inAugust of 1942. In sharp contrast to World War II, there were no reports of sand flyfever among coalition forces during the Persian Gulf War. The military significance ofsand fly fever is magnified because of its short incubation period, which may result inlarge numbers of nonimmune troops being rendered ineffective early in an operation,while endemic forces would be largely immune and unaffected.Disease Distribution. Sand fly fever is widespread in the Middle East and is probablyendemic in every country in the region. Appendix A.2. lists the known distribution ofsand flies from the Middle East.Transmission Cycle(s). No vertebrate reservoir has been established, but there is someserological evidence that gerbils serve as reservoirs. Infected humans can infect sandflies and thus have an amplifying effect during epidemics. The principal reservoirmechanism appears to be transovarial transmission within the vector. The virus is mostefficiently replicated in the sand fly vector and transmitted when temperatures exceed25 ° C. Infected sand flies remain infective for life and are not harmed by the virus.Vector Ecology Profiles.Phlebotomus papatasi is the primary vector. Phlebotomus sergenti and Sergentomyiaspp. are suspected vectors. Phlebotomus papatasi is widely distributed throughout theregion and has been reported from nearly every country in the Middle East. This speciestends to be more rural and periurban in distribution because it requires warm, humidmicrohabitats for larval development, often in animal burrows. Phlebotomus sergenti isalso widely distributed but is not as ubiquitous as P. papatasi.Some Phlebotomus papatasi are autogenous, that is, they are capable of producing eggswithout a bloodmeal, at least during the first gonotrophic cycle. Females deposit eggs, 30to 70 at a time, in gerbil or other rodent burrows, poultry houses, masonry cracks, rock74