crevices, leaf litter, or moist tree holes. Eggs hatch and larvae develop in warm, moistmicrohabitats that provide abundant organic matter for food. In military fortifications,larvae may live in the cracks between stacked sandbags. The four larval instars require 4to 8 weeks to reach the pupal stage. Fourth instar larvae may diapause for weeks ormonths if the environment is excessively cold or dry. Alternatively, if environmentalconditions improve, diapause may be quickly broken. Pupation occurs in the larvalhabitat. There is no cocoon; rather, the pupa is loosely attached to the substrate by thecast skin of the 4th larval instar.Phlebotomus papatasi feeds most intensely at dusk and dawn, with some feedingcontinuing sporadically through the rest of the night. Phlebotomus papatasi and P.sergenti are both endophilic and follow odor plumes to their hosts. Only females takeblood, but both sexes feed on plant sugars and nectar. Female sand flies feed on theblood of humans as well as that of a variety of birds and mammals, commonly dogs,gerbils, and hedgehogs. On humans, they feed on exposed skin around the head, neck,legs, and arms. Female sand flies will crawl under the edge of clothing to bite skin whererepellent hasn't been applied. Sand flies feed outdoors or indoors, and readily penetrateordinary household screening. After engorgement, P. papatasi and other sand flies restbriefly on objects near their host, then move to gerbil burrows or other cool, moistenvironments to lay eggs. They also rest in caves and other areas that are relatively cooland shaded during the daytime.Sand flies are weak fliers and do not travel in wind that exceeds a few kilometers perhour. Phlebotomus papatasi may be active at low relative humidities of 45 to 60%, butother vector species require 75 to 80% relative humidity in order to fly and feed. Sandflies fly in short hops, which usually limit their feeding radius to about 100 to 200 m frompupation sites. However, unengorged females may occasionally disperse as far as 1.5km. Mating dances occur on the ground, often at dusk, with males landing first, followedby females.Vector surveillance and suppression. Because of their small size and retiringbehavior, sand flies must be collected with specilized methods. The simplest is activesearching of daytime resting sites with an aspirator and flashlight. Human-landingcollections are an important method of determining which species are anthropophilic.Sticky traps (paper coated with a sticky substance or impregnated with castor oil) areused to randomly capture sand flies moving to or from resting places. Traps are placed atthe entrances of animal burrows, caves, or crevices. A variety of light traps have beenused to collect phlebotomines, but their effectiveness varies according to the speciesbeing studied and the habitat. Light traps are inefficient in open desert. Traps usinganimals as bait have also been devised. Collection of larvae is extremely labor intensiveand is often unsuccessful because specific breeding sites are unknown or hard to find.Emergence traps are useful for locating breeding sites.Because of their flight and resting behavior, sand flies that feed indoors are verysusceptible to control by residual insecticides. When sand flies are exophilic or bite awayfrom human habitations, control with insecticides is impractical. Some success in75
educing vector populations has been achieved by controlling the reservoir or hostpopulation. Sand flies are able to penetrate standard mesh screening used on houses andstandard mesh bednets. Fine mesh bednets must be used, but these are uncomfortableunder hot, humid conditions because they restrict air circulation. The use of repellents onexposed skin and clothing is the most effective means of individual protection. Insectrepellent should be applied to exposed skin and to skin at least two inches under theedges of the BDU to prevent sand flies from crawling under the fabric and biting.C. Dengue fever. (Breakbone fever, Dandy fever)Dengue is an acute febrile disease characterized by sudden onset, fever for 3 to 5 days,intense headache, and muscle and joint pain. It is commonly called breakbone feverbecause of the severity of pain. There is virtually no mortality in classical dengue.Recovery is complete, but weakness and depression may last several weeks. Dengue iscaused by a Flavivirus and includes four distinct serotypes (dengue 1, 2, 3 and 4).Recovery from infection with one serotype provides lifelong immunity from the sameserotype but does not protect against other serotypes. Dengue hemorrhagic fever (DHF)and associated dengue shock syndrome (DSS) were first recognized during a 1954dengue epidemic in Bangkok, Thailand. DHF/DSS have spread throughout SoutheastAsia, Indonesia and the southwest Pacific, Latin America and the Caribbean. DHFrequires exposure to two serotypes, either sequentially or during a single epidemicinvolving more than one serotype. DHF is a severe disease that produces high mortalityin children.Military Impact and Historical Perspective. Dengue virus was first isolated andcharacterized in the 1940s, but dengue fever can be identified clinically from the 18thcentury. Epidemics of dengue are noted for affecting a large proportion of the populationin a community or in military forces operating in an endemic area. Outbreaks involving500,000 to 2 million cases have occurred in many parts of the world. During World WarII, at Espiritu Santo in the Pacific, an estimated 25% of US military personnel became illwith dengue, causing a loss of 80,000 man-days. Other campaigns in the Pacific weremarked by dengue epidemics, and throughout the war the US Army experienced nearly110,000 cases. Dengue was an important cause of febrile illness among US troops duringOperation Restore Hope in Somalia. In recent years dengue, especially DHF, has beenexpanding throughout the world. Thirty to 50 million cases of dengue are reportedannually.Disease Distribution. Dengue is present in nearly all tropical countries. Its distributioncoincides with that of its primary vector, Aedes aegypti, between 40 o N and 40 o Slatitude. Epidemics generally coincide with the rainy season and high mosquitopopulations. Historically, dengue has been endemic throughout the <strong>Middle</strong> <strong>East</strong>, and Ae.aegypti currently occurs in every country of the region. Urbanization and discarded litterhave increased breeding habitats for dengue vectors. The only recent outbreaks ofdengue in the <strong>Middle</strong> <strong>East</strong> occurred during 1994 and 1995 in the Saudi Arabian cities ofJeddah and Medina. DHF was reported during these outbreaks.76
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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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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