Middle East DVEP - Armed Forces Pest Management Board

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Military Impact and Historical Perspective. Descriptions of a disease compatible withCCHF can be traced back to antiquity in eastern Europe and Asia. CCHF was firstdescribed in soldiers and peasants bitten by ticks of the genus Hyalomma while workingand sleeping outdoors in the Crimean peninsula in 1944. The virus was first isolated in1967. Since there are no available treatment regimens of proven value and recovery fromCCHF can be very protracted, military personnel with CCHF would require significantmedical resources.Disease Distribution. CCHF virus is enzootic in the steppe, savanna, semi-desert andfoothill environments of eastern and central Europe, Russia, parts of Asia, and throughoutAfrica. Several Eurasian epidemics have taken a great toll on human life. In recentyears, cases of CCHF have tended to be sporadic, with most reported from Bulgaria andSouth Africa. CCHF is underdiagnosed in many countries due to lack of appropriatemedical and laboratory services. In most countries surveyed, the prevalence of humanantibodies to CCHF virus in rural areas ranges from 0.1 to 2%. CCHF virus iswidespread in the Middle East, infecting domestic animals everywhere except the islandof Cyprus. Movement of domestic animals between countries in the region is commonand can easily spread the disease. Human outbreaks of CCHF have occurred in Kuwait,Iraq, and the United Arab Emirates. In Iraq there were 63 cases with 41 deaths reportedfrom 1979 to 1981. Over 50% of Iraqi goat, sheep, and horse sera were positive forantibodies, and in another serosurvey 29% of all animal breeders tested in Iraq werepositive. In 1990, seven cases of CCHF occurred in Mecca in western Saudi Arabia. Asubsequent serological survey of abattoir workers in 12 facilities in Saudi Arabiaidentified 40 confirmed or suspected human cases of CCHF between 1989 and 1990, with12 fatalities. Thirteen species of ixodid ticks were collected from livestock. Camels hadthe highest rate of infestation, and Hyalomma dromedarii was the most common tickcollected.Transmission Cycle(s). CCHF virus has been isolated from at least 30 species of ticks.From experimental evidence it appears that many species of ticks are capable oftransmitting the virus, but members of the genus Hyalomma are the most efficientvectors. The aggressive host-seeking behavior of adult hyalommines makes these ticksideal vectors. The highest prevalence of antibodies in wild and domestic reservoirs hasbeen found in arid areas where Hyalomma ticks are common. Antibodies to CCHF virusare widespread in large wild and domestic herbivores. Domestic ruminants generallyacquire infection early in life. Viremia in livestock is short-lived and of low intensity.Antibodies or virus have been found in a variety of small mammals, including hares,hedgehogs and rodents. Transovarial transmission of virus in vector ticks is an importantreservoir mechanism.Humans acquire CCHF virus from tick bites, from contamination of broken skin ormucous membranes with crushed tissues or feces of infected ticks, or from contact withblood or other tissues of infected animals. CCHF virus is highly infectious, andnosocomial infection of medical workers has been important in many outbreaks.85
CCHF virus loses infectivity shortly after the death of an infected host. There is noindication that consumption of meat processed according to normal health regulationsconstitutes a hazard.Vector Ecology Profiles.Hyalomma rufipes, H. anatolicum anatolicum, H. anatolicum excavatum, H. truncatum,and H. marginatum s.l. are considered the primary human vectors. Their importancedepends heavily on host preference. Hyalomma dromedarii and H. impeltatum areprimarily enzootic vectors. Boophilus annulatus and Rhipicephalus sanguineus, thebrown dog tick, are suspected zoonotic vectors of CCHF and will feed on humanswhenever close associations occur. Ixodes ricinus, Rhipicephalus bursa, andDermacentor marginatus are possible vectors in Turkey.Boophilus annulatus and R. sanguineus are believed to occur throughout all the countriesof the Middle East. Vector ticks, and hence disease, tend to be more rural than urban indistribution. An exception is the brown dog tick, which concentrates in urban areaswhere canine hosts are more abundant. Vector ecology profiles of Middle Eastern ticksare summarized in Appendix B.2. Appendix A.3. lists the distribution of ticks in theMiddle East.Specific Distribution of Ticks:Cyprus: Boophilus annulatus, H. anatolicum anatolicum, H. anatolicum excavatum,I. ricinus, and R. sanguineus occur.Iraq and Saudi Arabia: Boophilus annulatus, H. anatolicum anatolicum, H. anatolicumexcavatum, H. dromedarii, H. impeltatum, H. marginatum turanicum, H. marginatums.l. and R. sanguineus occur. Amblyomma variegatum, an introduced species, mayoccur in the Asir District of Saudi Arabia.Iran: Boophilus annulatus, H. anatolicum anatolicum, H. dromedarii, H. impeltatum,H. marginatum turanicum, H. marginatum s.l., I. ricinus and R. sanguineus occur.Israel, Jordan, Lebanon, and Syria: Boophilus annulatus, H. anatolicum anatolicum,H. anatolicum excavatum, H. impeltatum and H. marginatum s.l. and R. sanguineousare believed to occur. Ixodes ricinus also occurs in Israel. Tick distribution is notdefinitively known in Syria, but the country probably has a mixture of the same speciesthat occur in Iraq, Jordan, Israel and Lebanon.Kuwait: Boophilus annulatus, H. anatolicum s.l., H. marginatum s.l. and R. sanguineousoccur.Oman: Amblyomma variegatum, Boophilus annulatus, H. anatolicum, H. dromedarii,H. impeltatum, H. rufipes and R. sanguineous occur.Turkey: Boophilus annulatus, Dermacentor marginatus, I. ricinus, Rhipicephalus bursaand R. sanguineous occur. Hyalomma anatolicum anatolicum, H. anatolicumexcavatum and H. marginatum s.l. also occur.United Arab Emirates: Boophilus annulatus, Hyalomma anatolicum anatolicum,H. anatolicum excavatum, H. impeltatum and R. sanguineous occur.Yemen: Amblyomma variegatum, B. annulatus, H. anatolicum anatolicum,H. anatolicum excavatum, H. dromedarii, H. impeltatum, H. rufipes, H. truncatum andR. sanguineous occur.86
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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
Page 47 and 48: leptospires, various bacteria and i
Page 49 and 50: Bandar Abbas (elevation 10 m)Mean D
Page 51 and 52: a wide variety of human pathogens.
Page 53 and 54: The Jordan Valley area is part of t
Page 55 and 56: still numerous sites where waste di
Page 57 and 58: highlands (445 m elevation) are sim
Page 59 and 60: ocky central plateau, the Nejd, whi
Page 61 and 62: MONTH J F M A M J J A S O N DMaximu
Page 63 and 64: known as the Liwa, form an arc alon
Page 65 and 66: ___________________________________
Page 67 and 68: Table 1. Drug-Resistant Falciparum
Page 70 and 71: Saudi Arabia: Malaria occurs in the
Page 73 and 74: General Bionomics. Female anophelin
Page 75: host with the body nearly perpendic
Page 78 and 79: crevices, leaf litter, or moist tre
Page 80 and 81: All dengue serotypes are now endemi
Page 82 and 83: period immediately following it (19
Page 84: Military Impact and Historical Pers
Page 87: on camels, pigs, dogs, donkeys, hum
Page 91 and 92: that usually is associated with cat
Page 93 and 94: and sheep, although immature stages
Page 95 and 96: Haemaphysalis punctata is also wide
Page 98 and 99: The risk of transmission is seasona
Page 101: from bites of infected fleas in sou
Page 104 and 105: and then only while they are on the
Page 106 and 107: Culex pipiens pipiens occurs throug
Page 108 and 109: human morbidity in areas of norther
Page 110 and 111: mortality in calves and lambs and a
Page 112 and 113: 109
Page 114 and 115: 111
Page 116 and 117: human and animal structures. Abando
Page 118 and 119: hospitalized 2,088 patients with sc
Page 120 and 121: Oman: Recognized foci of intestinal
Page 122 and 123: Female worms can deposit from 300 t
Page 124 and 125: Cercariae are killed by exposure fo
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Page 128 and 129: personnel moving into an endemic ar
Page 130 and 131: The biology of the Cx. pipiens comp
Page 132 and 133: Depending on the stage of developme
Page 134 and 135: higher in the Balkans. Convalescenc
Page 136 and 137: 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.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
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