Middle East DVEP - Armed Forces Pest Management Board

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and spills have polluted sea- and lakeshores. Desalination is providing an important new sourceof fresh water but is expensive, and demand is growing faster than desalinized water can besupplied. Air and soil pollution are significant concerns in certain places. Poor sanitation due toinadequate water and waste treatment facilities, indiscriminate disposal of wastes, and unsafefood handling practices throughout most of the Middle East, poses serious health risks andsupports large populations of rodents, flies, mosquitoes and other vectors.DIARRHEAL DISEASEGastrointestinal infections are the principal disease threats in both rural and urban areas in theMiddle East. Fecal-oral transmission from person to person is common, but most infections areacquired from the consumption of contaminated food, water or ice. Filth flies can be importantin the mechanical transmission of pathogens to food, food preparation surfaces, and utensils. Flypopulations sometimes reach very high levels in many areas of the Middle East. Bacteria andviruses causing diarrheal disease include Staphylococcus aureus, Clostridium perfringens,Bacillus cereus, Vibrio parahaemolyticus, numerous serotypes of Salmonella, Shigella spp.,Campylobacter, pathogenic strains of Escherichia coli, and hepatitis A and E, among other viralspecies. Bacterial pathogens account for more than 75% of cases. Onset of symptoms is usuallyacute and may result in severe gastroenteritis. Shigella infections can produce significantmortality even in hospitalized cases. The resistance of enteric pathogens to commonly usedantibiotics can complicate treatment. Years of indiscriminate antibiotic use in the Middle Easthave selected bacterial populations with extremely high rates of resistance to multiple antibiotics.Bacillary dysentery has had a profound impact on military operations throughout history. In1958, at the request of the Lebanese government, the United States rushed a task force to helprestore order. Soon after the troops arrived in Lebanon, gross admission rates for diseaseapproached 1,000 per 1,000 average strength per annum, and more than half of all the diseasewas enteric. During Operation Desert Shield, when military personnel were being rapidlydeployed to the Middle East, the US military experienced high rates of diarrheal disease due tobacterial and viral enteropathogens. Strict sanitation and fly control can significantly reduce therisk of gastrointestinal infections. A 64% reduction in house fly density by yeast-baited fly trapsreduced clinic visits for diarrheal disease in Israeli soldiers by 42%.LEISHMANIASIS*Cutaneous leishmaniasis is moderately or highly endemic regionally. As many as 90% of thepeople in some areas of Southwest Asia have scars from previous infections. Two species ofLeishmania cause skin lesions in the region. The less severe and rurally distributed Leishmaniamajor is a parasite of desert rodents, especially gerbils such as the fat sand rat, Psammomysobesus. The most commonly implicated vector is the sand fly Phlebotomus papatasi.Leishmania tropica is usually a parasite of man in urban environments and is transmitted by P.sergenti. Cases of visceralizing Le. tropica were reported among US personnel stationed inSaudi Arabia during the Persian Gulf War.Visceral leishmaniasis, caused by Le. infantum and Le. donovani, is a less prevalent but moresevere systemic disease. It generally occurs in rural foci. The most common reservoirs for Le.infantum are believed to be domestic dogs and wild canines, such as jackals and foxes.Transmission occurs during the warmer months of April through October, coinciding with theactivity of vector sand flies. Phlebotomine sand flies bite from dusk to dawn but may feed5
during the day if hosts enter their resting habitat. The distribution of sand flies and the diseasesthey carry is very focal because of their limited flight capabilities.SCHISTOSOMIASISSchistosomiasis produces serious acute and chronic morbidity and has had a significant impacton military operations in the past. Schistosoma mansoni (urinary schistosomiasis) and S.haematobium (intestinal schistosomiasis) are endemic in the Middle East. Intestinalschistosomiasis occurs primarily in Turkey, Syria, Saudi Arabia, Iran, Iraq and Yemen. Urinaryschistosomiasis predominates in Saudi Arabia, Oman and Yemen. Incidence is low, except forfocal areas of Yemen and Saudi Arabia. Infection rates are commonly high among migrantforeign workers. Consequently, nonendemic countries frequently report imported cases.Infection is acquired when free-swimming larval forms of these trematode parasites penetrate theskin. The larvae develop in freshwater snails of the genus Bulinus, the intermediate host for S.haematobium, and the genus Biomphalaria in the case of S. mansoni. The snail intermediatehosts prefer slow-moving shallow water associated with rivers and their tributaries, marshes,irrigation canals, cisterns, aqueducts, and seasonally wet streambeds. Extensive irrigationprojects in Turkey, Syria, Jordan and other countries have expanded snail distribution and therisk of infection. Humans are the reservoir host. Untreated individuals can remain infected formany years. Cases often are not diagnosed until after returning from endemic areas. Militarypersonnel should avoid contact with potentially contaminated water.MALARIA*A low to moderate risk of malaria exists in parts of Iran, Iraq, Oman, Saudi Arabia, Syria,Turkey, the United Arab Emirates (UAE), and Yemen. Nearly a dozen species of Anophelesmosquitoes act as primary or secondary vectors throughout the region. Limited rainfall in thearid and semiarid Middle East restricts the natural distribution of malaria vectors. Irrigationprojects for agriculture have extended the ranges of malaria vectors in many countries, so diseaseprevalence may increase in such areas. Insecticide resistance in many vector populations hasresulted from decades of malaria control operations. The sporozoan parasite Plasmodium vivaxpredominates in Iran, Iraq, Syria and the UAE, while P. falciparum is more frequent in Oman,Saudi Arabia, Turkey and Yemen. Plasmodium malariae occurs at low levels in Yemen andIran. Transmission may occur year-round in most areas. Because competent vectors exist incountries considered malaria-free, imported immigrant cases have the potential to initiateindigenous transmission of malaria. Infected foreign troops can be expected to spread malariainto malaria-free areas. Chloroquine resistance has been documented in Iran, Iraq, Oman, SaudiArabia, UAE and Yemen. Fansidar resistance occurs in Iran, Iraq and Oman. Mefloquineresistance is suspected in Iran. Chemoprophylaxis should be strictly enforced in militarypersonnel at risk of infection.ARBOVIRUSES*Over 100 arthropod-borne viruses produce disease in humans worldwide. Many of these haveshort incubation periods and elicit clinical symptoms ranging from acute benign fevers of shortduration to acute central nervous system illness, hemorrhagic fevers, polyarthritis, and rash.They can have a serious medical impact on military personnel. Many illnesses diagnosed asfevers of unknown origin are the result of arboviral infections. New arboviruses are discoveredevery year, and some are emerging as serious threats to human health.6
Page 4 and 5: 1. Table of ContentsI. Preface.....
Page 6 and 7: IX.Selected ReferencesA. Military P
Page 10 and 11: Sand fly fever is the most widespre
Page 12 and 13: VENOMOUS ANIMALSThere are 31 specie
Page 14: 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
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ocky central plateau, the Nejd, whi
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MONTH J F M A M J J A S O N DMaximu
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known as the Liwa, form an arc alon
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___________________________________
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Table 1. Drug-Resistant Falciparum
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Saudi Arabia: Malaria occurs in the
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General Bionomics. Female anophelin
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host with the body nearly perpendic
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crevices, leaf litter, or moist tre
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All dengue serotypes are now endemi
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period immediately following it (19
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Military Impact and Historical Pers
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on camels, pigs, dogs, donkeys, hum
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CCHF virus loses infectivity shortl
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that usually is associated with cat
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and sheep, although immature stages
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Haemaphysalis punctata is also wide
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The risk of transmission is seasona
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from bites of infected fleas in sou
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and then only while they are on the
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Culex pipiens pipiens occurs throug
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human morbidity in areas of norther
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mortality in calves and lambs and a
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109
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111
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human and animal structures. Abando
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hospitalized 2,088 patients with sc
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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.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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