Middle East DVEP - Armed Forces Pest Management Board

is maintained primarily through airborne transmission. Outbreaks of Q fever in humanshave been traced to consumption of infected dairy products, contact with contaminatedwool or hides, infected straw, and infected animal feces. Coxiella burnetii may enterthrough minor abrasions of the skin or the mucous membranes. Although rare, humanto-humantransmission of Q fever has occurred.Vector Surveillance and Suppression. A satisfactory vaccine has not been developed,and human vaccination has been hampered by the high rate of adverse reactions.Measures to identify and decontaminate infected areas and to vaccinate domestic animalsare difficult, expensive and impractical. Military personnel should avoid consumption oflocal dairy products and contact with domestic animals, hides, and carcasses of deadanimals. This is militarily significant, since troops had frequent exposure to domesticanimals and animal carcasses during the Persian Gulf War. Soldiers should not rest,sleep, or work in animal sheds or other areas where livestock have been housed.K. Murine Typhus. (Flea-borne typhus, Endemic typhus, Shop typhus)The infectious agent, Rickettsia typhi, causes a milder disease than does R. prowazekii,but it still results in a debilitating illness with high fever. The incubation period rangesfrom 1 to 2 weeks, and clinical symptoms may last up to 2 weeks in untreated cases.Mortality is very low, and serious complications are infrequent. The disease is easilytreated with antibiotics. Absence of louse infestation, seasonal distribution, and thesporadic occurrence of murine typhus help to differentiate it from epidemic typhus.Military Impact and Historical Perspective. Confusion in diagnosis between murinetyphus and closely related diseases may occur. Prior to World War II, murine typhus wasnot distinguished from the epidemic form, and its importance in prior wars is unknown.During World War II, there were 786 cases in the US Army with 15 deaths. There arelittle available data on the incidence of murine typhus during military operations in Koreaor Vietnam. During the Vietnam War, murine typhus was concentrated in port cities andincidence seemed low. However, retrospective studies indicated that a large proportionof fevers of unknown origin experienced by Americans during that conflict were due toR. typhi. The disease is most common in lower socioeconomic classes and increaseswhen disruptions by war or mass migration force people to live in unsanitary conditionsin close association with domestic rodents. However, murine typhus has not been amajor contributor to disease rates in disaster situations. Because of the sporadicincidence of murine typhus, it is difficult to confidently predict the potential impact ofthis disease on future military operations, although its military impact would probably beminimal.Disease Distribution. Murine typhus occurs worldwide, and sporadic cases have beenreported throughout the Middle East. Current distribution is depicted in Figure 5.Human cases occur principally in urban areas where commensal rodent infestations arecommon, although infected rodents have been collected from rural villages. In the city ofKuwait, the incidence of murine typhus is highest in lower socioeconomic classes, wherenearly 80% of houses are infested with rats.93