Middle East DVEP - Armed Forces Pest Management Board

only 5 to 6 days. These mites will readily infest humans if their rodent hosts are suddenlyeliminated.Vector Surveillance and Suppression. Methods of surveillance for rodent ectoparasitesare discussed in the following section on plague. Rodent control is thoroughly discussedin Technical Guide (TG) 138, Guide to Commensal Rodent Control. Insecticidesrecommended for flea control are listed in TIM 24, Contingency Pest ManagementPocket Guide.L. Plague. (Pestis, Black death)Plague is a zoonotic bacterial disease involving rodents and their fleas, some species ofwhich occasionally transmit the infection to man and other animals. The infectiousagent, Yersinia pestis, causes fever, chills, myalgia, nausea, sore throat and headache.Bacteria accumulate and swelling develops in the lymph nodes closest to the infectedbite. Since most flea bites occur on the lower extremities, the nodes in the inguinalregion are involved in 90 percent of cases. The term bubonic plague is derived from theswollen and tender buboes that develop. Plague is most easily treated with antibiotics inthe early stages of the disease. However, untreated bubonic plague has a fatality rate of50%. Infection may progress to septicemic plague with bloodstream dissemination of thebacteria to diverse parts of the body. Secondary involvement of the lungs results inpneumonia. Pneumonic plague is of special medical significance since respiratoryaerosols may serve as a source of person-to-person transmission. This can result indevastating epidemics in densely populated areas. Untreated pneumonic or septicemicplague is invariably fatal but responds to early antibiotic therapy. To ensure properdiagnosis, medical personnel should be aware of areas where the disease is enzootic.Plague is often misdiagnosed, especially when travelers or military personnel developsymptoms after returning from an enzootic area.Military Impact and Historical Perspective. Epidemics of plague have been knownsince ancient times and have profoundly affected civilization. During the Middle Ages,Europe experienced repeated pandemics of plague. Twenty-five percent of thecontinent’s population died during the great pandemic of the 14th century. The lastpandemic of plague originated at the close of the 19th century in northern China andspread to other continents by way of rats on steamships. Plague has been a decisivefactor affecting military campaigns, weakening besieged cities or attacking armies duringthe Middle Ages. Severe ecological disturbances and dislocations of human populationsduring the Vietnam War led to outbreaks of plague. Even though plague has beendeclining on a worldwide basis, persistent enzootic foci can trigger the recurrence ofepidemics when general sanitation and health services are disrupted by war or naturaldisaster. Presently, the threat of plague to military operations is low.Disease Distribution. Human cases of plague have been known from the Middle Eastsince 1815. Human infections have been uncommon in recent decades, with theexception of a 1994 outbreak in Iraq. However, enzootic plague is focally distributed inmany countries of the Middle East, including Iran, Iraq, Lebanon, Saudi Arabia, Turkeyand Yemen (Figure 6). Transmission is seasonal and occurs from May to September innorthern countries (Turkey, Lebanon, Iran, and Iraq). There is a potential year-round risk96