Frank J. Newton, MDCOL USA<strong>Command</strong> SurgeonFORCE HEALTH PROTECTION (FHP) AND A REVIEWOF COUNTERMEASURES TO REDUCE THE THREAT OFRABIES TO U.S. MILITARY FORCESOur commanders have come to expect that they willhave a healthy, fit force that is prepared to execute any mission,at any time, and under any conditions. Surgeons, theirstaffs, and a robust medical network rapidly conveys informationabout disease outbreaks and emerging threats (likethe H1N1 flu virus), better than ever in our history to countermedical threats to U.S. military forces..Looking over the specific medical threats in Southand SE Asia, with rare exception, our troops are immunizedagainst many of the disease threats encountered. Two notableexceptions, which do not have immunizations availablefor primary prevention are some diarrheal illnesses andDengue. In both cases, personal protective measures, gooddiscipline, and command emphasis are required to maintainfitness to complete the mission and redeploy in good health.Rabies, a medical threat frequently encountered bySOF in the developing countries where they are employed,requires constant vigilance and command emphasis. Thevirus is transmitted by the saliva of infected mammalsthrough bite wounds, open cuts in skin, and when there ismucous membrane contact, with saliva or other infectious tissuesuch as brain. In the U.S., wildlife (especially raccoons,skunks, and bats) are responsible for most human and domesticanimal infections. In most of the world where rabiesis enzootic, including most of Asia, Latin America, andAfrica, dogs remain the major source of rabies transmission.SOF personnel receive primary or pre-exposure vaccinationfor rabies. This is an important FHP measure, consideringthat infection with rabies is universally fatal, and thatSOF operates in austere settings where there is a high prevalenceof rabies, and medical support, including biologics(vaccine and RIG) may not be immediately available. Manyof the support personnel that deploy to augment our taskforces have not received rabies vaccination. Their exposureto rabid animals (or even suspected rabid animals) is a medicalurgency.Recently, such an exposure occurred in the Philippines,where the incidence of rabies is ranked number six inthe world. The servicemember had been playing with a sixmonth-olddog outside of a military camp when the unprovokeddog bit the Soldier on the hand, causing afull-thickness injury. The dog was quarantined, and wasfound dead in his kennel less than 24 hours later. Brain fluorescencefor the rabies antibody was positive.Treatment for an animal bite includes immediatecleansing of the wound with soap and water, or preferablypovidone-iodine (betadine).* For previously vaccinated individuals,post-exposure treatment consists of two IM dosesof rabies vaccine, (1.0ml each) ), into the deltoid muscle. Thefirst is given as soon as possible after exposure and the secondis given three days later. Unvaccinated individuals aregiven a five shot series on day zero, three, seven, fourteen94Journal of <strong>Special</strong> <strong>Operations</strong> Medicine Volume 9, Edition 3 / <strong>Summer</strong> 09
and twenty-eight. Rabies immune globulin (RIG) is administeredonly once, to previously unvaccinated individuals, andshould be administered as soon as possible after exposure.The dog or cat that bit the servicemember should bequarantined for up to ten days of observation to see if theywill exhibit signs of rabies. If the animal exhibits signs ofrabies, then it should be euthanized by the closest militaryveterinary treatment facility or authorized contract agency,and the head submitted for definitive testing. Any animalother that a cat or dog that bites a servicemember will be immediatelyeuthanized and the head submitted for testing. Thepreferred method of euthanasia is an injection of euthanasiasolution. If euthanasia solution is unavailable, then any approvedmethod that preserves the brain should be used.A discussion of rabies testing submission procedurescan be found in the <strong>Command</strong> Veterinarian column.Link to CDC, Human rabies prevention-U.S.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm.*Editor’s note: The 5th Edition of Auerbach’s Wilderness Medicineadvises (p 1218) us not to trust reports of vaccination of dogs in foreigncountries as … “fatal rabies has been reported in U.S. citizensand in others who were bitten by “vaccinated” dogs in developingcountries.” On this same page, the former Chief of the Viral and RickettsialZoonoses Branch of the CDC advises us that “… local treatment[i.e., cleansing wound with soap and water] is perhaps the singlemost effective means of preventing rabies.”TSOC Surgeon 95
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An 18D deworms a camel during a “
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Field Evaluation and Management of
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The circumferential anchoring strip
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In doing so, all the skin is closed
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NATO SOF Transformation and theDeve
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current and future operations, thes
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REFERENCES1. James L. Jones, “A b
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This article is the first of two me
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Figure 4 : A Special Forces medic c
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exposure. Conversely, the customary
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7. Ted Westmoreland. (2006). Attrib
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first three days of injury, althoug
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9. Markgraf CG, Clifton GL, Moody M
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the only sign of OCS may be elevate
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E. The canthotomy allows for additi
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33. Rosdeutscher, J.D. and Stradelm
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Tinnitus, a Military Epidemic:Is Hy
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The development of chronic NIHL pro
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supplied by diffusion. During expos
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similar to those of other authors,
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promising effect on tinnitus. Howev
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- Page 49 and 50: et al. demonstrated that both right
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- Page 55 and 56: ABSTRACTS FROM CURRENT LITERATUREMa
- Page 57 and 58: tourniquet times are less than 6 ho
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- Page 61 and 62: Operation Sadbhavana: Winning Heart
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- Page 65 and 66: of the X chromosome. Notable is tha
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- Page 73 and 74: spondents without PTSD (M = 4.6, SD
- Page 75 and 76: patients, whereas the mean score of
- Page 77 and 78: 29. Whealin JM, Ruzek JI, Southwick
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- Page 81 and 82: ing functioning in both PTSD (Zatzi
- Page 83 and 84: Editorial Comment on “Psychologic
- Page 85 and 86: Blackburn’s HeadhuntersPhilip Har
- Page 87 and 88: The Battle of Mogadishu:Firsthand A
- Page 89 and 90: Task Force Ranger encountered enemy
- Page 91 and 92: Peter J. Benson, MDCOL, USACommand
- Page 93 and 94: Numerous military and civilian gove
- Page 95 and 96: Anthony M. Griffay, MDCAPT, USNComm
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- Page 103 and 104: LTC Craig A. Myatt, Ph.D., HQ USSOC
- Page 105 and 106: LTC Bill Bosworth, DVM, USSOCOM Vet
- Page 107 and 108: Europe, Mideast, Africa and SWAU.S.
- Page 109 and 110: SOF and SOF Medicine Book ListWe ha
- Page 111 and 112: TITLE AUTHOR ISBNCohesion, the Key
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- Page 115 and 116: TITLE AUTHOR ISBNRats, Lice, & Hist
- Page 117 and 118: TITLE AUTHOR ISBNThe Healer’s Roa
- Page 119 and 120: TITLE AUTHOR ISBNGuerilla warfare N
- Page 121 and 122: TITLEAUTHORBlack Eagles(Fiction)Bla
- Page 123 and 124: TITLE(Good section on Merrill’s M
- Page 125 and 126: GENERAL REFERENCESALERTS & THREATSB
- Page 127 and 128: Aviation Medicine Resources: http:/
- Page 129 and 130: LABORATORYClinical Lab Science Reso
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