Tallil AB, Iraq2003

AF Vector Surveillance Team(BAT-L)

Worst Possible Scenario

Leish endemic area Epidemic cutaneous

and visceral

10,000+ troops at Tallil Hundreds of bites/night

for unprotected personnel

Result: Leishmaniasis

Biological Augmentation Team

Normally a WMD response capability

Ruggedized RT-PCR platform (RAPID)– Lyophilized reagents

Lab personnel and equipment + ento = BAT-Leish

Lightweight and mobile

Air Force “System”

Attached to EMEDS Captive military

population– Education, PPE

monitoring Controlled environment

ISO office/laboratory Surveillance/testing of

flies and reservoirs 1Sep-15Nov

So, did we do anything different?

Reservoir Testing

Tested feral dogs, foxes, and rodents

RAPID used to prevent unnecessary euthanasia – Foxes released if neg

“Vatican City” Ecosystem

AF TC (Vatican City) SF infection rate consistently higher even though primary reservoirs uncommon– Few fat sand rats,

jirds, or gerbils– Plenty of mice – 2 rodents came back

PCR positive (WB)

Peak Flight Time

Sand Fly Flight Time (24 Oct 03)

2

42

91

103

76

60

19 21

0 2 0 0 0

5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 5:00

Time

To

tal N

um

ber

Sa

nd

Flie

s

Flight time is dynamic Changes constantly Species shift? Or adaptation to changing environment? Implications: control, education, PPE/avoidance measures

Lessons Learned

The sand flies haven’t read the books There’s not enough time in the day Know the priorities (Leish is not a big

concern when shrapnel is flying) Take everything you need with you!

– Murphy’s Law kicks in as soon as your boots hit the ground

Recommendations

Focus Leishmaniasis control efforts on reservoir control– Easier to find and fewer to control– Identify primary reservoirs and eliminate– Turn the vector into a pest

Alternative approaches to vector control– Vegetation management, baiting, trapping,

aerial spray Monthly flight time studies

Will The Leish Threat Remain?

If the sand fly/Leish threat is exacerbated by dry conditions of forced drought, then what happens when the water comes back?

Converts back to malarious area?

Other Fun Things

Mosquito surveillance Cats for rodent control Where are all the flies?

What Now?

Continue development/validation of new assays

Back to Iraq to assist with surveillance and control of vector-borne diseases

Transition from BAT-L to Medical Entomology Team (MET)