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Vector-Borne Disease Control in Peacekeeping and Combat

Operations

MAJ Elizabeth WanjaArmed Forces Research Institute

of Medical Sciences (AFRIMS)Elizabeth.wanja.mil@afrims.org

www.afrims.org

Asia Pacific Military Health ExchangeDa Nang, Vietnam14-18 September 2015

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DisclaimerThe views expressed in this presentation are those of the author and do not represent the official policy or position of AFRIMS, the US Department of the Army, Department of Defense, or US Government.

This work was funded by the United States Africa Command (US-AFRICOM) and Armed Forces Health Surveillance Center, Global Emerging Infections Surveillance and Response System (AFHSC-GEIS)

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“This will be a long war, if for every Division I have facing the enemy, I must count on a

second Division in the hospital with malaria, and a third Division convalescing

from this debilitating disease”

General Douglas MacArthur (1943)

Introduction

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• Wartime epidemics severely reduce fighting strength• Until WW1, infectious diseases rather than battle and

non-battle injuries were main causes of morbidity and mortality

• Advances in military hygiene and disease-control measures has resulted in disease decline  

• Unfortunately, these diseases remain of central importance in developing countries in terms of morbidity and mortality

Introduction Cont…

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• Vector-borne diseases especially malaria and dengue fever remain top threats during contingency and combat deployments

• Most preventable with a combination of •The right prophylaxis•Proper use of personal protective measures (PPM)•Vector control•Proper sanitation

Introduction Cont…

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•Example between 2004 & 2006 Swedish troops deployed to Liberia - no malaria cases • Reason-Soldiers used DEET-based repellent,

mosquito nets, and took anti-malaria tablets

• In contrast in Liberia, 2003• 44 U.S. Marines evacuated- with confirmed or

presumed P. falciparum malaria

• Reason: Failure to use PPE and inadequate adherence with chemo-prophylaxis

Introduction Cont…

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Major Issues• For peace-keeping operations, issues include

1. PPE Availability- Limited• Bed Nets• DEET/ Topical repellents• Treated Uniforms

2. PPE Acceptability• Permethrin-treated uniforms / DEET-cause skin diseases to include cancer• Malaria prophylaxis drugs cause psychiatric problems

3. Lack of education/ information on***• Proper application of PPE• Importance of sanitation for vector disease control

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Major Issues cont…

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1.Ectoparasites: Diseases*Fleas– Plague, murine typhus*Ticks: encephalitis, Erlichiosis*Mites- Scrub typhus2. Leptospirosis3. Lassa fever virus

Major Issues cont…

1.Diarrheal diseases2. Myiasis

*Trypanosomiasis*Onchocerciasis (river blindness)

• Protozoa: Malaria• Viruses: Dengue, chikungunya,

Rift Valley fever, Yellow fever• Helminths: Filariasis• Allergy

Other protozoan parasite vector-borne disease1. Visceral Leishmaniasis (Somalia- 665 cases in 2013)

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• Africa and other developing nations bear the greatest burden of vector-borne diseases

• Required skills and capacity to control them remain adversely scarce

• Malaria -labeled the signature disease of concern by US Africa Command (AFRICOM) Surgeon

• Preventable through correct malaria diagnosis, vector surveillance, control, proper use of personal protective measures (PPM)

Major Concern

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• AFRICOM established East/West African Malaria Task Force (E/WAMTF) • To help partner nations create a unified front

against vector-borne diseases

• Task force objectives• Identify ways to encourage self-protection • Promote improved surveillance, diagnosis and

treatment

• Approach• Training/capacity building

Mitigation

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•Military personnel from E/WAMTF member countries attended Entomology training in Kisumu, Kenya

•Nepal engagement- GEIS funded• AFRIMS Entomology Department conducted similar training-17-24 August 2014

•Aim was to develop participants’ ability • To conduct surveillance, identify, prevent, control disease vectors

• Understand importance of sanitation in vector disease prevention

Training

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Outdoor collection

Training cont…Indoor collection

Vector identification

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• Understand importance of PPE & correct use of PPM• Permethrin uniform treatment using

• Individual dynamic absorption application (IDAA) kits

• 0.5 Aerosol can

• 2-gallon sprayer

• Skin treatment using DEET• Proper wear of uniform to prevent arthropod bites• Protecting the ‘at Risk Soldier’ using PPM

Training cont…

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Training Cont…

IDAA Kits

2-gallon sprayer

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Skin treatment using DEET

Training cont…

DEET applied DEET not applied

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Quest ons??

Questions??