Transcript Wanja Tues 1030 (2)

Vector-Borne Disease Control in
Peacekeeping and Combat
Operations
Asia Pacific Military Health Exchange
Da Nang, Vietnam
14-18 September 2015
MAJ Elizabeth Wanja
Armed Forces Research Institute
of Medical Sciences (AFRIMS)
[email protected]
www.afrims.org
Disclaimer
The 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)
Introduction
“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 Cont…
• 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…
• 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…
• 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
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
Major Issues cont…
Major Issues cont…
• Protozoa: Malaria
• Viruses: Dengue, chikungunya,
Rift Valley fever, Yellow fever
• Helminths: Filariasis
• Allergy
Other protozoan parasite vectorborne disease
1. Visceral Leishmaniasis
(Somalia- 665 cases in 2013)
1.Diarrheal diseases
2. Myiasis
*Trypanosomiasis
*Onchocerciasis
(river blindness)
1.Ectoparasites: Diseases
*Fleas– Plague, murine typhus
*Ticks: encephalitis, Erlichiosis
*Mites- Scrub typhus
2. Leptospirosis
3. Lassa fever virus
Major Concern
• 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)
Mitigation
• 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
Training
• 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 cont…
Outdoor collection
Indoor collection
Vector identification
Training cont…
• 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…
IDAA Kits
2-gallon sprayer
Training cont…
Skin treatment using DEET
DEET applied
DEET not applied