Impact of Phlebotomine Sand Flies on U.S. Military Operations at Tallil Air Base, Iraq: 1. Background, Military Situation, and Development of a “Leishmaniasis Control Program”

Abstract

One of the most significant modern day efforts to prevent and control an arthropod-borne disease during a military deployment occurred when a team of U.S. military entomologists led efforts to characterize, prevent, and control leishmaniasis at Tallil Air Base (TAB), Iraq, during Operation Iraqi Freedom. Soon after arriving at TAB on 22 March 2003, military entomologists determined that 1) high numbers of sand flies were present at TAB, 2) individual soldiers were receiving many sand fly bites in a single night, and 3) Leishmania parasites were present in 1.5% of the female sand flies as determined using a real-time (fluorogenic) Leishmania-generic polymerase chain reaction assay. The rapid determination that leishmaniasis was a specific threat in this area allowed for the establishment of a comprehensive Leishmaniasis Control Program (LCP) over 5 mo before the first case of leishmaniasis was confirmed in a U.S. soldier deployed to Iraq. The LCP had four components: 1) risk assessment, 2) enhancement of use of personal protective measures by all personnel at TAB, 3) vector and reservoir control, and 4) education of military personnel about sand flies and leishmaniasis. The establishment of the LCP at TAB before the onset of any human disease conclusively demonstrated that entomologists can play a critical role during military deployments.

Impact of Phlebotomine Sand Flies on U.S. Military Operations at Tallil Air Base, Iraq: 2. Temporal and Geographic Distribution of Sand Flies

“…Important vector species (e.g., P. papatasi and P. alexandri) are abundant from April to October in all sites that were examined. Although we have not presented results from testing of sand ßies for leishmaniasis in this paper, our data suggest that Leishmania parasites are present in a signiÞcant (Ͼ1%) proportion of sand ßies at TAB (Coleman et al 2006). In the absence of a vaccine or chemoprophylactic drugs, the best method of protection against leishmaniasis remains a combination of a sand ßy control and effective use of personal protective measures.…”

“…The abundance of the sand ßies was reßected in the high number of bites received by U.S. military personnel stationed at TAB. In 2003, up to 75% of soldiers in certain units reported receiving insect bites, with a number of soldiers receiving an estimated 1,000 or more bites in a single night (Coleman et al 2006). Examination of the bites, interviews with the soldiers, and collection of biting arthropods in areas where bites occurred all suggested that sand ßies were responsible for almost all of these bites.…”

“…However, this species has been implicated as a vector of visceral leishmaniasis (Sukkar 1974(Sukkar , 1985Li-ren et al 1986;KillickKendrick 1990) and Azizi et al (2006) reported that Ͼ30% of parous P. alexandri had fed on human blood. Visceral leishmaniasis due to L. infantum is common in the vicinity of TAB (H. Ali, personal communication), whereas initial sequencing of the glucose-6-phosphate isomerase gene indicated that 20% (3/15) of Leishmania isolates from sand ßies were L. infantum (Coleman et al 2006). If P. alexandri is indeed the vector of this parasite, the abundance of this species of sand ßy at TAB is not surprising.…”

“…We have previously provided an overview of our efforts during Operation Iraqi Freedom to establish a "Leishmaniasis Control Program" at Tallil Air Base (TAB) (Coleman et al 2006). Although the primary goal of this effort was to reduce sand ßy populations at TAB, we also were able to conduct a variety of studies assessing the general biology and ecology of sand ßies at the base.…”

The sandflies (Diptera: Psychodidae, Phlebotominae) in military camps in northern Afghanistan (2007–2009), as identified by morphology and DNA ‘barcoding’

“…major in this region is the great gerbil, Rhombomys opimus (Rodentia: Muridae), other rodents can be infected with the parasite (Nadim et al, 1979). Since the deployment of international military forces to Iraq and, subsequently, to Afghanistan, hundreds of the soldiers involved have developed zCL (Coleman et al, 2006;Faulde et al, 2006). Appropriate preventive schemes based on monitoring and control need to include sandfly trapping, assessments of the prevalences of infection in local sandflies, reduction in the numbers of potential breeding sites for the vector species, and personal protection against sandfly bites .…”