The past and present threat of vector-borne diseases in deployed troops

Reduced effectiveness of permethrin-treated military uniforms after prolonged wear measured by contact irritancy and toxicity bioassays with Ixodes scapularis (Acari: Ixodidae) nymphs

Factory-treated permethrin uniforms are the primary method used by the US Army to prevent arthropod bites and transmission of arthropod-borne diseases. In this study previously worn uniforms were collected from cadets at the United States Military Academy in West Point, NY to determine the amount of permethrin remaining after prolonged wear and subsequent effects on ticks. Six trousers were collected from cadets in the sophomore, junior, and senior classes. A new, unwashed uniform served as a positive control and an untreated maternity uniform served as a negative control. Fabric samples were removed from each trouser and used in bioassays with laboratory-reared Ixodes scapularis Say nymphs. Contact irritancy bioassays measured the nymphs' ability to remain in contact with fabric for a period of 5 min. Toxicity bioassays measured tick survival at 1 and 24 h after contacting uniform samples. liquid chromatography-mass spectrometry was used to quantify the permethrin content (mg/cm2) in each uniform after the bioassays were complete. The results showed significant amounts of permethrin were lost after extended wear and it was related to the cadet year group. The contact irritancy assays found uniforms with less permethrin did not irritate ticks and cause them to dislodge. Mortality was also affected by permethrin levels, with less ticks dying at 24 h on older uniforms. The results from this study show older uniforms lose most of their permethrin and no longer provide the same levels of protection.

Repellent activity of essential oils to the Lone Star tick, Amblyomma americanum

BACKGROUND

The Lone Star tick, Amblyomma americanum is important to human health because of a variety of pathogenic organisms transmitted to humans during feeding events, which underscores the need to identify novel approaches to prevent tick bites. Thus, the goal of this study was to test natural and synthetic molecules for repellent activity against ticks in spatial, contact and human fingertip bioassays.

METHODS

The efficacy of essential oils and naturally derived compounds as repellents to Am. americanum nymphs was compared in three different bioassays: contact, spatial and fingertip repellent bioassays.

RESULTS

Concentration response curves after contact exposure to 1R-trans-chrysanthemic acid (TCA) indicated a 5.6 μg/cm2 concentration required to repel 50% of ticks (RC50), which was five- and sevenfold more active than DEET and nootkatone, respectively. For contact repellency, the rank order of repellency at 50 μg/cm2 for natural oils was clove > geranium > oregano > cedarwood > thyme > amyris > patchouli > citronella > juniper berry > peppermint > cassia. For spatial bioassays, TCA was approximately twofold more active than DEET and nootkatone at 50 μg/cm2 but was not significantly different at 10 μg/cm2. In spatial assays, thyme and cassia were the most active compounds tested with 100% and 80% ticks repelled within 15 min of exposure respectively and was approximately twofold more effective than DEET at the same concentration. To translate these non-host assays to efficacy when used on the human host, we quantified repellency using a finger-climbing assay. TCA, nootkatone and DEET were equally effective in the fingertip assay, and patchouli oil was the only natural oil that significantly repelled ticks.

CONCLUSIONS

The differences in repellent potency based on the assay type suggests that the ability to discover active tick repellents suitable for development may be more complicated than with other arthropod species; furthermore, the field delivery mechanism must be considered early in development to ensure translation to field efficacy. TCA, which is naturally derived, is a promising candidate for a tick repellent that has comparable repellency to commercialized tick repellents.

Field survey and molecular characterization of apicomplexan parasites in small mammals from military camps in Afghanistan

Small mammals are an important reservoir for causative agents of numerous infectious diseases, including zoonotic and vector-borne diseases. The occurrence of these pathogens represents a regional but permanent threat for humans and animals in general and might especially weaken military personnel and companion animals in abroad missions. In our study, small mammals collected in military camps in Afghanistan (Feyzabad, Mazar-e Sharif, and Kunduz) were investigated for the presence of apicomplexans using histopathology and molecular methods. For this purpose, well-established and newly developed real-time PCR assays were applied. A high prevalence was detected not only in house mice (Mus musculus), but also in shrews (Crocidura cf. suaveolens) and grey dwarf hamsters (Cricetulus migratorius). The molecular characterization based on the 18S rRNA gene revealed a close relationship to a cluster of Hepatozoon sp. detected in voles of the genus Microtus. Hepatozoon canis DNA was detected in one house mouse as well as in two Rhipicephalus ticks from a dog puppy. In addition, around 5% of the house mice were found to be infected with far related adeleorinids showing the highest sequence identity of 91.5% to Klossiella equi, the only published Klossiella sequence at present. For their better phylogenetic characterization, we conducted metagenomics by sequencing of two selected samples. The resulting 18S rRNA gene sequences have a length of about 2400 base pairs including an insertion of about 500 base pairs and are 100% identical to each other. Histopathology together with organ tropism and detection rates verified this sequence as of Klossiella muris. In conclusion, we documented naturally occurring protozoan stages and the additional taxonomic characterization of a well-known commensal in mice by applying a combination of different approaches. The study is of medical, social, and biological importance for ensuring human and animal health in military camps and also stresses the required awareness for the potential risk of zoonoses.

Rickettsia felis DNA recovered from a child who lived in southern Africa 2000 years ago

The Stone Age record of South Africa provides some of the earliest evidence for the biological and cultural origins of Homo sapiens. While there is extensive genomic evidence for the selection of polymorphisms in response to pathogen-pressure in sub-Saharan Africa, e.g., the sickle cell trait which provides protection against malaria, there is inadequate direct human genomic evidence for ancient human-pathogen infection in the region. Here, we analysed shotgun metagenome libraries derived from the sequencing of a Later Stone Age hunter-gatherer child who lived near Ballito Bay, South Africa, c. 2000 years ago. This resulted in the identification of ancient DNA sequence reads homologous to Rickettsia felis, the causative agent of typhus-like flea-borne rickettsioses, and the reconstruction of an ancient R. felis genome.

A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health

The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil-military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.

Diversity of tick species (Acari: Ixodidae) in military training areas in Southeastern Brazil

Tick-borne pathogens belong to one of the two main groups of occupational biohazards, and occupational exposure to such agents puts soldiers at risk of zoonotic infections, such as those caused by rickettsiae. There are few studies on acarological fauna and occupational risk in military areas in Brazil. Thus, the present study aimed to analyze the diversity of ticks present in the military training areas of municipalities in the Southeast Region of Brazil. The ticks were collected from the selected areas using the dragging and flagging techniques as well as by visual detection on the operators' clothing, and environmental information was also recorded. A total of ten species were collected from the 66 surveyed areas, belonging to five genera and nine species: Amblyomma sculptum, Amblyomma dubitatum, Amblyomma brasiliense, Amblyomma longirostre, Amblyomma aureolatum, Dermacentor nitens, Rhipicephalus spp., Ixodes spp. and Haemaphysalis spp. The frequent presence of tick species in military training areas along with traces and sightings of wild animals, most commonly capybaras (Hydrochoerus hydrochaeris), in most of the studied areas, indicates high levels of exposure of the military to tick vectors of spotted fever group rickettsiae and the possible occurrence of infections among the troops.

Predictive Model of Lyme Disease Epidemic Process Using Machine Learning Approach

Lyme disease is the most prevalent tick-borne disease in Eastern Europe. This study focuses on the development of a machine learning model based on a neural network for predicting the dynamics of the Lyme disease epidemic process. A retrospective analysis of the Lyme disease cases reported in the Kharkiv region, East Ukraine, between 2010 and 2017 was performed. To develop the neural network model of the Lyme disease epidemic process, a multilayered neural network was used, and the backpropagation algorithm or the generalized delta rule was used for its learning. The adequacy of the constructed forecast was tested on real statistical data on the incidence of Lyme disease. The learning of the model took 22.14 s, and the mean absolute percentage error is 3.79%. A software package for prediction of the Lyme disease incidence on the basis of machine learning has been developed. Results of the simulation have shown an unstable epidemiological situation of Lyme disease, which requires preventive measures at both the population level and individual protection. Forecasting is of particular importance in the conditions of hostilities that are currently taking place in Ukraine, including endemic territories.

Effect of interventions to reduce malaria incidence among military personnel on active duty: study protocol for a cluster randomised controlled trial of the impact of etofenprox-treated uniforms, permethrin-treated uniforms and DEET insect repellent

BACKGROUND

While there is strong evidence that bite protection methods such as permethrin-treated clothing and topical insect repellents are protective against insect bites, there are few studies assessing the impact on malaria infection. This study will estimate the protective efficacy of treated uniforms and DEET insect repellent on the incidence of malaria infection among military personnel in an operational setting. Permethrin-treated uniforms used with DEET lotion will be compared to etofenprox-treated uniforms with DEET lotion. The effect of DEET lotion will be estimated by comparing permethrin-treated uniforms with DEET or placebo lotion.

METHOD

A cluster randomised double-blind placebo-controlled trial is planned to evaluate the effectiveness of the interventions on preventing malaria infections in soldiers on active duty at Mgambo National Service Camp in Tanga, Tanzania. The arms are (1) permethrin-treated uniform with 30% DEET liposome formula; (2) permethrin-treated uniform with placebo lotion; (3) candidate insect repellent system, i.e. etofenprox-treated uniform with 30% DEET liposome formula; and (4) placebo, i.e. untreated uniforms with placebo lotion. The primary outcome is the incidence of Plasmodium falciparum malaria infection detected by polymerase chain reaction (PCR) by active case detection using surveys every 2 weeks for 12 months. Rapid diagnostic tests will be used for the diagnosis of participants with symptoms. The unit of randomisation will be combania: companies formed by recruits aged 18 to 25 years; combania do activities together and sleep in the same dormitory. Unequal randomisation will be used to optimise statistical power for the primary comparison between permethrin-treated uniforms with DEET and etofenprox-treated uniforms with DEET.

DISCUSSION

This trial will provide the estimate of the effects of permethrin with DEET compared to those of the new fabric treatment etofenprox with DEET and any additional effect of using DEET. The results will inform strategies to protect military personnel and civilians who have more outdoor or occupational malaria exposure than the general public.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02938975 .

Predictive Analytics of Cattle Host and Environmental and Micro-Climate Factors for Tick Distribution and Abundance at the Livestock-Wildlife Interface in the Lower Okavango Delta of Botswana

Tick distribution and abundance is influenced by several factors that include micro-climate and environmental and host factors. Contextual understanding of the role played by these factors is critical to guide control measures. The aim of this study was to determine the predictive value of these factors for changes in tick distribution and abundance at the livestock-wildlife interface of the lower Okavango Delta. A two-stage quota sampling design was adopted to select 30 clusters of seven cattle each for tick investigation. Tick investigation was done by lifting the tail to count the total number of ticks at the anno-vulva region during the four meteorological seasons of the year. Additional data were collected on ear tag number, location of origin, sex, age, body condition score (BCS), season of the year, stocking density, and Normalized Difference Vegetation Index values of source terrain. A random effects model was used to evaluate predictive value of the above for tick abundance. Additional mapping of tick distribution pattern in the abattoir catchment area was conducted using spatial autocorrelation and hot-spot analysis. Tick intensity of infection increased linearly from males to females (Z = 3.84, p < 0.001), decreased linearly from lower to higher BCS (Z = -4.11, p < 0.001), and increased linearly from cold-dry through dry to wet seasons (Z = 10.19, p < 0.001). Significant clustering of neighboring crushes on account of tick count was noted in the late-hot-dry season, with high tick count in crushes located along the seasonal flood plains and low tick counts in those located in the dry grasslands. It was concluded from this study that cattle tick abundance is influenced largely by season of the year and that the micro-climatic conditions brought about by the seasonal flooding of the delta have a decided effect on tick distribution during the driest of the seasons. Our study has, for the first time, profiled drivers of tick distribution and population growth in this unique ecosystem. This has the potential to benefit human and veterinary public health in the area through implementation of sustainable tick control strategies that are not heavily reliant on acaricides.

Military Participation in Health Security: Analysis of Joint External Evaluation Reports and National Action Plans for Health Security

Militaries around the world play an important but at times poorly defined and underappreciated role in global health security. They are often called upon to support civilian authorities in humanitarian crises and to provide routine healthcare for civilians. Military personnel are a unique population in a health security context, as they are highly mobile and often deploy to austere settings domestically and internationally, which may increase exposure to endemic and emerging infectious diseases. Despite the role of militaries, few studies have systematically evaluated their involvement in global health security activities including the Global Health Security Agenda. We analyzed Joint External Evaluation (JEE) mission reports (n = 94) and National Action Plan for Health Security plans (n = 12), published as of July 2020, to determine the extent to which military organizations were involved in the evaluation process, military involvement in health security activities were described, and specific recommendations were provided for the country's military. For JEE reports, descriptions of military involvement were highest in 3 of the 4 core areas: Respond (76%), Prevent (39%), and Detect (32%). Similarly, National Action Plan for Health Security plans mentioned military involvement in the same 3 core areas: Respond (58%), Prevent (33%), and Detect (33%). Only 28% of JEE reports provided recommendations for the military in any of the core areas. Our results indicate that military roles and contributions are incorporated into some aspects of country-level health security activities, but that more extensive involvement may be warranted to improve national capabilities to prevent, detect, and respond to infectious disease threats.

US Department of Defense Support of Civilian Vector Control Operations Following Natural Disasters

The United States Department of Defense (DoD) employs advanced-degreed entomologists as Preventive Medicine and Public Health Officers in the Army, Navy, and Air Force. While the primary objective of military entomologists is service member health and readiness ("force health protection"), military entomology resources can provide support to civil authorities as directed by the President or Secretary of Defense through Department of Defense Directive 3025.18, Defense Support of Civil Authorities (DSCA). The employment of DSCA is complex and involves the consideration of such factors as the proper request process, funding, legality, risk, appropriateness, and readiness. Once approved and mobilized, however, military preventive medicine assets can be of significant help to civil authorities when dealing with emergency vector control. This paper will address some of the policy issues surrounding the use of DSCA, outline the resources available from the individual military services, and provide examples of DoD contingency vector control support to civil authorities.

Chikungunya Virus Infections in Military Deployments in Tropical Settings-A Narrative Minireview

Chikungunya fever is a vector-borne viral disease in subtropical and tropical areas of endemicity. Apart from the burden on local populations, chikungunya virus infection also poses a risk for travelers and, in particular, soldiers during prolonged deployment-associated outdoor activities. The absence of rapid diagnostic tests makes surveillance challenging during military deployments in war and crisis zones with restricted medical infrastructure. Consequently, both historical and up-to-date surveillance data from battlefields are scarce. From several studies and postdeployment assessments, some information on the epidemiology of chikungunya virus infections in deployed military personnel is nevertheless available. The few published data homogeneously suggest a low infection risk in the endemic setting. During outbreaks, however, the infection risk of military personnel is comparable to that of the local population. Infection clusters of soldiers without pronounced outdoor activity have been reported under such circumstances as well. In spite of efforts focusing on the development of a chikungunya virus vaccine, no licensed product is available so far.

A review on test methods for insecticidal fabrics and the need for standardisation

Insecticidal fabrics are effective personal protective measures against disease vectors and unlike bed nets, these fabrics can provide protection from day-biting mosquitoes and in outdoor environments. The rapid geographical expansion of day-biting mosquitoes and their role in disease transmission necessitate technological interventions, which can be effectively used during the daytime. There is a renewed interest in insecticidal fabrics mainly due to the recent outbreaks and geographical spread of dengue and chikungunya and with the emerging threat of Zika virus infection. Insecticidal fabrics are useful for protection from night-biting mosquitoes and also in situations were sleeping under a bed net is not possible. They are also effective against other biting arthropods like ticks, mites, tsetse flies, sand flies and body lice. Although long-lasting insecticidal fabrics factory-treated with permethrin are now commercially available for military and civilian use, there are no international guidelines for testing their efficacy. The different methods employed so far for testing bioefficacy, washing and quantification of permethrin are compiled in this review. The future prospects and challenges ahead for long-lasting insecticidal fabrics are discussed in the context of the increased threat from day-biting mosquitoes and the diseases transmitted by them. The review focuses on the need for standardisation of the test methods for ensuring adequate bioefficacy and safety to the user. The differences between long-lasting insecticidal nets and long-lasting insecticidal fabrics are elaborated, and the need for a separate registration and licencing procedure for long-lasting insecticidal fabrics is highlighted. A test procedure for insecticidal fabrics is described, which could be used until internationally accepted guidelines are available.

Malaria, tuberculosis and HIV: what's new? Contribution of the Institut Hospitalo-Universitaire Méditerranée Infection in updated data

The Institut Hospitalo-Universitaire Méditerranée Infection is positioned for the diagnosis, prevention and treatment of the ‘big three’ killer diseases: malaria, tuberculosis and HIV. We implemented the use of new diagnostic samples such as stools and new diagnostic tests such as mass spectrometry for the dual identification of vectors and pathogens. Furthermore, advances in the prevention and treatment of malaria and tuberculosis are reviewed, along with advances in the understanding of the role of microbiota in the resistance to HIV infection. These achievements represent a major step towards a better management of the ‘big three’ diseases worldwide.

Medical Entomology: A Reemerging Field of Research to Better Understand Vector-Borne Infectious Diseases

In the last decade, the Chikungunya and Zika virus outbreaks have turned public attention to the possibility of the expansion of vector-borne infectious diseases worldwide. Medical entomology is focused on the study of arthropods involved in human health. We review here some of the research approaches taken by the medical entomology team of the University Hospital Institute (UHI) Méditerranée Infection of Marseille, France, with the support of recent or representative studies. We propose our approaches to technical innovations in arthropod identification and the detection of microorganisms in arthropods, the use of arthropods as epidemiological or diagnostic tools, entomological investigations around clinical cases or within specific populations, and how we have developed experimental models to decipher the interactions between arthropods, microorganisms, and humans.

Leishmania infections in Austrian soldiers returning from military missions abroad: a cross-sectional study

OBJECTIVES

The incidence of leishmaniasis is known to increase in conflict areas. The aims of this study were to determine the exposure to Leishmania species in Austrian soldiers returning from missions abroad and to assess possible risk factors.

METHODS

A retrospective explorative cross-sectional serologic study was conducted in 225 healthy Austrian soldiers returning from UN or EU peacekeeping missions in Syria, Lebanon and Bosnia and Herzegovina (BIH). Sera were tested for anti-Leishmania antibodies using a commercial enzyme-linked immunosorbent assay. All positive individuals were screened for Leishmania DNA by PCR targeting the ITS1 region using EDTA blood samples.

RESULTS

In total, 13.3% (30/225) of the individuals tested were either positive (8%, 18/225) or borderline (5.3%, 12/225) in the enzyme-linked immunosorbent assay, with the highest seroprevalence in soldiers returning from Syria (17.8%, 18/101; 12 positive, six borderline), second from Lebanon (11.1%, 7/63; four positive, three borderline) and lowest from BIH (8.2%, 5/61; two positive, three borderline). Ten soldiers returning from Syria and one from BIH were also positive for Leishmania DNA. Six of these were identified as Leishmania donovani/infantum complex, two as L. tropica and another three as mixed infections by DNA sequencing. Epidemiologic data were collected via a questionnaire, and seropositivity was correlated with a history of insect bites that took a long time to heal (odds ratio, 5.33; 95% confidence interval, 1.23-23.04; p 0.025).

CONCLUSIONS

Although pretravel serologic data were not available in this study, the exposure of soldiers to Leishmania spp. during their missions can be assumed to be considerable. Because even asymptomatic infections may resurge in case of emerging immunodeficiencies, adequate prevention measures seem important.

Arthropod-borne pathogens of dogs and cats: From pathways and times of transmission to disease control

Vector-borne pathogens have developed a close relationship with blood feeding arthropod ectoparasites (e.g., mosquitoes, ticks, phlebotomine sand flies, black flies, fleas, kissing bugs, lice) and exploited a huge variety of vector transmission routes. Therefore, the life cycles of these pathogens result in a long evolved balance with the respective arthropod biology, ecology and blood feeding habits, instrumentally to the infection of several animal species, including humans. Amongst the many parasite transmission modes, such as ingestion of the arthropod, with its faeces or secretions, blood feeding represents the main focus for this article, as it is a central event to the life of almost all arthropod vectors. The time frame in which pathogens are transmitted to any animal host is governed by a large number of biological variables related to the vector, the pathogen, the host and environmental factors. Scientific data available on transmission times for each pathogen are discussed relative to their impact for the success of vector-borne disease control strategies. Blocking pathogen transmission, and thus preventing the infection of dogs and cats, may be achievable by the use of chemical compounds if they are characterised by a fast onset of killing activity or repellence against arthropods. The fast speed of kill exerted by systemic isoxazoline, as well as the repellent effect of pyrethroids have renewed the interest of the scientific community and pharmaceutical companies towards reducing the burden of vector-borne diseases under field conditions. However, endosymbionts and vaccines targeting arthropods or pathogen antigens should be further investigated as alternative strategies towards the goal of achieving an effective integrated control of vector-borne diseases.

Field Evaluation of Indoor Thermal Fog and Ultra-Low Volume Applications For Control of Aedes aegypti in Thailand

Efficacies of a handheld thermal fogger (Patriot™) and a backpack ultra-low volume (ULV) sprayer (Twister™) with combinations of 2 different adulticides (pyrethrin, deltamethrin) and an insect growth regulator (pyriproxyfen) were field-tested and compared for their impact on reducing indoor Aedes aegypti populations in Thailand. The effectiveness of the indoor space sprays was evaluated by sampling the natural Ae. aegypti population in houses and determining their physiological status, by monitoring mortality of sentinel caged mosquitoes (AFRIMS strain) and by assessing larval mortality in laboratory bioassays using water exposed to the spray. A total of 14,742 Ae. aegypti were collected from Biogents Sentinel traps in this study. The combination of ULD® BP-300 (3% pyrethrin) and NyGuard® (10% pyriproxyfen) sprayed either by the Patriot or Twister significantly reduced some Ae. aegypti populations up to 20 days postspray relative to the control clusters. The addition of pyriproxyfen to the adulticide extended how long household mosquito populations were suppressed. In 2 of the 4 products being compared, the Twister resulted in higher mortality of caged mosquitoes compared with the Patriot. However, neither machine was able to achieve high mortality among Ae. aegypti placed in hidden (protected) cages. The larval bioassay results demonstrated that the Twister ULV provided better adult emergence inhibition than the Patriot (thermal fogger), likely due to larger droplet size.

Determination of airborne concentrations of dichlorvos over a range of temperatures when using commercially available pesticide strips in a simulated military guard post

Dichlorvos is a chemical compound which has been used for decades as a pesticide. Potential inhalational exposure to dichlorvos vapor associated with using commercially-based, dichlorvos-impregnated resin strips in a simulated military guard post was evaluated. A varying number of these pesticide strips, ranging from the manufacturer's guidelines ((3)-16 g strips) up to a full package of strips ((12)-16 g strips), were placed in a small, enclosed space (2.31 m x 2.26 m x 2.44 m, 12.7 m³), which was similar in size to a typical military guard post. Static air sampling was then conducted to simulate personal air sampling, followed by analysis using OSHA Method 62 (GC-ECD). Air sampling was conducted over a range of discrete temperatures (26-38˚C) which approximated average ambient temperatures expected in a variety of deployed environments. Air sampling in this range was conducted to determine the airborne concentration generated at each temperature setting. Airborne concentrations were then compared to established short term military exposure guidelines (MEGs) and the 8-hr OSHA permissible exposure limit (PEL) for dichlorvos (both criteria limits are 0.99 mg/m³). Results from air sampling indicated that exceeding the manufacturer-recommended number of strips for the workspace volume and environmental conditions produced airborne dichlorvos concentrations above established occupational standards (1.77-3.70 mg/m³). Such exposures may potentially lead to adverse effects, such as loss of mental and visual acuity for guard post watch standers who employ more strips within a space than recommended per the manufacturer for the size of the space. However, concentrations of airborne dichlorvos generated when adhering to manufacturer's guidelines based on workspace volume resulted in levels of 0.16-0.39 mg/m³ for 1-hr and 8-hr timeframes, which were below the established occupational health limits. While dichlorvos-impregnated strips are not currently recommended for use in manned workspaces for periods > 4 hr, findings suggest that prolonged use (8 hr) of similar pesticide strips within manned spaces to repel and/or kill disease-carrying insects may be possible without experiencing adverse health effects.

Toxicity and Synergistic Activities of Chalcones Against Aedes aegypti (Diptera: Culicidae) and Drosophila melanogaster (Diptera: Drosophilidae)

Mosquito-borne illnesses are of great concern throughout the world, and chemical insecticides are commonly employed to decrease mosquito populations. However, the developmental insecticide pipeline for vector control has primarily been filled by repurposed agricultural products, and is hampered by their widespread use and insecticide resistance. The present study was performed in the search for new chemical insecticides or insecticide synergists. Screening of 31 chalcone analogs was performed using Aedes aegypti (Linnaeus) first-instar larval toxicity assay, and oral feeding to Drosophila melanogaster's proper authority should be (Meigen). Synergism studies were performed by topically applying chalcones to adult female Ae. aegypti mosquitoes to examine its impact on activity of carbaryl, which was compared to piperonyl butoxide alone. Fourteen chalcone analogs had LC50 values in the range of 0.4-38 ppm against first-instar Ae. aegypti larvae, and three chalcones displayed toxicity against D. melanogaster via feeding (LC50 values ranged from 146-214 μg/ml). Two chalcones synergized carbaryl toxicity against adult Ae. aegypti with efficacy similar to piperonyl butoxide. As a result, it is concluded that chalcones may serve as novel insecticides and synergists after further structural optimization.

Long-lasting permethrin-impregnated clothing: protective efficacy against malaria in hyperendemic foci, and laundering, wearing, and weathering effects on residual bioactivity after worst-case use in the rain forests of French Guiana

Personal protective measures against hematophagous vectors constitute the first line of defense against arthropod-borne diseases. However, guidelines for the standardized testing and licensing of insecticide-treated clothing are still lacking. The aim of this study was to analyze the preventive effect of long-lasting polymer-coated permethrin-impregnated clothing (PTBDU) against malaria after exposure to high-level disease transmission sites as well as the corresponding loss of permethrin and bioactivity during worst-case field use. Between August 2011 and June 2012, 25 personnel wearing PTBDUs and exposed for 9.5 person-months in hyperendemic malaria foci in the rain forest of French Guiana contracted no cases of malaria, whereas 125 persons wearing untreated uniforms only, exposed for 30.5 person-months, contracted 11 cases of malaria, indicating that PTBDU use significantly (p = 0.0139) protected against malaria infection. In the field, PTBDUs were laundered between 1 and 218 times (mean 25.2 ± 44.8). After field use, the mean remaining permethrin concentration in PTBDU fabric was 732.1 ± 321.1 min varying between 130 and 1270 mg/m² (mean 743.9 ± 304.2 mg/m²) in blouses, and between 95 and 1290 mg/m² (mean 720.2 ± 336.9 mg/m²) in trousers. Corresponding bioactivity, measured according to internal licensing conditions as KD₉₉ times against Aedes aegypti mosquitoes, varied between 27.5 and 142.5 min (mean 47.7 ± 22.1 min) for blouses, and between 25.0 and 360 min (mean 60.2 ± 66.1 min) for trousers. We strongly recommend the use of long-lasting permethrin-impregnated clothing for the prevention of mosquito-borne diseases, including chikungunya, dengue, and zika fevers, which are currently resurging globally.

Controlling Aedes aegypti in Cryptic Environments with Manually Carried Ultra-Low Volume and Mist Blower Pesticide Applications

Because Aedes aegypti , a vector of dengue, chikungunya, and Zika viruses, exhibits resting and reproductive behaviors that present challenges to control them, pesticide application equipment available for vector control must be evaluated for their ability to control this species in a variety of cryptic environments. Five types of pesticide sprayers, representing 3 spray technologies (1 mister, 2 ultra-low volume [ULV] cold foggers, and 2 ULV thermal foggers), were evaluated for their ability to control adult and immature stages of Ae. aegypti in indoor and outdoor environments. Cages holding adult mosquitoes and larvae were placed in cryptic sites for indoor sprays and placed among dense vegetation for outdoor sprays. Adult and pupal mortality data were recorded following applications of a mixture of synergized pyrethrins and pyriproxyfen. We found that no single sprayer was best suited for controlling Ae. aegypti in indoor and outdoor environments, nor was one best for controlling adult and immature mosquitoes. Sprayers producing larger droplets (misters and cold foggers) were more effective in controlling immature mosquitoes indoors and outdoors. Thermal fogging was more effective in controlling adults indoors, whereas cold fogs and misters were more effective for outdoor control.

Bioinformatic Characterization of Mosquito Viromes within the Eastern United States and Puerto Rico: Discovery of Novel Viruses

Mosquitoes are efficient, militarily relevant vectors of infectious disease pathogens, including many RNA viruses. The vast majority of all viruses are thought to be undiscovered. Accordingly, recent studies have shown that viruses discovered in insects are very divergent from known pathogens and that many of them lack appropriate reference sequences in the public databases. Given that the majority of viruses are likely still undiscovered, environ mental sampling stands to provide much needed reference samples as well as genetic sequences for comparison. In this study, we sought to determine whether samples of mosquitoes collected from different sites (the Caribbean and locations on the US East Coast) could be differentiated using metagenomic analysis of the RNA viral fraction. We report here distinct virome profiles, even from samples collected short distances apart. In addition to profiling the previously known viruses from these samples, we detected a number of viruses that have been previously undiscovered.

Seroconversion for infectious pathogens among UK military personnel deployed to Afghanistan, 2008-2011

Military personnel are at high risk of contracting vector-borne and zoonotic infections, particularly during overseas deployments, when they may be exposed to endemic or emerging infections not prevalent in their native countries. We conducted seroprevalence testing of 467 UK military personnel deployed to Helmand Province, Afghanistan, during 2008-2011 and found that up to 3.1% showed seroconversion for infection with Rickettsia spp., Coxiella burnetii, sandfly fever virus, or hantavirus; none showed seroconversion for infection with Crimean-Congo hemorrhagic fever virus. Most seroconversions occurred in personnel who did not report illness, except for those with hantavirus (70% symptomatic). These results indicate that many exposures to infectious pathogens, and potentially infections resulting from those exposures, may go unreported. Our findings reinforce the need for continued surveillance of military personnel and for education of health care providers to help recognize and prevent illnesses and transmission of pathogens during and after overseas deployments.

[Epidemiology and prevention of leishmaniasis in northern Afghanistan]

BACKGROUND

Leishmaniasis is estimated to cause the ninth largest disease burden among infectious diseases worldwide and it is not preventable by vaccination or chemoprophylaxis, but only by personal protective measures preventing bites of infectious arthropod vectors.

OBJECTIVES

Which leishmania species are endemic in northern Afghanistan, what are the clinical characteristics of skin lesions produced by cutanizing leishmania species, what are their epidemiological characteristics, and which preventive measures are feasible?

METHODS

The medical literature was reviewed, knowledge gaps were analyzed and completed by our own data collected locally.

RESULTS

Four Leishmania species are considered endemic in northern Afghanistan, of which Leishmania tropica, L. major, and L. donovani can produce skin lesions while L. donovani and L. infantum visceralize. Transmission modes and seasons vary markedly among focally epidemic urban anthroponotic L. tropica and rural enzootic L. major. Combined preventive measures may reduce the infection rate by more than 10,000-fold.

CONCLUSION

Cutaneous as well as visceral leishmaniasis can occur among returnees from Afghanistan. Atypical, poorly healing skin lesions can be caused by L. donovani. Extensive use of personal protective measures against arthropod vectors is strongly recommended for all travelers.

Is there a risk of filarial infection during long-term missions in Haiti?

BACKGROUND

Haiti has the highest prevalence of lymphatic filariasis (Wuchereria bancrofti) in the Western Hemisphere. Still, the risk of filarial infection for long-term visitors such as humanitarian aid workers or military personnel is uncertain. The presented study analyzed the exposure to W. bancrofti in Chilean participants of the UN Stabilization Mission in Haiti (MINUSTAH) in 2011.

METHODS

Blood samples collected from 531 participants were screened for antifilarial antibodies by IgG ELISA, and, if positive, analyzed by immunofluorescence assay (IFA), IgG4 ELISA, Real-Time PCR, and circulating filarial antigen (CFA) card test.

RESULTS

ELISA screening was positive in 10 cases. Seroconversion occurred in only two cases (0.38%) based on ELISA values determined in samples taken before and after deployment. Positive IgG ELISA values could not be confirmed by IFA and IgG4 ELISA. Real-Time PCR and CFA testing did not reveal the presence of filaria.

CONCLUSIONS

Our data indicate that in the examined cohort of MINUSTAH participants in 2011, the risk of filarial exposure or infection was low.

Evaluating Liquid and Granular Bacillus thuringiensis var. israelensis Broadcast Applications for Controlling Vectors of Dengue and Chikungunya Viruses in Artificial Containers and Tree Holes

The principal vectors of chikungunya and dengue viruses typically oviposit in water-filled artificial and natural containers, including tree holes. Despite the risk these and similar tree hole-inhabiting mosquitoes present to global public health, surprisingly few studies have been conducted to determine an efficient method of applying larvicides specifically to tree holes. The Stihl SR 450, a backpack sprayer commonly utilized during military and civilian vector control operations, may be suitable for controlling larval tree-hole mosquitoes, as it is capable of delivering broadcast applications of granular and liquid dispersible formulations of Bacillus thuringiensis var. israelensis (Bti) to a large area relatively quickly. We compared the application effectiveness of two granular (AllPro Sustain MGB and VectoBac GR) and two liquid (Aquabac XT and VectoBac WDG) formulations of Bti in containers placed on bare ground, placed beneath vegetative cover, and hung 1.5 or 3 m above the ground to simulate tree holes. Aedes aegypti (L.) larval mortality and Bti droplet and granule density data (when appropriate) were recorded for each formulation. Overall, granular formulations of Bti resulted in higher mortality rates in the simulated tree-hole habitats, whereas applications of granular and liquid formulations resulted in similar levels of larval mortality in containers placed on the ground in the open and beneath vegetation.

Trace amines inhibit insect odorant receptor function through antagonism of the co-receptor subunit

Many insect behaviors are driven by olfaction, making insect olfactory receptors (ORs) appealing targets for insect control.  Insect ORs are odorant-gated ion channels, with each receptor thought to be composed of a representative from a large, variable family of odorant binding subunits and a highly conserved co-receptor subunit (Orco), assembled in an unknown stoichiometry.  Synthetic Orco directed agonists and antagonists have recently been identified.  Several Orco antagonists have been shown to act via an allosteric mechanism to inhibit OR activation by odorants.  The high degree of conservation of Orco across insect species results in Orco antagonists having broad activity at ORs from a variety of insect species and suggests that the binding site for Orco ligands may serve as a modulatory site for compounds endogenous to insects or may be a target of exogenous compounds, such as those produced by plants.  To test this idea, we screened a series of biogenic and trace amines, identifying several as Orco antagonists.  Of particular interest were tryptamine, a plant-produced amine, and tyramine, an amine endogenous to the insect nervous system.  Tryptamine was found to be a potent antagonist of Orco, able to block Orco activation by an Orco agonist and to allosterically inhibit activation of ORs by odorants.  Tyramine had effects similar to those of tryptamine, but was less potent.  Importantly, both tryptamine and tyramine displayed broad activity, inhibiting odorant activation of ORs of species from three different insect orders (Diptera, Lepidoptera and Coleoptera), as well as odorant activation of six diverse ORs from a single species (the human malaria vector mosquito, Anopheles gambiae).  Our results suggest that endogenous and exogenous natural compounds serve as Orco ligands modulating insect olfaction and that Orco can be an important target for the development of novel insect repellants.

Knockdown and repellent effect of permethrin-impregnated army uniform cloth against Aedes aegypti after different cycles of washings

Personnel protection is one of the methods for protection from bites of mosquitoes and other arthropod vectors transmitting many dreadful diseases. Insect repellents and other plant products are normally used to ward off mosquitoes. Application of synthetic pyrethroid permethrin on cloth is adopted for repelling arthropod vectors in many countries for military and civil purposes. In the present study, attempt has been made to impregnate permethrin in the army uniform cloth and to evaluate for its knockdown and repellency against unfed female Aedes aegypti mosquitoes in laboratory condition. WHO protocols were adopted for impregnation of permethrin on cloth and evaluation for its knockdown and repellency after different cycles of washing. Results showed that 93.33% of mosquitoes were knocked down within 1 h after the first washing while its efficacy reduced gradually till the fifty-fifth washing. Landing of mosquitoes on the permethrin-treated cloth was found to increase with respect to number of washings as compared to the untreated cloth. Within 24 h, 100% mortality of all the mosquitoes exposed to permethrin-impregnated cloth was observed. SEM-EDX studies on the texture of untreated cloth and permethrin-treated cloth after different cycles of washing also revealed presence of permethrin on treated cloth.

High-throughput mosquito and fly bioassay system for natural and artificial substrates treated with residual insecticides

A high-throughput bioassay system to evaluate the efficacy of residual pesticides against mosquitoes and muscid flies with minimal insect handling was developed. The system consisted of 4 components made of readily available materials: 1) a CO2 anaesthetizing chamber, 2) a specialized aspirator, 3) a cylindrical flat-bottomed glass bioassay chamber assembly, and 4) a customized rack.

The resident decision-making process in global health education: appraising factors influencing participation

The globalization of pediatric graduate medical education is ongoing; thus, this study was conducted to begin to explore the nature of resident interest in global health (GH) training and to further identify potentially modifiable factors influencing participation in away rotations. The authors surveyed all residents at Cincinnati Children's Hospital Medical Center to identify factors influencing participation in education efforts and away rotations. With a participation rate of 79.4% (n = 143), 5 key factors emerged as most significant in the decision-making process amid all participants. Among residents who had previous experience, 82.1% were interested in participating in an away elective compared with 58.3% of those without experience (P = .002). Residents with previous experience abroad were also more likely to plan to integrate GH into their careers (61.7% vs 26.7%, P < .0001). This article describes specific obstacles to resident participation in GH education and documents the association between previous experience and significant interest in long-term involvement.

Longevity and efficacy of bifenthrin treatment on desert-pattern US military camouflage netting against mosquitoes in a hot-arid environment

The current Department of Defense pest management system does not provide adequate protection from arthropod disease vectors to personnel deployed in support of US military operations. We hypothesized that military camouflage netting, ubiquitous around living and working areas in current US military operations in Africa and the Middle East, treated with a residual pesticide such as bifenthrin may reduce the presence of biting insects and improve the military pest management system. In this study, we examined the longevity and efficacy of bifenthrin applied to camouflage netting material at the maximum label rate of 0.03 liter formulation (7.9% AI) per 92.9 m2 against field populations of mosquitoes in southern California in a hot-arid environment similar to regions of Iraq, Afghanistan, and the Horn of Africa. We showed that bifenthrin treatment of camouflage netting was effective at reducing mosquito populations, predominantly Psorophora columbiae and Aedes vexans, by an average of up to 46% for 56 days, and could cause as much as 40% mortality in Culex quinquefasciatus in laboratory bioassays for nearly 2 months postapplication. These population reductions could translate to commensurate reductions in risk of exposure to mosquito-borne pathogens, and could potentially be effective against sand flies and filth flies.

Malaria transmission and insecticide resistance of Anopheles gambiae in Libreville and Port-Gentil, Gabon

Background

Urban malaria is a major health priority for civilian and militaries populations. A preliminary entomologic study has been conducted in 2006-2007, in the French military camps of the two mains towns of Gabon: Libreville and Port-Gentil. The aim was to assess the malaria transmission risk for troops.

Methods

Mosquitoes sampled by human landing collection were identified morphologically and by molecular methods. The Plasmodium falciparum circumsporozoïte (CSP) indexes were measured by ELISA, and the entomological inoculation rates (EIR) were calculated for both areas. Molecular assessments of pyrethroid knock down (kdr) resistance and of insensitive acetylcholinesterase resistance were conducted.

Results

In Libreville, Anopheles gambiae s.s. S form was the only specie of the An. gambiae complex present and was responsible of 9.4 bites per person per night. The circumsporozoïte index was 0.15% and the entomological inoculation rate estimated to be 1.23 infective bites during the four months period. In Port-Gentil, Anopheles melas (75.5% of catches) and An. gambiae s.s. S form (24.5%) were responsible of 58.7 bites per person per night. The CSP indexes were of 1.67% for An. gambiae s.s and 0.28% for An. melas and the EIRs were respectively of 1.8 infective bites per week and of 0.8 infective bites per week. Both kdr-w and kdr-e mutations in An. gambiae S form were found in Libreville and in Port-Gentil. Insensitive acetylcholinesterase has been detected for the first time in Gabon in Libreville.

Conclusion

Malaria transmission exists in both town, but with high difference in the level of risk. The co-occurrence of molecular resistances to the main families of insecticide has implications for the effectiveness of the current vector control programmes that are based on pyrethroid-impregnated bed nets.

New protective battle-dress impregnated against mosquito vector bites

BACKGROUND

Mixing repellent and organophosphate (OP) insecticides to better control pyrethroid resistant mosquito vectors is a promising strategy developed for bed net impregnation. Here, we investigated the opportunity to adapt this strategy to personal protection in the form of impregnated clothes.

METHODS

We compared standard permethrin impregnated uniforms with uniforms manually impregnated with the repellent KBR3023 alone and in combination with an organophosphate, Pirimiphos-Methyl (PM). Tests were carried out with Aedes aegypti, the dengue fever vector, at dusk in experimental huts.

RESULTS

Results showed that the personal protection provided by repellent KBR3023-impregnated uniforms is equal to permethrin treated uniforms and that KBR3023/PM-impregnated uniforms are more protective.

CONCLUSION

The use of repellents alone or combined with OP on clothes could be promising for personal protection of military troops and travellers if residual activity of the repellents is extended and safety is verified.