A Zoonotic Disease Summary for Public Health … Library/2017...2017/12/31 · Of the 263 zoonotic cases, 20 were Army cases reported from non-Army locations: 12 Lyme disease, 4 malaria,

A Zoonotic Disease Summary for Public Health Personnel in the United States Army

Approved for public release, distribution unlimited

In this issue: Army tick and mosquito testing, rabies animal testing, and human zoonotic disease cases diagnosed at Army and Joint Base (JB) military treatment facilities (MTFs), or their designated catchment areas.

Male Gulf Coast Tick (Amblyomma maculatum). Photo courtesy of Army Public Health Center’s Visual Information and Digital Media office.

2 Executive Summary

3 Human Disease Summary

5 Animal Disease Summary

7 Vector surveillance -

Mosquitoes

9 Vector surveillance - Ticks

17 References

18 Appendices

Contact Us: Disease Epidemiology Division

2

1 January - 31 December 2017

Human Disease

Executive Summary

Rabies: In 2017, 3,567 rabies-positive animal samples were reported from 31 U.S. states, the majority from wild animals(91%). Bats were the most frequently identified infected species (35%), followed by raccoons (27%), and skunks (21%).There were 93 animal specimens associated with 162 human exposures tested for rabies by Army labs; 8% (7/93) ofspecimens were positive; 5% (5/93) were indeterminate. PHC-Europe tested 17 of the animal samples and 76% (13/17) ofthese samples were collected from U.S. Army Central Command (CENTCOM). Installations from PHC-Pacific, PHC-Central,and PHC-Atlantic submitted 76 samples associated with 112 human exposures to the Department of Defense (DOD) FoodAnalysis and Diagnostic Laboratory (FADL); 7 samples were positive (3 from Arizona, 3 from Texas, and 1 from Virginia)and 1 was indeterminate.

The most frequently identified zoonotic diseases among Army Active Duty (AD) and non-Active Duty (NAD) beneficiaries are tick-borne (Lyme disease and Spotted fever group rickettsioses).

Zoonotic Diseases as a Proportion of Reportable Medical Events: In 2017, zoonotic diseases comprised 9% (263/2,885)of all Reportable Medical Events (RMEs), excluding sexually transmitted infections (STIs). Zoonotic disease reports amongArmy AD Service members (SMs) comprised 4% (105/2,885) of all non-STI RMEs and 5% (158/2,445) among NADbeneficiaries.

Most Common Zoonosis: Borreliosis, also known as Lyme disease, continued to be the most frequently reportedzoonotic RME, comprising 46% of all reportable zoonotic diseases. Borreliosis was also the most commonly codedzoonotic diagnosis in medical records, making up 40% (421/1,062) of zoonotic diseases identified.

A total of 3,690 mosquito pools from military installations were tested for West Nile Virus (WNV) in 2017. Overall, 4%(155/3,690) of pools were WNV-positive. In PHC-Atlantic, 128 (3%) pools tested positive, and 27 (<1%) pools in PHC-Central tested positive; no pools in PHC-Europe or PHC-Pacific tested positive for WNV.

In 2017, 5,132 ticks were tested by Regional Health Command (RHC) laboratories and the DOD Tick Test Kit Program atthe U.S. Army Public Health Center (APHC). Of the 1,709 Ixodes spp. ticks that were tested, 297 (17%) were positive forBorrelia burgdorferi and Borrelia spp. Of 1,630 ticks tested for Anaplasma phagocytophilum, 31 (1.9%) were positive.

Animal Disease

Vector Surveillance

mailto:usarmy.apg.medcom-aphc.mbx.disease-epidemiologyprogram13@mail.mil


3


Human Disease Summary: U.S. Army Reportable Medical Events

Zoonotic Diseases in DOD Beneficiaries from Army and Joint Army Installations in DRSi, 2017

Not shown in the table (diseases with <5 cases): brucellosis (1 NAD), chikungunya virus disease (2 AD), hantavirus (1 AD), ehrlichiosis (1 AD, 2 NAD), leishmaniasis (3 AD), leptospirosis (2 AD, 2 NAD), meningoencephalitis (1 AD), tick-borne encephalitis (1 AD), typhus fever (1 NAD), and Zika virus disease (1 AD). Note: USAG (United States Army Garrison)

Excluding STIs, 2,885 RME records with a date of diagnosis in calendar year 2017 were entered into the Disease ReportingSystem-internet (DRSi). Of these, 263 (9.1%) were for zoonotic diseases and 314 (10.9%) were for related events (rabiespost-exposure prophylaxis (PEP)). Of the 263 zoonotic disease cases, 105 (39.9%) were among AD SMs (includes Cadetsand Recruits) and 158 (60.1%) were among NAD beneficiaries (Family members, Retirees, civilians). Of the rabies PEPcases, 166 (52.9%) were among AD SMs and 146 (46.5%) were among NAD beneficiaries.

Of the 263 zoonotic cases, 20 were Army cases reported from non-Army locations: 12 Lyme disease, 4 malaria, 2 spottedfever rickettsiosis, 1 dengue fever, and 1 typhus fever.

Two tick-borne diseases (Lyme disease and spotted fever rickettsiosis) comprised the majority (80.2%, 211/263) of allzoonotic disease records (excluding rabies PEP) in DRSi in 2017; Lyme disease alone made up 46.4% (122/263) of records.

Two of the leishmaniasis cases had a history of travel to Iraq, a geographic area where the occurrence of leishmaniasis iswidespread.

AD NAD AD NAD AD NAD AD NAD AD NAD

Ft. Rucker AL 1 4

Ft. Benning GA 1 1

JTF-B MED EL-HONDURAS HN 1

Ft. Campbell * Ft. Knox KY 2 1 3 2 3 8 4

Aberdeen Proving Ground * Ft.

Detrick * Ft. Meade * Walter

Reed National Military Medical

Center

MD 6 12 1 2 3

Ft. Bragg NC 1 2 21 13 3

Ft. Drum * West Point USMA NY 11 16 1 3

Carlisle Barracks PA 3 15

Ft. Jackson SC 1 1

Ft. Myer * Ft. Belvoir * Ft. Lee VA 1 8 1 1 14 18 3

24 55 1 0 7 6 42 42 4 11

Ft. Huachuca AZ 1

Ft. Carson CO 5 4 1

Ft. Riley * Ft. Leavenworth KS 1 3 1

Ft. Polk LA 2 1

Ft. Leonard Wood MO 5 8 6 11 26 37

Ft. Sil l OK 6

Ft. Sam Houston * Ft. Hood * Ft.

BlissTX 2 3 1 1 2 1 26 50 7

7 11 1 1 2 1 46 70 27 45

Ft. Wainwright AK 1 1 2

Tripler Army Medical Center HI 1 2 2 1

Camp Casey * Camp Stanley *

Camp Walker * USAG Yongsan KS 1 1 2 1 8 5

Ft. Lewis WA 1 1 1 1

4 3 1 3 3 1 12 5 0 0

USAG Bavaria * USAG Hohenfels

* USAG Stuttgart * USAG

Ansbach * USAG Rhineland-

Pfalz

GM 3 3 1 1 46 20

USAG Italy IT 1 1

3 3 1 0 1 0 47 21 0 0

11 2

4 8 1 3 1 8 8 2

42 80 4 5 16 9 166 148 31 58

Region and Location

Borreliosis

(Lyme Disease)

Dengue

FeverMalaria

Rabies Post-Exposure

Prophylaxis

Spotted Fever

Rickettsiosis

Atlantic

Atlantic Total

Central

Central Total

Pacific

Pacific Total

Europe

Europe Total

OtherArmy Locations

Non-Army Locations

Total



4


Human Disease Summary: U.S. Army Location Medical Data Zoonotic Disease Cases in DOD Beneficiaries Identified from Medical Visit Data in M2, 2017

Inpatient and outpatient medical records from Army, Joint Base (JB) MTFs, and non-Army locations (Army beneficiaries only), and purchased care records from beneficiaries residing within these catchment areas were reviewed for zoonotic disease diagnoses codes. Cases listed in this section may not meet RME reporting guidelines, leading to higher case counts than reported elsewhere. Also, changes in methodologies concerning how purchased care records were matched to the nearest Army locations, and how Army beneficiary cases were selected from non-Army locations led to an increase in case counts from 2016 to 2017.

During 2017, 1,062 newly diagnosed zoonotic diseases were identified in Military Health System Management Analysis and Reporting Tool (M2). Forty-three percent of cases were identified in purchased care records. One hundred and ninety-seven (18.6%) zoonotic diseases were diagnosed among AD SMs. An additional 392 records were identified as possible rabies exposures.

Borreliosis (Lyme disease) was the most common zoonosis diagnosed in 2017 (39.6%, 421/1,062). Spotted fever rick-ettsiosis was the second most common zoonosis identified (23.4%, 248/1,062), followed by relapsing fever (19.7%,209/1,062).

Among cases from Army and JB MTFs (non-purchased care records), the majority of diseases (39.3%) were diagnosed in RHC-A, followed by RHC-C (35.9%), RHC-E (7%), and RHC-P (6.5%).

AD NAD AD NAD AD NAD AD NAD AD NAD AD NAD AD NAD AD NAD AD NAD

Ft. Rucker * Redstone Arsenal AL 3 1 2 2 3 1 11

Ft. Benning * Ft. Gordon * Ft.

Stewart * Hunter Army AirfieldGA 10 14 1 1 3 2 5 17 1 13 3 5 2

Rock Island Arsenal IL 1 3

Ft. Campbell * Ft. Knox KY 7 9 1 3 8 21 2 17 3 16 1

Aberdeen Proving Ground * Ft.

Detrick * Ft. Meade * Walter

Reed National Military Medical

Center

MD 2 31 1 2 1 1 7 1 6 2 1

Ft. Bragg * Pope Army Airfield NC 2 21 1 1 2 2 2 1 8 22 19 6 30 1

Ft. Drum * West Point USMA NY 15 28 2 4 4 3 3 4 1

Carlisle Barracks * New

Cumberland Army DepotPA 2 23 4 4 1

Ft. Jackson SC 1 9 1 3

Ft. Campbell TN 1 3 1 8

Ft. Lee * Joint (AF) Base

Langley-Eustis * Joint (AN)

Base Myer-Henderson Hall

VA 2 16 1 4 6 1 1 2 8 1

42 157 4 7 7 8 2 6 31 87 8 78 16 73 0 3 0 3

Ft. Huachuca * Yuma Proving

GroundAZ 4 3 3 1

Ft. Carson CO 4 2 1 2 6 10 1 1

Ft. Leavenworth * Ft. Riley KS 2 4 1 2 3 2 7 1 2 1

Ft. Polk LA 4 3 1 5 1

Ft. Leonard Wood MO 4 8 4 1 1 4 23 58 1

Ft. Sill OK 3 5 5 1 4

Ft. Bliss * Ft. Hood * Joint (AF)

San Antonio LAF-RAF-FSHTX 3 16 11 1 1 5 33 100 1 22 3 25 1

16 44 0 5 11 1 3 6 41 113 4 54 29 90 1 0 0 3

Ft. Wainwright * Joint (AF)

Base Elmendorf-RichardsonAK 1 2 1 1 1

Ft. Irwin * Presidio of

MontereyCA 1 1 1 2

Ft. Shafter * Schofield Barracks HI 4 1 1 7 1 1 8

Camp Humphreys * Camp Red

Cloud * USAG YongsanKS 1 1 2 1

Joint (AF) Base Lewis-Mcchord WA 3 5 1 1 4 3 4 1 1

5 12 1 0 0 3 0 8 3 7 6 14 1 0 0 0 0 2

USAG Rheinland-Pfalz * USAG

Bavaria * USAG Stuttgart *

USAG Ansbach * USAG

Wiesbaden

GM 6 17 1 6 4 2 4 5 23

6 17 0 0 0 0 0 1 6 4 2 4 0 0 5 23 0 0

OTHER 8 109 1 7 1 2 6 4 32 2 33 6 33 1 1 5

77 339 6 19 18 13 7 27 85 243 22 183 52 196 6 27 1 13

PACIFIC

Pacific Total

EUROPE

Europe Total

Non-Army Locations

Total

Tick-borne

EncephalitisTularemia

ATLANTIC

Atlantic Total

CENTRAL

Central Total

Region and LocationLeishmaniasis Leptospirosis

Rabies

Exposure

Relapsing

Fever

Spotted

Fever

Rickettsiosis

Borreliosis

(Lyme

Disease)

Ehrlichiosis/

Anaplasmosis

Diseases with <11 cases excluded: Brucellosis (1 AD, 6 NAD), hantavirus (2 AD, 8 NAD), plague (2 NAD), Q fever (4 AD, 6 NAD), Rift Valley fever (1 NAD), sandfly fever (2 NAD), trichinosis (5 NAD), and West Nile virus (6 NAD). Note: Air Force (AF)


Contact Us:

Disease Epidemiology Division

5


Animal Disease Summary: State Rabies Testing

U.S. Annual Rabies Data Summary, 2017

*Only states that conduct and report rabies testing data are shown. € Data for Montana and Virginia did not span the entire year of 2017. Data was collected up to 9/8/2017 and 9/30/2017 for Montana and Virginia, respectively. Note: Numbers represent positive cases for each animal type in each state.

Thirty-one states had publicly available animal rabies data listing the species of animals tested for all or part of 2017.

A total of 3,567 animals tested positive for rabies in 2017.

Texas reported the highest number of animals testing positive for rabies (19%, 679/3,567), and Pennsylvania reported the second highest number of animals testing positive for rabies (9.7%, 346/3,567).

Among known animal types, most positives were from wild animals (91.2%, 3,254/3,567).

Bats were the most commonly identified rabid animal, accounting for 35.2% of all positive results, and were reported in all 31 states’ data except North Dakota. Raccoons were the second most commonly identified rabid animal, accounting for 26.7% of all positive results.

Skunks (20.7%) and felines (6.7%) were the next most commonly reported positive animals, followed by foxes (6.4%), other/unknown animals (3.3%), and canines (0.9%).

Feline Canine Other Total Bat Skunk Fox Raccoon Other Total

Alabama 2 0 0 2 9 0 9 26 0 44 46

Arizona 0 0 0 0 80 33 34 0 8 155 155

Arkansas 1 1 0 2 22 19 0 0 0 41 43

California 1 3 0 4 198 28 1 0 0 227 231

Colorado 0 2 0 2 63 93 5 1 1 163 165

Connecticut 2 1 1 4 14 4 3 13 1 35 39

Florida 11 2 0 13 19 2 8 36 0 65 78

Illinois 0 0 0 0 58 0 0 0 0 58 58

Iowa 2 0 0 2 6 2 0 0 0 8 10

Kansas 3 1 0 4 4 26 0 0 5 35 39

Louisiana 0 0 0 0 2 13 0 0 0 15 15

Maine 0 0 0 0 8 19 8 26 0 61 61

Maryland 33 0 1 34 40 9 10 139 10 208 242

Massachusetts 1 0 0 1 20 20 11 34 10 95 96

Minnesota 1 0 2 3 19 10 1 1 0 31 34

Missouri 0 2 0 2 17 1 0 0 0 18 20

Montana€ 0 0 0 0 13 0 0 0 0 13 13

Nebraska 2 0 0 2 10 7 0 0 0 17 19

New Jersey 18 0 2 20 31 30 8 113 6 188 208

New Mexico 0 0 0 0 5 2 2 0 4 13 13

New York 43 1 6 50 92 59 45 204 14 414 464

North Dakota 2 0 1 3 0 11 0 0 0 11 14

Oklahoma 7 2 6 15 3 24 0 0 0 27 42

Oregon 1 0 0 1 12 1 1 0 1 15 16

Pennsylvania 62 2 5 69 39 32 25 175 6 277 346

South Carolina 6 2 1 9 4 12 7 28 3 54 63

Texas 20 12 10 42 396 210 12 17 2 637 679

Utah 0 0 0 0 23 0 0 0 0 23 23

Vermont 0 0 0 0 7 5 6 21 1 40 40

Virginia€ 22 1 6 29 19 67 34 120 4 244 273

Washington 0 0 0 0 22 0 0 0 0 22 22

Total 240 32 41 313 1255 739 230 954 76 3254 3567

Overall

TotalState*

Domestic Wild


Contact Us:


6


Animal Disease Summary: Army Rabies Testing Rabies Testing by RHC-Europe Laboratory Sciences, 2017

In 2017, RHC-Europe Laboratory Sciences tested 17 total samples for rabies: ten felines, four canines, two bats, and one jackal. All samples were tested using polymerase chain reaction (PCR); the results of four samples could not be determined and the others tested negative for rabies.

A total of 50 human exposures were associated with the tested samples. Most of the human exposures (74%) occurred in Kuwait and all individuals were exposed by felines.

U.S. military installations in RHCs-Atlantic, Central, and Pacific submitted 76 samples to the DOD Food Analysis and Diagnostics Laboratory (FADL) for rabies testing in 2017; specimens were tested using direct fluorescent antibody (dFA), which is the gold standard for testing rabies. The specimens were associated with 112 human exposures. The number of specimens submitted decreased by approximately 26% from 2016 to 2017.

One specimen was dFA-indeterminate. The sample was unable to be tested due to sample condition issues and a result could not be determined from the sample.

Seven samples were dFA-positive: three bats from Texas and Virginia, and four skunks from Arizona and Texas. Overall, 9% of specimens tested by the FADL were positive for rabies. Seventeen humans were exposed to the animals whose specimens tested positive.

For detailed location information on DOD animal rabies testing, see Appendix A on pages 18 and 19.

Rabies Testing by the FADL, 2017

Submitting

LocationCountry Species No. Tested

No.

Human

Exposures

No.

Indeterminate

%

Indeterminate

No.

Positive% Positive

Canine 3 2 1 33 0 0

Feline 1 1 1 100 0 0

Kandahar

AirfieldJackal 1 1 0 0 0 0

Panzer

KaserneFeline 1 1 0 0 0 0

Spangdahlem

ABBat 2 4 0 0 0 0

Joint Training

CenterJordan Feline 2 2 0 0 0 0

Osan AB Korea Feline 1 1 1 100 0 0

Camp Arifjan Feline 4 36 1 25 0 0

Kuwait Naval

BaseFeline 1 1 0 0 0 0

Camp As

SayliyahQatar Canine 1 1 0 0 0 0

17 50 4 24 0 0

Afghanistan

Germany

Kuwait

Bagram AB

Total

No. % No. %

Bat 4 5 0 0 1 25

Canine 6 4 0 0 0 0

Feline 9 6 0 0 0 0

Oppossum 2 0 1 50 0 0

Raccoon 1 0 0 0 0 0

Total 22 15 1 5 1 5

Bat 16 13 0 0 2 13

Canine 9 15 0 0 0 0

Deer 1 0 0 0 0 0

Feline 10 39 0 0 0 0

Raccoon 4 13 0 0 0 0

Skunk 5 0 0 0 4 80

Total 45 80 0 0 6 13

Canine 6 12 0 0 0 0

Feline 2 4 0 0 0 0

Rat 1 1 0 0 0 0

Total 9 17 0 0 0 0

Central

Pacific

dFA-IndeterminateNo.

Human

Exposures

No. TestedSpeciesRegion

dFA-Positive

Atlantic


Contact Us:


7


Vector Surveillance: Mosquito Summary-West Nile Virus Results

Military Mosquito Testing for WNV in the United States, 2017

A total of 33,881 mosquitoes from 3,690 pools were collected and tested for WNV by military assets; 155 (4%) of the

pools were WNV-positive. Most of the pools were collected and tested by PHC-Atlantic (66%, 2,448/3,690), followed by PHC-Central (31%,

1,131/3,690), PHC-Pacific (3%, 109/3,690), and RHC-Europe (<1%, 2/3,690).

Two mosquito genera (Aedes and Culex) were tested for WNV; the majority were Culex spp. (97%, 32,884/33,881).

Fewer mosquito pools were tested for WNV in 2017 compared to 2016 (3,690 pools v. 5,067 pools). However, a greater proportion tested positive for WNV in 2017 than 2016 (155 v. 83).

The majority of military WNV testing efforts in 2017 were centered on the Washington, District of Columbia (DC) area (30%, 10,316/33,881), although the number of mosquitoes collected and tested in Washington, DC decreased by approxi-mately 47% from 2016.

Military WNV testing efforts were also heavily concentrated in Texas, where 6,822 mosquitoes from 740 pools were collected and tested; 10 (1%) of the pools were WNV-positive. The mosquitoes were collected in Ft. Bliss, Ft. Hood, Lackland Air Force Base (AFB), Randolph AFB, Camp Bullis, and Corpus Christi.

For a map displaying the distribution of mosquito testing, see Appendix B on page 20.

RegionNo. Pools

Tested

No.

Mosquitoes

Tested

No. Pools

Positive

Atlantic 2448 21982 128

Central 1131 11447 27

Pacific 109 450 0

Europe 2 2 0

Total 3690 33881 155

Military Mosquito Testing for Other Pathogens, 2017

RHC-Atlantic tested 6,817 mosquitoes for chikungunya, dengue, and Zika viruses, and all were negative.

RHC-Central tested 915 mosquitoes for chikungunya and Zika viruses, and all were negative.

RHC-Pacific tested 9,894 mosquitoes for chikungunya, dengue, and Zika viruses, and 1,061 mosquitoes for Japanese encephalitis virus. All specimens tested negative for these diseases.

RHC-Europe tested 66 Anopheles spp. mosquitoes for malaria and eight pools were positive. Additionally, 1,823 Phlebo tomus spp. sandflies in 427 pools were tested for leishmaniasis and sandfly fever; one pool was positive for leishmaniasis and one was positive for sandfly fever (data not shown).

Anopheles spp. Culex spp. Anopheles spp.

Chikungunya

virusDengue virus Zika virus

Plasmodium

spp.

Japanese

encephalitis

Virus

Malaria

Atlantic 6817 6817 6817

Central 915 0 915

Pacific 9894 9894 9894 1061

Europe 66 66

Total 17626 16711 17626 66 1061 66

Aedes spp.

Region

No. Mosquitoes Tested*


Contact Us:


8


Vector Surveillance: Mosquito Summary-WNV Results

The highest minimum infection rate (MIR), 17.3, was observed at the Naval Support Center, Carderock, Maryland. The next highest MIRs were observed at JB Anacostia-Bolling (MIR=11.2) and the Walter Reed National Military Medical Center (MIR=10.9), which are both in the Maryland/DC/Virginia (DMV) area. Maryland had the highest overall MIR (MIR=131.1). In contrast, an overall MIR of 0.3 was observed in Georgia and 0.4 in Florida.

In 2017, Fort Bliss, Texas had a yearly MIR of 2.7 with 3,652 WNV-spreading mosquito species (Culex and Aedes) tested. This was approximately the same MIR as in 2016 (MIR=2.4).

One pool of Aedes spp. mosquitoes tested positive for WNV; all other WNV-positive pools were of Culex spp. mosquitoes. This is in contrast to previous years where all WNV-positive pools were Culex spp. mosquitoes.


Contact Us:


9


Vector Surveillance: Tick Summary Tick Collecting by Genus, Collection Method, and Testing Location, 2017

A total of 5,127 ticks were tested by RHC laboratories and the DOD Human Tick Test Kit Program (HTTKP) for select pathogens.

The HTTKP exclusively tests ticks removed from humans. Regional laboratories tested ticks collected from the environment (e.g., tick drags), and those removed from animals (wild and domestic) and humans.

The majority of ticks (52%) tested were Amblyomma spp. ticks. Most of the ticks were tested for Ehrlichia.

* Tick origin may differ from tick testing location (e.g., ticks collected in Afghanistan may have been tested by PHC-Europe laboratory). ** Ticks may be tested for more than one pathogen (e.g., Ixodes pacificus ticks tested for Anaplasma phagocytophilum may also be tested for Borrelia spp.). Note: Crimean-Congo hemorrhagic fever (CCHF); DOD Human Tick Test Kit Program (HTTKP); Spotted fever group rickettsioses (SFGR); Tick-borne encephalitis virus (TBEV).

OCONUS Origin Tick Testing Results, 2017

Tick samples from Afghanistan, Germany, Italy, Romania, and Saudi Arabia were tested by PHC-Europe in 2017.

Approximately 9% (13/153) of ticks from Germany tested positive for Borrelia spp. No ticks tested positive for any disease in any other country.

Note: Infection Prevalence (IP)

No.

Tested

No. Pos

(IP)*

No.

Tested

No. Pos

(IP)No. Tested

No. Pos

(IP)No. Tested

No. Pos

(IP)

No.

Tested

No. Pos

(IP)

Afghanistan 24 0 24 0 24 0 24 0 24 0

Germany 47 0 153 13 (8.5) 45 0 153 0

Italy 2 0 3 0 2 0 3 0

Romania 3 0 3 0

Saudi Arabia 1 0 1 0

TBEVOriginating

Country

A. phagocytophilum Borrelia spp. CCHF Ehrlichia spp.

Anaplasma Babesia

A. phago-

cytophilum

B.

microti

E.

chaffeensis

E.

ewingiiE. spp. PME

B.

spp.

B.

burgdorferi

B.

miyamotoiSFGR

R.

parkeri

R.

rickettsii

R.

montanensisTBEV CCHF

Collection Method Testing Entity*

Animal (wild & domestic) Atlantic 20 20 145 145 20 20 2

Animal (wild) Central 129 129 129 129 3 3

Animal (wild & domestic) Europe 70 68 73 73 24

Environment Atlantic 1085 1085 167 167 1085 1085 14 44

Environment Europe 3 3

Animal Pacific 26 18 26 31

Human Europe 3 3 108 108

Human HTTKP 317 313 2332 2332 2332 313 5 655 650

1650 1547 2662 2644 71 2332 210 1547 1234 31 22 704 650 184 24Total

Ehrlichia Borrelia

Number of Ticks Tested**

VirusesRickettsia


Contact Us:


10


Vector Surveillance: Tick Summary Anaplasmosis Pathogen Identified in Ticks by Submitting Installations, 2017

Continental U.S. (CONUS) military laboratories tested 1,535 Ixodes spp. ticks and 4 Dermacentor variabilis ticks for the bacteria A. phagocytophilum, the pathogen that causes human granulocytic anaplasmosis. Military laboratories in Europe and the Pacific region also tested 48 Ixodes spp. ticks, 25 Rhipicephalus spp. ticks, and 18 Haemaphysalis longicornis ticks for A. phagocytophilum.

A total of 31 ticks infected with A. phagocytophilum were identified; 20 positive ticks were collected from the environ-ment, and 11 ticks were removed from humans and submitted to the HTTKP. All infected ticks were from CONUS locations. In 2016, 71 ticks infected with A. phagocytophilum were identified. No infected ticks from outside the continental U.S. (OCONUS) were identified.

The infection prevalence (IP)* of A. phagocytophilum ranged from 2% at Aberdeen Proving Ground, Maryland to 10% at Hanscom AFB, Massachusetts.

This map only displays information for locations in the United States. *The infection prevalence was only calculated for areas where greater than ten ticks were tested.


Contact Us:


11


Vector Surveillance: Tick Summary Lyme Disease Pathogen Identified in Ticks by Submitting Installations, 2017

In 2017, CONUS military laboratories tested 1,547 Ixodes spp. ticks for the bacteria B. burgdorferi - the pathogen that causes Lyme disease.

A total of 284 ticks infected with B. burgdorferi were identified; 197 ticks were collected from the environment, 85 were removed from humans and submitted to the HTTKP, and 2 were removed from animals. In 2016, 280 ticks infected with B. burgdorferi were identified.

The IP* of B. burgdorferi ranged from 10% at Blossom Point Field Test Facility, Maryland to 70% at Saratoga Springs, New York.



Contact Us:


12


Vector Surveillance: Tick Summary

In 2017, CONUS and OCONUS military laboratories tested 2,644 Amblyomma spp. ticks, 46 Ixodes spp. ticks, 25 Rhipicephalus spp. ticks, and 18 H. longicornis ticks for Ehrlichia chaffeensis, E. ewingii, and Ehrlichia species pathogen organisms; these pathogens cause ehrlichiosis.

A total of 24 ticks infected with E. chaffeensis were identified and 49 ticks were infected with E. ewingii; 56 positive ticks were removed from humans and submitted to the HTTKP, 16 were collected from the environment, and 1 was removed from an animal. None of the positive ticks were from OCONUS locations.

The IP* of E. chaffeensis ranged from 1% at Ft. Lee, Virginia and Ft. Knox, Kentucky to 6% at JB Andrews, Maryland.

Ehrlichiosis Pathogens Identified in Ticks by Submitting Installations, 2017



Contact Us:


13


Vector Surveillance: Tick Summary Panola Mountain Ehrlichiosis Pathogen Identified in Ticks by Submitting Installations, 2017

In 2017, CONUS military laboratories tested 2,332 Amblyomma spp. ticks for Panola Mountain Ehrlichia (PME).

A total of 14 ticks infected with PME were identified; all positive ticks were removed from humans and submitted to the HTTKP.

The IP* of PME ranged from less than 1% at Ft. Knox, Kentucky to 6% at JB Andrews, Maryland.



Contact Us:


14


Vector Surveillance: Tick Summary Spotted Fever Group Rickettsioses Identified in Ticks by Submitting Installations, 2017

In 2017, CONUS and OCONUS military laboratories tested 709 Dermacentor spp. ticks, 22 Amblyomma spp. ticks, and 18 H. longicornis ticks for various spotted fever group rickettsioses (Rickettsia montanensis, R. parkeri, and R. rickettsii).‡

A total of 23 infected ticks were identified; 3 Amblyomma spp. ticks were infected with R. parkeri, 8 Amblyomma spp. ticks were infected with R. rickettsii, and 12 Dermacentor spp. ticks were infected with R. montanensis. Ten positive ticks were collected from the environment and 13 positive ticks were removed from humans and submitted to the HTTKP. No infected ticks from outside OCONUS were identified. One tick infected with R. parkeri was identified in 2016.

This map only displays information for locations in the United States. *The infection prevalence was only calculated for areas where greater than ten ticks were tested. ‡All ticks were not tested for all pathogens.


Contact Us:


15


Vector Surveillance: Tick Summary Borrelia Species Pathogenic Organisms Identified in Ticks by Submitting Installations in Europe and Pacific, 2017

In 2017, military laboratories in Europe, the Pacific region, and the Central Command region tested 162 Ixodes spp. ticks, 25 Rhipicephalus spp. ticks, 18 H. longicornis ticks, and 5 unknown ticks for B. burgdorferi and Borrelia species pathogenic organisms.

A total of 13 ticks infected with Borrelia spp. were identified; 11 positive ticks were removed from humans and submitted to the HTTKP, and 2 were collected from animals.

The IP* of Borrelia spp. ranged from 8% at Pulaski, Germany to 33% at Wiesbaden, Germany.

*The infection prevalence was only calculated for areas where greater than ten ticks were tested.


Contact Us:


16


Vector Surveillance: Tick Summary

Department of Defense Human Tick Test Kit Program, 2017

In 2017, 3,300 ticks removed from humans in the United States were submitted to the DOD HTTKP (an increase of 87 ticks compared to 2016). The majority of ticks were submitted from states in PHC-Atlantic; 3,147 (95%) of ticks were collected from PHC-Atlantic.

Co-infections were detected in 12 I. scapularis ticks across 6 states: 5 were co-infected with A. phagocytophilum and B. burgdorferi, 6 were co-infected with B. burgdorferi and Babesia microti, and 1 was co-infected with A. phagocytophilum, B. burgdorferi, and B. microti. The ticks were collected in Connecticut, Massachusetts, Maryland, New Hampshire, Pennsylvania, and Rhode Island.

In 2017, 1 out of 5 (20%) of the A. maculatum tested for R. parkeri were positive. This was the same proportion observed in 2016.

Although no ticks have tested positive for R. rickettsia In the past 4 years (2014–2017), 12 D. variabilis ticks tested positive for R. montanensis in 2017.

Not shown in the table: seven I. pacificus ticks from California were tested for A. phagocytophilum, B. burgdorferi, and B. microti, and three D. occidentalis Marx ticks from California were tested for R. montanenis and R. rickettsia; all ticks tested negative for the diseases.

ᵟ Dermacentor andersoni and Dermacentor andersoni Stiles ¥ Dermacentor variabilis † Panola Mountain Ehrlichia

Babesia Borrelia

microti burgdorferi E. ewingii PME†

StateNo.

Tested

No. Pos

(IP)No. Pos (IP) No. Pos (IP)

No.

Tested

No. Pos

(IP)No. Pos (IP)

No. Pos

(IP)

No.

Tested

No. Pos

(IP)No. Pos (IP)

No.

Tested

No. Pos

(IP)No. Pos (IP)

No.

Tested

No. Pos

(IP)

No. Pos

(IP)

AL 30 0 0 0 2 0 0

AR 2 0 0 0 1 0 0

CA 1 0 0 6 0 0

CO

CT 51 2 (3.9) 5 (9.8) 20 (39.2) 1 0 0 0 25 0 0

DC 3 0 0 1 (33.3) 36 0 0 0 3 0 0

DE 2 0 0 1 (50) 17 0 0 0 10 0 0

FL 3 0 0 0

GA 3 0 0 0 29 0 1 (3.4) 0 1 0 0 1 0 0

IL 1 0 0 0

IN 5 0 0 0

KS 29 0 0 0 18 0 1 (5.6)

KY 5 0 0 0 1279 13 (1.0) 25 (2.0) 5 (0.4) 188 0 6 (3.2)

MA 21 2 (9.5) 2 (9.5) 6 (28.6) 1 0 0 0 27 0 0

MD 79 1 (1.3) 0 19 (24.1) 331 2 (0.6) 5 (1.5) 4 (1.2) 143 0 2 (1.4)

ME 1 0 0 0

MN 6 0 0 2 (33.3) 4 0 0

MO 1 0 0 0 19 0 1 (5.3) 0 4 0 0

MT 1 0 0

NC 2 0 0 0 23 0 0 0 3 0 0 2 1 (50) 0

NE 1 0 0 0 1 0 0 0

NH 10 0 0 4 (40) 4 0 0

NJ 21 0 0 3 (14.3) 86 0 4 (4.7) 0 49 0 1 (2.0)

NV 2 0 0 0

NY 3 0 0 3 (100) 2 0 0

OK 4 0 0 0 1 0 0

PA 62 2 (3.2) 0 17 (27.4) 24 0 0 0 41 0 0

RI 21 2 (9.5) 2 (9.5) 7 (33.3) 2 0 0 0 26 0 0

SC 10 0 0 0

TN 1 0 0 0

TX 1 0 0

VA 11 0 0 1 (9.1) 396 2 (0.5) 3 (0.8) 5 (1.3) 56 0 2 (3.6) 1 0 0

WA 1 0 0 1 0 0

WI 3 0 0 1 (33.3) 22 0 0

WY 7 0 0

Anaplasma Rickettsia

rickettsii

Ehrlichia Rickettsia

rickettsii

Rickettsii

montanensis

Ixodes scapularis Amblyomma americanum A. maculatumD. andersoni ᵟ D. variabilis ¥

Rickettsia

rickettsiiphagocytophilum E. chaffeensis

Rickettsia

parkeri

Rickettsii

montanensis


https://phc.amedd.army.mil/topics/envirohealth/epm/Pages/HumanTickTestKitProgram.aspx

Contact Us:


17


References: Data Sources

For this report, zoonotic diseases are defined as diseases with an animal host or reservoir that can be transmitted to a human. RME case reports and medical encounters were queried in accordance with the 2012 and 2017 Armed Forces RME Guidelines and Case Definitions. Modifications were applied such that only medical encounters with any of the defining diag-noses in the first four diagnostic positions were considered a case as opposed to any diagnostic position. This modification reduces the selection of potential chronic disease events. More information on these rules can be found here: https://www.health.mil/Military-Health-Topics/Health-Readiness/Armed-Forces-Health-Surveillance-Branch/Epidemiology-and-Analysis/Surveillance-Case-Definitions.

Each U.S. state is responsible for animal rabies testing and publishing results. APHC personnel query each state’s official web-site to identify animal rabies testing information. All information is compiled and summarized.

U.S. Army Public Health Center Entomological Sciences Division

The Entomological Sciences Division of the Environmental Health Sciences & Engineering Directorate at the APHC and Laboratory Sciences at each Regional Health Command (Europe, Pacific, Atlantic, Central) completed all of the vector surveillance testing (mosquito, tick, etc.) and U.S. Army installation-related rabies specimen testing. Each RHC collates the results from their area of responsibility for the calendar year and sends the data to the APHC Disease Epidemiology Division.

Case Definitions and Incidence Rules Used for Human Zoonotic Disease Surveillance

The Military Health System Management Analysis and Reporting Tool (M2)

Disease Reporting System-internet (DRSi)

State Animal Rabies Testing

M2 is a web-based data repository that contains select information on MTF medical records, personnel data, ancillary care records, and Tricare insurance claims for non-MTF care. M2 was queried based on zoonotic disease International Classifica-tion of Diseases, 9th Edition (ICD-9) and ICD-10 codes as referenced in the 2012 and 2017 Armed Forces RME Guidelines and Case Definitions. ICD codes listed in the first four diagnostic fields were used to select inpatient and outpatient medical encounters from the year of interest based on the encounter date in M2. Direct-care records from Army and JB MTFs and purchased-care records from non-MTFs in their designated catchment areas were included. Historic medical data for the prior five years were also reviewed to exclude chronic or previously diagnosed infections.

DRSi is a Web-based application developed by the Navy and Marine Corps Public Health Center (NMCPHC) that all Services use to monitor RMEs. Cases that meet RME case definitions are entered into DRSi by individuals at MTFs. These medical event reports are reviewed by the APHC Disease Epidemiology Division for completeness and accuracy. For this report, only RME records that are considered final with a case status of confirmed or probable are included; records were queried using date of diagnosis.


https://www.health.mil/Military-Health-Topics/Health-Readiness/Armed-Forces-Health-Surveillance-Branch/Epidemiology-and-Analysis/Surveillance-Case-Definitions



Contact Us:


18


Appendix A: Animal Rabies Testing by the DOD Food Analysis & Diagnostics Laboratory (FADL)

Testing by State or Country of Submission and Animal Species, 2017

Region Submitting LocationState/

CountrySpecies

No.

Tested

No.

Human

Exposures

No. dFA-

Indeterminate

% dFA-

Indeterminate

No. dFA-

Positive

% dFA-

Positive

Feline 1 1 0 0 0 0

FL Total 1 1 0 0 0 0

Canine 1 1 0 0 0 0

Feline 4 4 0 0 0 0

GA Total 5 5 0 0 0 0

Canine 2 0 0 0 0 0

Feline 2 0 0 0 0 0

KY Total 4 0 0 0 0 0

Canine 3 3 0 0 0 0

Feline 2 1 0 0 0 0

Raccoon 1 0 0 0 0 0

NY Total 6 4 0 0 0 0

Bat 4 5 0 0 1 25

Oppossum 2 0 1 50 0 0

VA Total 6 5 1 17 1 17

Bat 2 1 0 0 0 0

Canine 1 1 0 0 0 0

Feline 1 1 0 0 0 0

Skunk 3 0 0 0 3 100

AZ Total 7 3 0 0 3 43

Canine 1 1 0 0 0 0

Feline 1 1 0 0 0 0

CA Total 2 2 0 0 0 0

Canine 3 3 0 0 0 0

Feline 1 1 0 0 0 0

Skunk 1 0 0 0 0 0

CO Total 5 4 0 0 0 0

Bat 4 0 0 0 0 0

Canine 2 8 0 0 0 0

Raccoon 1 0 0 0 0 0

KS Total 7 8 0 0 0 0

Feline 2 12 0 0 0 0

MO Total 2 12 0 0 0 0

Bat 10 12 0 0 2 20

Canine 3 3 0 0 0 0

Deer 1 0 0 0 0 0

Feline 6 25 0 0 0 0

Raccoon 3 13 0 0 0 0

Skunk 1 0 0 0 1 100

TX Total 24 53 0 0 3 13

Central

Atlantic

CO

Ft. Leavenworth ● Ft. Riley KS

Ft. Leonard Wood MO

Ft. Hood ● Ft. Sam Houston ● Lackland AFB ● Randolph AFB TX

Air Force Academy ● Ft. Carson

Davis Montham AFB ● Ft. Huachuca ● Yuma Proving Ground AZ

Eglin AFB FL

Ft. Benning ● Ft. Stewart GA

Ft. Campbell KY

Ft. Drum ● West Point Military Academy NY

Ft. Eustis ● VTF Norfolk VA

29 Palms ● Ft. Irwin CA

NAS: Naval Air Station; VTF: Veterinary Treatment Facility TABLE CONTINUED ON NEXT PAGE


Contact Us:


19


Appendix A: Animal Rabies Testing by the DOD Food Analysis & Diagnostics Laboratory (FADL), Continued

Testing by State or Country of Submission and Animal Species, 2017

Region Submitting LocationState/

CountrySpecies

No.

Tested

No.

Human

Exposures

No. dFA-

Indeterminate

% dFA-

Indeterminate

No. dFA-

Positive

% dFA-

Positive

Rat 1 1 0 0 0 0

CA Total 1 1 0 0 0 0

Canine 4 10 0 0 0 0

Feline 1 3 0 0 0 0

Japan Total 5 13 0 0 0 0

Canine 1 1 0 0 0 0

WA Total 1 1 0 0 0 0

Vandenberg AFB CA

Pacific Okinawa Japan

Whidbey Island NAS VTF WA


Contact Us:


20


Appendix B: Military Mosquito Testing for WNV in the United States


Contact Us:


21


Appendix C: Mosquito Testing

Military Mosquito Testing for WNV by Mosquito Genera and Testing Region, 2017

Testing Region Species

No.

Mosquitoes

Tested

No. Pools

Tested

No. Pools

Positive

Culex 21982 2448 128

Region Total 21982 2448 128

Aedes 970 382 1

Culex 10450 747 26

Culiseta 27 2 0


Culex 2 2 0

Region Total 2 2 0

Culex 450 109 0


Aedes 970 382 1

Culex 32884 3306 154

Culiseta 27 2 0

Atlantic

Central

Pacific

Europe

Total


Contact Us:


22


U.S. Army Public Health Command Zoonotic Disease Summary

Disease Epidemiology Program Resources: Epidemiology Training: http://phc.amedd.army.mil/topics/healthsurv/de/Pages/Epi-TechTraining.aspx DRSi Resources: http://phc.amedd.army.mil/topics/healthsurv/de/Pages/DRSiResources.aspx Resource Materials: https://phc.amedd.army.mil/Pages/Library.aspx

Suggested Citation: Disease Epidemiology Division. U.S. Army Zoonotic Disease Report, 2016. Army Public Health Center; 2017.


http://phc.amedd.army.mil/topics/healthsurv/de/Pages/Epi-TechTraining.aspx

http://phc.amedd.army.mil/topics/healthsurv/de/Pages/DRSiResources.aspx

https://phc.amedd.army.mil/Pages/Library.aspx

Documents

A Zoonotic Disease Summary for Public Health … Library/2017...2017/12/31 · Of the 263 zoonotic cases, 20 were Army cases reported from non-Army locations: 12 Lyme disease, 4 malaria,