Surveillance, Trap Evaluations, Bednets, & Assessing Air-Conditioning to Prevent

Sand Fly Bites at Tallil AB, Iraq 2003

Major Douglas A. Burkett, Ph.D.332nd AEW Expeditionary Medical Group

Collaborators: LTC Coleman, LTC Sherwood, LtCol McMeans, Maj Caci, Col Swaby, Col Strickman, Capt Blount, Capt Wolf, Don Teig,

Capt Dennett, LT Knight, Ed Rowton, Capt Silvernale, Capt Jennings,

MSgt Cushing, TSgt Walter, TSgt Long

Army and AF Preventive Medicine/Entomology Assets Working Together…

AF relied on Army for vector control/pesticides from Apr - June

Tallil AB

Tallil ABTallil AB Two 12K runways, 30 miles of inner fenceTwo 12K runways, 30 miles of inner fence 24K US & Coalition Forces (~ 1500 AF)24K US & Coalition Forces (~ 1500 AF)

Most with NO PPE….Most with NO PPE…. Historically Agricultural AreaHistorically Agricultural Area

Sand Sand Fly Fly

BitesBites

WRAIR found

2% Infected June 03

BednetsBednets• AF personnel lucky - tents came with bed nets.

• Virturally no AF personnel deployed with bednets/ PPE

• Troops concerned about crickets…

Percentage of Personnel Using Bednets in AF Tent City (1st AEF), Tallil AB – June 03

0

20

40

60

80

100

% Males Bednets -

Cots

% MalesBednets -

Beds

% Femalesw/ Bednets

Cots

% Females w/ Bednets -

Beds

Fliers - A-10 SFPersonnel

% P

erso

nn

el Everyone Else – AF Tent City

n = 198

n = 61

n = 35 n = 70* Didn’t have Commander or NCO support!

AF Bednet Use Jun 03 vs. Aug 03

80

010203040506070

% Males w/Bednets -

Cots

% Males w/Bednets -

Beds

% Femalesw/ Bednets -

Cots

% Femalesw/ Bednets -

Beds

% B

ed

ne

t U

se

June

August

N = ~ 30 tents

2nd AEF Rotation:

-“Right Start” Brief

- Col Swaby Visits

- 1st AF case

- CC/NCO support

Surveillance: CDC Unbaited Light Traps

Joint EffortJoint Effort Purpose:Purpose:

Track sand fly populationsTrack sand fly populations Evaluate Control effectiveness Evaluate Control effectiveness ID sand fly & disease “hot spots”ID sand fly & disease “hot spots” Determine Determine LeishmaniaLeishmania infection rates infection rates

Traps effective w/ NO CO2! Traps effective w/ NO CO2! Which trap designs were most Which trap designs were most

effective?effective?

Trap Evaluations

Black Light

CDC Style

Up Draft CDC Style Sticky

Trap & Chem Lite

Two 4 x 4 Latin Squares

Trap Evaluation - Sand Flies and Mosquitoes, Tallil AB, Iraq

0

10

20

30

40

50

60

70

80

StandardCDC

UV Down Draft

Sticky TrapChem Lite

CDC Up Draft

Mea

n #

/tra

p/n

igh

t Female Sand Flies

Female Mosquitoes

N = 8 nights

A

B

A

B

CB BB

Chem-Light & Sticky Trap Evaluation for Sand Flies

0

2

4

6

8

10

12

14

16

18

20

Blue

Green

Yellow

Orang

eRed

Infra

Red

Unbait

ed

Casto

r Oil

Mea

n S

and

Flie

s/T

rap/

Nig

ht

n = 8 nights

ABAB

A

B

ABAB

B B

Sand Fly* Host Seeking Activity

0

5

10

15

20

25

30

35

2000-2200 2200-2400 2400-0200 0200-0400 0400-0600

% o

f T

ota

l San

d F

lies

n = 15 trap nights

Time* Species not yet determined

Fire Dept

EPW Camp

Main Gate

Tower

AIR FIELD

June/July 2003

A-10 Ops

Motor Pool

Army MPs

AF PO

WOC

171 ASG

Finance

2220 Trans Co.

100 75 50 25 0

Control Sites No Insecticide

AF Tent City

Army Tent City

Typical Night of Trapping

607 MP

Lots of Infected Sand Flies…120

50

75

100

6076

175

125

90

40 50

25

25

KeyGraphic: LTC Coleman

02468

101214161820

6-12

Jan

27 Ja

n-2

Feb

17-2

3 Feb

17-2

3 M

ar

13-1

9 Apr

4-10

May

25-3

1 M

ay

22-2

8 Ju

n

6-12

Jul

27 Ju

l-2 A

ug

17-2

3 Aug

7-13

Sep

t

28 S

ept-5

Oct

20-2

6 Oct

10-1

6 Nov

1-7

Dec

22-2

8 Dec

% o

f T

ota

l

Tallil 2003Historical

Seasonal Sand Fly DistributionDon’t Always Believe What You

Read….

0

20

40

60

80

100

120

140

160

180

200

5/23 5/25 5/27 5/29 5/31 6/2 6/4 6/6 6/8 6/10 6/12 6/14 6/16 6/18 6/20

A-10 OpsMotor Pool744 MP BNAF PostalAF WOC171st ASGFinance2220 Trans203 MI BN933 MP COControl Average

San

d F

lies/

Tra

p/N

ight

Trapping DateSpray

Changes in Sand Fly Densities at Standardardized Trap Locations

Untreated Army Quarter Master Tent City

Evaluating Effectiveness of Insecticidal Treatments

Residuals (Cyhalothrin) Dusting (Carbaryl)

Truck Fogging (ULV) (Resmethrin)

Sand Fly Control Evaluation - Army Tent City

0.0

50

100

150

200

250

300

350

400

450

500

6/19 6/20 6/21 6/22 6/23 6/24 6/25 6/26 6/27 6/28 6/29 6/30

Mea

n S

and

Flie

s/T

rap

/Nig

ht

Inside Tents

Outside Tents

Treated Tree Line

Controls

Residual and Fogging

Dusting and Fogging

N/A N/A

Dusting and Fogging

“Classic Vector Control Activities May Not Always Work”

Pristine Sand Fly Habitat Everywhere

Before Tent Cities….

Even habitat destruction didn’t have the desired effect…

Denuded Habitat in Tent Cities

Air Force Tent City

Army Tent City No AC

n = 5 nights

0

1020

3040

50

6070

8090

100

Inside Tents Outside Tents Control Area

Air Force

Army

Mea

n S

and

Flie

s/T

rap

/Nig

ht

AC

A

B

BB

C

Sand Flies Inside vs Outside of Tents, AF With AC - Tallil AB Iraq (May 03)

Mea

n S

and

Flie

s/T

rap

/Nig

ht

020

4060

80100

120140

160180

200

Inside Tents Outside Tents Control Areas

Air Force

Army

n = 5 nights

AA

BBCC

AC

Sand Flies Inside vs Outside of Tents With AC - Tallil AB Iraq (Aug 03)

Percentage of Male Sand Flies Inside vs Outside Air Force and Army Tents

0

5

10

15

20

25

30

35

40

Inside Tents Outside Tents Control Area

Per

cen

t M

ales

Male Sand Flies AF

Male Sand Flies Army

n = 5 nights

Rodents and Sand Flies Breeding

Under Tents?

Questions?