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?