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File: 970613_010191_dec_txt_0001.txt
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[b.2.]



SUBJECT: CURRENT DISEASE INFORMATION ON COUNTRIES OF POTENTIAL INTEREST TO DESERT SHIELD 

 [b.2.]                                    REVIEW HAS BEEN PROVIDED
BY THE AFMIC SURGEON.                                        ~ _


1.             KUWAIT                   [b.1. sec. 1.5.(c)]
                        DISEASES INCLUDING "SEVERE GASTRO-INTESTINAL 
PROBLEMS, TYPHOID, AND MENINGOCOCCAL DISEASE" HAVE OCCURRED IN THE
CIVILIAN POPULATION- INCIDENCE OF SHIGELLOSIS REPORTEDLY HAS
SIGNIFICANTLY EXCEEDED NORMAL LEVELS SINCE THE IRAQI INVASION,
POSSIBLY BECAUSE OF LACK OF AVAILABLE IODINE FOR DISINFECTING FRESH
FRUITS AND VEGETABLES. {DETERIORATION OF SANITARY CONDITIONS AND
PREVENTIVE MEASURES IN GENERAL HAVE CREATED CONDITIONS FAVORABLE FOR
OUTBREAKS OF FOOD- AND WATERBORNE DISEASES.} IN ADDITION, ALTHOUGH
NOT SPECIFICALLY MENTIONED [b.1. sec. 1.5.(c)]   MULTIPLE DRUG-
RESISTANT SALMONELLA AND SHI6ELLA STRAINS APPEAR COMMON. THE CASES OF
"MENINGOCOCCAL DISEASE~ {PRESUMABLY MENINGOCOCCAL MENINGITIS}
OCCURRED IN CHILDREN~ BUT WHETHER INCIDENCE EXCEEDED NORMAL LEVELS IS
UNCLEAR- NO SEROGROUP DATA WERE AVAILABLE ALTHOUGH GROUP A
PREDOMINATED DURING THE 1980'S, GROUP W135 INCREASINGLY HAS BEEN
REPORTED.       [b.2.]                                    
2.              KUWAIT -- A HIGH INCIDENCE OF "INTESTINAL DISORDERS
AND DERMATOLOGICAL FUNGAL INFECTIONS" HAS BEEN REPORTED AMONG IRAQI
SOLDIERS IN KUWAIT. KUWAITI DOCTORS HAVE ESTIMATED THAT ABOUT 50 PERCENT OF IRAQI SOLDIERS HAVE DERMATOLOGICAL FUNGAL INFECTION ATTRIBUTABLE TO POOR PERSONAL HYGIENE. ALTHOU6H NOT SPECIFIED, THE "INTESTINAL DISORDERS" PROBA8LY INCLUDE SHIGELLOSIS AND TYPHOID FEVER.                                                    [b.2.]              THE OVERALL INFECTIOUS DISEASE ATTACK RATE REPORTEDLY IS
MUCH HIGHER AMONG PEOPLES' ARMY SOLDIERS THAN AMONG THE REPUBLICAN
GUARD FORCES. THE IRAQI MILITARY HISTORICALLY HAS HAD POOR FIELD
SANITATION CAPABILTTIES AND SHOULD BE CONSIDERED VULNERABLE TO
OUTBREAKS OF COMMUNICABLE DISEASES, PARTICULARLY THOSE WITH FOOD-
.  ETOLOGlES. HOWEVER, lNCONSISTENCIES AND GAPS IN DISEASE
REPORTING HAVE RENDERED ASSESSMENT OF THE IMPACT OF INFECTIOUS
DISEASES ON IRAQI COMBAT EFFECTIVENESS HIGHLY SPECULATIVE.
3.              KUWATT -- RECENT REPORTS FROM NON-MEDICAL PERSONNEL
IN KUWAIT INDICATED THAT "CHOLERA" OUTBREAKS HAD OCCURRED. HOWEVER,
SEVERE GASTROENTERITIS~ PARTICULARLY BACILLARY DYSENTERY, OFTEN MAY
BE INCORRECTLY IDENTIFIED AS "CHOLERA" BY LAY PERSONNEL        [b.2.]                                
 AND DYSENTERY {PRESUMABLY SHIGELLOSIS} CURRENTLY IS BELIEVED TO BE THE
ACTUAL CAUSE OF ILLNESS IN THE "CHOLERA~ CASES- THIS ASSESSMENT HAS
BEEN SUBSTANTIATED BY [b.1. sec. 1.5.(c)]
CHOLERA IS NOT CONSIDERED ENDEMIC IN THE REGION, BUT SPORADIC CASES  {USUALLY IMPORTED HAVE BEEN REPORTED IN RECENT YEARS. 

[b.2.]                               HOWEVER, CARRIERS IN THE IRAQI
MILITARY AND THE FOREIGN CIVILIAN LABOR FORCE {FROM ENDEMIC AREAS
SUCH AS BANGLADESH. PAKISTAN, INDIA} COULD INTRODUCE CHOLERA. WITH
SUBSEQUENT OUT8REAKS LIKELY BECAUSE OF THE POOR SANITARY CONDITIONS
AND LACK OF ADEQUATE CONTROL MEASURES.
4. {U} OMAN -- THE FIRST DOCUMENTED HUMAN DEATH FROM RABIES IN OMAN
RECENTLY WAS REPORTED AN 8-YEAR-OLD BOY DEVELOPED THE DISEASE 4
MONTHS AFTER BEING BITTEN BY A FOX NEAR HIS HOME. 240 KILOMETERS WEST
OF MUSCAT. THE REPORT DID NOT INDICATE WHETHER THE FOX WAS TESTED FOR
RABIES OR IF THE BOY RECEIVED POST-EXPOSURE PROPHYLAXIS. SYLVATIC
RABIES IS ENZOOTIC IN OMAN, WITH THE DESERT FOX AS THE PRINCIPAL
ENZOOTIC RESERVOIR. SPILLOVER INTO DOMESTIC ANIMAL POPULATIONS OCCURS
{LABORATORY-CONFIRMED CASES IN TWO FOXES AND A GOAT RECENTLY WERE
REPORTED}- WITH STRAY DOGS {CATS AND OTHER ANIMALS TO A LESSER
EXTENT} RESPONSIBLE FOR MOST OF THE HUMAN BITE/SCRATCH INCIDENTS
REQUIRING POST-EXPOSURE PROPHYLAXIS. RISK FROM RABIES IN OMAN
PREVIOUSLY HAD BEEN CONSIDERED RELATIVELY LOW. BUT THE IMPLEMENTATION
OF STRICTER ANIMAL CONTROL MEASURES {DOG VACCINATION AND
LICENSURE} IN LATE 1989 AND A PUBLIC EDUCATION PROGRAM {SUBSEQUENT TO  THE B0Y'S DEATH} ON THE DANGERS OF ANIMAL BITES MAY INDICATE THAT
HEALTH OFFICIALS NOW CONSIDER RABIES RISK TO BE ELEVATED.

[b.1. sec. 1.5.(c)]

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