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ANALYSIS OF IRAQI SERUM SAMPLES           14 DEC 90

Filename:0500br.95


SUBJECT: ANALYSIS OF IRAQI SERUM SAMPLES           14 DEC 90

GENERAL:

1. The data and resulting analysis/conclusions that can be made 
from these serum specimens are inconclusive and at best 
presumptuous. From an epidemiological perspective, the primary 
factors limiting the value of these serological results include,

	a. Lack of demographic information from Iraqi personnel. 
	b. Absence of sero-surveys of endemic diseases in indigenous 
personnel. 
	c. Small number of samples. 
	d. Break in chain-of-custody of the samples. (How sure are we 
that these are really Iraqi specimens?)

2. The positive Iraqi samples conform to plausible expectations 
resulting from natural exposure to endemic disease agents or non-
specific cross reactions. It is unlikely that the positive 
reactions are due to immunizations. Two agents warrant additional 
comments.

	a. Coxiella burnetii (Q Fever): The agent is considered to be 
widely distributed throughout the region; serological studies 
suggest that it is highly endemic/enzootic in eastern Saudi 
Arabia, and it is probably endemic/enzootic in Iraq at similar 
levels. Sporadic cases have been reported areawide, but incidence 
is suspected to be greater than reported due to limited diagnostic 
capabilities. Serology from indigenous personnel in rural areas in 
Saudi Arabia indicates that subClinical infection develops in 
Childhood, and virtually all young adults have had sensitizing 
contact (inducing acquired immunity). Due to similar epidemiologic 
characteristics, adding tests for Brucella spp. antigens would 
improve the confidence of the analysis suggesting that the 
positive titers are from natural exposure.

	b. Sandfly Fever: Both the Sicilian and Naples strains are 
highly endemic in Iraq and the Positive results represent natural 
exposure. 

RECOMMENDATIONS FOR FUTURE SAMPLE TESTING AND REPORTING:

[      (b)(1) sec 1.3(a)(4)    ]



[   (b)(6)   ]
	ANALYSIS OF IRAQI SERUM SAMPLES

SPECIMEN DESCRIPTION

Serum specimens were collected from 20 Iraqi personnel [   (b)(1) 
sec 1.3(a)(4)   ].  Histories for the Iraqi population were not 
provided; the information may be furnished at a later date.

Serum specimens previously collected from American troops in Saudi 
Arabia were used as control samples for comparison.

ANALYSIS PERFORMED

The sera were screened for antibody against the likely biological 
warfare agents Bacillus anthracis and botulinum toxin. The samples 
were also screened for Coxiella burnetii, Francisella tularensis, 
Yersinia Pestis, Venezuela equine encephalitis virus, and Crimean 
Congo hemorrhagic fever virus reactive antibodies and serological 
evidence of the naturally occurring diseases murine typhus, 
Chlamydia pneumonia, Rift Valley fever, West Nile fever, and 
sandfly fever.

CONCLUSIONS

The results do not show convincing evidence that the few Iraqi 
troops tested have been vaccinated against anthrax or the 
botulinum toxins. The reactions with the "protective antigen" from 
Bacillus anthracis are low-level and may indicate prior natural 
exposures to anthrax or possibly a non-specific reaction. Tests 
are being performed to confirm this result. Tests are also being 
performed to detect very low levels of antibodies to botulinum 
toxin, such as might occur after administration of a poor vaccine.

Several of the Iraqi troops seem to have had natural infections 
caused by Coxiella burnetii, Francisella tularensis, Rickettsia  
typhi, and sandfly fever viruses, or serologically cross-reacting 
agents. The presence of IGM reactive antibody in several of the  
specimens may suggest recent infections.

The presence of Yersinia Pestis reactive antibody among a few of 
the American troops suggests a previous vaccination history or a 
natural exposure to plague. A small number of the Americans 
demonstrated antibody levels indicating little or no previous 
exposure to most of the agents.












	RECOMMENDATIONS

[      (b)(1) sec 1.3(a)(4)    ]





TECHNICAL RESULTS

The results of the serological tests are presented in the 
accompanying table. These answers were generated with the best 
available rapid serological assays. Conclusive data, particularly 
for low-level antibody titers, may require traditional serological 
methods which need large volumes of sera and several days to 
complete.

1. 3/20 Iraqi and 3/20 American samples reacted with Bacillus 
anthracis antigen. These seropositives react at low titers with 
"protective antigen" but not "lethal factor".

2. None of the Iraqi samples tested reacted convincingly with the 
botullnum toxins: 20 samples were tested with type A toxin; 19 
samples with type B or C toxins; and 18 samples type D, E, or F  
toxins.  The American specimens were not tested.

3. 11/18 Iraqi and 0/20 American samples were Coxiella burnetii 
antibody positive. 5/18 Iraqi samples were IGM and 6/18 Iraqi 
samples were IGG positive.

4. No definite positives were observed; 9/18 Iraqi and 5/20 
American samples reacted weakly with Francisella tularensis 
antigens. 4/18 Iraqi samples were IGM and 5/18 Iraqi samples were 
IGG weak reactions. 1/20 American samples were IGM and 4/20 
American samples were IGG weak reactions.

5. 0/20 Iraqi and 5/20 American samples were Yersinia Pestis 
antibody positive.

6. 0/16 Iraqi and 0/20 American samples were Venezuela equine 
encephalitis virus antibody positive.

7. 1/16 Iraqi and 1/20 American samples were Crimean Congo 
hemorrhagic fever virus antibody positive.






8. No definite positives were observed; 10/18 Iraqi and 10/20 
American samples reacted weakly with Rickettsia tYphi antigens. 
7/18 Iraqi samples were IGM and 3/18 Iraqi samples were IGG weak 
reactions. 9/20 American samples were IGM and 1/20 American  
samples were IGG weak reactions.

9. No definite positives were observed; 5/18 Iraqi and 3/20 
American samples reacted weakly with Chlamydia Pneumoniae 
antigens. 3/18 Iraqi samples were IGM and 2/18 Iraqi samples were 
IGG weak reactions. 1/20 American samples were IGM and 2/20 
American samples were IGG weak reactions.

10. 0/16 Iraqi and 1/20 American samples were Rift Valley fever 
virus antibody positive.

11. 1/16 Iraqi and 1/20 American samples were West Nile virus 
antibody positive.

12. 13/16 Iraqi and 0/20 American samples were sandfly fever virus 
(Sicilian strain) antibody positive.

13. 7/16 Iraqi and 1/20 American samples were sandfly fever virus 
(Naples strain) antibody positive.































ANTIBODY FREQUENCY IN SERA FROM IRAQI AND AMERICAN PERSONNEL

					No. Antibodv Positive/Total Tested (a)
	Aqent				Iraqi Specimens American Specimens

Bacillus anthracis				3/20			3/20
  Protective Antigen			3/20			3/20
  Lethal Factor				0/20			0/20

Botulinum toxin:
   Type A						0/20	 		ND (b)
   Type B						0/19	 		ND
   TYPE C						0/19	 		ND
   TYPE D						0/18	 		ND
   TYPE E						0/18	 		ND
   TYPE F						0/18	 		ND

Coxiella burnetii				11/18		0/20

Francisella tularensis (c) 		0/18			0/20

Yersinia pestis				0/20			5/20

Venezuela equine				0/16			0/20
 encephalitis virus

Crimean Congo hemorrhagic		1/16			1/20
 fever virus

Rickettsia tyPhi (c)			0/18			0/20

Chlamydia pneumoniae (c)			5/18			3/20

Rift Valley fever virus			0/16			1/20

West Nile virus				1/16			1/20

Sandfly fever virus				13/16		0/20
(Sicilian strain)

Sandfly fever virus				7/16			1/20
(Naples strain)

(a) Total number of sera tested was dependent upon sample 
availability.
(b) Not Done.
(c) Several sera had low-level reactions of doubtful significance 
and are under further study.
 



 

 



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