AFMIC SPECIAL WEEKLY WIRE 34-90A

File: 123096_08071515_90_0001.txt
Page: 0001
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SUBJECT: AFMIC SPECIAL WEEKLY WIRE 34-90A



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UNCLAS 

1. THIS SPECIAL WIRE IS INTENDED TO PROVIDE CLARIFICATION AND
FURTHER 
DISSEMINATION OF MEDICAL INTELLIGENCE ON A SUBJECT OF CURRENT 
INTEREST. 
2. DESERT SHIELD: SANDFLY FEVER AND LEISHMANIASIS THREAT 
ALTHOUGH SAND FLY-BORNE DISEASES ARE THE MOST PREVALENT VECTORBORNE

DISEASE THREATS IN THE REGION, THE OVERALL RISK IS LOW TO MODERATE,

DEPENDING ON LOCATION. THE FOUR REPORTED SAND FLY-BORNE DISEASES 
INTHE AREA, PRIORITIZED IN ORDER OF PROBABLE OCCURRENCE, ARE 
CUTANEOUS LEISHMANIASIS (RURAL WET TYPE AND URBAN DRY TYPE),
SANDFLY 
FEVER, AND VISCERAL LEISHMANIASIS. THE RISK OF NONINDIGENOUS 
PERSONNEL ACQUIRING THESE DISEASES IS EXPECTED TO INCREASE IN 
PROPORTION TO LENGTH OF STAY IN THE REGION. 
THE TWO TYPES OF CUTANEOUS LEISHMANIASIS ARE APT TO CAUSE THE 
GREATEST LOSS OF MAN-DAYS. THE OCCURRENCE OF CUTANEOUS
LEISHMANIASES 
IS HIGHLY FOCAL, DESPITE RATHER BROAD DISTRIBUTION. THE
DISTRIBUTION 
OF SAND FLY-BORNE DISEASES, INCLUDING LEISHMANIASIS, PRIMARILY 
DEPENDS ON THE DISTRIBUTION OF THE VECTOR AND RESERVOIR HOSTS. SAND

FLY DISTRIBUTION OCCURS IN A BELT ABOUT 250 MILES WIDE ACROSS SAUDI

ARABIA. THIS BELT CENTERS AROUND JEDDAH ON THE WEST COAST, BROADLY 
ENCIRCLES RIYADH, AND EXTENDS TO DAMMAN ON THE EAST COAST. SAND FLY

DENSITY GENERALLY IS HIGHEST ON THE WEST COAST AND LOWEST ON THE
EAST 
COAST. OTHER ENDEMIC AREAS INCLUDE RURAL KUWAIT, MOST OF IRAQ
(EXCEPT 
FOR THE SOUTHWESTERN BORDER WITH SAUDI ARABIA), NORTHERN JORDAN,
AND 
ALL OF ISRAEL AND IRAN. 
THE RURAL FORM OF THE DISEASE, CAUSED BY LEISHMANIA MAJOR, PRODUCES

WET, ULCERATED SORES (OFTEN ONLY ONE) 1 TO 6 WEEKS AFTER AN
INFECTIVE 
SAND FLY BITE. THE SORE NORMALLY SELF-RESOLVES, BUT MAY BECOME 
CHRONIC IF UNTREATED. GERBILS AND FAT-TAILED RATS ARE THE PRIMARY 
RESERVOIRS OF THE DISEASE. THE DISEASE, ALTHOUGH DECLINING IN
RECENT 
YEARS, MAY INCREASE RAPIDLY IF RODENTS PROLIFERATE AROUND SOLID
WASTE 
DISPOSAL AREAS LOCATED CLOSE TO HUMAN ENCAMPMENTS. 
AN INCREASED INCIDENCE IN RECENT YEARS OF THE DRY, URBAN FORM OF 
CUTANEOUS LEISHMANIASIS, CAUSED BY L. TROPICA, HAS BEEN ASSOCIATED 
WITH A HIGH INCIDENCE IN NONIMMUNE FOREIGN WORKERS. HUMANS AND DOGS

ARE THE PRIMARY AND SECONDARY RESERVOIRS, RESPECTIVELY. AN
INCUBATION 
PERIOD UP TO SEVERAL MONTHS FOLLOWS AN INFECTIVE SAND FLY BITE, 
WHEREUPON THE PARASITE PRODUCES MULTIPLE DRY CIRCUMSCRIBED LESIONS 
(CALLED ORIENTAL SORES OR ALEPPO SORES) THAT OCCASIONALLY SELF- 
RESOLVE, BUT MORE OFTEN BECOME CHRONIC, WITH RESULTING DISFIGURING 
SCARS. 
SANDFLY FEVER IS A VIRAL DISEASE THAT MAINLY AFFECTS CHILDREN AND 
NONIMMUNE NONINDIGENOUS PERSONNEL. SANDFLY FEVER DISPLAYS
INFLUENZA- 
LIKE SYMPTOMS (MINUS RESPIRATORY SIGNS) WITHIN 3 TO 4 DAYS OF AN 
INFECTIVE SAND FLY BITE. THE DISEASE IS SELF-LIMITING (FATALITIES
ARE 
UNKNOWN), AND COMPLETE RECOVERY GENERALLY OCCURS WITHIN 3 TO 5
DAYS. 
SANDFLY FEVER CASES ARE REPORTED ONLY IN A FEW FOCI ALONG THE WEST 
COAST IN SAUDI ARABIA, BUT POTENTIAL RISK EXISTS IN ALL AREAS 
REPORTED TO HAVE SAND FLIES (SEE CUTANEOUS LEISHMANIASIS AREAS 
ABOVE), WITH GREATER RISK IN NEARLY ALL COUNTRIES SURROUNDING SAUDI

ARABIA, INCLUDING IRAQ, JORDAN, ISRAEL, KUWAIT, AND EGYPT. IN
EGYPT, 
WHERE FOCI ARE INTENSE, THE DISEASE MAY SPREAD RAPIDLY THROUGH 
NONINDIGENOUS FORCES, WITH POTENTIAL OPERATIONAL DEGRADATION IF
LARGE 
PERCENTAGES OF PERSONNEL ARE INFECTED CONCURRENTLY. 
VISCERAL LEISHMANIASIS (OR KALA-AZAR), CAUSED BY L. INFANTUM,
OCCURS 
SPORADICALLY THROUGHOUT THE REGION. THE DISEASE IS CHARACTERIZED BY
A 
2 TO 4 MONTH INCUBATION PERIOD, SEVERE DAILY BIMODAL FEVER SPIKES, 
AND GRADUALLY INCREASING HEPATOSPLENOMEGALY, LYMPHADENOPATHY, 
EMACIATION, AND WEAKNESS. IF UNTREATED, VISCERAL LEISHMANIASIS MAY
BE 
FATAL WITHIN WEEKS. ALTHOUGH IT IS CONSIDERED A CHILDHOOD DISEASE
IN 
THE REGION, NONIMMUNE NONINDIGENOUS PERSONNEL COULD BE SUSCEPTIBLE.

DOGS ARE THE MOST COMMON RESERVOIR HOST. VISCERAL LEISHMANIASIS 
OCCURS IN FOCAL AREAS OF EXTREME SOUTHWESTERN SAUDI ARABIA, 
THROUGHOUT ISRAEL, WESTERN JORDAN, AND CENTRAL, EASTERN, AND
NORTHERN 
IRAQ. KUWAIT IS FREE OF THE DISEASE. 
MOST DISEASE TRANSMISSION IS EXPECTED DURING PERIODS OF GREATEST
SAND 
FLY ABUNDANCE (GENERALLY JUNE THROUGH AUGUST), ALTHOUGH LONG 
INCUBATION PERIODS FOR LEISHMANIASIS MAY CAUSE A PROTRACTED PEAK 
ONSET OF CASES FROM OCTOBER TO FEBRUARY. DELAYED ONSET OF CASES 
MANDATES THAT PREVENTIVE ACTIONS MUST OCCUR WELL  AHEAD OF CLINICAL

CASES IF OUTBREAKS ARE TO BE AVOIDED. THE PRINCIPAL SAND FLY
VECTORS 
ARE PHLEBOTOMUS PAPATASI AND P. SERGENTI. P. SERGENTI LIVES IN
RODENT 
(PRIMARILY GERBIL) BURROWS, WHILE P. PAPATASI BREEDS IN EARTHEN OR 
WOODEN STRUCTURES, WHERE HUMIDITY IS HIGH. SAND FLIES CAN READILY 
PENETRATE MOSQUITO NETTING, SO PREVENTION OF EXPOSURE TO FLY BITES 
AFFORDS THE BEST PROTECTION AGAINST SAND FLY-BORNE DISEASES.
EXPOSURE 
IN RURAL AREAS OFTEN CAN BE AVOIDED BY SITING BIVOUAC AREAS WELL
AWAY 
FROM RODENT BURROWS, SINCE SAND FLIES FLY ONLY AT NIGHT AND RARELY 
MORE THAN 100 METERS FROM THEIR RODENT BURROW HABITATS. IF SAND FLY

INFESTED AREAS CANNOT BE AVOIDED, RECOMMENDED MEASURES USUALLY 
INCLUDE USE OF PERSONAL REPELLENTS (DEET), VECTOR CONTROL
OPERATIONS, 
OR THE DESTRUCTION OF VECTOR HABITATS (RODENT BURROWS). VACCINES
AND 
CHEMOPROPHYLAXIS ARE NOT AVAILABLE FOR U.S. PERSONNEL FOR THESE 
DISEASES.   [b.6.]


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