AFMIC SPECIAL WEEKLY WIRE 32-90(D)

File: 970613_ww32_90d_txt_0001.txt
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WPC4?[b.2.]

SUBJECT: AFMIC SPECIAL WEEKLY WIRE 32-90(D)

1. THIS MESSAGE CONSISTS OF SCIENTIFIC, TECHNICAL, AND GENERAL
MEDICAL INTELLIGENCE. IT IS INTENDED TO PROVIDE A TIMELY SUMMARY OF
THE MALARIA THREAT IN THE MIDDLE EAST AND EASTERN MEDITERRANEAN AREA.
BROAD DISSEMINATION OF THIS WIRE TO SUBORDINATE UNITS IS ENCOURAGED.
CLINICAL REVIEW PROVIDED BY THE AFMIC-SG, [b.6.]

2. THE MIDDLE EAST AND EASTERN MEDITERRANEAN AREA: MALARIA SUMMARY
MALARIA POSES LITTLE OR NO RISK IN THE MIDDLE EAST AND EASTERN
MEDITERRANEAN AREA EXCEPT IN DISCRETE FOCI. MALARIA TRANSMISSION HAS
BEEN INTERRUPTED IN SEVERAL AREAS, INCLUDING EASTERN SAUDI ARABIA,
THROUGH ACTIVE VECTOR (ANOPHELES MOSQUITOES) CONTROL PROGRAMS.
DISRUPTION OF THESE VECTOR CONTROL PROGRAMS COULD LEAD TO RE-
INTRODUCTION OF ACTIVE TRANSMISSION. DEPLOYED UNITS SHOULD INSTITUTE
ACTIVE VECTOR SURVEILLANCE AND CONTROL MEASURES AT BIVOUAC SITES,
ESPECIALLY IN RURAL AREAS NEAR OASES.
COMMENT: MALARIA TRANSMISSION DOES NOT OCCUR IN BAHRAIN, CYPRUS,
DIEGO GARCIA. JORDAN, KUWAIT, QATAR. OR THE UNITED ARAB EMIRATES.
TRANSMISSION IS LIMITED IN EGYPT, IRAQ, OMAN, AND SAUDI ARABIA, BUT
IS WIDESPREAD IN YEMEN. MALARIA IS ALMOST EXCLUSIVELY VIVAX IN IRAQ
AND TURKEY, WHILE IN OMAN, SAUDI ARABIA, AND YEMEN IT IS FALCIPARUM.
BOTH TYPES OCCUR IN EGYPT, WITH VIVAX PREDOMINATING. RECENT
UNCONFIRMED REPORTS INDICATED THAT CHLOROQUINE-RESISTANT STRAINS
COULD OCCUR IN THE SOUTHWESTERN ARABIAN PENINSULA (INCLUDING YEMEN)
AND OMAN. HOWEVER, DRUG-RESISTANT FALCIPARUM MALARIA HAS NOT BEEN
CONFIRMED IN THIS REGION, AND CHLOROQUINE IS THE RECOMMENDED
PROPHYLAXIS FOR TRAVELERS IN MALARIA ENDEMIC AREAS. A DESCRIPTION OF
ENDEMIC AREAS FOLLOWS.
A. EGYPT - OVERALL LOW ENDEMICITY. RISK PERIOD PRIMARILY FROM
JUNE TO OCTOBER. OCCURS IN RURAL AREAS OF THE NILE DELTA, EL FAIYUM
AREA, THE OASES, AND PART OF SOUTHERN EGYPT (PRESUMABLY IN RURAL
AREAS OUTSIDE OF ASWAN). CASES PREVIOUSLY HAVE BEEN REPORTED ALONG
THE SUEZ CANAL AND THE NORTHERN RED SEA COAST. ALEXANDRIA, CAIRO, AND
OTHER URBAN AREAS ARE RISK-FREE.
B. IRAQ - OVERALL LOW ENDEMICITY. RISK PERIOD PRIMARILY FROM MAY
TO NOVEMBER, WITH A PEAK IN JULY AND AUGUST. OCCURS BELOW 1,500
METERS ELEVATION IN RURAL AND URBAN AREAS IN THE NORTHERN PROVINCES
OF DAHUK, NINAWA, IRBIL, AND AS SULAYMANIYAH. BAGHDAD AND SOUTHERN
IRAQ ARE RISK-FREE.
C. OMAN - OVERALL LOW ENDEMICITY. YEAR-ROUND TRANSMISSION,
PEAKING NOVEMBER TO APRIL. OCCURS BELOW 2,000 METERS ELEVATION IN THE
INLAND MOUNTAINOUS VILLAGE AREAS OF NORTH-CENTRAL OMAN, ESPECIALLY
AROUND NAZWA, AND ALONG THE 8ATINAH COASTAL PLAIN NORTH OF THE SEEB
INTERNATIONAL AIRPORT TO THE NORTHERN BORDER. THE CAPITAL AREA AROUND
MUSCAT AND THE SOUTHERN DHOFAR REGION (INCLUDING THAMRAT) ARE RISK-
FREE.
D. SAUDI ARABIA - OVERALL LOW ENDEMICITY. YEAR-ROUND
TRANSMISSION, PEAKING OCTOBER TO APRIL. OCCURS BELOW 2,000 METERS
ELEVATION IN THE TIHAMA COASTAL REGION AND THE ASIR HIGHLANDS IN THEÔIN THE HIJAZ MOUNTAINS. URBAN AREAS IN THE WESTERN PROVINCES
(INCLUDING JEDDAH) AND ALL OTHER PARTS OF THE COUNTRY (INCLUDING
RIYADH AND DHAHRAN) ARE RISK-FREE.
E. TURKEY - OVERALL LOW ENDEMICITY. TRANSMISSION OCCURS FROM
FEBRUARY AND NOVEMBER, PEAKING IN JUNE AND JULY. OCCURS BELOW 1,700
METERS ELEVATION IN RURAL AREAS IN THE SOUTHEAST (TIGRIS-EUPHRATES
BASIN) AND ALONG THE MEDITERRANEAN COAST, EAST OF ANTALYA. URBAN
AREAS ARE RISK-FREE.
F. YEMEN (NORTH AND SOUTH) - OVERALL HIGH ENDEMICITY. YEAR-ROUND
TRANSMISSION, PEAKING NOVEMBER TO MARCH. OCCURS BELOW 1,500 METERS
ELEVATION THROUGHOUT YEMEN AND ON THE ISLAND OF SOCOTRA (URBAN AND
RURAL AREAS). ADEN AND SANAA ARE RISK-FREE.
[b.2.]
[b.6.]