SPECIAL WEEKLY WIRE 48-90A

File: 971030_ww48_90a_001.txt
Page: 001
Total Pages: 1
SUBJECT:  SPECIAL WEEKLY WIRE 48-90A


1. INTRODUCTION  THIS WIRE IS INTENDED TO PROVIDE ADDITIONAL
INFORMATION ON INFECTIOUS DISEASES AND GENERAL ENVIRONMENTAL FACTORS
DURING WINTER MONTHS IN THE DESERT SHIELD AREA OF OPERATIONS WHICH
MAY IMPACT OPERATIONAL UNITS AND HUMANITARIAM MEDICAL MISSIONS.
CLINICAL REVIEW HAS BEEN PROVIDED BY     [b.6.]

2. GENERAL  MILITARY CONFLICT WILL WEAKEN EXISTING MEDICAL
INFRASTRUCTURE. REDUCE PREVENTIVE MEDICINE PROGRAMS, INTERFERE WITH
UASTE DISPOSAL, AND COMPROMISE PERSONAL HYGIENE. THESE FACTORS WILL
LEAD TO INCREASED INCIDENCE OF ENDEMIC DISEASES, AND REFUGEE
POPULATIONS WILL BE AT ELEVATED RISK FOR THESE DISEASES.
ADDITIONALLY, THE IMMIGRATION OF NONINDIGENOUS PERSONS INTO SOME
REGIONS MAY INTRODUCE NONENDEMIC DISEASES AND WILL CHANGE THE
BASELINE HEALTH STATUS OF THE RESIDENT POPULATION.
3. FOOD- AND WATERBORNE DISEASES: THE RISK OF ACUTE DIARRHEAL
DISEASES FROM BACTERIAL ETIOLOGIES GENERALLY IS GREATEST FROM JULY
THROUGH SEPTEMBER, BUT THESE AGENTS WILL CONTINUE TO BE THE PRIMARY
INFECTIOUS DISEASE THREAT TO OPERATIONAL FORCES. INCIDENCE FROM VIRAL
ETIOLOGIES (PRIMARILY ROTAVIRUS IN CHILDREN) IS ELEVATED FROM
DECEMBER THROUGH MARCH. RISK FROM HEPATITIS A IS ELEVATED FROM
OCTOBER THROUGH DECEMBER, AND DUE TO THE LONG INCUBATION PERIOD (15-
180 DAYS) AND LENGTH OF DEPLOYMENT  CLINICAL CASES MAY BEGIN TO OCCUR
IN INCREASED FREQUENCY IN MILITARY PERSONNEL NOT PROTECTED BY IMMUNE
SERUM GLOBULIN (ISG). HEPATITIS A CAUSES APPROXIMATELY 50 PERCENT OF
THE CLINICAL CASES (MOSTLY CHILDREN) OF ACUTE VIRAL HEPATITIS IN THE
INDIGENOUS POPULATION.
4. VECTORBORNE DISEASES: IN ENDEMIC AREAS (SOUTHWEST SAUDI ARABIA,
YEMEN, AND OMAN)' MALARIA TRANSMISSION PEAKS FROM NOVEMBER THROUGH
APRIL. MOSQUITO POPULATIONS WILL BE INFLUENCED BY THE AMOUNT OF
RAINFALL, AND VECTOR SURVEILLANCE WILL BE IMPORTANT FOR ASSESSING
RISK IN SPECIFIC AREAS. COMPETENT MALARIA VECTORS ARE PRESENT IN
AREAS WHERE MALARIA TRANSMISSION HAS BEEN INTERRUPTED (EASTERN SAUDI
ARABIA, KUWAIT. AND SOUTHERN IRAQ); WITH THE INFLUX OF MALARIA
CARRIERS AND REDUCED VECTOR CONTROL MEASURES, RESURGENCE MAY OCCUR.
PLASMODIUM VIVAX, FOLLOWED BY P. FALCIPARUM, WOULD BE THE MOST LIKELY
FORMS OF MALARIA TO BE INTRODUCED INTO SOUTHERN IRAQ AND KUWAIT. RISK
FROM ARBOVIRAL FEVERS (SANDFLY, CRIMEAN CONGO HEMORRHAGIC, WEST NILE'
DENGUE, AND SINDBIS) IS REDUCED DURING COLDER MONTHS. RISK FROM
CUTANEOUS AND VISCERAL LEISHMANIASIS IS LOW DURING THIS PERIOD
(TRANSMISSION PEAKS FROM APRIL TO SEPTEMBER); HOWEVER, DUE TO THE
LONG INCUBATION PERIOD (1 WEEK TO MANY MONTHS) AND LENGTH OF
DEPLOYMENT, CLINICAL CASES MAY BEGIN TO OCCUR IN INCREASED FREQUENCY
IN MILITARY PERSONNEL. INTESTINAL AND URINARY SCHISTOSOMIASIS RISK IS
LOWER DURING WINTER MONTHS (TRANSMISSION OCCURS YEAR ROUND WITH PEAKS
FROM JUNE THROUGH SEPTEMBER)  HOWEVER, DUE TO THE LONG INCUBATION
PERIOD (2 TO 6 WEEKS) AND LENGTH OF DEPLOYMENT, CLINICAL CASES MAY
BEGIN TO OCCUR IN INCREASED FREQUENCY IN MILITARY PERSONNEL.
5. OTHER OPERATIONALLY IMPORTANT DISEASES: RISK FROM INFLUENZA IS
HIGHEST FROM DECEMBER THROUGH FEBRUARY; DURING THE LATE 1980'S,
ISOLATES OF INFLUENZA A(H3N2) PREDOMINATED OVER THOSE FOR A(H1N1) AND
B. MENINGOCOCCAL MENINGITIS RISK IS ELCVATED FROM NOVEMBER THROUGH
FEBRUARY AND IS GREATEST FOR PERSONNEL HAVING CLOSE CONTACT WITH
LOCAL NATIONALS, PARTICULARLY CHILDREN  GROUP A PREDOMINATES,
ALTHOUGH ALL GROUPS ARE REPORTED (REPORTING OF GROUP W135 ISOLATES
INCREASED DURING THE LATE 1980'S).
6. OTHER DISEASES ENDEMIC IN THE LOCAL POPULATION: EPIDEMIC LOUSE-
BORNE TYPHUS IS MORE PREVALENT IN COLDER MONTHS AND COMMONLY IS
ASSOCIATED WITH OVERCROWDING, TRANSIENT POPULATIONS  IMPOVERISHED
PEOPLE, AND POOR SANITARY CONDITIONS. STRAY DOG AND CAT POPULATIONS
USUALLY DECLINE IN WINTER MONTHS, DECREASING (NOT ELIMINATING) THE
RISK OF ANIMAL BITES AND RABIES EXPOSURE. MEASLES IS THE MOST
SIGNIFICANT CHILDHOOD DISEASE IN THE REGION' WITH A MARKED SEASONAL
PEAK IN INCIDENCE IN LATE WINTER AND EARLY SPRING (JANUARY THROUGH
APRIL); DIPHTHERIA IS REPORTED IN LOW NUMBERS, WITH INCREASES IN
COLDER MONTHS (NOVEMBER THROUGH MARCH).
7. COLD WEATHER: SUBFREEZING TEMPERATURES (INTO THE TEENS) ARE MORE
COMMON DURING THE NIGHTS IN CENTRAL AND NORTHERN SAUDI ARABIA AND IN
THE NORTHEAST MOUNTAINS OF IRAQ. FREEZING TEMPERATURES IN THE
INTERIOR OF THE ARABIAN PENINSULA HAVE BEEN OBSERVED AS EARLY AS
NOVEMBER AND AS LATE AS MARCH.
8. PRECIPITATION: ANNUAL PRCCIPITATION IS CONCENTRATED DURING THE
WINTER MONTHS, AND ALTHOUGH THE TOTAL VOLUME IS LOW, IT MAY OCCUR IN
THE FORM OF VIOLENT STORMS. FLASH FLOODING MAY FILL WADIS AND DISRUPT
ROADBEDS. TRAFFICABILTY OVER SEBBKAHS (SALT FLATS) MAY ALSO BE MORE
HAZARDOUS FOLLOWING RAINY PERIODS AS RESULT OF INCREASED SUBSURFACE
WATER. FLOODING IS MOST FREQUENT IN WINTER AND SPRING ALONG THE
TIGRIS RIVER IN IRAQ AS RESULT OF BOTH HEAVY PRECIPITATION AMD
MELTING SNOW IN THE MOUNTAINS.
9. WIND STORMS: MIGRATORY LOW PRESSURE SYSTEMS AFFECT IRAQ AND THE
NORTHERN PART OF THE ARABIAN PENINSULA AND ARE MORE FREQUENT IN
NOVEMBER AND APRIL THAN THE OTHER WINTER MONTHS. ONE FEATURE OF THE
MIGRATORY SYSTEMS IS THE PRODUCTION OF SAND AND DUST STORMS BY THE
ACCOMPANYING WINDS SWEEPING OVER DRY, LOOSELY PACKED SURFACES. OTHER
WINTER WINDS INCLUDE THE KAUS' THE BLAT, AND THE FOEHN. THE KAUS IS A
POTENTIALLY GALE FORCE SOUTHEASTERLY WIND ON THE PERSIAN GULF DURING
THE MONTHS OF DECEMBER THROUGH APRIL THAT IS ACCOMPANIED BY HUMID,
CLOUDY WEATHER AND RAIN SQUALLS. THE BLAT IS A STRONG DUSTY (OR
SANDY) NORTHWESTERLY WIND ON THE SOUTH COAST OF THE ARABIAN
PENINSULA  THE WARMTH PRODUCED IN THE DESCENDING AIR OF THE FOEHN
WINDS IS PARTLY RESPONSIBLE FOR THE ABSENCE OF SEVERELY COLD WEATHER
IN IRAQ.
10. POISONOUS SNAKES: SOME NORMALLY NOCTURNAL SNAKES MAY BE MORE
ACTIVE DURING WINTER DAYLIGHT HOURS FROM DECEMBER TO MARCH. THE MOST
NOTABLE BEING THE SAW-SCALED VIPER (ECHIS COLORATUS - REPORTED IN
VARIOUS DARK SHADES OF GRAY, BLUE' OR SILVER. DAPPLED WITH LIGHTER
SPOTS AND A WHITE UNDERSIDE; HEAD IS BELL SHAPED). THE SAW-SCALED
VIPER IS AN EXTREMELY AGGRESSIVE SNAKE AND IS RESPONSIBLE FOR MORE
SNAKEBITE DEATHS WORLDWIDE THAN ANY OTHER SNAKE  WHEN ENCOUNTERED, IT
ASSUMES A CHARACTERISTIC FIGURE 8 COIL, RUBBING ITS SERRATED SIDE
SCALES TOGETHER TO PRODUCE A BUZZING OR SIZZLING NOISE. THE SNAKE
INHABITS DRY SANDY AREAS, ROCKY OUTCROPPINGS  RODENT BURROWS, AND DRY
SCRUB FORESTS OF SAUDI ARABIA  ESPECIALLY IN THE SOUTHWEST REGION OF
THE KINGDOM AND THE ENVIRONS AROUND RIYADH. THE SAW-SCALED VIPER MAY
ALSO CLIMB INTO BUSHES TO ESCAPE FLOODING FROM RAINS. THE VIPER HAS
NOT BEEN REPORTED FROM THE NORTHEASTERN AREA. A RELATED FAMILY MEMBER
INHABITING THE ARABIAN PENINSULA, THE CARPET VIPER (REDDISH BROWN
WITH WHITE BARS ON ITS BACK WITH A YELLOWISH COLORED BELLY AND EGG-
SHAPED, SPECKLED HEAD WITH A TRIDENT POINTING TO THE REAR) POSES A
SIMILAR THREAT, BUT ITS PRESENCE IN THE AREA OF OPERATIONS HAS NOT
BEEN CONFIRMED.

 [b.2.]   [b.6.]