1. Surveillance, Trap Evaluations, Bednets, & Assessing Air-Conditioning to Prevent Sand Fly Bites at Tallil AB, Iraq 2003 Major Douglas A. Burkett, Ph.D. 332nd AEW Expeditionary Medical Group Collaborators: LTC Coleman, LTC Sherwood, LtCol McMeans, Maj Caci, Col Swaby, Col Strickman, Capt Blount, Capt Wolf, Don Teig, Capt Dennett, LT Knight, Ed Rowton, Capt Silvernale, Capt Jennings, MSgt Cushing, TSgt Walter, TSgt Long

2. Army and AF Preventive Medicine/Entomology Assets Working Together… AF relied on Army for vector control/pesticides from Apr - June

3. Tallil AB

4. Two 12K runways, 30 miles of inner fence Two 12K runways, 30 miles of inner fence 24K US & Coalition Forces (~ 1500 AF) 24K US & Coalition Forces (~ 1500 AF) Most with NO PPE…. Most with NO PPE…. Historically Agricultural Area Historically Agricultural Area

5. Sand Fly Bites WRAIR found 2% Infected June 03

6. Bednets AF personnel lucky - tents came with bed nets. Virturally no AF personnel deployed with bednets/ PPE Troops concerned about crickets…

7. Percentage of Personnel Using Bednets in AF Tent City (1 st AEF), Tallil AB – June 03 0 20 40 60 80 100 % Males Bednets - Cots % Males Bednets - Beds % Females w/ Bednets Cots % Females w/ Bednets - Beds Fliers - A-10SF Personnel % Personnel Everyone Else – AF Tent City n = 198 n = 61 n = 35 n = 70 * Didn’t have Commander or NCO support!

8. AF Bednet Use Jun 03 vs. Aug 03 80 0 10 20 30 40 50 60 70 % Males w/ Bednets - Cots % Males w/ Bednets - Beds % Females w/ Bednets - Cots % Females w/ Bednets - Beds % Bednet Use June August N = ~ 30 tents 2 nd AEF Rotation: -“Right Start” Brief - Col Swaby Visits - 1 st AF case - CC/NCO support

9. Surveillance: CDC Unbaited Light Traps Joint Effort Joint Effort Purpose: Purpose: Track sand fly populations Track sand fly populations Evaluate Control effectiveness Evaluate Control effectiveness ID sand fly & disease “hot spots” ID sand fly & disease “hot spots” Determine Leishmania infection rates Determine Leishmania infection rates Traps effective w/ NO CO2! Traps effective w/ NO CO2! Which trap designs were most effective? Which trap designs were most effective?

10. Trap Evaluations Black Light CDC Style Up Draft CDC Style Sticky Trap & Chem Lite Two 4 x 4 Latin Squares

11. Trap Evaluation - Sand Flies and Mosquitoes, Tallil AB, Iraq 0 10 20 30 40 50 60 70 80 Standard CDC UV Down Draft Sticky Trap Chem Lite CDC Up Draft Mean #/trap/night Female Sand Flies Female Mosquitoes N = 8 nights A B A B CBB B

12. Chem-Light & Sticky Trap Evaluation for Sand Flies 0 2 4 6 8 10 12 14 16 18 20 Blue Green Yellow Orange Red InfraRed Unbaited Castor Oil Mean Sand Flies/Trap/Night n = 8 nights AB A B B B

13. Sand Fly* Host Seeking Activity 0 5 10 15 20 25 30 35 2000-22002200-24002400-02000200-04000400-0600 % of Total Sand Flies n = 15 trap nights Time * Species not yet determined

14. Fire Dept EPW Camp Main Gate Tower AIR FIELD June/July 2003 A-10 Ops Motor Pool Army MPs AF PO WOC 171 ASG Finance 2220 Trans Co. 100 75 50 25 0 Control Sites No Insecticide AF Tent City Army Tent City Typical Night of Trapping 607 MP Lots of Infected Sand Flies… 120 50 75 100 60 76 175 125 90 40 50 25 Key Graphic: LTC Coleman

15. Seasonal Sand Fly Distribution Don’t Always Believe What You Read….

16. Changes in Sand Fly Densities at Standardardized Trap Locations

17. Untreated Army Quarter Master Tent City Evaluating Effectiveness of Insecticidal Treatments

18. Residuals (Cyhalothrin) Dusting (Carbaryl) Truck Fogging (ULV) (Resmethrin)

19. Sand Fly Control Evaluation - Army Tent City 0.0 50 100 150 200 250 300 350 400 450 500 6/196/206/216/226/236/246/256/266/276/286/296/30 Mean Sand Flies/Trap/Night Inside Tents Outside Tents Treated Tree Line Controls Residual and Fogging Dusting and Fogging N/A Dusting and Fogging “Classic Vector Control Activities May Not Always Work”

20. Pristine Sand Fly Habitat Everywhere Before Tent Cities…. Even habitat destruction didn’t have the desired effect…

21. Denuded Habitat in Tent Cities

22. Air Force Tent City Army Tent City No AC

23. n = 5 nights 0 10 20 30 40 50 60 70 80 90 100 Inside TentsOutside Tents Control Area Air Force Army Mean Sand Flies/Trap/Night AC A B B B C Sand Flies Inside vs Outside of Tents, AF With AC - Tallil AB Iraq (May 03)

24. Mean Sand Flies/Trap/Night 0 20 40 60 80 100 120 140 160 180 200 Inside TentsOutside Tents Control Areas Air Force Army n = 5 nights A A B B C C AC Sand Flies Inside vs Outside of Tents With AC - Tallil AB Iraq (Aug 03)

25. Percentage of Male Sand Flies Inside vs Outside Air Force and Army Tents 0 5 10 15 20 25 30 35 40 Inside TentsOutside TentsControl Area Percent Males Male Sand Flies AF Male Sand Flies Army n = 5 nights

26. Rodents and Sand Flies Breeding Under Tents?

27. Questions?