of Entomology, Armed Forces Research Institute of Medical Sciences Vector-borne Disease Surveillance in Southeast Asia – Challenges and Opportunities in Vector Collection and Pathogen Detection MAJ Brian Evans, Ph.D.; Jim McAvin; Alongkot Ponlawat, PhD; Ratree Takhampunya, PhD; LTC Jason Richardson, PhD

of Entomology, Armed Forces Research Institute of Medical SciencesAgenda Mission Intelligence requirements PM detachment capabilities Detection capabilities (JBAIDS) Value of pathogen assays Where is the gap? Conclusion

of Entomology, Armed Forces Research Institute of Medical SciencesMission To accurately asses the risk of vector-borne disease in an AO and to recommend/ implement measures that reduce the disease threat among soldiers.

of Entomology, Armed Forces Research Institute of Medical Sciences Intelligence Requirements Human case data Vector data (presence/absence) Pathogen data (presence/absence) Environmental data

of Entomology, Armed Forces Research Institute of Medical Sciences PM Detachment Capabilities Pre-deployment intelligence Gather case data (non-specific/specific) Limited vector surveillance Limited or no pathogen detection capability.

of Entomology, Armed Forces Research Institute of Medical Sciences Detection Capability JBAIDS AssayGRI Rank*Activities UnderwayComments Dengue virus5 Deployed Vector SurveillanceAFPMB Approved Chikungunya virus6Wet Assay OptimizationFunded: Pending FY10 Award Aedes aegypti mosquitoesnot ranked Deployed Vector SurveillanceAFPMB Submission Planned Leishmania spp50 Deployed Vector SurveillanceAFPMB Approved Leishmania visceral genotype20 Deployed Vector SurveillanceAFPMB Approved Leishmania human pathogenic sppVariousWet Assay OptimizationFunded: Pending FY10 Award Plasmodium spp, P. f and P. v1Wet Assay OptimizationFunded: Pending FY10 Award Flavivirus sppVariousWet Assay OptimizationFunded: Pending FY10 Award Japanese enchephalitis virus24Wet Assay OptimizationFunded: Pending FY10 Award

of Entomology, Armed Forces Research Institute of Medical Sciences Value of Pathogen Assays Information Availability Cases Vector PathogenRisk accuracyControl efficacy Pathogen assay (value added)Example XXXAccurateEffectiveLimitedDengue - Thailand XX AccurateEfffectiveNA X AccuratePartialNAMalaria - Thailand X InaccurateIneffectiveNA **XXPartiallyPartialSignificantDengue – Thailand XNA X X Relative impact of information availability on risk accuracy, control efficacy, and on the added value of a pathogen detection assay Assumptions: Case data is specific in number and location. Vector surveillance, pathogen detection tools, and control tools are effective.

of Entomology, Armed Forces Research Institute of Medical Sciences Case data is valuable!

of Entomology, Armed Forces Research Institute of Medical Sciences Where is the gap? Adult mosquito/sand fly collection devices minimally effective; taxonomic keys -1 or 2 Ae. aegypti /house (15 mins/house); countless man-hours and houses needed for sufficient sample sizes (1 in 1000 infected); this is an area where there is transmission of dengue year-round.

of Entomology, Armed Forces Research Institute of Medical Sciences Where is the gap? Bed net trap - NAMRU-2 BG Sentinel (BG Lure)

of Entomology, Armed Forces Research Institute of Medical Sciences Where is the gap? Rodent-baited traps as a tool for collecting chigger mites, vectors of scrub typhus. & Figure 13: Field caught rodent on snap trap Figure 4: Rodent with chiggers

of Entomology, Armed Forces Research Institute of Medical Sciences Other Challenges? Low densities; seasonality? How does pathogen/vector data translate into risk? –What does it mean to have 6 in 1000 infected; should I be concerned? Even when we know the vector locations and where the pathogen is most prevalent in the vector, do we understand the biology? Not one-size fits all solutions; same species from different locations may have evolved independently; different vector ecology

of Entomology, Armed Forces Research Institute of Medical SciencesConclusion Bottom-line: Pathogen detection has greatest added value for risk determination and control efficacy in instances where there is limited or no case data. If disease is seasonal, a valuable forecasting tool. Challenge: Relevancy of pathogen detection data is highly-dependent on the vector surveillance tool. Pathogen surveillance should be a critical part of the PM mission; need more effective surveillance tools to complement this mission; need trained soldiers who can interpret information/data. Where time/resources/money are limited, should be very selective about when and where to use pathogen detection assays.