1. Tallil AB, Iraq 2003 AF Vector Surveillance Team (BAT-L)

2. Worst Possible Scenario  Leish endemic area  Epidemic cutaneous and visceral  10,000+ troops at Tallil  Hundreds of bites/night for unprotected personnel

3. Result: Leishmaniasis

4. Biological Augmentation Team  Normally a WMD response capability  Ruggedized RT-PCR platform (RAPID) –Lyophilized reagents  Lab personnel and equipment + ento = BAT-Leish  Lightweight and mobile

5. Air Force “System”  Attached to EMEDS  Captive military population –Education, PPE monitoring  Controlled environment  ISO office/laboratory  Surveillance/testing of flies and reservoirs 1Sep- 15Nov

7. So, did we do anything different?

8. Reservoir Testing  Tested feral dogs, foxes, and rodents  RAPID used to prevent unnecessary euthanasia –Foxes released if neg

9. “Vatican City” Ecosystem  AF TC (Vatican City) SF infection rate consistently higher even though primary reservoirs uncommon –Few fat sand rats, jirds, or gerbils –Plenty of mice –2 rodents came back PCR positive (WB)

13. Peak Flight Time  Flight time is dynamic  Changes constantly  Species shift? Or adaptation to changing environment?  Implications: control, education, PPE/avoidance measures

14. Lessons Learned  The sand flies haven’t read the books  There’s not enough time in the day  Know the priorities (Leish is not a big concern when shrapnel is flying)  Take everything you need with you! –Murphy’s Law kicks in as soon as your boots hit the ground

18. Recommendations  Focus Leishmaniasis control efforts on reservoir control –Easier to find and fewer to control –Identify primary reservoirs and eliminate –Turn the vector into a pest  Alternative approaches to vector control –Vegetation management, baiting, trapping, aerial spray  Monthly flight time studies

20. Will The Leish Threat Remain?  If the sand fly/Leish threat is exacerbated by dry conditions of forced drought, then what happens when the water comes back?  Converts back to malarious area?

22. Other Fun Things  Mosquito surveillance  Cats for rodent control  Where are all the flies?

24. What Now?  Continue development/validation of new assays  Back to Iraq to assist with surveillance and control of vector-borne diseases  Transition from BAT-L to Medical Entomology Team (MET)