Impact of Phlebotomine Sand Flies on U.S. Military Operations at Tallil Air Base, Iraq: 1. Background, Military Situation, and Development of a “Leishmaniasis Control Program”

Abstract

One of the most signiÞcant modern day efforts to prevent and control an arthropod- borne disease during a military deployment occurred when a team of U.S. military entomologists led efforts to characterize, prevent, and control leishmaniasis at Tallil Air Base (TAB), Iraq, during Operation Iraqi Freedom. Soon after arriving at TAB on 22 March 2003, military entomologists determined that 1) high numbers of sand ßies were present at TAB, 2) individual soldiers were receiving many sand ßy bites in a single night, and 3) Leishmania parasites were present in 1.5% of the female sand ßies as determined using a real-time (ßuorogenic) Leishmania-generic polymerase chain reaction assay. The rapid determination that leishmaniasis was a speciÞc threat in this area allowed for the establishment of a comprehensive Leishmaniasis Control Program (LCP) over 5 mo before the Þrst case of leishmaniasis was conÞrmed in a U.S. soldier deployed to Iraq. The LCP had four components: 1) risk assessment, 2) enhancement of use of personal protective measures by all personnel at TAB, 3) vector and reservoir control, and 4) education of military personnel about sand ßies and leishmaniasis. The establishment of the LCP at TAB before the onset of any human disease conclusively demonstrated that entomologists can play a critical role during military deployments.