Focus

FVBI surveillance projects address vector-borne and zoonotic pathogens, including malaria, that cause acute febrile illness in humans through surveillance of:

• U.S. military and in foreign military and civilian populations
• Vector distribution and pathogen presence in vectors and reservoirs
• Environmental drivers of exposure and infection studies

Importance of FVBI Surveillance within the U.S. Military

Vector-borne and zoonotic pathogens are often associated with undifferentiated febrile illness, making them difficult to distinguish clinically and creating challenges for diagnosis and control. Those pathogens comprise at least two-thirds of the 57 top infectious disease threats to Defense Department personnel as identified by the 2019 Military Infectious Diseases Research Program (MIDRP) Infectious Disease Threat Prioritization Panel. The limited diagnostic and treatment options available for these pathogens, particularly in the austere and unstable environments typical of military operations, increase the threat.

Historical examples of the impact of vector-borne diseases on military operations include malaria, scrub typhus, and dengue during World War II and hemorrhagic fever with renal syndrome during the Korean War. More recently, malaria outbreaks have occurred among marines deployed to Liberia in 2003 (Plasmodium falciparum) and in a rotational unit deployed to the Republic of Korea in 2015 (Plasmodium vivax). Other current threats include chikungunya and Zika viruses, which have spread to the Western Hemisphere and placed garrisoned and deployed troops at increased risk for infection.

FVBI Focus Area Strategy

• Provide timely, accurate, and actionable FVBI surveillance data for decision makers within the Department of Defense and global public health community
• Coordinate a surveillance network for vector-borne and zoonotic pathogens; conduct surveillance activities that include multidisciplinary vector-borne pathogen surveillance that incorporate human, animal, vector, and ecological monitoring to identify human cases and detect novel pathogens in arthropod vectors and reservoir hosts
• Support projects that inform risk assessments and medical countermeasure development
• Provide support for outbreaks of vector-borne or zoonotic pathogens as requested by the U.S. government or partners

Pathogens of interest include:

Plasmodium species (malaria), dengue virus, alphaviruses (such as chikungunya, Ross River, and Venezuelan equine encephalitis viruses), Leptospira species, Rickettsia species, hantaviruses, Leishmania species, Coxiella burnetii, Borrelia species, Zika virus, Rift Valley fever virus, tick-borne encephalitis virus, Crimean-Congo hemorrhagic fever virus, severe fever with thrombocytopenia syndrome virus, and Lassa virus. Novel or previously undetected pathogens must also be identified and characterized to determine their potential threat to military and global health.

FVBI Focus Area Activities

• Clinic-based surveillance for infectious causes of acute undifferentiated febrile illness
• Characterization of resistance patterns to medical countermeasures in vector-borne and zoonotic pathogens, particularly malaria drug resistance
• Optimization and validation of disease risk modeling and prediction tools, including geographical distribution of pathogens, vectors, and reservoir hosts
• In-depth genetic sequencing and phylogentic analysis of targeted vector-borne and zoonotic pathogens, including full genome sequencing and analysis where appropriate
• Discovery and characterization of novel pathogens in military-relevant locations and populations
• Characterization of the incidence, risk factors, or epidemiology of severe malaria and other vector-borne and zoonotic diseases
• Entomologic surveillance for arthropod vectors and associated pathogens, including insecticide-resistance patterns

What's New in the FVBI Focus Area for FY20

The FVBI focus area provides approximately $20 million of funding to support partner surveillance projects around the world.

New projects include:

• Vector surveillance along the Southwest border between the US and Mexico
• Tickborne encephalitis virus surveillance with NATO partners in the EUCOM AOR
• Surveillance for vectors and associated pathogens in Lake Chad Basin countries
• Chagas disease surveillance and characterization in Central America
• Mapping, monitoring, and forecasting global chikungunya outbreaks and risk
• Expanded surveillance for Plasmodium falciparum mutations (pfhrp2 deletions) associated with malaria rapid test failure in the INDOPACOM, AFRICOM, and SOUTHCOM AORs

Where We're Going

• Increasing coordination and collaboration on vector-borne diseases – including harmonization of laboratory protocols with Department of Defense and interagency partners
• Incorporating advanced diagnostic platforms for multi-pathogen identification into surveillance activities
• Leveraging next-generation sequencing capabilities for pathogen detection, identification, and characterization
• Improving risk mapping for pathogens, vectors, and reservoirs to enhance the capability to identify known and/or emerging FVBI vectors and pathogens for expanded force health protection decision making capabilities globally
• Increasing data sharing across the Department of Defense network and with key U.S. and international partners

See what GEIS is doing to combat antimicrobial resistant infections and sexually transmitted infections, enteric infections, and respiratory infections.

If you are involved with the Department of Defense medical community and are interested in partnering with GEIS, or if you would like more information, please contact us.