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Military infectious disease surveillance guards service members against illness

GEIS laboratory partners conduct surveillance of vector-borne diseases that are transmitted to humans, animals, and plants through arthropods such as mosquitoes. A U.S. Air Force Senior Airman sets up a dry ice trap to catch mosquitoes to test for viruses. GEIS laboratory partners conduct surveillance of vector-borne diseases that are transmitted to humans, animals, and plants through arthropods such as mosquitoes. A U.S. Air Force Senior Airman sets up a dry ice trap to catch mosquitoes to test for viruses. (U.S. Air Force file photo)

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Armed Forces Health Surveillance Branch | Global Emerging Infections Surveillance | Febrile and Vector-Borne Infections (FVBI) Surveillance

YONGSAN, SEOUL, South Korea – When it comes to the potential disease risk that mosquitoes, ticks, mites, biting midges and rodents pose to U.S. service members, entomologist Terry Klein stands on the front lines.

Klein, of the 65th Medical Brigade, collects these blood-feeding species at various spots along the edge of the demilitarized zone (DMZ) between North and South Korea. The specimens are later tested to determine the risk for vector-borne diseases, such as malaria, Zika virus, dengue fever, Japanese encephalitis, Lyme disease, hantaviruses, and rickettsiae that deployed service members might face in this particular region.

Susceptibility to infectious disease has long been a concern of the military, threatening the health and readiness of service members. Klein’s surveillance work is part of broader effort by the Defense Department to inform and utilize preventive measures available to protect service members and their beneficiaries against often life-threatening diseases.

As part of its work under the Defense Health Agency, the Armed Forces Health Surveillance Branch funds and coordinates a robust global surveillance program of militarily relevant disease surveillance like Klein’s through its Global Emerging Infections Surveillance (GEIS) section. In 2016, GEIS provided $56.9 million in funding to 21 Defense Department service laboratories that operate in the U.S. and overseas to implement infectious disease surveillance in support of force health protection. GEIS’s Febrile and Vector-Borne Infections Focus Area supported 67 projects totaling $17.4 million.

“You can’t predict with certainty when service members are going to get a virus without surveillance,” said Klein, a former Army colonel who has been conducting vector-borne disease surveillance in South Korea for 17 years. “It’s important to get the information about potential diseases to the medical community so that they are familiar with the signs and symptoms and can help our service members take precautions and stay healthy.”

For example, malaria has been a threat to service members in the region for a long time. In 2016, malaria was diagnosed at or reported from 25 different medical facilities in the U.S., Afghanistan, Germany and Korea, based on an analysis in Medical Surveillance Monthly Report. More recent military engagements in Africa, Asia, Southwest Asia, the Caribbean, and the Middle East have necessitated heightened vigilance, preventive measures, and treatment of cases.The number of cases in Korea has increased since 2012, including a cluster of 11 Plasmodium vivax cases in 2015.

Over the past several months, Klein has been setting up mosquito traps laced with lactic acid that attract mosquitoes at a variety of locations near or in the DMZ in Korea. He has just set mosquito traps at Camp Bonifas where 100 U.S. soldiers, along with the Republic of Korea Army, monitor the DMZ. Traps also were set at the Warrior Base, a U.S. training site and at Dagmar North, another training site and the location where the 2015 cluster of 11 Plasmodium vivax malaria cases among U.S. service members occurred. Klein captured more mosquitoes there during his recent surveillance effort than at other trapping locations.

Klein also collects ticks near the DMZ where three cases of severe fever with thrombocytopenia syndrome were diagnosed among soldiers at two Republic of Korea Army bases in May.

Klein sends all mosquito specimens to the Walter Reed Army Institute of Research in Silver Spring, Maryland, where they are tested for novel viruses and bacteria. Dr. Jun Hang of WRAIR identified rickettsiae, a group of bacteria that can cause typhus and various other febrile diseases in humans, in the mosquitoes. The rickettsiae were later identified by the Naval Medical Research Center as three new species. While the human health impact of these three new species is yet unknown, the finding demonstrates the importance of surveillance for novel viruses and bacteria.

In addition to mosquitoes and ticks, Klein also collects rodents for surveillance of hantaviruses, in collaboration with Korea University. Hantaviruses are transmitted to humans by direct or indirect contact with the saliva and excrement of rodents and can cause high fever and kidney failure. He has collected more than 12,000 small mammals, of which at least 60 percent were striped field mice, a primary reservoir for Hantaan virus, the most serious form of hemorrhagic fever with renal syndrome in Korea.

At training sites near the DMZ, rates of striped field mice infection with hantavirus average about 15 percent to 20 percent, which is considered to be high risk. Korea University is working with the Korea Agency for Advanced Development and the U.S. Army Medical Research Institute of Infectious Diseases to map out the geographical variability of Hantaan virus, which will allow the U.S. military to better track the source of infections among service members when the virus is detected in their blood.

Since arriving in Korea, Klein has seen firsthand the impact surveillance can have on military operations. “Surveillance allows the infantry and medical to take more precautions to make sure that our forces are healthy and able to conduct their missions,” he said.

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