LONGITUDINAL EVALUATION OF MALARIA EPIDEMIOLOGY IN AN ISOLATED VILLAGE IN WESTERN THAILAND: I. STUDY SITE AND ADULT ANOPHELINE BIONOMICS.

This is the first in a series of papers describing the epidemiology of malaria in an isolated village in western Thailand. The study site was the village of Kong Mong Tha, located in Sangkhla Buri District, Kanchanaburi Province, Thailand. In this paper we present an overview of the study site and results from our adult anopheline mosquito surveillance conducted over 56 consecutive months from June 1999 until January 2004. The collection site, indoor/outdoor location, parity, biting activity and Plasmodiumfalciparum (Pf) and P. vivax (Pv) infection rates were used to calculate seasonal entomological inoculation rates for the predominant four Anopheles species. A total of 21,566 anophelines representing 28 distinct species and 2 groups that were not identified to species were collected using human bait, with almost 95% of the collection consisting of Anopheles minimus, An. maculatus, An. sawadwongporni and An. barbirostris/campestris. Mosquitoes generally peaked during the wet season, were collected throughout the night, and were collected most often outside (ca. 75%) versus inside (ca. 25%) of houses. Approximately 50% of collected mosquitoes were parous. Overall Plasmodium infection rates were 0.27%, with a total of 16 and 42 pools of Pf- and Pv-positive mosquitoes, respectively. Annual EIRs were 2.3 times higher for Pv than for Pf, resulting in approximately 5.5 and 2.6 infective bites per person per year, respectively. The results suggest An. minimus and An. maculatus are the primary and secondary vectors of Pf and Pv transmission in Kong Mong Tha, while An. sawadwongporni and An. barbirostris/campestris also appear to play a role based on the presence of circumsporozoite protein (CSP) in the head/thorax of the specimens tested.

Evaluation of thermotherapy for the treatment of cutaneous leishmaniasis in Kabul, Afghanistan: a randomized controlled trial.

Anthroponotic cutaneous leishmaniasis (CL) is a common cause of ulcerative lesions and disfiguring scarring among children in Afghanistan. Most lesions occur on the face and are commonly caused by the trypanosome protozoan parasite Leishmania tropica, transmitted by the bite of an infected sandfly (Phlebotomus sergenti). This study compared the effectiveness of a single localized treatment with thermotherapy to 5 days of intralesional administration of Glucantime for the treatment of CL. Three hundred and eighty-two patients with CL were randomly assigned to the two treatment groups and followed for 6 months. The cure rate for the thermotherapy group was 82.5%, compared to 74% in the Glucantime group. The authors concluded that a single localized treatment with thermotherapy was more effective than 5 days of intralesional administration of Glucantime. Additionally, thermotherapy was more cost-effective, with fewer side effects, of shorter duration, and with better patient compliance than intralesional Glucantime.

Plasmodium-infected Anopheles mosquitoes collected in Virginia and Maryland following local transmission of Plasmodium vivax malaria in Loudoun County, Virginia.

Two recent outbreaks of locally acquired, mosquito-transmitted malaria in Virginia in 1998 and 2002 demonstrate the continued risk of endemic mosquito-transmitted malaria in heavily populated areas of the eastern United States. Increasing immigration, growth in global travel, and the presence of competent anopheline vectors throughout the eastern United States contribute to the increasing risk of malaria importation and transmission. On August 23 and 25, 2002, Plasmodium vivax malaria was diagnosed in 2 teenagers in Loudoun County, Virginia. The Centers for Disease Control and Prevention (CDC) deemed these cases to be locally acquired because of the lack of risk factors for malaria, such as international travel, blood transfusion, organ transplantation, or needle sharing. The patients lived approximately 0.5 mi apart; however, 1 patient reported numerous visits to friends who lived directly across the street from the other patient. Two Anopheles quadrimaculatus s.l. female pools collected in Loudoun County, Virginia, and 1 An. punctipennis female pool collected in Fairfax County, Virginia, tested positive for P. vivax 210 with the VecTest panel assay and enzyme-linked immunosorbent assay (ELISA). In addition, 2 An. quadrimaculatus s.l. female pools collected in Montgomery, Maryland, tested positive for P. vivax 210. The CDC confirmed these initial results with the circumsporozoite ELISA. The authors believe that this is the 1st demonstration of Plasmodium-infected mosquitoes collected in association with locally acquired human malaria in the United States since the current national malaria surveillance system began in 1957.

The growing challenges of vector-borne diseases to regionally-aligned forces.

The long-term strategic focus of US foreign policy has pivoted to the Pacific, but tensions in the Middle East require constant attention in the present. As our current role in Afghanistan diminishes, we must seize the opportunity to refocus on the new priority of regionally-aligned forces. The short-term reality requires first reestablishing core warfighting competencies of a smaller Army and then building the capacity of forces focused on regional alignment. The continuing threat of vector-borne and other infectious diseases will present growing challenges to US forces focused on regional alignment and engagement. Greater understanding of these threats, host nation vulnerabilities and capabilities, and the regional presence of international and nongovernmental organizations will enable US forces to respond and engage more effectively and appropriately to accomplish assigned missions and future contingencies. Effective vector surveillance and control has a longstanding and proven record of preventing, reducing, and eliminating vector-borne diseases and must remain a focus of regionally-aligned forces. Operational readiness of armed forces continues to rely heavily on vector surveillance and control, and on personal protection strategies. Regionally-aligned forces must also work closely with the US Department of State and US Agency for International Development, international governments, governmental and nongovernmental organizations, and private organizations operating in the region and know how to effectively interact with these diverse organizations. In addition, a working knowledge of a host country's public health policy, capabilities and economic realities will be essential. Teamwork with previously unfamiliar groups and organizations will be an essential component of working in regional environments and can present unfamiliar tasks for traditionally-trained military units.

Recover, Recycle, and Reuse: Prove-Out of Pyrotechnic Illuminants Containing Demilitarized Magnesium.

The development and prove-out of yellow-light-emitting pyrotechnic illuminants based on recover, recycle, and reuse (R3 ) technology is described. Magnesium used in this investigation was recovered from four different illuminating pyrotechnic munitions by means of an environmentally friendly demilitarization process. Despite significant differences in the particle size and purity between the four lots of recovered magnesium, the performance of each lot-on evaluation in the M127A1 US Army yellow-light-emitting illuminant configuration-exceeded the military requirement and performance of the virgin magnesium-containing control. All formulations were found to have low sensitivities to various ignition stimuli and possessed high thermal onset temperatures. In addition to the military significance, this demonstrated "green" pyrotechnics technology of using recycled magnesium in illuminating pyrotechnics may also be of interest to the civilian fireworks community.

The expanding role of military entomologists in stability and counterinsurgency operations.

Military entomologists function as part of medical civil-military operations and are an essential combat multiplier direction supporting COIN operations. They not only directly support US and coalition military forces by performing their traditional wartime mission of protecting personnel from vector-borne and rodent-borne diseases but also enhance the legitimacy of medical services by the host nation government such as controlling diseases promulgated by food, water, vectors, and rodents. These unique COIN missions demand a new skill set required of military entomologists that are not learned from existing training courses and programs. New training opportunities must be afforded military entomologists to familiarize them with how to interact with and synergize the efforts of host nation assets, other governmental agencies, nongovernmental organizations, and international military partners. Teamwork with previously unfamiliar groups and organizations is an essential component of working in the COIN environment and can present unfamiliar tasks for entomologists. This training should start with initial entry training and be a continual process throughout a military entomologist's career. Current COIN operations require greater tactical and operational flexibility and diverse entomological expertise. The skills required for today's full spectrum medical operations are different from those of the past. Counterinsurgency medical operations demand greater agility, rapid task-switching, and the ability to adequately address unfamiliar situations and challenges.