Comments from Website author: JAMA writes here of a caution for troops in Bosnia-Herzegovina (which I believe also extends to the Mid-East region) that tick-borne disease is a danger. They caution that the same risks are additionally associated with mosquitoes, sand flies, fleas, mites, biting flies, and lice. "Desert Storm Syndrome" parallels one characteristic of Lyme in that this spirochetal infection also can be sexually transmitted to spouse.
Comments from Physicians at this article's end: None


Spring Brings Tick Threat to Peace Enforcers

JAMA, May15,1996, Medical News & Perspectives


AS THE HALFWAY point approaches in the year-long North Atlantic Treaty Organization (NATO) peace-enforcement effort in Bosnia-Herzegovina, military are putting more physicians emphasis than ever on keeping US troops healthy.

US Army, Air Force, Navy, and Marine Corps personnel in the former Yugoslavia are carrying laminated plastic cards reminding them of the diseases that can be transmitted via various vectors there, particularly ticks (JAMA. 1994;272:337-340 and p 1470 in this issue). With the arrival of warmer weather, ticks are expected to be a problem until as late as November.

Early Winter Withdrawal

Although there is talk of a few troops staying longer, November and early December are when US forces are supposed to withdraw (JAMA. 1996;275:24). President Clinton made a public pledge to extract US troops within a year of the December 20, 1995, date when NATO assumed peace-enforcement duties from the United Nations, meaning that pull-out planning could begin as early as next month.

In the meantime, US military physicians are concerned about tickborne encephalitis and Lyme disease, for which Ixodes ricinus is the primary vector; Crimean-Congo hemorrhagic fever, for which Hyalomma marginatum marginatum is the primary vector, and perhaps boutonneuse fever rickettsiosis or Bhanja virus fever, also transmitted by the bite of an infective tick.

Troops are being urged to tuck their trousers in their boots and otherwise cover their skin when in tick-infested areas, use tick repellent, check frequently for the presence of ticks on clothing or skin, and to remove ticks carefully, seeking medical assistance if possible and applying an antiseptic to the bite site.

What's more, US troops are reminded that "mosquitoes, sand flies, fleas, mites, biting flies, and lice may also present a disease threat in specific locations." Use of repellents and "maintaining good personal hygiene" are urged.

In addition, there is the potential for hantavirus (Bunyaviridae family) infection, a cause of hemorrhagic fever or respiratory problems, and thought to result from direct contact with, or inhaling, dust contaminated by infected rodents' excretions. Thus, rats, mice, squirrels, voles, and other rodents also are a concern for the military in the Balkans (JAMA. 1996;275:422 and Lancet. 1996;347:30), and troops are being cautioned to "mist" or lightly spray previously unoccupied areas to avoid dust inhalation before mopping or sweeping preparatory to moving in.

Removing trash and sources of water, sealing tiny wall openings, and using repellents can reduce the chance of disease transmission from rodents, the troops are advised. They are told to seek immediate medical assistance if bitten or scratched by a rodent.

Preventive Efforts Working

The US Army Center for Health Promotion and Preventive Medicine, Aberdeen (Md) Proving Ground, has been working on these and other health-precaution efforts. As always, American GIs have their own name for the laminated materials, calling them "tick cards."

So far, there has been no major increase in illness or injury among US troops participating in the peace-enforcement effort. John G. Jernigan, MD, the US Air Force brigadier general-designee who is command surgeon, Air Mobility Command, Scott Air Force Base, Ill, says that, to date, there has been no increase in demand for aeromedical evacuation above that normally required to support US troop activity in Europe other than Bosnia-Herzegovina.

--by Phil Gunby