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2018 Zoonotic Disease Report

A Zoonotic Disease Summary for Public Health Personnel in the U.S. Army

June 2020TA-498-0120

Approved for public release, distribution unlimited

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1

Table of Contents

2 Human Disease Summary: U.S. Army Reportable Medical Events

4 Animal Disease Summary: Army Rabies Testing

6 Vector Surveillance: Mosquito Summary – West Nile Virus Testing

8 Vector Surveillance: Tick Summary

11 Data Sources

2

Human Disease Summary: Zoonotic Disease-Related Reportable Medical Events (RMEs)In 2018, 277 zoonotic disease cases were reported in the Disease Reporting System internet (DRSi); 498 rabies post-exposure prophylaxis (PEP) reports were also reported during the same time period.

Of the 277 zoonotic cases, 139 (50.2%) were among Active Duty (AD) service members and 138 (49.8%) were among non-AD individuals. Of the rabies PEP cases, 238 (47.8%) were among AD service members and 260 (52.2%) were among non-AD individuals.

* Zoonotic diseases where at least a total of ten cases were reported during 2017-2018.

0

20

40

60

80

100

120

140

160

102

121

140

66

25

50

20172018

512 9

3 76

Spotted fever

rickettsiosis

Lymedisease

Malaria Dengue virus

infection

LeishmaniasisEhrlichiosis/anaplasmosis

Zoonotic Disease Cases Reported in DRSi*, 2017-2018

Num

ber o

f cas

es

Rabies PEP events

Non-AD individuals

Non-Rabies Zoonotic cases

AD service members

277

139(50.2%)

138(49.8%) 260

(52.2%)

238(47.8%)

498

3

67.5% Lyme disease

and Spotted fever rickettsiosis (SFR)

(n=187) comprised the majority of all zoonotic disease records (n=277)

(excluding rabies PEP)

Overall, the number of zoonotic disease cases(excluding rabies PEP)

18.6%increase in the number of SFR

cases

52.9%decrease in the number of Lyme

disease cases

2017 to 2018

2016 to 2017

6.7%DECREASED

25.8%INCREASED

2017 to 2018

Ft. Leonard Wood reported 103 (37.2%) of the zoonotic cases, of which 89 (86.4%)

were SFR cases.

Ft. Bragg reported the highest number of rabies PEP cases

(20.3%, n=101).

4

Animal Disease Summary: Army Rabies TestingRabies Testing by PHC-Europe

In 2018, PHC-Europe tested 14 samples for rabies; all samples were tested using polymerase chain reaction (PCR). None of the samples tested positive for rabies.

Most of the human exposures (56.5%) occurred in Turkey, and all of those individuals were exposed by felines.

Germany

Total

Turkey

Kuwait

Japan

Kosovo

Italy

United Kingdom

Animal Type

% Indeterminate

No. Tested

No. Positive

No. Human Exposures

% Positive

Country

No. Indeterminate

Bat

14 Bat

BatFox

Bat

Bat

1

4

1

1

11

1

1

Feline

23

0

00

0 Feline

Feline

Mole

1

1

3

3

1

13

3

1

5

Atlantic

Central

Pacific

Total

Bat

Bat

Bat

Squirrel

SquirrelSkunk

Skunk

Raccoon

Raccoon

Opossum

Hamster

1

56

10

25

18

27

29

100

2

1

3

2

2

1

64

1

1

4

11

7

1

1

1

2

4

2

1

36

Canine

Canine

Canine

Feline

Feline

Feline

1

18

13

2

8

5

61 161

2

38

13

2

9

4

2

6

3

Animal TypeNo. TestedNo. Human Exposures

Region% IndeterminateNo. Positive% Positive

No. Indeterminate

Rabies Testing by the DoD Food Analysis and Diagnostics Laboratory (FADL), 2018

U.S. military installations in RHCs-Atlantic, Central, and Pacific submitted 61 samples to the DoD FADL for rabies testing in 2018. The specimens were associated with 162 human exposures. The number of specimens submitted decreased by approximately 20% from 2017 to 2018. However, the number of human exposures increased by approximately 45%.

Two specimens were indeterminate; the samples were unable to be tested due to sample condition issues.

Eight samples were dFA-positive: six bats from California, Kansas, New York, and Texas, and two skunks from Col-orado. Overall, 13% of specimens tested by the DoD FADL were positive for rabies, and 11 humans were exposed to the animals whose specimens tested positive.

6

Vector Surveillance: Mosquito Summary – West Nile Virus TestingMilitary Mosquito Testing for West Nile Virus, 2018

A total of 41,619 mosquitoes from 4,171 pools were collected and tested for West Nile Virus (WNV) by mili-tary assets; 97 (2.3%) of the pools were WNV-positive.

PHC-Atlantic (44%, n=1845) collected and tested most of the pools, followed closely by PHC-Central (44%, n=1,831), PHC-Pacific (12%, n=490), and PHC-Europe (<1%, n=5).

Three mosquito genera (Aedes, Culex, and Culiseta) were tested for WNV; the majority were Culex spp. (81%, n=3,378).

Fewer mosquito pools were tested for WNV in 2017 compared to 2018 (3,690 pools v. 4,171 pools). How-ever, a greater number of pools tested positive for WNV in 2017 than 2018 (155 v. 97).

The majority of military WNV testing efforts in 2018 were centered in Texas; 17,332 (52%) of the 41,619 mos-quitoes tested for WNV were collected in Camp Bullis, Ft. Bliss, Ft. Hood, Ft. Sam Houston, Lackland Air Force Base, and Randolph Air Force Base.

Military WNV testing efforts were also heavily concentrated in Washington, DC, where 4,201 mosquitoes from 229 pools were collected and tested; 56 (19%) of the pools collected and tested were WNV-positive.

The highest minimum infection rate (MIR), 71.4, was observed at Carlisle Barracks, PA. The next highest MIRs were observed at Ft. Hamilton, NY (MIR=53.3), and Letterkenny Army Weapons Depot, PA (MIR=52.6). New York had the highest overall MIR (MIR=53.3). In contrast, an overall MIR of 1.0 was observed in Texas.

4171

41619

97

Atlantic Region

Europe RegionPacific RegionCentral Region

No. Pools TestedNo. Mosquitoes TestedNo. Pools Positive

1845

12916

74

1831

20524

23

490

8174

0

5

5

0

7

Military Mosquito Testing for Other Pathogens, 2018

PHC-Atlantic tested 150 mosquitoes for chikungunya, dengue, and Zika viruses; all were negative.

PHC-Central tested 1563 mosquitoes for chikungunya and Zika viruses; all were negative.

PHC-Europe tested 16 mosquitoes for chikungunya and dengue viruses; all were negative.

PHC-Pacific tested 392 mosquitoes for chikungunya, dengue, and Zika viruses, as well as 123 mosquitoes for Japanese encephalitis virus; all mosquitoes tested negative for these pathogens.

2121

558

150

150

1563

0392

392

16

16

Chikungunya virus**

Dengue virus¥

2105

123

62

27

27

Zika virus**

Japanese encephalitis

virus

Malaria

Leishmaniasis

Sandfly fever

150

0

0

62

27

27

392

1563

0

0

0

0

0

0

0

0

123

0

0

0

* Mosquitoes may be tested for more than one pathogen.** Of these mosquitoes tested, 28 were Culex spp. mosquitoes and 16 were of unknown species.¥ Of the 558 mosquitoes tested, 16 were of unknown species.

Atlantic Aedes spp.No. Mosquitoes Tested*

Central Culex spp.Pacific Anopheles spp.Europe Phlebotomus spp.

8

Vector Surveillance: Tick Summary A total of 4,946 ticks were tested by PHC laboratories and the DoD Human Tick Testing Kit Program (HTTKP) for select pathogens. The majority of ticks (56%) tested were Amblyomma spp. ticks. There were 385 ticks collected from locations outside of the continental United States (OCONUS).

*Other includes 2 Hyalomma marginatum, 9 Ornithodoros kelleyi, and 1 unknown tick species

GenusNo. Ticks TestedTotal No. of Ticks Tested

Other*12

Ixodes 1046Amblyomma

2792

Dermacentor

1081Rhipicephalus

15

4946

Anaplasma phagocytophilum

Continental U.S. (CONUS) and outside continental United States (OCONUS) military laboratories tested 1,420 Amblyomma americanum, Dermacentor spp., Ixodes spp., and Rhipicephalus turanicus ticks for the bacteria Ana-plasma phagocytophilum, which is the pathogen that causes human granulocytic anaplasmosis.

A total of 88 ticks infected with A. phagocytophilum were identified; 75 positive ticks were collected from the environment, 11 ticks were removed from humans and submitted to the HTTKP, and 2 were collected from ani-mals. Ninety-seven percent of the infected ticks were from CONUS locations. In 2017, 31 ticks infected with A. phagocytophilum were identified; no infected ticks from OCONUS were identified.

The infection prevalence (IP) of A. phagocytophilum ranged from 6% at Carlisle Barracks, PA to 19% at Ft. Drum, NY.

The infection prevalence of all pathogens was only calculated for areas where greater than ten ticks were tested.

9

Ehrlichia spp.

CONUS and OCONUS military laboratories tested 2,956 Amblyomma spp., Dermacentor marginatus, Ixodes spp., and Rhipicephalus turanicus ticks for Ehrlichia chaffensis, Ehrlichia ewingii, and Ehrlichia spp. pathogenic organisms; these pathogens cause ehrlichiosis.

There were 89 ticks infected with at least one of these pathogens identified; 3 positive ticks were collected from the environment, 81 ticks were removed from humans and submitted to the HTTKP, and 5 were collected from animals. Ninety-eight percent of the infected ticks were from CONUS locations. In 2017, 73 ticks infected with at least one of these pathogens were identified.

The IP of E. chaffeensis ranged from 1% at Ft. Knox, KY to 14% at an undisclosed location. The IP of E. ewingii ranged from 1% at Joint Base McGuire-Dix-Lakehurst, NJ to 8% at both Ft. Eustis, VA and Ft. Lee, VA.

Panola Mountain Ehrlichia (PME)

The HTTKP tested 2,322 Amblyomma spp. ticks for Panola Mountain Ehrlichia (PME). Thirty-three ticks infect-ed with PME were identified. The IP of PME ranged from 1% at both Ft. Campbell, KY and Joint Base Mc-Guire-Dix-Lakehurst, NJ to 3% at Joint Base Andrews, MD; Naval Weapons Station Earle, NJ; and a private property in Maryland.

Lyme Disease

CONUS and OCONUS military laboratories tested 1,065 A. maculatum, Dermacentor marginatus, Hyalomma marginatum, Ixodes spp., and Rhipicephalus turanicus ticks for the bacteria Borrelia burgdorferi, which is the pathogen that causes Lyme disease.

A total of 163 ticks infected with B. burgdorferi were identified; 67 positive ticks were collected from the environ-ment, 86 ticks were removed from humans, and 10 were collected from animals. Most (44%) of the infected ticks were from OCONUS locations.

The IP of B. burgdorferi ranged from 10% at Blossom Point Tracking Facility, MD to 42% at Hanscom G. Laurence Field, MA.

Spotted fever rickettsioses

CONUS and OCONUS military laboratories tested 1,140 Amblyomma spp., Dermacentor spp., Ornithodoros kelleyi, and Rhipicephalus sanguineus ticks for various Spotted fever rickettsioses (Rickettsia andenae, R. montan-ensis, R. parkeri, R. rickettsii, and R. spp.

There were 38 ticks positive for at least one of these pathogens; 32 were collected from humans, and 6 were collected from the environment.

The IP ranged from 2% at Aberdeen Proving Ground, MD to 5% at Ft. Knox, KY.

10

Anaplasma phagocytophilum

Ehrlichia chaffeensis

Borrelia burgdorferi, Borrelia spp.

Panola Mountain Ehrlichia

Spotted fever rickettsioses

Ehrlichia ewingii

1420

1065

2322

752

2956

88

163

33

38

89

6%Carlisle

Barracks, PA

1%Ft. Knox, KY

10%Blossom Point

Tracking Facility, MD

1%Ft. Campbell, KY JB McGuire-Dix- Lakehurst, NJ

2%Aberdeen Proving Ground

1%Joint Base

McGuire-Dix- Lakehurst, NJ

19%Ft. Drum, NY

14%Undisclosed

location

42%Hanscom

G. LaurenceField, MA

3%JB Andrews, MD Naval Weapons

Station Earle, NJ

5%Ft. Knox, KY

8%Ft. Eustis, VA Ft. Lee, VA

No. Ticks TestedNo. InfectedMinimum IP/LocationMaximum IP/Location

Babesia microti

There were 673 Ixodes spp. ticks tested for Babesia microti; three positive ticks collected from humans were identified.

11

Data SourcesThe Disease Reporting System internet (DRSi)

The DRSi is a web-based application developed by the Navy and Marine Corps Public Health Center (NMCPHC) that all Services use to monitor RMEs. Cases that meet RME case definitions are entered into the DRSi by individuals at military medical treatment facilities. The U.S. Army Public Health Center (APHC) Disease Epide-miology Program (DEP) reviews these medical event reports for completeness and accuracy. For this report, only RME records that are considered final with a case status of confirmed, probable, or suspect are included (case classifications are disease-specific); records were queried using diagnosis date.

APHC and Public Health Command (PHC) Laboratories, and the DoD FADL

The Tick-Borne Disease Laboratory at the APHC and laboratories within each PHC (Atlantic, Central, Europe, and Pacific) completed all of the vector surveillance testing included in the report. Each PHC collates the results from their area of responsibility for the calendar year and sends the data to the APHC DEP. The DoD FADL completed rabies specimen testing and furnished data to the APHC DEP.