Vector-borne and zoonotic pathogen diagnostic needs for

U.S. NavyEntomologists Deployed in

support of the U.S. Marine Corps

Craig A. StoopsLCDR MSC USNNavy Entomology

Center of Excellence

Disclaimer

The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U. S. Government

Testing Needs - Pathogens

Malaria

Dengue

Chikungunya

Leishmaniasis

Rickettsia

Schistosomiasis

Importance

Value

Timeliness

Impact on decision loop

Contractors/Local Nationals/TCNs

Humanitarian Missions (coordinating with host nation governments)

Issues

Division/Group/Regimental/Battalion Surgeons

Will not impact combat operations

Varying levels of trust in rapid diagnostics within physician community

Will not be used for diagnosis in most cases

Could be used to screen

Camp Ramadi

Would leish or sand fly fever rapid tests been helpful on Camp Ramadi?

81st Regimental Combat TeamRegimental Combat Team 6Combat Logistics Battalion 4Rogues gallery of HTT/Special OPS/OGAKBRLNs and TCNs

Hypothetical Example

Patients with symptoms were screened with test kit

Positives were placed on SIQ status. Number of patients set to trigger full

quarantineBig risk of quarantining healthy patients

taking them out of the fightBig risk of waiting too long and not being

able to contain the outbreak

Example

What to do about the Contractors, Local Nationals and TCNs?

Communication up and down chain of command from Division and Group of how to solve local problems is difficult

Positives/Negatives

Would a negative result stop surveillance and control OPS?

What is worse – False Positive or Negative?

Presenting a negative result to the chain of command. Guidance needed.

False Positives

Must rigorously test kits in areas of low endemicity where chance of a false positive is greater

NAMRU-2 tested 6681Anopheles spp. From across Indonesia

Five positives confirmed with ELISA

Confident that there were no false positives

Conclusion

Entomologists should continue surveillance and control ops even without diagnostics

Regional intelligence estimates or published reports are not enough. Since vector-borne diseases are focal – information on what is happening on your base or in your battlespace will be essential

Diagnostics will provide area specific information on very focal pathogen presence/absence