Hazard Identification and Risk Assessment: The pre-deployment planning process begins with the identification of the hazards, and once identified, evaluation to estimate the risk associated with each hazard. The first step in obtaining sound medical intelligence is to access the National Center for Medical Intelligence (NCMI) Infectious Disease Risk Assessment (IDRA) for entomological and zoonotic threats in the country/region of interest. The NCMI tracks and assesses a full range of global health issues for the DoD, specifically monitoring and analyzing health events that could negatively impact the health of U.S. military and civilian populations abroad. A secure account must be established to access the NCMI website, and unclassified information can be accessed with a Common Access Card (CAC).
An initial hazard assessment must address the following topics:
What military entomological and zoonotic hazards are endemic to this area?
Do you have a copy of the Entomological and Zoonotic Operational Risk Assessment (EZORA) for the country where you are deploying?
Have you checked out the NCMI IDRA for the country where you are deploying?
Another good source of hazard information is the
Armed Forces Pest Management Board (AFPMB)
Disease Vector Ecology Profiles (DVEP).
Is there a DVEP for the country where you are deploying?
What is the potential impact of each endemic vector-borne and zoonotic disease on the operation?
The EZORAs and NCMI IDRAs include risk assessments.
These risk assessment products are on a countrywide basis; therefore, you should consider making an assessment for the specific region within the country of your deployment.
As an example, for malaria, examine sources such as the NCMI Malaria Risk map, Walter Reed Biosystematics Unit (WRBU) VectorMap, Centers for Disease Control and Prevention (CDC) interactive malaria map, and World Health Organization (WHO) reports.
In addition, identify other hazards that Soldiers may encounter such as biting and stinging arthropods, venomous snakes and scorpions, poisonous plants, wild and stray animal, and potential pesticide exposure from contaminated industrial and agricultural sites.
Therefore, in addition to diseases listed in the EZORA/IDRA, list other potential environmental, entomological and zoological hazards.
Are the Command Surgeon and the medical staff aware of entomological and zoonotic threats and their potential impact on the operation?
Does the current Preventive Medicine (PM) Annex to the Operation Order (OPORD) contain medical threat information, or have PM personnel received a medical threat briefing? Does the medical threat brief include the entomological and zoonotic threats?
Force health protection issues that must be addressed during pre-deployment planning:
Based on the initial hazard assessment and the anticipated exposure during the deployment, formulate pre-deployment Force Health Protection (FHP) recommendations through appropriate medical chain of command to include:
Inclusion of a qualified entomologist, supportive PM personnel and appropriate equipment for surveillance and control measure in support of the deployment.
Procurement and distribution of personal protective equipment (PPE) such as insect repellents, permethrin-treated bed nets and other PPE items as necessary.
Field Sanitation Teams (FSTs): FSTs provide unit level PM support and are responsible for teaching Soldiers how to use protective measures, issue skin and clothing repellents and monitor their use, provide timely feedback to the commander regarding compliance, and coordinate with Division or Corps PM assets.
Are unit FSTs manned?
Each company-sized unit or equivalent is required to have an FST.
Are FSTs ready?
FST personnel must be trained and equipped to handle the identified vector-borne disease threat.
Individual Protection: Individual force protection measures include the use of DoD Insect Repellent System (skin and clothing repellants and proper wearing of uniform), sleeping under treated bed nets, chemoprophylaxis, and vaccination.
Do the units have an adequate supply of DoD approved skin repellents?
FM 4-25.12 (Unit Field Sanitation Team) requires 4 tubes per person be pre-stocked for use by the FST.
Have Soldiers' issued Army Combat Uniforms (ACUs) that are factory treated with permethrin (ACU Permethrin)?
If not, do units have an adequate supply of IDA kits?
FM 4-25.12 requires 4 IDA kits per person be pre-stocked for use
by the FST.
Have bed nets been issued to personnel?
If not, do units have an adequate supply on-hand?
Are bed nets treated with permethrin?
If not, do units have an adequate supply of aerosol permethrin spray?
FM 4-25.12 requires 1 can of aerosol permethrin
spray per person be pre-stocked for use by the FST.
Are Personal Protective Measures (PPM) items taken on all deployments?
Prevention of arthropod vector bites remains the best method to reduce the burden of vector-borne diseases on the
military and military health care system.
History has shown that disease outbreaks occur when units encounter a
highly focal area of vectors/disease during deployments that were not expected.
Even in areas relatively free of vector-
borne diseases, exposures to biting arthropods have caused many casualties from secondary infections and allergic
Guidance on personal protection from arthropods and other invertebrates can be found in the
AFPMB TG 36 (Personal Protective Measures Against Insects and Other Arthropods of Military Significance)
AFPMB TG 24 (Contingency Pest Management Guide) (CAC required) and
AFPMG TG 41 (Protection from
Rodent-Borne Disease with Special Emphasis on Occupational Exposure to Hantavirus
Has chemoprophylaxis been initiated?
Prophylactic antimalarial regimens must be started before deployment (up to two weeks) to be effective.
Has "reach back" expertise been identified?
These people can provide assistance when a problem or unexpected hazard is encountered during the deployment.
Contact these people during pre-deployment planning to help with developing the sampling plan and identifying the
supporting Regional Health Command or vector-specific sampling equipment requirements.
Has a sampling plan for vector surveillance for each of the identified threats been prepared?
A sampling plan should be developed during pre-deployment planning.
If a vector-borne disease hazard/risk has been
identified in the IDRA/EZORA, then sampling of the vector must be conducted at the deployment site.
Keep in mind
that the risk level in the IDRA/EZORA is an ESTIMATE, and the risk level will get impacted by many other factors in any
given deployment area.
Maintaining the flexibility to collect a wide variety of vectors is a fundamental component of a
thorough sampling plan.
The PM assets, once on site, will use this plan to confirm or disprove the potential hazards
identified during pre-deployment assessment.
Is additional surveillance equipment or supplies required beyond the authorized TOE of the PM assets?
After preparing a pre-deployment sampling plan review the list of items in the standard sampling kit to ensure that items
needed for planned surveillance are included.
Do the PM Detachments that will be deployed have all their required TOE and basic load of pesticides and pesticide dispersal equipment on hand to control identified pests/vectors?
See Appendix C, FM 4-25.12, Unit Field Sanitation Team, for the list of supply items for control of arthropods/rodents.
Have provisions been made to record and report pesticide use?
The requirement for recording, reporting, and archiving pesticide use during deployment is addressed in
DoDI 4150.07 (DoD Pest Management Program), and
DA PAM 40-11
External Link (Preventive Medicine)
Access the Pesticide Use Reporting and Recording page.
Have you established an account to use the Defense Occupational & Environmental Health Readiness System
If not, you can
click here for information on how to request an account to be able to use DOEHRS.
Deployment Related Training Videos: The following entomological instructional videos are prepared by the APHC, and you can find these videos on our
APHC YouTube page:
Malaria Prevention While Staying in a Malarious Area
How to Apply DEET Insect Repellent
Treating Civilian Clothing with Permethrin
Proper Use of a Bed Net with Poles Over a Cot
Safely Deploy and Secure a Pop-Up Bed Net
CDC Miniature Light Trap Setup
Performing a Tick Drag
How to Treat a Bed Net with Permethrin
Surveillance: Surveillance is the process of determining the presence of vectors and pests and estimating their general population levels. Such information is the basis for developing a risk assessment that can be used to qualitatively or quantitatively predict the occurrence of vector-borne disease or pest outbreaks. Upon arrival at the deployment site, conduct on-site entomological surveillance using the DOEHRS (Defense Occupational & Environmental Health Readiness System) Entomology Survey, Vector Surveillance Survey, and Pest Surveillance Survey forms to verify or refute the pre-deployment risk assessment. Surveillance should be ongoing, as conditions affecting risk are likely to change with weather, unanticipated changes in the mission profile taking troops into new areas, etc. There are many methods, techniques, and equipment that can be used to accomplish surveillance. The
AFPMB TG 48, Contingency Pest and Vector Surveillance (CAC required) is an excellent source for obtaining comprehensive guidance on surveillance during deployment operations.
Properly conducted surveillance of disease vectors and medical pests during deployments should answer the following:
Do vectors and medical pests in the deployment area threaten the health and morale of deployed personnel?
Determine who is at risk.
Available medical information seldom gives more than a general idea of the vector-borne disease threat in an area.
Pre-deployment risk assessment must be validated and refined on-site.
Presence or absence of a key vector, abundance of the vector, and presence of pathogen-specific antibodies in animal reservoirs or in people living in the area of operations can all provide useful information that can help assess risk and facilitate the development of targeted control programs.
Multiple surveillance techniques for immature and adult vectors should be used to accurately quantify vector abundance.
Arthropod Vector Rapid Detection (AV-RDD) kits are hand-held assays that can be used to determine whether arthropods are infected with pathogens capable of infecting deployed personnel.
Video instructions on procedures for the Malaria Detection Kit (MAL-K020), Leishmania Antigen Assay Kit (P/N LMAJ-K020), and Dengue Kit were prepared by the Walter Reed Army Institute of Research (WRAIR) and the U.S. Army Medical Materiel Development Activity (USAMMDA) staff.
These instructional videos can be accessed on the
USAMMDA YouTube site or by clicking the links below:
Introduction video for Arthropod Vector Rapid Detection (AV-RDD)
Procedures for Detecting Malaria in Mosquitoes
Procedures for Detecting Leishmaniasis in Sand Flies
Procedures for Detecting Dengue in Mosquitoes
Where (by geographical area and type of terrain) and when (by season and time of day) could vectors and medical pests occur in the area of operation?
Not all disease vectors may be present in a given area, or their occurrence may be associated with different times of day or seasons.
In addition to vector surveillance, review your area of operation (AO) disease and non-battle injury (DNBI) reports for possible cases of vector-borne illnesses.
This information is valuable in determining Soldiers compliance or non-compliance with recommended preventive medicine (PM) countermeasures.
Additional information on vector distributions can be found at VectorMap, a product of the Walter Reed Biosystematics Unit (WRBU).
VectorMap provides disease maps, and mapped collection data and distribution models for arthropod disease vector species, including mosquitoes, ticks, sand flies, mites, and fleas, as well as the hosts/reservoirs of vector-borne disease pathogens.
Command Emphasis: Command emphasis in all phases of deployment is the cornerstone of prevention. Commanders can influence the use of personal protective measures (PPM) and are responsible for implementing the theater policy on prevention of disease and DNBI during all aspects of a deployment. Unit Commanders are also responsible for implementing practices which prevent disease or injury caused by association with feral animals. Good sanitation and field hygiene as well as full implementation of PPM in deployed forces is critical to successful mitigation efforts and should be continually stressed through the chain of command.
Does the unit commander make force health protection a priority?
Preventive medicine personnel can make recommendations, but only the chain of command can enforce PPM measures.
The individual Soldier is the most important element in any combat system.
Protection of his/her health is absolutely critical to maintenance of a high state of combat readiness.
Medical advisors have the job of supporting the commander by providing sound technical advice and training in the prevention of arthropod-borne diseases.
Thus, it is imperative that DoD leaders at all levels understand and endorse the need and the use of these personal protective measures.
At the individual level, education on the safety and efficacy of DoD approved skin repellents and permethrin-treated uniforms, emphasis on proper and regular use of PPM, and availability of supplies is crucial.
Pest Control Measures: Surveillance of vectors and pests is the basis for determining what, when, and if control measures should be implemented. Vector control must never be implemented unless surveillance shows there is an actual, or potential, problem that must be prevented. Better understanding of the types and numbers of vector species in a deployed area and the diseases they transmit affords a better opportunity for their control, and ultimately a healthier force. The
AFPMB TG 24, Contingency Pest Management Guide (CAC required) is an excellent source for obtaining guidance on vector control during deployment.
Where and when pest controllers should apply control measures against vectors and pests?
Communication between the unit conducting surveillance and the organization providing control is essential for effective control.
Do implemented control measures actually control the target vectors and pests?
Post-control surveillance serves as a validation of control efforts.
Alternative control or management efforts must be considered if initial control measures fail.
Are pest management practices recorded and reported?
"Record and report all pesticide application, except arthropod skin and clothing repellent applications, according to the guidance in
DA Pam 40-11 (Preventive Medicine).
Data gathered during deployments can provide medical planners with information that can be used to shape combat health support for similar future operations and missions.
Share your entomological and zoonotic experiences for follow-on and future deployments with organizations such as:
Armed Forces Pest Management Board (AFPMB)
National Center for Medical Intelligence (NCMI) (CAC required)
Army Public Health Center (APHC)
Other entities per Combating Command (COCOM) policy and guidance.
Any changes made to the initial assessment and the Entomological and Zoonotic Operational Risk Assessment (EZORA) for the specific site(s) during the deployment and changes to Force Health Protection (FHP) countermeasures should be widely shared within and outside of the theater to appropriate organizations.
At a minimum, assess the operational risk in retrospect in comparison to your pre-deployment risk assessment, and annotate significant differences between the expected and the experienced risks.
DoD Instruction 6490.03, Deployment Health, 11 August 2006
(Certified Current as of Sep 30, 2011)
AFPMB Technical Guide 46 (TG 46), DoD Entomological Operational Risk Assessments (CAC required)
Related Public Health Command Programs