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KOREAN HEMORRHAGIC FEVER An Ever Present Danger to U.S. Forces Korea

KOREAN HEMORRHAGIC FEVER An Ever Present Danger to U.S. Forces Korea. COL (Ret) Terry A. Klein, PhD Regional Emerging Infectious Disease Consultant Force Health Protection, 18 th Medical Command 13 February 2007. Collaborators. Dr. Jin-Won Song, Korea University

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KOREAN HEMORRHAGIC FEVER An Ever Present Danger to U.S. Forces Korea

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  1. KOREAN HEMORRHAGIC FEVERAn Ever Present Danger to U.S. Forces Korea COL (Ret) Terry A. Klein, PhD Regional Emerging Infectious Disease Consultant Force Health Protection, 18th Medical Command 13 February 2007

  2. Collaborators • Dr. Jin-Won Song, Korea University • Dr. Luck-Ju Baek, Korea University • Dr. Heung-Chul Kim, 5th MED DET • LTC William Sames, 18th MEDCOM • LTC Douglas Burkett, Air Force • LTC Monica O’Guinn, USAMRIID • MAJ John Lee, USAMRIID • MAJ Anthony Schuster, CHPPM • Commanders and Personnel, MED DETS

  3. Rodent-borne Disease Surveillance • Purpose: Reduce the impact of rodent-borne diseases • Background: >400 cases of HFRS annually • Problem: Rodent-borne diseases often “epidemic”. • Benefits: Increase “early warning” potential • Surveillance: HFRS, murine typhus, scrub typhus, and leptospirosis • Environmental modifications: Affects population and disease potential of emerging infectious diseases

  4. Introduction • Hantaviruses are worldwide • HFRS (KHF) is a viral disease • Maintained by rodent reservoirs • Ranges in severity from mild to fatal • Prevention is the best measure • If prevention fails, requires rapid treatment/supportive care (ribovirin) • Risks related to occupation and behavior • No US approved vaccine

  5. HFRS Transmission • Respiratory via aerosolized rodent secreta/excreta (3 - 8% mortality) • No horizontal human to human transmission • 2,422 US cases during Korean war • Prevention requires good field sanitation • Early supportive treatment required

  6. Number of Korean Hemorrhagic FeverCases in ROK Personnel, 1986 - 2006

  7. Number of HFRS Cases in USFK Personnel*, 1986 – 2005 Number of Reported Cases # Year * USFK includes US soldiers and KATUSAs; #One case during 2001 due to Seoul virus contracted at Yongsan Garrison

  8. HFRS Patients by Area, 2005 KHF Patients by Area, ROK Military

  9. Rodents & Hantaviruses of Korea Apodemus agrarius Rattus norvegicus Figure 2. Rattus norvegicus, the primary reservoir of Seoul virus Figure 1. Apodemus agrarius, the primary reservoir of Hantaan virus Apodemus peninsulae Figure 3. A. peninsulae, primary reservoir of Soochong virus

  10. Rodent-borne disease surveillance at selected US military training sites near the DMZ, 2000 - 2006 1 2 North Korea 1 1 South Korea 1 2 2 HFRS Risk High Risk Moderate Risk Low Risk HFRS Cases 1

  11. Rodent-borne disease surveillance at Dagmar North Training Area A B D C (A) Overview of training site. (B) Rice paddies associated with tall grasses bordering training area. (C) Road leading through a “tank trap” to the main training area (A). (D). Tall grassy intermittent stream bed.

  12. Early Summer Spring Winter Early Fall Changing Seasons, FP-60 Early Fall

  13. Habitat Modification, FP-60

  14. Number of Small Mammals Captured Near the DMZ, 2001 – 2005

  15. Table 1. Summary of patient histories for four patients that acquired HFRS infections while training at US and ROK operated military training sites near the DMZ. Patient # 1 # 2 # 3 # 4 Onset of 5 Oct 3 Nov 6 Nov 12 Nov Symptoms Training 20-29 Sep 8-21 Oct 8-15 Oct 8-21 Oct Dates Training LTA 320, 36, 37 Twin Bridges Twin Bridges Twin Bridges Sites FP 60 Rodriguez Rodriguez Watkins Watkins Incubation 27 – 36 Days 26 – 39 Days 29 – 35 Days 35 – 48 Days Period Virus FP 60 Twin Bridges Twin Bridges Twin Bridges Match South North South

  16. HTN/04-182 FP60 63 HTN/04-618 FP60 HTN/04-1293 FP60 HTN/04-1332 FP60 HTN/04-1282 FP60 HTN/04-1325 FP60 USFK patient #1 HTN/05-1459 TB HTN/05-1465 TB NJ Tree based on 281-bps nucleotides of G2-M segment of HTNV from USFK HFRS patient #1-4, 2005 USFK patient #3 HTN/05-1410 TB HTN/05-1411 TB HTN/05-1437 TB USFK patient #2 USFK patient #4 HTN/YJ89-13 HTN/05-1438 TB 60 HTN/05-1458 TB HTN/05-1439 TB HTN/04-1257 FP10 HTN/01-425 FP10 HTN/01-431 FP10 HTN/01-542FP10 HTN/02-185FP10 HTN/WC98-181 HTN/HC97-91 HTN/YC98-44 76 HTN/IJ97-100 HTN/HoJo HTN/LEE 100 HTN/PC89-43 HTN/JH96-25 100 HTN/SN94-2 HTN/76-118 HTN/NS94-20 100 100 HTN/Jiang13 China HTN/Bao9 China HTN/AA1028 Russia 89 SOO/SOO-1 SOO/SOO-3 DOB SEO/80-39 0.01 substitutions/site FP60 TBTA-N TBTA-S FP10 Figure 10. NJ Tree based on 281-bps nucleotides of the G2-M segment of the HTNV from USFK HFRS Patients 1-4, 2005.

  17. Firing Point 60, Rodent Habitat/Activities

  18. Firing Point 60, Rodent Habitat/Activities Primary Rodent Trapping Lines

  19. Patient # 3-05 Patients # 2-05 and # 4-05

  20. Twin Bridges TA – Rodent Habitat Rodent Foraging and Migration Virus Laden Rodent Feces Fighting Position Potential Infected Dust Dirt Road Adjacent to Fighting Positions Virus Laden Rodent Feces

  21. Twin Bridges TA – Rodent Habitat Rodent Activity Dirt Road Training Site

  22. Fig. 12. Dust created by wheeled vehicles along a dirt road and tracked vehicles at barren training site associated with tall grass habitats. Fig. 13. Wetting down dirt roads to reduce dust. Fig. 14. Discarding of refuse adjacent to primary rodent habitat (tall grasses).

  23. Dagmar North

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