Citation
U.S. Army Medical Department journal

Material Information

Title:
U.S. Army Medical Department journal
Alternate title:
United States Army Medical Department journal
Alternate Title:
AMEDD journal
Running title:
Army Medical Department journal
Abbreviated Title:
U.S. Army Med. Dep. j.
Creator:
United States -- Army Medical Department (1968- )
Place of Publication:
Fort Sam Houston, TX
Publisher:
U.S. Army Medical Department
Publication Date:
Frequency:
Quarterly[<Oct.-Dec. 2001->]
Bimonthly[ FORMER Sept.-Oct. 1994-]
quarterly
regular
Language:
English
Physical Description:
volumes : illustrations ; 28 cm

Subjects

Subjects / Keywords:
Medicine, Military -- Periodicals -- United States ( lcsh )
Military Medicine ( mesh )
Medicine ( mesh )
Medicine, Military ( fast )
United States ( mesh )
United States ( fast )
United States
Genre:
Electronic journals.
Periodicals.
Periodicals. ( fast )
Fulltext.
Government Publications, Federal.
Internet Resources.
serial ( sobekcm )
federal government publication ( marcgt )
periodical ( marcgt )
Electronic journals ( lcsh )
Periodicals ( mesh )
Periodicals ( fast )
Fulltext
Government Publications, Federal
Periodicals
Internet Resources

Notes

Dates or Sequential Designation:
Sept.-Oct. 1994-
General Note:
Title from cover.

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
This item is a work of the U.S. federal government and not subject to copyright pursuant to 17 U.S.C. §105.
Resource Identifier:
32785416 ( OCLC )
98642403 ( LCCN )
1524-0436 ( ISSN )
ocm32785416
Classification:
RC970 .U53 ( lcc )
616.9/8023/05 ( ddc )
W1 JO96 ( nlm )

Related Items

Preceded by:
Journal of the US Army Medical Department.

UFDC Membership

Aggregations:
Digital Military Collection

Downloads

This item is only available as the following downloads:


Full Text

PAGE 1

JulySeptember2007Perspective1MGRussellJ.CzerwHealthyAnimals,HealthyPeople:InextricablyLinked4BGMichaelB.CatesEmergingRolesoftheUSArmyVeterinaryService8COLGaryVroegindewey,VC,USAArmyVeterinaryFoodAnalysisLaboratories:Past,Present,andFuture12MAJScottHanna,VC,USA;etalTheImpactofLeishmaniasisonMilitaryWorkingDogswithMediterraneanBasinExposure17MAJJerrodW.Killian,VC,USATheHiddenWorkofaLaboratoryAnimalVeterinarian26MAJCraigA.Koeller,VC,USAChallengesinBiodefenseResearchandtheRoleofUSArmyVeterinaryPathologists28COLKeithE.Steele,VC,USA;MAJDerronA.Alves,VC,USA;MAJJenniferL.Chapman,VC,USAAVeterinaryComparativeMedicineOfficersDreamAssignment38MAJSamYingst,VC,USACanineHipDysplasia:SurgicalTreatmentfortheMilitaryWorkingDog44CPTKentJ.Vince,VC,USAAClinicalTrialofIvermectinAgainstEyewormsinGermanShepherdMilitaryWorkingDogs51COLMackFudge,VC,USA;LTCSookwanJeong,VC,ROKA;PatMcInturff,DVM,PhDUsingPredictiveMicrobiologytoEvaluateRiskandReduceEconomicLosses57AssociatedwithRawMeatsandPoultryExposedtoTemperatureAbuseCW3GregM.Burnham,VC,USA;etalTheUSArmyVeterinaryCorpsReserveComponent66CPT(P)CristopherA.Young,VC,USASpecialOperationsForcesVeterinaryPersonnel69COLRobertVogelsang,VC,USAStabilizationAndReconstructionOperations:TheRoleOfTheUSArmyVeterinaryCorps71LTCJohnC.Smith,VC,USAUNITEDSTATESARMYVETERINARYCORPS

PAGE 2

MGGaleS.Pollock ActingTheSurgeonGeneral Commander,USArmyMedicalCommandMGRussellJ.CzerwCommandingGeneral USArmyMedicalDepartmentCenterandSchool JulySeptember2007 TheArmyMedicalDepartmentCenter&School PB8-07-7/8/9 0716302 GEORGEW.CASEY,JR General,UnitedStatesArmy ChiefofStaff DISTRIBUTION:Special AdministrativeAssistanttothe SecretaryoftheArmy ByOrderoftheSecretaryoftheArmy: Official: JOYCEE.MORROW Onlineissuesofthe AMEDDJournal areavailableathttps://secure-akm.amedd.army.mil/dasqaDocuments.aspx?type=1 AProfessionalPublication oftheAMEDDCommunity The ArmyMedicalDepartmentJournal [ISSN1524-0436]ispublishedquarterlyfor TheSurgeonGeneralbytheUSArmyMedicalDepartmentCenter&School,ATTN: MCCS-DT,2423FSH-HoodST,FortSamHouston,TX78234-5078. CORRESPONDENCE: Manuscripts,photographs,officialunitrequeststoreceive copies,andunitaddresschangesordeletionsshouldbesenttothe Journal atthe aboveaddress.Telephone:(210)221-6301,DSN471-6301 DISCLAIMER: The Journal presentsclinicalandnonclinicalprofessionalinformation toexpandknowledgeofdomestic&internationalmilitarymedicalissuesand technologicaladvances;promotecollaborativepartnershipsamongServices, components,Corps,andspecialties;conveyclinicalandhealthservicesupport information;andprovideapeer-reviewed,highquality,printmediumtoencourage dialogueconcerninghealthcareinitiatives. Viewsexpressedarethoseoftheauthor(s)anddonotnecessarilyreflectofficialUS ArmyorUSArmyMedicalDepartmentpositions,nordoesthecontentchangeor supersedeinformationinotherArmyPublications.The Journal reservestherighttoedit allmaterialsubmittedforpublication(seeinsidebackcover). CONTENT: Contentofthispublicationisnotcopyrightprotected.Materialmaybe reprintedifcreditisgiventotheauthor(s). OFFICIALDISTRIBUTION: ThispublicationistargetedtoUSArmyMedical Departmentunitsandorganizations,andothermembersofthemedicalcommunity worldwide.

PAGE 3

JulySeptember20071TheUSArmyVeterinaryCorpsisthecenterpieceofthismonthsissueoftheAMEDDJournal.AlthoughthemajorityofourSoldiersandFamilymembersdonotoftencomeintodirectcontactwithArmyveterinaryspecialists,membersoftheveterinaryservicearepartandparcelofallofourdailylives.Eachdaytheycanbefoundworkinginthefieldandlaboratoriesinfoodscienceandfooddefense,performingresearchoncommunicablediseasesandbiologicalweapons,orensuringthehealthofthemilitaryworkingdogswhichhavelongbeenvitalcontributorstofrontlinecombatoperations.Manyreaderswillnodoubtbesurprisedtolearnoftheextensivevarietyofskillsandresponsibilities,andthehighlevelsofqualificationsandeducationthataretypicalamongourveterinaryprofessionals.ThisissueoftheAMEDDJournalprovidesauniqueandlongoverduelookintotheachievementstheseprofessionalshavemadeovertheyears,andtheircontinuedinvaluablecontributionstothehealthandwell-beingofusall.Inthisissue,theAMEDDJournalwelcomesbackBGMichaelCates,thistimefromhisperspectiveasChief,ArmyVeterinaryCorps.BGCatessetsthestageforthisissueasheclearlyandsuccinctlydescribestheundeniablelinksbetweenhumanhealthandthehealthoftheanimalsthatsurroundus.Indeed,atnotimeinhistoryhavetheinterrelationshipsofveterinaryandhumanmedicalsciencesbeensowellunderstood,andtheextentofthatknowledgeiscontinuallyexpanding.ThefactthattheArmyVeterinaryCorpsisanintegralcomponentoftheArmyMedicalDepartment,andhasbeenfor91years,isaconfirmationofthisrelationshipbetweenthedisciplines.BGCatesarticleisanexcellentoverviewoftherolesArmyveterinaryspecialistsplay,notonlyinsupportofUSmilitarymissions,butonthelargerstageofUSforeignpolicyeffortstostabilizeourturbulentworld.Understandably,themilitaryisanorganizationthatisinconstantevolutionasitadaptstochangesdictatedbysocietyandtechnology,whileatthesametimecontendingwiththedynamicnatureofpotentialandactivethreatstotheUnitedStates.Notsurprisingly,theArmyVeterinaryCorpsresponsibilitiesarealsochanginginconcertwiththosedemands.Inhisconcise,informativearticle,COLGaryVroegindeweyprovidesacleardescriptionofnotonlytheemergingroles,butalsotheexpansionofcurrentdutiesthatArmyveterinarypersonnelareperforminginsupportoftheGlobalWaronTerroreffortsoftoday.Theworkofveterinarypreventivemedicinespecialistsisfeaturedin2articles.Intheircontribution,MAJScottHannaandhiscoauthorspresentaninterestinghistoryoftheArmysfoodanalysislaboratoriesandtheiroperationstoday.TheydescribehowthoselaboratorieshavechangedfromaQuartermasterCorpsfunctionforcontractcomplianceandqualitycontrol,totheircurrentpositionaskeystonesintheVeterinaryCorpsforceprotectionroleoffoodsafetyandfooddefense.Theincreasingsophisticationandformalizationoftestingpracticesandtechniques,andthequickincorporationofemergingtechnologiesaremoreexamplesoftheCorpsadaptationstotheever-changingthreatstoournationalsecurity.Next,MAJJerrodKilliandescribesaresearchprojectfocusedonaserious,difficult-to-treatdiseasewhichistransmittabletobothhumansanddogs.LeishmaniasisisendemicinalargepartofsouthernEuropeandthemiddleeast,areaswheretheUSmilitarydeployslargenumbersofmilitaryworkingdogs.MAJKillianinvestigatesthepotentialforthediseasetobetranslocatedtootherPerspectiveMajorGeneralRussellJ.Czerw

PAGE 4

2ArmyMedicalDepartmentJournalPerspectiveregions,especiallytheUnitedStates,whereitisnotcurrentlyaseriousthreat.ThistypeofinvestigativeworkbyourArmyveterinariansisintensive,detailed,andabsolutelyvitalinthemanagementofdiseasesamongourincreasinglymobileglobalpopulations.Theuseoflaboratoryanimalsinmedicalresearchiswellunderstoodasessentialandinvaluable.Lesswellknownisthevitallyimportantuseofanimalsinthetrainingofmedicalpersonnel.MAJCraigKoellersarticleprovidesinsighttothatelementoftraining,whichwouldnotbepossiblewithouttheArmyveterinarian.Hesuccinctlydescribestheprotocolsandproceduresthatmustbefollowedduringtheplanningandconductofanytraininginwhichlaboratoryanimalsareused,andtheveterinariansresponsibilitiesinensuringstrictcomplianceineveryphaseofthatprocess.Theveterinarianssupportofthisindispensabletrainingcontributesdirectlytohumanlivessavedinthefuture.Armyveterinarypathologistsarehighly-trainedprofessionalschargedwiththeresponsibilitiesofsomeofthemostdemandingandpotentiallyhazardousareasoftheDefenseDepartmentsbiomedicalresearchefforts.COLKeithSteeleandhiscoauthorshavecontributedacomprehensive,importantarticledescribingthiscriticalsectorofArmyveterinarymedicine.Indeed,thetoolsandtechnologyforbiologicalwarfareareveryhighonterroristwant-listsandrepresentarealandpresentdangertoallmankind.ThearticleshowshowVeterinaryCorpsexpertshavelongbeenonthefrontlinesofthisverydangerous,albeitlargelyunrecognizedtheateroftheGlobalWaronTerror.Fortunately,Armyveterinarypathologistsarehardatworkeverydayinthisdomainwhichisincreasinglyvitaltoournationaldefense.VeterinarianCorpsprofessionalsareoftenfoundinseeminglyunlikelylocations.MAJSamYingstisoneofthose,andhedescribeshisworkasacomparativeveterinarymedicineofficerattheUSNavalMedicalResearchUnitNo.3inCairo,Egypt,astrulyadreamassignment.Hisworkfocusesoninfluenza,oneofthemostmobileandthereforepotentiallythreateningformsofdiseaseintodayshighlymobilepopulations.Influenzadiseaseshavebeenresponsibleforthemostextensiveanddeadlypandemicsinhistory.Theyareeasilycommunicableamongpeople,andassuchrepresentaconstantthreat,eitherasnaturallyoccurring,constantlymutating,rapidlyspreadingdiseases,orasbioengineeredweapons.MAJYingstsarticleisafascinatinglookatthediverse,dynamic,andrewardingworkthatnotonlyrequireskeenscientificandanalyticskills,butalsomandatesaglobalperspectiveandtheabilitytoworkwithmultiple,geographicallyandpoliticallydiverseagenciesandindividuals.Veterinarianswerefirstbroughtintomilitaryservicetocareforthenumerouslargeanimalsrequiredforarmiestomoveandsurviveduringcampaigns:draftandcavalryhorses,andcattle.Astechnologicalprogressgraduallyeliminatedtherequirementforthoseanimals,anotheranimalbecameindispensableforUSforcesthemilitaryworkingdog.Therefore,amongthemyriadotherresponsibilitiesoftheVeterinaryCorps,veterinaryclinicalmedicineremainsaprimaryfunction,andprobablytheonemostfamiliartothegeneralmilitarypopulation.Twoarticlesdiscussdifferentaspectsofcareoftheseinvaluabledogs.CPTKentVinceexploreshipdysplasia,achronicproblemthatplaguesseveralbreedsoflargedogspreferredformilitaryservice.Hisdetailedarticledescribestheadvancesindetection,diagnosis,andtreatments,especiallytheincreasinglysuccessfulsurgicalrepairsofthehipjoint.Theextensionofthemilitarydogsworkinglifemadepossiblebythesurgeryisoftremendousvalue,bothintermsofthequickreturnofanexperienceddogtoservice,andeliminationoftheexpenseofobtaining,training,andfieldingareplacementanimal.Inthefollowingarticle,COLMackFudgeandhiscoauthorsdescribeanefforttoassistaUSally,theRepublicofKorea,indealingwithamedicalproblemthatafflictstheirmilitaryworkingdogpopulation.Eyeworminfestationiswidespreadwithintheirdogpopulation,andgraduallyreducestheirmilitaryusefulness.Thearticledetailsaclassicclinicaltrialoftheeffectivenessofadrugwhichhadbeenusedforotheranimalspeciesbuthadnotbeenevaluatedinacontrolledstudyfordogs.ThisisanotherexampleoftheinitiativeanddedicationofArmyveterinaryspecialistswhocontinuetoadvancetheartandscienceoftheirprofession,bothathomeandabroad.CW3GreggBurnham,aVeterinaryCorpsFoodSafetyOfficer,andateamofhighlyskilleduniversityresearchersinvestigatedtheactualriskassociatedwithrawmeatwhichhadbeensubjectedtotemperature

PAGE 5

JulySeptember20073 abuseinstorage.Thisscientificallyrigorous,complexstudytoaccuratelyquantifythatrisktoconsumershasthepotentialtosignificantlyreducecostsofDefenseDepartmentmeatprocurementanddistribution.Further,suchresearchshouldinspirefurtherinvestigationswithinthefoodsafetycommunity,bothmilitaryandcivilian.CW3Burnhametalpresenttheirresearchinandetailed,clearlypresented,andveryinformativearticlewhichdemonstratesyetanotherwayinwhichArmyveterinaryscienceisbenefitingsocietyasawhole.Inhisarticle,CPTCristopherYoungremindsusthattheArmyVeterinaryCorpsiswellrepresentedintheReserveComponent.Theexperience,qualifications,talent,andcertificationstheseprofessionalsbringintotheArmyarevitallyimportantfactorsinsustainingtheforcereadinesssoimportantintodaysextremelyfluidmobilizationenvironment.CPTYoungsenlighteningarticleisatestimonytotheselflessdedicationtoservicethatisthehallmarkofArmyReservists.ThetruejacksofalltradesintheArmyVeterinaryCorpsarethoseveterinarianswhoserveinSpecialOperationsForcesunits.COLRobertVogelsangprovidesuswithasnapshotlookatwheretheyworkandwhattheydo.Hisarticledescribesthedynamicnatureandoftenspartanconditionsoftheiroperationalenvironment,andhowtheirresourcefulnessandflexibilityarecriticalinmissionsuccessoftheirunits.LTCJohnSmithclosesthisissueoftheAMEDDJournalwithanexcellent,big-picturediscussionofthevitallyimportantroleArmyveterinaryspecialistscananddoplayinsupportofUSglobaleffortstoimprovestabilizationoffailedandfailingeconomies.Instabilityinregionalandnationalsocietiesandinstitutionsattractthoseinterestedinfosteringcalamityandsworntothedestructionofwesterncivilization.Weakstatesarefertilebreedinggroundsforrecruitmentandtrainingofinsurgentsandterroristorganizers.LTCSmithsarticleisacarefullyresearched,veryunderstandablepresentationofthesituationsandconditionswhichcauseandsustainstateinstability,theanalysisofthesocietaldynamicswhichmustbeaddressed,andtheroleoftheArmyveterinarianinUSeffortstoreconstructthoseeconomiesandsocieties.Thisisanimportantlookatboththepresentandthefutureofglobalsecurity,amustreadforallofusdedicatedtothepreservationoffreedomandourwayoflife.COLDEBBOUNJOINSTHEAMEDDJOURNALEDITORIALREVIEWBOARDTheAMEDDJournalwelcomesCOLMustaphaDebboun,MS,USA,asamemberoftheEditorialReviewBoard.COLDebbounistheChief,MedicalZoologyBranch,AcademyofHealthSciences,AMEDDCenter&School,FortSamHouston,Texas.COLDebbounjoinstheboardreplacingCOLGeorgeL.Adams,MS,USA,whohasbeenamemberoftheboardsinceApril,2006.WethankCOLAdamsforhisdedicationtothehighstandardsandprofessionalqualityofthispublication,andhisyearsofserviceandsupporttothemissionoftheJournal.TheEditors

PAGE 6

4ArmyMedicalDepartmentJournalDogsanddolphins,monkeysandcats,horsesandmules,rabbits,rodents,reptiles,andhumansmultiplespecies,andallarepartofthefocusedmissionoftheUSArmyVeterinaryCorps.Forover91years,officersinourCorps,alongwithsupportpersonnel,havebeenanintegralpartoftheArmyMedicalDepartment,makingcriticalglobalcontributionstowardthehealthofanimals,aswellasthehealthofSoldiers,Familymembers,andothers.TheUSArmyVeterinaryCorpswasformedin1916atatimewhenourcountrywasjustbeginningtocomprehendtherelationshipbetweenanimalandhumanhealth.Wenowknowthatthosetiesaretremendous.Withextraordinaryversatilityandvigilance,ourrelativelysmallveterinaryteamof3500totalpersonnelhascontinueditsquestoftheArmyversionofOneMedicine,OneHealth.ONEMEDICINE,ONEHEALTHToday,ournationsmedicalandveterinaryprofessionsareworkingcloselytogetherinaresurgenceofwhatwecallOneMedicineorOneHealth,thatis,therecognitionandappreciationforthelinkagebetweenhumanandanimalhealth.TheAmericanVeterinaryMedicalAssociationandtheAmericanMedicalAssociationhavebothtakenformalstepstowardbettercollaborationandpartnerships,andveterinariansandphysiciansacrosstheentirespectrumoftheirprofessionsinacademia,privatepractice,governmentagencies,andmanyotheraspectshavejoinedthem.The19thCenturyGermanphysicianandpathologistRudolphVirchowwasoneofthefirstmedicalprofessionalstoconnectanimalandhumanhealth,stating:Betweenanimalandhumanmedicinethereisnodividingline,norshouldtherebe.Theobjectisdifferentbuttheexperienceobtainedconstitutesthebasisofallmedicine.1(piii)DrCalvinSchwabe,aveterinarianandepidemiologist,andaprofessoratmedicalandveterinarymedicalcolleges,agreed,writing:Impactsonhumanhealtharewhatmostclearlydelimitveterinarymedicinesworldviewandbestdefineitsbroadlymanifestedimportanceasaprofession.1(pp1-2)ThisconceptofOneMedicine,OneHealthisembracedbytheUSArmyMedicalDepartment,andtheVeterinaryCorpsisthecornerstoneofitsefforts.HEALTHYANIMALSWhenmostpeoplethinkofveterinaryservices,theythinkoftheactualhealthcareforanimals.And,ofcourse,therootsofmilitaryveterinarymedicinewereinanimalcare,beginningin1776,whenGeneralWashingtondemandedafarrierforaregimentofhorses.DuringtheWarBetweentheStates,therequirementforadequatehorsehealthcontinued,andtheWarDepartmentprovidedeachcavalryregimentwithaveterinarysurgeon.Later,congressrequiredHealthyAnimals,HealthyPeople:InextricablyLinkedBrigadierGeneralMichaelB.Cates BGCatesistheChief,ArmyVeterinaryCorps;theCommandingGeneral,USArmyCenterforHealthPromotionandPreventiveMedicine;andtheFunctionalProponent,USArmyPreventiveMedicine.

PAGE 7

JulySeptember20075thateveryapplicantforthesepositionsbegraduatesofarecognizedveterinarycollege.AftertheVeterinaryCorpsinception,withpassageoftheNationalDefenseActof1916,equinemedicineandsurgerywasamajoraspectofourmission.ThroughthemanywarssinceWorldWarI,theuseofanimalsinthemilitaryhasevolved,andwithit,sohasthehealthcareofthoseanimals.Today,mostofwhatareusuallyconsideredmilitaryworkinganimalsarespecialtytraineddogs(eg,explosivedetection,minedetection,narcoticdetection,andpatroldogs),allhelpingourentireDepartmentofDefensewithforceprotectionaroundtheglobe.Veterinarypersonnelprovidemedicalandsurgicalcaretothosemilitaryworkingdogswhereverandwheneverneeded.OurCorpsalsoprovideshealthcaretohorses,mules,marinemammals,serviceanimals,andallanimalsinvolvedwithmilitarybiomedicalresearch.These,whencombinedwithpetsofmilitarypersonnel,totalover750,000,similartothenumberofactivedutySoldiersandCivilianemployeesoftheentireUSArmy.Anadditional,invaluableVeterinaryCorpsmission,morereadilyvisibleinrecentyears,isanimalcareforhostnationcountriesnormallyreferredtoascivilaffairsorhumanitarianassistance.Duringthesedeployments,veterinarysupportpersonnelprovideclinicalandpreventiveveterinarycaretolivestockandotheranimalsofthenativepeopleinAfghanistan,Iraq,Nicaragua,Africancountries,andthePhilippines,forexample.Wenotonlyimprovethehealthoftheanimals,butalsodirectlyimpactthequalityoflifeforthefamiliesand,manytimes,theeconomiesofthosecountries.TheneedforveterinarypersonnelintheUSmilitarybeganwithanimalhealthcarerequirements,anditremainsrelevantevenintodaysworld.Whilethediversityofanimals,aswellastheiruseinourmilitary,haschangedovertime,theirhealthisanessentialpartofmilitarymedicine.HEALTHYPEOPLEShortfallsinSoldierhealthduringtheSpanishAmericanWarwerepivotalintheevolutionarypathwayleadingtoestablishmentoftheVeterinaryCorpsbeforeWorldWarI.Afterthousandsofallegedunnecessarycasualtiesduetopreventableillnesses,thecountrydemandedthatsomethingbedonetoprecludesuchcatastrophesinthefuture.ThetimingcoincidedwithwideracceptanceofVirchowsviewsofanimalandhumanlinks,andveterinarianswerepartofthesolution.Over60%ofdiseasepathogensand75%oftheemerginghumanpathogensarezoonotic,thatis,transmissiblebetweenanimalsandhumans.TheSevereAcuteRespiratorySyndrome(SARS)outbreak,thecontinuingHumanImmunodeficiencyVirus(HIV)epidemicandpastinfluenzapandemicsalloriginatedinnonhumanspecies.Foodandwater-borneillnessesapproximateatotalof76millioncasesannuallyintheUnitedStates,andmanycanbetracedtoanimalorigins.Thisisespeciallytruewhenthefoodcommoditiesareanimalby-products,suchasmilk,meat,andeggs.ProtectingthefoodofdeployedSoldiers,Sailors,Airmen,andMarinesisakeymissionfortheVeterinaryService,whosemembersaredeployedalongwiththeseforces.BovineSpongiformEncephalopathy,ormadcowdisease,thespinachrecallduetopathogenicE.coli,andtheintentionalmelaminecontaminationofpetfoodarejustafewexampleswhichillustratethenecessityofhavingrobustfoodsafetyanddefenseprogramstomitigatetheincreasedriskspresentedthroughconsolidatedfoodmanufacturingsystemsandtheglobalizationoffoodproductdistribution.Veterinariansareuniquelyqualifiedtoprovideexpertiseincombatingsuchoutbreaks,notonlybecauseofourtraininginzoonoses,butalsobecauseofourherdhealthunderstandingandoursystemicapproachestodiseasepreventionandcontrol.Toaccomplishthis,ArmyVeterinaryServicepersonnelauditseveralthousandfoodproducersinmorethan80countriesannually,toensuresafefoodforservicemembersandbeneficiaries.AnexampleofthebenefittothecombatcommanderwasVeterinaryServiceapprovaloflocallyownedbottledwaterplantsinAfghanistanatasavingsofmorethan$38millionperyearandtheeliminationofover4,000water-deliverytripsfromsupplyroutes,decreasingdriverexposuretoimprovisedexplosivedevices.Thesewaterplantsarenowpartoftheapprovedsourceauditprogramwhichislinkedwithothergovernmentfoodsafetyprogramstoshareinformation,protectingservicemembersandcontributingtothenationsfoodsafety.Oneothersignificantexampleofzoonoses,withnationalandinternationalprominence,isAvianInfluenza.Armyveterinarianshaveactively

PAGE 8

6ArmyMedicalDepartmentJournalcontributedtomilitaryandinteragencyplanningprocesses.WehaveparticipatedindevelopingtheUSDepartmentofAgriculture(USDA)AvianInfluenzaPlaybookinsupportoftheNationalResponsePlan,assignedVeterinaryCorpsOfficerstotheJointTaskForce-CivilSupport,developedacapacitytorespond,initiatedtrainingandequipmentrequirementstosupporttheleadfederalagency,andhostedinteragencyAvianInfluenzasurveillanceandresponseconferences.VeterinarypersonnelarecurrentlyanessentialpieceofoverseasAvianInfluenzatestingandsurveillanceprograms.Inaddition,wehavetrainedover150veterinariansintheDepartmentofHomelandSecurityPlumIslandForeignAnimalDiseaseDiagnosticiansCoursetosupportcombatcommandersinthefield,aswellastheUSDAathome.ThiscapacitytorespondtonaturaloragroterrorismemergencyeventswasdemonstratedbythedeploymentofveterinarypersonneltosupporttheUSDAduringthe2002AvianInfluenzaoutbreakinVirginiaandPennsylvania.VeterinaryServicesalsoconductsprogramstodetect,preventandcontrolotherzoonoticdiseases,suchascertainparasiticinfectionsandrabiesinpetsofmilitarypersonnel,aswellasgovernment-ownedanimals.Giventhecloseassociationofownerswiththeirpetsandhandlerswiththeirmilitaryworkinganimals,suchprogramsareessentialintheprotectionofthehealthofall.Thephysiologicalandpsychologicalbenefitstohumansfromanimalsarenotcompletelyunderstood,butthehuman-animalbondissostrongthatitsometimestranscendscomprehension.Examplestyingmentalandphysicalwellbeingofhumanstotheirassociationwithanimalsabound,inourcountryandHealthyAnimals,HealthyPeople:InextricablyLinked

PAGE 9

JulySeptember20077abroad,incivilianaswellasmilitarypopulations.Katrinavictimsrefusedtoleavetheirhomeswithoutanimals,andmilitarynoncombatantevacuationshavestalleduntilpetscouldgotoo.AnimalassistedtherapyandvisitationanimalsareimportantaspectsoftheWarriorsinTransitionprogram,inadditiontoinpatientprogramsintheVeteransAdministrationandDepartmentofDefense.Petsareconsideredimportant,inseparablepartsofthefamily,andmascotsarealmostalwaysdesiredamongdeployedunits.Again,veterinarypersonnelpositivelyimpactbothanimalhealthandhumanhealththroughtheirsupport.VeterinaryServicecontributionstomilitarymedicineextendpastfoodsafety,animalmedicine,andzoonoticdiseasecontrolprograms.Approximately30%ofVeterinaryCorpsOfficersarespecialtytrainedinlaboratoryanimalmedicine,veterinarypathology,orveterinarycomparativemedicine,andassignedtoresearchanddevelopmentpositions.Theircontributionsinpreventionspanawidespectrumofactivities,fromdevelopingnew-generationsmallpoxvaccinestomalariavaccinesandprophylaxes,andevaluatingFutureCombatSystemsforSoldiersafety,fromwhichthederivedbenefitsextendfromtheDepartmentofDefensetothenationtotheworld.INEXTRICABLELINKVeterinaryCorpsparticipationinallofournationsconflictssinceWorldWarIhasbeenanessentialelementinthemaintenanceofthehealthandwellbeingofbothanimalsandSoldiers.Thehighlytechnicaleducationobtainedbyveterinarianshascontinuedtopreparethemfortheirchangingmissionrequirementsoverthepast91years,andweareuniquelyqualifiedtocontributeandleadinfutureefforts.AccordingtoZahn,Kaplan,andSteele,strategiesrelatedtoOneMedicine,OneHealthmustspantheentirespectrumofveterinaryandmedicaleducation,clinicalcare,publichealthandbiomedicalresearch.2Since1980,theArmyhasbeentheDepartmentofDefenseExecutiveAgentforVeterinaryServices,providingveterinarysupporttoallservices,anytime,anyplace.Ourveterinarymissions,dictatedinDepartmentofDefenseDirective6400.43foodsafetyanddefense,animalmedicine,zoonoticdiseasepreventionandcontrol,andmedicalresearchandtrainingsupporthavebeenandcontinuetobeinextricablylinkedtomilitaryhumanmedicine.Composedof7areasofconcentration,theVeterinaryCorpshasover750veterinariansandwarrantofficers,andourentireveterinaryteamincludesenlistedandcivilianemployees;activeduty,reservecomponent,andArmyNationalGuard;inTableofOrganizationandEquipment*andTableofDistributionandAllowancesorganizations.Recenteventsinthenationalandinternationalfoodsafetyandzoonoticdiseasearenasunderscorethecriticalityofcontinuingandevenbuildingenhancedveterinarycapabilities.IamveryproudthatthiseditionoftheAMEDDJournalshowcasesexamplesofthebreadthanddepthofexpertise,capabilities,andsupportmissionsoftodaysArmyVeterinaryCorps.Itisanhonortobeapartofthisextraordinaryteam,aswecontinuetoworkdiligently,withothermembersoftheArmymedicalteam,towardhealthieranimalsandhealthierpeople. *Definesthestructureandequipmentforamilitaryorganizationorunit.Prescribestheorganizationalstructure,personnelandequipmentauthorizations,andrequirementsofamilitaryunittoperformaspecificmissionforwhichthereisnoappropriatetableoforganizationandequipmentREFERENCES 1.SchwabeCW.VeterinaryMedicineandHumanHealth.3rded.Baltimore,MD:WilliamsandWilkins;1984.2.KahnLH,KaplanB,SteeleJH.Confrontingzoonosesthroughclearcollaborationbetweenmedicineandveterinarymedicine(asonemedicine).VetItal.2007;43(1):5-19.3.DepartmentofDefenseDirective6400.4,DoDVeterinaryServicesProgram.Washington,DC:USDeptofDefense;August22,2003.

PAGE 10

8ArmyMedicalDepartmentJournalSince1916theUSArmyVeterinaryServicehasprovidedsupporttothewarfighterthroughensuringthesafetyofthemilitaryfoodsuppliesandprovidingcareforgovernment-ownedanimals.Thesearehistoricandenduringcorefunctionsthatarecriticaltomissionsuccessofourfightingforcesworldwide.Infact,theArmyistheExecutiveAgentfortheprovisionofveterinarymedicalcareandservicesthroughouttheDepartmentofDefense(DoD).TheSurgeonGeneralhasdelegatedthatresponsibilitydirectlytotheArmyVeterinaryService.Inthatrole,theimportanceofmedicalresearchanddevelopmentcannotbeoverstated.Itisoneofthe3missionpillarssupportingtheoverarchinggoalofForceHealthProtectionofallUSmilitarypersonnelandbeneficiaries,andhasbeenaddedasaprimaryroleoftheVeterinaryService.Inaddition,recentnationalandglobaleventshavebothrefinedtheVeterinaryServicesoldermissionsandexpandeditsroleintonewareas.Thenewareasincludediseasesurveillance;homelanddefense;disasterresponse;fooddefense;andsecurity,stabilization,transition,andreconstructionoperations.DISEASESURVEILLANCEHistorically,diseasesurveillancehasbeenapassivesystemofreportingtheincidenceofspecificdiseasesastheyoccur.Over60%ofallinfectiousdiseasesand75%ofemergingdiseasesarezoonotic,thosediseasespassedtohumansfromanimalsandanimalvectors.Threeeventstriggeredtherecognitionfortheneedforactivesurveillancesystems:GulfWarSyndrome,WestNilevirus,andtheavianinfluenza/pandemicflu.GulfWarSyndromeinSoldiersandtheinabilitytofindacausewastheimpetusforestablishingaGulfWarSyndromeStudyinMilitaryWorkingDogs.Sincetheseanimalsarecollocatedinareaswhereenvironmentalanddiseaseexposuretookplaceandhaveashorterlifetime,theyserveasapotentialsentinelforhumandisease.Thestudywasresponsible,inpart,fortheestablishmentoftheElectronicMedicalRecordforgovernment-ownedanimals,andthecreationoflinksamongthedeploymenthistory,medicalfindings,andnecropsyreportstoprovideanactivesurveillancesystem.ThisDoD(HealthAffairs)fundedprogramhasbeenapprovedandbegandevelopmentin2007.WestNilevirusemergedasapotentiallysignificantthreat.Thisvirus,whichaffectsbothpeopleandanimals,isanexampleofoneofmanyemergingzoonoticdiseases.Aspartofanationalsurveillanceprogram,theUSArmyVeterinaryServiceprovidesactivesurveillanceofhorsesownedbythemilitary,andtestingofillanddyingbirdsoninstallationsnationwide.Thelatesteventisthecurrentglobalavianinfluenzaoutbreakandpotentialpandemicfluthreat.Armyveterinariansareworkingonarangeofplanning,response,testing,andsurveillanceprograms.TosupporttheDoDrequirements,aveterinarianwithbothaPhDinPublicHealthandanepidemiologicbackgroundhasbeenassignedtoTheDoDGlobalEmergingInfectionsSurveillanceandResponseSystem(GEIS)todirectthesurveillanceofbothhumaninfluenzaandzoonoticdiseases.UnderthesponsorshipofGEIS,theDoDVeterinaryServiceActivityhostedanInternationalAvianInfluenzaSurveillanceConferencein2006,alongwithothertrainingfunctions.Globally,VeterinaryServicepersonnelassignedtotheNavyAreaMedicalResearchUnit-3inCairo,Egypt,*areprovidingforwardavianinfluenzasurveillanceinAfricaandthroughouttheUSCentralCommandsareaofresponsibility.EmergingRolesoftheUSArmyVeterinaryServiceCOLGaryVroegindewey,VC,USA *Seerelatedarticleonpage38. AnArmyVeterinaryServicefoodinspectorexaminingmilitaryfoodsuppliespriortoloading.

PAGE 11

JulySeptember20079HOMELANDDEFENSEPriortotheterroristattacksofSeptember11,2001,theVeterinaryCorpshadrecognizedthevulnerabilityoffoodtopurposefulcontamination.Toaddressthisissue,theFoodandWaterSafetyCommitteewasestablishedtoevaluatecurrentvulnerabilities,doctrineandpoliciestomitigaterisk,emergingtechnologytodetectandpreventcontamination,andtrainingrequiredtomeettheseneeds.TheArmyMedicalDepartment(AMEDD)PostgraduateProfessionalShortCourseProgramandtheAMEDDCenterandSchoolDepartmentofVeterinaryServicedevelopedaFoodSafetyandSecurityCoursewhichispresentedyearlyformultiservicepersonnel,alongwithinteragencyrepresentationfromtheFederalBureauofInvestigation(FBI),theUSDepartmentofAgriculture(USDA),theFoodandDrugAdministration(FDA),statepublichealthpersonnel,commercialpartners,andeducationalinstitutions.ThecoursecontinuestobetaughtaspartoftheUSArmyCenterforHealthPromotionandPreventiveMedicines(CHPPM)annualForceHealthProtectionConference.ThecommitteealsoidentifiedtechnologysolutionsforfooddefensethatresultedintheacquisitionandfieldingoftheportablefoodtestsetsaswellastheJointBiologicalAgentIdentificationandDetectionSystem(JBAIDS)portablerapidpolymerasechainreactiontestsets.ArmyveterinarianshaveservedasliaisonstonumerousactivitiesinsupportofHomelandDefense.TheseincludeapublichealthveterinarianassignedtotheNorthernCommandsSurgeonsStaff;DoDLiaisontotheUSDA;supporttotheUSJointForcesCommandsJointTaskForce-CivilSupport;participationinWhiteHouseworkinggroupsonagroterrorism;andworkwiththeGovernmentCoordinatingCouncil,comprisedofFederal,state,tribal,andlocalgovernmentalagenciesresponsibleforavarietyofactivities,includingagricultural,food,veterinary,publichealth,laboratory,andlawenforcementprograms.StrengtheningofpartnershipshasbeenaccomplishedthroughprogramsforinformationsharingwithFDA,DepartmentofHomelandSecurity(DHS),andotherfederalagencies.ThesepartnershipswereprovenvaluableinexecutionoftherecentpetfoodrecallduetomelaminethatalsoenteredthehumanfoodsupplychainandFDAcannedchiliproductrecalls.Veterinaryteamshavedeployedtosupporthurricanerecoveryeffortsandeventssuchasthe2002OlympicGamesinSaltLakeCity,openingoftheUnitedNationsGeneralAssembly,RepublicanandDemocraticnationalconventions,theG-8Summit,thepresidentialinaugurals,presidentialfunerals,andothereventsaspartofourDefenseSupporttoCivilAuthorities.DISASTERMANAGEMENTTheroleveterinarymedicineplaysindisastermanagementwashighlightedintheaftermathofhurricanesAndrew,Floyd,andKatrina.AfterhurricaneAndrew,theVeterinaryCorpsinitiatedanannualVeterinaryDisasterscoursetopreparepersonneltomeettherequirementsofnationalandinternationaldisasters.WorkinginconjunctionwiththeUniformedServicesUniversityofHealthSciences(USUHS)CenterofDisasterandHumanitarianAssistanceMedicine,andtheCenterofExcellenceforHumanitarianAssistanceandDisasterRelief,thecoursewasdevelopedtotrainpersonnelandencouragenetworkingwithothernongovernmentagencies,governmentagencies,andacademicinstitutions.VeterinarymoduleshavealsobeendevelopedandincorporatedintotheCombinedHumanitarianAssistanceResponseTraining(CHART)course,theHomelandSecurityforHealthcareExecutivescourse,andintheUSUHShumanitarianassistancecurriculum.FOODDEFENSEFoodsafety,thedetectionandpreventionofaccidentalfoodcontamination,hasbeenacoremissionoftheVeterinaryCorpssinceitsinception.Fooddefense,thepreventionanddetectionofpurposefulfoodcontamination,hasemergedasaVeterinaryCorpsresponsibilitywhichissharedwithmilitarysecurityagencies.TheVeterinaryCorpshastakentheleadandassistedinawiderangeoffooddefenseactivities.InconjunctionwithCHPPM,theDoDVeterinaryServiceActivitywroteTechnicalGuide1881andestablishedfooddefensecriteriawhichisusedinthepublicationoftheDoDWorldwideDirectoryofSanitarilyApprovedFoodEstablishmentsforArmedForcesProcurement,*DoDsauditprogramforcommercialfoodestablishments. *http://vets.amedd.army.mil/vetcom/directory.htm

PAGE 12

10ArmyMedicalDepartmentJournalVeterinaryServicepersonnelcontinuetoparticipateintheDHSandFBIledStrategicPartnershipProgram-Agroterrorismtoevaluateindustrysectorfooddefensevulnerabilitiesanddevelopindustrystandardstoprotectournationsfoodsupply.ThisisbeingdonewiththeVeterinaryCorpsveterinaryofficersandhighlytrainedandexperiencedFoodSafetyOfficers.TheDoDVeterinaryServiceActivity,anArmyFieldOperatingAgency,isworkingwithFDA,USDA,DHS,andcommercialpartnerstoestablishfooddefenseguidelinesandstrengthenthesafetyofournationalfoodsupply.ThesefooddefenseinitiativesarefurthersupportedbyVeterinaryServicepersonnelassignedtosupportDoDagenciesoutsideoftheUSArmyVeterinaryCommand.TheseincludekeystaffpositionswiththeDefenseLogisticsAgency,DefenseSupplyCenterPhiladelphia,DefenseCommissaryAgency,NavalSupplyCenter,ArmyCenterofExcellence-Subsistence,Army-AirForceExchangeService,andothers.SpecializedMedicalAssistanceResponseTeamsVeterinarymembershavedeployedaspartofamultifunctionalFoodandWaterDefenseTeamtosupportArmyChiefofStaffhighprofileeventsforbothfoodsafetyanddefense.TheUSArmyVeterinaryServicehasparticipatedinandlednumerousexercisestotrainparticipantsandtestthecapacityofveterinarianstosupportawiderangeofnationalsignificantevents,involvingsubjectsfrombioterrorismandagroterrorismtoweaponsofmassdestruction.SECURITY,STABILITY,TRANSITION,ANDRECONSTRUCTIONOPERATIONSDoDDirective3000.052identifiesthesecurity,stability,transition,andreconstruction(SSTR)activitiesascoreDoDmissionsthatshallbegivenprioritycomparabletocombatoperations.TheUSArmyVeterinaryServicehasbeenengagedintheseandsimilaractivitiesoverseveralyearsthroughprovidingVeterinaryReadinessTrainingExercises,VeterinaryCivicActionPrograms,andCooperationAfloatReadinessandTrainingmissionsupportthoughtheCivilAffairsandSpecialForcesVeterinaryCorpsassets,plusTOE*andTDApersonnel.Whilethisisnotatotallynewmission,theemphasisandrequirementsfortheseactivitieshaveincreasedalongwithcombatantcommanderrecognitionofthevalueofstrengtheningagriculturalprogramsasasocial,political,andeconomicstabilizingforce.Combatantcommanderstheaterengagementplansincreasinglyfocusonveterinaryrelatedprograms.Thishasresultedinanincreaseinbothnumberandscopeofdeployments.TheReserveComponentVeterinaryCorpsOfficersprovidethelargestnumberofassetsfortheseprogramsandaresupportedwithactivedutyVeterinaryCorpsofficers.ExamplesoftheseprogramsincluderebuildingtheBosnianVeterinaryCollegeinSarajevo,herdhealthprogramsintheHornofAfrica,avianinfluenzaprogramsinIraq,transboundarydiseaseprogramsinAfghanistan,theestablishmentofnationaldiagnosticlaboratories,MedflagexercisesinAfrica,andotherdeploymentactivities.InadditiontotheSSTRoperations,theVeterinaryCorpshasbeentaskedtosupportDepartmentofStateProvincialReconstructionTeamsinIraq,whilecontinuingCivilAffairssupporttobrigadecombatteamsandtheMultinationalEmergingRolesoftheUSArmyVeterinaryService *TableofOrganizationandEquipment:Definesthestructureandequipmentofamilitaryorganizationorunit.TableofDistributionandAllowances:Prescribestheorganizationalstructure,personnelandequipmentauthorizations,andrequirementsofamilitaryunittoperformaspecificmissionforwhichthereisnoappropriatetableoforganizationandequipmentSeerelatedarticleonpage66.AnArmyveterinarianexaminesalocalfarmersdonkeyduringaVeterinaryCivicActionProgramvisittoavillageintheHornofAfricaregion.

PAGE 13

JulySeptember200711Coalition-Iraq.Topreparefortheseexpandingroles,theVeterinaryCorpshasinitiatedlong-termhealtheducationandtrainingopportunitiesinludingmastersleveltraininginhumanitarianassistance,combinedMastersofPublicHealthprogramswiththefocusoninternationalaffairsandlivestockmanagement,aswellasjust-in-timetrainingfordeployingVeterinaryCorpsofficers.SUMMARYWhenleavingoffice,TommyThompson,theformerSecretaryoftheDepartmentofHealthandHumanServices,indicatedthatthe2thingsthatconcernedhimmostwereavianinfluenzaandthesafetyoftheUnitedStatesfoodsupply:I,forthelifeofme,Idonotknowwhytheterroristshavenot,youknow,attackedourfoodsupply,becauseitissoeasytodo.TheseareDoDandnationalconcernsandareadirectfocusoftheUSArmyVeterinaryServiceaspartofitsemergingrolesandresponsibilities.Whilecontinuingitscoremissionsoffoodsafety,animalmedicine,andresearchanddevelopmentinsupportoftheDoD,theUSArmyVeterinaryServicemustbeabletomeetitsresponsibilitiesinthenewemergingarenas.Inordertomeettheserequirements,additionalresourcesintheformofauthorizations,training,equipment,andfundingwillberequired.Inaddition,innovativepartnershipsandcollaborationwithintheAMEDD,DoD,andinteragencypartnerswillbecritical.REFERENCES 1.TechnicalGuide188,USArmyFoodandWaterVulnerabilityAssessmentGuide.AberdeenProvingGround,MD:USArmyCenterforHealthPromotionandPreventiveMedicine.2002.Availableat:http://chppm-www.apgea.army.mil/tg.htm.2.DepartmentofDefenseDirective3000.05:MilitarySupportForStability,Security,Transition,AndReconstruction(SSTR)Operations.Washington,DC:USDeptofDefense;November28,2005.AUTHOR COLVroegindeweyistheDirectoroftheDepartmentofDefenseVeterinaryServiceActivityintheofficeofTheSurgeonGeneral,FallsChurch,VA.

PAGE 14

12ArmyMedicalDepartmentJournalARMYVETERINARYLABORATORYSERVICEThethreepillarsthatformthecoreforcehealthprotectionmissionoftheArmyVeterinaryServicearefoodsafety,animalmedicine,andresearchanddevelopment.Veterinarylaboratoryservicehasalwaysplayedakeyroleineachoftheseareas,andcontinuestodosotoday.Veterinaryofficersholdvitalpositionsinmedicalresearchlaboratories,particularlyinareassuchastoxicology,virology,pathology,andlaboratoryanimalmedicine.Veterinarypathologists,clinicalpathologists,andveterinarydiagnosticiansareessentialelementsinthehealthmaintenanceofmilitaryanimals.Veterinarypersonnelinfoodanalysislaboratories,thefocusofthisarticle,helpprovidethesciencethatcomplementstheartoffoodinspection.AlthoughanArmyveterinarylaboratoryservicehasexistedalmostsincetheinceptionoftheVeterinaryCorpsitself,itssizehasvariedgreatlythroughouttheyears.InDecember1917,theArmySurgeonGeneralestablishedaveterinarylaboratoryservicetoinclude6or7laboratoryofficers.1BytheendofWorldWarII,some100veterinaryofficerswereservingworldwideintheveterinarylaboratorysectionsof32Armymedicallaboratories.2Veterinarylaboratorypersonnelhavesupportedmilitaryconflictsthroughoutthelatterhalfofthe20thcenturyandbeyond,fromtestingicechlorinationpotabilityinVietnam,3toprovidingfoodtestingforOperationIraqiFreedom.Theyalsohavearoleincivil-militaryfunctions,whethersupportingmissionssuchasJointTaskForceBravoinLatinAmerica,orclosertohomeintheaftermathofHurricaneKatrina.Thenumberofveterinarylaboratorieshasgreatlydecreasedsince1945.BaseRealignmentandClosure,alongwiththeadventofovernightshippingservices,allowedvariousregionallaboratoriestobeconsolidatedintothecurrentDepartmentofDefense(DoD)VeterinaryFoodAnalysisandDiagnosticLaboratoryatFortSamHouston,Texas,andVeterinaryLaboratoryEuropeinLandstuhl,Germany.SmallerfoodanalysislaboratoriesinHawaiiandKoreacoverthosepartsoftheworldthatcannotquicklygetsamplestothe2largerlaboratories.ThemissionofArmyfoodanalysislaboratorieshasalsochanged.Mostoftheearlyfocuswasonqualityassurancetestingandcontractcomplianceforlargestockpilesofsubsistence.Dairytestingcomprisedalargeportionofthefoodanalysislaboratorywork,asdidcananalysisandpackagingtestingofoperationalrations.ThelaboratorieswereoftenalignedundertheQuartermasterBranch,untilultimatelyitwasdecidedthatfoodanalysisisamedicalmission,andtheresponsibilityoftheVeterinaryCorps.Morerecently,particularlywiththeadventofprimevendorcontracts,foodsafetyhasbecomeamainfocusforthefoodanalysislaboratories.Qualityassurancechecksarestillperformed,butmoreinthecontextofverifyingtheproducersownqualityassuranceprogram.Detectionofharmfulpathogens,toxins,andchemicals,andprovidinglaboratorytestingforfoodborneillnessoutbreakshastakenpriority.Also,thefoodanalysislaboratoriesarebecomingmoreandmoreinvolvedwithfooddefense,gainingexpandedcapabilitiestoquicklydetectintentionalcontaminationofsubsistencewitheithertraditionalfoodbornethreatsorwithbioterrorismagents.CURRENTARMYVETERINARYFOODANALYSISLABORATORIESTheDoDVeterinaryFoodAnalysisandDiagnosticLaboratory(FADL)atFortSamHoustonistheArmyslargestandmostrobustfoodanalysislaboratory.TheFADLiscapableofperformingawidevarietyofmicrobiologicalandchemicaltestsonfoodArmyVeterinaryFoodAnalysisLaboratories:Past,Present,andFutureMAJScottHanna,VC,USAMAJMargeryHanfelt,VC,USAMAJKelleyEvans,VC,USALTCRobinKing,VC,USA

PAGE 15

JulySeptember200713andwatersamples,supportingmilitaryandnonmilitarycustomersacrosstheglobe.FoodmicrobiologyassaysattheFADLrunthegamutfrombasic,conventionalmicrobiologyusingagarplates,toadvanced,rapidtechniquessuchasreal-timepolymerasechainreaction.Themicrobiologysectiontestsforroutinequalityindicatorsaswellasspecificfoodbornepathogensandtoxins,screensoperationalrationsforpotentialanthraxcontamination,andtestssamplesassociatedwithfoodborneillnessoutbreaks.AlthoughmostofthesamplessubmittedformicrobiologicaltestingcomefromNorthandSouthAmerica,thesectionalsoconfirmslaboratoryresultsforthesurveillancelaboratoriesinHawaiiandKoreawhenneeded.Thefoodchemistrysectionsroutinecapabilitiesincludethedetectionofpesticidesinfoodandwaterandhistamineincertainseafoods,heavymetalanalysis,antibioticresiduesinfoodanddairyproducts,andproximateanalysessuchasfatcontentofgroundbeef.FADLchemistsareoftencalledupontoidentifyforeignobjectsinfoodsamples,andtorespondtocustomercomplaints.Thechemistrysectionoftenreceivessamplesfromtheotherlaboratorieswhenmoreadvancedchemistrytestingisneeded.Newtechniquescurrentlyunderdevelopmentincludeanalysisforcyanide,betterandfasterwaystodetectpesticidesandheavymetals,andequipmentandprotocolstoidentifyandquantifyradioisotopesinfoodandwatersamples.Toensurethevalidityofitsresults,theFADLisaccreditedthroughtheAmericanAssociationofLaboratoryAccreditation(A2LA).ThisagencyauditstheFADLagainsttheISO17025standard,theGeneralRequirementsfortheCompetenceofTestingandCalibrationLaboratories.ExternalA2LAaccreditationprovidesfurtherconfidenceintheaccuracyandreliabilityoftheFADLlaboratoryresults,andallowstheFADLtoactasaconfirmatorylaboratorywhennecessary.DuetothetechnicalnatureofmanyoftheproceduresattheFADL,mostoftheanalystsarecivilians.Militaryfoodinspectors(militaryoccupationalspecialty[MOS]68R)augmenttheciviliansandperformmanyofthefoodmicrobiologyandseveralofthefoodchemistryassays.Thismixallowsaconsistent,stableworkforceofhighlytrainedcivilians,whileallowingthemilitaryfoodinspectorstoreceivevaluabletraininginfoodanalysistechniquestheycanapplyinfutureassignments.AprimarymissionoftheUSArmysVeterinaryLaboratoryEurope(VLE)inLandstuhl,Germany,istoconductmicrobiologicalandchemicalanalysisoffoodandbottledwaterforsafetyandwholesomeness.VLEistheonlyotheraccreditedlaboratoryintheUSmilitarytoconductthistesting,andemploysconventional,rapid,andmolecularmethodstocarryoutthesetasksinsupportofEuropeanCommandandCentralCommandunits.VLEcustomersincludeArmy,AirForce,Navy,andStateDepartmentassets,withsamplesubmissionsfrommorethan40countries.UnliketheFADL,mostofthefoodanalysistechniciansatVLEarejuniorenlistedpersonnel,MOS68R.InadditiontotheirAdvancedIndividualTraining,theyreceive6monthsoftrainingatthelaboratorytolearnthetechnicalstandingoperatingproceduresandmanuals,alongwithpassingassociatedproficiencytesting.TheFoodSafetyLaboratoryattheTriplerArmyMedicalCenter,Honolulu,Hawaii,performsmicrobiologicalscreeningforfoodsamplesfromthroughoutthePacifictheater.Theyuseavarietyofrapidandminiaturizedmethodstoperformthistesting.Thelaboratoryisstaffedbyacivilianmicrobiologistandanoncommissionedofficer,MOS68R.Finally,the106thMedicalDetachment(VeterinaryServices)Laboratory,Yongsan,inSeoul,SouthKorea,providesmicrobiologicalscreeningandlimitedchemicalanalysisofsubsistenceprocuredfromtheKoreanpeninsula.Itisstaffedbyacivilianmicrobiologist,aVeterinaryCorpsofficer,andMOS68Rpersonnel.VETERINARYFOODSURVEILLANCELABORATORIESDespitethewidegeographicdispersionofthefixedlaboratories,manyfoodproductsofinterestareperishable,andthetransporttimemayresultinsamplesthatarenottestable.Inaddition,therearesituationsinwhichmoreimmediateresultsarenecessaryduetooperationalconsiderations,andthetime-sensitivenaturemayrequireamoreexpedientpreliminaryresult.Difficultiesshippingfoodsamplesacrossbordersfromonecountrytoanothermayalsoexist,whichdelayorevenpreventneededtesting.

PAGE 16

14ArmyMedicalDepartmentJournalAccordingtoArmyFieldManual4-02.18:Currentlythereisminimaltestingthatcanbedoneatthedeployedunitlevel.SuspectfoodsamplesaresenttotheFADLinFortSamHouston,Texas,ortotheUSArmyVeterinaryLaboratory,Germany.InthenearfuturetheMDVS[medicaldetachment,veterinaryservice]willbeabletoscreenfoodsamplesforthepresenceoffoodborne[alsowaterandiceborne]pathogensandbiologicalwarfareagents.Ifapathogenorbiologicalagentisdetectedthroughthescreeningprocess,foodsamplesarecollectedandshippedtoaconfirmatorylaboratoryforfurtheranalysis.4Thatdayhasfinallyarrived,withthefieldingof2foodtestingsetsspecificallydesignedforuseonthebattlefield,infoodproductionplants,storagefacilities,and/orprimevendorfacilities.UnitAssemblage(UA)913AVeterinaryEquipmentSetFieldMicrobiologyDiagnosticKitwillbeusedforrapidscreeningoffoodsamplestoassistinensuringfoodsafety.Thiskitfeaturesahandheldinstrumentwhichdetectsluminescenceforadensosinetriphosphate(ATP)associatedwithmicroorganismsandfood/organicresiduesandpesticides.TheVeterinaryServiceSupportTeamoftheMDVSisauthorizedtousethiskit.UA914AVeterinaryEquipmentSetFoodTestingSetwillbeusedforrapidscreeningaswellaspresumptiveresultsoffoodsamplestoassistinensuringfoodsafetyanddefense.ThissetfeaturesasmallbenchtopanalyzerthatusesliquidscintillationcounterfortestingforaflatoxinandantibioticsandabioluminescencecounterforpesticidesandATPassociatedwithmicroorganismsandfood/organicresidues.TheFoodProcurementTeamoftheMDVSisauthorizedtousethisset.Basedontheneeds,andknowingthatfieldingofthenewsetswasimminent,VLEinitiatedatrainingprogram,theSurveillanceFoodLaboratoryTechnicianWorkshops.Thegoalistoprovidethetrainingandreferencestoallowaunittostandupandrunalocalsurveillancefoodandbottledwaterlaboratoryinsupportoftheunitcommandersmission.Whilethepurposeofthesurveillancelaboratoriesistosupportthelocalcommandsmission,theyarenotyetdesignedtorecoverandidentifypathogens.Instead,theirroleistoruleoutproblemsbasedonindicatortesting,orforreferraltoareferencelaboratorysuchasVLE.Implementationoftheselaboratorieshasgreatlyenhancedlocalsurveillanceanddestinationmonitoring,andidentifiedpotentialproblemsbeforethoseproblemsrisetoalevelthatwouldaffecttheconsumer.Duetothenumberoftrainingtopicsandthelaboratoryhands-ontechniquestomaster,theworkshopsaredesignedwiththelowstudent-to-teacherratioof2:1or3:1.Trainingconsistsofacombinationoflecturesandlaboratories,andtopicsincludeproperlaboratorysetupandmaintenance,basiclaboratorytechniques,processingfoodandbottledwatersamples,readingandinterpretationofresults,followupactionstopresumptivepositiveresults,andreportingofresults.Thetrainingemphasizestheuseofrapidmethodsthatcanbeusedingarrisonorfieldlaboratories,includingthefollowing:PlatingfoodproductsusingPetrifilmplates(3MCorporation,StPaul,Minnesota),aready-madeculturemediumsystemcontainingstandardmethodsnutrients,acold-water-solublegellingagent,andadditionalchemicalsorantibioticsasnecessaryforenumeration,selectivity,ordifferentiationofmicroorganisms.Testingof100mLsubsamplesofwater,rinse,ordilutedfoodsamplesusingasingleassaycapableofselectivelygrowing,detecting,andquantifyingcoliforms,E.coli,andhydrogensulfideproducingEnterobacteriacae(suchasProteusandSalmonella).Useofatabletopsystemforscreeningfoodandbottledwatersamplesforpesticidesandanindicationofproperpasteurization.Thesystemisalsocapableofscreeningforantimicrobials,aflatoxins,andotherimportantchemicalresiduesandindicators.UseofATPswabstodeterminethepresenceofATPinwateroronsurfaces,reflectingthepresenceoforganicmaterialandlevelofsanitationinthesample.Theyareportableandrapid,andarecarriedonsiteintoproductionplants,commissaries,andotherareaswherefoodisprocessedtodeterminethecleanlinessoffoodprocessingsurfaces.Resultsrequireonlya5-secondluminescentreadinginaportablecounter.TheVeterinaryLaboratoryEuropehasconducted4workshopssofar,trainingjustover30personnel.ArmyrankshaverangedfromPrivatetoMajor,includingWarrantOfficers.StudentshaveattendedArmyVeterinaryFoodAnalysisLaboratories:Past,Present,andFuture

PAGE 17

JulySeptember200715fromtheEuropeanCommand,CentralCommand,andKorea.Inaddition,classeshaveincludedAirForcePublicHealthOfficersandacivilianinvolvedinqualityassuranceatameatprocessingfacility.Inadditiontotheformalworkshops,VLEhasexportedthetrainingtothefieldduringfieldtrainingexercisestoteachanddemonstratesetupandoperationofafoodandbottledwaterlaboratoryinthefield.Inthelast3years,VLEhasprovidedsubjectmatterexpertsandexportablelaboratoriesfor3differentunitson3fieldtrainingexercisestomeetrequestedneeds.ThefirstformaltrainingcoursehasrecentlybeenconductedattheDepartmentofVeterinaryScience(DVS)attheArmyMedicalDepartmentCenterandSchool,acombinedeffortofDVS,theFADL,andVLE.ThecoursewasdesignedtosupportVeterinaryCommandpersonnelwhoarereceivingoneofthefoodanalysissets.Additionalcoursesareplanned,andtheFADLisdevelopingaproficiencytestingprogramtoensureattendeesmaintaintheirskillset.DVScontinuestoupdateanddeveloptrainingtoensureveterinaryservicepersonnelinTOE*andTDAunitsaretrainedtousetheequipment.Providingtheseworkshops,takingthetrainingtothefield,anddeployingsubjectmatterexpertsareallcriticalcomponentsinensuringthewholesomenessandsafetyofthefoodandbottledwatersupplyfortheUSmilitary.Accesstoonsitelaboratorytestingwillallowcommanderstomakebetterinformed,moretimelydecisionsonwhethertouseaparticularcommodity,supplier,orproducer.EMERGINGTECHNOLOGIESThefooddefensemissionhasalsotakengreatleapsforwardinrecentyears.Withtheincreasedpotentialforbiologicalagentwarfareandgeneticallyalteredbiologicalagents,thecapabilitytoconfirmthepresenceofabiologicalagenthasbecomeessentialtopreventingcasualties,thusmaintainingeffectivecombatpower.OneofthefastestwaystoidentifyabiologicalagentistodetermineifthatagentsDNAispresent.Polymerasechainreaction(PCR)hasbeenusedforyearsinfixedfacilitylaboratoriesandisnowavailableonthebattlefield.Inthemid-1990s,ajointserviceeffortwasstartedfortheJointBiologicalAgentIdentificationandDiagnosticSystem(JBAIDS)whichusesPCRtechnologytoidentifyandquantifybiologicalwarfareagentsandotherbiologicalagentsofoperationalsignificanceforconfirmatoryandprognosticpurposes.JBAIDSwillperformspecializedanalyticaltestsonbiologicalwarfareagentsormetabolitesinenvironmentalorfoodsamples,samplesorspecimensfrombiologicalorigins,orsamplesfrommilitarymateriel.Currently,JBAIDSonlydetectsaselectgroupofthe39agentsthatcanbepotentiallyusedasbiologicalweapons.However,withtherightsetsofreagents,JBAIDShasthepotentialtodetectanylivingorganism *TableofOrganizationandEquipment:Definesthestructureandequipmentforamilitaryorganizationorunit.TableofDistributionandAllowances:Prescribestheorganizationalstructure,personnelandequipmentauthorizations,andrequirementsofamilitaryunittoperformaspecificmissionforwhichthereisnoappropriatetableoforganizationandequipment. AninstructorassistsstudentsintheexaminationofplateculturesaspartoftheFoodSurveillanceLaboratoryCourseattheArmyMedicalDepartmentCenter&School,FortSamHouston,Texas.

PAGE 18

16ArmyMedicalDepartmentJournal thatcancauseillnessinbothhumansandanimals.SinceJBAIDSisajointserviceprogram,acentralizedtrainingprogramwasalsodeveloped.InitialJBAIDSoperatortrainingforauthorizedmilitaryspecialistsconsistsofa2-weekcoursecurrentlyheldatBrooksCityBase,SanAntonio,Texas.BeforeaunitcanreceiveJBAIDS,2usersfromthatunitmustattendthistraining.ThefirstJBAIDSfieldedtotheArmywenttotheFADL.ArmyveterinaryunitsthathaveorwillreceiveJBAIDSaretheFoodProcurementTeamsintheMedicalDetachment,VeterinaryServices,aswellasselectTDAunitssuchastheFADLandVLE.Duetothehighlycomplexnatureoftestingfoodsamples,theFADLhasbeenworkingonrefiningtechniquesandprocedurestaughtintheJBAIDSoperatorscourse,aswellasdevelopingmethodstodetecttraditionalfoodbornepathogensusingtheJBAIDSplatform.Ifsuchtechniquescanbevalidated,surveillancelaboratoriescouldbeginlookingforspecificpathogensinfoodandwatersamples,inadditiontoquantifyingindicatororganisms.OthertechnologiesarecurrentlybeingevaluatedanddevelopedbytheFADL,theNatickSoldierSystemsCenter,otherDoDagencies,theFoodandDrugAdministration,theDepartmentofHomelandSecurity,andnumerousotherpublicandprivateorganizations.Thecandidatetechnologiesarediverse,suchaselectrochemiluminescence,whichcandetectfoodbornetoxins;immunomagneticcapture,whichcanseparateaparticularbacteriaorvirusfromtheotherorganismsinthefood;andmicroarrays,whichcanrapidlyidentifyseveralpotentialpathogensusingasingle,smallchip.Asthesebecomemoremature,ruggedized,andexportabletothefield,thesurveillancelaboratorieswillbeabletoprovideawealthofinformationaboutthemicrobialstatusoffoodandwatersamplesinaveryshortamountoftime.CONCLUSIONInmanyways,Armyfoodanalysislaboratorieshavecomefullcircle.Whilefastshippingonceallowedareductioninthenumbersoflaboratories,thedesireforevenfasterresultsisnowincreasingtheirnumbersonceagain.Astechnologyhasprogressed,advancedtestingprotocolsarenowavailabletothesurveillancelaboratories,andmorearesuretofollow.REFERENCES 1.Miller,EB.UnitedStatesArmyVeterinaryServiceinWorldWarII.Washington,DC:OfficeofTheSurgeonGeneral,USDeptoftheArmy;1961:381.2.Randall,R.WartimeArmymedicallaboratoryactivities:wartimeactivitiesoftheArmyveterinarylaboratories.AmJPubHealth.1947;37(7):829-835.3.Neel,S.VietnamStudies:MedicalSupportoftheUSArmyinVietnam1965-1970.Washington,DC:USDeptoftheArmy;1991:137.4.FieldManual4-02.18:VeterinaryServiceTactics,Techniques,andProcedures.Washington,DC:USDeptoftheArmy;December2004:para3-9.ArmyVeterinaryFoodAnalysisLaboratories:Past,Present,andFutureAUTHORS MAJHannaisDeputyCommanderofVeterinaryLaboratoryEurope,Landstuhl,Germany.Previously,hewasDeputyDirectoroftheDoDVeterinaryFoodAnalysisandDiagnosticLaboratory,FortSamHouston,Texas.MAJHanfeltisChiefoftheFoodProtectionBranch,DepartmentofVeterinaryScience,ArmyMedicalDepartmentCenterandSchool,FortSamHouston,TX.Previously,shewasDeputyCommanderoftheVeterinaryLaboratoryEurope,Landstuhl,Germany.MAJEvansisChief,CombatDoctrineandDevelopment,ArmyVeterinaryServices,FortSamHouston,Texas.LTCKingisCommander,VeterinaryLaboratoryEurope,Landstuhl,Germany.Previously,shewasDeputyDirectoroftheDODVeterinaryFoodAnalysisandDiagnosticLaboratory,FortSamHouston,Texas.

PAGE 19

JulySeptember200717INTRODUCTIONLeishmaniasisistransmittedtohumansandanimalsthroughthebiteoftheinfectedphlebotominesandfly.1Thediseaseisendemicin88countries,includingallcountriesborderingtheMediterraneanSeawithanestimated12millionpeopleworldwideaffected,2andthenumberofcaseshasincreasedinthepastdecade.3Leishmaniainfantumistheetiologicalagentofhumanandcaninevisceralleishmaniasis(CanL)intheMediterraneansubregion.Domesticdogsarethemainreservoirhostinurbanareas.4,5Leishmaniasisinfectionsinbothcanineandhumanpopulationsaremostoftennonfatalandasymptomatic,butcanbecomefatalifleftuntreated.Humansshowabroadspectrumofresponsestoleishmaniasis.Someindividualsdisplaysevereclinicalmanifestations,yetothersonlyshowpositiveantibodytiters.Clinicalmanifestationsinhumansarevaried,buttheyincludeweightlossandintermittentspikingfevers.Leishmaniasisalsopresentsapublichealthproblembecauseitisdifficulttotreat.Existingchemotherapiesarenotwhollyeffectiveagainstthedisease,anddrugresistanceisagrowingproblem.6CanineleishmaniasisisendemicintheMediterraneanBasin.TheseroprevalenceofCanLrangesbetween10%and37%,andisevenhigherinisolatedpopulations.7Whileleishmaniasiswasonceconsideredprimarilyaruraldisease,itisincreasinglyfoundinsuburbanareaswheresmallgardenscreatefavorableconditionsforthesandfly.6InEurope,whereleishmaniasisisprimarilyaveterinaryproblem,estimatessuggestthatupto7milliondogsareinfected.8TheImpactofLeishmaniasisonMilitaryWorkingDogswithMediterraneanBasinExposureMAJJerrodW.Killian,VC,USA ABSTRACTBackgroundLeishmaniasisisaninfectiousprotozoandiseaseofpeopleanddomesticanimalsthatoccursthroughouttemperate,subtropical,andtropicalregionsoftheworld.IntheMediterraneanBasin,CanineLeishmaniasis(CanL)isendemicandmightposearisktomilitaryworkingdogs(MWDs)stationedinthearea.ConcernsovertranslocatingexposedMWDsintoCanLnonendemicareascreatetheneedtoascertaintheimpactofCanLinexposedMWDs.ObjectiveTodeterminethemagnitudeofCanLinexposedMWDs.DesignSerum/tissueexaminationofexposedMWDsusingpolymerasechainreaction(PCR)andimmunofluorescenceassay(IFAT)teststargetedtoL.infantum;abstractionofMWDmedicalrecordsforCanL-relatedsigns.SettingMilitarybaseswithintheMediterraneanbasin.ParticipantsSixty-fourMWDslocatedfromarecordssearch.MainOutcomeMeasuresPCRresults;IFATtiters;frequencyandnumberofCanL-relatedclinicalsignsabstractedfrommedicalrecords;casedefinitions.ResultsAllPCRandIFATtestswerenegative.NoMWDswereclassifiedasCanLcasesorCanLprobablecases.Although16MWDsmettheCanLsuspectcasedefinition,nocorrelationwasfoundbetweenthelengthoftimeMWDswereexposedandthenumberofCanL-relatedclinicalsignsabstractedfrommedicalrecords.ConclusionsTheresultssuggestthatthepotentialforMWDstotranslocateCanLisverylow.

PAGE 20

18ArmyMedicalDepartmentJournalInMallorca,Spain,theprevalenceofcanineinfectionwasdeterminedbyusingpolymerasechainreaction(PCR)andserologicaltests.Theresultsindicatethat67%ofdogsmightbeinfectedbyleishmaniasisandthattheprevalenceofinfectionismuchgreaterthantheprevalenceofovertleishmaniasis-relateddisease.7Leishmaniasiscanalsodisplayawidediseasespectrumindogsrangingfromclinicaldiseasetoasymptomaticinfections.9However,successfultreatmentdoesnotcompletelyeliminatetheCanLthreat.10Evenclinicallycureddogsremainparasitologicallypositiveand,therefore,infectioustothesandflyvector.11DogsinfectedwithCanLthathavefailingimmunesystemscanpresentavagueclinicalpicturewithnonspecificandsporadicsigns(seeFigure1).Themostcommonclinicalsignsincludeulcerateddermallesions,dryskinwithdesquamation/scaling(lastinglessthan2months),lymphadenopathy,nephropathy,facialmuscleatrophy,underweightatnecropsy,andconjunctivitis.TheincubationperiodofCanLcanlastfromseveralweekstoseveralyears,whichmakesimmediatediagnosisdifficult,especiallyifthedogisnolongerinanareawhereleishmaniasisisendemic.Theseproblemsaddtothelongdelaybetweensamplecollection,analysis,diagnosis,andsubsequentcontrolofoutbreaks,makingleishmaniasisdifficulttoeradicate.3Therelationshipbetweentheprevalenceofleishmaniasisinthecaninepopulationandhumandiseasehasdirectpublichealthimplications.12,13Theproblem,inpart,arisesbecauseclinicalformsofCanL,characterizedbychronicevolutionofviscerocutaneoussigns,occurinlessthan50%ofinfecteddogs.14Infected,asymptomaticdogsaresourcesoftheparasiteforthephlebotominevectorsandflies.Therefore,thesedogsplayanactiveroleinthetransmissionofleishmaniasis,15posingasmallriskoftransmissionfrompetstomembersoftheownersfamilyandotherpeopleintheircommunity.16Inaddition,ithasbeensuggestedthatinfecteddogsbittenbysandfliesinnonendemicareascanspreadtheinfection,creatingnewendemicareas.17Theriskformilitaryworkingdogs(MWDs)tocontractCanLwhilestationedintheMediterraneanBasinisundetermined.Typically,upto60MWDsarestationedatbasesthroughouttheMediterraneanarea.SomeideaofexposureofMWDstoleishmaniasiscanbegainedfromaseroprevalencestudyperformedon50dogs,whichresidedwithUSpersonnelassignedtoNavalAirStationSigonellainSicily.ThedataindicatedahighexposureratetoCanL,with60%ofthestudypopulationhavingelevatedimmunoglobulinMantibodylevels.Theseresultssuggestthatthedogswererecentlyinfectedwithleishmaniainfantumduringa2-to3-yeartourinSicily.18Thediseasespectrumofleishmaniasisappearstocorrelatewiththeorganismloadlevelwithinindividualdogs.Dogswithclinicaldiseasehavehighertissueandserumleishmaniasisorganismlevels.Testinginstruments,inparticularPCRandtheimmunofluorescentantibodytest,moreeasilydetectthesehigherorganismlevels.Conversely,dogswithalowerLeishmaniaburdenhavefewerorganismsfordiagnosticteststodetectandareconsequentlymoredifficulttodiagnose.InadditiontothelackofwidespreadtestingofMWDs,anothermajorlimitationistheinabilitytoidentifyandcountasymptomaticcarriers,becauseclassicdiagnostictestsareinsufficientlysensitive.2Inaddition,clinicalsignsarenotreliable,makingdiagnosisofCanLdifficult.Theseproblemsindiagnosingasymptomaticallyinfectedleishmaniasis-positivedogshavepreventedaclearassessmentofthetrueriskofCanLtoMWDsstationedneartheMediterraneanBasin,althoughtherehavebeenno Figure1.Rottweilerwithleishmaniasis TheImpactofLeishmaniasisonMilitaryWorkingDogswithMediterraneanBasinExposure

PAGE 21

JulySeptember200719knownreportedclinicalcasesofleishmaniasisinMWDsoriginatingfromthatarea.Accordingly,areliablediagnostictestforthedetectionofCanL,bothinsymptomaticdogsandsuspectedanimals,isneeded.19Theparasitologicalgoldstandardisisolationoftheleishmaniasisorganism,butparasitesarerarelyseen,andthehistopathologicalmethodisnonspecific.20Parasitologicaltechniquescurrentlyinuse,usuallyperformedonbonemarrowaspiratesorlymphnodeaspirates,lacksensitivitytodirectexamination.Serologicalmethods(immunofluorescenceassay,enzymelinkedimmunosorbentassay[ELISA])areeffectiveindetectingactiveleishmaniasiswhenlargeamountsofspecificantibodiesarepresent.However,theusefulnessofthesetechniquesislimitedintheareaswherethediseaseisendemicduetothehighnumberofanimalswithlowlevelsofantibodies.21ThepurposeofthisstudywastodeterminetheprevalenceofCanLinMWDsstationedatselectedlocationsintheMediterraneanBasinusingimmunofluorescenceassaytesting(IFAT),PCRtests,aswellasmedicalrecordabstractionandanalysis.Publichealthconcernsregardingleishmaniasisinfectionswerealsoaddressed.METHODSStudyPopulationRecords,sera,andtissuesamplesweredrawnfromMWDsstationedinthefollowingleishmaniasis-endemiclocations:IraklionandSoudaBayNavalStation,CreteNeaMakie,GreeceEgyptItalySigonellaNavalAirStation,SicilyNaplesNavalAirStationVicenzaArmyBasePalmenolaAirBaseSpainZaragozaAirBaseTorrejonAirBaseRotaNavalAirStationTurkeyIncirlikAirForceBaseAnkaraSamplingandTestingProtocolAsearchwasconductedtoidentifyMWDsstationedattheselectedmilitaryinstallationsusingtheMWDdatabaseattheDepartmentofDefenseDogCenter,LacklandAirForceBase,SanAntonio,TX.Ofthe2,315MWDmedicalrecordsavailable,64matchedthecriteria.However,themedicalrecordsof7MWDscouldnotbelocated,resultingin57recordsfordataabstraction.Frozenserumwasavailableforonly32(56%)ofthese57MWDS.Becausepost-Mediterraneanbasinexposureserologysampleswereused,25MWDswereidentifiedaseithermissingserologyrecordsafterCanLexposure,ormissingfrozenserum.Thirty-sixmedicalrecordshadcorrespondingtissuesamplesavailableattheWalterReedArmyInstituteofResearch(63%).Tissuesamplesfor21MWDswereunavailable,becausenonecropsywasperformedorthemedicalrecorddidnotcontainapathologyreportfromtheArmedForcesInstituteofPathology(AFIP)inWashington,DC.Figure2illustrateshowthestudypopulationwasidentified,andtheproceduresforobtainingtissue(PCR),serum(IFAT),andmedicalrecords.SerologicaltestingwasperformedbyFrankSeuter,utilizingmethodologydevelopedattheCentersforDiseaseControlandPrevention(CDC)byDrPeterSchantz,DivisionofParasiticDiseases.Immunofluorescenceassaytestingwasconfiguredtodetectspecificantibodiestotheleishmaniasisorganism.Theintensityofthetiterreflectsboththestageoftheinfectionandtheanimalsresponsetotheinfection,withtheantibodytitergenerallyincreasing(from1:16to1:512orgreater)astheinfectionprogresses.22TheinterpretationoftheIFATcloselyfollowedtheCDCsrecommendations:leishmaniasis-positiveserumtitersof1:16orhigherweretermedpossibleinfections,titersof1:64orgreaterweretermedhighlysuspectedinfections.Fluorogenicpolymerasechainreaction(SmartCyclerPCRcyclingprotocol)testswereperformedwithenhancedspecificity,astheassaytargetincorporatedasegmentofthesmall-subunitrRNAgene,whichisconservedamongallleishmaniasisspecies.

PAGE 22

20ArmyMedicalDepartmentJournalSections(5mthick)werecutfromthesamples,whileparaffinremoval,DNApurification,andDNAextraction(bycolumnchromatography)wereperformedaccordingtothemanufacturersinstructions(QIAampTissueKit;Qiagen,Valencia,CA).SpecificPCRreactionmixturesincorporatedwater,MgCl2,PCRbeads(formerlyAmershamPharmaciaBiotech,Inc.,Uppsala,Sweden,nowAmershamBiosciences),primers,andtheleishmaniasisprobe.ALeishmaniainfantumprobewasusedforPCRtesting,becauseitwasthedominantleishmaniasissubspeciesfoundintheMediterraneanBasin.SamplesforPCRtestingwereruningroupsof10-13. DefineCanLendemicareasofinterest Identifymilitarybaseswheremilitaryworkingdogsarestationedwithinendemicareas LocatemilitaryrecordsofmilitaryworkingdogsattheDoDDogCenter* Militaryworkingdogrecordutilization:PCR,IFAT,medicalhistory CollateandforwardaccessionnumberstotheArmedForcesInstituteofPathologyfortissueretrieval(63%MWDs) WalterReedArmyMedicalCenterreceivestissuesamplesandperformsPCRtesting. LocateserumsamplesattheFortSamHoustonVeterinaryLaboratory(56%MWDs) CDC**receivesserumsamplesandperformsIFATtesting. Locateandrecordnecropsyaccessionnumbersfromnecropsyreports. Locateandrecordserologyaccessionnumbers. Abstractmedicalrecords. Figure2.Processflowofmilitaryworkingdogtissuesamplingstrategy*DepartmentofDefenseDogCenteratLacklandAirForceBase,Texas PolymerasechainreactionImmunofluorescenceassaytestMilitaryworkingdogs**CentersforDiseaseControlandPrevention,Atlanta,GeorgiaTheImpactofLeishmaniasisonMilitaryWorkingDogswithMediterraneanBasinExposure

PAGE 23

JulySeptember200721MWDMEDICALRECORDSMedicalrecordswereavailableineitherhardcopyormicroficheformat.ThestudyfocusedontheMWDmedicalrecordsMasterProblemList(Form3071),standardform600(SF600),andtherecordofmilitarydogphysicalexamination(DDForm1829).Therecordssummarizedsignificantdiagnoses,andaidedinthecollationofCanL-relatedmedicalproblems.Laboratoryandnecropsyreportswithinthemedicalrecordsenhancedtheclinicalpicture.DATAANALYSISQuestionsconcerningthemedicalhistoryofMWDsweredesignedtodeterminethepresenceorabsenceofspecificCanL-relatedclinicalsigns.ThecharacteristicsofMWDsineachcategorywerecollatedtoderivethecorrespondingpercentagesforMWDshavingdesignatedsignsandsymptoms.ThisclassificationstrategyallowedtheidentificationofpotentialCanL-positiveandnegativeMWDsusingtherelativefrequenciesofobservedsignsandsymptoms.Anabstractedlistofvariables,includingspecificclinicalsigns,ispresentedintheTable.InformationwasrecordedinanExcel(MicrosoftInc,Redmond,WA)spreadsheetandstoredfordataanalysis.MinitabStatisticalSoftware(MinitabInc,StateCollege,PA)wasusedfordataandstatisticalanalysis.ThecorrelationofexposuremonthsandnumberofclinicalsignswastestedusingthePearsoncorrelationcoefficient.CaseDefinitionsSeveralCanLcasedefinitionswereused.CanLCase.MilitaryworkingdogswithpositiveCanLparasitologicaltestresults(PCR,stainedsmearsfrombonemarrow,spleen,liver,lymphnode,orblood).CanLProbableCase.ExposedMWDswithapositiveanti-CanLantibodytest(ELISA,IFAT)andanyclinical,laboratory,andnecropsyfinding,suchasdryskindesquamation/scaling,facialmuscleatrophy,underweightatnecropsy,lymphadenopathy,conjunctivitis,ornephropathy.CanLSuspectCase.ExposedMWDspossessinganytwoofthepreviouslymentionedclinical,laboratory,andnecropsyfindings.ResultsNoMWDssatisfiedeithertheCanLcaseorCanLprobablecasedefinitioncriteria.AlthoughallMWDsdisplayedbothnegativePCRandIFATresults,16MWDsmettheCanLsuspectcasedefinitionbydisplayingatleast2CanLsignsorsymptomsafterexposuretotheMediterraneanBasin.AllMWDswerenegativefor>1:16titerserology(N=32)andPCRresults(N=36).BothnegativePCRandIFATresultswereobtainedfor16of57MWDs(28%),increasingtheconfidencethattheseMWDswerenegativeforCanL.Figure3showstheclinicalsignscollatedfromthe57medicalrecords.Themostfrequentsignswerelymphadenopathy(21%),nephropathy(19%),anddesquamation(18%).Figure4showsthefrequencyofclinicalsignsforthenumberofclinicalsigns.Thirty-ninepercentoftheMWDs(N=57)hadnoclinicalsigns,while37%hadonesign,and25%ofMWDshad2ormoreclinicalsigns.Figure5showsascatterplotofthenumberofclinicalsignsversusMediterraneanbasinexposure.ThePearsoncorrelationcoefficientof-0.080reflectsthelackofassociationbetweenthese2variables(P=0.553).AbstractedlistofvariablescollectedfrommilitaryworkingdogmedicalrecordstouseindataanalysistodeterminethepresenceorabsenceofspecificCanL-relatedclinicalsigns.DemographicVariablesMedicalHistoryVariablesNameUlcerateddermallesion(s)TattoonumberSkindesquamation/scalingDateofbirthUnderweightonnecropsyDateofdeathFacialmuscleatrophyAgeatdeathNephropathyBreedLymphadenopathyGenderConjunctivitisNumberoftimesreportingtoMediterraneanBasinLeishmaniasisscreeningMonthsinMediterraneanBasinLeishmaniasisdiagnosisLocation(s)stationedReportdateDeparturedate

PAGE 24

22ArmyMedicalDepartmentJournalDISCUSSIONPriortothisstudy,thepotentialforMWDstoharborsubclinicalCanLappearedlikely,giventheprevalence(10%to37%)ofCanLinsouthernEurope,7andthecloseproximityofMWDstothecompetentsandflyvector.Clinical-complexmaskingofCanLwasconsideredpossiblebecauseofthehighlevelofmedicalandnutritionalsupportprovidedtoMWDs.HealthyMWDsarethoughtlesslikelytodisplaytypicalCanLsymptoms.StraydogsinsouthernEuropefrequentlyexhibitclinicalsigns,largelyduetoimmunosuppressionarisingfrompoornutritionandinadequatemedicalcare,includingtheabsenceoftopicalinsecticides.ThefactthatnoMWDsinthisstudywereclassifiedasCanLcasesorCanLprobablecasessuggeststhatthepotentialforMWDstotranslocateCanLisverylow.Although16MWDsmettheCanLsuspectcasedefinition,nocorrelationwasfoundbetweenthelengthoftimeMWDswereexposedandthenumberofCanL-relatedclinicalsignsabstractedfrommedicalrecords.However,previousstudiesofdogslocatedwithintheMediterraneanBasinhaveclearlydemonstratedapositivecorrelationbetweenlengthoftimeexposedandthenumberofdogswithCanL,23whichmightcastdoubtontheassumptionthattheabstractedclinicalsignsinthisstudyarepredictiveforCanL.Thelackofdiagnosticallypositive(PCR/IFAT)symptomatic,orasymptomatic(basedonabstractedclinicalsigns)MWDsinthisstudyalsosuggeststhatMWDsarelesslikelytobesubclinicalcarriers,andwereprobablyneverinfectedwithCanL.Moreover,MWDsappearlessvulnerabletothepotentiallyinfectiveandubiquitoussandfly.AplausibleexplanationisthattheregulartreatmentofMWDswithseveraltopicalinsecticidesmightproduceasandflyantifeedingeffect.Recentstudiessupportthisassumption.Forexample,onestudyfoundthatsandflybloodfeedingandthesurvivalrateofbothfedandunfedfliesweresignificantlyreducedbythepermethrin,deltamethrin,andfenthiontreatments.24Thus,insecticidesappliedtoMWDsforexternalparasitecontrolappeartohavereducedtheincidenceofCanL,whichwould,inturn,reducethepotentialforMWDstoactasreservoirsforhumanleishmaniasis. F r e q u e n c y o f C l i n i c a l S i g n s 102345510152025NumberofClinicalSignsFigure4.Thefrequencyofclinicalsignsplottedagainstthenumberofclinicalsignsdeterminedinthedataanalysisofthemilitaryworkingdogmedicalrecords(N=57). TheImpactofLeishmaniasisonMilitaryWorkingDogswithMediterraneanBasinExposure GABCDEFA.Lymphadenopathy,21%B.Nephropathy,19%C.Desquamation,18%D.Underweightnecropsy,14%E.Conjunctivitis,12%F.Ulcerateddermallesions,10%G.Facialmuscleatrophy,6%Figure3.CanL-relatedclinicalsignsabstractedfromthemedicalrecordsofmilitaryworkingdogs(N=57).

PAGE 25

JulySeptember200723WhiletheresultsofthisstudycannotdefinitivelydescribetheriskofCanLtoMWDsintheMediterraneanBasin,theydosuggestthatthepotentialforMWDstotranslocateCanLleishmaniasisintononendemicareas,orserveasareservoirforhumanleishmaniasis,ismoreunlikelythanpreviouslyassumed.Thereareanumberoflimitationsinherentinthedesignofthisstudy.First,theselectionofMWDswithMediterraneanBasinexposurecouldnotberandomizedduetothelimitednumbersofexposeddogs.Second,thestudywasdescriptiveinnatureandprovidedonlyquantitativeestimatesofthemagnitudeofCanLinfectionsinMWDs.Thedesignofthisprevalencestudyfellshortofidentifyingcausation,becausethepresenceofCanLinfectionsinselectedMWDscouldnotberuledoutpriortotheirexposureintheMediterraneanBasin.Third,allmedicalrecordabstractionswereperformedafterthePCRandIFATresultswerecollated.IfanyofthePCRorIFATresultshadbeenpositive,thisknowledgemighthavebiasedthefocusoftheabstractionprocess.Finally,theauthorofthisstudywasstationedataveterinaryclinicwithintheMediterraneanBasinwherehediagnosedandeuthanizeddogswithCanL.TheseexperiencesmighthaveaffectedhisopiniononCanLsimpactinsouthernEurope.Thereisno100%specificandsensitivetestforCanL.ThesimplestandmostspecificdiagnosticmethodisthedemonstrationofCanLamastigotesinstainedsmearsofbonemarroworinthefineneedleaspiratesoflymphnodes.Utilizingthesemethodstofindtheparasiteprovidesanextremelyspecifictest,butthesensitivityofthisapproachispoor(30%withlymphnodesmears).Forthisreason,IFAT(widelyconsideredtheserologygoldstandard,anda3%to4%false-positiverate),andPCR(proventobehighlysensitiveandspecific)wereemployed.Forthepurposeofthisstudy,bothpossiblyinfectedandhighlysuspectedMWDswouldhavebeenconsideredserologicallypositive.NegativeIFATresultsforCanLdidnotnecessarilyindicatetheabsenceofCanL,butdidindicateeithertheabsenceortheinabilitytodetectleishmaniasisantibodies.ThecausativeagentsoftheTrypanosomeCruziandLeishmaniaspp.parasitesbelongtotheTrypanosomatidaefamilyandsharevariousantigensthatcausecross-reactivityinserologicaldiagnosis.AstheMWDstudypopulationmighthavebeenexposedtoTrypanosomaCruziitisendemicinsouthTexas,andallMWDsselectedforthisstudyspentvaryinglengthsoftimeinthatareacross-reactivityconcernswereaddressedbyusingbothPCRandIFATtesting.PCRtestsprovidegreaterspecificitythroughamplificationofleishmaniasisDNA.Inaddition,ifanyoftheIFATtestshadbeenpositive,serumsampleswouldhavebeentestedforT.Cruzitoquantifyandcontrolforpotentialcross-reactivity.MilitaryworkingdogsthathadanegativePCRtestwithbothapositiveCanLIFATandT.Cruzitestresultwouldhavebeenconsideredcross-reactive,andnotcategorizedasaCanLcase,probablecase,orsuspectedcase.FurtherresearchontheprevalenceofCanLwouldbeuseful.ManystraydogsarefoundinornearUSinstallationsinsouthernEurope,andareoftenadoptedbyUSservicemembersandbroughttothe 0 20 40 60 80 100 120 1 2 3 4 0 MediterraneanBasinExposure(months) N u m b e r o f C l i n i c a l S i g n s i n M W D s Figure5.ThescatterplotofthenumberofclinicalsignsagainstMediterraneanbasinexposuredeterminedinthedataanalysisofthemilitaryworkingdog*medicalrecords.ThePearsoncorrelationcoefficientof-0.080reflectsthelackofassociationbetweenthe2variables(P=0.553).

PAGE 26

24ArmyMedicalDepartmentJournalUnitedStateswithoutbeingtestedforCanL.AccordingtointernalUSArmyVeterinaryCommanddata,approximately1,000privatelyowneddogsareimportedannuallyfromsouthernEuropewithUSmilitaryfamilies.UnitedStatesentryrequirementsareminimal,requiringonlyacurrenthealthcertificateandproofofrabiesvaccination.TheinfluxofdogsandminimalscreeningrequirementshaveraisedconcernsofimportingCanLintotheUnitedStatesandotherhistoricallyCanLnonendemicareas.InMarchof2002,theCDC,inconjunctionwiththeUSArmyVeterinaryCorps,startedcollectingserumfromdogsownedbymilitaryservicemembersreturningtotheUnitedStatesfrombasesaroundtheMediterraneanSea.ItishopedthatthisprojectwillbetterdefinetheriskofimportingCanLfrommilitarybasesinsouthernEuropetononendemicleishmaniasisareas.ACKNOWLEDGEMENT TheauthorthanksDrMichelleFleetwoodattheAFIPwhoretrievedtheformalin-fixedandparaffin-embeddedliverandspleenMWDtissuesforPCRtestingfromstorageattheWalterReedArmyInstituteofResearch,andLisaHochenbergattheWalterReedArmyMedicalCenterforherassistancewiththePCRtesting.REFERENCES 1.AshfordRW.Leishmaniasisreservoirsandtheirsignificanceincontrol.ClinicalDermatol.1996;14:523-532.2.RyanJR,SmithymanAM,RajasekariahGH,HochbergL,StitelerJM,MartinSK.Enzyme-linkedimmunosorbentassaybasedonsolublepromastigoteantigendetectsimmunoglobulinM(IgM)andIgGantibodiesinserafromcasesofvisceralandcutaneousleishmaniasis.JClinMicrobiol.2002;40:1037-1043.3.ReithingerR,QuinnellRJ,AlexanderB,DaviesCR.RapiddetectionofLeishmaniainfantuminfectionindogs:comparativestudyusinganimmunochromatographicdipsticktest,enzyme-linkedimmunosorbentassay,andPCR.JClinMicrobiol.2002;40:2352-2356.4.MorenoJ,AlvarJ.Canineleishmaniasis:epidemiologicalriskandtheexperimentalmodel.TrendsParasitol.2002;18:399-405.5.SiderisV,PapadopoulouG,DotsikaE,KaragouniE.AsymptomaticcanineLeishmaniasisingreaterAthensarea,Greece.EuroJEpidemiol.1999;15:271-276.6.CarrioJ,PortusM.InvitrosusceptibilitytopentavalentantimonyinLeishmaniainfantumstrainsisnotmodifiedduringinvitroorinvivopassagesbutismodifiedafterhosttreatmentwithmeglumineantimoniate.BMCPharmacol.2002;2:11.7.Solano-GallegoL,MorellP,ArboixM,AlberolaJ,Ferrer,L.PrevalenceofLeishmaniainfantuminfectionindogslivinginanareaofcanineleishmaniasisendemicity.JClinMicrobiol.2001;39:560-563.8.GradoniL.EpizootiologyofcanineleishmaniasisinsouthernEurope.In:Killick-KendrickR,ed.Canineleishmaniasis:anupdate.ProceedingsoftheCanineLeishmaniasisforum,Barcelona,Spain.Wiesbaden,Germany:HoechstRousselVet;1999:32-39.9.Solano-GallegoL,LlullJ,ArboixM,FerrerL,AlberolaJ.Evaluationoftheefficacyoftwoleishmaninsinasymptomaticdogs.VetParasitol.2001;102:163-166.10.BanethG,ShawSE.Chemotherapyofcanineleishmaniosis.VetParasitol.2002;106:315-324.11.ReithingerR,DaviesCR.Americancutaneousleishmaniasisindomesticdogs:anexampleoftheuseofthepolymerasechainreactionformassscreeninginepidemiologicalstudies.TransRSocTropMedHyg.2002;96(Suppl1):S123-S126.12.GavganiAS,MohiteH,EdrissianGH,MohebaliM,DaviesCR.DomesticdogownershipinIranisariskfactorforhumaninfectionwithLeishmaniainfantum.AmJTropMedHyg.2002;67:511-515.13.MartyP,LeFichuY,GiordanaD.LeishmaninreactioninthepopulationofahighlyendemicfocusofcanineleishmaniasisinAlpesMaritimes,France.TransRSocTropMedHyg.1995;86:249-250.14.LanotteJA,PeriersJ,VollhardtY.EcologyofleishmaniasisinthesouthofFrance.AnnParasitolHumComp.1979;54:666-667.Availableat:http://wcentre.tours.inra.fr/sfpar/revues.htm.15.MolinaR,AmeloC,NietoJ,San-AndresM.InfectivityofdogsnaturallyinfectedwithLeishmaniainfantumtocolonizedPhlebotomuspernicious.TransRSocTropMedHyg.1994;88:491-493.16.Strauss-Ayali,D.,Baneth,G.:Caninevisceralleishmaniosis.In:CarmichaelL,ed.RecentAdvancesinCanineInfectiousDisease.Ithaca,NY:InternationalVeterinaryInformationService;2000.TheImpactofLeishmaniasisonMilitaryWorkingDogswithMediterraneanBasinExposure

PAGE 27

JulySeptember20072517.TraviBL,FerroC,CadenaH,Montoya-LermaJ,AdlerGH.Caninevisceralleishmaniasis:doginfectivitytosandfliesfromnonendemicareas.ResVetSci.2002;72:83-86.18.OrndorffGR,CooperBA,SmithW,RyanJR.CaninevisceralleishmaniasisinSicily.MilitaryMed.2000;165:29-32.19.PozioE,GradoniL,BettiniS,GramicciaM.CanineLeishmaniasisinthefocusofMonteArgentRio(Grosseto).ActaTrop.1981;38:383-393.20.SchalligHD,SchooneGJ,KroonCC,HailuA,ChappuisF,VeekenH.DevelopmentandapplicationofsimplediagnostictoolsforvisceralLeishmaniasis.MedMicrobiolImmunol.2001;190:69-71.21.AsiaMJ,CastillejoS,GallegoM,FisaR,RieraMC.DiagnosticpotentialofwesternblotanalysisofserafromdogswithLeishmaniasisinendemicareas.AmJTropMedHyg.2001;99:105-111.22.SchantzP.VisceralLeishmaniasisinDogs.Atlanta,GA:CentersForDiseaseControlandPrevention;2002.23.MaroliM,MizzoniV,SiragusaC.EvidenceforanimpactontheincidenceofCanineLeishmaniasis.MedVetEntomol.2001;15:358-363.24.ReithingerR,TeodoroU,DaviesCR.Topicalinsecticidetreatmentstoprotectdogsfromsandflyvectorsofleishmaniasis.EmergInfectDis.2001;7:872-876.AUTHOR MAJKillianistheExecutiveOfficer,JapanDistrictVeterinaryCommandatCampZama,Japan.Previously,hewastheBranchChief,SouthernEuropeVeterinaryDetachment,SigonellaBranch,Sicily,Italy,fromAugust1999toAugust2000.

PAGE 28

26ArmyMedicalDepartmentJournalTheHiddenWorkofaLaboratoryAnimalVeterinarianMAJCraigA.Koeller,VC,USAIfoneasksmostpeoplehowalaboratoryanimalveterinarianintheArmycanmakeadifferencetotheSoldiersinatimeofwar,thelikelyresponsewillconcernmedicalproducttesting,vaccines,therapiesfordiseases,orperhapsbasicresearchintoareassuchaslimbregeneration.Anotherpossibility,butonemorelikelytobeoverlooked,istheprovisionofhelpinthetrainingofmedicalpersonnel,especiallythecombatmedic.Thistrainingwilllikelybemultifaceted,butmayinvolvetheuseofanimals,thusrequiringaveterinariantooverseetheiruse.Thefinaltrainingisimportantandcanyieldgreatresults,1buthowissuchtrainingdevelopedandwhatoccursinthehoursbehindthevisibleportionofrunningsuchtraining?Thisarticleprovidesaninsidelookfromtheperspectiveofaveterinarian,basedonmyexperienceinassistingintheimplementationofacombattraumacourseattheMadiganArmyMedicalCenter.Theeffortstartedinthemostbasicfashion,withsomeoneperceivinganeedforSoldiers(inthiscase,combatmedics)togetmoretraumatrainingtohelpsavethelivesoftheircomradesonthebattlefield.Inmyspecificcircumstance,itwasachancelunchtimemeetingwithoneofthelocalbrigadesurgeonswhoaskedifIknewofagroupinthehospitalthatcouldprovidesuchtraining.Theentiregroupmustbewillingtosupportthedevelopmentandexecutionofthetraining.Thegroupmustdetermineexactlywhatsubjectsshouldbetaught,relevanceofsubjectstrainedasrelatedtoinjuriesencountered,andactualmethodofprovidingthetraining.Thesubjectstaughtandrelevancearemainlydecidedbythedoctorsforwhomthemedicsworkandthesurgeonswhoseetheresultsofthetreatmentsmedicsprovide.Medicalsimulators,didactics,skillstations,andanimalmodelsallhavearoleinthistraining.TheUSAnimalWelfareAct2andArmyRegulation40-333requirethattheveterinarianbeintimatelyinvolvedinallaspectsofanimaluse,toincludehelpingtheresponsibleindividualwritetheproposalforthetrainingprogram.Theveterinarianmustactastheadvocateoftheanimalintryingtomakesuretheappropriatespecieswillbeused,onlytheactualnumberofanimalsthatareneededwillbeused,andthattheplannedandperformedproceduresmatchaftertheprotocolhasbeenapproved.ThisinformationiswrittenintoaproposalcalledananimalprotocolthatmustbeapprovedbyanInstitutionalAnimalCareandUseCommittee(IACUC).Thiscommitteewillreviewtheproposaltodetermineif1.theproposalwarrantsusinganimals,2.theprocedurestobeperformedareappropriatetothestudyortraininggoals,3.thepersonnelthatwillbeconductingthetrainingarequalifiedtodoso,4.therearealternativestousinganimals(atleasttosomeextentbyutilizingmedicalsimulators),and5.thewelfareoftheanimalsisprotected.TheCommitteecanaccepttheproposal,requirerevisionsbeforeacceptingtheproposal,orwithholdapproval.Inthecaseoftraumatraining,thediscussiononsuchaprotocolwilltendtobequiteinvolved.Itemsofinterestnormallyinclude:Appropriateanesthesiawillbemaintainedwhenanimalsarebeingused.Theanimalwillbeeuthanizedinahumanemanner.Maximumuseoftheanimal.Trainingofthemedicswillbebalanced.Procedurestobeperformedmatchwiththepeoplewhowillperformthem.Anesthesiaissimplertomaintainwhentheanimalisinasurgerytypesettingwheregasanesthesiacanbeused,butmoredifficultinafieldenvironment.Thecasualtywillbemovedandtransportedinafieldenvironment,andinjectableanesthesiaisused.Inthefield,theveterinarianandveterinarystaffmustbemorevigilantinconstantlyassessingtheanimals

PAGE 29

JulySeptember200727planeofanesthesiaaseachanimalwillmetabolizetheinjectableanestheticatadifferentrate.AfterthelocalIACUCapprovestheprotocol,theprotocolissubmittedtotheClinicalInvestigationsRegulatoryOffice(CIRO)toensurethatallapplicablelawsandregulationswillbefollowed.Afterreviewingtheprotocol,CIROwilladdressanyconcernstheyhavetothelocalIACUC.Thereare2otherareaswithinwhichtheveterinarianmustalsointeractinordertomakeacoursesuchasthispossible.Publicaffairsofficialsmustknowaboutthecourseandbefullybriefedonwhatwillbeoccurringandhowitisconducted.Itisespeciallyimportantthatitiswellunderstoodthattheanimalswillbeanesthetizedandmonitoredatalltimestoensuretheyfeelnopain.Photographstakenofanimalsusedduringthistrainingcouldresultinalargeoutcryfromanimalrightsproponents,especiallyifmisinformationaccompaniesthepictures,suchasnoacknowledgementthattheanimalsareanesthetized.Itisthejobofpublicaffairsofficialstohelpdiffusethemisconceptionsandensurefactsaredisseminatedifinformationmustbeprovidedtooutsidemediaorinresponsetoquestionsfromindividuals.ThelastagencythatshouldbeconsultedisofficeofOccupationalHealthandSafety.Anyworkaroundanimalscarriessomerisks.Themostcommonriskistheallergensthatanimalscarry.Peoplecanhaveanallergicreactiontothefur,dander,orotheraspectsoftheanimals.OccupationalHealthwillhelptoperformariskassessmentforexposurestopotentialallergensforbothparticipantsandinstructors.IncooperationwithOccupationalHealth,partoftheveterinariansbriefingaboutthelabandfieldphasesincludesinformationaboutpossiblezoonoticdiseasestheanimalsmayharbor,andaswellasthepotentialallergensandallergies.Studentsarewarnedaboutthepossibilityofallergies.TheyareaskedtoinformtheinstructorsorOccupationalHealthiftheysufferfromasthmaorknownallergiesthatcouldaffecttheirhealthduringthecourse.Theveterinarianoverseesthepurchaseandcareofallanimals.Theveterinarystaffmustanesthetizeandpreparetheanimalsforthecontrolledskillslaboratoryandthefieldexercise.Whiletheinstructorsdemonstrateskillsorassesstheskillsofthestudents,theveterinarystaffworksinthebackgroundcontrollingtheanimalsanesthesiatoensurethatnopainisfelt.ItisextremelysatisfyingtobeaparticipantinacoursesuchastheMadigancombattraumacourse,asthegrowthofthemedicsskillsisclearlyevidentasthecourseprogresses.Theirconfidenceintheirskillsincreasesaswell.Thehourscanbelong,especiallywhenperformingfieldtraining.TheUSmilitaryownsthenight,thereforemedicsmusttreatpatientsinthedark.Wehonorthecreedtotrainaswefight,accordingly,thetraumatrainingofmedicsmustincludetrainingduringthehoursofdarkness.Thus,thefinaldayofthefieldphaseportionoftheMadigancombattraumacoursewouldlastfromabout9AMuntilmidnight.Thelaboratoryanimalveterinarianisavitalmemberofanytraininginvolvinganimals.Thepersonfillingthisroleisnotonlyinahighlyvisiblepositionintheconductoftheactualtraining,butisalsoverymuchinvolvedintheworkrequiredtoobtainapprovalforsuchaprogram.Indeed,perhapsthemostimportantroleoftheveterinarianishelpingtoobtainprotocolapproval,andensuringthatalloftherequirementsoffederallawandmilitaryregulationsarefollowed.Althoughitmaynotbeasvisibleorappreciated,itisthisworkthatmakesthetrainingpossible.REFERENCES 1.SohnVY,MillerJP,KoellerCA,etal.Fromthecombatmedictotheforwardsurgicalteam:theMadiganmodelforimprovingtraumareadinessofbrigadecombatteamsfightingtheglobalwaronterror.JSurgRes.2007;138(1):25-31.2.AnimalWelfareAct,7USC,2131-2159(1990).3.ArmyRegulation40-33:TheCareandUseofLaboratoryAnimalsinDODPrograms.Washington,DC:USDeptoftheArmy;February16,2005.AUTHOR MAJKoellerisChief,VeterinarySupportServices,VeterinaryMedicineDivisionattheUSArmyResearchInstituteofInfectiousDisease,FortDetrick,Maryland.Previously,hewasChief,LaboratoryAnimalResourcesServiceDepartmentofClinicalInvestigation,MadiganArmyMedicalCenter,FortLewis,Washington.

PAGE 30

28ArmyMedicalDepartmentJournalINTRODUCTIONTheuseofinfectiousagentsasbiologicalweaponsdatesatleastasfarbackasthe14thcentury.Sincethattime,therehavebeendocumentedinstancesofthedeliberateuseofbiowarfareagentssuchasplague,smallpox,glanders,andanthraxtoachievemilitarygoals.1Extensivestate-sponsoredbiologicalweaponsprogramswereconductedinthe20thcenturybyGermany,Japan,andtheformerSovietUnion.2TheUnitedStatesalsooperatedaprogramthatincludedtheweaponizationofseveralinfectiousagentsuntil1969,whenPresidentRichardNixonendedthecountrysoffensiveweaponsprogram.Sincethattime,theUnitedStateshaslimiteditseffortstodefensivecountermeasuresagainstbiologicalagents.ConcernsaboutthethreatsposedbybiologicalweaponshaveintensifiedinrecentyearsduetoinformationbroughttolightsincethefalloftheSovietUnion,attemptsbyterroristgroupsandotherstoobtainbiowarfareagents,andasaresultoftheanthraxmurdersintheUnitedStatesin2001.Concernaboutbiologicalweaponsisfurtherincreasedbecauseofanunderstandingofthepotentialharmpresentedbygeneticallyengineeredagents.Notsurprisinglythen,thematterofbiologicalweaponsisofgreatinteresttotheDepartmentofDefense(DoD).Theinfectiousagentstypicallyassociatedwithbiologicalweaponsarealsoofconcernbecausemilitarymembersmaybeexposedtothemnaturallyinareasofmilitarydeployments.Thenatureofthediseasethatmayresultfromexposureoftroopstobiowarfareagents,whethernaturallyorthroughdeliberatespread,canvarygreatly.Somebiowarfareagentscauseincapacitatingdiseasewithhighmorbidity,whileotherscanbehighlylethal.Eitherway,theyposeamajorchallengeforcombatcommandersandsupportpersonnel,especiallymedicalunits.Thereis,therefore,agreatneedtodevelopeffectivecountermeasurestocontendwiththethreatposedbybiologicalagents.Countermeasuresagainstbiologicalagentsincludediagnostics,vaccines,therapeuticagents,andoperationalpractices.Historically,muchoftheresearchnecessarytodevelopsuchcountermeasureshasfallenuponthemilitarybecauseitwasnotconsideredtohavemuchrelevancetothecivilianpopulation.Thatphilosophyhaschangedinrecentyears,however,especiallyinlightoftheanthraxmurders.Nonetheless,themilitaryhasplayedaleadroleinthenationsbiodefenseresearchprogram.TheUSArmyMedicalResearchandMaterielCommandistheexecutiveorleadagencyresponsiblefor2keybiodefenseprograms,theMedicalChemicalandBiologicalDefenseResearchProgramandtheMilitaryInfectiousDiseasesResearchProgram.ActualresearchinvestigationsundertheseprogramsareperformedatavarietyofDoDandcivilianinstitutions.ThemajorityofmilitarystudiesthatrequirebiologicalcontainmentareperformedattheUSArmyMedicalResearchInstituteofInfectiousDiseases(USAMRIID),whichhousesbiocontainmentfacilitiesatbothbiosafetylevel3(BSL-3)andBSL-4(maximumbiocontainment).ResearchatUSAMRIIDisconductedincompliancewiththeAnimalWelfareAct*andotherfederalstatutesandregulationsrelatingtoanimalsandexperimentsinvolvinganimals,andadherestoprinciplesestablishedbytheInstituteofLaboratoryAnimalResearch.3ThefacilitywhereresearchisconductedatUSAMRIIDisfullyaccreditedbytheAssociationforAssessmentandAccreditationofLaboratoryAnimalCareInternational(5283CorporateDrive,Suite203,Frederick,MD21703-2879).Thechallengestodevelopingcountermeasurestobiologicalagentsaremanyandvaried.Thedevelopmentofvaccines,antibiotics,andothertherapeuticsforuseinhumansisaprocessthat,underChallengesinBiodefenseResearchandtheRoleofUSArmyVeterinaryPathologistsCOLKeithE.Steele,VC,USAMAJDerronA.Alves,VC,USAMAJJenniferL.Chapman,VC,USA *7USC,2131-2159.Availableat:http://www.nal.usda.gov/awic/legislat/awa.htm.

PAGE 31

JulySeptember200729thebestofcircumstances,takesseveralyearsandcostsmillionsofdollarsforeachproduct.Productdevelopmenttypicallyrequiresadvancedknowledgeaboutthepathogenesisofthediseaseagentinhumans.Italsorequiresthatoneormoreappropriateanimalmodelsexistforwhichthediseasecourseissufficientlysimilartothehumancondition,sothatthesafetyandefficacyofthevaccineortherapeuticagentcanadequatelybeassessed.Formanybiowarfareagents,theefficacyofvaccinesortherapeuticscannotevenbetestedinhumans,forethicalorotherreasons.Thishasrecentlyledtotheacceptanceoftheso-calledanimalrule,whichpermitstheFoodandDrugAdministration(FDA)torelyonevidencefromanimalstudiestojudgethelikelyeffectivenessofvaccinesortherapeuticsinhumans.Thisapproachrequiresthatthepathogenesisofaparticulardiseaseagentiswelldemonstratedinoneormoreanimalmodelsandthatthenaturebywhichavaccineortherapeuticwouldprovideprotectioniswellunderstood.Theuseoftheanimalruletofacilitatedevelopmentofbiowarfarecountermeasuresprovidesakeytoolinbiodefenseprograms,however,itplacesevengreateremphasisontheproperconductofanimalstudies,includingpathogenesisstudiesandvaccineordrugtherapystudiesinvolvingpathology.ArmyVeterinaryCorps(VC)officersarekeycomponentsoftheresearch,support,andheadquartersstaffsofUSAMRIID.SeveralVCofficershaveservedasUSAMRIIDcommandersanddeputycommandersinrecentyears.VeterinaryCorpspathologistsdirectUSAMRIIDspathologyservices,performallphasesofpathologyanalysisforinstitutestudies,andconductprimaryresearch.VeterinaryCorpspathologistsrepresentaverysmallproportionoftheofficersintheArmyMedicalDepartment,yettheyaresomeofthemosthighlytrainedprofessionalsintheUSArmyandperformsomeofthemostdemandingandpotentiallyhazardousportionsofDoDbiomedicalresearch.PathologytrainingofgraduateveterinariansintheVeterinaryCorpsconsistsofarigorousresidencyprogramattheArmedForcesInstituteofPathology(AFIP),leadingtoboardcertification.Uponcompletionoftheresidency,veterinarypathologists(areaofconcentration64D)areassignedtoArmy,Navy,AirForce,andjointlaboratoriesatanumberofsites,bothinandoutsideoftheUnitedStates.TheseincludetheAFIP,WalterReedArmyInstituteofResearch,USArmyMedicalResearchInstituteofChemicalDefense,AirForceResearchLaboratory,andArmedForcesResearchInstituteofMedicalSciences.SomeVCpathologistslaterentergraduateprogramsleadingtothePhDdegree.Areasofbiomedicalresearchinwhichveterinarypathologistsareinvolvedrangefromcombatcasualtycaretochemicalagentcountermeasurestostudiesofavarietyofinfectiousdiseases.Theseresearchareasrelyheavilyonanimalmodelsassurrogatesforhumanconditions.PathologistsatUSAMRIIDspecificallystudycountermeasurestosomeofthemostlethalbiologicalagentsknown,includingplague,anthrax,botulinumneurotoxin,Ebolavirus,andsmallpox.4WorkingwiththeseagentsrequiresthatveterinarypathologistsatUSAMRIIDconductresearchinBSL-3andBSL-4laboratories.Pathologistsmaygainsufficientexperienceandknowledgetobecomesubjectmatterexpertsonparticularagents,andareoftencalledupontoprovidetheirexpertisetoorganizationswithinandexternaltothemilitary.Forexample,ArmypathologistsfromUSAMRIIDhaveplayedmajordiagnosticrolesindiseaseoutbreaks,suchastheimportationintotheUnitedStatesofEbolavirusinmonkeys,theemergenceofWestNilevirusinbirdsandhorses,andanoutbreakofmonkeypoxinimportedpetanimals.5-8Also,USAMRIIDpathologistshaveparticipatedinfieldstudiesaround USAMRIIDpathologypersonnelatworkinabiosafety-level-4laboratory.Biocontainmentandpersonalsafetyconsiderationsforresearchwithcertainpathogensmandateavarietyofpreventivemeasures,includingthatpersonnelwearself-contained,chemicallydisinfectablesuitssuppliedwithHEPA-filteredair.

PAGE 32

30ArmyMedicalDepartmentJournaltheworldrelatedtodiseasesliketularemia,plague,andEbolavirus.SuchstudiesareeitherDoDsponsoredorpathologistsmayserveastemporaryconsultantstoorganizationsliketheWorldHealthOrganization.TherolethatUSAMRIIDpathologistsplayinbiodefenseresearchhasevenbeenfeaturedinthepopularliterature.9,10Intheremainderofthisarticle,weillustrateimportantchallengesinbiodefenseresearchbyconsidering3importantbiowarfare-relateddiseasesofconcerntotheDoD.Wediscussthenatureofthechallengepresentedbyeachdisease,reviewkeybiologicalfeaturesofeach,andhighlighttheroleofarmyveterinarypathologistsinbiomedicalresearchthroughtheircontributionstotheknowledgebaseofthesediseaseareas.VENEZUELANEQUINEENCEPHALITISVenezuelanequineencephalitis(VEE)isanimportantmosquito-transmittednaturaldiseaseofhorses.Itissimilarto2othermembersoftheAlphavirusgenus,easternequineencephalitisandwesternequineencephalitis.Despitetheirnames,however,all3virusesaresignificantnaturalcausesofhumandisease,areconsideredbiowarfareagents,andhavebeenthesubjectofextensivevaccinedevelopmenteffortsatUSAMRIID.InvestigationswiththesevirusesareconductedatBSL-3.Inhumans,VEEvirususuallycausesanacute,febrile,incapacitatingdisease.Onoccasion,VEEcauseslargeoutbreaks,suchasthe1995epidemicinColumbiaandVenezuelathatinfectedasmanyas100,000people.11Thevirusisalsohighlyinfectiousbyaerosol,havingcausedatleast150infectionsinlabworkers,mostofwhichwereprobablytheresultofaerosolinfection.12TheVEEvirusisalsoeasilygrowntohightiterincultureandisrelativelystableinstorage,conditionsthatfacilitateweaponization.AlthoughVEEisrarelylethalinadults,theviruscouldserveasasignificantincapacitatingagentifusedinabiologicalattack.TheVEEvaccineprogramatUSAMRIIDhasbeenactiveforseveralyears,buteffortshavebeenconfoundedby2importantfactors.Oneistheneedforavaccinethatdemonstrateseffectiveimmunityagainstaerosolinfection,amoredifficultstandardtoachievethanimmunityagainstnaturalinfectionbymosquitoes.Further,multipleserotypesofVEEvirusesexistandthevirusisreadilyamenabletogeneticmanipulation,soavaccinemustbecapableofprovidingasignificantdegreeofcross-protectionagainstanumberofvirusstrains.FrominvestigationsofVEEoutbreakstogetherwithexperimentalanimalstudies,thereisafairamountknownaboutthepathogenesisofVEE.TheincubationperiodofVEEvirusinhumansisabout1to4days,afterwhichpatientsdevelopfever,severeheadache,myalgia,andchills,lastingfromafewdaysto2weeks.11,13,14InfectionofthecentralnervoussystemdevelopsinaminorityofVEEcases,resultinginconvulsions,paralysis,andsometimesdeath.AnumberofanimalspeciesaresusceptibletoVEEvirusandtheymimicimportantaspectsofthehumandisease.15RhesusandcynomolgusmacaquesarebothsusceptibletoinfectionwithVEEvirusandexhibitdiseasemuchlikethatofhumans.16Theirusefulnessislimitedthoughbytheircost,availability,size,andanimal-useconcerns.Therefore,micehavebeenthemostextensivelyusedanimalmodelforVEE.Likehumans,micealsoexhibitabiphasicillnesswithinfectionofperipheraltissuesprecedingneuroinvasion.Inmice,though,100%ofsusceptiblestrainsdevelopcentralnervoussysteminfectionanddie.InthemousemodelofVEEthatmimicsmosquitotransmissionofvirus,so-calleddendriticcellsintheskinarethefirsttypeofcellinfected.17ThemobiledendriticcellstransportvirustothedraininglymphChallengesinBiodefenseResearchandtheRoleofUSArmyVeterinaryPathologists AUSAMRIIDpathologist(facing)processingsamplesinajunglelaboratory.USAMRIIDpathologistshavedeployedinavarietyofscientificroles,includinginvestigationstodiscoverthenaturalreservoirofEbolavirusintheDemocraticRepublicoftheCongoandtheIvoryCoast(shownabove).

PAGE 33

JulySeptember200731node,whereinitialreplicationoccurs.18Thisresultsinviremia,afterwhichvirionsinthebloodappeartogainaccesstothebrainbywayoftheolfactorynerves.19Virusthenspreadsthroughoutthebrainandintothespinalcord.20,21Neuronsaretheprimarytargetofviralinfectioninthebrain,andtheysuffermassivecelldeath.20-22AtUSAMRIID,aerosolstudiesofVEEinmicehavebeenusedtostudythecourseofdiseaseexpectedinabiowarfareevent.Bytheaerosolroute,VEEvirusfirstinfectstheolfactoryneuronsofthenasaltract.20,21Becausetheolfactoryneuronsprojectaxonsdirectlytothebrain,VEEvirusrapidlyinvadesthebrainbythisrouteofinoculation,independentofthedevelopmentofviremia.Althoughothertissuesarealsoinfectedafteraerosoladministration,therapidandoverwhelminginfectionofthebrainisthekeyevent.Bycomparison,macaquesinfectedwithVEEvirusbybothperipheralandaerosolroutesdevelopfever,viremia,lymphopenia,andoccasionallyencephalitis,butrarelydie.16NeuroinvasionbyVEEvirusindependentofviremiaillustratesakeychallengeindevelopingvaccineseffectiveagainstaerosolizedvirus.ViremiaappearstobeanobligatorystepinthepathogenesisofnaturalVEEinfection,thereforethedevelopmentofserumneutralizingantibodies(IgG)protectsagainstaperipheralinfection,asisalsothecaseforotheralphaviruses.23,24However,neutralizingIgAantibody,notserumIgGantibody,isrequiredtoprotectmiceagainstaerosolchallengewithVEEvirus.23,25AneffectiveVEEvaccinemustthereforebeabletostimulatesufficientmucosalIgAantibodiestoprotectagainstaerosolinfectionofthenasaltract,aswouldbeexpectedinabiowarfareevent.TC-83,alive-attenuatedVEEvaccinedevelopedatUSAMRIID,isusedtovaccinatelaboratoryworkerswhohandleVEEvirusunderInvestigationalNewDrugstatus.TC-83islimitedinitsbroaderusefulness,though,becauseitcausesadversesideeffectsinapproximately23%ofhumanrecipients,anadditional18%ofrecipientsfailtodevelopprotectiveserumantibodies,andthevaccinedoesnotprovidesufficientprotectionagainstaerosolinfectioninanimals.23,25V3526isarationallydesigned,geneticallyengineeredVEEvaccine,underdevelopmentforseveralyears.26StudiesatUSAMRIIDcomparingV3526andTC-83showedthatV3526inducedprotectiveserumandmucosalantibodytiterswithfewernonrespondersinmiceanddemonstratedbetterprotectionagainstaerosolinfectionofmiceandnonhumanprimates.25,27ItalsoprotectedmiceandnonhumanprimatesagainstchallengewithaheterologousstrainofVEEvirus.28,29AdditionalUSAMRIIDstudiesshowedthatV3526appearedsaferthanTC-83inrodents,beinglessreactogenicandexhibitingsignificantlyreducedneurovirulenceanddecreasedreversionpoten-tial.20,25,28Byseveralmeasuresbasedonanimalstudies,V3526appearstobeasaferandmoreeffectivevaccinecandidatethanTC-83.16,30CompletionofhumantrialswithV3526requiredforFDAapprovalandlicensureremainsasignificanthurdlebeforethisvaccinecanbeusedinitstargetpopulation.SMALLPOXSmallpoxvirusisanagentofpotentiallydevastatingimpacttoboththemilitaryandtheciviliancommunities.Thevirusiseasilytransmittedfrompersontopersonandproducesdiseasewithamortalityratearound30%.31Forcenturiesthescourgeofmankind,smallpoxwasofficiallyconsiderederadicatedin1980,providingperhapsthegreatestpublichealthachievementagainstaninfectiousdiseaseinhistory.Officialrepositoriesofvariolavirus,theagentofsmallpox,continuetoexist;however,theyareconfinedtobiocontainmentfacilitiesattheCentersforDiseaseControlandPrevention(CDC)inAtlanta,GA,andattheStateResearchCentreofVirologyandBiotechnologyinRussia.32Additionalclandestinesourcesmayalsocontinuetoexistinotherlocationsaroundtheworld.33TheSovietUnionisreportedtohavemanufacturedlargequantitiesofvariolavirusformilitarypurposes.1,34Variolavirusisconsideredrelativelystableinaerosols,makingitamenabletoweaponization.Forthesereasons,smallpoxremainsaseriousconcernasanagentofbiowarfareorbioterrorism.Thisconcernismadegreaterbecausepopulationimmunitytovariolavirushasgreatlywanedsinceactivevaccinationofpeopleceasedaftertheeradicationofsmallpox.Effortstoreconstitutethesmallpoxvaccinationprogramforindividualsconsideredatriskhavebeenmetwithresistance,duetoconcernsabouttheadverseeventsthatmaybeassociatedwiththevaccine.Complicationssuchaspostvaccinalencephalitisandgeneralizedvacciniaareaparticularriskforpeoplewithimmunosuppressionorexistingskindiseasesuchaseczema.33Forvariousreasonsthen,anydeliberateuseofsmallpoxvirus

PAGE 34

32ArmyMedicalDepartmentJournalwouldplacegreatdemandsonourabilitiestoquicklydetectitsintroduction,totreataffectedindividuals,andtolimititsspread.Animalmodelsofsmallpoxarethereforeneededtodevelopimprovedcountermeasureslikeantiviraldrugs,aneffectiveandsafevaccine,andrapiddiagnostictests.Inaddition,thereisaneedtobetterunderstandmanyofthebasicpathophysiologicalandimmunologicalaspectsofsmallpoxinhumans,asthediseasewaseradicatedbeforemanymodernscientifictechniquescouldbeappliedtohumaninfections.35,36Variolavirusisoneof5speciesinthegenusOrthopoxvirusthatmaycauseactiveinfectioninhumans.Theothersaremonkeypoxvirus,cowpoxvirus,andtoalesserextent,camelpoxandvacciniaviruses,thelatterbeingthevirususedforsmallpoxvaccination.Additionalorthopoxviruses,suchasrabbitpoxandectromeliavirus(mousepox),arenotpathogenicforhumans,yetliketheotherorthopoxviruses,theycanserveasusefulanimalmodelsforunderstandingsmallpox.Whilemonkeypox,cowpox,andcamelpoxarezoonoticdiseases,variolaviruswasstrictlyahumanpathogeninnature.Infact,theeradicationofsmallpoxfromtheworldwassuccessfulmuchduetothefactthatanimalreservoirsofthevirusdidnotexisttoreintroducethevirusintothehumanpopulation.Thedevelopmentofananimalmodelforsmallpoxresearchisaverydifficultendeavorbecauseoftheresistanceofanimalstoinfection,achallengemadeevengreaterbythelogisticalcomplicationsofworkingwithvariolavirus.NotonlyisvariolavirusaBSL-4agent,butlaboratoryworkwiththevirusintheUnitedStatescanonlybeperformedundermaximumbiocontainmentattheCDC.Tomeetthesechallenges,researchatUSAMRIIDmakesuseofavarietyofanimalmodelsoforthopoxdiseaseaimedatfulfillingtheanimalrule.Thereare2varietiesofsmallpox,variolamajorandvariolaminor,basedonseverityofdiseaseandmortalityrate.Variolamajorhasacase-fatalityrateof30%amongunvaccinatedpersons,whereasvariolaminorhasa1%case-fatalityrate.Factorsthataffectmortalityincludeage,viralstrain,immuneresponse,andnutritionalstatus.Bothhumoralandcell-mediatedimmunityareimportantinrecoveryfromthisdisease.31Theclassic,orordinary,formofsmallpoxisafebrilediseasewithacharacteristicvesiculopustularskinrash.Itisnaturallyspreadthroughaerosolordropletsfromoropharyngealsecretions,orbydirectcontactwithinfectedpersonsorfomites.37Thecauseofdeathfromsmallpoxappearstobetheresultofacytokinestorm,ahostresponsetoviralinfectionpreviouslyreferredtoastoxemia,aswellasbydirectvirustissuedamage.35,37,38Otherclinicalformsofsmallpox,suchasthehemorrhagicandflat-type,arelesscommonbuthighlypathogenic.USAMRIIDinvestigatorsandpathologistsworkingattheCDChaverecentlyestablishedanonhumanprimatemodelofsmallpoxbyinfectingcynomolgusmacaques(Macacafascicularis)withstrainsofvariolaintravenously.Usinghighdosesofvirus,monkeysdevelopsystemicdiseasethatcloselyresemblesthehemorrhagicformofhumansmallpox,andexhibituniformlethality.38Pathologydemonstratedviralinfectionandorgandysfunctionaffectingthelymphoidtissues,skin,oralmucosa,gastrointestinaltract,reproductivesystem,andliver.Elaborationofcytokineswasalsoshowninthesemonkeys.Inoculationofcynomolgusmonkeyswithhighdosesofvariolabyaerosolproducesanonlethalillnessinwhichthemonkeysdevelopamildskineruptionbutdonotdeveloplesionstypicalofclassicsmallpox.39Thenonhumanprimatemodelofvariolainfectionhasalreadybeenusedtoevaluatetheefficacyoftheantiviraldrugcidofovir,showingthatthedrugcansignificantlylowerviremiasandthedevelopmentofskinlesions,aswellaspreventdeath.35Monkeypoxisnotonlyaveryusefulanimalmodelforsmallpox,itissometimesafatalhumanpathogenaswell.SeveralhumancasesofmonkeypoxoccurredintheUnitedStatesin2003afterintroductionofthevirusbyimportedrodentsfromGhana.6Monkeypoxisgenerallyverysimilarclinicallytosmallpoxbutthevirusdoesnotspreadaseasilyamonghumans,likelydecreasingitseffectivenessasabiowarfareagent.Therouteofinfectionbymonkeypoxvirusisalsosimilartothatofsmallpox,includingbytherespiratoryroute.31AsignificantbenefitofthemonkeypoxmodelisthatexperimentscanbeconductedunderBSL-3atUSAMRIID.Inparticular,theaerosolmodelofmonkeypoxisrelevanttothediseaseexpectedafterabiowarfarerelease.AkeyUSAMRIIDpathologystudyshowedthataerosolinfectionofcynomolgusmonkeysproducedlethalmultisystemicdiseaseandthatviralinfectionofthelowerairwayscausingbronchopneumoniawasprominent.40MonkeyshavealsobeenshowntobesusceptibletomonkeypoxvirusChallengesinBiodefenseResearchandtheRoleofUSArmyVeterinaryPathologists

PAGE 35

JulySeptember200733bytheintravenous(IV)route.35TheIVandaerosolmodelsofmonkeypoxhavebothbeenusedtoinvestigatealternativemethodsofvaccination,withpromisingresults.35TheIVmonkeypoxmodelhasbeenusedtoshowtheefficacyofcidofovirtreatment,similartothesmallpoxmodel.Avarietyofadditionalanimalmodels,includinginfectionofmicewithectromeliaandvacciniaviruses,havebeenusedtostudymechanismsoforthopoxvirusinfection.AnotherUSAMRIIDpathologystudyrelevanttobiowarfareconcernsshowedthatinfectingmicewithaerosolizedcowpoxvirusreproducedkeyfeaturesoforthopoxvirusdiseaseandspecificallytargetedtherespiratorysystem.41Thismodelwasusedtoshowthataerosolizedcidofoviradministrationcouldprovideausefultherapyforaerosolinfectionsbysmallpoxandmonkeypoxwhilelimitingsomeofthepotentialtoxicsideeffectsofthisdrug.42Manychallengesremainintheuseofanimalmodelstodevelopcountermeasurestosmallpox,includingamorethoroughunderstandingofpoxvirusvirulencefactors,host-pathogeninteractions,andthebasicpathophysiologyofinfection.Inparticular,itremainstobedeterminedwhichofthemonkeymodels,monkeypoxorvariola,betterrecapitulatesmallpoxinfectioninhumansandhowappropriateeitherofthesemodelsistoinfectionwithsmallpoxvirusintheeventofabiowarfarereleaseorthesubsequenthumantohumantransmissionthatmightfollowabiowarfarerelease.EBOLAVIRUSEbolahemorrhagicfeverisoneofthemostlethaldiseasesofhumans,withmortalityratesinnaturaloutbreaksapproaching90%.43,44AnumberofconfirmedoutbreaksofEbolavirus(EBOV)havebeendocumentedsincetheviruswasfirstrecognizedin1976,mostofthesearisingincentralAfrica.Humanoutbreaksappeartobeinitiatedthroughthehandlingofinfectedwildanimals,inparticularchimpanzeesandgorillas.45,46Subsequenthumantohumantransmissionthenoccursthroughcontactwithinfectedbodilyfluids,secretionsortissues,usuallyamongfamilymembersorfrominfectedpatientstomedicalpersonnel.Withregardtothepotentialforweaponizationandbiowarfareuse,EBOVisfairlystableunderharshenvironmentalconditionsandishighlyinfectiousandstableasfineaerosols.44EbolavirusisaBSL-4pathogen.TheincubationperiodofEbolavirusinfectioninhumansisrelativelybroadat2to21days,however,mostcasesprobablyinvolveamuchshorterincubationperiodwithdeatharound7to10daysafterinfection.Infectionischaracterizedinitiallyasanacute,severe,febrileillnesswithevidenceofvascularinvolvement.47,48Laterinthediseasecourse,immunesuppression,multisystemdysfunction,shock,andcoagulopathyoccur.Patientsoftenbegintodevelopdisseminatedintravascularcoagulopathy(DIC)byday5postinfection.ThekeytargetsofEbolavirusarecellsofthemononuclearphagocytesystem,hepatocytes,andpossiblyendothelialcells.PathologistsatUSAMRIIDhaveworkedextensivelywithotherinvestigatorstocharacterizeanimalmodelsofEbolavirustobegintounderstanditsextremevirulence.Todate,mouse,hamster,guineapig,andnonhumanprimatemodelsofEbolavirusinfectionhavebeendevelopedandusedtoinvestigateavarietyofpathogeneticfactorsthatcontributetovirulence.AsisthecasewithbothVEEvirusandsmallpox,thenonhumanprimatemodelofEbolavirusinfectionmorecloselyresemblesthehumancondition.NonhumanprimatestudieshaveshownthatEbolaviruscanbetransmittedbyavarietyofroutes,includingintramuscularinoculation,aerosoladministration,andbytheoralandconjunctivalroutes.18Studiesofmice,guineapigs,andnonhumanprimateshaveallshownthatmonocytesandmacrophagestogetherrepresentanearlyandsustainedtargetofEBOVandarethemainmeansbywhichthevirusisdisseminatedthroughoutthebody.18,49-52ThesefindingshelpconfirmtheimportanceofinfectedmacrophagesinhumanEbolahemorrhagicfever.Dendriticcellsinanimalsappeartobekeyearlytargetsaswell.53Ebolavirusalsotargetsandcausesextensivedamagetohepatocytes,adrenalcells,fibroblasts,andavarietyofepithelialcelltypeslaterinthecourseofdisease.LymphoiddamageandthrombocytopeniaarealsoprominentfeaturesofEbolavirusinfection,buttheseareindirecteffectsofviralinfection.WhileendothelialcellshavebeenconsideredimportantinthepathogenesisofhumanEbolahemorrhagicfever,theanimalstudieshavequestionedthisparadigm,suggestingthatthehemorrhagicmanifestationofEbolahemorrhagicfeverismorelikelytheresultofacytokinestormsubsequenttoinfectionofmononuclearphagocytesthanadirecteffectofvirus-inducedcytolysisof

PAGE 36

34ArmyMedicalDepartmentJournalendothelialcells.49,53Virus-mediatedalterationofmononuclearphagocytesanddendriticcellsalsoappearscriticaltotheimmunesystemdisruptionthatisanotherkeyfeatureofEbolainfection.WhilethemouseandguineapigmodelssharethekeyfeaturesofEbolavirusinfectionwithrespecttoviraltropism,organdamage,andlethaldiseasecourse,theydonotexhibitotherimportantfeaturesofthedisease.ThemousemodelofEbolaviruscharacteristicallylackstissuefibrindepositionandDIC,andinfectedmicefailtodevelopthecharacteristicmaculopapularrashoroverthemorrhageseeninhumanandnonhumanprimateEbolavirusinfections.51Experimentallyinfectedguineapigsexhibitvariabletissuefibrindepositionandonlylimitedhemorrhagiclesions.49Nonhumanprimates,however,developfibrindeposition,DIC,andhemorrhagesimilartohumans.Thus,nonhumanprimatesexhibitavarietyofthefeaturesofEbolahemorrhagicfeverseeninhumansandgenerallyconstituteamorerelevantanimalmodel.Oneoftheimportantbenefitsofpathogenesisstudiesisthattheycanidentifyavenuestodeveloptherapeuticcountermeasures.Therefore,thevariousanimalmodelsofEbolahemorrhagicfevercontinuetobeusedtoexplorethemolecularmechanismsthatunderlietheseverenatureofthisdisease.Asadirectresultofsuchresearch,thedevelopmentofapotentialtherapytomitigatecoagulopathybytreatmentwitharecombinantinhibitoroftissuefactorVIIAhasshownpromiseinnonhumanprimatesinfectedwithEbolavirusatUSAMRIID.54Avarietyofothermediatorsofcoagulopathyandinflammationremaintobeexplored.Inaddition,animalmodelsofEbolavirushavebeenextensivelyutilizedinvaccinedevelopment.ThedevelopmentofasafeandeffectiveEbolavirusvaccinerepresentsanotherdifficultchallengeofbiodefenseresearch.Inactivatedvaccineshavenotshownmuchpromiseinanimalstudies.55,56AttenuatedvaccinesforanagentlikeEbolavirusmakepoorcandidatesbecauseofconcernsoverreversiontovirulence.Asaresultoftheseconcerns,anumberofnovelalternativemethodshavebeenrecentlystudied,withvaryingsuccessinanimals.TheseincludeDNAvaccines,virus-likeparticlevaccines,andvesicularstomatitisvirus-basedvaccines.56Recently,aDNAvaccineforEbolaviruswasshownsafeandimmunogenicinhumantesting.57ManyhurdlesremaininthesearchforeffectiveEbolavirusvaccinesandtherapies,andultimatelythetestingofsuchcountermeasuresforefficacywillrequiretheuseofappropriateanimalmodelsinordertofulfilltheFDAsanimalrule.SUMMARYForyearsthenationsdevelopmentofmedicalcountermeasurestobiowarfareagentshasprimarilyexistedasthedomainoftheUnitedStatesmilitary,butithastakenonincreasedurgencyinthelastfewyears.Therealizationthatthecivilianpopulationisalsoatriskfrombiologicalagentshasresultedintheinstitutionofnewbiodefenseprogramsatavarietyofnonmilitaryorganizations.USAMRIID,along-timeleaderinthenationsbiodefenseeffort,willsoonbejoinedbyotherUSgovernmentagenciesaspartofaplannedNationalInteragencyBiodefenseCampusatFortDetrickMaryland.*USArmyveterinarypathologistsatUSAMRIIDhaveplayedanimportantroleinthenationsbiodefenseeffort,alongwithourveterinarycolleaguesrepresentingotherspecialties,ourmilitarycolleaguesinotherArmyMedicalDepartmentcorps,andourciviliancolleagues.Together,wewillcontinuetostrivetodevelopthediagnostics,vaccines,therapeuticagents,andoperationalpracticesthatarerequiredtomeetthegreatdemandsposedbythethreatofbiowarfareagents.REFERENCES 1.MartinJ.Thehistoryofbiologicalweapons.In:SwearengenJR,ed.Biodefense:ResearchMethodologyandAnimalModels.BocaRaton:TaylorandFrancis;2006:1-23.2.SmartJ.Historyofchemicalandbiologicalwarfare:anAmericanperspective.In:ZajtchukR,ed-in-chief;SidellFR,TakafujiET,FranzDR,eds.TextbookofMilitaryMedicine:MedicalAspectsofChemicalandBiologicalWarfare.Washington,DC:BordenInstitute,OfficeoftheSurgeonGeneral,USDeptoftheArmy;1997:9-86.3.NationalResearchCouncil.GuidefortheCareandUseofLaboratoryAnimals.WashingtonDC;NationalAcademyPress;1996.ChallengesinBiodefenseResearchandtheRoleofUSArmyVeterinaryPathologists *InformationabouttheNationalInteragencyBiodefenseCampusisavailableathttp://www.detrick.army.mil/nibc/nibc01.cfm.

PAGE 37

JulySeptember2007354.HenchalE,Vander-LindenC.USAMRIID:Thecornerstoneformedicalbiodefense.ArmyMedDeptJ.October-December2004:8-12.5.JahrlingPB,GeisbertTW,JaaxNK,HanesMA,KsiazekTG,PetersCJ.ExperimentalinfectionofcynomolgusmacaqueswithEbola-Restonfilovirusesfromthe1989-1990USepizootic.ArchVirolSuppl.1996;11:115-134.6.KuleshDA,LovelessBM,NorwoodD,etal.Monkeypoxvirusdetectioninrodentsusingreal-time3'-minorgroovebinderTaqManassaysontheRocheLightCycler.LabInvest.2004;84(9):1200-1208.7.LanciottiRS,RoehrigJT,DeubelV,etal.OriginoftheWestNilevirusresponsibleforanoutbreakofencephalitisinthenortheasternUnitedStates.Science.1999;286:2333-2337.8.SteeleKE,LinnMJ,SchoeppRJ,etal.PathologyoffatalWestNilevirusinfectionsinnativeandexoticbirdsduringthe1999outbreakinNewYorkCity,NewYork.VetPathol.2000;37(3):208-224.9.PrestonR.TheHotZone.NewYork:RandomHouse;1994.10.PrestonR.TheDemonintheFreezer.NewYork:RandomHouse;2002.11.RivasF,DiazLA,CardenasVM,etal.EpidemicVenezuelanequineencephalitisinLaGuajira,Columbia,1995.JInfectDis.1997;175(4):828-832.12.PowersAM,ObersteMS,BraultAC,etal.Repeatedemergenceofepidemic/epizooticVenezuelanequineencephalitisfromasinglegenotypeofenzooticsubtypeIDvirus.JVirol.1997;71(9):6697-6705.13.BowenGS,FashinellTR,DeanPB,GreggMB.ClinicalaspectsofhumanVenezuelanequineencephalitisinTexas.BullPanAmHealthOrgan.1976;10(1):46-57.14.WattsDM,CallahanJ,RossiC,etal.VenezuelanequineencephalitisfebrilecasesamonghumansinthePeruvianAmazonRiverregion.AmJTropMedHyg.1998;58(1):35-40.15.delaMonteS,CastroF,BonillaNJ,GaskindeUrdanetaA,HutchinsGM.ThesystemicpathologyofVenezuelanequineencephalitisvirusinfectioninhumans.AmJTropMedHyg.1985;34(1):194-202.16.PrattW,HartM,ReedD,SteeleK.Alphaviruses.In:SwearengenJR,ed.Biodefense:ResearchMethodologyandAnimalModels.BocaRaton:TaylorandFrancis;2006:181-206.17.MacDonaldGH,JohnstonRE.RoleofdendriticcelltargetinginVenezuelanequineencephalitisviruspathogenesis.JVirol.2000;74:914-922.18.JaaxNK,DavisKJ,GeisbertTJ,etal.LethalexperimentalinfectionofrhesusmonkeyswithEbola-Zaire(Mayinga)virusbytheoralandconjunctivalrouteofexposure.ArchPatholLabMed.1996;120(2):140-155.19.CharlesPC,TrgovcichJ,DavisNL,JohnstonRE.Immunopathogenesisandimmunemodulationofvenezuelanequineencephalitisvirus-induceddiseaseinthemouse.Virology.2001;284(2):190-202.20.SteeleKE,DavisKJ,StephanK,KellW,VogelP,HartMK.Comparativeneurovirulenceandtissuetropismofwild-typeandattenuatedstrainsofVenezuelanequineencephalitisvirusadministeredbyaerosolinC3H/HeNandBALB/cmice.VetPathol.1998;35(5):386-397.21.VogelP,AbplanalpD,KellW,etal.VenezuelanequineencephalitisinBALB/cmice:kineticanalysisofcentralnervoussysteminfectionfollowingaerosolorsubcutaneousinoculation.ArchPatholLabMed.1996;120(2):164-172.22.SteeleKE,SethP,Catlin-LebaronKM,etal.TunicamycinenhancesneuroinvasionandencephalitisinmiceinfectedwithVenezuelanequineencephalitisvirus.VetPathol.2006;43(6):904-913.23.HartMK,PrattW,PaneloF,TammarielloR,DertzbaughM.VenezuelanequineencephalitisvirusvaccinesinducemucosalIgAresponsesandprotectionfromairborneinfectioninBALB/c,butnotC3H/HeNmice.Vaccine.1997;15(4):363-369.24.JohnstonRE,PetersCJ.Alphaviruses.In:FieldsN,KnipeDM,HowleyPM,eds.FieldsVirology.Vol1.3rded.Philadelphia,PA:LippincottRaven;1996:843-898.25.HartMK,Caswell-StephanK,BakkenR,etal.ImprovedmucosalprotectionagainstVenezuelanequineencephalitisvirusisinducedbythemolecularlydefined,live-attenuatedV3526vaccinecandidate.Vaccine.2000;18(26):3067-3075.26.DavisNL,BrownKW,GreenwaldGF,etal.AttenuatedmutantsofVenezuelanequineencephalitisviruscontaininglethalmutationsinthePE2cleavagesignalcombinedwithasecond-sitesuppressormutationinE1.Virology.1995;212(1):102-110.27.PrattWD,DavisNL,JohnstonRE,SmithJF.Geneticallyengineered,liveattenuatedvaccinesforVenezuelanequineencephalitis:testinginanimalmodels.Vaccine.2003;21(25-26):3854-3862.

PAGE 38

36ArmyMedicalDepartmentJournal28.HartMK,LindC,BakkenR,RobertsonM,TammarielloR,LudwigGV.OnsetanddurationofprotectiveimmunitytoIA/IBandIEstrainsofVenezuelanequineencephalitisvirusinvaccinatedmice.Vaccine.2001;20(3-4):616-622.29.ReedDS,LindCM,LackemeyerMG,SullivanLJ,PrattWD,ParkerMD.Geneticallyengineered,live,attenuatedvaccinesprotectnonhumanprimatesagainstaerosolchallengewithavirulentIEstrainofVenezuelanequineencephalitisvirus.Vaccine.2005;23(24):3139-3147.30.RaoV,HinzME,RobertsBA,FineD.ToxicityassessmentofVenezuelanEquineEncephalitisvirusvaccinecandidatestrainV3526.Vaccine.2006;24(10):1710-1715.31.McClainD.Smallpox.In:ZajtchukR,ed-in-chief;SidellFR,TakafujiET,FranzDR,eds.TextbookofMilitaryMedicine:MedicalAspectsofChemicalandBiologicalWarfare.Washington,DC:BordenInstitute,OfficeoftheSurgeonGeneral,USDeptoftheArmy;1997:539-559.32.WorldHealthOrganization.Smallpoxeradication:Destructionofvariolavirusstocks.59thWorldHealthAssembly;18May2006.Provisionalagendaitem11.5.33.HendersonDA,InglesbyTV,BartlettJG,etal.Smallpoxasabiologicalweapon:medicalandpublichealthmanagement.WorkingGrouponCivilianBiodefense.JAMA.1999;281(22):2127-2137.34.SelgelidMJ.Smallpoxrevisited?AmJBioeth.Winter2003;3(1):W-IF1.35.JahrlingP,Huggins,JW.Orthopoxviruses.In:SwearengenJ,ed.BiodefenseResearchMethodologyandAnimalModels.BocaRaton:Taylor&FrancisGroup;2006:207-225.36.RubinsKH,HensleyLE,JahrlingPB,etal.Thehostresponsetosmallpox:analysisofthegeneexpressionprograminperipheralbloodcellsinanonhumanprimatemodel.ProcNatlAcadSciUSA.2004;101(42):15190-15195.37.BremanJG,HendersonDA.Diagnosisandmanagementofsmallpox.NEnglJMed.2002;346(17):1300-1308.38.JahrlingPB,HensleyLE,MartinezMJ,etal.Exploringthepotentialofvariolavirusinfectionofcynomolgusmacaquesasamodelforhumansmallpox.ProcNatlAcadSciUSA.2004;101(42):15196-15200.39.LeDucJW,JahrlingPB.Strengtheningnationalpreparednessforsmallpox:anupdate.EmergInfectDis.2001;7(1):155-157.40.ZauchaGM,JahrlingPB,GeisbertTW,SwearengenJR,HensleyL.Thepathologyofexperimentalaerosolizedmonkeypoxvirusinfectionincynomolgusmonkeys(Macacafascicularis).LabInvest.2001;81(12):1581-1600.41.MartinezMJ,BrayMP,HugginsJW.Amousemodelofaerosol-transmittedorthopoxviraldisease:morphologyofexperimentalaerosol-transmittedorthopoxviraldiseaseinacowpoxvirus-BALB/cmousesystem.ArchPatholLabMed.2000;124(3):362-377.42.BrayM,MartinezM,KefauverD,WestM,RoyC.Treatmentofaerosolizedcowpoxvirusinfectioninmicewithaerosolizedcidofovir.AntiviralRes.2002;54(3):129-142.43.Update:outbreakofEbolaviralhemorrhagicfeverZaire,1995.MMWRMorbMortalWklyRep.1995;44(25):468-469,475.44.WarfieldKL,JaaxNK,DealEM,SwensonDL,LarsenT,BavariS.Viralhemorrhagicfevers.In:SwearengenJR,ed.Biodefense:ResearchMethodologyandAnimalModels.BocaRaton,FL:CRCPress;2006:227-257.45.LeroyEM,RouquetP,FormentyP,etal.MultipleEbolavirustransmissioneventsandrapiddeclineofcentralAfricanwildlife.Science.2004;303:387-390.46.RouquetP,FromentJM,BermejoM,etal.WildanimalmortalitymonitoringandhumanEbolaoutbreaks,GabonandRepublicofCongo,2001-2003.EmergInfectDis.2005;11(2):283-290.47.JahrlingP.Viralhemorrhagicfevers.MedicalAspectsofChemicalandBiologicalWarfare.Washington,DC:BordenInstitute,OfficeoftheSurgeonGeneral,USDeptoftheArmy;1997:591-602.48.SanchezA,KahnAS,ZakiSR,NabelGJ,KsiazekTG,PetersCJ.Filoviridae:MarburgandEbolaViruses.In:KnipeDM,HowleyPM,etal,eds.FieldsVirology.4thed.Philadelphia:LippincottWilliams&Wilkins;2001:1279-1303.49.ConnollyBM,SteeleKE,DavisKJ,etal.PathogenesisofexperimentalEbolavirusinfectioninguineapigs.JInfectDis.1999;179(suppl1):S203-217.ChallengesinBiodefenseResearchandtheRoleofUSArmyVeterinaryPathologists

PAGE 39

JulySeptember20073750.DavisKJ,AndersonAO,GeisbertTW,etal.PathologyofexperimentalEbolavirusinfectioninAfricangreenmonkeys.Involvementoffibroblasticreticularcells.ArchPatholLabMed.1997;121(8):805-819.51.GibbTR,BrayM,GeisbertTW,etal.PathogenesisofexperimentalEbolaZairevirusinfectioninBALB/cmice.JCompPathol.2001;125(4):233-242.52.SteeleK,CriseB,KuehneA,KellW.Ebolavirusglycoproteindemonstratesdifferentialcellularlocalizationininfectedcelltypesofnonhumanprimatesandguineapigs.ArchPatholLabMed.2001;125(5):625-630.53.GeisbertTW,YoungHA,JahrlingPB,etal.PathogenesisofEbolahemorrhagicfeverinprimatemodels:evidencethathemorrhageisnotadirecteffectofvirus-inducedcytolysisofendothelialcells.AmJPathol.2003;163(6):2371-2382.54.GeisbertTW,HensleyLE.Ebolavirus:newinsightsintodiseaseaetiopathologyandpossibletherapeuticinterventions.ExpertRevMolMed.2004;6(20):1-24.55.GeisbertTW,PushkoP,AndersonK,SmithJ,DavisKJ,JahrlingPB.EvaluationinnonhumanprimatesofvaccinesagainstEbolavirus.EmergInfectDis.2002;8(5):503-507.56.ReedDS,MohamadzadehM.Statusandchallengesoffilovirusvaccines.Vaccine.2007;25(11):1923-1934.57.MartinJE,SullivanNJ,EnamaME,etal.ADNAvaccineforEbolavirusissafeandimmunogenicinaphaseIclinicaltrial.ClinVaccineImmunol.2006;13(11):1267-1277.AUTHORS COLSteeleisChief,DivisionofPathologyattheUSArmyMedicalResearchInstituteofInfectiousDiseases,FortDetrick,Maryland.MAJAlvesisAssistantChief,UltrastructuralPathology,inthePathologyDivisionattheUSArmyMedicalResearchInstituteofInfectiousDiseases,FortDetrick,Maryland.MAJChapmanisAssistantChief,MolecularPathology,inthePathologyDivisionattheUSArmyMedicalResearchInstituteofInfectiousDiseases,FortDetrick,Maryland.

PAGE 40

38ArmyMedicalDepartmentJournalBACKGROUNDTheWorldHealthOrganization(WHO)globalinfluenzasurveillancesystemiscomprisedofapproximately110NationalInfluenzaCenters(NIC)and4WHOCollaboratingCenters(WHOCC)forInfluenza.The4WHOCCsarelocatedintheUnitedKingdom,*Japan,Australia,andtheUnitedStates(CDC).TheintentofthesystemisthatNICstakesamplesfromacrosssectionofthepopulationsufferingfrominfluenza-likeillness,isolateviruses,conductinitialsubtyping,andforwardrepresentativeisolatesespeciallyanythatcannotbesubtypedtoaWHOCC.Formuchoftheworld,ordinaryseasonalinfluenzaisnotseenasapublichealthpriority,sointernalfundingisnotavailable.ThecurrentlyrecognizedNICsthroughouttheworldareshownintheFigure.NAMRU-3issituatedwithinoneofthelargestregionalgapsinthissurveillancenetwork.NAMRU-3isnowfundedbyCDC,theDoDGlobalEmergingInfectionsSurveillanceandResponseSystem,andotherstoenhanceNICproductivityinitsregion.TheseagenciesfundNAMRU-3becauseofthefacilitysinherentlaboratorycapacity(includingabiosafetylevel[BL]3thatcanbeusedasaBL4inneed),strategiclocation,and,mostimportant,itsdemonstratedabilitytobuildinternationalrelationshipsand,throughthese,toenhancehostcountrylaboratory,surveillancesystem,andresearchcapacity.NAMRU-3hasalonghistoryofworkingwithzoonoticdisease,andanequallylonghistoryofincludingveterinariansinitspublichealthteam,acriticalreasonthattheinstitutioniscapableofrespondingtoemergingdiseasethreatssuchasavianinfluenza.Theforceprotectionbenefitofenhancedinfluenzasurveillanceistwofold:1.Greaterrefinementofinformationleadingtothebiannualvaccinedecisionsuchthatthevaccineusedismoreoptimal.2.Actionableinformationaboutnovelstrainscirculatinginregionsinwhichtroopsaredeployed.Currently,donorsandevenpublichealthprofessionalsfrequentlytalkaboutavianinfluenza(AI)asahumandisease.Indeed,therehavebeenover300casesofinfluenzainhumanscausedbyH5N1,andoverhalfhavedied,butitiseminentlyclearthatthevirusinitscurrentformrequiresaveryhighdosetoinfecthumansandremainsfirstandforemostadiseaseof(primarilygallinaceous)poultry.However,about30,000peopledieeachyearintheUnitedStatesfromseasonalinfluenza,andtheworldwideannualdeathtollfromseasonalinfluenzamayrangeintothehundredsofthousands.Apandemicvirusiswidelyviewedashavingthepotentialtokillmillions,andthisAVeterinaryComparativeMedicineOfficersDreamAssignmentMAJSamYingst,VC,USA ABSTRACTThe5DepartmentofDefense(DoD)overseaslaboratoriesconductresearchonavastarrayofinfectiousdiseases.1,2ThiscommentaryfocusesontheroleoftheNavalMedicalResearchUnitNo.3(NAMRU-3,Cairo,Egypt)ininfluenzasurveillanceandresearch,withemphasisontheroleofthecomparativemedicine(USArmymilitaryoccupationalspecialty64E)veterinarianassignedthere.Everyyear,tensofthousandsofmembersoftheUSArmedForcesarevaccinatedforso-calledseasonalinfluenza.Thevaccineusedisreformulatedannually,basedonantigeniccharacterizationofviralisolatesgeneratedthroughglobalsurveillance.NAMRU-3contributestothisglobalsurveillancefortheEasternMediterraneanregion.TheemergenceofH5N1Highly-pathogenicAvianInfluenza(HPAI)andconcernsoveritspossibleroleinprecipitatingapandemichaveaccentuatedtheroleofveterinarianswithfieldandlaboratorydiagnosticsexperienceinthissystem. *NationalInstituteforMedicalResearch(London)NationalInstituteofInfectiousDiseases(Tokyo)CentreforReferenceandResearchonInfluenza(Victoria)CentersforDiseaseControlandPrevention

PAGE 41

JulySeptember200739 CountrywithrecognizedNationalInfluenzaCenterNoNationalInfluenzaCenterGlobalcoverageofthe110recognizedNationalInfluenzaCenters. isthevalidbasisforconcernaboutthecontinuedcirculationofH5N1viruses.ApproximatelyabillionbirdshavebeenaffectedbyH5N1andthevirusprobablyreplicatestrillionsoftimesineachinfectedanimal.Asimplemutationcouldleadtowardincreasedhumantohumantransmissibility,andalsoraisethechancesforareassortment*eventinsomeanimalthatiscoinfectedwithH5N1andanotherinfluenzavirus.Thisisthereasonthatitisessentialtohaveasmanyhealthcareworkersaspossibleimmunizedwithseasonalinfluenzavaccine.Wide-reachinginfluenzasurveillanceraisesthechancesthatseasonalinfluenzavaccinesareefficacious,andthisreducesthechancesofanRNAreassortmenteventbetweenhumaninfluenzaandH5N1.AlthoughNAMRU-3continuestoemphasizetheimportanceofseasonalinfluenzasurveillance,theincreasedpandemicthreatposedbyH5N1demandsaction.Avianinfluenzawasalreadyamajorproblem3yearsago,butonlyforsoutheastAsia.WHOworkedhardtoencouragenationalpublichealthauthoritiesoutsidesoutheastAsiatorecognizethatthevirusposedathreattobecomeapandemic,butmostnationshadotherpriorities.NAMRU-3preparedinadvanceforthevirus,andthepanic,toreachourregion.Rapiddiagnosticsareessentialtoguideveterinaryorhumanpublichealthresponse.Currently,onlypolymerasechainreaction(PCR)representsawell-testedmeanstodiagnoseacutecasesinaviansorhumans.TestingwithPCRrequiresextensivetraining,experience,andconsultation,butwehaveshownthatthesearenotinsurmountableobstacles,eveninAfghanistandespitetheongoingconflict.Suchplacescannotbeneglectedbecausetheyaredifficult.Onthecontrary,thisdifficultyshouldstimulateevengreateremphasis,buttomeetthatneedsometimesincurssignificantrisk.Suchaneffortisthereforetheclearpurviewofuniformedlaboratorydiagnosticspecialists.TheUSArmycomparativemedicineveterinarianisuniquelyqualifiedtofulfillallaspectsofthisneed.ItshouldbeobviousthatthisworkisalsoacriticalelementinourefforttomaintaintheimageoftheUnitedStatesasapartnerinpeace.NAMRU-3acknowledgesthatamajorimpetusforourworkistoserveasanadvocateofUSforeignpolicy,notnecessarilyinapurelyscientificcapacity.WhiletheconversationamonglaypeopleaboutAI,pandemicinfluenza,andseasonalinfluenzaoftenbecomesclouded,thecurrentsituationinwhichH5N1HPAIisviewedasthegreatestthreatforprecipitatingapandemicinhumansisbeneficialintermsofprovidingimpetusforfundingthatcanthenbeusedmorebroadly.Constanteffortisrequiredtokeepthefocusonthefactthatcurrentlythisisfundamentallyadiseaseofanimals,anditsgreatestimpactisonnutritionandincomeofpoultryowners,notdirectlyontheirhealth.4Thisisanotherreasonthatitisa *Themixof2differentinfluenzaviruses

PAGE 42

40ArmyMedicalDepartmentJournalfortunatetimeforveterinarypublichealthprofessionals.Leadersatalllevelsnowrecognizetheimportanceofhavingamultidisciplinaryteamtotacklethismultifacetedissue.Thishasallowedveterinarians,especiallythosewithlaboratorydiagnosticsskills,toserveinauniquecapacityasmedicaldiplomats.APPROACHBecausethemilitarystaffoftheoverseaslaboratoriesoccupyapositionthatwouldotherwisebeavailableforanadditional,currentlymuch-neededlineSoldierorSailor,andbecausetheresearchandsurveillanceroleiswidelyseenassimilarorevenduplicativewiththeroleofinternationally-projectedlaboratoriesliketheCDC,thecosteffectivenessoftheinstitutionsthemselvesareoccasionallyquestioned.Also,asimilarquestionisoftenasked,especiallybyinternationalhealthprofessionalcolleaguesinregardtotheoverseaslaboratoriesroleininfluenzasurveillance:whyDoD?In1996,PresidentialDirectiveNSTC-7directedfederalagencies,includingDoD,todevelopaglobalsurveillancenetwork,enhancingresearchandtraining,engagingourinternationalpartners,andstrengtheningpublicoutreach.Thereisanelementofriskinstudyingandconductingsurveillanceforinfluenza(avianorotherwise).Thereisinherentrisk(intermsofthebiohazardriskofworkingwithdangerouspathogens),andalsooccasionallyintermsofsecurity.ItisimportanttohavepeoplewithaSoldiersmindset,commitment,drive,andsenseofdutytoaccomplishwhatmustbedone.Circumstancessuchasapandemicmayrequirethatindividualsoraforceareorderedtorespondinordertodiagnose,attempttocontainoutbreaks,ormaintainorder.Militarytransport,communications,andlogisticssystemsmaybetheonlysuchsystemsthatremainoperational,andwecanrestassuredthatDoDpublichealthprofessionalswillexecutesuchorders.Withthesefactsinmind,theoverseaslaboratorieshavealwayspracticedprojection,engagement,andcollaboration,andareexpertsunlikeanyothersinthearea.Withthissenseofnecessity,NAMRU-3beganworkingwithhostcountriestoenhanceseasonalinfluenzasurveillancein1998.Thefollowinglistofinitiationsofcollaborationsillustratestheexponentialgrowthoftheeffort:1998Egypt1999Syria,Oman2000Djibouti2001Kazakhstan2002Ukraine2003Kyrgyzstan2004SaudiArabia,Kenya,Uzbekistan2005Pakistan,Nigeria,Georgia,Azerbaijan2006Afghanistan,Bulgaria,Macedonia,Iraq2007Tajikistan,Turkmenistan,Ghana,Sudan,Jordan,LibyaThepurposeoftheeffortistoidentifymutatedinfluenzavirusesthathavebeguntocirculatewidelybecausethiswouldcompelWHOanditsWHOCCstorecommendachangeintheseasonalepidemicvaccinecomposition.Initially,weworkedslowlyandselectively,choosingcountrieswithdensepopulationsandsignificanthumanmovementthatwethoughtmightbeflashpointsfortheemergenceofnewstrainsofinfluenza.ThecompositionofthevaccinedirectlyaffectsthehealthofdeployedtroopsandAmericansathome.Becauseonlywealthywesternnationshadformerlyconductedinfluenzasurveillance,wehadtoinitiatethesurveillanceourselvesastheonlymeanstodeterminewhetherexistingvaccineswouldprotecttroopsagainstvirusescirculatinginareasinwhichtheyaredeployed.However,conductingmeaningfulinfluenzasurveillanceisatime-consumingpropositionwhichrequiresaccesstocivilian,especiallypediatric,populationsinordertogainthebestsenseofintroductionofnewviruses.Inotherwords,thisisajobforon-the-ground,daily-engagedofficialsofnationaldepartmentsorministriesofhealth.Thus,itisonlybyworkingintruecollaborationwithsuchgovernmentalagenciesthatwecanachievethegoal,inotherwords,employingtheteachamantofishconcept.Ingeneralterms,theeffortentailsanapproximatescenarioof:Year1:Initiation,training,capacitybuildingYear2:TechnologytransferYear3:TechnicalsupportAVeterinaryComparativeMedicineOfficersDreamAssignment

PAGE 43

JulySeptember200741NAMRU-3sworkinenhancingregionalseasonalinfluenzasurveillancehasalwaysbeenledbyacomparativemedicinespecialistandhasinvolvedveterinariansinmanyroles.ThisisbecauseNAMRU-3recognizedinfluenzaasazoonosisbeforethisviewwascommon.Theincreasedemphasisonavianinfluenzarequiredonlythatveterinariansalreadyworkingininfluenzadiagnosticschangefocusslightly.ThisslightchangeinemphasishasdictatedthatNAMRU-3takeonanincreasedroleincapacityenhancementintheregion.Werecognizedearlyonthateachsovereignnationneedsthetoolstodiagnoseacuteavianinfluenzaaswellasinfluenzainhumanscausedbyavirusofavianorigin.Serologicmethodscannotmeetthisneed;theonlyoptionsarePCRorvirusisolationandsubtyping.Ofthese,onlyPCRprovidesthesamedaydiagnosisthatisessentialinthisarea.Thisargumentisnowwidelyacceptedbymajordonors,suchastheWorldBank,whichhadpreviouslycounteredthatdonorprovidedPCRmachinesaregatheringdustinmanynationallaboratories.NAMRU-3hasalwaysrecognizedthattechnologytransferisnotamatterofsimplyprovidingequipmentitisalong-termrelationshipbetweenteacherandstudent.VeterinarianshavealwaysservedasprimarytrainersinNAMRU-3capacity-buildingengagements.RESULTSNAMRU-3hasprovidedavianinfluenza-focused,PCRdiagnosticstrainingtopublichealthorveterinarycentrallaboratorystaffinover40countries,andmaintainsveryclosecollaborativesupportforthePCRlaboratoriesinAfghanistan,Jordan,Egypt,Libya,andGhana.NAMRU-3veterinarianshavedeployedtoBulgaria,Djibouti,Pakistan,Palestine,Sudan,Kenya,Nigeria,Ghana,Yemen,Ethiopia,Iraq(twice),Afghanistan,Ukraine,Azerbaijan,Armenia,Georgia,Turkey,andKazakhstantofollowuponsuspectedHPAIoutbreaks.Insomecases,thisinvolvescivilianveterinarians,butonlyuniformedstaffaredeployedtocombatzones.Comparativemedicineveterinarianshaveprovidedlaboratory,biosafety,andoutbreakinvestigationtrainingtootherveterinariansparticipatingintheseresponses.NAMRU-3hasneverlostfocusontheimportanceofsurveillanceforseasonalinfluenza.OureffortshaveresultedinthecharacterizationofthousandsofisolateswhichotherwisewouldnothavereachedaWHOCollaboratingCenter.Mostimportantly,isolateshavebeenobtainedfromcountriesandregionsfromwhichnoinformationwaspreviouslyavailable(eg,allofcentralAsia).TwolaboratoriesthatwereinactivepriortoNAMRU-3assistance,UkraineandKazakhstan,arenowindependentlyfunctioningWHOrecognizedNICs.Withthenewemphasisonavianinfluenza,NAMRU-3surveillanceeffortsalsoresultedincriticalviruscharacterizationsthatotherwisewouldnothaveoccurred.Forexample,virusesfromIraq,Djibouti,andKazakhstanwerefullycharacterizedandsequenced.NAMRU-3ledthewayinsharingphylogeneticinformation.Whilemanyinstitutionsretainedsequencingdatapendingcompletionoftheirownmanuscripts,onthedaywereceivedhostcountrypermission,wepublishedthesequenceofthefirstH5N1isolateweobtained.InAugust2006,aconsortiumincludinginfluenzaresearchersatUSCDCandglobalInternationalOfficeofEpizootics*/FoodandAgricultureOrganization(OIE/FAO)referencelaboratoriescalledonotherstodoso.5ThefirstH5N1outbreakinAfghanistanoccurredinMarch2006.NAMRU-3deployedamobilePCRlaboratorywhichwasabletodiagnosethecauseoftheoutbreakasH5avianinfluenza,butgovernmentsystemswerenotinplacetorespond.Thegovernmentdidnotattempttocontainoutbreaksuntilitreceivedreferencelaboratoryconfirmation.Resultswereindeedconfirmed,butthewaitforconfirmationcausedadelayinresponseofoveraweek,duringwhichtheoutbreakcontinuedtospread.Severalthousandbirdsintheinfectedvillageswereeventuallyculled,perhapsunnecessarily,giventhelongdelay.Thishadasignificantimpactonlivelihoodsandconfidenceinthegovernment.Thereisnodefinitiveinformation,butthetemporalandgeographicalspreadwassuggestiveofintroductionfromPakistan,andspreadwithinAfghanistanthroughthelivebirdmarketsystem.Eventuallythevirusspreadtomorethan6provincesinAfghanistan. *Anorganizationof127membercountriesheadquarteredinParis,France.Informationavailableathttp://www.oie.int.AnagencyoftheUnitedNationswhichwasfoundedin1946toleadinternationaleffortstodefeathunger.Informationavailableathttp://www.fao.org.

PAGE 44

42ArmyMedicalDepartmentJournalOverthenextyear,NAMRU-3workedwiththeMinistryofAgriculture,Irrigation,andLivestocktoestablishapermanentPCRlaboratoryintheCentralVeterinaryDiagnosticandResearchLaboratoryinKabul.ThislaboratorydiagnosedH5N1reintroductionintoAfghanistaninFebruary2007.Incontrasttolastyearshesitation,thegovernmentnowshowstotalconfidenceinthelaboratory,andimmediateactionwastakenwhenpositiveresultswereobtained.Thusthenovelcapabilityofthelaboratorytoprovidereal-timeresultswaswellused.Outbreaksthisyearwerelimitedto3provinces,andonlyafewhundredbirdswereculled.Thus,thisisasuccessstory,notmerelyinphysicallyestablishinglaboratorycapacity,butinintegratingthephysicalcapacitywithgovernmentsystems.InJanuary2006,unusualmortalitywasnotedinbackyardchickensinSulymaniyah,Iraq,withclinicalsignsconsistentwithavianinfluenza.SamplesweretestedwitharapidantigendetectionpurportedtobeabletospecificallydetectH5.Theassayisa2-stepprocess:1.TestforinfluenzaAantigenand,ifpositive,2.TestforH5antigen.ThetestwaspositiveforinfluenzaA,butnotpositiveforH5antigen.ThevillagerswereadvisedthatthiswasnotanoutbreakofH5.Approximatelyoneweeklater,ayounggirlandheruncle,whohadslaughteredsickbirds,diedofH5N1.Aspartofthefollowuptotheoutbreakinvestigation,NAMRU-3examinedtheantigendetectionassaythatwasusedtodiagnoseinfluenzaA,butdidnotdetectH5.TheinfluenzaAantigendetectioncomponentoftheassayappearstobemoresensitivethantheH5component,andtheH5componentdoesnotdetectallH5viruses.Thus,thereisthepossibilitythattheassaymayresultinfalsenegativesforH5through2mechanisms,withtheformerbeingextremelymisleadingbecauseitresultsintheappearancethatanoutbreakisduetoanon-H5avianinfluenza.Manynon-H5avianinfluenzavirusesarecommonintheMiddleEast,anddonotappeartobeserioushumanpathogens.AdditionalpoultrysamplesfromSulymaniyahweresubmittedtoNAMRU-3.ThesampleshadbeentestedinBaghdadtotheextentpossibleaccordingtocurrentOIE/FAOrecommendations.Underthecircumstances,thiswaslimitedtoserologictesting.Unfortunately,mostchickensthatareexposedtoH5N1diebeforedevelopingantibody,soamajoroutbreakinabroilerbarnwasdiagnosedasnotavianinfluenzabecauseantibodycouldnotbedetected.SamplescontainedhightitersofH5N1viruswhicharedetectablebyPCR.NAMRU-3diagnosedthecasesofinfluenzainhumanscausedbyH5N1virus,andNAMRU-3veterinariansparticipatedinaWHO-ledfollowupoftheoutbreak.TheinvestigationresultedindiagnosisofH5N1inpoultryandcatsinanotherIraqigovernorate,andprovidedopportunitiestolinktheH5casesinhumanstodiseaseinanimals.LESSONSLEARNEDComparativemedicineveterinariansareuniquelycapableofprovidingthebroadarrayofexpertisenecessarytosupportallaspectsofinfluenzasurveillance,research,andresponsecapabilities.Theycanaddresspublichealthandinfectioncontrolissues,vaccinationandbiosecuritypolicyinpoultry,aswellasdiagnostictechniques.VeterinariansplayanimportantroleinkeepingthefocusoftheresponsetothecurrentH5N1outbreakwhereitbelongsontheimpactonagriculturaleconomies,whileprovidingabalancedapproachinlightofthefactthatthereisapotentialroleofthispan-zooticinprecipitatingapandemic.NAMRU-3hasmadedirectcontributionstothebodyofscientificknowledgeconcerningavianinfluenza.Mostvirologybooksinprintstillhighlighttheroleofmigratorybirdsasreservoirsofavianinfluenza.NAMRU-3workhasshownthatalthoughmigratorybirdshaveprobablyhadaroleinsomeintroductionsofavianinfluenzaintopreviouslynaveplaces,poultrytradeisalmostcertainlythepredominantmechanismoftransmission.Throughitstrainingprogramsandcollaborations,NAMRU-3effortsbringscientiststogetherandbuildbridgesthatmaybekeyinrespondingregionallyandgloballytoapandemic.ThisefforthasnotonlyprovidedopportunitiesforexchangebetweenhostcountryandUSscientists,butalsoservestoforgeregionalandevenintercontinentalrelationshipsandunderstanding.AVeterinaryComparativeMedicineOfficersDreamAssignment

PAGE 45

JulySeptember200743Ourworkbuildsonexistingstructures;weworkwithintheWHOsysteminternationally,andwithintheministryofhealthoragriculturesysteminagivencountry.CONCLUSIONNAMRU-3hasauniquerelationshipwiththeWHOEasternMediterraneanRegion(servingasitsinfluenzareferencelaboratory),andisoneofthe9global,WHO-recognizedH5referencelaboratories.NAMRU-3hasuniquediagnosticcapacitythatUSArmyveterinarymicrobiologistsandotherveterinarianshaveestablished,includingvirusisolationandsubtypingintissuecultureandeggs;PCRforinfluenzaA,B,H1,H3,H5,H7,H9,N1;fullgenomesequencingofinfluenzaAviruses;neuraminidaseresistancetesting;andmicroneutralizationanddiagnosisofotherrespiratorydisease(eg,severeacuterespiratorysyndrome).BecausetheArmyVeterinaryCorpsprovidestheveterinarymissionfortheentireDoD,USArmyveterinariansalreadyhavethegoodfortunetoworkinnumerousjointassignments.However,assignmenttooneoftheoverseaslaboratoriesprovidesanopportunityforavastlyexpandeddegreeofinteragencyexperience.ThecomparativemedicineveterinarianassignedtoNAMRU-3isexpectedtoconsultandcollaboratewiththeUSDepartmentsofState(directlyandthroughtheUSAgencyforInternationalDevelopmentandtheembassies),Agriculture,andHealthandHumanServices(directlyandthroughtheUSCDC).InternationalagencieswithwhichroutinecontactisessentialincludetheWorldHealthOrganization,theUNFoodandAgricultureOrganization,andtheWorldBank.Themostimportantrelationshipsofallarewithhostcountryofficialsfromministriesofhealth,agriculture,andotherswhohaveassignedrolesinpublichealth.Thenextpandemicmaybeinsidiousandmaybedetectedfirstthroughroutineseasonalinfluenzasurveillance.Thenextpandemicwillprobablynotbeassociatedwithdiseaseinpoultry.Ordinaryinfluenzaandordinarysurveillancesystemscannotbeneglectedinfavorofafocusonavianinfluenza.NAMRU-3isessentialinimplementingtheNationalStrategyforPandemicInfluenza,6andthecomparativemedicineveterinarianassignmentthereiskeyinthatfacilitation.Thestrategyemphasizestheimportanceofcapacitybuilding,coordination,rapidresponseteams,andtransparency.NAMRU-3hasadecadeofexperienceimplementingthosethemesintheareaofinfluenza.REFERENCES 1.ChretienJP,BlazesDL,GaydosJC,etal.Experienceofagloballaboratorynetworkinrespondingtoinfectiousdiseaseepidemics.LancetInfectDis.2006;6(9):538-540.2.ChretienJP,GaydosJC,MaloneJL,BlazesDL.Globalnetworkcouldavertpandemics.Nature.2006;440(7080):25-26.3.NationalCenterforImmunizationandRespiratoryDiseasesAdvisoryCommitteeonImmunizationPractices.PreventionandControlofInfluenza.MMWRRecommRep.2006;55(RR10).4.CapuaI,AlexanderDJ.Thechallengeofavianinfluenzatotheveterinarycommunity.AvianPathol.2006;35(3):189-205.5.BognerP,CapuaI,CoxNJ,etal.Aglobalinitiativeonsharingavianfludata.Nature.2006;442(7106):981.6.NationalStrategyforPandemicInfluenza.Washington,DC:HomelandSecurityCouncil,TheWhiteHouse;November2005.Availableathttp://www.whitehouse.gov/homeland/nspi.pdf.AccessedJune5,2007.AUTHOR MAJYingstistheInfluenzaSurveillanceandCentralAsiaProjectsCoordinatoratNavalMedicalResearchUnitNo.3inCairo,Egypt.

PAGE 46

44ArmyMedicalDepartmentJournalHipdysplasiaisoneofthemostcommonorthopedicdiseasesindogs.Allbreedsofdogscanbeaffectedbythisdevelopmentaldisease.However,itmainlyaffectsmediumandlargebreeddogssuchastheGermanShepherdDog.Painanddecreasedhindlimbmobilityandfunctionaretheendresultofthiscomplexdiseaseprocess.Severecaninehipdysplasia(CHD)canbecareer-endingfortheMilitaryWorkingDog(MWD).TheGermanShepherdDogandBelgianMalinoismakeuptheoverwhelmingmajorityofMWDsinAmerica.Theirhighenergy,trainability,intelligence,physicalstature,andidealpersonalitiesmakethemexcellentworkingdogs.Unfortunately,theselargebreedsareoftenafflictedwithorthopedicdevelopmentaldiseasessuchashipandelbowdysplasia.TheDepartmentofDefenseMilitaryWorkingDogCenter(DoDMWD)performsavarietyofscreeningtestspriortothepurchaseofpotentialMWDs.Over60%ofalldogsevaluatedarerejectedbecauseofbehavioralormedicalproblems.1Asonepartofthescreeningprocess,radiographsofthepelvisareperformedtolookforsignsofhipdysplasia.Dogswithsignsofhiplaxityordegenerativejointdiseasebasedontheseradiographsorphysicalexamarerejectedfrompurchase.SeveralretrospectivestudieshaveevaluatedthecauseforretirementoreuthanasiaoftheMWD.From1993to1996,19.5%(178/927)ofallMWDremovalsfromservicewereduetoappendiculardegenerativejointdisease(DJD),primarilyhipandelbowdysplasia.2From2000through2004,thatfigureimprovedto8.2%(22/268).3Severalconclusionscanbedrawnfromthesefigures:1.MedicalmanagementofDJDhasimprovedsignificantlytokeeptheMWDworkinglonger.2.Morestringentphysicalexamandradiographicscreeningtestsareperformedpriortopurchase,thustheDoDMWDpurchasesfewerdogswithdevelopmentalproblems.3.Breedersarecullingundesirabledevelopmentalconditionsfromtheirbreedingprograms,thusproducingahealthierdogforsale.Inanycase,thefactthatfewerMWDsareforcedintoretirementduetocaninehipdysplasiaisinthebestinterestoftheDoD.DIAGNOSISThediagnosisofCHDisbasedonhistory,clinicalsigns,physicalexaminationfindings,andradiographsofthecoxofemoraljoint(s).Hipdysplasiaoftenclinicallypresentsinabiphasicprocess.Lamenessdevelopsinitiallyat3to10monthsofageduringtheearlyphaseofthedisease.Thispainisduetosubluxation,inflammation,andsynovitisinducedfromthehipjointlaxity.MostyoungdogssufferingfromCHDwillgrowoutoftheirlamenessclosetoayearofage.Thepainusuallyreturnsduringmidlifeofthedog,startingaround4to5yearsofage.Thissecondphaseofpainisagainassociatedwithinflammationandsynovitis,butinaddition,thecoxofemoraljointhasundergoneerosivecartilagechanges,thickeningofthejointcapsule,osteophyteformation,andbonyremodelingchanges.Theexhibitedlamenesscanrangefromverymildonlyafterstrenuousactivity,toverysevere,suchastheinabilitytobearsignificantweightorwalkontheaffectedpelviclimb.Someownersreportabunnyhoppingrunasthedoglimitsitscoxofemoraljointrangeofmotiontopreventexacerbationofthepain.Physicalexamfindingsmostoftenelicitpainofthehipregionduringextension,externalrotation,andCanineHipDysplasia:SurgicalTreatmentfortheMilitaryWorkingDogCPTKentJ.Vince,VC,USA

PAGE 47

JulySeptember200745abductionofthecoxofemoraljoint.Somedogswillbecomefearfulandpotentiallyaggressivewhentheexaminerattemptstopalpateormanipulatethehipjoint.Crepitusisusuallyfeltduringthelaterphaseofthediseaseasthejointhasundergonesignificantdegenerativechanges.Subluxationcanbefeltinmanyyoungdogs.Alowclunkisusuallyfeltorheardduringtheabductionofthecoxofemoraljointinyoungdogsasaresultofthereductionofthesubluxatedfemoralhead.ThisclunkisreferredtoasanOrtolanisignandishighlysuggestiveforhipjointlaxity.MuscleatrophyofthethighiscommonlyseenincasesofCHD,butmostobviouswhenonlyonelegisaffected.Severalradiographictechniqueshavebeendescribedtoscreenforsignsofcaninehipdysplasia.ThePennHIP*distractionradiographtechnique,thedorsalacetabularrimview,andtheventrodorsalpelvicviewareallroutinelyperformed.However,themostcommonlyperformedradiographistheventrodorsalpelvicextendedview(Figure1,Figure2)fordiagnosisofCHD.Theradiographicchangesseenwithcaninehipdysplasiacanincludesubluxationofthefemoralhead;flatteningofthefemoralhead;osteophytosisofthefemoralhead,neck,oracetabulum;sclerosisofthefemoralneck;andevidenceoftheinsertionofthejointcapsuleonthefemoralneck.CONSERVATIVETREATMENTThegoalofstandardconservativemanagementofCHDisthealleviationofhippain.Thepillarsofconservativemanagementincludeexercisemodification,weightmanagementanddiet,painrelievingdrugs,andchrondroprotectiveagents.Adequateexerciseisimportantformaintainingandimprovingmusclemassandfunction.Thiscanbeachievedthroughdailyleashwalkactivity,moderaterunning,andveterinaryphysicalrehabilitationexercises,includingtheuseoftreadmillsorunderwatertreadmills.Disuseatrophycanoftenberemediedwiththeadditionofanappropriateexerciseprogram.WeightmanagementanddietaryintakearetwoofthemostimportantexternalcontributingfactorsinCHD.ItiswellknownthatoverweightorobesedogsareFigure1.Aventrodorsalextendedpelvicviewradiographfroma2-year-olddogwithoutanyevidenceofdegenerativejointdiseaseorcaninehipdysplasia. Figure2.Aventrodorsalextendedpelvicviewradiographofa6-year-oldfemaleGermanShepherdDogwithseveredegenerativejointdiseasefromcaninehipdysplasia. *UniversityofPennsylvaniaHipImprovementProgram

PAGE 48

46ArmyMedicalDepartmentJournaloftenlessactivethannormalweightdogsandtheaddedweightputssignificantstrainonligamentsandjoints.Alifelongstudyevaluatedtheaffectofarestricteddietontheonsetofradiographicevidenceofhiposteoarthritisindogs.Themedianageforonsetofradiographicsignsofosteoarthritisindogsfedadlibitumwas6yearsversus12yearsfordogsfeda25%reduceddiet.Theinvestigatorsconcludedthatdietaryrestrictionby25%resultedinsignificantdelayoftheonsetofradiographicsignsofhiparthritis.4PainrelievingdrugsareanimportantweaponinthetreatmentofCHD.Amultimodalapproachtotreatingthepainofhipdysplasiahasbeenusedwithavarietyofclassesofdrugs.Nonsteroidalanti-inflammatories(NSAID),suchascarprofen,deracoxib,meloxicam,andtepoxalin,areusuallythefirstlineofdefense.Theyworkwellatreducingtheinflammationwithinthejointwhichreducesthesensitivityofthenervesandresultsindecreasedpain.ExtensiveresearchhasbeenperformedanddeterminedthatseveraloftheseNSAIDscanbesafelyusedforlong-termtherapy.Tramadolisasyntheticopioidthathasgreatbenefitinrelievingpainindogs.AmantadineisanNMDAantagonistthatcanbeusedinthetreatmentofchronicpain.Inaddition,gabapentin,anantiepilepticdrug,hasbeensuccessfullyusedtotreatpresumedpainindogs.AcombinationofanNSAIDandtheseadditionaldrugscanbeusefulinalleviatingthepaininducedbyCHD.Chondroprotectiveagentshavebecomequitepopularinthetreatmentofarthriticdiseaseindogs.Thesedrugsaimtoprotectandprovidethebuildingblocksofcartilageandsynovialfluidtohelppromotetheidealjointhealth.ThereareseveralglucosaminecontainingveterinaryproductsavailableincludingCosequin,GLC5500,andGlyco-Flex,allaimedatpromotingjointhealth.Adequanisaninjectablepolysulfatedglycosaminoglycanthathelpspreventthebreakdownofjointcartilage.VeterinaryresearchshowingsignificantimprovementindogssufferingfromCHDwiththeadministrationofthesechrondroprotectiveagentsislimited.Becausesomedogsappeartoimproveclinically,manycliniciansadvocateatrialtoseeiftheyhelpaspecificindividual.SURGICALTREATMENTTheprimarygoalsofsurgicaltreatmentforCHDarealleviationofhippainandreturntonormalfunctionoftheaffectedleg.Surgeryisoftenusedinconjunctionwithmedicalmanagement.Totalhipreplacement(THR)andfemoralheadostectomyarethe2primarysurgicaloptionsfortreatmentofhipdysplasia.Surgeryisusuallyperformedwhenmedicalandconservativemanagementofthediseaseisnolongersuccessful.Femoralheadostectomyistypicallythoughtofasalastresortsalvageprocedureindogssufferingfromseverehipdysplasia.Inthissurgery,thefemoralheadandportionsoftheneckarecutandremovedthuseliminatingtheboneonbonecontactofthecoxofemoraljoint.Themusclesandsofttissuessurroundingtheproximalfemurandacetabulumwillformafalsejoint.Thelong-termreturntofunctionoftheaffectedlegisvariableandoftendependentonseveralfactorsincludingthesizeandbodyconditionofthedog.Whiledogsundergoingfemoralheadostectomywillnothave100%normalfunctionoftheaffectedleg,nearly90%ofownersreportedagoodoutcomewiththisprocedure.5Caninetotalhipreplacementisthebestsurgicaloptionforreturninganaffectedcoxofemoraljointtonormalfunction.THRhasbeenperformedinbotharesearchandcommercialsettingincaninepatientsforseveraldecades.Initialmetalimplantswerefixedwithbonecementintothefemurandacetabulum.Thistechnologyhasgoneunderseveralimprovementsandadvancementsoverthepast30yearsandisstillusedtodayinbothdogsandhumans.Newertechnologyhasledtothedevelopmentofuncementedimplants.Porous-coatedimplantsarepressfittedintotheproximalfemurandacetabulum.Thebonegrowsintotheporouscoating,permanentlystabilizingtheimplantinapproximately2to4weeks.Along-termstudyevaluatingtheuseofuncementedporous-coatedTHRimplantsindogsrevealedan87%successrate.Theauthorsconcludedthataftera6-yearfollowup,uncementedfixationoffemoralstemandacetabularcupimplantswassuccessful.6AttheNorthCarolinaStateUniversityVeterinaryTeachingHospital,theimplantofchoiceistheBFX(biologicalfixation)totalhipreplacementsystembyBioMedtrix(Boonton,NewJersey).Thissystemusesacobaltchromefemoralstemwith3layersofmicrobeadssurroundingtheproximalthirdoftheimplant(Figure3).ThefemoralheadcomponentisahighlypolishedcobaltchromespherethatislightlyCanineHipDysplasia:SurgicalTreatmentfortheMilitaryWorkingDog

PAGE 49

JulySeptember200747hammeredontothefemoralstemcomponent.Theacetabularcupcomponenthasanoutershellmadeoftitaniumwith3layersofmicrobeadsandanultrahighmolecularweightpolyethyleneliner(Figure4).Thelayersofmicrobeadscreateaporouscoatingontheimplantsthatallowforbonyingrowthandwhenhealed,averystableimplant-boneinterface.Inhumantotalhipreplacements,theimplantsareexpectedtolastgreaterthan20years.Thus,theBFXtotalhipreplacementimplantsareexpectedtolastthelifetimeofthedog.Properpatientselectionandsurgicalplanningareimperativeforsurgicalsuccess.Thepatientmustbefreeofanysystemicdiseasesorinfectionsthatcouldpotentiallyspreadtotheimplants,asimplantassociatedinfectionwouldresultinfailure.Thepatientmustbewell-trainedandsensiblesoastotoleratesmallcage/kennelconfinementandcontrolledactivityduringrecovery.Anyexcessiveactivitytooearlyinthepostoperativerecoveryphasecouldleadtoimplantmovement,or,evenworse,implantassociatedbonefractureorluxation.Whilethereareavarietyofimplantsizestoaccommodatemostmediumandlargebreeddogs,thepatientmustbeofappropriatesizetoensureproperimplantfit.Preoperativeradiographsareusedtoestimatethesizeoffemoralandacetabularimplantandtogivethesurgeonanideaofhowmuchbonetoremoveduringthepreparationofthebonebed.Thepatientshouldbefreeofanyneurologicalconditionsthatmightaffecttheuseofthehindlimbssuchaslumbosacraldisease.Thepatientshouldalsobefreeofanyotherorthopedicdiseaseaffectingeitheroneofthepelviclimbs,suchascranialcruciateligamentrupture.Thesurgicalprocedureforcaninetotalhipreplacementistechnicallychallengingandshouldonlybeperformedbyahighlyqualifiedveterinarysurgeon.Duringtheprocedure,theanesthetizedpatientisplacedinapelvicpositioningdevicetoaidinappropriateimplantalignment.Strictaseptictechnique,perioperativeantibiotics,andsurgeonsterilityarevitalinpreventingsurgicalassociatedinfection.Acraniolateralsurgicalapproachismadetothecoxofemoraljoint.Theheadofthefemurispreciselycuttoexposethefemoralcanalandalsotoprovideincreasedexposuretotheacetabulum.Theacetabulumissequentiallyreamedandshapedtoaccuratelypreparethebonebedfortheimplant.Oncethebonebedispreparedtothepropersize,theporous-coatedtitaniumacetabularimplantisseatedandhammeredintopositionandcorrectorientation.Thefemoralcanalisthendrilledandshapedwithaseriesofgraduatedbroachestopreparethefemoralbonebed.Oncetheappropriatecanalpreparationisattained,thefemoralstemisimpactedintotheproximalfemoralcanal.Atrialsizefemoralheadisthenplacedonthefemoralstemtodeterminetheappropriatefemoralheadimplant.Differentfemoralheadsallowthesurgeontolengthenorshortenthefemoralneck,thushelpingtominimizethepossibilityofpostoperativecoxofemoralluxation.Oncetheappropriatelysizedheadhasbeenplaced,thefemurisreducedandthejointcapsuleisclosed.Themuscles,softtissues,andskinareclosedinaroutinemannerandanadhesivebandageisappliedoverthesurgicalincision.Postoperativeradiographsaremadetoensureappropriateorientationandalignmentoftheimplants.Thepostoperativerecoveryperiodisimperativetosurgicalsuccessofthetotalhipreplacementprocedure.Alldogsareadministeredatleast2typesofdrugstoaidinpainreliefduringthefirst2to4weeksofrecovery.Mostdogsaretoe-touchinglamethedayaftersurgery.Thepatientwilloftenbearsignificantweightontheaffected Figure3.TheBFXfemoralstemimplant Figure4.TheBFXacetabularcupimplant

PAGE 50

48ArmyMedicalDepartmentJournallimbtheseconddayaftersurgery.Ownersareinstructedtouseaslingplacedunderthedogsabdomentohelppreventafallwhilethedogiswalkingandtohelpcontrolthepatientiftheytrytobetooactive.Thedogisstrictlyconfinedandonlyallowedtogooutsideonleashforbathroomuseforthefirst4weeks.Duringthesecondmonth,short5-minuteleashwalksareperformedtwicedailyandgraduallyincreasedto30minutesbytheendofthemonth.Duringthethirdmonth,theleashwalkactivityiscontinuedandasmallamountofsupervisedoff-leashrunningispermitted.Postoperativerecheckexaminationsareperformedat3,6,and12months.Radiographsaremadetoevaluatetheimplantsforanysignsofmovement,bonereaction,orpossibleinfection.Ifnoproblemsaredetectedonphysicalexamorradiographsat3months,thedogispermittedtoreturntonormalactivityandtraining.WhilethecomplicationratewiththeBFXtotalhipreplacementsystemislow,thecomplicationscanbesignificant.Postoperativecoxofemoralluxation,femurorpelvicfracture,implantsubsidenceormovement,andimplantinfectionareallpossibleTHRcomplications.Coxofemoralluxationisusuallytreatedwithreoperationandtheplacementofaniliofemoralsuturetohelppreventcraniodorsalluxation.Femurorpelvicfracturesareusuallytreatedwithreoperationandinternalfixationwithaboneplateandscrews.Dependingonthedegreeandseverityoftheimplantmovementorsubsidence,surgerymaynotbeindicated.Inextremecasesofimplantmovement,reoperationisusuallyperformed,andeitheralargerimplantisplacedoracementedimplantisused.Intheveryrarecasethatanimplantassociatedinfectiondevelops,bacterialcultureisperformedandantibiotictherapyinstituted.Iftheinfectionfailstoresolve,theimplantsusuallymustbesurgicallyremoved.CASEREPORT:MWDBENNYAtthetimeoforiginalpresentationtotheNorthCarolinaStateUniversityVeterinaryTeachingHospital(NCSUVTH),MWDBennywasa5-year-old,male,GermanShepherdDogcertifiedinpatrolandexplosivesdetectionstationedatMarineCorpsAirStation,Beaufort.Hehada3-monthhistoryofrighthindlimblamenessduringtrainingandworking.HehadbeenpreviouslytreatedbytheattendingVeterinaryCorpsOfficerattheMarineCorpsRecruitDepot,ParrisIsland,withcarprofen(Rimadyl)100mgorallyevery12hours,Cosequin2tabletstwicedaily,andexerciserestriction.HisphysicalexamfindingsattheNCSUVTHincludedmildlamenessoftherighthindlegwhilewalking,painonextensionoftherightcoxofemoraljoint,slightpainonextensionoftheleftcoxofemoraljoint,positiveOrtolanisignoftherightcoxofemoraljoint,andmildrighthindlegmuscleatrophywhencomparedtothelefthindleg.Completebloodcountandbloodserumchemistryindicatedelevatedcholesterol(454mg/dLref.range92-324)withallothervalueswithinnormallimits.RadiographsperformedatNCSUVTHrevealedpronouncedleftcoxofemoralDJDwithosteochondralfragments,bilateralmildcoxofemoralsubluxation,andmildrightfemoralheadremodeling(Figure5).Onthebasisofphysicalexamandradiographicfindings,thediagnosisofcoxofemoralDJDandhipdysplasiawasmade.SinceMWDBennyslamenessandpainresponseweremoresevereontherighthindleg,atotalhip Figure5.PreoperativeventrodorsalextendedpelvicviewofMWDBenny.Despitethemoderatedegenerativejointdiseasechangesinheadoftheleftfemur,thereisradiographicevidenceofdisusemusclemassatrophyintherightlegcomparedtotheleft.CanineHipDysplasia:SurgicalTreatmentfortheMilitaryWorkingDog

PAGE 51

JulySeptember200749replacementwasperformedonlyontherightcoxofemoraljoint.ABFXmodulartotalhipreplacementsystemwasusedinMWDBenny.Hisidealtemperament,outstandingdrive,andexcellentdetectionabilitiesmadehimtheidealpatient.Theanesthetizedpatientwasplacedinapelvicpositioningdeviceonthesurgerytabletoensureappropriatealignment.Amodifiedcraniolateralapproachtotherightcoxofemoraljointwasmade.Thefemurwasexternallyrotated,theroundligamentwascut,andthefemurluxatedtoexposethefemoralhead.Theneckcuttingguidewaspositionedandafemoralneckcutwasmadeatthelevelofthelessertrochanterwithanoscillatingbonesaw.Thefemoralheadwasremoved.Withtheacetabularcupexposed,asetofsequentiallysizedreamingdeviceswereuseduntilthemedialacetabularcortexwasidentified.A26mmBFXacetabularcupwasplacedandseatedwithintherightacetabulum.Thefemurwasthenelevatedandthecaudalandlateralfemoralneckwasremovedwithrongeurs.Thefemoralcanalwasopenedwitha5mmdrillbitandthensequentienallyenlargedwith#6,#7,#8,and#9broaches.A#9BFXfemoralstemwasimpactedandfirmlyseatedintherightfemur.A+3femoralheadwaslightlyhammeredontothefemoralneck.Thejointwasreducedandthelimbcouldexternallyrotate90withoutluxation.Thejointcapsule,muscles,subcutaneoustissues,andskinwereclosedinaroutinemanner.Postoperativeradiographsweretakentoassessimplantplacementandpositioning.Thepatientrecoveredfromanesthesiawithoutcomplications.Hydromorphoneandmedetomidinewereadministeredpostoperativefor24hoursasneededforpainrelief.MWDBennywasdischargedapproximately48hoursaftersurgery.Carprofen75mgorallyevery12hoursandCosequin2tabletstwicedailywereprescribed.Strictkennelconfinementandactivityrestrictionwasmandatedfor4weeks.Duringthesecondmonthofrecovery,MWDBennysactivityincludedleashwalks2to3timesaday,startingat5minutesandincreasingprogressivelyto30minutesbytheendofthemonth.Duringthethirdmonth,activitycontinuedtoincreasetoallowforshortperiodsofoff-leashrunningonadailybasisandcontinuallyworkinguptoresumeanearnormalpresurgerylevelofexercise.Attherecheckexamination3monthspostoperative,MWDBennywasusingtherightlegwithnoobservedlamenessineitherlimb.Therewasnopainonpalpationormanipulationoftherightpelviclimbwithrangeofmotionwithinnormallimits.Therewasmildmuscleatrophyoftherighthindlegcomparedtotheleft.Radiographsdidnotdetectanysignificantchangeintheimplantsorthebonefromtheradiographstakenimmediatelyaftersurgery.MWDBennywasauthorizedtoreturntofullactivity.Atthe6-monthrecheckexamination,MWDBennyhadreturnedtonormaltraining(obstaclecourse)andactivity(patrol/attackwork)withoutanylamenessorproblemsnotedbythehandler.Therewasnolamenessorpaindetectedinthepelviclimbsonphysicalexam.Currentradiographsdidnotdetectanysignificantchangefromtheradiographstakenimmediatelyaftersurgery. Figure6.VentrodorsalextendedpelvicviewofMWDBennyat17monthspostoperative

PAGE 52

50ArmyMedicalDepartmentJournalMWDBennyreturnedtotheNCSUVTH17monthspostoperativeforarecheckexamination.Hehadjustreturnedfroman8-monthdeploymenttoIraqandperformedwithoutcomplicationsduringhistourofduty.Physicalexamagaindidnotdetectanyabnormalities,lameness,orpainineitherpelviclimb.Radiographsdidnotdetectanychangesfromtheradiographsmade11monthsearlier(Figure6).DJDoftheleftcoxofemoraljointwasstillpresentbutunchangedfromearlierradiographs.MWDBennymadeatotalof3deploymentstoIraqafterhistotalhipreplacementinFebruary2004.Hehasnotdevelopedanyclinicallamenessaffectinghisrighthindlegassociatedwiththetotalhipreplacement.Unfortunately,MWDBennydevelopedsignificantlamenessofhisleftpelviclimbduetotheprogressionofdegenerativejointdiseaseandhipdysplasiaduringhisthirddeploymentandreturnedhomeearly.CONCLUSIONSTotalhipreplacementforthetreatmentofcaninehipdysplasiaishighlysuccessfulatalleviatingpainandreturningtheaffectedlimbtonormalfunction.CaninehipdysplasiahasbeenthemostcommonmedicalcauseofearlyretirementforMWDs.TheBFXuncementedtotalhipreplacementprovidesapainfreenormalfunctioningcoxofemoraljointinthedog.Inspecialcasesofwell-mannered,highlyskilled,andtechnicallyproficientMWDsafflictedwithseverecaninehipdysplasia,totalhipreplacementsurgerycanbesuccessfullyperformedtosignificantlyextendthepain-freeworkingcareerofthedog.ACKNOWLEDGEMENTSIthankDrSimonRoeforhisreviewofthismanuscriptandBioMedtrixforthephotographsoftheBFXimplantproducts.REFERENCES 1.OlsonRC.Physicalevaluationandselectionofmilitarydogs.JAmVetMedAssoc.1971;159:1444-1446.2.MooreGE,BurkmanKD,CarterMN,etal.Causesofdeathorreasonsforeuthanasiainmilitaryworkingdogs:927cases(1993-1996).JAmVetMedAssoc.2001;219:209-214.3.EvansRI.Causesforthedischargeofmilitaryworkingdogsfromservice[mastersthesis].Houston,TX:UniversityofTexasHealthScienceCenter,SchoolofPublicHealth;2005.4.SmithGK,PasterER,PowersMY,etal.Lifelongdietrestrictionandradiographicevidenceofosteoarthritisofthehipjointindogs.JAmVetMedAssoc.2006;229:690-693.5.LippincottCL.Excisionarthroplastyofthefemoralheadandneckutilizingabicepsfemorismusclesling.PartII.Thecaudalpass.JAmAnimHospAssoc.1984;20:377-384.6.Marcellin-LittleDJ,DeYoungBA,DoyensDH,etal.Canineuncementedporous-coatedanatomicaltotalhiparthroplasty:resultsofalong-termprospectiveevaluationof50consecutivecases.VetSurg.1999;28:10-20.AUTHOR CPTVinceisaResidentinSmallAnimalSurgeryattheCollegeofVeterinaryMedicine,NorthCarolinaStateUniversity,Raleigh,NorthCarolina.CanineHipDysplasia:SurgicalTreatmentfortheMilitaryWorkingDog

PAGE 53

JulySeptember200751INTRODUCTIONMilitaryworkingdogs(MWDs)havelongbeenusedasaneffectiveandreliableforcemultiplierformilitarygroundforces.Aswithanyothercombatsystem,maintenanceisessentialtoassuringsustainedpeakeffectiveness.InthecaseofMWDs,thismaintenanceistheirmedicalcareandmanagement.SurveysmadeofthemostcommonmedicalproblemsencounteredinRepublicofKorea(ROK)ArmyMWDsrevealseveralconditionsthatpotentiallycanbeefficientlymedicallymanaged(Table1).Amongthesemedicalproblemsisaneyeworminfestation,Thelaziacallipaeda.MedicalreviewsoftheROKArmyMWDpopulationsuggesta90%incidenceofeyeworms.Thesedogsalsomaintainahighincidenceoftickinfestation.Thelaziaspecieseyewormsareaspeciesofsmallroundwormsprincipallyfoundinoraroundtheeyesofseveralanimals.1(p80)Thewormscuticleshowswell-marked,coarsetransversestriations,whichlooktooth-likeinprofile.2ThelaziacallipaedaoccursinAsiainthemembrananictitansofthedogs,andlessfrequentlyinrabbitsandman.3-6ThelifecycleofmostThealziaspeciesdependsuponfliesasintermediatehostsandvectors.TheintermediatehostsandvectorsforThelaziacallipaedaaregenerallyunknown3;however,thehousefliesofgenusMuscusorFanniaprobablyserveastheintermediatehost.7EyewormAClinicalTrialofIvermectinAgainstEyewormsinGermanShepherdMilitaryWorkingDogsCOLMackFudge,VC,USALTCSookwanJeong,VC,ROKAPatMcInturff,DVM,PhD ABSTRACTObjective:Todetermineifmonthlyivermectinwasefficaciousinreducingtheobservedincidenceofeyewormsoveraperiodof2monthsascomparedwithnormalhusbandrypracticesinapopulationofRepublicofKoreaArmymilitaryworkingdogs(MWDs).Methods:Prospectiveobservationof114GermanShepherdMWDsinarandomized,double-blind,controlledclinicaltrial.MWDswererandomlyassignedtoeitheratreatmentgroupreceivingamonthlydoseof0.2mg/kgBWivermectinorally,ortoacontrolgroupgivenanequivalentdosevolumeandfrequencyofasalineplacebo.AquantitativenumericalcountofeyewormsfoundintheeyesofMWDswasconductedat25-dayintervals.Results:Theprevalenceofeyewormsinthetreatmentgroupwenttozeroat25daysandremainedlowerat50days(5%)thanbaseline(24%).Prevalenceinthecontrolsremainedapproximatelyconstantoveralltreatmenttimes(14%to18%).Conclusion:Althoughivermectindoesnotpreventdogsfrombeinginfectedwitheyeworms,thestudysuggeststhativermectinadministeredorallyatadoseof0.2mg/kgevery3weekssignificantlyreducestheprevalenceofThelaziaspecieseyewormsindogs.Table1.MostCommonMedicalProblemsFoundinKoreanArmyMilitaryWorkingDogsTraumaGastroenteritiswithdiarrheaENT(Conjunctivitis)Fungalinfection/bacterialinfectionHipdysplasia(usuallyunder6yearsofage)Heartworms(20%)Eyeworms(90%)Ticks

PAGE 54

52ArmyMedicalDepartmentJournalAClinicalTrialofIvermectinAgainstEyewormsinGermanShepherdMilitaryWorkingDogspresenceintheconjunctivalsaccanresultinclinicallyrelevantphotophobia,blepharospasm,excessivelacrimationoramucopurulentoculardischarge,keratitis,orcornealulcer.7Mechanicaldamagetotheinfecteddogseyesislikelycausedfromthewormscoarsecuticleasitmovesabouttheoculartissues.Ifnotremoved,eyewormsarereportedtocauseblindness,presumablythroughproductionofcornealopacity.Thediagnosisismadebyfindingandidentifyingtheparasitesintheconjunctiva.3Treatmentinvolvesmanualremovalofthewormswithforcepsorflushingafterapplicationoftopicalanesthesia.Aftercareconsistsofsymptomatictreatmentoftheconjunctivitisandkeratitis,ifpresent.1(p80),7Ivermectinisanavermectinclassanthelminticcommonlyusedforroundworms(nematodes)andarthropods.Itsmodeofactioninvolvestheneurotransmittergamma-aminobutyricacid(GABA).Inroundworms,ivermectinstimulatesthereleaseofGABAfromnerveendingsandenhancesbindingofGABAtospecialreceptorsatnervejunctions,thusinterruptingnerveimpulses.Thisactionparalyzesandkillstheparasite.TheenhancementoftheGABAeffectinarthropodssuchasmitesandliceresemblesthatinroundwormsexceptthatnerveimpulsesareinterruptedattheneuromuscularjunction.Thisalsoleadstoparalysisanddeathoftheparasite.8,1(p263)Theprincipalperipheralneurotransmitterinmammals,acetylcholine,isunaffectedbyivermectin.IvermectindoesnotreadilypenetratethecentralnervoussystemofmostmammalswhereGABAfunctionsasaneurotransmitter.Recommendeddosesofivermectinhaveawidesafetymargininmostmammals,includingdogs.Incertaindogs,particularlyColliebreeds,theconcentrationofivermectininthecentralnervoussystemfollowingtreatmentisgreaterthanitisinotherdogs.Thisispossiblyduetoamorereadilypenetratedblood-brainbarrierinCollies,ortosequestration.Inthesedogs,theapparentpotentiationofinhibitoryneurotransmitter,GABA,byivermectinhasresultedinadversereactions:mydriasis,depression,ataxia,drooling,paresis,recumbency,excitability,stupor,coma,anddeath.8Ivermectinwasshowntosignificantlyreducethegeometricmeaninthenumberofeyeworms(Thelaziaspecies)collectedfromthesurfaceofeyesintreatedcattle.9Kennedy10andSolletal11demonstrated>99%efficacyoftheinjectableformulationofivermectinagainstThelaziaskrjabiniincattle.Kennedy12laterdemonstrated>99%efficacyoftopicalivermectinagainstthesamespecieseyewormincattle.Wetheorizedthativermectinwouldbesimilarlyeffectiveinworkingdogs.Theprimaryobjectiveofthisstudywastodetermineifmonthlyivermectinwasefficaciousinreducingtheobservedincidenceofeyewormsoveraperiodof2monthsascomparedwithnormalhusbandrypracticeswithouttheuseofivermectininapopulationofROKArmyMWDs.Secondaryobjectivesofthisstudyweretoascertain,inthissamepopulationofMWDs,ifthesamemonthlyadministrationofivermectinwouldreducethenumberofticksfoundontheMWDs.LastlywehopedtoestimatetheheartwormprevalenceinROKArmyMWDs.MATERIALSANDMETHODSStudyPopulationandSetting.ThestudypopulationconsistedofMWDsstationedintheFirstRepublicofKoreaArmy(FROKA)nearChunchon,ROK.AllstudiedFROKAMWDswereGermanShepherds.ThisstudywasperformedinthemedicalfacilitiesoftheFROKAMilitaryWorkingDogTrainingCenter.ApprovalforthisstudywasobtainedfromadhocmedicalreviewcommitteesfromboththeUSArmy18thMedicalCommandandtheFROKAGeneralStaff.InclusionandExclusionCriteria.AllMWDswhichwereassignedtotheFROKAandweregreaterthan6monthsofagewereconsideredforenrollmentassubjectsinthisstudy.Dogswereexcludediftheywereunabletocompletethestudy.GroupAssignments/Treatments.Dogswereassignedviasimplecomputerrandomizationintoeitheratreatmentorcontrolgroup.Treatmentwasdefinedastheoraladministrationof0.2mgofivermectinperkgbodyweight.Thecontrolgroupwasgivenanequivalentdosevolumeandfrequencyofasalineplacebo.AllmonthlydoseswereadministeredbytrainedUSArmyAnimalCareSpecialists.DataCollectionandQuality.Weprospectivelyobserved114MWDsinarandomized,double-blind,controlledclinicaltrial.Baselinedataconsistingofsex,age,weight,andgeneralmedicalconditionofthe

PAGE 55

JulySeptember200753dogswascollectedatthestartofthestudy.EachMWDselectedwasexaminedforthepresenceofeyeworms.Ifobserved,thewormsweremechanicallyremovedandtheeyewaslavagedwithsaline.AquantitativenumericalcountofeyewormsfoundintheeyesofMWDswasconductedat25-dayintervals,days0,25,and50.AsimilarcountwastakenofticksfoundonthebodyoftheMWDsatthesameinterval.Tickswereleftonthedogs.Bloodwasdrawnuponentryintothestudyandexaminedforthepresenceofheartwormantigenandlarvae.Afterallnumericalcountsweretaken,drug(salineorivermectin)wasadministeredanddogswereobservedforanypotentialadversereactions.AllmedicalinterventionsandnumericalcountsofparasiteswereconductedbytrainedUSArmyanimalcarespecialists.HandlingandrestraintofMWDswereconductedintheusualmannerbytrainedROKArmySoldiers.Neitherthetechniciansnorthehandlerswereawareofgroupassignmentormedicationadministeredtothedogs.Dogswerepositivelyreassuredthroughouttheinterventionperiod.AdministrativerecordingofdataandblindingwereconductedbyseparateUSArmyadministrativeandlogisticspecialists.On-siteoversightoftheentirestudywasperformedbyVeterinaryCorpsofficersfromboththeUSandROKArmies.BaselineComparisons.Baselinedataincluded:age,sex,bodyweight,presenceandnumberofeyeworms,presenceandnumberofticks,presenceofheartwormserumantigen(SNAPCanineHeartwormPFAntigenTest*),andpresenceofheartwormmicrofilaria(Difiltest).ResponseVariablesEyewormsTheresponsevariablewascontinuous,aquantitativenumericalcountofeyewormsfoundintheeyesofMWDsat25daysintervals.TicksTheresponsevariablewascontinuous,aquantitativenumericalcountofticksfoundonMWDsatthesame25dayintervals.HeartwormTheresponsevariablewasqualitative,adichotomous(positiveornegative)presenceofserumheartwormantigenasdeterminedbyassayormicrofilariaasdeterminedbyDifiltest.DataAnalysis.BaselinedatawasanalyzedusingaZ-testfordifferenceofproportionsandaStudentsT-testfordifferenceofmeans.Eyewormswereanalyzedusinggraphicproportions(proportioninfected).Drugefficacywasbasedonageometricmean,andeyewormburdenwasassessedusingaWilcoxonnonparametrictest.Cureratewasdeterminedbytheproportioninfected.HeartwormsandtickswereanalyzedusingaZ-testfordifferenceofproportions.SignificancewassetatP<0.05.RESULTSOnehundredtwenty-oneMWDswereenrolledintothestudywith114beinganalyzed.Ofthose,3MWDsdiedofunrelateddisease,2dogsbecameillfromunrelatedillnessandwereexcluded,onedogdepartedthestudyearlytoreturntoduty,andonedogwasremovedfromthestudyduetodisposition.Withtheexceptionofmalestofemales,the2groupswereabsolutelycomparable.Maledogsmadeup63%ofthetreatmentgroup(SEM6.4%)ascomparedto46%malepopulationofthecontrolgroup(SEM6.7%).Theproportionofmalestofemaleswasnotsignificantlydifferentat=0.05,butwasclosewithap=0.067.Therewerenosuspectedbiologicalimplicationstocaninehostswithregardtoeyeworms,ticks,orheartwormsandthesexofthehost.Treatmentdogshadameanageof30.5months(SEM3.0).Controlgroupmeanagewas31.7months(SEM3.4).Meanweightsforthetreatmentgroupwere28.4kgforthetreatmentgroup(SEM0.7)and28.3kgforcontrols(SEM0.7).Eyeworms.PrevalenceofeyewormsinMWDsofeachgroupisshownintheFigure.Nodifferenceinnumbersofeyewormsbetweengroupswasobservedatday0(p=0.16).Prevalenceinthecontrolsremainedapproximatelyconstantoveralltreatmenttimes(14%to18%)withnosignificantdifferenceobservedinoverallbaselineproportions.Theprevalenceofeyewormsinthetreatmentgroupwenttozeroat25daysandremainedlowerat50days(5%)thanthe24%seenatbaseline.Combinedtreatmentproportionsweresignificantlylessthanbothcombinedbaselineandcontrolproportions(p<0.005). StandardErroroftheMean *IDEXXLabs,OneIDEXXDrive,Westbrook,Maine04092EVSCOPharmaceuticals,Buena,NewJersey08310

PAGE 56

54ArmyMedicalDepartmentJournalDuetothelackofindependencebetweengroups,thenumber(orproportion)ofdogswho,overagiventimeinterval,recover(eg,theyhadgreaterthanoneeyewormattimeX,buthadzeroeyewormsattimeX+1),anddeveloptheinfection(eg,theydidnothaveeyewormsattimeX,buthadgreaterthanoneeyewormattimeX+1)wereobserved.Theseobservations,depictedinTable2,presentthenumberofanimalsthatwouldnormallyrecoveroveraninterval,andthenumberofanimalsexpectedtobecomeinfectedoveraninterval.Inthetreatmentgroup,4newcasesofeyewormswereobservedbetweenday25andday50.Onlyoneofthesefourwasreinfected(ie,initiallyhadeyewormsatthestartofthestudy,thenhadnoeyewormsduringthefirstinterval,andsubsequentlydidhaveeyewormsagainduringthelastinterval).Ofthecontroldogs,therewere7dogsthatdevelopedeyewormsbetweenday25andday50.Threeofthesesevenwerereinfections.Ivermectinefficacywas100%atDay25and71.5%atDay50.CurerateatDay25showed100%recoverywithivermectininthetreatmentgroup,with14MWDsinitiallyinfectedwitheyewormsand14improved.Controldogsshoweda25%recoverywiththeplacebooverthesameperiod,with8MWDsinitiallyinfectedwitheyewormsand2improved.Themeannumberofeyewormsperdog,giventhatthedoghadoneormoreeyeworms,didnotappeardifferentbetweengroups,withtheexceptionofthetreatmentgroupatDay25asnoinfecteddogswereobserved(Table3).Ticks.Therewasnosignificantdifferencebetweengroupsregardingticks.Prevalenceandnumberofticksperdogincreasedovertimeinbothgroups.Noassociationwasfoundbetweenthenumberofticksorpresenceofticksandeyeworms.Heartworms.Heartwormseroprevalencewas16%intreatmentdogsand18%incontrols.Onlyonecontroldogwaspositiveforheartwormmicrofilariaatthebeginningofthestudy.Noassociationwasfoundbetweenthepresenceofheartwormsorpresenceofheartwormsandeyewormsortreatmentgroups.Animalswithheartwormswerenotmorelikelytohaveeyeworms,whetherreceivingivermectinornot.DISCUSSIONTheresultsofthisstudysuggestthativermectinadministeredorallyat0.2mg/kgevery3weeksappearstobeeffectiveinreducingtheprevalenceofThelaziacallipaedaindogs.ThesefindingsareconsistentwithsimilarstudiesTable2.ProportionofNewCases*andRecoveriesperStudyIntervalInterval1(Day0toDay25)NewCasesRecoveriesControl7.1(3.4)5.4(3.0)Treatment0(NA)22.4(3.4)Interval2(Day25toDay50)NewCasesRecoveriesControl8.9(3.8)14.3(4.7)Treatment6.9(3.3)NA*NewcasesweredefinedaszeroeyewormsattimeX,butatleastoneeyewormattimeX=1.RecoverywasdefinedasthepresenceofatleastoneeyewormattimeX,butzeroeyewormsattimeX=1.Alldogsthatinitiallyhadeyewormsrecovered.SincenotreatmentdogswereinfectedatDay25,nonecouldhaverecoveredinthesucceedinginterval. Percentageofdogswitheyeworminfestation(with95%Cls)atDay0,Day25,andDay50. 0%5%10%15%20%25%30%Day0Day25Day50 P e r c e n t a g e o f I n f e c t e d M W D s Control Treatment0%5%16%18%14%24%Table3.MeanNumberofEyewormsPerDogWithEyeInfestation*ControlGroupBaselineDay25Day50Number9118Mean16.6(8.7)3.2(0.8)3.4(0.9)TreatmentGroupBaselineDay25Day50Number13NA4Mean18.8(8.4)NA3.3(1.7)*Atleastoneeyeworminthedog AClinicalTrialofIvermectinAgainstEyewormsinGermanShepherdMilitaryWorkingDogs

PAGE 57

JulySeptember200755incattleinvolvingThelaziaspecieswheretheefficacyofivermectininthemedicaltreatmentoftheeyewormswasdemonstrated.Thesestudiesshoweda97%to100%efficacyincattleat8to14daysposttreatmentwithivermectin.Immaturewormstypicallyreturnedat22dayspost-treatment.Multipleroutesofadministrationwereused(subcutaneousinjectionandtopicalpour-on)overadosagerangefrom0.2to0.5mg/kgbody.Solletalnotedthatalthoughivermectinadministeredsubcutaneouslywas>99%effectiveagainstThelaziarhodesii,7of16cattletheyexaminedbecamereinfected22daysfollowingtreatment.11Thehighefficacyoftheinjectableformulationofivermectinalsodemonstratedinotherstudiesincattle8,1(p263)suggestsinfectionwasreestablishedbyimmigratinginfectedflies.Facefliescanmigrate1-2kilometerswithin24hours,implyingthataneffectiveflyabatementprogramwouldbeanecessarycomponentofanoveralleyewormcontrolprogramforworkingdogshousedandworkedoutdoors.Anaddedbenefitofusingivermectinasapartofaneyewormpreventionprogramisthatitwouldbecoincidentallyeffectiveasaheartwormpreventive.Thedosageofivermectinreportedhereisapproximately10timestheusualdosageusedforheartwormprevention.Theobserveddogshadanotablesero-prevalencesuggestingaheartwormpreventionprogramwouldbebeneficial.Ivermectin,andtheavermectinsasagroup,arerelativelyinexpensive,widelyavailable,andeasytouseveterinarydrugs.Effectiveoverawidedosagerangeandviamultipleroutesofadministration,ivermectinprovidesmultipletherapeuticmodalityoptionsforthecareprovider.Althougharelativelyolderdrug,andsomewhatlimitedinuseinsomecaninebreeds,ivermectinoffersagoodmanagementchoice/alternativeforGermanShepardworkingdogs.Furtherstudyshouldexplorethepotentialuseandefficacyofnewer,safer,andeveneasiertouseavermectinclassdrugs.Itshouldbenotedthat,althoughnotcommon,Thelaziainfestationsarepossibleinhumans.Thismakeseyewormcontrolapotentialconsiderationforthoseworkinginareasofincreasedlikelihoodofexposure.LIMITATIONSThisstudywassignificantlylimitedinregardtoitsobservationsofticks.Betterobservationsassupportedbysimilarstudiesinotheranimalspecieswouldhavebeeninnotingthegenus/speciesofticksfoundontheMWDs,volumeofbloodconsumedbytheticks,averagebodyweightofticksafterivermectintreatment,andperhapstickeggproductionafterivermectin.Althoughivermectinuseinanimalshasbeenshowntoreducetheabundanceofallstagesofticksinpastures,13reducethebodyweightandamountofbloodconsumedbyticks,14andreducesubsequenteggproductionofticks,15reductioninticknumbersontreatedanimalswerenotreadilyapparent.16CONCLUSIONAlthoughivermectindoesnotpreventdogsfrombeinginfectedwitheyeworms,thisstudysuggeststhativermectinadministeredorallyatadoseof0.2mg/kgevery3weeksreducestheprevalenceofThelaziaspecieseyewormsindogs.Usedinconcertwithapracticalflyabatementprograminendemicareas,ivermectincouldeffectivelymanageeyewormsinworkingdogpopulations.ACKNOWLEDGEMENTThesuccessfuloutcomeofthisstudyisinlargepartduethediligenteffortsoftheSoldiersontheFROKAMilitaryWorkingDogCenterandthe129thMedicalDetachment(VeterinaryMedicine).OfparticularnoteistheworkofMSG(Ret)FrankRinkerincoordinatingthelogisticsandmovementofpersonnel,andSGTKimYonginprovidinginteragencytranslationandcoordinationsupport.REFERENCES 1.UrquhartGM,ArmourJ,DuncanJL,DunnAM,JenningsFW.VeterinaryParasitology.Harlow,Essex,England:LongmanScientific&Technical;1987.2.LapageG.VeterinaryParasitology.2ndreved.Springfield,Illinois:CharlesCThomasPublisherLTD;1968:275-276.3.JonesTC,HuntRD.VeterinaryPathology.5thed.Philadelphia:Lea&Febiger;1983:836.

PAGE 58

56ArmyMedicalDepartmentJournal4.HongST,ParkYK,LeeSK,YooJH,KimAS,ChungYH,HongSJ.TwohumancasesofThelaziacallipaedainfectioninKorea.KoreanJParasitol.1995;33(2):139-144.5.CheungWK,LuHJ,LiangCH,PengML,LeeHH.ConjunctivitiscausedbyThelaziacallipaedainfestationinawoman.JFormosMedAssoc.1998;97(6):425-427.6.ChoiWY,YounJH,NamHW,KimWS,KimWK,ParkSY,OhYW.ScanningelectronmicroscopicobservationsofThelaziacallipaedafromhuman.KisaengchunghakChapchi.1989;27(3):217-223.7.HelperLC.MagranesCanineOphthalmology.4thed.Philadelphia:Lea&Febiger;1989:98-99.8.PlumbDC.VeterinaryDrugHandbook.5thed.Boston:BlackwellPublishing;2005:433-437.9.KennedyMJ,HolsteJE,JacobsenJA.Theefficacyofivermectin(pour-on)againsttheeyeworms,ThelaziagulosaandThelaziaskrjabiniinnaturallyinfectedcattle.VetParasitol.November1994;55:263-266.10.KennedyMJ.Theefficacyofivermectinagainsttheeyeworm,Thelaziaskrjabini,inexperimentallyinfectedcattle.VetParasitol.December1992;45:127-131.11.SollMD,Carmichael,I.H,SchererHR,GrossSJ..TheefficacyofivermectinagainstThelaziarhodesii(Desmarest,1828)intheeyesofcattle.VetParasitol.April1992;42:67-71.12.KennedyMJ.TheeffectoftreatingbeefcattleonpasturewithivermectinontheprevalenceandintensityofThelaziaspecies(Nematoda:Thelaziodea)inthevector,Muscaautumnalis(Diptera:Muscidae).JParasitol.1994;80(2):321-326.13.PoundJM,MillerJA,GeorgeJE,OehlerDD,HarmelDE.Systemictreatmentofwhite-taileddeerwithivermectin-medicatedbaittocontrolfree-livingpopulationsoflonestarticks(Acari:Ixodidae).JMedEntomol.1996;33(3):385-394.14.WilsonKJ,HairJA,SauerJR,WeeksDL.Effectofivermectinonthevolumeofbloodingestedbytwospeciesofticks(Acari:Ixodidae)feedingoncattle.JMedEntomol.1991;28(3):465-468.15.TaylorSM,KennyJ.Anivermectinsustainedreleasebolusincattle:itseffectsonthetickIxodesricinus.MedVetEntomol.1990;4(2):147-150.16.SollMD,BenzGW,CarmichaelIH,GrossSJ.Efficacyofivermectindeliveredfromanintraruminalsustained-releasebolusagainstnaturalinfestationsoffiveAfricantickspeciesoncattle.VetParasitol.November1990;37:28-96.AUTHORS COLFudgeistheCommanderoftheCentralPacificDistrictVeterinaryCommandlocatedonFortShafter,Hawaii.Atthetimethearticlewaswritten,hewastheCommanderofthe129thMedicalDetachment(VeterinaryMedicine),locatedattheYongsanBase,Seoul,RepublicofKorea.LTCJeongisChief,VeterinaryResearchSectionwiththeMinistryofNationalDefenseatYongsanBase,Seoul,RepublicofKorea.Atthetimethearticlewaswritten,hewastheVeterinaryOfficeroftheFirstROKArmyMilitaryWorkingDogTrainingCenter,Chunchon,RepublicofKorea.DrMcInturffobtainedhisPhDinEpidemiologyandaDVMfromtheUniversityofCalifornia,Davis.Hewasapracticingveterinarianservingthedairyindustry.DrMcInturffdiedinOctober,2006.AClinicalTrialofIvermectinAgainstEyewormsinGermanShepherdMilitaryWorkingDogs

PAGE 59

JulySeptember200757INTRODUCTIONTheUSArmyVeterinaryService,theDepartmentofDefenseExecutiveAgentforFoodSafety,reportstensofthousandsofdollarsincondemnedrawmeat(beefandpork)andpoultrylosseseachyear.Thisestimateislikelyconsiderablylowerthantheactuallosses.Mostoftencondemnationresultsfromrefrigerationfailureorpoortransportationandwarehousing/storagepracticeswhichallowtheproducttemperaturetoriseabovethe5C(41F)cold-holdingrequirement.Theprimaryreferenceforthiscold-holdingrequirementistheFoodandDrugAdministrationsFoodCode,1whichiscitedinthefoodsafetyregulationsofallbranchesoftheUSarmedforces.Anothercriterionoftentiedtothiscold-holdingrequirementisthatexposureofpotentiallyhazardousfoods(rawmeatandpoultry)toanout-of-temperatureconditionshouldnotexceed4hours,thoughthisisnotspecificallydetailedinthesectionoftheFoodCodecoveringcold-holdingofpotentiallyhazardousfood.The4-hourcriterionlikelycomesfromanothersectionoftheFoodCodeaddressingtheuseoftimeonlyasapublichealthcontrolratherthantimeinconjunctionwithtemperature.However,thissectionappliesspecificallytoready-to-eatfoodsortoaworkingsupplyofrawfoodsjustbeforecooking,bothintendedforimmediateconsumption.Thusthecriteriondoesnotapplytosituationssuchasrefrigerationfailuresorimpropertransportation/storagepracticesinwhichrawmeatandpoultryhavebeenexposedtotemperaturesabove5C(41F)foranyperiodoftime.SincetheFoodCodeiswritteninamannerthatestablishesinflexiblelimitsforregulatorycontrol,itdoesnotofferanydeviationguidancewhichwouldberequiredtomakeappropriatedispositiondecisionsintheseout-of-temperaturesituations.Thecurrentdecisionmakingtoolforthispurpose,historicallyreferredtoastheNatickRefrigerationFailuresGuide(TheGuide),hasbeenincorporatedintochapter5oftheUSArmyMedicalCommandsPamphlet40-13.2Itcategorizestemperature-abusedfoodsaseitherSAFEorRISK.SAFEfoodsarethoseitemsforwhichrefrigerationisusedasaqualitycontrolmeasureandnotforthecontrolofpathogengrowth.Examplesincludefreshfruitsandvegetables,frozenbakeryitems,processedUsingPredictiveMicrobiologytoEvaluateRiskandReduceEconomicLossesAssociatedwithRawMeatsandPoultryExposedtoTemperatureAbuseCW3GregM.Burnham,VC,USAStevenC.Ingham,PhDMelodyA.Fanslau,MSBarbaraH.Ingham,PhDJohnP.Norback,PhDDonaldW.Schaffner,PhD ABSTRACTTheDepartmentofDefensesufferseconomiclosseswhentemperature-abusedrawmeatandpoultryarecondemned.CurrentUSArmyguidanceregardingtime/temperaturelimitsassociatedwiththesefoods(RISK-3category)isultraconservative,especiallyatlowertemperatures.Wehavedevelopedamoreaccurate,yetconservativeorfail-safecomputer-basedtoolforpredictingpathogengrowthinrawmeatandpoultry.In20trialsofthistool,growth(>0.3logcolony-formingunitincrease)ornogrowthofSalmonellaserovars,EscherichiacoliO157:H7,andStaphylococcusaureuswasaccuratelypredicted67%to95%ofthetimeforinoculatedandtemperature-abusedpoultryproductsandgroundbeef.Fail-safepredictionswereobtainedintrialsforwhichthetoolwasinaccurate.Thepredictivetoolisreadyforfurthervalidationtrialsandfieldtesting.Usingthistoolasasupplementtothecurrentguidancewilldecreaselossesassociatedwiththecondemnationofrawmeatandpoultryproductsexposedtoshort-termtemperatureabuse.

PAGE 60

58ArmyMedicalDepartmentJournalandhardcheeses,etc.RISKcategoryfoods(refrigerationcontrolspathogengrowth)arebrokendowninto3groupsandaflowcharttodetermineanitemsRISKgroupisinTheGuide.RawmeatandpoultrywouldbeclassifiedassubgroupsofRISK-3foods.Time/temperaturelimitsforthe3RISKgroupsarealsoinTheGuideandprovideamaximumexposuretime(inhours)foreachRISKgroupgivenin1Cintervalsfora6Cto25C(42Fto77F)range.Insummary,thetime/temperatureguidelinesforRISK-3foods(meatandpoultry)areexposurefornotmorethan4hoursattemperaturesof6Cto22C(42Fto72F)ornotmorethan3hoursattemperaturesof23Cto25C(72Fto77F).Ourresearchsuggeststhattheseguidelinesareultraconservativeforrawmeatandpoultryproducts,especiallyatthelowertemperaturerange.Havingatooltoaccuratelypredictpathogenbehaviorinrawmeatandpoultrycoulddrasticallyreducelossesassociatedwithcondemnationofthesetemperature-abusedfoods.Wedevelopedsuchatool,THERM(TemperatureHistoryEvaluationofRawMeats),toaddresstheneedforsmallandverysmallmeatandpoultryprocessorstovalidatetheirHazardAnalysisandCriticalControlPoint*criticallimitsandtoprovidethemwithadecision-makingtoolforprocessdeviations.TOOLDEVELOPMENTThedevelopmentofTHERMwasdescribedinIngham,etal.3Itisbasedonisothermalinoculationexperimentsinrawmeat.Themeatsusedintheisothermalstudieswererawwholemusclepork,beef,andturkeyobtainedfromalocalretailstoreordirectlyfromalocalwholesaledistributor.Themeatwastrimmedoffatandgroundinourlaboratory.Levelsofindigenousmicroflora,fat,protein,water,andsaltweredetermined.Thenthegroundmeatwasportionedandfrozenat-20Cuntilusedinisothermalstudies.Inoculawerepreparedbycombiningeachof5cultured(stationaryphase)strainsofEscherichiacoliO157:H7,SalmonellaserovarsandStaphylococcusaureus.FortheporkandbeefisothermalstudiesE.coliO157:H7andSalmonellaserovarswerecombinedintooneinoculumandS.aureuswasaseparateinoculum.Forisothermalstudiesusingturkey,separateinoculaofSalmonellaserovarsandS.aureuswereused;E.coliO157:H7wasnotused.Isothermalstudieswereconductedatapproximately2.8C(5F)intervalsovera10Cto43.3C(50Fto110F)range.Groundrawpork,beef,andturkeywereweighed(about25g)intosmallsamplebagsandallowedtoreachthetesttemperatureeitherinastaticwater-bath(temperaturesaboveroomtemperature)oranincubator(temperaturesat,orbelow,roomtemperature).Whenthetesttemperaturewasreached,eachmeatsamplewasinoculatedwith100Loftheappropriateinoculum.Eachinoculatedsamplebagwassealedandmanuallymassagedfor20secondstodistributetheinoculumthroughoutthemeatmass.Bagsofinoculatedproductwerereturnedtotheisothermalexperimenttemperatureasquicklyaspossible(<5minutes).Threeconcurrenttrialswereconductedateachtesttemperatureforallmeat/pathogencombinations.Threebagsperinoculumtype(onepertrial)wereremovedateachsamplingtimefromthewaterbathorincubator.Theoutersurfaceofeachbagwassanitizedwith70%ethanolandallowedtodry.Oncedry,thecontentsofeachsamplebagweretransferredtoaseparate,large,filteredbag.Theoriginalsamplebagwasevertedtoexposeanyinoculumstillonthebag,andwasthenplacedintothefilteredbag.Thegroundmeatsampleandoriginalsamplebagwerediluted,stomachedatnormalspeedfor30seconds,andtheresultingmeathomogenatewasseriallydiluted.SimilarsamplingandinitialsamplehomogenizationwasdoneateachsamplingtimeinexperimentstotestTHERM,asdetailedlaterinthisarticle.Foreachdilution,100Lofappropriatelydilutedsamplewasspreadonasingleplate.TheselectivemediumusedforE.coliO157:H7wasSorbitolMacConkeyagaronwhichtypicalcoloniesarecolorless-to-whiteandopaque.TheselectivemediumusedforSalmonellaserovarswasXyloseLysineDeoxycholateagaronwhichtypicalcolonieshaveablackcenterandawelldefinedclear-to-opaquehalo.TheselectivemediumusedforS.aureuswasBaird-Parkeragarbasewithtelluriteeggyolksupplementonwhichtypicalcoloniesareshinyblackwithadistinctiveclearzoneinthesurroundingagar.Foreachmeat/pathogencombinationandtesttemperature,thelogcolony-formingunit(CFU)/samplewasdeterminedateachsamplingtimeforeachofthe3trials.ThesamplingtimeandlogCFU/sampledatawerethenenteredintotheDMFit2.0program(J.Baranyi,4InstituteofFoodResearch,NorwichResearchPark,NorwichNR47UA,UK)whichgeneratedabest-fitgrowthcurve,withanestimatedUsingPredictiveMicrobiologytoEvaluateRiskandReduceEconomicLossesAssociatedwithRaweatsandPoultryExposedtoTemperatureAbuse *AprogramoftheUSFoodandDrugAdministrationtoinstituteauniformstandardforfoodsafetytestsandinspections.Informationavailableathttp://www.cfsan.fda.gov/~comm/haccpov.html.

PAGE 61

JulySeptember200759lagphaseduration(LPD),growthrate(GR),andcorrespondingR-squaredvalue.TheLPDandGRvaluesforeachmeat/pathogencombinationwereusedtodeveloptheTHERMtool.Asoftwareapplicationwaswrittenwhichallowstheusertoenterupto20elapsed-time(minutes)andtemperature(F)datapairs.TheapplicationusesanintervalaccumulationstrategytoestimatethepercentofLPDelapsingineachtimeinterval(constanttemperatureassumed)bydividingtheintervaltimebytheLPDandmultiplyingtheresultingvalueby100.ThepercentLPDcontributedbyeachintervalisaccumulatedanddisplayedinterval-by-intervaluntil100%ofthetimeinlagphasehaselapsedasshowninthefollowingformula:Afterlagphaseiscomplete,intervalaccumulationisusedtoestimatesubsequentgrowth,inlogCFU.Asshowninthefollowingformula,thelogCFUofgrowthiscomputedbymultiplyingGR(logCFU/minute)byeitherthetime(minutes)remainingintheintervalduringwhichlagphaseended,orbythetotaltimeoftheinterval(forallintervalsthereafter).Whentemperaturevaluesenteredbytheuserdonotcoincidewithexperimentaltemperaturesused(2.8Cintervalsfrom10Cto43.3C),linearinterpolationisperformedbetweenDMFit-derivedLPDandGRvaluestoobtainLPDandGRvaluesforuseincalculatingtheprediction.TESTINGTHETOOLTheaccuracyofTHERMwastested,asdescribedinInghametal,3andsummarizedhere,in20inoculationstudieswithcoarse-groundbeeforpoultryproducts.Theseproductswereinoculated,subjectedtovariousshort-termtemperature-abuseregimes,andanalyzedtodeterminepathogenpopulationsatpredeterminedtimepointsduringthetemperatureabuse.Atime/temperaturehistoryforeithertheproduct(4.5kgchubsofcoarse-groundbeef)orthestorageenvironment(poultryproducts)wasalsoobtainedineachexperimenttoenterintoTHERMandobtainagrowthprediction.Coarse-groundbeefin4.5kgsealedcylindricalpackages(chubs)wasobtainedfromalocalwholesaledistributor.Compositionalandmicrobiologicalanalysesweredoneasdescribedabove.Toinoculatethechubs,12samples(25geach)wereremovedbycuttingincisionsthroughthepackagingmaterialonthetophalfofthelongaxisofthechub.The25gsampleswereplacedinsmallsamplingbags,inoculated,andtheinoculumwasdispersedasdescribedearlier.Thebaggedinoculatedsampleswereplacedbackintothechubsjustunderneaththepackagingandsecured.Foreachcoarse-groundbeefexperiment(Table1,experiments1through12),atemperatureprobeattachedtoadataloggerwasinsertedjustunderthesurfaceinthecenterofthechubtorecordtime/temperaturedatathatwasthenenteredintoTHERM.Datapointswereselectedbydividingtheexperimenttimeinto20equalintervals,anddeterminingthetemperatureateachofthetimesfromthedataloggeroutput.Inoculatedcoarse-groundbeefchubsweresubjectedtooneof3temperature-abusesituations:1.Pathogencontaminationofrefrigeratedrawmeatfollowedbyshort-termholding(3hoursto6hours)atroomtemperatureor35C(experiments1through4).2.Thawingpreviouslycontaminatedandfrozenproductatroomtemperatureor35C(12hoursto15hours;experiments5through8).3.Holdingpreviouslycontaminated,frozen,andthawedmeatatroomtemperatureor35Cfor12hours(experiments9through12).Sampling(onesamplebagperinoculum)andpathogenenumerationweredoneasdescribedearlieratpredeterminedtimesthroughouteachexperiment.Frozenorfrozen/thawedsampleswerespread-platedonNutrientAgarandincubatedat35Cforonehourtoencouragerepairoffreeze/thaw-inducedinjury.TheNutrientAgarwasthenoverlaidwiththeappropriateselectivemedium(temperedat48C).Incubationthencontinuedat35Cfortheusual24or48hourperiod.Forthepoultryexperiments(Table1,experiments13through20),freshskinlesschickenbreastsandgroundturkeymeatfrom2differentprocessorswereobtainedatalocalretailstore,storedfrozen,andthenthawedat5Cbeforeuse.FrozenturkeyscapulameatwasNTotalpercentLPD=intervaltime/LPDix100i=1NTotalGrowth=GRforintervalixintervaltimeii=1

PAGE 62

60ArmyMedicalDepartmentJournalobtainedfromalocalwholesaledistributor,storedfrozen,andthenthawedat5Cbeforeuse.Bothcompositionalandmicrobiologicalanalysesweredoneasdescribedabove.Eachtypeofpoultryproductwassubdividedintosmallportions,inoculatedasdescribedearlier,andthenexposedto2differenttemperature-abusestorageconditions.Storagetreatmentswereeither13Cfor8hours(experiments13through16),mimickingaprocessingenvironmentbarelycomplyingwithUSDAregulations,5orsequentiallyfor3hoursat13C,3hoursat21C,and4hoursat30C(experiments17through20).Thelatterexperimentsmimickedanextremelossoftemperaturecontrol(eg,productinadvertentlyleftonaloadingdock,coolerfailure).Smallpiecesofmeatwereexcisedfromthesurfaceoftheskinlesschickenbreastsandtheturkeyscapulameat,placedintoasmallsamplebagandinoculatedwith100Loftheappropriateinoculum,whichwasthendistributedoverthesurfaceofeachpiece.Groundturkeymeat(25g)wasweighedintoasmallsamplebag,inoculated,andtheinoculumwasmanuallydispersedasdescribedearlier.AdataloggeragainwasusedtomonitorstoragetemperatureandprovidedatatoenterintoTHERM.Datapointswereselectedbydividingtheexperimenttimeinto20equalintervals,anddeterminingthetemperatureateachofthetimesfromthedataloggeroutput.Onesampleofeachproducttypewasanalyzedat3hours,6hours,and8hours(experiments13through16)orat3hours,6hours,and10hours(experiments17through20).Microbiologicalanalyseswereconductedasdescribedearlier.STATISTICALANALYSISThepairedt-test,witha5%significancelevelwasusedtocompareLPDandGRvaluesforagivenpathogenbetweenproducts(groundpork,groundbeef,groundturkey)andforagivenproductbetweenpathogens(E.coliO157:H7,Salmonellaserovars,andS.aureus).InexperimentstotestTHERM,eachlogCFUvalueobtainedinanexperimentwassubtractedfromitscorrespondingtime-zerovaluetoobtainobservedchangeinlogCFUvalues.Time/temperaturedatafromeachexperimentwereenteredintoTHERMtoobtainpredictedchangeinlogCFUvalues.Theobservedvalueswerecomparedtothepredictedvaluesusingthepairedt-testandregressionanalysis.RESULTSANDDISCUSSIONPreliminaryexperimentsshowedthatthelevelofindigenousmicroorganismshadasignificanteffectonLPDvaluesforS.aureusbutnotE.coliO157:H7andSalmonellaserovars,withlargerS.aureusLPDvaluesresultingwhenthereweregreaternumbersofindigenousorganisms.Therefore,inordertodevelopaconservativepredictivetool,alldevelopmentexperimentsusedmeatproductswhichhadwhatweconsideredtobelow,butrealistic,levelsofbackgroundorganismsAerobicPlateCount<3.5logCFU/g.ThislevelwasslightlylowerthanmeanAerobicPlateCountvaluesreportedinUnitedStatesDepartmentofAgriculturebaselinesurveysofgroundbeef,turkey,andchicken.6-8ExperimentProductStorageTemperaturesHoldingTime1GBRT*340minutes2GBRT*360minutes3GB35C180minutes4GB35C240minutes5GB-20C/RT15hours6GB-20C/RT15hours7GB-20C/35C12hours8GB-20C/35C12hours9GB-20C/5C/RT12hours10GB-20C/5C/RT12hours11GB-20C/5C/35C12hours12GB-20C/5C/35C12hours13C5C/13C8hours14T5C/13C8hours15GT-A5C/13C8hours16GT-B5C/13C8hours17C5C/13C/21C/30C10hours18T5C/13C/21C/30C10hours19GT-A5C/13C/21C/30C10hours20GT-B5C/13C/21C/30C10hours*RTroomtemperature(21C)Holdingtimeatroomtemperature(21C),13C,or35C.Initialsamplingoccurredoninoculation(fornonfrozencoarse-groundbeefsamples),wheninoculatedpoultryproductsweremovedto13Cstorage,orwhenfrozencoarse-groundbeefwasremovedfromthefreezer.Samplingdoneoncecenterofthemeatmassreached5CandperiodicallyduringstorageatRTor35C.Productheldat13Cfor3hours,21Cfor3hours,andat30Cfor4hours.Initialsamplingwasdonewhenproductwasmovedto13Cstorage.Table1.Outlineoftemperature-abuseexperimentswithinoculatedcoarse-groundbeef(GB),skinlesschickenbreasts(C),turkeyscapulameat(T),groundturkeymeatfromplantA(GT-A)andgroundturkeymeatfromplantB(GT-B). UsingPredictiveMicrobiologytoEvaluateRiskandReduceEconomicLossesAssociatedwithRaweatsandPoultryExposedtoTemperatureAbuse

PAGE 63

JulySeptember200761TheDMFit-derivedR-squaredvalueisanumberfrom0to1thatrepresentstherelativepredictivepowerofthemodel.TheclosertheR-squaredvalueisto1,thegreaterthemodelsaccuracy.AllR-squaredvaluesforeachmeat/pathogencombinationwere>0.70with73%0.90.Theonlystatisticallysignificant(0.05)differencesinLPDorGRvalueswere:1.LPDvaluesforSalmonellaserovarswerelowerinbeefthaninpork.2.LPDvaluesforS.aureuswerehigherthanthoseforE.coliO157:H7andSalmonellaserovarsinbeef,andhigherthanthoseforE.coliO157:H7inpork.3.GRvaluesforS.aureuswerelowerthanthoseforE.coliO157:H7andSalmonellaserovarsinbeefandturkey,respectively.Asexpected,LPDdecreasedandGRincreasedastemperatureincreasedtoanoptimumforgrowth(illustratedintheFigure).AsconcludedinInghametal,3theTHERMtoolwasaccurateorfail-safeinpredictingwhetherE.coliO157:H7,Salmonellaserovars,andS.aureusgrewinrawbeefandpoultryproductsduringexperimentsdesignedtotestthetoolsperformance.Toreachthisconclusion,wequalitativelyevaluatedthepredictedandobservedchangeinlogCFUvalues,ie,describedpredictionsandobservationsaseithergrowthornogrowth.WeusedthecriteriaofgrowthequalsachangeinlogCFU>0.3(morethanonedoubling)andnogrowthequalsachangeinlogCFU0.3.AsshowninTable2,theTHERMtoolaccuratelypredictedwhethergrowthwouldoccurin67%,85%,and95%ofexperimentsinvolvingE.coliO157,Salmonellaserovars,andS.aureus,respectively.Inallotherexperiments,THERMpredictedpathogengrowthwhenitwasnotobservedexperimentally,ie,madeafail-safeprediction.Notably,THERMnevermadeafail-dangerousprediction,ie,THERMneverfailedtopredictgrowthwhenitwasobservedexperimentally.InadditiontocomparingthepredictedandobservedchangeinlogCFUvaluesforeachpathogenineachindividualexperiment,thepairedt-testwasusedtocomparepredictedandobservedchangeinlogCFUvaluesforeachpathogenforallexperimentscombined.ThisanalysisshowedthatthepredictedchangesinlogCFUvaluesweresignificantlyhigherthantheobservedchangeinlogCFUvaluesforE.coliO157:H7(0.007)andSalmonellaserovars(0.02).TheR-squaredvaluesfromregressionanalysiswere0.94and0.89,respectivelyforthese2pathogens,indicatingaveryconsistentrelationshipbetweenpredictedandobservedvalues.TheR-squaredvalueforS.aureuswasonly0.43,reflectingthedivergenceofpredictedandobservedvaluesinpoultryproductexperiments17through20.Thepairedt-testanalysisdidnotshowanystatisticallysignificantdifferencebetweenpredictedandobservedvaluesforS.aureusforallexperimentscombined(0.49),perhapsreflectingtheinconsistentrelationshipbetweenpredictedandobservedresults.AnadditionalwayoftestingtheaccuracyofTHERMistocompareitspathogengrowthpredictionstoexperimentalpathogengrowthobservedinexperimentsinotherlaboratories.Forexample,arecentstudybyMannetal9suggestedacriticallimitforgroundbeefprocessorsoftimeintheprocessingareaof6hoursorlesswiththeprocessingareatemperaturedefinedas22Cto23C.For22.5Cstorageofgroundbeeffor6hours,withnoadditionalGrowthratesandlagphasedurationvaluesforE.coliO157:H7ingroundbeefinthetemperaturerange50Fto110F. 00.0050.010.0150.020.0250.0350556065707580859095100105110020040060080010001200140016001800 L a g P h a s e D u r a t i o n ( m i n ) GrowthRate LagPhaseDuration GrowthRate LagPhaseDuration GrowthRate LagPhaseDuration G r o w t h R a t e ( l o g C F U / m i n u t e ) L a g P h a s e D u r a t i o n ( m i n u t e s )Temperature(F)

PAGE 64

62ArmyMedicalDepartmentJournalTable2.Accuracyofqualitativepredictions(THERM*)forgrowth(>0.3logCFUincrease)ornogrowth(< 0.3logCFUincrease)ofEscherichiacoliO157:H7(EC),Salmonellaserovars(SALM),andStaphylococcusaureus(SA)incoarse-groundbeef,onskinlesschickenbreastsandturkeyscapulameat,oringroundturkeyfromplantsAandBduringstorageatabusivetemperatures.Product&ExperimentECgrowth>0.3logCFU?+=yes=noSALMgrowth>0.3logCFU?+=yes=noObservedPredictedAccuracyObservedPredictedAccuracyObservedPredictedAccuracyCoarse-GroundBeef1AccAccAcc2+FS+FSAcc3AccAccAcc4+FS++AccAcc5+FS+FSAcc6AccAccAcc7++Acc+FSAcc8++Acc++Acc+FS9+FSAccAcc10++Acc++AccAcc11++Acc++Acc++Acc12++Acc++Acc++AccGroundBeefTotals67%Acc33%F-S75%Acc25%F-S91%Acc9%FSChickenBreast13NT**NTNTAccAcc17NTNTNT++Acc++AccTurkeyScapula14NTNTNTAccAcc18NTNTNT++Acc++AccGroundTurkeyA15NTNTNTAccAcc19NTNTNT++Acc++AccGroundTurkeyB16NTNTNTAccAcc20NTNTNT++Acc++AccTotalforPoultry100%Acc100%AccOverallTotal67%Acc33%F-S85%Acc15%F-S95%Acc5%F-S*TemperatureHistoryEvaluationofRawMeatsColonyFormingUnitAccurateFail-safe,ie,predictedgrowth>0.3logCFU,andobservedgrowth< 0.3logCFU**NottestedSAgrowth>0.3logCFU?+=yes=no UsingPredictiveMicrobiologytoEvaluateRiskandReduceEconomicLossesAssociatedwithRaweatsandPoultryExposedtoTemperatureAbuse

PAGE 65

JulySeptember200763warm-upandcool-downtimes(thesameconditionsaslaidoutbyMannetal9),theTHERMtoolpredicteda0.54logCFUincreaseofE.coliO157:H7.TheexperimentallydeterminedchangeinlogCFUvaluewas0.49,indicatinggoodagreementbetweenTHERMandtheinoculationstudy.Withlongerroom-temperatureincubation,Mannetal9observedachangeinlogCFUvalues(rounded)of1.0,1.4,and1.8forE.coliO157:H7storedfor8hours,10hours,and12hours,respectively.ThecorrespondingchangesinlogCFUvaluespredictedbyTHERMforthesetimeswere0.9,1.3,and1.7.Forgroundbeefstoredat10C,Mannetal9observedchangesinlogCFUvaluesofapproximately0.1,0.1,0.2,0.4,0.8,and1.0at4hours,8hours,12hours,24hours,48hours,and72hours,respectively.TheTHERMtoolpredictednogrowthofE.coliO157:H7through27hours,withchangesinlogCFUvaluesof0.5at48hoursand1.1at72hours.Usingthequalitativeapproachdiscussedearlier,weconcludethattheTHERMtoolpredictionsareconsistentwiththosefromtheMannetalstudy.9Experimentallydeterminedcriticallimits,asinthefirstMannetal9exampleabove,expressedinmaximumsafetimeatagiventemperature,areusefulforprocessors,socriticallimittablesweredevelopedforeachmeattypebasedontheshortestLPDtimeofthe3pathogens.Table3wasusedtoevaluateseveralout-of-temperaturesituationsreportedintheUSArmyVeterinaryCommandsInstallationSupportPlandatabase.10Inoneexample,rawbeefandpoultryitemswereexposedtoanout-oftemperaturesituationfor7hoursandhadreachedinternaltemperaturesof50F.Basedonourcriticallimittable,rawbeefcanbesafelyexposedtothistemperatureforupto27hoursandrawpoultryupto22.5hours.Anotherexamplewasareportedout-of-temperaturesituationinvolvingaraw-meatsdisplaycase(meattypenotreported)inwhichitemsweretemperature-abusedfor5hoursandreachedatemperatureof57F.TheTHERMcriticallimittablereportssafeexposuretimesatthistemperatureof9hours,6hours,andmorethan13hoursforpork,beef,andpoultryrespectively.Whenseveraltimeandtemperaturemeasurementsareavailablefromarefrigerationfailuresituation,amorespecificTHERMpredictionispossible.Forexample,inarecentlyreportedout-of-temperaturesituation,internalproducttemperaturesat2hours,4hours,8hours,and12hourswere42F,48F,60F,and38F.ForallmeattypesTHERMpredictedthat67%orlessofLPDelapsedforE.coliO157:H7and58%orlessofLPDelapsedforSalmonellaserovars.BecausenoS.aureusgrowthoccurredduring240-hourexperimentsattemperaturesbelow60Finourisothermalstudies,THERMdidnotpredictanyLPDelapsingforS.aureusduringthisout-of-temperaturesituation.OneconservativefeatureofTHERMisthatitdoesnotaccountforavarietyofinhibitoryingredients(eg,fat,sodiumchloride,sodiumnitrite,liquidsmoke)orinhibitoryprocessingconditions(eg,dry-curing,cold-smoking,ordrying)towhichpathogensorcompetingmicroorganismsmaybeexposedduringtemperatureabuseofrawmeatproducts.Forexample,in2independentindustrychallengestudiesinvolvingpartiallycookedbaconandfinishedbiltonganddrowors*conductedbyourlaboratory,11,12THERMalwayspredictedgrowthofall3pathogenswhenexperimentaltime/temperaturedatawereentered.Yet,nogrowthofinoculatedpathogenswasobservedinanyofthetrials.TomakethemostaccuratepredictionsforcriticallimitvalidationorprocessCriticalLimit(hours:minutes)Temperature(F)PorkBeefPoultry5054:4527:0022:305517:309:0014:45609:006:0013:45658:153:458:15705:453:304:45754:152:303:00804:152:003:00851:301:452:00901:301:302:00951:301:152:001001:301:151:301050:451:000:451100:451:000:45Table3.Criticallimittableexpressedinmaximumsafetime,inhoursandminutes,atagiventemperatureforpork,beef,andpoultry *Biltonganddroworsare2shelf-stable,ready-to-eat,driedbeefproductsdevelopedinSouthAfrica.Traditionallytheseproductsweremadebydryingunderambientconditions.Tomakebiltong,beefstripsareseasoned(high-salt)anddried.Tomakedrowors,smallpiecesofbeefareobtainedfromtrimmingand/orgrinding,seasoned(high-salt),stuffedintocasings,anddried.Inessence,thesetwoproductscouldbeviewedasverythickversionsofwhole-muscleandground-and-formedbeefjerky,madewithoutelevatedheat.

PAGE 66

64ArmyMedicalDepartmentJournaldeviationdecisionmakingfortheseproducts,additionalversionsofTHERMwouldhavetobedevelopedusingmeatscontainingrepresentativeamountsofsalt,nitrite,and/orotherinhibitorycompounds.Otherresearchershaveattemptedtoaccountforinhibitorsofmicrobialgrowthandhavemodeledthetemperature,pH,andwateractivityconditionsatthegrowth/nogrowthboundaryforSalmonellaTyphimuriuminlaboratorymedia.13However,analogousworkwithmeatsystemshasnotbeenpublished.WearecurrentlyworkingonaversionofTHERMusingastandardizedpork-basedbratwurstbatter.AnotherrestrictionofTHERMisitslimitedtemperaturerange.However,growthattemperaturesbelowtheTHERMlowerlimitswouldlikelyhavelittleeffectontheaccuracyofTHERMpredictionsbecauseoftheextremelylonglagphasedurationvaluesexpectedatsuchlowtemperatures.However,THERMgrowthpredictionscouldbeerroneouslylowifgrowthoccurredattemperaturesabovethe43.3CupperlimitofTHERM.Furthermore,atevenhighertemperatures,suchasthoseemployedinslow-cooking,pathogenswillbegintodie.WearecurrentlystudyingtheexpansionofTHERMbeyondthe43.3Cupperlimit.However,manyphysiologicalandenvironmentalfactorsmustfirstbeconsideredbeforedevelopingatoolthatpredictspathogenbehaviorattheuppergrowth/nogrowthtemperatureboundary,andwhentemperatureishighenoughtocausecelldeath.CONCLUSIONSTHERMisaneffectiveprototypetoolforqualitativelypredictingpathogenbehaviorinrawmeatandpoultry.ItsapplicationinDepartmentofDefensetemperaturedeviationevaluationcouldreduceeconomiclossesassociatedwithtemperature-abusedmeatswithoutjeopardizingthehealthofarmedforcespersonnel.OngoingextensionsoftheTHERMprototypewillenhanceitsapplicability.ThecurrentdownloadableversionofTHERM,aswellasaweb-basedbeta-version,maybefoundonthewebsite,http://www.meathaccp.wisc.edu.REFERENCES 1.FoodCode.FoodandDrugAdministrationWebsite.Availableat:http://www.cfsan.fda.gov/~dms/fc05-toc.html.Accessed3April,2007.2.MEDCOMPamphlet40-13:USArmyVeterinaryCommandGuidelinesandProcedures.FortSamHouston,TX.USArmyMedicalCommand,USDeptoftheArmy;February13,2006.3.InghamSC,FanslauMA,BurnhamGM,InghamBH,NorbackJP,SchaffnerDW.Predictingpathogengrowthduringshort-termtemperatureabuseofrawpork,beefandpoultry:useofanisothermalbasedpredictivetool.JFoodProt.2007;70:1146-1456.4.BaranyiJ,RobertsTA.Adynamicapproachtopredictingbacterialgrowthinfood.IntJFoodMicrobiol.1994;23:277-294.5.AnimalsandAnimalProducts,9CFRvol2ch3,part381.66(2003).6.FoodSafetyandInspectionService.NationwideFederalPlantRawGroundBeefMicrobiologicalSurvey;August1993-March1994.USDeptofAgriculture;April1994.Availableat:http://www.fsis.usda.gov/OPHS/baseline/rwgrbeef.pdf.AccessedMay26,2006.7.FoodSafetyandInspectionService.NationwideRawGroundTurkeyMicrobiologicalSurvey.USDeptofAgriculture;May1996.Availableat:http://www.fsis.usda.gov/OPHS/baseline/rwgrturk.pdf.AccessedMay26,2006.8.FoodSafetyandInspectionService.NationwideRawGroundChickenMicrobiologicalSurvey.USDeptofAgriculture;May1996.Availableat:http://www.fsis.usda.gov/OPHS/baseline/rwgrchck.pdf.AccessedMay26,2006.9.MannJE,BrashearsMM.ValidationoftimeandtemperaturevaluesascriticallimitsforthecontrolofEscherichiacoliO157:H7duringtheproductionoffreshgroundbeef.JFoodProt.2006;69:1978-1982.10.InstallationSupportPlanDatabase.USArmyVeterinaryCommand.Availableat:https://vet1.amedd.army.mil/86257023007ECD8C(restrictedaccess).AccessedApril17,2007.11.BurnhamGM,FanslauMA,InghamSC.Evaluatingmicrobialsafetyofslowpartial-cookingprocessesforbacon:useofapredictivetoolbasedonsmall-scaleisothermalmeatinoculationstudies.JFoodProt.2006;69:602-608.12.BurnhamGM,HansonDJ,KoshickCM,InghamSC.DeathofSalmonellaserovars,EscherichiacoliO157:H7,StaphylococcusaureusandListeriamonocytogenesduringthedryingofmeat:acasestudyusingBiltongandDrowors.JFoodSaf.Inpress.UsingPredictiveMicrobiologytoEvaluateRiskandReduceEconomicLossesAssociatedwithRaweatsandPoultryExposedtoTemperatureAbuse

PAGE 67

JulySeptember200765 13.KoutsoumanisKP,KendallPM,SofosJN.ModelingtheboundariesofgrowthofSalmonellaTyphimuriuminbrothasafunctionoftemperature,wateractivity,andpH.JFoodProt.2004;67:53-59.AUTHORS CW3BurnhamistheVeterinaryLiaisonattheUSArmyNatickSoldierResearch,DevelopmentandEngineeringCenteratNatick,Massachusetts.Whenthisarticlewaswritten,hewascompletingtherequirementsforaPhD(FoodScience)attheUniversityofWisconsin-Madison.DrStevenInghamisaProfessorintheDepartmentofFoodScienceattheUniversityofWisconsin-Madison.MsFanslauisaResearchAssistantintheDepartmentofFoodScienceattheUniversityofWisconsin-Madison.DrBarbaraInghamisaProfessorintheDepartmentofFoodScienceattheUniversityofWisconsin-Madison.DrNorbackisaProfessorintheDepartmentofFoodScienceattheUniversityofWisconsin-Madison.DrSchaffnerisaProfessorintheDepartmentofFoodScienceatRutgers,theStateUniversityofNewJersey,NewBrunswick,NewJersey.

PAGE 68

66ArmyMedicalDepartmentJournalTheUSArmyVeterinaryCorpsReserveComponent(VCRC)iscomposedofCitizenSoldierswhoareleadersandexpertsinthecivilianveterinarymedicalcommunity,aswellasleadersintheircommunities.ThisarticlebrieflyexplainstheVeterinaryCorpsmissionasdefinedbyArmydoctrineanddemonstratestheVeterinaryCorpsroleinForceHealthProtectionasdescribedintheForceHealthProtectionCapstoneDocument,1preparedbytheMedicalReadinessDivision,J-4,JointForcesCommand.ThediversecompositionoftheVCRCisfeaturedthroughhighlightingthemilitaryeducation,civilianeducation,militaryassignments,anddeploymentsofitsSoldiers.AnoverviewoftheresponsibilitiesofUSArmyVeterinariansisstatedinFieldManual4-02.182:TheUSArmyVeterinaryCorpsReserveComponentCPT(P)CristopherA.Young,VC,USA 1-3.VeterinaryConceptofOperationsVeterinaryservicesfunctioninthreebroadcategories.Thesecategoriesinclude:Foodsafety,fooddefense,andqualityassuranceVeterinarymedicalcareVeterinarypreventivemedicinea.FoodSafety,FoodDefense,andQualityAssuranceServices.Foodsafetyincludeshygieneandsanitation,defense,andqualityassuranceservicesasaprimarycomponentofpreventingdiseaseandnonbattleinjury(DNBI)withinanAO[areaofoperations].b.VeterinaryMedicalCare.LevelIandIIveterinarycareforMWDs[militaryworkingdog]includesemergencytreatment,stabilization,andevacuation.ThereisnoLevelIVveterinarycareandLevelVveterinarycareisfoundinCONUS[continentalUnitedStates]attheDoDMWDCenter.LevelIIIveterinarymedicalandanimalhospitalcareisprovidedbytheMDVM.LevelIIIveterinaryhospitalcareincludescomprehensiveveterinarymedicalandsurgicalanimalhospitalcare.ThelevelsofveterinarymedicalcareandthenumberofveterinarydetachmentsdeployedtoanAOaredeterminedbymission,enemy,terrainandweather,troopsandsupportavailable,timeavailable,andcivilconsiderations(METT-TC).Atalllevelsofveterinarymedicalcare,surveillance,prevention,andcontrolprogramsfordiseasescommontobothanimalandmanareimplemented.Theseniorveterinarystaffofficerprovidesadviceandguidanceonthesethreatstothemedicalcommandersandcommandsurgeons.c.VeterinaryPreventiveMedicine.Supportpreventionandcontrolprogramstoprotectsoldiersfromfoodbornediseases.EvaluatezoonoticdiseasedatacollectedintheAOandadvisePVNTMED[preventivemedicine]elementsandhigherheadquartersonpotentialhazard(s)tohumans.EstablishanimaldiseasepreventionandcontrolprogramstoprotectsoldiersandtheirfamiliesandotherDoDandAlliedpersonnelfromzoonoticdiseases.AssessthepresenceofanimaldiseasesthatmayimpacttheCONUSagriculturesystemifcontaminatedequipmentorpersonnelareallowedtoredeploy.Performinvestigationsofunexplainedanimaldeathstoincludelivestockandwildlife.

PAGE 69

JulySeptember200767Themilitaryveterinariansdoctrinalmissionisdescribedabove,butReserveComponentVeterinaryCorpsofficers(VCO)arenotlimitedtoassignmentsinMedicalDetachment(VeterinaryService)units.VCOsmaybeassignedtoCivilAffairsunitswheretheymayparticipateinagriculturaland/orpreventivemedicineteams.Veterinariansparticipatinginthesemissionsworkonawiderangeofactivitiesfromdevelopinginfrastructuretodesigningandimplementingveterinarypreventivemedicineprogramsforhostnationlivestock.AnotherpotentialVCOassignmentisthenewlycreatedMedicalReadinessTrainingCommand.AssignedveterinariansareworkingtointegrateActiveArmyandReserveComponenttrainingopportunitiesandtoappropriatelyutilizetheMedicalTrainingBrigadesandRTSMeds.VCOscanacceptassignmentsasDrillingIndividualMobilizationAugmentees,whoserveasresourcesforbothDistrictVeterinaryandRegionalVeterinaryCommands.Thereareseveralcolonellevelassignmentswithinthestructure,includingmedicalbrigades,theArmyMedicalCommand,andOfficeofTheSurgeonGeneral.Therearecurrently12VeterinaryCorpsofficersservingintheNationalGuard.Regardlessofassignment,thesmallfamilyofapproximately173ReserveComponentVCOsisatight-knitgroupthatrepresentstremendousexperienceinmanyfacetsofveterinarymedicine.TherelevanceoftheveterinarymissionisasstrongtodayasitwasattheoriginoftheArmyVeterinaryCorps,whenthehorseplayedafundamentalroleinthelogisticsapparatusofthemilitary.Assuch,animalmedicinewasthekeymission.Eventually,however,theVeterinaryCorpsrolegrewtoencompassprocurementofsubsistence.ThefocusonfoodsafetyevolvedfromthefindingsbythemilitarythatthefoodstuffsprocuredforthesoldiersfightingtheSpanish-AmericanWarweresubstandardandfilledwithverminandcontaminants.Inaddition,UptonSinclairsnovelTheJungle,3withitsexposofthehorrendousconditionsinthemeatpackingindustry,ledtocongressionalpassageofboththePureFoodandDrugActandtheMeatInspectionActin1906.TheVeterinaryCorpsmandateexpandedtoensurethatgovernmentfoodprocurementcontractswerefulfilledwithintegrity,asisstillthecasetoday.Infact,todaytheVeterinaryCorpsistheDepartmentofDefenseExecutiveAgencyforfulfillingtheveterinarymissionforallbranchesoftheArmedForces,plussupportingnumerousexecutivebranchagencies.Further,theVeterinaryCorpsroleinforcehealthprotectionisacriticalmission.In2006,theMedicalReadinessDivision(J4)oftheUSJointStaffpreparedtheForceHealthProtectionCapstoneDocument.1Thedocumentprioritizes10criticalsuccessfactors.ThetoppriorityisinthecategoryofHealthyandFitForce,ofwhichitemoneis:OccupationalandenvironmentalhealthIdentify,evaluate,andcontrolpotentialchemical,biological,andphysicalhazards.ThefourthlistedpriorityisagaininthecategoryofHealthyandFitForce.Theselecteditemsarerelevanttomilitaryveterinarymedicine:Injury/diseaseprevention.Goal:inprevalence/incidenceIdentifypreventableinjuriesanddiseaseaffectingmissionreadiness.Establishstandardsforoccurrenceratesandacceptablebehaviors.Developpreventionstrategies.ThefinalcategoryrelevanttotheveterinarymissionisSurveillance.Thefollowingitemsareimpactedbymilitaryveterinarians:DevelopajointcomprehensivestandardhealthsurveillancesystemEnvironmental/occupationalcapabilityDNBIcapabilityOperationalcasualtiescapabilityLinkagestopersonnelexposure(locationanddurationinformation)Seamlessgarrison/fieldcapabilityWiththeprioritiesoftheCapstoneDocument2asabackdrop,considerthecontextofadeployment.NomedicalprofessionalisbetterpreparedtoaddressthecomplexinterfacebetweentheSoldier,wildlife,domesticanimals,andtheenvironmentthanveterinaryspecialists.Zoonoticagentsmakeup65%ormoreoftheagentsthatcauseinfectiousdisease.Manyoftheseareforeignanimaldiseases,which,bydefinition,arecausedbyagentsthatdonotoccurinCONUS.Toaddresstheseconcerns,amajorityoftheofficersintheVeterinaryCorpsarePreventiveVeterinaryMedicinespecialists.Further,manyofficersaretrainedForeign

PAGE 70

68ArmyMedicalDepartmentJournalAnimalDiseaseDiagnosticians,veterinariansthathavespecializedtrainingindiagnosingtheclinicalsignsandgrosspathologyofforeignanimaldiseases.TheReserveComponenthastheadditionalbenefitofbringingthecivilianjobskillsandexperienceofitsmemberstobearwhendeployed.Suchvalue-addedcontributionbytheReserveComponentveterinariansisespeciallyprofound.Asmentionedearlier,thereareapproximately173RCVCOs.Indicativeofthelevelofprofessionalismandskillrepresentedwithintheranksofthoseofficersarethenumberofboardcertificationsanddiversityofspecialties,displayedintheTable.Fifteenofficersholdpost-doctoraldegrees,including11mastersand4PhDs.Atthewritingofthisarticle,4RCVCOsarecompletingresidencyprogramsintheriogenology,pathology,internalmedicine,andanesthesiology,respectively.Degreesandboardcertificationsareimportant,butthereareothermetricsthatdemonstratetheexceptionalcaliberoftheofficersintheVeterinaryCorpsReserveComponent,whoseranksinclude:2003KentuckyVeterinarianoftheYear2002OklahomaVeterinarianoftheYear2003TexasSpecialtyVeterinarianoftheYear2003KansasVeterinarianoftheYear2006WashingtonStateUniversityCollegeofVeterinaryMedicineOutstandingServiceAwardwinnerOneoftheAuburnUniversityCollegeofVeterinaryMedicineClassof1994YoungAchievers.Suchhonorsspeakvolumesaboutthequalityoftheofficers.TheRCVCOsareengagedinawiderangeofcivilianveterinarycareers,includingepidemiology,laboratorypathology,labanimalmedicine,collegesofveterinarymedicine,mixedanimalpractice,largeanimalpractice,smallanimalpractice,specialtypractices,amongothers.RCVCOsholdpositionsofleadershipinorganizedveterinarymedicineatbothstateandnationallevels.Theofficersareinvolvedatthecommunitylevelwithhospitalboards,religiousorganizations,charities,localgovernmentoffices,BoyScouts,CubScouts,sportsteams,andmore.ThefollowingcharacterizationofexcellencetrulyexemplifiestheVeterinaryCorpsReserveComponent:Excellenceistheresultofcaringmorethanothersthinkiswise,riskingmorethanothersthinkissafe,dreamingmorethanothersthinkispractical,andexpectingmorethanothersthinkispossible.(anonymous)REFERENCES 1.ForceHealthProtectionCapstoneDocument.FallsChurch,VA:USDeptofDefense,OfficeoftheAssistantSecretaryofDefense(HealthAffairs),TRICAREManagementActivity;2004.Availableat:http://www.ha.osd.mil/forcehealth/library/main.html.2.FieldManual4-02.18:VeterinaryServiceTactics,Techniques,andProcedures.Washington,DC:USDeptoftheArmy;30December2004:para1-3.3.SinclairUB.TheJungle:TheUncensoredOriginalEdition.Tucson,Arizona:SharpPress;2003.AUTHOR CPT(P)YoungisCommander,358thMedicalDetachment(VeterinaryService),Tuskegee,Alabama.BoardofCertificationNumberCertifiedVeterinaryPathology10LaboratoryAnimalMedicine4VeterinaryPreventiveMedicine8VeterinaryInternalMedicine5VeterinaryPractitioner1AmericanBoardofToxicology1VeterinarySurgery1 SpecialtycertificationsofUSArmyReserveVeterinaryCorpsOfficers TheUSArmyVeterinaryCorpsReserveComponent

PAGE 71

JulySeptember200769ThereisnoAdditionalSkillIdentifierorAreaofConcentrationdesignatingUSArmyVeterinaryCorpsSoldiersasSpecialOperations.However,membersoftheCorpscurrentlyserveinandsupportSpecialOperationsForces(SOF)units.VeterinaryCorpsofficersandenlistedanimaltechnicianshavebeenpartofSOFsinceatleastWorldWarII.Duetotheheavyuseofpackanimals,veterinarypersonnelwerepartofMerrillsMaraudersandtheMARSTaskForce,employedintheChina-Burma-Indiatheaterofoperations.TheMARSTaskForceincludedthereorganizedremainderoftheMarauders(redesignatedthe475thInfantryRegiment),the124thCavalryRegiment,aswellassomeQuartermasterPackTroops.The475thInfantryRegimentwasredesignatedthe75thInfantryRegimentin1954,thedirectancestorofwhichisthenowthe75thRangerRegiment.ArmyVeterinaryCorpsinvolvementinArmySpecialForcesgoesbacktoatleasttheearly1960swhenveterinarianswereassignedtoCivilAffairsGroupsinOkinawa(97th)andPanama(3rd).Atthattime,however,eventhoughveterinariansweregoingthroughtheSpecialForcesQualificationCourse,theywerenotassignedtoSpecialForcesGroups(Airborne).Suchassignmentdidnotbeginuntilthemid-1960s.TheassociationofVeterinaryCorpspersonnelwithCivilAffairsandSpecialForcesunitscontinuestothepresentday.VeterinariansinSpecialForcesGroups(SFG)assistinplanningandexecutingpreventivemedicinetaskstopreservethehealthoftheGroup,andparticipateinveterinarycivicactionprograms,alsoknownasheartsandminds,duringexercisesanddeployments.GroupveterinariansalsoassistinthetrainingofSpecialForcesMedicalSergeants(Armymilitaryoccupationalspecialty[MOS]18D)throughactivitiessuchasdidacticandhands-oninstructioninsmallandlargeanimalemergencytreatment,foodsafety,zoonoticandforeignanimaldiseaserecognition,packanimaloperations,animalhusbandryandgeneralveterinarycare,andfieldslaughterandcarcassevaluation.Thereare5ActiveArmyand2NationalGuardSFGs.AlthoughtheArmyReserveCivilAffairsunitsweretakenoutofUSArmySpecialOperationsCommand(USASOC)inOctober2006andplacedunderUSArmyReserveCommand,theActiveArmy95thCivilAffairsBrigaderemainsunderUSASOC.The95thandits4subordinatebattalionseachhaveaVeterinaryCorpsofficerontheirTableofOrganizationandEquipment.ThemissionoftheCivilAffairs(CA)veterinarianistoworkwithindigenousmilitaryassetsandallied,coalition,orforeigngovernmentagencies.Theyassistinplanningandexecutingpopulationandresourcecontrol,civicaction,andothersecuritydevelopmentandstabilityprograms.Duringmilitaryandparamilitaryoperations,theyassistinplanningandexecutingcivicaction,humanitarianassistance,andotherprogramsdesignedtoexpandthehostnationgovernmentslegitimacy.TheCAveterinarianalsoprovidesestimatesanddataontheresourcesessentialtobuildaneffectiveinfrastructureforcivilhealthandagriculturaladministrationoperations.TheCAveterinarianofferstechnicaladvicetothecommanderonissuesofagriculturalproductionsystems;effectsoflarge-scale,cross-borderlivestockmovements;effectsfromoutbreaksofendemicandforeignanimaldiseases;andcooperationwithnon-governmentalorganizations.Additionally,veterinariansarepartoftheSpecialOperationsSustainmentBrigadeandtheJohnF.KennedySpecialWarfareCenterandSchool.AnimalCare(MOS68T)noncommissionedofficers(NCO)arealsoauthorizedandassignedtotheschool.AllSOFpositionsrequireparachutequalification.ThereareveterinariansontheSurgeonsstaffatbothUSASOCandUSSpecialOperationsCommand(USSOCOM).ThoughallSOFveterinarypersonnelcurrentlyserveinArmyunitsexceptUSSOCOM,aVeterinaryCorpsofficerandAnimalCareNCOareSpecialOperationsForcesVeterinaryPersonnelCOLRobertVogelsang,VC,USA

PAGE 72

70ArmyMedicalDepartmentJournalexpectedtobecomeauthorizedandassignedtotheUSMarineCorpsForceSpecialOperationsCommand(MARSOC)inCY08.ThesepersonnelwillcareforMilitaryWorkingDogs(MWD)assignedtoMARSOCaswellasperformarolesimilartothatoftheSFGveterinarianwhentheunitisdeployed.The75thRangerRegimenthasindicatedaninterestinobtainingaveterinarysupportcapabilitywhich,ifapproved,wouldauthorizeassignmentofoneVeterinaryCorpsofficerandatleastoneAnimalCareNCO.SOFveterinarypersonnelhavebeenawardedorqualifiedfortheCombatActionBadge,asSpecialOperationsCombatDiver,andPathfinder.AnumberareSeniorandMasterParachutists,andsomehaveforeignjumpwings.OneNationalGuardSFGveterinarianisamemberoftheWorldWarIIAirborneDemonstrationTeam,acivilianreenactmentgroup.AllSFGveterinariansandmostoftheotherSOFpersonnelhavebeendeployedinsupportofOperationsIraqiFreedomandEnduringFreedom.DuetothesometimesremotelocationsinwhichSOFoperates,theunitVeterinaryCorpsofficermaybetheonlyveterinarianinaparticulararea.Assuch,theywillworkwithhostnationpublichealthpersonneltoimprovelocalcapabilities.SOFveterinarianshaverespondedtosuspectedanimaldiseases,and,specificallyinAfghanistan,workedwithalocalveterinariantocollectandsubmitsamplestotheMinistryofAgricultureandAnimalHealthfordiagnosis.Also,attherequestoftheAfghanagriculturalministry,aSOFveterinariangavelecturesonHighlyPathogenicAvianInfluenza(HPAI)andotheranimaldiseasestoagroupoflocalveterinarians.Shortlythereafter,thefirstreportedcaseofHPAIoccurredinAfghanistanandaGroupVeterinarianassistedinthecollectionanddistributionofessentialveterinarymedicalsuppliestoveterinariansinoutlyingareas.TheGroupVeterinarianhelpedtoeducatepersonnelworkingatveterinarydiagnosticlabsintheproperapplicationanduseoftheBrucellosiscardteststhatwereprovidedbytheUSDepartmentofAgriculturethroughtheeffortsofotherArmyveterinariansdeployedtoAfghanistan.TheGroupVeterinariansparticipatedinnumerousveterinarycivicactionprogramsthroughoutthedeployments.Severalthousandanimalswerevaccinatedanddewormedduringthesemissions,improvingrelationswithlocallivestockownersandgovernmentofficials.Wheneverpossible,localveterinarianswereencouragedtoparticipateinthesemissionstohelpbuildatrustinthelocalinfrastructureandservicesavailable.ThisinteractionalsoprovidedexcellentopportunitiesforthesharingofknowledgebetweenAmericanandlocalveterinarians.Toprovidealternativemodesoftransportationinareaswherevehiculartravelwasnotpractical,severalfirebasesobtainedhorses,mules,anddonkeysfromlocalstock.GroupVeterinariansassistedinthepurchaseofandcarefortheseanimals,oneVCOperformedcastrationsonseveralstallionsandassistedduringthefoalingseasonwhen6maresgavebirthononefirebase.GroupVeterinariansconductedspayandneutersurgeriesonanimalsownedbylocalnationalsthatwereincloseproximitytocoalitionpersonnel.Theseanimalswerealsovaccinatedagainstrabiesanddewormedtoreducetherisktohumanhealthinthoseareas.GroupVeterinariansworkedwithPreventiveMedicineOfficerstoensurethatdiningfacilitieswereproperlymaintainedandthattheriskoffood-borneillnesswasminimizedatbasesthroughoutAfghanistan.OneGroupVeterinarianalsoassistedinhumantraumacasesataForwardSurgicalElementslocaltraumacenterinsouthernAfghanistan.Veterinarysupportofspecialoperationsforceshasgrownsignificantlyinthelastdecadeandwilllikelycontinuetodosowithinthecurrentoperationalclimate.DespitethefactthatthereisnoveterinaryAreaofConcentrationforspecialoperations,therearenowasufficientnumberofhigherrankingpositionsthatmayallowaVeterinaryCorpsofficertohaveatypeofcareerprogressionwithintheSpecialOperationsenvironment.SOFassignmentsaregenerallyconsideredoneofthebestandmostrewardingtoursofdutywithinthecareerofaVeterinaryCorpsofficer.Remember,theresnogreaterthreatthananAirborneVet!AUTHOR COLVogelsangistheDeputySurgeonforClinicalOperations,UnitedStatesSpecialOperationsCommandatMacDillAirForceBase,Florida.SpecialOperationsForcesVeterinaryPersonnel

PAGE 73

JulySeptember200771StabilizationandreconstructionoperationsinfailedorfailingstatesarevitaltoUSsecurityinterests.DiminishingtheconditionsthatpermitterrorismtoflourishanddenyingterroristssafehaveninfailedstatesareamongtheobjectivesoftheNationalMilitaryStrategytoprotecttheUnitedStates.1Inhisforewordtothe2005NationalDefenseStrategy,DefenseSecretaryRumsfeldemphasizedthattheUnitedStatesmusttakeactionstoinfluenceeventsbeforetheybecomemoredangerousandlessmanageable.HealsosuggestedthatwemusttransformhowwethinkaboutsecuritytoachievethefavorablesecurityconditionsrequiredtoprotectthehomelandandUSinterestsaroundtheworld.2CAUSESOFSTATEINSTABILITYEconomicdistress,includingfoodinsecurity,urbanization,refugeeanddisplacedpersonsmovements,incapacitatedand/orcorruptgovernments,infectiousdiseases,andsocioeconomicdisparitychallengethesecurityandsurvivalofindividualsandcommunities,andareprimarydestabilizingfactorsleadingtoweakenedandfailedstates.3-5Theselong-termfactorsarecloselyinterrelated,andthepresenceofmultiplefactorsresultsinsynergisticnegativeeffectsonthepopulation,creatingorexacerbatingstateinstability.3Earlyidentification,intervention,andimprovementinthestatesagriculturalsectorcanStabilizationAndReconstructionOperations:TheRoleOfTheUSArmyVeterinaryCorpsLTCJohnC.Smith,VC,USA ABSTRACTStabilizationandreconstructionoperationsinfailedorfailingstatesarevitaltoUSsecurityinterests.Theseoperationsrequireabottom-upapproach,focusingonthepopulationasthestrategiccenterofgravity.Thisbottom-upapproachmustaddressthepopulationsbasicneeds,asdefinedbyDrAbrahamMaslowshierarchyofneeds,andprovidealong-termmeansofself-sufficiency,ratherthancreatinganaiddependenteconomy.Focusingoperationsonagriculturalprojectsprovidesrelieffromdonordependency,stimulateseconomicgrowth,andthwartsthepowerofspoilers.USArmyVeterinaryCorpspersonnelprovideessentialservicesensuringtheprocurementofsafeandwholesomesubsistenceandprovisionofmedicalcaretogovernment-ownedanimals.VeterinaryCorpsofficersarealsouniquelyqualifiedtodesignandimplementagriculturalstabilizationandreconstructionprogramsinconjunctionwithhost-stateministriesandagenciesacrossthefullrangeofmilitaryoperations.Early,sustainedengagementbyveterinariansstimulatesagriculturalproductivity,improvesanimalandhumanhealth,directlysupportsthepopulationshierarchyofneedsonalllevels,andacceleratesstabilizationoperationsbyreducingthepopulationssusceptibilitytospoilers.TheeventsofSeptember11,2001,taughtusthatweakstates,like Afghanistan,canposeasgreatadangertoournationalinterestsasstrongstates.Povertydoesnotmakepoorpeopleintoterroristsandmurderers.Yetpoverty,weakinstitutions,andcorruptioncanmakeweakstatesvulnerabletoterroristnetworksanddrugcartelswithintheirborders.PresidentGeorgeW.Bush

PAGE 74

72ArmyMedicalDepartmentJournalreducethepossibilityofahumanitariancrisisormountinginsurgency.7Between70%and75%oftheworldspoorliveinruralareasandearntheirincomedirectlyorindirectlyfromagricultureandagriculture-relatedactivities.6,7Themajorityofthesepooragriculturalistsresideinweakstatesandarehighlysubjecttoinsurgentandterroristinfluences.Indevelopingstates,theperformanceoftheagriculturalsectordeterminesthestatesoveralleconomicgrowth,expansionoftrade,andincome-earningopportunities.6,7Improvingagriculturalproductivityreducespovertyandstimulateseconomicgrowthinallsectors.Infragilestates,theassistanceobjectivesoftheUnitedStatesmustfocusonstabilization,recovery,andreform.8Agoalofagriculturalprogramsistotiethepopulationtotheirhomesandlandwheretheyareinterdependentonthelandfortheirlivelihoodandcannotaffordtoleaveit.Fooddonationscounterminethisconcept,requiringpeopletoleavethefarmandincreasingtheirsusceptibilitytoinsurgentsandterrorists.STABILITYANDRECONSTRUCTIONOPERATIONSDuringstabilityandreconstructionoperations,thegoalisnottoreturnthestatetostatusquoantebellum,buttoimprovetheconditionsforthepopulationinordertoeliminatetherootcausesoftheinstability.9(p2)Duringstabilityandreconstructionoperations,therewillbespoilerstothateffort,betheyinsurgents,terrorists,religiousorpoliticalfactions,drugcartels,warlords,orindividualsseekingtobenefitthemselvesortheirparticularcause.9(pp11-15)Spoilersusethestatesinstabilitytofurthertheircausesandhavelittletogainshouldtheneedsofthepopulationbemet.Asindividualneedsaremetandstatestabilityimproves,thespoilersactiveandpassivesupportwithinthepopulationprovidingrecruits,supplies,andsafehavenisdiminished.10(pp16-20)Combatoperationsarefocusedondefeatingtheenemystrategiccenterofgravity.Thesameobjectiveappliestostabilizationandreconstructionoperations.Currentmethodsofstabilizationandreconstructionarefocusedatthestatelevel,workingtoimprovethestateasawhole,withwide-sweepingprogramsandprojects.Statescannotbestabilizedfromthetopdown,thecenterofgravityforstabilizationandreconstructionoperationsisthestatespopulation.Statestabilizationrequiresasoundfoundationtobuildupon,andthatfoundationisapopulationthathasitsbasicneedsmetandthereforecanconcentrateonthegreaterissuesofstate.3,4MASLOWSHIERARCHYOFNEEDSDrAbrahamMaslow,duringthe1940sand1950s,developedatheoryofhumanmotivationandadvocatedapersonalhierarchyofneeds.Histheoriesgenerallyhavebeenaccepted,withsomecriticism,andcontinuetobeusedasabasisofhumanmotivationaltheoryyettoday.ManyscholarshaveenhancedandaddedtoMaslowshierarchicalneedsconceptovertheyears,buthisbasicbuildingblocksremainsteadfast.Maslowbelievedthathumansaremotivated,positivelyornegatively,bytheirunsatisfiedneedsanduntilthehierarchyslowerneedsaresatiated,thehigherneedsareunfulfillingandimmaterial.Maslowconsideredhumanstobegenerallynonviolent,trustworthy,self-protecting,andself-governing.Peoplewhoareunabletomeettheirbasicneedsaremotivatedintoactionstoachievefulfillment;theirstandardsandmoralsmaygivewaytosurvivalinstincts.11Whilemanyexamplesofdeviantbehaviorexistinallsocieties,theyaretheexceptionratherthanthenorm.Rationalindividualssteal,lie,ormurdernotbecausetheyfindpleasureintheseactivities,butbecausetheyhavedeficienciesintheirbasicneeds.Maslowalsoidentifiedconditionsthatareprerequisitesforthebasicneedstobesatisfied.Theseconditionsincludethefreedomsofspeech,expression,andself-defense.Deficienciesintheindividualbasicneedsmustbesatisfiedbeforeapersoncanbegintoactunselfishlyandbeafullyproductivememberofsociety.Needsdeficienciesalsomayoccuronasociety-widelevel.Thus,whenmanypeoplearehungrytheylookforreliefoutsidetheirfamily,clan,orcommunity.Whenthishappens,theregionishighlysusceptibletoinfluencesfromspoilers,whetherornottheycantrulyaffecttheplightoftheindividuals.Astrongleaderspromisesofabetterlifeprovidethepopulationhopeandallowtheleadertogaininfluenceoverthem.DrMaslowespousedthatindividualsneedsarecenteredon5primaryareas:biologicalandphysiologicalneeds,safetyneeds,belongingnessandloveneeds,esteemneeds,andtheneedforself-actualization.12-16BIOLOGICALANDPHYSIOLOGICALBiologicalandphysiologicalneedsrepresentthemostbasicneedsofanindividual,andthepopulationasawhole.AtthenucleusoftheseneedsarethosethatStabilizationAndReconstructionOperations:TheRoleOfTheUSArmyVeterinaryCorps

PAGE 75

JulySeptember200773keepanindividualalive:food,water,andshelterfromtheelements.Untiltheseneedsaremet,individualscannotmovetothehigherlevelsofneeds.Maslowhypothesizedthatevenwiththehigherneedsmet,individualscannotovercometheirconcernsforthelower-levelneeds.MilitaryforcessupporthoststatesinprovidingsecuritytotheirpopulationsandoftenfacilitatethedeliveryofAmericanandinternationallydonatedhumanitarianaid.However,thisaiddoesnotadequatelyaddressthebasicneedbecauseitfailstoprovidethepopulationtheabilitytomeetbiologicalandphysiologicalneedsforthemselves.Anoften-usedChineseproverbisapplicabletothesesituations:Giveamanafish;youhavefedhimfortoday.Teachamanhowtofish;andyouhavefedhimforalifetime.17Foodisanindispensablecommodityeveninthepoorestofstates,andthelackoffoodcreatestensionbetweentherichandthepoorbothwithinastateandamongstates.18Supportforstrugglingstatesintheireffortstodevelopsoundagriculturalprogramsreducesthethreatoflocalandregionalfoodcrises,andcreatesthegerminalconditionsforcontinuedeconomicgrowthatareasonablepace.Asthe2002USNationalDefenseStrategystates:Decadesofmassivedevelopmentassistancehavefailedtospureconomicgrowthinthepoorestcountries.Worse,developmentaidhasoftenservedtopropupfailedpolicies,relievingthepressureforreformandperpetuatingmisery.Resultsofaidaretypicallymeasuredindollarsspentbydonors,notintheratesofgrowthandpovertyreductionachievedbyrecipients.Thesearetheindicatorsofafailedstrategy.19(p21)States,andtheirpopulations,becomedependentanddevelopaideconomiesratherthandevelopingtheirownagriculturalorindustrialcapabilities.11Aideconomiesdoprovidejobswithinthetransportation,warehousing,distribution,andrelatedfields,butthesesamejobsareavailablewithinanagriculturaleconomyandarelesssubjecttotheabuse,graft,andeconomicinflationseeninaideconomies.11DevelopmentalassistancehasfocusedonrapidtransformationofpoorstatestobringthemuptoWesternstandards.Whatpoorstatesneedarestructuredprogramsofprogressthatlikelywilltakeyearstofullymature;theyneedtobeabletorideabicyclebeforetheycanrideaHarley.20SAFETYSafetyneedsisthesecondtierrequirementthatincludessecurity;stability;protection;freedomfromfear,anxiety,andchaos;andadesireforstructurewithlawandorder.Withinsafetyneeds,theabilitytosafelyaccesstherequiredbiologicalandphysiologicalneedsmaybecomeaprimarydrivingforcetotheindividualorpopulation.SecurityoperationsareanaturalmissionforUSmilitaryforcesduringstabilizationandreconstructionoperations.However,withoutthepopulationsbiologicalandphysiologicalneedsbeingmet,theyremaindiscontentandsubjecttospoilerinfluences.DuringtheVietnamWar,theMarineCorpsconductedOperationGoldenFleece,designedtosevertheVietCongfromtheirsourceoffoodinthesouth.10(pp109-110)MarinesprovidedsecuritytoVietnamesevillagesandsurroundingfarmlandduringharvestseason,allowingfarmerstosafelyharvestandselltheircropswithouttaxationbytheVietCong.ThisprogramwassuccessfulonseveralMaslowlevels.Besidestheobviousbiologicalandsecurityneeds,itprovidedtheVietnameseself-esteemintheirabilitytogrowandharvesttheirowncrops,maintainedtheirsenseofbelongingbyallowingthemtoremainintheirhomesandvillages,andmayhaveprovidedself-actualization.AnotherlesssuccessfulUSsecurityprogramdirectlyaffectingagricultureinVietnamwasOperationRanchHand.10(pp109-110)ThiswasadefoliationprogramwiththeintentofdenyingcoverandconcealmenttotheinsurgentsandthusreducingaccesstolocalVietnamesevillagesandcrops.WhileOperationGoldenFleeceimprovedthesituationforthelocalpopulation,OperationRanchHanddeterioratedit.Frequently,theapplicationdriftofAgentOrangekilledthecropsitwasintendedtoprotect.ThelossofcropproductionalienatedthelocalpopulationandcreatedstrongresentmentofUSforces,whichinturnstrengthenedthelocalsupporttotheVietCong,astheywereonlydemandingtaxation,notthelossofanentireharvest.BELONGINGNESSANDLOVEThethirdorderofneedsarethebelongingnessandloveneeds.Theseneedsmaybemetwithasenseofneighborhood,clan,orcommunitybelonging.Peoplerequireasenseofbelongingtotheirrootsandoriginwheretheycanfindsecurityandstability.Refugeesanddisplacedpersonsresidinginartificial

PAGE 76

74ArmyMedicalDepartmentJournalcommunitiesorfleeingintourbanpopulationcenterslackthatsenseofbelongingandeasilymaybeenticedbyspoilersrhetorictojointhemtoachievebelongingness.Maintainingthepopulationinruralareasbyincreasingtheirabilitytoproducetheirownsubsistence,andthenincreasingproductioninorderforthemtocreateincomereducesurbanizationandovercrowdinginthestatescitieswheretheyarelessabletofindworkandaremoresusceptibletospoilers.21(pp217-218,227)Urbanizationworsensenvironmentalproblemssuchasairandwaterpollutionandcreatesanidusforepidemicsofinfectiousdiseases,whichmayexpandintointernationalpandemics.22Landownershipprovidesasenseofbelongingness,andthelackoflandownershipoftenisamongtherootcausesofcivilunrestandinsurgency,aswasseeninthePhilippinesfollowingWorldWarIIandrecentlyinsouthernAfrica.Landownershipprovidesindividualsandfamilyunitsameansofprovidingfortheirbiologicalandphysiologicalneeds,givesthemasenseofsecurityandbelongingness,andallowsthemtogarnerself-esteemandpossiblyachieveself-actualization.InthePhilippines,grantinglandownershipwasasuccessfulmethodofdisarmingtheinsurgentsandreturningthemtoproductivemembersofsociety.10(pp75-82)Tradinggunsforlandownershipcanbeasuccessfulmethodtosupportindividualsintheirquesttomeettheirbasicneedsandforthestatetoincreaseitsinfluenceandincreasethelocalandnationaleconomicbase.ESTEEMEsteemneedsaremetbyanindividualssenseofself-esteemandself-respectalongwiththeesteemderivedfromothersintheformofrespect,reputation,prestige,andpraise.Amanwhocannotfeedhisfamilylosesself-respectwhenstandinginahumanitarianrationsline,dependentonthemercyandgoodwillofothers.Thedwindlingself-respectleadstofeelingsofloweredself-worthandself-confidence.Whenindividualsfeelinadequatetheyareincreasinglysusceptibletotheinfluenceofspoilerspromisingthemfame,glory,orstatus.Spoilersprovideindividualswithasenseofimprovementintheirself-worth,strength,andcapabilitytoimprovetheirusefulness.Spoilersoftenhavegreateraccesstohumanitarianaidshipmentsthroughcoercion,theft,orgraftandthusenabletheirfollowerstobetterprovidefortheirfamiliesneeds.Frequently,internationaldonationsofsubsistencefallpreytotheblackmarketandprofiteers,whooftenareinsurgentsorsupportersoftheinsurgency,ortogovernmentalcorruption.Ineithercase,thecitizendoesnotgainfromthesehumanitarianshipments.Onlywhenthesubsistencecanbeproducedlocallyandsoldopenlyonlocalfreemarketscanthebasicneedsoftheindividualcitizenbeaddressed.SELF-ACTUALIZATIONAtthetopofMaslowshierarchicalpyramidisself-actualization.Self-actualizationisanindividualsneedtodowhathestronglydesirestodoandisfittedtodo,whatamancanbe,hemustbe.23Anindividualcannotachieveself-actualizationuntilthe4previousneedshavebeenfulfilled.Acarpentermayfindgreatsatisfactioninhisabilitiesandqualityofwork,butifheishungryandafraidforhislifeandthatofhisfamily,hewillnotachieveself-actualization.Inordertodeflatethepowerandinfluenceofthespoilers,thepopulationsbasicneedsmustbemet.Itmayrequirecoordinatedpsychologicaloperationseffortstobringthepopulationtoasolidrealizationthatitistheirbasicneedsthattheydesire,notthespoilersrhetoricofmeetingtheirpie-in-the-skydreams.Inmanyunstablestates,internationalandnongovernmentalorganizationsaretryingtoimprovetheplightofthecitizensbybringingthemintothemodernworldandprovidingthemwithallofthemodernconveniencesofthewesternworld.Whereconcentrationisreallyneededisontheindividualsandcommunitiesfirst4basicneeds.Whenthepopulationiscapableofmeetingandmaintainingthose4needs,theywillthemselvesdevelopintothemodernworldbyseekingself-actualization.USNATIONALSECURITYSTRATEGYAmongthegoalsoftheUSnationalsecuritystrategyarechampioningaspirationsforhumandignityanddefusingregionalconflicts.19(p1)ThesegoalsareharmoniouswithMaslowsconceptsandtheneedsforself-esteem,self-actualization,andsecurity.Therefore,ournationalsecuritystrategysetstheimpliedtasktofocusourstabilizationandreconstructionoperationsondevelopingmethodstomeetMaslowshierarchyofneedswithinthestatespopulation.Becausethehierarchyofneedsmustbemetintheordergiven,appropriateattentionmustbeappliedtomeeteachlevelbeforeanindividualorpopulationcantrulyacceptthehigherneeds.StabilizationandStabilizationAndReconstructionOperations:TheRoleOfTheUSArmyVeterinaryCorps

PAGE 77

JulySeptember200775reconstructionoperationalplansmustincorporateboththewaysandmeansofaddressingallofMaslowsneedstoreturnthepopulationtoapeacefulandproductivesociety.Tomeetthisimpliedtask,amethodologymustbedevelopedtoassessthepopulationsabilitytomeettheirneedsbasedonMaslowshierarchicalconcept.ASSESSINGSTABILIZATIONANDRECONSTRUCTIONNEEDSTherearenumerousmodels,surveys,andevaluationmethodscurrentlyusedbymilitary,governmental,international,andnongovernmentalorganizationstodeterminetheneedsofastateduringstabilizationandreconstructionoperations.24Whilesimilaritiesexistamongthesesurveyandevaluationmethods,theyalsoarediverseintheircontentandscope.Eachorganizationssurveyandevaluationschemeisdesignedtoevaluatetheneedsthattheirparticularorganizationcanprovide:medical,nutritional,engineering,educational,political,financial,agricultural,etc.Thisis,ofcourse,areasonableapproachfortheindividualorganizationstoidentifyandprovidethesupportthatiswithintheircapacity.WhatislackingisanoverallassessmentlookingatthestateasawholebasedonMaslowshierarchyofneeds.Interviewswithindividualsandcommunities,notjustgovernmentofficials,willleadtoamorecomprehensiveandreasonableassessmentofMaslowsneeds.Themanonthestreettypeinterviewsareextremelyeffectiveindeterminingwhatthecommonmandesires.FrominterviewsinAfghanistan,Djibouti,andHonduras,averagepeoplehavethesamedesiresasmostAmericans.Theywanttohaveajob,earnaliving,providefortheirfamilies,andgivetheirchildrenmorethantheyhad,withabrighterfuture.ThecoalitionforcesprovincialreconstructionteamsinAfghanistanaresuccessfullyusingcommunitymeetingstoconnectwiththepopulation.Theyarefindingthatsomecommunitiesdesirelittlemorethanshovels,axes,andwheelbarrowswhileothersdesirewells,textbooks,orcropseeds.25Itiseasytovisualizethatinmanystabilizationandreconstructionoperations,thebiologicalandphysiologicalneedswillbetheprimaryrequirementtobemet.Thestateswherewearecurrentlyinvolvedinsubstantialstabilizationandreconstructionoperations,AfghanistanandIraq,previouslywereagriculturalbasedeconomies.Iraq,priortoSaddamHussein,wastheworldssixthlargestagriculturalexporter;todayitisafooddependentstate.CoupledwithitscurrentdependenceontheOilforFoodprogram,Iraqiagriculturelackseconomicviability.UnderSaddam,Iraqsagricultureproductivityrapidlydecreasedduetolackofinvestmentcapitalandpoorlandmanagement,resultinginarequirementtoimportover60%ofitsfood.26Afghanistan,withlimitednaturalresources,remainsasubsistenceagriculturestate.Inbothofthesestates,asinthemajorityofotherstateswhereinstabilityposesathreattoUSinterests,thestateseconomyandoverallpublichealtharecloselytiedtoagriculture.AGRICULTURALECONOMICS101Foodshortagesleadingtohumanitariandisastersrequiringinternationalreliefresponseareoftenthoughttobetheresultofdroughtorothernaturalphenomenon.Inpart,theyare,buttherealityisthatmanystatesfailtoprovideadequateinvestmentandresourcestodevelopmentofanagriculturaleconomy,focusinginsteadondevelopmentofanindustrialeconomy.27Interventionsinthesupplyoffood,whilemeetingtheimmediateneedsoftheat-riskpopulation,leadtodestabilizationofthestatesagriculturaleconomy.Provisionoffreefoodsuppliesreducesthemarketabilityoflocallygrowncommodities,whilegovernmentalprogramstokeepconsumercostslowbankruptstheproducers.27PromotingastrongworldeconomyenhancesUSnationalsecurityandadvancesprosperityandfreedomthroughouttheworld.Enhancingeconomicgrowthinaworldwherethemajorityofthepopulationlivesonlessthan$2adayallowspeopletomeettheirbasichierarchyofneedsandleadhealthierlives,createsjobs,andraisesincomes.Liftingtheveilofpovertystimulatessocial,economic,andlegalreform,detersspoilers,andreinforcesliberty.19(p17)TheUnitedStatesandotherdonorstateshaveprovidedbillionsofdollarsindevelopmentalassistancetopoorstatesandyethavefailedtospureconomicgrowthand,inmanycases,havecreateddependentsocieties.19(p21)Often,theaidprovidedhinderedtherecipientstateseconomicdevelopment.Theprovisionoffreegrainandothersubsistenceproductsdestroysthemarketforlocallyproducedproducts.InAfghanistan,theprovisionoffreegraintothegeneralpopulationhasdestroyedthe

PAGE 78

76ArmyMedicalDepartmentJournallocalgrainmarket,forcingfarmerstoreturntoraisingopiumpoppiesasacashcrop.Thisisacasewhereahelpinghandisaslapintheface.Cultivationofopiumpoppiescontinuesthecycleofsmuggling,trafficking,andorganizedcrimeinAfghanistan,reducingtheabilityofthecentralgovernmenttoachieveaneconomicandpoliticalbaseforstabilizationandreconstruction.Arapidinfluxofinternationalandnongovernmentalorganizationsintoadestabilizedstatedoesnotnecessarilyimprovetheabilityofindividualstomeettheirbasicneeds.Frequently,theseaidorganizationscompetewiththelocalpopulationforfoodandshelterandcreateinflationinthelaborandhousingmarkets,muchtothedetrimentofthestateseconomicstabilizationandreconstructionprograms.10(pp92-96)Historically,traditionalsocietieswerebasedonagriculture,todaysmodernsocietiesarebasedonindustry.28Thetransitionfromsubsistenceagriculturetothedevelopmentandmanufactureofmicrochipsisanevolutionaryprocessrequiringmanyyearsofsmallsequentialchanges.Promotingagriculturalprojectspromotesasustainabledevelopmentindevelopingortransitionalstates.Forthemajorityofthewesternstates,agriculturewasthebuildingblockoftheirbeginning.Astatemustbeabletoprovidesustenanceforitsownpopulacebeforeitcanmoveontobecominganinternationalplayer.Today,thirdworldstatesreadilyseewhattheWesthastoofferandwanttoleapforwardintoinstantWesternization.Intheireagerness,theyfailtorealizethattheWestdidnotjusthappeninayear,oradecade;ittookcenturiesforWesterncountriestoachievethewealthandprosperitytheynowenjoy.Westernersmayhaveforgottenthatourancestorsstruggledthroughthecrawlwalkrunstagesofdevelopmenttoachieveourprosperoussocieties.ManyWesternorganizationswishtobringthethirdworldintothemodernagewithoutworkingthroughthegrowingpains,struggles,andself-satisfactionofthecrawlwalkrunscenario.TheUnitedStates,whileextremelysuccessful,wasnotbornrichandfamousAmericansworkedforit,startingoutasagriculturalists.Oncetheywerecapableofmeetingtheirbiologicalneedstheyprogressedbymovingtoindustrialenterprisesandbeyond.Focusingonagriculturalprojectsprovidesrelieffromdependencyondonorcountriestothefarmerandhisfamily,andcreateslong-termemploymentinagriculturalrelatedoccupationssuchasmilling,processing,foodproduction,anddistribution.Asasingleindustry,agricultureisthemostcapableofprovidingthepopulationwithameansofachievingitsbasicneedswithminimalinvestmentrequiredfromdonorcountries.INTERRELATIONSHIPBETWEENHUMANANDANIMALHEALTHThecomplexinterrelationshipsbetweenhumanandanimalhealth,transmissionofdisease,foodproductionandprocessing,andeconomichealthatalllevelssignificantlyaffecttheoverallphysicalandeconomichealthofastate.Theraisingandmaintenanceoflivestockforfoodandmilkproduction(camels,cattle,sheep,goats,swine,andpoultry)andastransportationandlabor(camels,cattle,andequines)isavitalcomponentoftheindividualsandstateseconomyandpublichealth.Eventhepoorestsubsistencefarmersregardlivestockaskeyinvestmentsthatwillprovidesupportthroughdroughtsandcropfailure.Indevelopingandtransitioncountries,animalhusbandryisthelargestsinglesectorofagriculturaleconomics,and,asthestatedevelops,theimportanceoflivestockincreases.29Indevelopingcountries,muchoftheagriculturalenterpriseconsistsoffamilyfarmsgrowingcropsandraisinglivestocktoprovidetheirownsubsistence.Asastatedevelops,farmersandlivestockproducersmustincreasetheirproductioncapabilitiestomeettheneedsofagrowingpopulation.30Therearemanyexamplesofagricultural-basedprogramsincounter-insurgencyoperations.Inthe1970s,theBritishArmywasperformingcounter-insurgencyoperationsinOman.Oneoftheirsuccessfulprogramswasveterinarysupporttolocalcattleowners,improvingtheirherds,providingwellstowaterthem,andprovidingveterinarymedicalsupport.Theconditionoftheareaslivestockimproved,resultinginincreasesinboththeavailabilityoffoodandamountofincome.Thisinturnledtogreaterabilitytopurchaseconsumergoods,reducinginsurgentrecruitingamonglocalpopulation.21(pp217-218)USARMYVETERINARYCORPSTheUSArmyVeterinaryCorpsdoesnotincludetheperformanceofstabilityandreconstructionoperationsinitscurrentmissionstatement.31However,VeterinaryCorpspersonnelfrequentlyareengagedintheseStabilizationAndReconstructionOperations:TheRoleOfTheUSArmyVeterinaryCorps

PAGE 79

JulySeptember200777operationsasmembersofspecialoperationsforces,civilaffairsunits,andcivil-militaryoperationstaskforces.UtilizationofVeterinaryCorpsPersonnelVeterinaryCorpspersonnel,inlimitednumbers,areassignedorattachedtospecialoperationsforcesandcivilaffairsunitsatvariouscommandlevels.Intheseassignments,theyworkcloselywithhoststatesmilitarycounterpartsandgovernmentministriesandagencies.Specialoperationsforcesveterinaryassetsassistintheplanningandexecutionofpopulationandresourcecontrol,civicaction,humanitarianassistanceandothersecurity,development,andstabilityprograms.Inthesepositions,VeterinaryCorpspersonnelperformassessmentsandcollectdataonthehoststatesavailablehealthandagriculturaladministrationandoperationsinfrastructure,developingsupportandassistanceprogramstoexpandthelegitimacyofthehoststatesgovernment.CivilaffairsVeterinaryCorpsassetsfrequentlyareinvolvedinhumanitariananddisasterreliefprogramsincoordinationwithUSgovernmentalagencies,otherDoDelements,coalitionpartnergovernmentalagencies,internationalandnongovernmentalorganizations,andthehoststateministriesandagencies.Civilaffairsveterinariansperformawiderangeofpublichealthandveterinarypreventivemedicineactivitiesandprogramsinconcertwiththehoststatesministriesandagencies.VeterinaryCorpsofficersareversatileandcapableofworkingcloselywithawidevarietyofhoststateministries,andgovernmental,international,andnongovernmentalagencies.TheCoalitionJointCivil-MilitaryOperationsTaskForce-Kabul(CJCMOTF-Kabul)VeterinaryCorpsofficersworkednotonlywiththeAfghanMinistryofAgricultureandAnimalHusbandry,butalsowiththeMinistriesofHigherEducation,PublicHealth,andDefense.TheycoordinatedwithinternationalandnongovernmentalorganizationssuchastheUnitedNationsFoodandAgricultureOrganizationandWorldHealthOrganization,theDutchCommitteeforAfghanistan,andtheMayhewAnimalHomeofLondononavarietyofprojectstoimprovethehealthofboththeanimalandhumanpopulations.ImprovementofagriculturalprogramsandnationalfoodproductioncapabilitiesdirectlysupportsMaslowshierarchyofneeds.Duringstabilityandreconstructionoperations,veterinaryservicesupportoperationstoUSandcoalitionforcesincludesubsistenceinspectionstoensuresafety,security,andwholesomeness;andtheprovisionofveterinarymedicalservicestomilitaryworkingdogsandothergovernment-ownedanimals.Thelocalprocurementoffoodandwater,providingadequatesourcesareavailablewithoutinhibitingtheavailabilitytothelocalpopulace,isameansofstimulatingthelocaleconomy.VeterinaryserviceinspectionsoflocalcommercialsubsistenceoperationsnotonlyservestodetermineiftheyarecapableofmeetingUSprocurementstandards,butalsoprovidetheoperatorsasetofgoalstoimprovetheirfacilities.WhileitisnotcurrentlyinthescopeoftheVeterinaryCorpstoinspectcommercialoperationswiththeintentofprovidingguidanceandtraining,thatareashouldbeexplored.VeterinaryCorpspersonnelcouldprovidetraininginfoodindustrygoodmanufacturingprocesses,foodsanitationandhygiene,inspectionproceduresandtechniques,hazardousandcriticalcontrolpointsprogram,andfoodhandlingandstorageprocedures.Improvingthestatesabilitytoproducesafeandwholesomesubsistenceleadstoanoverallimprovementinpublichealth,reducingtheburdenondonorsforfoodandhealthcare.Workingalongsidethehoststategovernmentsministriesofagriculture,animalhusbandry,andpublichealthpersonnel,ArmyVeterinaryCorpspersonneldesignandexecutelocal,regional,andnationalsupportprogramstoimprovethehealthofthedomesticanimalpopulation.Improvingthehealthofthedomesticanimalpopulation,whilemanpowerintensive,isgenerallyacosteffectivemethodtoimprovethehealthofthehumanpopulation.Reducingenzootic(animaldiseasesthatcirculateamongandaffectonlytheanimalpopulation)andzoonotic(animaldiseasesthatcirculateamongtheanimalpopulationandcreatediseaseinhumans)diseasesleadstoanimprovementinoverallpublichealth.Veterinarycorpspersonnel,workingwithhoststateveterinarians,candevelopanimalvaccinationprograms,herdhealthprograms,andanimalhusbandryprograms.Healthieranimalsproducemoremeatandmilk,haveincreasedreproductivecapacity,andcostlesstomaintain.Thesegainscanbeseenwithoutachangeintheavailabilityoflivestockfeedandmayevenreducethefeedrequirementsbasedonproductivity.

PAGE 80

78ArmyMedicalDepartmentJournalVeterinariansfrequentlyconductdomesticanimalvaccinationprogramstoreducetheprevalenceofenzooticandzoonoticdiseaseinsupportofhoststategovernments.Theseprogramsprovideadeep-rootedpositiveimpressionoftheUnitedStatesanditscommitmenttothehoststatesgovernment.Currently,veterinaryprogramsareongoinginAfghanistan,Iraq,andtheHornofAfricaregiontoimproveanimalhealthandprovidetrainingtolocalproducers,veterinarians,andveterinarytechnicians.Whenavailable,theseprogramsmaybeconductedinconcurrencewithinternationalornongovernmentalorganizationstoincreasethesupportprovided.InHonduras,mountaindwellersoftentraveled2daystobringtheiranimalstoArmyVeterinarianswhowereprovidingvaccinationsanddewormingmedications.Whencombinedmedical,dental,andveterinaryserviceswereofferedinHonduranvillages,itwastheveterinarianwhohadthemostpatientsandlongestlines.Whenaskedwhytheyweremoreconcernedwithhavingtheirlivestockimmunizedthantheirchildren,theHonduransstandardreplywasitiseasytogetmorechildren,butIonlyhaveonehorse(cow,goat,etc)andmyfamilycannotsurvivewithoutit.ProgramsinAfghanistaninitiatedbytheCJCMOTF-KabulVeterinaryCorpsofficersincludedreinvigorationoftheAfghanMinistryofAgricultureandAnimalHusbandrysveterinaryinfrastructure,rebuildingthenationalveterinarydiagnosticlaboratoryandnationalvaccinelaboratory;workingwithnongovernmentalorganizationstobuildveterinaryclinicstoimproveaccesstoveterinaryservicesandtoserveasveterinarytrainingfacilities.OtherCJCMOTF-Kabulveterinaryprojectsincludedrebuildinggreenhousestoprovidethepopulationwithgardenplantstartsforself-sufficiency;developingresourcestoimprovedairyherdgenetics;rebuildingthenationalanimalandcropproductionresearchfacilities;rebuildingthenationalpoultryindustryinfrastructure;andprovidingsuppliestoregionalveterinaryclinicstoservicelocalpopulations.ProgramsdevelopedwiththeAfghanMinistryofHigherEducationincludedrebuildingandprovidingwaterandelectricitytotheSchoolsofVeterinaryScienceandPharmacy;provisionofsuppliesandequipmenttotheSchoolsofVeterinaryScience,Pharmacy,andEducation;supplyinganimalsandteachinganatomyattheSchoolofVeterinaryScience;anddevelopingaself-sustainingpoultrycooperativeattheveterinaryschooltobothteachandfeedstudentsandfacultymembers.TheCJCMOTF-KabulveterinaryofficersalsowereresponsibleforassessmentsofAfghanmedicalfacilitiesandcoalitionpartnersmedicalsupporttotheAfghanpopulation,andcollectionandreportingofhumanandanimaldiseaseprevalencedata.Theyalsopromotedinfrastructureprojectstoimprovecropirrigation,developwellstowaterlivestock,androadstoimproveagriculturalcommerce.MEETINGMASLOWSHIERARCHYOFNEEDSArmyVeterinaryCorpsofficerscandesignandconductstabilizationandreconstructionoperationstosupportallofMaslowshierarchyofneeds.Increasinganimalandcropfoodproductionandfoodsafetyincreasesthepopulationsabilitytomeettheirbiologicalandphysiologicalneeds.ThepresenceofArmyVeterinaryCorpspersonnelworkingwithhost-statepersonnelinlocalcommunitiesisasignofUSmilitarypresence,stimulatesfaithandallegiancetotheUS-supportedgovernment,andsupportssafetyneeds.Maintainingorreturningthepopulationtoruralenvironswheretheycanbecomeself-sufficient,ratherthanindisplacedpersonscampsorinurbanslumswithoutjobsorresources,improvesthesenseofbelongingnessandsupportstheconceptoffamiliesworkingcloselytogetherforacommonfuture.Supportingtheabilityofthepopulationtoprovideforthemselvesandtheirfamiliesandreducingtheirdailydependenceondonororganizationsfortheirsubsistenceelevatestheirself-esteem.Bymeetingandsustainingthe4lowerhierarchicalneeds,individualscannowseekself-actualization,bethatmaintaininganagrarianlifestyleordevelopingotherindustries.OTHERORGANIZATIONSManyorganizations,independentlyorasacoalition,developandexecuteprogramssimilartothosecommonlydevelopedbyArmyVeterinaryCorpsofficers.However,thoseorganizationsgenerallyareabsentduringarmedconflictanddonotreturnuntilthestatesinternalsecurityhasstabilized.AsapartoftheUSforce,theVeterinaryCorpscanoperateinhostileenvironmentswheretheearlyestablishmentofstabilizationandreconstructionprogramsiscriticaltotheoveralloutcomeoftheoperation.UnlikesomeStabilizationAndReconstructionOperations:TheRoleOfTheUSArmyVeterinaryCorps

PAGE 81

JulySeptember200779internationalandnongovernmentalorganizations,ArmyVeterinaryCorpspersonnelarenottryingtoestablishdependencyonoutsideorganizations,butaresupportingthehoststateandenhancingitslegitimacytothepopulation.CONCLUSIONStabilizationandreconstructionoperationsareintegralcomponentsofbothpeaceandwar,andthereforecannotbeoverlookedintheplanningcycleforpeacetimeengagementandcombatoperations.Inthewaronterrorism,theUnitedStatesmustpromptlyaddresstheinternalconcernsoftroubledandfailingstatestoreducethepotentialforterroristorganizationstoachieveafootholdinthesestates.32,33UnitedStatesinterventioninthesefailedorfailingstatesmustbeproactiveandaddressthepopulationsbasicneeds.Focusingonagriculturalproductioncanbeanefficientandcost-effectivemechanismforearlyintervention.32Theincorporationofagriculturalprograms,ledbyVeterinaryCorpsofficers,intotheaterengagementplansmayreducetheoccurrenceofagreaterhumanitariancrisisthatcouldrequirealargerUSmilitarypresencetoalleviate.34TheArmyVeterinaryCorpscanprovidesubstantialassistanceasaleadingcomponentinstabilityandreconstructionoperationstostimulatetheagriculturalsystemsandeconomyofthestate.TheinclusionofVeterinaryCorpspersonnelintheearlystagesofoperationalplanningandtheearlydeploymentofveterinaryassetscanimprovetheJointForceCommandersabilitytonegatespoilerswithinthepopulation,andprovidethepopulationameansofself-sufficiencyrequiringlessinternationalandnongovernmentalaid,andreducethetimerequiredtocompletesuchoperations.Thepromotionandinitiationofsustainableagriculturalprogramswithinthestatewillsignificantlyimprovethestatusquoandleadtooverallnationaleconomicandsocialgrowth.EffectiveutilizationofUSArmyVeterinaryCorpsofficersinstabilizationandreconstructionoperationscanreducethepossibilityofahumanitariancrisisormountinginsurgency,andthusachievethefavorablesecurityconditionsrequiredtoprotectthehomelandandUnitedStatesinterestsaroundtheworld.REFERENCES 1.TheNationalMilitaryStrategyoftheUnitedStatesofAmerica:AStrategyforToday:AVisionforTomorrow.WashingtonDC:JointChiefsofStaff,USDeptofDefense;2004:10-11.2.TheNationalDefenseStrategyoftheUnitedStatesofAmerica.WashingtonDC:USDeptofDefense;March2005:iii.3.FoxCW,Jr.Phantomwarriors:diseaseasathreattoUSnationalsecurity.Parameters.1997;27(4):121-136.Availableat:http://www.carlisle.army.mil/usawc/parameters/97winter/fox.htm.AccessedMarch29,2005.4.ManwaringMG.PeaceandstabilitylessonsfromBosnia.Parameters.1998;28(4):28-38.Availableat:http://www.Carlisle.army.mil/usawc/Parameters/98winter/manwarin.htm.AccessedMarch31,2005.5.OakleyRB.Developingastrategyfortroubledstates.JointForcesQuarterly.Summer1996:82.Availableat:http://www.dtic.mil/doctrine/jel/jfq_pubs/1512.pdf.AccessedMarch31,2005.6.Amoresecureworld:Oursharedresponsibility.ReportoftheHigh-levelPanelonThreats,ChallengesandChange.NewYork:TheUnitedNations;2004:29.7.UnitedStatesAgencyforInternationalDevelopment.Foodsecurity.Availableathttp://www.usaid.gov/our_work/agriculture/food_security.htm.AccessedApril2,2005.8.USAIDAgricultureStrategy,LinkingProducerstoMarkets.WashingtonDC:UnitedStatesAgencyforInternationalDevelopment;July2004:3.Availableat:http://pdf.usaid.gov/pdf_docs/PDABZ800.pdf.9.StabilityOperationsJointOperatingConcept(ver1.9).WashingtonDC:JointChiefsofStaff,USDeptofDefense:2.10.ArmstrongBJ.RebuildingAfghanistan:CounterinsurgencyAndReconstructionInOperationEnduringFreedom[mastersthesis].Monterey,CA:NavalPostgraduateSchool:2003:16-20.Availableat:http://library.nps.navy.mil/uhtbin/cgisirsi/sat+may+21+05:11:28+pdt+2005/sirsi/0/518/0/03dec_armstrong.pdf/content/1?new_gateway_db=hyperion.AccessedMarch25,2005.11.LeRicheM.Unintendedalliance:theco-optionofhumanitarianaidinconflicts.Parameters.2004;34(2):109-112.Availableat:http://www.Carlisle.army.mil/usawc/parameters/04spring/leriche.htm.AccessedMarch31,2005.12.MaslowAH.Atheoryofhumanmotivation.PsycholRev.1943;50(4):370-396.Availableat:http://psychclassics.yorku.ca/Maslow/motivation.htm.AccessedMarch31,2005.

PAGE 82

80ArmyMedicalDepartmentJournal13.BoereeCG.PersonalityTheories:AbrahamMaslow,1908-1970.ShippensburgUniversityfacultywebsite.Availableat:http://webspace.ship.edu/cgboer/maslow.html.AccessedMarch29,2005.14.ChapmanA.Maslowshierarchyofneeds;AbrahamMaslowshierarchyofneedsmotivationalmodel.Availableat:http://www.businessballs.com/maslow.htm.AccessedMarch29,2005.15.SimonsJA,IrwinDB,DrinnienBA.Psychology-TheSearchforUnderstanding.NewYork:WestPublishingCompany;1987.Extractavailableat:http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/maslow.htm.AccessedMarch29,2005.16.GwynneR.Maslowshierarchyofneeds.1997.Accessed29March2005at:[nolongeravailable]http://web.utk.edu/~gwynne/maslow.html.17.BrainyQuote.LaoTzuquotes.Availableat:http://www.brainyquote.com/quotes/quotes/l/laotzu121559.html.AccessedMarch29,2005.18.KaneTM,SerewiczLW.Chinashunger:theconsequencesofarisingdemandforfoodandenergy.Parameters.2001;31(3):63-75.Availableat:http://www.Carlisle.army.mil/usawc/Parameters/01autumn/Kane.htm.AccessedMarch31,2005.19.BushGW.TheNationalSecurityStrategyoftheUnitedStatesofAmerica.Washington,DC:TheWhiteHouse;September2002:21.Availableat:http://www.whitehouse.gov/nsc/nss.pdf.20.PetersR.Stability,Americasenemy.Parameters.2001;31(4):5-20.Availableat:http://www.Carlisle.army.mil/usawc/Parameters/01winter/peters.htm.AccessedMarch31,2005.21.BeckettIFW.ModernInsurgenciesandCounter-Insurgencies,Guerillasandtheiropponentssince1750.NewYork:Routledge;2001:217-218,227.22.SmithPJ.Transnationalsecuritythreatsandstatesurvival:aroleforthemilitary?.Parameters2000;30(3):77-91.Availableat:http://www.Carlisle.army.mil/usawc/parameters/00autumn/smith.htm.AccessedMarch29,2005.23.MaslowAH.Atheoryofhumanmotivation.In:MotivationandPersonality,2nded.NewYork:HarperandRow;1970:Availableat:http://www.xenodochy.org/ex/lists/maslow.html.AccessedMarch29,2005.24.MllerKE.Towardaconceptofstrategiccivilaffairs.Parameters.1998;28(4):80-98.Availableat:http://www.Carlisle.army.mil/usawc/parameters/98winter/muller.htm.AccessedMarch29,2005.25.DoughertyK.SemperGumbyAlwaysflexible,USmilitaryteamadoptsmottoasitexploresunchartedAfghantowns.StarsandStripes[MideastEdition].3(30);May10,2005:4.26.USCongress.IraqStabilizationAndReconstruction:InternationalContributionsAndResources.TranscriptofhearingbeforetheSenateCommitteeOnForeignRelations,June4,2002.Availableat:http://frwebgate.access.gpo.gov/cgi-bin/useftp.cgi?IPaddress=162.140.64.128&filename=89517.pdf&directory=/disk3/wais/data/108_senate_hearings.27.RosenbergerLR.Thestrategicimportanceoftheworldfoodsupply.Parameters1997;27(2):84-105.Availableat:http://www.Carlisle.army.mil/usawc/parameters/97spring/rosenbe.htm.AccessedMarch29,2005.28.HuntingtonSP.TheClashofCivilizationsandtheRemakingofWorldOrder.NewYork:Simon&Schuster;1996:68-69.29.UnitedStatesAgencyforInternationalDevelopment.Agriculture:livestock.Availableat:http://www.usaid.gov/our_work/agriculture/livestock.htm.AccessedApril2,2005.30.UnitedStatesAgencyforInternationalDevelopment.Agriculture.Availableat:http://www.usaid.gov/our_work/agriculture/.AccessedApril2,2005.31.FieldManual4-02.18:VeterinaryServiceTactics,Techniques,andProcedures.Washington,DC:USDeptoftheArmy;30December2004:1-1,4-1-4-8.32.RecordJ.Collapsedcountries,casualtydread,andthenewAmericanwayofwar.Parameters.2002;32(3):5-9.Availableat:http://www.Carlisle.army.mil/usawc/parameters/02summer/record.htm.AccessedMarch31,2005.33.FieldKC,PeritoRM.Creatingaforceforpeaceoperations:ensuringstabilitywithjustice.Parameters.2002;32(4):77-81.Availableat:http://www.Carlisle.army.mil/usawc/parameters/02winter/field.htm.AccessedMarch31,2005.34.LangeJE.Civilian-militarycooperationandhumanitarianassistance:lessonsfromRwanda.Parameters1998;28(2):106-122.Availableat:http://www.Carlisle.army.mil/usawc/parameters/98summer/lange.htm.AccessedMarch31,2005.AUTHOR LTCSmithistheSeniorVeterinarianattheDefenseSupplyCenterPhiladelphia,inPhiladelphia,Pennsylvania.StabilizationAndReconstructionOperations:TheRoleOfTheUSArmyVeterinaryCorps

PAGE 83

SUBMISSION OF MANUSCRIPTS TO THE ARMY MEDICAL DEPARTMENT JOURNAL The United States Army Medical Department Journal is published quarterly to expand knowledge of domestic and international military medical issues and technological advances; promote collaborative partnerships among the Services, components, Corps, and specialties; convey clinical and health service support information; and provide a professional, high quality, peer reviewe d print medium to encourage dialogue concerni ng health care issues and initiatives. REVIEW POLICY All manuscripts will be reviewed by the AMEDD Journal s Editorial Review Board and, if re quired, forwarded to the appropriate subject matter expert for further review and assessment. IDENTIFICATION OF POTENTIAL CONFLICTS OF INTEREST 1. Related to individual authors commitments: Each author is responsible for the full disclosure of all financial and personal relationships that might bias the work or information presented in the manuscript. To prevent ambiguity, authors must state explicitly whether potential conflicts do or do not exist. Auth ors should do so in the manuscript on a conflict-of-interest notification section on the title page, pr oviding additional detail, if necessary, in a cover letter that accompanies the manuscript. 2. Assistance: Authors should identify Individuals who provide writing or other assistance and disclose the funding source for this assistance, if any. 3. Investigators: Potential conflicts must be disclosed to study participants. Authors must clearly state whether they have done so in the manuscript. 4. Related to project support: Authors should describe the role of the study sponso r, if any, in study design; collection, analysis, and interpretation of data; writing the repo rt; and the decision to submit the report for publication. If the supporting source had no such involvement, the authors should so state. PROTECTION OF HUMAN SUBJECTS AND ANIMALS IN RESEARCH When reporting experiments on human subjects, authors must indi cate whether the procedures follo wed were in accordance with the ethical standards of the responsible co mmittee on human experimentation (institution al and national) and with the Helsinki Declaration of 1975, as revised in 2000. If doubt exists whether the research was conducted in accordance with the Helsinki Declaration, the authors must explain the rationale for their approach and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study. When reporting experiments on animals, authors should indicate whether t he institutional and national guide for the care and use of laboratory animals was followed. GUIDELINES FOR MANUSCRIPT SUBMISSIONS 1. Articles should be submitted in digi tal format, preferably an MS Word docume nt, either as an email attachment (with illustrations, etc), or by mail on CD or floppy disk accomp anied by one printed copy of the manuscript. Ideally, a manuscript should be no longer than 24 double-spaced pages. However, exce ptions will always be considered on a case-by-case basis. In general, 4 double-spaced MS Word pages produc e a single page of 2 column text in the AMEDD Journal production format. 2. The American Medical Association Manual of Style governs formatting in the preparation of text and references. All articles should conform to those guidelines as cl osely as possible. Abbreviati ons/acronyms should be limited as much as possible. Inclusion of a list of article acronyms an d abbreviations can be very helpful in the review process and is strongly encouraged. 3. A complete list of refere nces cited in the article must be provided with the manuscript. The following is a synopsis of the American Medical Associ ation reference format: Reference citations of published articles must include the auth ors surnames and initials, arti cle title, publication title, year of publication, volume, and page numbers. Reference citations of books must includ e the authors surnames and initials, b ook title, volume and/or edition if appropriate, place of publ ication, publisher, year of copyright, and specific page numbers if cited. Reference citations for presentations, unp ublished papers, conferences, symposia, etc, must include as much identifying information as possible (l ocation, dates, presente rs, sponsors, titles). 4. Either color or black and white photographs may be submitted with the manuscript. Color produces the best print reproduction quality, but please avoid excessive use of multiple colors and shading. Digital graph ic formats (JPG, GIF, BMP) and MS Word photo files are preferred. Prints of phot ographs are acceptable. Please do not send photos embedded in PowerPoint. Images submitted on slides, negatives, or copies of X-ray film wi ll not be published. For clarit y, please mark the top of each photographic print on the back. Tape captions to the back of photos or submit them on a separate sheet. Ensure captions and photos are indexed to each other. Clearly indicate the desired position of each photo within the manuscript. 5. The authors names, ranks or academic/certification credenti als, titles or positions, current unit of assignment, and contac t information must be included on the title page of the manuscript. 6. Submit manuscripts to: EDITOR, AMEDD JOURNAL ATTN MCCS DT 2419 HOOD ST STE C FORT SAM HOUSTON, TX 78234-7584 DSN 471-6301 Comm 210-221-6301 Email: amedd.journal@amedd.army.mil