VectorVector--BorneBorne DiseaseDisease EcologyEcology ofof thethe MiddleMiddle EastEast

MichaelMichael J.J. Cuomo,Cuomo, MPHMPH

Tulane University School of Public Health & Tropical Medicine ScD Program

United States Air Force, ANG Biomedical Services Corps Public Health OVERVIEWOVERVIEW

„ BriefBrief DescriptionDescription ofof CountriesCountries inin thethe MiddleMiddle EastEast „ MilitarilyMilitarily ImportantImportant VectorVector--BorneBorne DiseasesDiseases withwith ShortShort IncubationIncubation PeriodsPeriods (<15(<15 days)days) „ MilitarilyMilitarily ImportantImportant VectorVector--BorneBorne DiseasesDiseases withwith LongLong IncubationIncubation PeriodsPeriods (>15(>15 days)days) „ OtherOther DiseasesDiseases ofof MilitaryMilitary SignificanceSignificance „ NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance BriefBrief DescriptionDescription ofof CountriesCountries inin thethe MiddleMiddle EastEast

„ BahrainBahrain „ LebanonLebanon „ CyprusCyprus „ OmanOman „ IranIran „ QatarQatar „ Saudi Arabia „ IraqIraq Saudi Arabia „ SyriaSyria „ IsraelIsrael „ TurkeyTurkey „ JordanJordan „ UnitedUnited ArabArab EmiratesEmirates „ KuwaitKuwait „ YemenYemen

GEOGRAPHYGEOGRAPHY

„ OverOver 66 millionmillion sqsq kmkm ofof landland „ TopologyTopology –– mainlymainly flatflat lowlandslowlands oror plateaus,plateaus, withwith severalseveral mountainmountain rangesranges inin thethe northnorth andand inin coastalcoastal areas.areas. „ ReliefRelief variesvaries fromfrom thethe highesthighest peak,peak, QollehQolleh--yeye DamavandDamavand inin northernnorthern IranIran atat 5,6715,671 mm aboveabove seasea level,level, toto thethe DeadDead Sea,Sea, borderedbordered byby JordanJordan andand Israel,Israel, atat 400400 mm belowbelow seasea levellevel „ SitsSits atopatop roughlyroughly halfhalf ofof thethe world’sworld’s knownknown reservesreserves ofof petroleumpetroleum CLIMATECLIMATE

„ OverallOverall characterizedcharacterized asas aridarid „ AnnualAnnual precipitationprecipitation –– „ TurkeyTurkey andand LebanonLebanon -- 640640 mmmm „ QatarQatar andand YemenYemen –– 8080 mmmm „ MEME AverageAverage 230230 mmmm „ PrevailingPrevailing windswinds –– WW oror NWNW „ EachEach countrycountry hashas itsits uniqueunique patternpattern ofof weatherweather PEOPLEPEOPLE && POPULATIONPOPULATION

„ AA mixturemixture ofof manymany differentdifferent cultures,cultures, races,races, religions,religions, andand ethnicethnic backgroundsbackgrounds „ NumerousNumerous wars,wars, migrations,migrations, naturalnatural upheavals,upheavals, andand routineroutine tradetrade activitiesactivities byby outsideoutside cultures,cultures, governments,governments, religiousreligious orders,orders, armies,armies, andand individualsindividuals overover severalseveral thousandthousand yearsyears havehave ledled toto nearlynearly everyevery imaginableimaginable combinationcombination ofof geneticgenetic andand culturalcultural mixingmixing „ VastVast majoritymajority areare MuslimMuslim (Shi’a(Shi’a oror Sunni)Sunni) withwith thethe exceptionexception ofof IsraelIsrael (Jews)(Jews) andand CyprusCyprus (Christian)(Christian) WATER,WATER, LIVINGLIVING && SANITARYSANITARY CONDITIONSCONDITIONS

„ WaterWater isis aa preciousprecious resourceresource „ OverOver use,use, depletiondepletion ofof groundwater,groundwater, andand contaminationcontamination (pollution)(pollution) ofof naturalnatural surfacesurface waterwater andand aquifersaquifers byby human,human, animal,animal, industrialindustrial andand agriculturalagricultural wasteswastes havehave furtherfurther reducedreduced suppliessupplies „ PoorPoor sanitationsanitation supportssupports largelarge populationspopulations ofof rodents,rodents, flies,flies, mosquitoes,mosquitoes, andand otherother vectorsvectors BAHRAINBAHRAIN BAHRAINBAHRAIN

„ LocationLocation -- archipelagoarchipelago inin thethe PersianPersian Gulf,Gulf, easteast ofof SaudiSaudi ArabiaArabia „ AreaArea –– „ total:total: 665665 sqsq kmkm „ water:water: 00 sqsq kmkm „ land:land: 665665 sqsq kmkm „ SizeSize -- 3.53.5 timestimes thethe sizesize ofof Washington,Washington, DCDC „ CoastlineCoastline -- 161161 kmkm „ NaturalNatural ResourcesResources -- oil,oil, associatedassociated andand nonassociatednonassociated naturalnatural gas,gas, fish,fish, pearlspearls BAHRAINBAHRAIN

„ ClimateClimate -- arid;arid; mild,mild, pleasantpleasant winters;winters; veryvery hot,hot, humidhumid summerssummers „ TerrainTerrain -- mostlymostly lowlow desertdesert plainplain risingrising gentlygently toto lowlow centralcentral escarpmentescarpment „ ElevationElevation ExtremesExtremes –– „ lowestlowest point:point: PersianPersian GulfGulf 00 mm „ highesthighest point:point: JabalJabal adad DukhanDukhan 122122 mm „ EnvironmentalEnvironmental IssuesIssues -- desertificationdesertification resultingresulting fromfrom thethe degradationdegradation ofof limitedlimited arablearable land,land, periodsperiods ofof drought,drought, andand dustdust storms;storms; coastalcoastal degradationdegradation (damage(damage toto coastlines,coastlines, coralcoral reefs,reefs, andand seasea vegetation)vegetation) resultingresulting fromfrom oiloil spillsspills andand otherother dischargesdischarges fromfrom largelarge tankers,tankers, oiloil refineries,refineries, andand distributiondistribution stations;stations; lacklack ofof freshwaterfreshwater resources,resources, groundwatergroundwater andand seawaterseawater areare thethe onlyonly sourcessources forfor allall waterwater needsneeds CYPRUSCYPRUS CYPRUSCYPRUS

„ LocationLocation -- islandisland inin thethe MediterraneanMediterranean Sea,Sea, southsouth ofof TurkeyTurkey „ AreaArea -- „ total: 9,250 sq km (of which 3,355 sq km are in the Turkish Cypriot area) „ water: 10 sq km „ land: 9,240 sq km „ SizeSize -- aboutabout 0.60.6 timestimes thethe sizesize ofof ConnecticutConnecticut „ CoastlineCoastline -- 648648 kmkm „ NaturalNatural ResourcesResources -- copper,copper, pyrites,pyrites, asbestos,asbestos, gypsum,gypsum, timber,timber, salt,salt, marble,marble, clayclay earthearth pigmentpigment CYPRUSCYPRUS

„ ClimateClimate -- temperate;temperate; MediterraneanMediterranean withwith hot,hot, drydry summerssummers andand coolcool winterswinters „ TerrainTerrain -- centralcentral plainplain withwith mountainsmountains toto northnorth andand south;south; scatteredscattered butbut significantsignificant plainsplains alongalong southernsouthern coastcoast „ ElevationElevation ExtremesExtremes -- „ lowest point: Mediterranean Sea 0 m „ highest point: Olympus 1,951 m „ EnvironmentalEnvironmental IssuesIssues –– waterwater resourceresource problemsproblems (no(no naturalnatural reservoirreservoir catchments,catchments, seasonalseasonal disparitydisparity inin rainfall,rainfall, seasea waterwater intrusionintrusion toto island'sisland's largestlargest aquifer,aquifer, increasedincreased salinationsalination inin thethe north);north); waterwater pollutionpollution fromfrom sewagesewage andand industrialindustrial wastes;wastes; coastalcoastal degradation;degradation; lossloss ofof wildlifewildlife habitatshabitats fromfrom urbanizationurbanization

IRANIRAN

„ LocationLocation -- borderingbordering thethe GulfGulf ofof Oman,Oman, thethe PersianPersian Gulf,Gulf, andand thethe CaspianCaspian Sea,Sea, betweenbetween IraqIraq andand PakistanPakistan „ AreaArea -- „ total: 1.648 million sq km „ land: 1.636 million sq km „ water: 12,000 sq km „ SizeSize -- slightlyslightly largerlarger thanthan AlaskaAlaska „ CoastlineCoastline -- 2,4402,440 km;km; notenote -- IranIran alsoalso bordersborders thethe CaspianCaspian SeaSea (740(740 km)km) „ NaturalNatural ResourcesResources -- petroleum,petroleum, naturalnatural gas,gas, coal,coal, chromium,chromium, copper,copper, ironiron ore,ore, lead,lead, manganese,manganese, zinc,zinc, sulfursulfur IRANIRAN

„ ClimateClimate -- mostlymostly aridarid oror semiarid,semiarid, subtropicalsubtropical alongalong CaspianCaspian coastcoast „ TerrainTerrain -- rugged,rugged, mountainousmountainous rim;rim; high,high, centralcentral basinbasin withwith deserts,deserts, mountains;mountains; small,small, discontinuousdiscontinuous plainsplains alongalong bothboth coastscoasts „ ElevationElevation ExtremesExtremes –– „ lowestlowest point:point: CaspianCaspian SeaSea --2828 mm „ highesthighest point:point: QollehQolleh--yeye DamavandDamavand 5,6715,671 mm IRANIRAN

„ EnvironmentalEnvironmental IssuesIssues -- airair pollution,pollution, especiallyespecially inin urbanurban areas,areas, fromfrom vehiclevehicle emissions,emissions, refineryrefinery operations,operations, andand industrialindustrial effluents;effluents; deforestation;deforestation; overgrazing;overgrazing; desertification;desertification; oiloil pollutionpollution inin thethe PersianPersian Gulf;Gulf; wetlandwetland losseslosses fromfrom drought;drought; soilsoil degradationdegradation (salination);(salination); inadequateinadequate suppliessupplies ofof potablepotable water;water; waterwater pollutionpollution fromfrom rawraw sewagesewage andand industrialindustrial waste;waste; urbanizationurbanization IRAQIRAQ IRAQIRAQ

„ LocationLocation –– borderingbordering thethe PersianPersian Gulf,Gulf, betweenbetween IranIran andand KuwaitKuwait „ AreaArea –– „ total:total: 437,072437,072 sqsq kmkm „ water:water: 4,9104,910 sqsq kmkm „ land:land: 432,162432,162 sqsq kmkm „ SizeSize –– slightlyslightly moremore thanthan twicetwice thethe sizesize ofof IdahoIdaho „ CoastlineCoastline –– 5858 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, naturalnatural gas,gas, phosphates,phosphates, sulfursulfur IRAQIRAQ

„ ClimateClimate -- mostlymostly desert;desert; mildmild toto coolcool winterswinters withwith dry,dry, hot,hot, cloudlesscloudless summers;summers; northernnorthern mountainousmountainous regionsregions alongalong IranianIranian andand TurkishTurkish bordersborders experienceexperience coldcold winterswinters withwith occasionallyoccasionally heavyheavy snowssnows thatthat meltmelt inin earlyearly spring,spring, sometimessometimes causingcausing extensiveextensive floodingflooding inin centralcentral andand southernsouthern IraqIraq „ TerrainTerrain –– mostlymostly broadbroad plains;plains; reedyreedy marshesmarshes alongalong IranianIranian borderborder inin southsouth withwith largelarge floodedflooded areas;areas; mountainsmountains alongalong bordersborders withwith IranIran andand TurkeyTurkey „ ElevationElevation ExtremesExtremes –– „ lowest point: Persian Gulf 0 m „ highest point: unnamed peak 3,611 m IRAQIRAQ

„ EnvironmentalEnvironmental IssuesIssues -- governmentgovernment waterwater controlcontrol projectsprojects havehave draineddrained mostmost ofof thethe inhabitedinhabited marshmarsh areasareas easteast ofof AnAn NasiriyahNasiriyah byby dryingdrying upup oror divertingdiverting thethe feederfeeder streamsstreams andand rivers;rivers; aa onceonce sizablesizable populationpopulation ofof MarshMarsh Arabs,Arabs, whowho inhabitedinhabited thesethese areasareas forfor thousandsthousands ofof years,years, hashas beenbeen displaced;displaced; furthermore,furthermore, thethe destructiondestruction ofof thethe naturalnatural habitathabitat posesposes seriousserious threatsthreats toto thethe area'sarea's wildlifewildlife populations;populations; inadequateinadequate suppliessupplies ofof potablepotable water;water; developmentdevelopment ofof thethe TigrisTigris and Euphrates rivers systemsystem contingentcontingent uponupon agreementsagreements withwith upstreamupstream riparianriparian Turkey;Turkey; airair andand waterwater pollution;pollution; soilsoil degradationdegradation (salination)(salination) andand erosion;erosion; desertificationdesertification

ISREALISREAL

„ LocationLocation –– borderingbordering thethe MediterraneanMediterranean Sea,Sea, betweenbetween EgyptEgypt andand LebanonLebanon „ AreaArea –– „ total:total: 20,77020,770 sqsq kmkm „ water:water: 440440 sqsq kmkm „ land:land: 20,33020,330 sqsq kmkm „ SizeSize –– slightlyslightly smallersmaller thanthan NewNew JerseyJersey „ CoastlineCoastline –– 273273 kmkm „ NaturalNatural ResourcesResources -- timber,timber, potash,potash, coppercopper ore,ore, naturalnatural gas,gas, phosphatephosphate rock,rock, magnesiummagnesium bromide,bromide, clays,clays, sandsand ISREALISREAL

„ ClimateClimate -- temperate;temperate; hothot andand drydry inin southernsouthern andand easterneastern desertdesert areasareas „ TerrainTerrain –– NegevNegev desertdesert inin thethe south;south; lowlow coastalcoastal plain;plain; centralcentral mountains;mountains; JordanJordan RiftRift ValleyValley „ ElevationElevation ExtremesExtremes –– „ lowest point: Dead Sea -408 m „ highest point: Har Meron 1,208 m „ EnvironmentalEnvironmental IssuesIssues -- limitedlimited arablearable landland andand naturalnatural freshfresh waterwater resourcesresources posepose seriousserious constraints;constraints; desertification;desertification; airair pollutionpollution fromfrom industrialindustrial andand vehiclevehicle emissions;emissions; groundwatergroundwater pollutionpollution fromfrom industrialindustrial andand domesticdomestic waste,waste, chemicalchemical fertilizers,fertilizers, andand pesticidespesticides JORDANJORDAN JORDANJORDAN

„ LocationLocation –– northwestnorthwest ofof SaudiSaudi ArabiaArabia „ AreaArea –– „ total:total: 92,30092,300 sqsq kmkm „ water:water: 329329 sqsq kmkm „ land:land: 91,97191,971 sqsq kmkm „ SizeSize –– slightlyslightly smallersmaller thanthan IndianaIndiana „ CoastlineCoastline –– 2626 kmkm „ NaturalNatural ResourcesResources -- phosphates,phosphates, potash,potash, shaleshale oiloil JORDANJORDAN

„ ClimateClimate -- mostlymostly aridarid desert;desert; rainyrainy seasonseason inin westwest (November(November toto April)April) „ TerrainTerrain –– mostlymostly desertdesert plateauplateau inin east,east, highlandhighland areaarea inin west;west; GreatGreat RiftRift ValleyValley separatesseparates EastEast andand WestWest BanksBanks ofof thethe JordanJordan RiverRiver „ ElevationElevation ExtremesExtremes –– „ lowestlowest point:point: DeadDead SeaSea --408408 mm „ highesthighest point:point: JabalJabal RamRam 1,7341,734 mm „ EnvironmentalEnvironmental IssuesIssues -- limitedlimited naturalnatural freshfresh waterwater resources;resources; deforestation;deforestation; overgrazing;overgrazing; soilsoil erosion;erosion; desertificationdesertification

KUWAITKUWAIT

„ LocationLocation –– borderingbordering thethe PersianPersian Gulf,Gulf, betweenbetween IraqIraq andand SaudiSaudi ArabiaArabia „ AreaArea –– „ total:total: 17,82017,820 sqsq kmkm „ water:water: 00 sqsq kmkm „ land:land: 17,82017,820 sqsq kmkm „ SizeSize –– slightlyslightly smallersmaller thanthan NewNew JerseyJersey „ CoastlineCoastline –– 499499 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, fish,fish, shrimp,shrimp, naturalnatural gasgas KUWAITKUWAIT

„ ClimateClimate -- drydry desert;desert; intenselyintensely hothot summers;summers; short,short, coolcool winterswinters „ TerrainTerrain –– flatflat toto slightlyslightly undulatingundulating desertdesert plainplain „ ElevationElevation ExtremesExtremes –– „ lowestlowest point:point: PersianPersian GulfGulf 00 mm „ highesthighest point:point: unnamedunnamed locationlocation 306306 mm „ EnvironmentalEnvironmental IssuesIssues -- limitedlimited naturalnatural freshfresh waterwater resources;resources; somesome ofof world'sworld's largestlargest andand mostmost sophisticatedsophisticated desalinationdesalination facilitiesfacilities provideprovide muchmuch ofof thethe water;water; airair andand waterwater pollution;pollution; desertificationdesertification

LEBANONLEBANON

„ LocationLocation –– borderingbordering thethe MediterraneanMediterranean Sea,Sea, betweenbetween IsraelIsrael andand SyriaSyria „ AreaArea –– „ total:total: 10,40010,400 sqsq kmkm „ water:water: 170170 sqsq kmkm „ land:land: 10,23010,230 sqsq kmkm „ SizeSize –– aboutabout 0.70.7 timestimes thethe sizesize ofof ConnecticutConnecticut „ CoastlineCoastline –– 225225 kmkm „ NaturalNatural ResourcesResources -- limestone,limestone, ironiron ore,ore, salt,salt, waterwater--surplussurplus statestate inin aa waterwater--deficitdeficit region,region, arablearable landland LEBANONLEBANON

„ ClimateClimate -- Mediterranean;Mediterranean; mildmild toto cool,cool, wetwet winterswinters withwith hot,hot, drydry summers;summers; LebanonLebanon mountainsmountains experienceexperience heavyheavy winterwinter snowssnows „ TerrainTerrain –– narrownarrow coastalcoastal plain;plain; ElEl BeqaaBeqaa (Bekaa(Bekaa Valley)Valley) separatesseparates LebanonLebanon andand AntiAnti--LebanonLebanon MountainsMountains „ ElevationElevation ExtremesExtremes –– „ lowest point: Mediterranean Sea 0 m „ highest point: Qurnat as Sawda' 3,088 m „ EnvironmentalEnvironmental IssuesIssues -- deforestation;deforestation; soilsoil erosion;erosion; desertification;desertification; airair pollutionpollution inin BeirutBeirut fromfrom vehicularvehicular traffictraffic andand thethe burningburning ofof industrialindustrial wastes;wastes; pollutionpollution ofof coastalcoastal waterswaters fromfrom rawraw sewagesewage andand oiloil spillsspills

OMANOMAN

„ LocationLocation –– borderingbordering thethe ArabianArabian Sea,Sea, GulfGulf ofof Oman,Oman, andand PersianPersian Gulf,Gulf, betweenbetween YemenYemen andand UAEUAE „ AreaArea –– „ total: 212,460 sq km „ water: 0 sq km „ land: 212,460 sq km „ SizeSize –– slightlyslightly smallersmaller thanthan KansasKansas „ CoastlineCoastline –– 2,0922,092 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, copper,copper, asbestos,asbestos, somesome marble,marble, limestone,limestone, chromium,chromium, gypsum,gypsum, naturalnatural gasgas OMANOMAN

„ ClimateClimate -- drydry desert;desert; hot,hot, humidhumid alongalong coast;coast; hot,hot, drydry interior;interior; strongstrong southwestsouthwest summersummer monsoonmonsoon (May(May toto September)September) inin farfar southsouth „ TerrainTerrain –– centralcentral desertdesert plain,plain, ruggedrugged mountainsmountains inin northnorth andand southsouth „ ElevationElevation ExtremesExtremes –– „ lowestlowest point:point: ArabianArabian SeaSea 00 mm „ highesthighest point:point: JabalJabal ShamsShams 2,9802,980 mm „ EnvironmentalEnvironmental IssuesIssues -- risingrising soilsoil salinity;salinity; beachbeach pollutionpollution fromfrom oiloil spills;spills; veryvery limitedlimited naturalnatural freshfresh waterwater resourcesresources

QATARQATAR

„ LocationLocation –– peninsulapeninsula borderingbordering thethe PersianPersian GulfGulf andand SaudiSaudi ArabiaArabia „ AreaArea –– „ total:total: 11,43711,437 sqsq kmkm „ water:water: 00 sqsq kmkm „ land:land: 11,43711,437 sqsq kmkm „ SizeSize –– slightlyslightly smallersmaller thanthan ConnecticutConnecticut „ CoastlineCoastline –– 563563 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, naturalnatural ggas,as, fishfish QATARQATAR

„ ClimateClimate -- arid;arid; mild,mild, pleasantpleasant winters;winters; veryvery hot,hot, humidhumid summerssummers „ TerrainTerrain –– mostlymostly flatflat andand barrenbarren desertdesert coveredcovered withwith looseloose sandsand andand gravelgravel „ ElevationElevation ExtremesExtremes –– „ lowestlowest point:point: PersianPersian GulfGulf 00 mm „ highesthighest point:point: QuraynQurayn AbuAbu alal BawlBawl 103103 mm „ EnvironmentalEnvironmental IssuesIssues -- limitedlimited naturalnatural freshfresh waterwater resourcesresources areare increasingincreasing dependencedependence onon largelarge--scalescale desalinationdesalination facilitiesfacilities

SAUDISAUDI ARABIAARABIA

„ LocationLocation –– borderingbordering thethe PersianPersian GulfGulf andand thethe RedRed Sea,Sea, northnorth ofof YemenYemen „ AreaArea –– „ total: 1,960,582 sq km „ water: 0 sq km „ land: 1,960,582 sq km „ SizeSize –– slightlyslightly moremore thanthan oneone--fifthfifth thethe sizesize ofof thethe USUS „ CoastlineCoastline –– 2,6402,640 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, naturalnatural gas,gas, ironiron ore,ore, gold,gold, coppercopper SAUDISAUDI ARABIAARABIA

„ ClimateClimate -- harsh,harsh, drydry desertdesert withwith greatgreat temperaturetemperature extremesextremes „ TerrainTerrain –– mostlymostly uninhabited,uninhabited, sandysandy desertdesert „ ElevationElevation ExtremesExtremes –– „ lowest point: Persian Gulf 0 m „ highest point: Jabal Sawda' 3,133 m „ EnvironmentalEnvironmental IssuesIssues -- desertification;desertification; depletiondepletion ofof undergroundunderground waterwater resources;resources; thethe lacklack ofof perennialperennial riversrivers oror permanentpermanent waterwater bodiesbodies hashas promptedprompted thethe developmentdevelopment ofof extensiveextensive seawaterseawater desalinationdesalination facilities;facilities; coastalcoastal pollutionpollution fromfrom oiloil spillsspills SYRIASYRIA SYRIASYRIA

„ LocationLocation –– borderingbordering thethe MediterraneanMediterranean Sea,Sea, betweenbetween LebanonLebanon andand TurkeyTurkey „ AreaArea –– „ total: 185,180 sq km „ note: includes 1,295 sq km of Israeli-occupied territory „ water: 1,130 sq km „ land: 184,050 sq km „ SizeSize –– slightlyslightly largerlarger thanthan NorthNorth DakotaDakota „ CoastlineCoastline –– 193193 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, phosphates,phosphates, chromechrome andand manganesemanganese ores,ores, asphalt,asphalt, ironiron ore,ore, rockrock salt,salt, marble,marble, gypsum,gypsum, hydropowerhydropower SYRIASYRIA

„ ClimateClimate -- mostlymostly desert;desert; hot,hot, dry,dry, sunnysunny summerssummers (June(June toto August)August) andand mild,mild, rainyrainy winterswinters (December(December toto February)February) alongalong coast;coast; coldcold weatherweather withwith snowsnow oror sleetsleet periodicallyperiodically inin DamascusDamascus „ TerrainTerrain –– primarilyprimarily semiaridsemiarid andand desertdesert plateau;plateau; narrownarrow coastalcoastal plain;plain; mountainsmountains inin westwest „ ElevationElevation ExtremesExtremes –– „ lowest point: unnamed location near Lake Tiberias -200 m „ highest point: Mount Hermon 2,814 m „ EnvironmentalEnvironmental IssuesIssues -- deforestation;deforestation; overgrazing;overgrazing; soilsoil erosion;erosion; desertification;desertification; waterwater pollutionpollution fromfrom rawraw sewagesewage andand petroleumpetroleum refiningrefining wastes;wastes; inadequateinadequate potablepotable waterwater TURKEYTURKEY TURKEYTURKEY

„ LocationLocation –– southeasternsoutheastern EuropeEurope andand southwesternsouthwestern AsiaAsia (that(that portionportion ofof TurkeyTurkey westwest ofof thethe BosporusBosporus isis geographicallygeographically partpart ofof Europe),Europe), borderingbordering thethe BlackBlack Sea,Sea, betweenbetween BulgariaBulgaria andand Georgia,Georgia, andand borderingbordering thethe AegeanAegean SeaSea andand thethe MediterraneanMediterranean Sea,Sea, betweenbetween GreeceGreece andand SyriaSyria „ AreaArea –– „ total: 780,580 sq km „ water: 9,820 sq km „ land: 770,760 sq km „ SizeSize –– slightlyslightly largerlarger thanthan TexasTexas „ CoastlineCoastline –– 7,2007,200 kmkm „ NaturalNatural ResourcesResources -- antimony,antimony, coal,coal, chromium,chromium, mercury,mercury, copper,copper, borate,borate, sulfur,sulfur, ironiron ore,ore, arablearable land,land, hydropowerhydropower TURKEYTURKEY

„ ClimateClimate -- temperate;temperate; hot,hot, drydry summerssummers withwith mild,mild, wetwet winters;winters; harsherharsher inin interiorinterior „ TerrainTerrain –– highhigh centralcentral plateauplateau (Anatolia);(Anatolia); narrownarrow coastalcoastal plain;plain; severalseveral mountainmountain rangesranges „ ElevationElevation ExtremesExtremes –– „ lowest point: Mediterranean Sea 0 m „ highest point: Mount Ararat 5,166 m „ EnvironmentalEnvironmental IssuesIssues -- waterwater pollutionpollution fromfrom dumpingdumping ofof chemicalschemicals andand detergents;detergents; airair pollution,pollution, particularlyparticularly inin urbanurban areas;areas; deforestation;deforestation; concernconcern forfor oiloil spillsspills fromfrom increasingincreasing BosporusBosporus shipship traffictraffic UNITEDUNITED ARABARAB EMIRATESEMIRATES UNITEDUNITED ARABARAB EMIRATESEMIRATES

„ LocationLocation –– borderingbordering thethe GulfGulf ofof OmanOman andand thethe PersianPersian Gulf,Gulf, betweenbetween OmanOman andand SaudiSaudi ArabiaArabia „ AreaArea –– „ total:total: 82,88082,880 sqsq kmkm „ land:land: 82,88082,880 sqsq kmkm „ water:water: 00 sqsq kmkm „ SizeSize –– slightlyslightly smallersmaller thanthan MaineMaine „ CoastlineCoastline –– 1,3181,318 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, naturalnatural gasgas UNITEDUNITED ARABARAB EMIRATESEMIRATES

„ ClimateClimate -- desert;desert; coolercooler inin easterneastern mountainsmountains „ TerrainTerrain –– flat,flat, barrenbarren coastalcoastal plainplain mergingmerging intointo rollingrolling sandsand dunesdunes ofof vastvast desertdesert wasteland;wasteland; mountainsmountains inin easteast „ ElevationElevation ExtremesExtremes –– „ lowestlowest point:point: PersianPersian GulfGulf 00 mm „ highesthighest point:point: JabalJabal YibirYibir 1,5271,527 mm „ EnvironmentalEnvironmental IssuesIssues -- lacklack ofof naturalnatural freshwaterfreshwater resourcesresources compensatedcompensated byby desalinationdesalination plants;plants; desertification;desertification; beachbeach pollutionpollution fromfrom oiloil spillsspills YEMENYEMEN YEMENYEMEN

„ LocationLocation –– borderingbordering thethe ArabianArabian Sea,Sea, GulfGulf ofof Aden,Aden, andand RedRed Sea,Sea, betweenbetween OmanOman andand SaudiSaudi ArabiaArabia „ AreaArea –– „ total: 527,970 sq km „ land: 527,970 sq km „ note: includes Perim, Socotra, the former Yemen Arab Republic (YAR or North Yemen), and the former People's Democratic Republic of Yemen (PDRY or South Yemen) „ water: 0 sq km „ SizeSize –– slightlyslightly largerlarger thanthan twicetwice thethe sizesize ofof WyomingWyoming „ CoastlineCoastline –– 1,9061,906 kmkm „ NaturalNatural ResourcesResources -- petroleum,petroleum, fish,fish, rockrock salt,salt, marble,marble, smallsmall depositsdeposits ofof coal,coal, gold,gold, lead,lead, nickel,nickel, andand copper,copper, fertilefertile soilsoil inin westwest YEMENYEMEN

„ ClimateClimate -- mostlymostly desert;desert; hothot andand humidhumid alongalong westwest coast;coast; temperatetemperate inin westernwestern mountainsmountains affectedaffected byby seasonalseasonal monsoon;monsoon; extraordinarilyextraordinarily hot,hot, dry,dry, harshharsh desertdesert inin easteast „ TerrainTerrain –– narrownarrow coastalcoastal plainplain backedbacked byby flatflat--toppedtopped hillshills andand ruggedrugged mountains;mountains; dissecteddissected uplandupland desertdesert plainsplains inin centercenter slopeslope intointo thethe desertdesert interiorinterior ofof thethe ArabianArabian PeninsulaPeninsula „ ElevationElevation ExtremesExtremes –– „ lowest point: Arabian Sea 0 m „ highest point: Jabal an Nabi Shu'ayb 3,760 m „ EnvironmentalEnvironmental IssuesIssues -- veryvery limitedlimited naturalnatural freshfresh waterwater resources;resources; inadequateinadequate suppliessupplies ofof potablepotable water;water; overgrazing;overgrazing; soilsoil erosion;erosion; desertificationdesertification

MilitarilyMilitarily ImportantImportant VectorVector--BorneBorne DiseasesDiseases withwith ShortShort IncubationIncubation PeriodsPeriods (<15(<15 days)days)

„ MalariaMalaria „ BoutonneuseBoutonneuse FeverFever „ SandSand FlyFly FeverFever „ TickTick--borneborne EncephalitisEncephalitis „ DengueDengue FeverFever „ QQ FeverFever „ EndemicEndemic TyphusTyphus „ MurineMurine TyphusTyphus „ RelapsingRelapsing FeverFever (Louse(Louse-- „ PlaguePlague borne)borne) „ WestWest NileNile FeverFever „ RelapsingRelapsing FeverFever (Tick(Tick-- „ SindbisSindbis VirusVirus borne)borne) „ OtherOther ArthropodArthropod--borneborne „ CrimeanCrimean--CongoCongo VirusesViruses HemorrhagicHemorrhagic FeverFever MalariaMalaria DrugDrug--ResistantResistant P.P. falciparumfalciparum MalariaMalaria inin thethe MEME

„ IranIran „ IraqIraq „ IsraelIsrael „ OmanOman „ SaudiSaudi ArabiaArabia „ UAEUAE „ YemenYemen

SandSand flyfly FeverFever (Papatasi(Papatasi fever,fever, ThreeThree--dayday fever)fever)

„ BahrainBahrain „ LebanonLebanon „ CyprusCyprus „ OmanOman „ IranIran „ QatarQatar „ Iraq Iraq „ SaudiSaudi ArabiaArabia „ IsraelIsrael „ SyriaSyria „ JordanJordan „ TurkeyTurkey „ KuwaitKuwait „ UnitedUnited ArabArab EmiratesEmirates „ YemenYemen SandSand flyfly FeverFever (Papatasi(Papatasi fever,fever, ThreeThree--dayday fever)fever)

„ SerologicalSerological evidenceevidence thatthat gerbilsgerbils serveserve asas reservoirsreservoirs „ PrincipalPrincipal reservoirreservoir mechanismmechanism appearsappears toto bebe transovarialtransovarial transmissiontransmission „ PhlebotomusPhlebotomus papatasipapatasi isis thethe primaryprimary vectorvector –– tendstends toto bebe moremore ruralrural andand periurbanperiurban inin distributiondistribution –– requiresrequires warm,warm, humidhumid microhabitatsmicrohabitats forfor larvallarval developmentdevelopment –– animalanimal burrowsburrows „ SomeSome PhlebotomusPhlebotomus papatasipapatasi areare autogenous,autogenous, duringduring firstfirst gonotropicgonotropic cyclecycle „ PhlebotomusPhlebotomus sergentiisergentii andand SergentomyiaSergentomyia spp.spp. areare suspectedsuspected vectors.vectors. DengueDengue (Breakbone(Breakbone fever,fever, DandyDandy fever)fever)

„ AedesAedes aegyptiaegypti –– primaryprimary vectorvector „ BetweenBetween 4040ºº NN andand 4040ºº SS latitudelatitude „ EpidemicsEpidemics coincidecoincide withwith thethe rainyrainy seasonseason andand highhigh mosquitomosquito populationspopulations „ Ae.Ae. aegyptiaegypti inhabitsinhabits allall ofof MiddleMiddle EastEast „ MostMost recentrecent outbreakoutbreak 19941994 andand 19951995 inin SaudiSaudi ArabiaArabia „ DHFDHF alsoalso reportedreported EpidemicEpidemic typhustyphus

„ TransmittedTransmitted byby humanhuman bodybody louse,louse, PediculusPediculus humanushumanus „ InfectiousInfectious agentagent isis thethe bacteriumbacterium RickettsiaRickettsia prowazekiiprowazekii „ CaseCase fatalityfatality ratesrates varyvary fromfrom 10%10% toto 40%40% inin thethe absenceabsence ofof specificspecific therapytherapy „ Fever,Fever, headache,headache, andand ggeneraleneral painspains followedfollowed byby aa rashrash thatthat spreadsspreads fromfrom trunktrunk toto thethe entireentire bodybody RelapsingRelapsing FeverFever (louse(louse--borne)borne) (Epidemic(Epidemic relapsingrelapsing fever)fever)

„ TransmittedTransmitted byby humanhuman bodybody louse,louse, PediculusPediculus humanushumanus „ CausedCaused byby thethe spirochetespirochete BorreliaBorrelia recurrentisrecurrentis „ PrimaryPrimary febrilefebrile attackattack followedfollowed byby anan afebrileafebrile intervalinterval andand oneone oror moremore subsequentsubsequent attacksattacks ofof feverfever andand headacheheadache „ IntervalInterval betweenbetween attacksattacks rangerange fromfrom 55 toto 99 daysdays „ MortalityMortality cancan reachreach 40%40% ifif untreateduntreated

RelapsingRelapsing FeverFever (tick(tick--borne)borne) (cave(cave fever)fever)

„ TransmittedTransmitted byby softsoft ticksticks ofof thethe genusgenus OrnithodorosOrnithodoros „ CausedCaused byby thethe spirochetespirochete BorreliaBorrelia recurrentisrecurrentis „ SporadicSporadic casescases areare mostmost oftenoften reportedreported fromfrom Iran,Iran, Iraq,Iraq, Israel,Israel, Jordan,Jordan, Syria,Syria, SaudiSaudi Arabia,Arabia, andand YemenYemen RelapsingRelapsing FeverFever (tick(tick--borne)borne) (cave(cave fever)fever)

„ PrimaryPrimary vectorsvectors „ OrnithodorosOrnithodoros erraticuserraticus –– SaudiSaudi Arabia,Arabia, IsraelIsrael „ O.O. tholozanitholozani –– Israel,Israel, Lebanon,Lebanon, Iran,Iran, Iraq,Iraq, Jordan,Jordan, Syria,Syria, TurkeyTurkey „ O.O. savignyisavignyi –– SaudiSaudi Arabia,Arabia, YemenYemen „ O.O. asperusasperus –– IranIran

„ SecondarySecondary vectorsvectors „ O.O. erraticuserraticus andand O.O. tholozanitholozani –– IranIran CrimeanCrimean--CongoCongo HemorrhagicHemorrhagic FeverFever

„ AA zoonoticzoonotic diseasedisease causedcaused byby aa ticktick--borneborne virusvirus ofof thethe familyfamily BunyaviridaeBunyaviridae „ Fever,Fever, headache,headache, musclemuscle painpain andand rash,rash, followedfollowed byby aa hemorrhagichemorrhagic statestate ofof hepatitishepatitis „ MortalityMortality raterate cancan exceedexceed 30%30% „ CCHFCCHF isis widewide spreadspread inin thethe MiddleMiddle east,east, infectinginfecting domesticdomestic animalsanimals everywhereeverywhere exceptexcept thethe islandisland ofof CyprusCyprus „ HumanHuman outbreaksoutbreaks ofof CCHFCCHF havehave occurredoccurred inin Kuwait,Kuwait, Iraq,Iraq, andand thethe UAEUAE CrimeanCrimean--CongoCongo HemorrhagicHemorrhagic FeverFever

„ PrimaryPrimary humanhuman vectorsvectors –– HyalommaHyalomma rufipes,rufipes, H.H. anatolicumanatolicum anatolicum,anatolicum, H.H. anatolicumanatolicum excavatum,excavatum, H.H. truncatum,truncatum, H.H. marginatummarginatum „ PrimaryPrimary enzooticenzootic vectorsvectors –– H.H. dromedarii,dromedarii, H.H. impeltatumimpeltatum „ SuspectedSuspected zoonoticzoonotic vectorsvectors –– BoophilusBoophilus annulatus,annulatus, RhipicephalusRhipicephalus sanguineussanguineus „ PossiblePossible vectorsvectors –– (Turkey)(Turkey) –– IxodesIxodes ricinus,ricinus, RhipicephalusRhipicephalus bursa,bursa, DermacentorDermacentor marginatusmarginatus BoutonneuseBoutonneuse FeverFever (Mediterranean(Mediterranean ticktick fever,fever, MediterraneanMediterranean spottedspotted fever,fever, MarseillesMarseilles fever,fever, AfricanAfrican ticktick typhus,typhus, KenyaKenya ticktick typhus,typhus, IndiaIndia ticktick typhus)typhus)

„ TickTick--borneborne typhustyphus –– causedcaused byby RickettsiaRickettsia conoriiconorii „ ButtonButton--likelike lesions,lesions, 22 toto 55 mmmm inin diameter,diameter, thatthat developdevelop atat ticktick attachmentattachment sitesite „ WithWith antibioticantibiotic treatment,treatment, feverfever lastslasts nono moremore thanthan 22 daysdays „ FatalityFatality raterate veryvery low,low, eveneven withoutwithout treatmenttreatment BoutonneuseBoutonneuse FeverFever

„ PrincipalPrincipal vectorvector –– RhipicephalusRhipicephalus sanguineussanguineus –– entireentire regionregion

„ AdditionalAdditional vectorsvectors –– „ HyalommaHyalomma rufipesrufipes –– Iraq,Iraq, Israel,Israel, Jordan,Jordan, Lebanon,Lebanon, Oman,Oman, SaudiSaudi Arabia,Arabia, YemenYemen „ AmblyommaAmblyomma variegatumvariegatum –– southwestsouthwest SaudiSaudi Arabia,Arabia, YemenYemen „ R.R. turanicusturanicus –– Israel,Israel, Jordan,Jordan, LebanonLebanon „ R.R. appendiculatusappendiculatus –– onlyonly inin thethe AsirAsir DistrictDistrict ofof southwestsouthwest SaudiSaudi ArabiaArabia TickTick--borneborne EncephalitisEncephalitis (TBE)(TBE)

„ CausedCaused byby aa complexcomplex ofof flavivirusesflaviviruses „ FarFar EasternEastern TBETBE (Russian(Russian springspring--summersummer encephalitis)encephalitis) „ CentralCentral EuropeanEuropean TBETBE (biphasic(biphasic meningoencephalitis,meningoencephalitis, diphasicdiphasic milkmilk disease)disease) TickTick--borneborne EncephalitisEncephalitis (TBE)(TBE)

„ PrincipalPrincipal vectorvector –– IxodesIxodes ricinusricinus –– Israel,Israel, Iran,Iran, Cyprus,Cyprus, TurkeyTurkey

„ SecondarySecondary vectorsvectors -- DermacentorDermacentor marginatus,marginatus, HaemaphysalisHaemaphysalis punctatapunctata –– Iran,Iran, TurkeyTurkey QQ FeverFever (Query(Query fever)fever)

„ Acute,Acute, selfself--limiting,limiting, febrilefebrile rickettsialrickettsial diseasedisease causedcaused byby CoxiellaCoxiella burnettiburnetti „ OutbreaksOutbreaks ofof QQ feverfever inin humanshumans havehave beenbeen tracedtraced toto consumptionconsumption ofof infectedinfected dairydairy products,products, contactcontact withwith contaminatedcontaminated woolwool oror hides,hides, infectedinfected straw,straw, andand infectedinfected animalanimal fecesfeces „ FatalityFatality raterate inin untreateduntreated acuteacute casescases isis <1%<1% MurineMurine TyphusTyphus (Flea(Flea--borneborne typhus,typhus, EndemicEndemic typhus,typhus, ShopShop typhus)typhus)

„ InfectiousInfectious agentagent –– RickettsiaRickettsia typhityphi „ MilderMilder thanthan R.R. prowazekiiprowazekii „ ClinicalClinical symptomssymptoms lastlast upup toto 22 weeksweeks inin untreateduntreated casescases „ EasilyEasily treatedtreated withwith antibioticsantibiotics „ AbsenceAbsence ofof louselouse infestation,infestation, seasonalseasonal distribution,distribution, andand sporadicsporadic occurrenceoccurrence differentiatedifferentiate itit fromfrom epidemicepidemic typhustyphus

MurineMurine TyphusTyphus

„ PrimaryPrimary vectorsvectors „ OrientalOriental ratrat fleaflea –– XenopsyllaXenopsylla cheopischeopis „ CatCat andand dogdog fleasfleas –– CtenocephalidesCtenocephalides felis,felis, C.C. caniscanis „ SecondarySecondary vectorvector „ BodyBody louselouse -- PediculusPediculus humanushumanus „ MaintenanceMaintenance vectorsvectors „ NorthernNorthern ratrat fleaflea –– NosopsyllusNosopsyllus fasciatusfasciatus „ SpinySpiny ratrat louselouse –– PolyplaxPolyplax spinulosaspinulosa „ TropicalTropical ratrat mitemite –– OrnithonyssusOrnithonyssus bacotibacoti PlaguePlague (Pestis,(Pestis, BlackBlack death)death)

„ AA zoonoticzoonotic bacterialbacterial diseasedisease involvinginvolving rodentsrodents andand theirtheir fleasfleas –– YersiniaYersinia pestispestis „ EasilyEasily treatedtreated withwith antibioticsantibiotics (early)(early) „ UntreatedUntreated fatalityfatality raterate 50%50%

WestWest NileNile FeverFever

„ AA mosquitomosquito--borneborne illnessillness characterizedcharacterized byby fever,fever, headache,headache, muscularmuscular pain,pain, andand rashrash „ FlavivirusFlavivirus „ OftenOften asymptomaticasymptomatic „ WideWide spreadspread throughoutthroughout thethe MiddleMiddle EastEast WestWest NileNile FeverFever

„ PrimaryPrimary vectorvector –– CulexCulex univittatusunivittatus –– Kuwait,Kuwait, Iran,Iran, Iraq,Iraq, Israel,Israel, Lebanon,Lebanon, Oman,Oman, SaudiSaudi Arabia,Arabia, Turkey,Turkey, YemenYemen

„ PotentialPotential vectorsvectors –– An.An. coustanicoustani,, Cx.Cx. antennatus,antennatus, Cx.Cx. pipienspipiens pipiens,pipiens, Cx.Cx. P.P. molestus,molestus, Cx.Cx. perexiguusperexiguus –– throughoutthroughout regionregion

„ PossiblePossible zoonoticzoonotic vectorvector –– OrnithodorosOrnithodoros capensiscapensis –– inin colonialcolonial birdsbirds inhabitinginhabiting islandsislands inin thethe CaspianCaspian SeaSea offoff thethe coastcoast ofof AzerbaijanAzerbaijan SindbisSindbis VirusVirus

„ BelongsBelongs toto thethe genusgenus AlphavirusAlphavirus inin thethe familyfamily TogaviridaeTogaviridae „ NoNo fatalfatal casescases reportedreported „ OneOne ofof thethe mostmost widelywidely distributeddistributed ofof allall knownknown arbovirusesarboviruses „ CirculatingCirculating inin manymany partsparts ofof thethe MiddleMiddle EastEast SindbisSindbis VirusVirus

„ SuspectedSuspected vectorsvectors –– CulexCulex antennatus,antennatus, Cx.Cx. pipienspipiens complexcomplex,, Cx.Cx. univittatus,univittatus, An.An. pharoensispharoensis OtherOther ArthropodArthropod--borneborne VirusesViruses

„ ManyMany enzooticenzootic arbovirusesarboviruses areare circulatincirculatingg inin thethe MiddleMiddle EastEast butbut littlelittle isis knownknown aboutabout themthem „ Tahyna virus - (Bunyaviridae, Bunyavirus, California group) (An. hyrcanus, Cx. pipiens) „ Batai virus (Bunyaviridae, Bunyavirus, Bunyamwera group) (Ae. communis complex, Anophelines) „ Bhanja viral infection – (tick-borne) „ Karimabad virus (phlebotomine sand flies) „ Salehabad virus (phlebotomine sand flies) „ Teheran virus (P. papatasi sand flies) „ Toscana virus (P. perniciosus sand flies) „ Al Khumer hemorrhagic fever (tick-borne) „ Rift Valley Fever (Cx. Pipiens complex, et. al.) MilitarilyMilitarily ImportantImportant VectorVector--BorneBorne DiseasesDiseases withwith LongLong IncubationIncubation PeriodsPeriods (>15(>15 days)days)

„ LeishmaniasisLeishmaniasis „ CutaneousCutaneous „ VisceralVisceral „ SchistosomiasisSchistosomiasis „ OnchocerciasisOnchocerciasis „ BancroftianBancroftian FilariasisFilariasis „ LymeLyme DiseaseDisease LeishmaniasisLeishmaniasis

„ AA diseasedisease causedcaused byby infectioninfection withwith protozoanprotozoan parasitesparasites ofof thethe genusgenus LeishmaniaLeishmania „ PhlebotominePhlebotomine sandsand fliesflies „ OldOld WorldWorld –– PhlebotomusPhlebotomus „ CutaneousCutaneous –– (Baghdad(Baghdad boil,boil, JerichoJericho boil,boil, OrientalOriental sore)sore) „ VisceralVisceral –– (Kala(Kala--azar,azar, DumDum DumDum fever)fever)

LeishmaniasisLeishmaniasis

„ ProvenProven sandsand flyfly vectorvector ((Le.Le. majormajor)) –– P.P. papatasipapatasi „ SuspectedSuspected vectorsvectors ((Le.Le. majormajor)) –– P.P. alexandri,alexandri, P.P. ansarii,ansarii, P.P. bergeroti,bergeroti, P.P. caucasicus,caucasicus, P.P. salehisalehi

„ IncriminatedIncriminated vectorvector ((Le.Le. tropicatropica)) –– P.P. sergentisergenti „ SuspectedSuspected vectorsvectors ((Le.Le. tropicatropica)) –– P.P. chabaudi,chabaudi, P.P. saevus,saevus, P.P. sergentisergenti LeishmaniasisLeishmaniasis

„ ProvenProven andand SuspectedSuspected vectorsvectors ((Le.Le. InfantumInfantum)) –– P.P. brevis,brevis, P.P. halepensis,halepensis, P.P. kandelakii,kandelakii, P.P. kryreniae,kryreniae, P.P. longiductus,longiductus, P.P. neglectus,neglectus, P.P. simici,simici, P.P. tobbi,tobbi, P.P. transcaucasicustranscaucasicus

„ ProvenProven vectorvector ((Le.Le. DonovaniDonovani)) –– P.P. alexanrialexanri „ SuspectedSuspected vectorsvectors -- ((Le.Le. DonovaniDonovani)) -- P.P. caucasicus,caucasicus, P.P. mongolensismongolensis SchistosomiasisSchistosomiasis (Bilharziasis,(Bilharziasis, SnailSnail fever)fever)

„ AA diseasedisease causedcaused byby trematodestrematodes inin thethe genusgenus SchistosomaSchistosoma „ WHOWHO considersconsiders fivefive speciesspecies ofof schistosomesschistosomes significantsignificant (hepatic(hepatic andand intestinal)intestinal) „ SchistosomaSchistosoma mansonimansoni „ S.S. japonicumjaponicum „ S.S. mekongimekongi „ S.S. intercalatumintercalatum „ S.S. haematobiumhaematobium –– (urinary)(urinary) SchistosomiasisSchistosomiasis

„ 200200 millionmillion personspersons infectedinfected worldwideworldwide „ S.S. mansonimansoni andand S.S. haematobiumhaematobium areare endemicendemic inin thethe MiddleMiddle EastEast „ ExceptExcept –– Bahrain,Bahrain, Cyprus,Cyprus, Israel,Israel, QatarQatar

SchistosomiasisSchistosomiasis

„ BiomphalariaBiomphalaria arabicaarabica,, BulinusBulinus beccarii,beccarii, Bu.Bu. Wrighti,Wrighti, andand Bi.Bi. TruncatusTruncatus areare thethe intermediateintermediate hostshosts ofof schistosomesschistosomes inin thethe MiddleMiddle EastEast

„ S.S. mansonimansoni isis associatedassociated withwith Bi.Bi. ArabicaArabica

„ S.S. haematobiumhaematobium isis associatedassociated withwith Bu.Bu. beccarii,beccarii, Bu.Bu. Wrighti,Wrighti, Bi.Bi. TruncatusTruncatus OnchocerciasisOnchocerciasis (River(River Blindness)Blindness)

„ AA chronic,chronic, nonfatalnonfatal diseasedisease inin whichwhich adultadult wormsworms formform fibrousfibrous nodulesnodules inin subcutaneoussubcutaneous tissuestissues „ TheThe parasiteparasite isis aa filarialfilarial nematodenematode worm,worm, OnchocercaOnchocerca volvulusvolvulus „ O.O. fasciata,fasciata, occursoccurs inin camelscamels butbut doesdoes notnot infectinfect manman „ MembersMembers ofof thethe SumuliumSumulium damnosumdamnosum complexcomplex areare thethe primaryprimary vectorsvectors (Black(Black Fly)Fly)

BancroftianBancroftian FilariasisFilariasis

„ CausedCaused byby thethe nematodenematode WuchereriaWuchereria bancroftibancrofti,, whichwhich normallynormally residesresides inin thethe lymphaticlymphatic systemsystem ofof infectedinfected humanshumans „ SporadicSporadic casescases havehave beenbeen reportedreported fromfrom Iran,Iran, Oman,Oman, Yemen,Yemen, andand southwesternsouthwestern SaudiSaudi ArabiaArabia „ MembersMembers ofof thethe CulexCulex pipienspipiens complexcomplex areare thethe primaryprimary vectorvector „ CulexCulex bitaeniorhynchus,bitaeniorhynchus, Ae.Ae. aegypti,aegypti, andand An.An. arabiensisarabiensis areare consideredconsidered possiblepossible secondarysecondary vectorsvectors

LymeLyme DiseaseDisease

„ AlsoAlso calledcalled LymeLyme borreliosis,borreliosis, ticktick--borneborne meningopolyyneuritis,meningopolyyneuritis, erythemaerythema chronicumchronicum migrans,migrans, LymeLyme arthritis,arthritis, andand Barnwart’sBarnwart’s syndromesyndrome „ CausativeCausative agentagent isis thethe spirochetespirochete bacteriumbacterium BorreliaBorrelia burgdorferiburgdorferi „ TheThe prevalenceprevalence ofof LymeLyme borreliosisborreliosis inin thethe MiddleMiddle EastEast isis unclearunclear „ SuspectedSuspected inin onlyonly TurkeyTurkey andand IsraelIsrael „ HardHard ticksticks -- IxodesIxodes ricinusricinus –– Israel,Israel, Iran,Iran, Cyprus,Cyprus, andand TurkeyTurkey OtherOther DiseasesDiseases ofof MilitaryMilitary SignificanceSignificance

„ LeptospirosisLeptospirosis „ HantaviralHantaviral DiseaseDisease DiarrhealDiarrheal DiseaseDisease

„ GIGI infectionsinfections areare principalprincipal diseasedisease threatsthreats inin ME,ME, bothboth urbanurban andand ruralrural „ ContaminatedContaminated food,food, foodfood preparationpreparation surfaces,surfaces, utensils,utensils, water,water, iceice „ FilthFilth fliesflies actact asas mechanicalmechanical transmissiontransmission forfor pathogens;pathogens; „ StaphylococcusStaphylococcus aureusaureus,, ClostridiumClostridium perfringensperfringens,, BacillusBacillus cereuscereus,, VibrioVibrio parahaemolyticusparahaemolyticus,, numerousnumerous serotypesserotypes ofof SalmonellaSalmonella,, ShigellaShigella spp.,spp., CampylobacterCampylobacter,, pathogenicpathogenic strainsstrains ofof EscherichiaEscherichia colicoli,, andand hepatitishepatitis AA andand E,E, amongamong otherother viralviral speciesspecies „ BacterialBacterial pathogenspathogens accountaccount forfor moremore thanthan 75%75% ofof casescases „ ResistanceResistance ofof entericenteric pathogenspathogens toto commonlycommonly usedused antibioticsantibiotics cancan complicatecomplicate treatmenttreatment NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance ARTHROPODSARTHROPODS

„ AcariAcari (ticks and mites) „ AraneaeAraneae (spiders) „ CeratopganidaeCeratopganidae (biting midges) „ ChilopodaChilopoda && DiplopodaDiplopoda „ CimicidaeCimicidae (bedbugs) „ DipteransDipterans CausingCausing MyasisMyasis „ HymenopteraHymenoptera (ants, bees, wasps) NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance ARTHROPODSARTHROPODS

„ LipidopteraLipidoptera (urticating moths & caterpillars) „ MeloidaeMeloidae && StaphylinidaeStaphylinidae (blister beetles & Rove beetles) „ ScorpionidaScorpionida (scorpions) „ SimuliidaeSimuliidae (black flies) „ SiphonapteraSiphonaptera (fleas) „ SolpugidaSolpugida (sun spiders, wind scorpions) „ TabanidaeTabanidae (horse flies & deer flies) NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance VENOMOUSVENOMOUS SNAKESSNAKES

„ AtractaspididaeAtractaspididae –– burrowing vipers „ ViperidaeViperidae –– vipers, adders, asps „ CrotalidaeCrotalidae –– pit vipers „ ColubridaeColubridae –– blue krait, cobras „ ElapidaeElapidae –– nonvenomous - with 1 exception „ HydrophiidaeHydrophiidae –– sea snakes NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance PLANTSPLANTS

„ PlantsPlants produceproduce manymany clinicalclinical classesclasses ofof contactcontact dermaldermal injury.injury. TheseThese includeinclude mechanicalmechanical injury,injury, delayeddelayed contactcontact sensitivity,sensitivity, contactcontact urticaria,urticaria, phototoxicityphototoxicity andand photoallergy,photoallergy, primaryprimary chemicalchemical irritation,irritation, oror somesome combinationcombination ofof these.these. NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance PLANTSPLANTS

„ ManyMany plantsplants havehave fruitingfruiting bodiesbodies thatthat appearappear edibleedible oror havehave attractiveattractive parts,parts, suchsuch asas castorcastor bean.bean. SomeSome militarymilitary personnelpersonnel maymay bebe temptedtempted toto consumeconsume plantsplants becausebecause thatthat areare usedused locallylocally forfor variousvarious purposes.purposes. TheThe cashewcashew nut,nut, AnacardiumAnacardium occidentaleoccidentale,, isis extremelyextremely toxictoxic ifif eateneaten uncooked,uncooked, andand thethe resinresin inin thethe plantplant cancan causecause severesevere dermatitis.dermatitis. NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance PLANTSPLANTS

„ LocalLocal lorelore maymay attributeattribute medicinalmedicinal qualities,qualities, psychotropicpsychotropic oror aphrodisiacaphrodisiac effectseffects ofof nativenative plants.plants.

„ KhatKhat isis aa shrubshrub cultivatedcultivated inin thethe MEME forfor itsits leavesleaves andand berries,berries, whichwhich areare chewedchewed oror usedused asas tea.tea. ItIt hashas euphoriceuphoric andand amphetamineamphetamine--likelike effects.effects. SUMMARYSUMMARY

„ BriefBrief DescriptionDescription ofof CountriesCountries inin thethe MiddleMiddle EastEast „ MilitarilyMilitarily ImportantImportant VectorVector--BorneBorne DiseasesDiseases withwith ShortShort IncubationIncubation PeriodsPeriods (<15(<15 days)days) „ MilitarilyMilitarily ImportantImportant VectorVector--BorneBorne DiseasesDiseases withwith LongLong IncubationIncubation PeriodsPeriods (>15(>15 days)days) „ OtherOther DiseasesDiseases ofof MilitaryMilitary SignificanceSignificance „ NoxiousNoxious // VenomousVenomous AnimalsAnimals andand PlantsPlants ofof MilitaryMilitary SignificanceSignificance REFERENCESREFERENCES

„ DefenseDefense PestPest ManagementManagement InformationInformation AnalysisAnalysis Center,Center, ArmedArmed ForcesForces PestPest ManagementManagement Board,Board, WalterWalter ReedReed ArmyArmy MedicalMedical Center,Center, Washington,Washington, DCDC AppendicesAppendices

„ AppendixAppendix AA –– ArthropodArthropod SpeciesSpecies andand theirtheir DistributionDistribution inin thethe MiddleMiddle EastEast „ A1A1 –– MosquitoesMosquitoes „ A2A2 –– SandSand FliesFlies „ A3A3 –– TicksTicks „ A4A4 –– FleasFleas „ A5A5 –– ScorpionsScorpions „ AppendixAppendix BB –– VectorVector EcologyEcology ProfilesProfiles „ B1B1 –– MalariaMalaria VectorsVectors „ B2B2 –– TicksTicks