1. Medical Briefing: Afghanistan

2. OVERVIEW Mission Medical Threats Medical Recommendations

3. MISSION Primary: Provide medical and preventive medicine support to deployed US Forces in Afghanistan Secondary: Provide information and recommendations to Local National Health Care Providers

5. WEATHER Rain and snow October to April Rainfall 15 inches/year “Wind of 120 days” June to Sept up to 110 mph Temperature: extremes Winter 37 F to -3F Summer 118 o to 68 o F

6. MEDICAL THREATS Diseases Environmental injuries and illnesses Flora/fauna

7. DISEASES:Food/Water Borne !!!HIGH Risk!!! Diarrhea High risk caused by bacterial, amoeba, viral In Afghanistan war, Soviets had an entire mechanized unit of 3,000 men, out of combat Resistance to standard treatment TMX/SMX Typhoid Fever- Highly endemic Hepatitis A- Almost 20% of Russian personnel hospitalized

8. DISEASES: Vector Borne Malaria (Primarily Plasmodium vivax) May through November West Nile fever (Mosquito) Sand fly fever Leishmaniasis ( sand fly) Scrub typhus (mite)

9. DISEASES: Other Tuberculosis- Highly endemic Cholera Meningococcal Meningitis Helminthic infections- 95% of population infected

10. DISEASES: Other Cont Leptospirosis Rabies Anthrax (animal-borne cutaneous) Flea-borne Typhus

11. DISEASES: Recreational Sexually Transmitted Diseases HIV/AIDS low 0.01% of population 15-49 y/o Hepatitis B/C found in 6.7% of women Fresh water recreation Leptospirosis

12. ENVIRONMENTAL INJURIES AND ILLNESSES Water shortages Water contamination with sewage Temperature extremes heat/cold injuries Dust storms 110 mph High altitude

13. FLORA/FAUNA Venomous land snakes Insects Plants

14. LOCAL MEDICAL FACILITIES Civil war has disrupted health care Operated by international humanitarian organizations. Local blood supply is not safe

15. MEDICAL SHOW STOPPERS Infectious disease epidemic Food/water borne Potable water availability Heat/cold casualties Mass casualty/evacuation

16. RECOMMENDATIONS: Pre-Deployment Vaccinations Hepatitis A, influenza, typhoid, yellow fever, Td, polio,MMR Verify status: HIV, PPD, G6PD Begin malaria prophylaxis Mefloquine or doxycycline (mefloquine not approved for flight status) Preventive medicine brief

17. RECOMMENDATIONS: Deployment Location DEET Malaria prophylaxis- Mefloquine 250 mg/week or doxycycline 100 mg/day. Post exposure primaquine required. Treat BDU’s/bed nets with permethrin Clothing discipline Monitor environmental conditions Field sanitation equipment/water discipline

18. SUMMARY Mission Food/Water threats Other Infectious Diseases Environmental Safety