1. U.S. Department of Defense Surveillance Recommendations for Management of Chikungunya and Dengue Vectors James E. Cilek

2. Navy and Marine Corps Public Health Center1 The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U. S. Government.

3. Navy and Marine Corps Public Health Center2 In early 2014, the Department of Defense (DoD) Armed Forces Health Surveillance Center/Division of Integrated Biosurveillance formed a Working Group of representative key DoD communities and external organizations to address “strengthening DoD surveillance and detection for chikungunya (CHIK) and dengue (DENV)” on CONUS installations. The Center is the central epidemiological resource and a global health surveillance proponent for the U.S. Armed Forces. It provides timely, relevant, actionable, and comprehensive health surveillance information in order to promote, maintain, and enhance the health of military and military-associated populations. On July 15, 2014, this group of about 20 people met in Silver Spring, MD at the headquarters of the Walter Reed Army Institute for Research (WRAIR).

4. Navy and Marine Corps Public Health Center3 The ambitious objectives of the working group were to: 1. Assess current DoD capability to detect and characterize CHIK and DENV infection in DoD personnel. 2. Recommend specific human surveillance efforts to enhance CHIK and DENV detection. 3. Assess and recommend specific entomological surveillance efforts to enhance risk assessment for CHIK and DENV transmission on military installations.

5. Navy and Marine Corps Public Health Center4 The ambitious objectives of the working group were to: 4. Recommend science and technology initiatives to improve CHIK and DENV surveillance and detection in DoD. 5. Propose policy, guidance, or other resources for issuance by appropriate DoD organizations to improve CHIK and DENV surveillance and detection in DoD.

6. Navy and Marine Corps Public Health Center5 I will address: 3. “Assess and recommend specific entomological surveillance efforts to enhance risk assessment for CHIK and DENV transmission on military installations.”  Currently, Department of Defense DODI 4150.07 implements policy, assigns responsibilities, and prescribes procedures for the DoD Integrated Pest Management (IPM) Program.  The Navy is committed to maintaining an integrated pest management (IPM) program consistent with DoDI 4150.07 through OPNANINST 6250.4C.

7. Navy and Marine Corps Public Health Center6 Departments of the Navy and Marine Corps: Commanders of all shore activities bear the responsibility for maintenance of an “adequate vector and economic pest control program” (OPNAVINST 6250.4). The Medical Department of each installation is required to plan and recommend vector control measures and to determine that all pesticides are applied safely (NAVMED P-5010). Pest control operations as a scheduled part of performed services can be conducted through the operations department on base (NAVFAC) or contracted to outside vendors but still monitored by the medical department.

8. Navy and Marine Corps Public Health Center7 The objective of the plan is to give general guidance for Navy and Marine Corps installations regarding surveillance and control of CHIK vectors for their installations.

9. Navy and Marine Corps Public Health Center8 Moreover, the CHIK plan is used to complement an Installation’s Pest Management Plan that contains an Emergency Vector Control Plan for disease vector surveillance and control during a disease epidemic. The CHIK plan also lists options for vector surveillance on each Navy and Marine Corps installations: 1. Local Public Health and/or Mosquito Control Agencies: If local, county, or state agencies are currently performing surveillance and control measures that meet or exceed US DoD CHIK recommendations then arrangements may be made to include the military installation as part of the agency’s operations.

10. Navy and Marine Corps Public Health Center9 The CHIK plan also lists options for vector surveillance on each Navy and Marine Corps installations: 2. Private Contractor: Installation may have contract with civilian mosquito pest control professionals that meet or exceed the DoD CHIK recommendations. 3. DoD Personnel: DoD medical personnel and equipment should be implemented to augment available civilian support. In the absence of civilian support, DoD personnel will provide support for their respective installations.

11. Navy and Marine Corps Public Health Center10 The Armed Forces Pest Management Board’s mission is to ensure that environmentally sound and effective programs are present to prevent pests and disease vectors from adversely affecting DoD operations.

12. Navy and Marine Corps Public Health Center11 Although a unified report by the Workshop on “Strengthening DoD Surveillance and Detection for CHIK and DENV” has yet to be officially released, below are some of the informal suggestions provided by the group: 1.DHA should consider developing policy for mosquito-borne disease preparedness in the DoD, including recommended responses to human cases on military installations, vector surveillance, risk communication, and other related measures. 2. Armed Forces Health Surveillance Center should consider collaborating with the Armed Forces Pest Management Board and Service Public Health Centers to identify ways of improving Aedes surveillance on military installations.

13. Navy and Marine Corps Public Health Center12 It was suggested that a model guideline could be adapted by the DoD is CDC, Preparedness and Response for Chikungunya Virus Introduction in the Americas, 2011.

14. 13 THANK YOU Navy and Marine Corps Public Health Center