1. Permethrin-Treated Uniforms What It Means To You
The purpose of this briefing is to tell you about a new Army uniform that protects you from diseases carried by insects.
“Insects” is the general term used throughout this brief to describe the mosquitoes, ticks, flies, chiggers, biting midges, and sand flies that not only can transmit disease, but can also inflict painfully distracting bites.
Biting insects can inflict severe physical, psychological, and economic stresses that threaten Force Health Protection and Readiness.
Briefer
Position
Unit
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

2. Bottom Line
Wearing a permethrin-treated uniform as a component of the DoD Insect Repellent System, provides safe, effective protection against biting insects that cause annoyance, injury, and disease.
In addition to military uniforms, permethrin is registered by the EPA as a repellent suitable for clothing worn by adults and children.
The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend wearing permethrin- treated clothing for disease prevention.
In order to provide Soldiers with the best possible protection from disease-carrying insects, the Army introduced the Factory-Treated Permethrin Army Combat Uniforms, termed the ACU with Permethrin (ACU Permethrin), which ultimately replaced the current Army Combat Uniform (ACU).
Soldiers spend a significant amount of time outdoors, working and training in habitats where they are more likely to be bitten by both disease-bearing and annoying insects. The Army objective is to provide 90% bite protection out to at least 50 launderings; an objective easily met through factory treatment of the ACU-Permethrin which demonstrates % bite protection out to 50 launderings (the expected lifetime of the uniform). Beyond this point, the uniform still provides bite protection, but not as much.
Factory-treating uniforms with permethrin is the most efficient, safest and most environmentally sound method which ensures that each Soldier is provided the best defense against biting insects. One less thing to worry about.
Permethrin is a low-toxicity chemical that repels insects when it’s applied to clothing. Both the Department of Defense (DoD) and civilian clothing manufacturers have been using permethrin safely for many years.
Organizations such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) advocate the use of permethrin-treated clothing for people who may be exposed to vector-borne diseases.
 In the next few minutes I’m going to explain that it’s not only safe for you to wear these uniforms, it’s critical for Force Health Protection and Readiness. This includes day to day work environments, motor pools, walking outdoors, training environments such as the Joint Readiness Training Center (JRTC), and other non-combat missions both throughout the Continental United States (CONUS) and Outside the Continental United States (OCONUS). The ACU Permethrin will provide protection from some pretty nasty diseases and annoying insects.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

3. Protecting The Force: Permethrin-Treated Uniforms
Wearing a permethrin-treated uniform provides safe, effective protection against biting insects that cause annoyance, injury, and disease.
By wearing clothing impregnated with permethrin and using DEET insect repellent on all exposed skin, Soldiers receive protection against more than diseases that are spread by insects.
The DOD Insect Repellent System is a proven strategy used to prevent diseases transmitted by mosquitoes, flies, ticks, and other biting insects.
The key to preventing diseases transmitted by arthropods (such as Lyme disease by ticks and malaria and West Nile virus by mosquitoes) is the simultaneous use of all elements of the DoD Insect Repellent System. Wearing permethrin-treated uniforms is a key component of this system. In FY 2013, the ACU Permethrin replaced the current ACU in the Army Military Clothing Sales stores and replaced the non-permethrin ACU as an Army Clothing Bag item. The uniform is also be available to the Army National Guard, Army Reserve, and the Senior/Junior Reserve Officers Training Corps.
There is no wear-out-date for non-permethrin treated ACUs.
A single factory treatment with this repellent offers significant benefits to the ACU wearer including increased protection against the bites of mosquitoes, flies, midges, ticks, and chiggers for the life of the uniform.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

4. Protecting The Force – How Permethrin Works
Courtesy Graham Snodgrass, USAPHC
Permethrin repels many species of crawling
and flying insects, including mosquitoes, ticks, chiggers, and flies.
Permethrin works as a contact insect repellent.
Ticks crawling across the ACU Permethrin will drop off before they are able to attach and feed.
Mosquitoes and flies that land on the ACU Permethrin will quickly fall from the fabric and often die from the exposure to the permethrin treatment.
Army personnel performing daily activities, participating in training and field operations inside the United States and overseas are at risk for insect-borne diseases, some of which may cause long-term health effects or even death. Uniforms treated with permethrin reduce this risk.
Permethrin is effective against many species of crawling and flying insects, including mosquitoes, ticks, chiggers, and flies.
Permethrin works as a contact insect repellent, stunning or killing flying and crawling insects that land or walk on the treated uniform.
An insect that lands on a treated uniform is immediately agitated and either flies or crawls away to avoid the irritation; Ticks will drop off before they are able to attach and feed; Mosquitoes and flies that land will quickly fall from the fabric and often die.
They don’t even have a chance to bite!
Courtesy PEO Soldier
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

5. Protecting The Force – Permethrin Works!
The Army has used permethrin for over 20 years to treat Soldiers’ uniforms, compiling an excellent safety record with Soldiers.
Permethrin is the only pesticide registered by the EPA to treat fabrics for protection against biting insects.
Permethrin spray products are widely
available at sporting goods and outdoor
retailers for treating civilian clothing and gear.
Permethrin field application techniques 1993 (courtesy USAPHC)
The Army has used permethrin for over 20 years (since 1991) to treat Soldiers’ uniforms, compiling an excellent safety record with Soldiers.
The EPA, the National Academy of Sciences, the Office of the US Army Surgeon General, and the Commandant of the US Marine Corps have all approved permethrin treatment of clothing. Since March of 2007, the US Marine Corps has sold and issued only factory-treated Marine Corps Combat Utility Uniforms (MCCUU).
Permethrin is the only insect repellent/insecticide registered by the EPA to treat clothing for protection against biting insects, ticks and other arthropods. The Centers for Disease Control and Prevention (CDC), World Health Organization, American College of Family Physicians, and other national and international health organizations all advocate the use of permethrin-treated clothing as a method of preventing insect-borne disease.
Permethrin is widely available at sporting goods and outdoor retailers for treating civilian clothing and gear. Since 2003, well-known companies have marketed permethrin factory-treated outdoor clothing.
The ACU Permethrin is factory treated by some of the same companies that produce treated clothing for the civilian market.
Since 2003, well-known companies have marketed permethrin factory-treated outdoor gear and clothing.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

6. Protecting The Force – Field Experience with Permethrin
Permethrin factory-treatment will save Soldiers time and effort.
Factory treatment ensures all ACU’s are treated precisely and uniformly, according to EPA label requirements.
Factory treatment eliminates the exposure risks associated with applying liquid and aerosol permethrin products.
Every Soldier will have the best protection against biting insects.
The factory-treatment of ACUs eliminates the need for Soldiers to ever think about treating their uniforms and is preferred to individual treatment.
Factory treatment guarantees:
Safe and effective amount of permethrin is precisely applied to your uniform.
Improvement over field application techniques translates into better protection from insect bites and the diseases/irritation they may cause.
You’re probably most familiar with the Individual Dynamic Absorption (IDA) kit, or the zip-lock “shake ‘n bake” bags. All past treatment methods required Soldiers to apply the permethrin themselves or by a certified pesticide applicator. Factory treatment gets rid of this requirement, eliminating the potential risk of unnecessary inhalation or contact exposure.
Because factory treatment binds permethrin so tightly to the fabric of the uniform, almost no permethrin transfers to the skin yet the Soldier who wears the ACU Permethrin will have protection from insect bites for the lifetime of the uniform.
Uniforms that are permethrin treated using the aerosol spray method can be retreated using the aerosol spray method. NO TREATMENT METHODS ARE ALLOWED TO RETREAT UNIFORMS THAT HAVE BEEN PERMETHRIN-TREATED AT THE FACTORY, OR USING THE INDIVIDUAL DYNAMIC ABSORPTION (IDA) KIT, OR 2 GALLON SPRAYER METHODS.
Individual application methods will remain available within the DoD for bed nets and non-treated uniforms.
Photos: Courtesy Armed Forces Pest Management Board and USAPHC
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

7. Protecting The Force – Safety to Soldiers
Years of research by scientists around the world has shown that permethrin-treated clothing is safe, even when worn for long periods of time.
The Army has thoroughly reviewed studies by several agencies concerning potential adverse health effects.
There are no known adverse health risks associated with wearing the permethrin factory-treated uniforms.
There are no known adverse health risks associated with wearing the ACU Permethrin.     
Safety testing of permethrin has been conducted almost continuously since the 1970s since its EPA registration for use in/on many different applications such as food/feed crops, livestock, Public Health Mosquito abatement programs, pets, and clothing.
The EPA registers permethrin, such as insect repellents for use on clothing and the US Food and Drug administration approves permethrin for medical treatments for head lice and scabies, only after thorough research has proven them safe.
In 2009, the EPA completed the human health and environmental risk assessments for permethrin. The EPA’s review reassessed the potential adverse health effects resulting from wearing permethrin-treated uniforms. Based upon the best science and studies performed to date, the EPA has determined that wearing or coming into contact with permethrin-treated uniforms is unlikely to cause adverse health effects.
“Soldiers who wear permethrin-impregnated BDUs (for 18 hours/day, days/week, for 10 years) are unlikely to experience adverse health effects” (National Research Council, 1994)
Courtesy PEO Soldier
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

8. Protecting The Force – Safety to Soldiers
There is no epidemiological evidence to suggest that permethrin causes cancer in humans.
Stories about the dangers of permethrin are not based on scientific evidence.
No health effects are expected at levels used on uniforms.
Small amounts of liquid permethrin applied directly to the skin are quickly absorbed and rapidly metabolized and removed from the body. Appel et al. Risk Assessment of Bundeswehr…. Int. J. of Hygiene and Envir Health, 211 (2008)
Some permethrin products (but not the permethrin-treated uniform) could possibly irritate skin and/or eyes.
Stories about the dangers of permethrin are not based on scientific evidence. There is NO scientific evidence linking permethrin to cancer, infertility, birth defects, or inherited mutations.
The EPA asked a group of independent experts to review the data and assess the cancer-causing potential of permethrin; this panel concluded that: “…based on all the data together …the possibility of [cancer caused by permethrin] in man was extremely remote.
The factory process used to impregnate uniforms with permethrin binds the repellent so tightly to the fabric that only a miniscule amount of the repellent that leaves the garment reaches your skin.
A number of studies that examine the dermal absorption potential of permethrin have been reviewed by the EPA. In general, these studies showed the absorption potential of permethrin is low (< 5 %).
Any permethrin that is absorbed through the skin is rapidly excreted by the body during urination.
Evidence in the medical literature indicates that exposure to permethrin from wearing permethrin-impregnated uniforms at the recommended concentrations is unlikely to cause skin sensitization, skin irritation, or other skin effects in Soldiers. Even after 6 years of issuing treated uniforms, the Marine Corps hasn’t received any reports of skin rash attributed to the wear of the permethrin treated MCCUU.
A few hypersensitive persons may show signs of skin irritation which could be attributed to the permethrin or laundry detergent used to wash the uniform. Service Members should consult with a Health Care Provider if they have concerns about reactions that may be associated with wearing the ACU Permethrin.
* Although not anticipated, Soldiers with documented medical profiles (permethrin specific hypersensitivity) exempting the wear of a factory or individually permethrin treated uniform, will be able to special order a non-treated uniform through local Army Military Clothing Stores. Receipt of special orders is approximately 4-6 weeks.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

9. Protecting The Force – Safety to Family and Pets
The ACU Permethrin is safe to wear around infants and children and the EPA has approved production of permethrin-treated children’s clothing.
Permethrin-treated clothing has not been shown to cause any danger to household pets.
The factory process that binds the permethrin to the uniform fabric only releases enough to repel/kill insects but does not release enough to cause danger to children and pets.
The EPA label instructs that all permethrin factory-treated clothing, civilian and military, be washed separately.
Even though wearing permethrin-treated uniforms is unlikely to cause adverse health effects, pregnant and nursing Soldiers, and those trying to get pregnant are authorized to wear a non-treated ACU or maternity uniform.**
Research confirms that your permethrin treated uniform is safe to wear around infants and children.
Permethrin is the only insect repellent/insecticide EPA-registered to treat clothing and has an excellent safety record when applied as an insect repellent to clothing since the early 1990’s.
The 2009 EPA risk assessment investigated toddlers and youth wearing clothing treated with permethrin at the levels of fabric impregnation concentration identical to the rate used for permethrin factory treatment of the ACU-Permethrin. The EPA concluded that all of the potential adverse health risks, including cancer and non-cancer risks, were below the Agency’s level of concern.
Permethrin-treated clothing has not shown to cause any danger to household pets due to the factory process that binds the permethrin with the fabric which allows only enough permethrin release to repel/kill insects; and not to cause danger to pets.
The labeling affixed to all garments, military and civilian, that are permethrin factory-treated, has the EPA statement to launder separately. Follow instructions on the EPA label and hang tag for care and use in a field and combat environment.
**Even though pregnant and nursing Soldiers and those trying to get pregnant, are authorized to wear a non-treated ACU, Soldiers must see their Health Care Provider to obtain a medical profile exempting the wear of a regular factory or individually permethrin-treated uniform (prior to/after maternity uniform wear). The medical profile allows the Soldier to special order a non-treated uniform through the Army Military Clothing Sales stores prior to or after the wear of a non-treated maternity uniform. The non-treated maternity ACU remains an Organizational Clothing & Individual Equipment item that can only be obtained through the Central Issuing Facilities. Commanders see counseling requirements for pregnant Soldiers AR or AR and medical profile guidance for Health Care Providers in AR , Standards of Medical Fitness.
The CDC recommends using products that have been shown to work in scientific trials containing active ingredients registered with the EPA for use as insect repellents on skin or clothing. When EPA registers a repellent, they evaluate the product for efficacy and potential effects on human beings and the environment which means the EPA does not expect a product, when used according to the label, to cause unreasonable adverse effects to human health or the environment.
Keep in mind protection from a vector-borne disease such as Lyme disease, it is much safer for you to wear this uniform when insect-borne diseases are a risk than to contract such a disease while pregnant. Additional precautions are not necessary for pregnant or nursing women using registered insect repellents when insect-borne diseases are a risk.
Courtesy PEO Soldier
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

10. Protecting The Force
Because disease transmission by insects is relatively rare in the US, many Soldiers don’t realize a potential danger still exists.
Biting insects, like mosquitoes and ticks, can carry diseases and transmit them to people; these types of diseases are known as “vector-borne diseases” or VBD. Such illnesses have become much less common in the United States over the past 60 years, because of public health improvements and ongoing pest control, so Americans usually don’t even think about such diseases.
But data compiled from review of Army Medical Records, shows that there still exists a significant threat from VBDs to the health of Soldiers and their Families at Army Installations. Unfortunately, there are insects here in the US that can transmit diseases, some that make you sick for a few days, some that are life debilitating, and some that are fatal.
As the data shows, although the number of cases of VBDs may seem low compared to some overseas locations where primitive local infrastructure or civil unrest frustrates health improvements and pest control, many Soldiers and their Families seek medical treatment over concerns or discomfort resulting from insect bites.
Source: Disease Epidemiology Program, Epidemiology and Disease Surveillance, US Army Public Health Command
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

11. Protecting Yourself From Disease Vectors
Permethrin-treated uniforms help protect Soldiers from the threat of tick-borne diseases.
CONUS THREATS:
Anaplasmosis
Babesiosis
Ehrlichiosis
Lyme disease
Rickettsiosis
Rocky Mountain spotted fever
Southern tick-associated rash illness
Tickborne relapsing fever
Tularemia
Due to many factors, the incidence of tick-borne illnesses is increasing in the United States. As a general rule, areas with woods, bushes, high grass, or leaf litter are likely to have more ticks. These same types of habitats are also utilized for training areas on Army installations, both in and outside of the United States. Tick-borne illnesses are caused by infection with a variety of pathogens.
In the United States, some ticks carry pathogens that can cause human disease, including: (Note – tick-borne diseases can result in mild symptoms treatable at home to severe infections requiring hospitalization. Although easily treated with antibiotics, these diseases can be difficult for physicians to diagnose. However, early recognition and treatment of the infection decreases the risk of serious complications, including death) but even better, is knowing you are protected when wearing a permethrin treated uniform and DEET insect repellent.
The following is background information only if asked about a certain disease.
Anaplasmosis (previously known as human granulocytic ehrlichiosis HGE) is transmitted to humans by tick bites primarily from the blacklegged tick (Ixodes scapularis) in the northeastern and upper Midwestern US and the western blacklegged tick (Ixodes pacificus) along the Pacific coast. The number of anaplasmosis cases reported to CDC has increased steadily since the disease became reportable, from 348 cases in 2000, to 1006 cases in 2008.
Babesiosis is caused by microscopic parasites that infect red blood cells. Most human cases of babesiosis in the United States are caused by Babesia microti. Babesia microti is transmitted by the blacklegged tick (Ixodes scapularis) and is found primarily in the Northeast and upper Midwest.
Ehrlichiosis is transmitted to humans by the lone star tick (Ambylomma americanum), found primarily in the south central and eastern US The number of ehrlichiosis cases due to E. chaffeensis that have been reported to CDC has increased steadily since the disease became reportable, from 200 cases in 2000, to 961 cases in 2008.
Lyme disease is transmitted by the blacklegged tick (Ixodes scapularis) in the northeastern US and upper Midwestern US and the western blacklegged tick (Ixodes pacificus) along the Pacific coast. Lyme disease is the most commonly reported vectorborne illness in the US, with over 30,000 confirmed cases reported annually.
Rickettsia parkeri Rickettsiosis is transmitted to humans by the Gulf Coast tick (Amblyomma maculatum).
Rocky Mountain Spotted Fever (RMSF) is transmitted by the American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and the brown dog tick (Rhipicephalus sangunineus) in the US The brown dog tick and other tick species are associated with RMSF in Central and South America.
STARI (Southern Tick-Associated Rash Illness) is transmitted via bites from the lone star tick (Ambylomma americanum), found in the southeastern and eastern US
Tickborne relapsing fever (TBRF) is transmitted to humans through the bite of infected soft ticks. TBRF has been reported in 15 states: Arizona, California, Colorado, Idaho, Kansas, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming and is associated with sleeping in rustic cabins and vacation homes.
Tularemia is transmitted to humans by the dog tick (Dermacentor variabilis), the wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma americanum). Tularemia occurs throughout the US
364D Rickettsiosis (Rickettsia phillipi, proposed) is transmitted to humans by the Pacific Coast tick (Dermacentor occidentalis ticks). This is a new disease that has been found in California.
Tickborne Diseases outside CONUS include:
Crimean-Congo hemorrhagic fever is transmitted by hard ticks, primarily of the genus Hyalomma found in Eastern Europe, particularly in the former Soviet Union; in northwestern China, central Asia; southern Europe; Africa; the Middle East; and the Indian subcontinent. In 2009, a US Soldier died from CCHF.
Lyme Disease in temperate forested regions throughout Europe and northern Asia although it is more common in eastern and central Europe than western Europe. In contrast to North America, Lyme disease can be caused by several different species of Borrelia burgdorferi and may have somewhat different symptoms. For example, the initial rash, or erythema migrans (EM), may last longer but have less associated inflammation than the EM produced by US infections. Additionally, tests in the US will not necessarily detect European strains of Lyme disease.
Tick-borne encephalitis (TBE) is found and transmitted by hard ticks, Ixodes, in many parts of Europe, the former Soviet Union, and Asia. Three virus sub-types include: European or Western tick-borne encephalitis virus, Siberian tickborne encephalitis virus, and Far eastern tick-borne encephalitis virus (formerly known as Russian Spring Summer encephalitis virus).
OCONUS THREATS:
Crimean-Congo hemorrhagic fever
Lyme disease
Tick-borne encephalitis
Courtesy Graham Snodgrass, USAPHC
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

12. Protecting The Force LYME & OTHER TICK-BORNE DISEASE
Source: CDC
NOTE: After discussing Lyme, click once in center of slide to fade in a map depicting distribution of other tick-borne diseases in the US.
Let’s take a closer look at Lyme disease in the US, a significant threat to non-deployed personnel. As you can see from the graph, incidence among Army personnel is on the rise, making it all the more important for you to have the additional protection provided by the ACU Permethrin.
Lyme disease, a tick-bone disease, is found in most of the Army training areas in the US and Europe. In the United States, Lyme disease is the most commonly reported vector-borne illness, with over 30,000 confirmed civilian cases reported annually. Lyme disease also impacts the health of Soldiers and their families, and is increasing. The ACU Permethrin can reduce these cases.
Data from the Reportable Medical Events System (RMES) and the Disease Reporting System-internet (DRSi) show that Lyme disease accounted for a total of 310 reported cases of disease in Soldiers between 2008 and 2012.
Tick-borne illnesses in total – Lyme disease, Ehrlichiosis, and Rocky Mountain Spotted Fever (RMSF), caused 332 cases out of 665 vector-borne diseases reported in RMES and DRSi between 2008 and And the number of cases/disease incidence is on the rise.
Source: Disease Epidemiology Program, Epidemiology and Disease Surveillance, US Army Public Health Command
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

13. How Well Does Permethrin Treatment Work?
Can you tell the treated uniform from the untreated uniform?
NOTE: If the movies do not play automatically, click over each picture. If the videos are still not working, please click on the hyperlinks in blue to be directed to the videos online.
Soldiers can help protect themselves against tick bites and diseases by wearing their uniforms with sleeves rolled down, closing all openings in clothing that might let ticks in. But without a permethrin treated uniform, this is only a partially effective technique when it comes to preventing tick bites.
Ticks crawling across ACU-Permethrin will drop off before they are able to find an opening in the fabric in order to attach to the skin attach and feed.
The videos show a side by side comparison between an untreated ACU and an ACU-Permethrin. The videos roll in real time, showing how quickly a crawling tick is immobilized and killed by the permethrin impregnated into the fabric of the ACU-Permethrin. Which uniform would you want to wear?
Videos Courtesy USAPHC
ACU (Untreated) Trousers
ACU-Permethrin Trousers
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

14. Protecting Yourself From Disease Vectors
Permethrin-treated uniforms help protect Soldiers from the threat of mosquito-borne diseases.
Soldiers living, training, and deployed on non-combat operations both in and outside the United States are at risk from:
Eastern equine encephalitis
La Crosse encephalitis
St. Louis encephalitis
West Nile virus
Western equine encephalitis
Dengue
Malaria
Rift Valley fever
Mosquito-Borne Diseases: Soldiers living, working and training in the CONUS or stationed OCONUS or deployed OCONUS on a non-combat mission are at increased risk to a number of mosquito-borne diseases. There are no licensed vaccines for humans to counter these diseases.
Background data only if required:
These diseases include:
Eastern Equine Encephalitis confirmed civilian cases in the US since 1964.
La Crosse encephalitis – In the US, there are approximately serious cases reported each year among the civilian population.
St. Louis encephalitis– over 4,600 hundred civilian cases have been reported in the US from 1964 to The mortality rate is from 5-30%, with higher rates among the elderly.
West Nile virus– about 1 in 150 people infected with West Nile virus will develop life-threatening symptoms. Since 1999, more than 30,000 people in the United States have been reported as getting sick from the virus, which includes more than 1,200 deaths.
Western equine encephalitis – 0ver 600 confirmed civilian cases in the US since 1964, with over 30% developing serious neurological damage, and 5% fatality rate.
Dengue Fever – also known as Break Bone Fever because of the excruciating aches it causes its sufferers may be returning to the United States after a 45-year absence. In 2010 and 2009, an outbreak occurred in Key West. In 2010, 5,382 persons in Puerto Rico were afflicted by the disease and 20 died as a result. Overall, 50 to 100 million infections occur yearly, with 22,000 deaths, mostly among children.
Malaria – in 2010, an estimated 216 million cases occurred worldwide and there were approximately 700,000 fatalities mainly in the AFRICOM AO. The cumulative number of malaria cases in Soldiers from was 262.
Rift Valley Fever – found generally in regions of eastern and southern Africa, also Saudi Arabia and Yemen, approximately 1% of humans who become infected with RVF die, many who survive experience permanent vision loss.
Courtesy Graham Snodgrass, USAPHC
There are no licensed vaccines for human use to counter these diseases!
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

15. The Danger: Mosquito-Borne Disease
WEST NILE VIRUS
Courtesy Graham Snodgrass, USAPHC
Lets take a closer look at West Nile virus in the US. Disease activity can fluctuate from year to year, so having ACU with Permethrin will mean you are prepared. This year in Texas, a State Health Emergency was declared due to an outbreak of WNV in Dallas County and since resulted in the first aerial insecticide spraying of the city since 1966.
About 1 in 150 people infected with West Nile virus will develop life-threatening symptoms. Since 1999, more than 30,000 people in the United States have been reported as getting sick from the virus, which includes more than 1,200 deaths.
Source: CDC
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

16. The Danger: Mosquito-Borne Disease
DENGUE
Courtesy Graham Snodgrass, USAPHC
Soldiers training, living, or operating in southern CONUS, AFRICOM, SOUTHCOM, PACOM, area of operations are at increased risk to a number of mosquito-borne diseases.
Although dengue rarely occurs in the continental United States (so far, only a few cases have occurred in the United States, but the mosquito that carries dengue lives in most of the Southern states), it is endemic in Puerto Rico, and in many Soldier deployment destinations in Latin America and Southeast Asia; periodic outbreaks occur in Samoa and Guam.
According to the World Health Organization, cases across the Americas, South-east Asia and Western Pacific exceeded 1.2 million cases in 2008 and over 2.2 million in 2010 (based on official data submitted by Member States). Recently the number of reported cases has continued to increase. In 2010, 1.6 million cases of dengue were reported in the Americas alone, of which 49,000 cases were severe dengue.
Dengue, also known as Break Bone Fever because of the excruciating aches it causes its sufferers, may be returning to the United States after a 45-year absence. In 2009 and 2010, an outbreak occurred in Key West, Florida. In 2010, 5,382 persons in Puerto Rico were afflicted by the disease and 20 died as a result.
Source: CDC
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

17. The Danger: Mosquito-Borne Disease
MALARIA
Throughout history, malaria has probably killed more people than any other disease, and it’s still with us today.
Soldiers training, living, or operating in AFRICOM, SOUTHCOM, CENTCOM and PACOM, area of operations are at increased risk to a number of mosquito-borne diseases. There are no licensed vaccines for human use to counter malaria.
Army data on reportable medical events show that malaria is the second leading cause of reported Vector-Borne Diseases among Soldiers. Most reported cases were contracted in deployed settings.
Malaria had the second highest frequency of occurrence among all vector-borne diseases from The cumulative number of malaria cases over this 5 year period was 262.
Source: CDC
Global Risk of Malaria Transmission
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

18. How Well Does Permethrin Treatment Work?
NOTE: If the movie does not play automatically, click over the picture. If the video is still not working, please click on the hyperlink in blue to be directed to the video online.
Permethrin works as a contact insect repellent against mosquitoes.
Mosquitoes that land on the ACU-P get “hot feet” and will quickly fly away or fall from the fabric, often dying.
The video shows a laboratory cage test using Aedes spp. The opening scene illustrates how the mosquitoes land and attempt to bite through the fabric on an untreated ACU. The camera pans to a sleeve of an ACU-P. Same cage; same horde of mosquitoes. Note that any mosquitoes that land on the ACU-P, quickly fly away, not even attempting to bite thru the fabric. That’s called effective bite protection, and you’ve seen it for yourself!
Video Courtesy USAPHC
Arm in cage tests against uninfected mosquitoes.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

19. The Danger: Sand Flies and Leishmaniasis
Courtesy Armed Forces Pest Management Board
Cutaneous leishmaniasis, as many of you know, affected Soldiers in Iraq during Operation Iraqi Freedom. This disease is spread by sand flies.
You’ll notice that leishmaniasis is found all over Central Asia, as well as Africa and South America. There are other forms of leishmaniasis as well, and some can be fatal.
Cutaneous leishmaniasis, the most common form of the disease, causes skin ulcers.
During Operation Iraqi Freedom, there were 653 cases of cutaneous leishmaniasis by the close of March Some estimates have placed the actual number much higher; figures ranging up to 2,500 have been cited which would be an infection of 1% of US service members serving in Iraq during 2003 – 2004.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

20. The Annoyance: Biting Flies and Midges, Chigger Mites
They may not transmit human disease in the United States, but these insects:
Inflict painfully distracting bites which can lead to
secondary infections, dermatitis, or allergic
reactions.
Impact individual performance and distracts from
mission readiness and effectiveness.
Horse fly
Biting midge
Chigger mite
Luckily, in the United States, these insects do not transmit human disease, but the bites they inflict:
- Can be painfully distracting and can lead to secondary infections, dermatitis, or allergic reactions.
Inflict severe physical, psychological, and economic stresses.
Threaten the military mission both in areas within the US and OCONUS by impacting individual performance and effectiveness.
Your ACU Permethrin is effective at repelling these biting and annoying insects.
NOTE: Pictures (not to scale) from top to bottom are of a horse fly, biting midge, deer fly and chigger mite.
Deer fly
Insect photos courtesy
Graham Snodgrass, USAPHC
Pictures are not to scale.
Courtesy Kevin Harkins, USAPHC
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

21. Protection Against the Threat
The ACU Permethrin will not eliminate the need for Soldiers to wear DEET and use other personal protection measures (PPM).
The uniform protects mainly the body parts it covers; it is still important to apply DEET to exposed skin when outdoors.
After all, the best way to preventing diseases transmitted by mosquitoes and ticks (such as West Nile virus and Lyme disease) is the simultaneous use of all elements of the DoD Insect Repellent System.
Wearing permethrin-treated uniforms is one key component of this system.  
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

22. Protection Against the Threat
….Why not just kill all the bugs!
Pesticide Use May Not Be the Best Option:
Use limited to trained and certified personnel.
Timeliness a factor - especially when authorization has to be obtained through environmental and medical channels.
No one chemical or application method works to kill all targeted insects.
Personal protective measures such as avoiding infested areas and wearing a permethrin-treated uniform and insect repellent on exposed skin provide the best means of protection available.
Of course, you might be thinking, “just kill all the bugs!” And sometimes that is the last option available in a measured response for insect-borne disease vector control.
The DoD uses an integrated approach designed to provide Soldiers maximum, safe protection from insect attack.
Insect-borne diseases and nuisance pests can be prevented or controlled by using a number of techniques. Pesticides are sometimes applied as part of an integrated approach to insect control, but their use in garrison, training areas, or non-combat related missions, such as humanitarian, disaster relief and civil support settings is sometimes neither practical nor possible.
In many situations, personal protective measures such as avoiding infested areas, or the use of physical barriers or insect repellents, may be the only means of protection available.
Think of permethrin-treated uniforms and repellents as body armor and your first line of defense against disease, just as the army combat helmet (ACH) and interceptor body armor (IBA) provide added survivability from small arms fire and shrapnel.
Courtesy Armed Forces Pest Management Board
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED 22

23. Recognizing and Caring for Permethrin Factory-Treated Uniforms
Companies that factory-treat uniforms with permethrin must be EPA registered.
EPA requires a sewn-in label and hang tag for permethrin factory-treated garments.
The EPA label instructs garments that are permethrin factory-treated, whether military or civilian, be laundered separately.
The ACU Permethrin can be put in the dryer without affecting the repellency.
Do not dry clean, commercially hot press, use bleach, bleach alternatives, fabric softener or starch.
Independent research has shown that the ACU Permethrin provides % bite protection out to 50 launderings even though the label reads 25 launderings.
The ACU Permethrin cannot be retreated with permethrin.
The ACU Permethin can be distinguished by looking for hang tags (bottom picture) attached to the uniform when new or for labels sewn on the inside of the blouse and trousers (top picture).
These tags are an EPA requirement and indicate that the uniform has been factory-treated with permethrin. The ACU Permethrin looks identical to the ACU; the permethrin treatment is invisible, odorless, and colorless, and does not change the feel of the uniform.
With the modern technology used to treat these new uniforms, only a very small amount of permethrin leaves the uniform when laundered. Although studies conducted to date indicate only tiny amounts of permethrin transfer to untreated clothing during laundering, the EPA label instructs consumers to launder permethrin-treated garments, military uniforms or civilian clothing, separately from other non-treated garments. Follow instructions on the EPA label and hang tag for care and use in a field and combat environment.
The ACU Permethrin can be put in the dryer without affecting the repellency.
The ACU Permethrin should not be dry-cleaned. Even a single dry cleaning will remove most, but not all of the active ingredient, and significantly reduce the bite protection. Dry cleaning will also fade the ACU Permethrin and weaken the fiber strength, causing it to become unserviceable.
Independent research has shown that the ACU Permethrin provides a Soldier with 99-100% bite protection out to 50 launderings (the expected lifetime of the uniform). Beyond this point, the uniform still provides bite protection, but not as much.
The factory-treated ACU Permethrin cannot be retreated with permethrin.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

24. Conclusions
Factory Treatment of Uniforms with Permethrin Enhances Force Health Protection and Readiness:
Ensures Soldiers are protected at all times from insects that transmit harmful diseases and those that cause discomfort and irritation.
Relieves individual Soldier uniform treatment responsibility.
Label clearly identifies the uniform as permethrin-treated.
Ready-to-wear uniform protection.
Provides permanent, safe, and effective insect bite protection for the lifetime of the uniform.
The introduction of the ACU Permethrin will provide Soldier protection from insect-borne diseases, while in garrison, training, and deployment environments world-wide in non-combat situations.
No more guesswork as to who has and who does not have a permethrin-treated uniform.
If you’ve ever treated your own uniform using the permethrin “Shake ‘n Bake” kits or aerosol spray, you’ll now have the ability to wear a pre-treated uniform without the hassle. Remember to use all of the components of the DoD Insect Repellent System, treated uniforms, pant legs tucked into boots, and the application of DEET lotion on exposed skin.
In conclusion, the Army is introducing the ACU Permethrin because it’s permanent, safe, effective, and provides the best protection while enhancing Force Health Protection and Readiness.
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED

25. Questions? For additional information contact: Your Local Preventive
Medicine Service
DOD Pesticide Hotline
(410) 436‐3773
DSN 584‐3773
The DoD Armed Forces
Pest Management Board
Contingency Liaison
Officer
(301)
DSN
POCs if you have any questions or concerns:
Contact your local Preventive Medicine Service/Army Public Health Command Regional Support Staff.
inquiries concerning the DoD Insect Repellent System and Personal Protective Measures to the DoD Pesticide Hotline at or via commercial telephone / DSN
Additional information is available from the DoD Armed Forces Pest Management Board (AFPMB) Website at
If the AFPMB website does not suffice to answer specific questions, contact the AFPMB, Contingency Liaison Officer by calling DSN /7476 or commercial ; or by writing to AFPMB, ATTN: Contingency Liaison Officer, US Army Garrison-Forest Glen, Armed Forces Pest Management Board, 2460 Linden Lane, Bldg 172, Silver Spring, MD
LTC Schleich / MCPO-SA / (210) (DSN 471)/ UNCLASSIFIED