**Author details**

biology and control of the vector, Coleman and co-authors identified several issues that were directly applied to control of leishmaniasis in Iraq [23, 24, 25]. Important findings in this series

**2.** Sand flies in the region were more active in early evening during cooler months, but

**3.** Lights could be used to improve the effectiveness of various traps for surveillance of the

**4.** PCR techniques could be utilized to identify the probable vector of leishmaniasis for a

These and other practical findings enabled military preventive medicine personnel to establish an effective leishmaniasis control program based on improved housing, targeted use of pesticides, expanded use of repellents, public education and effective vector surveillance. Many elements of this and similar programs have been implemented in the civilian environ‐ ment and in other militaries, sometimes with mixed effects. One part of the U.S. Army's personal protection regimen that is heavily emphasized is the use of permethrin-treated uniforms. The permethrin serves as a contact irritant and has been shown to be effective against many vectors. In one such study in Iran, soldiers were placed in leishmaniasis-endemic areas either with or without permethrin-treated uniforms and forbidden to use topical repellents. There was not a statistical difference in the rate of disease incidence between the two groups, leading the researchers to conclude that permethrin-treated uniforms were not effective for prevention of cutaneous leishmaniasis [26]. This finding is not surprising given that perme‐ thrin is not a spatial repellent and would not be effective in preventing the sand flies from biting on exposed skin. Conversely, Egyptian and U.S. Navy researchers tested commonly used insecticides on cotton duck and vinyl military tent surfaces for efficacy against sand flies, noting that insecticides on vinyl surfaces exhibited lower toxicities to the flies as well as shorter

The practical findings from the entomological research that was initiated because of the war in Iraq have been applied in endemic areas, especially after disasters and inside refugee camps. These environments resemble those of military campaigns in that large numbers of people are subjected to the elements while residing in emergency housing (tents) that is often less than

Conflicts often result in significant displacements of large populations, both civilian and military. These displacements and the accompanying violence often lead to breakdowns in infection control in medical care facilities, disruption of public health and disease control programs, reduced access to populations in need, and greater exposure to vectors and

**1.** Air conditioning reduced the number of sand flies inside a tent by up to 83%;

changed during warmer months to peak activity in the middle of the night;

included:

vector;

given region.

154 Leishmaniasis - Trends in Epidemiology, Diagnosis and Treatment

periods of efficacy [27].

adequate.

**3. Conclusions**

#### David M. Claborn

Master of Public Health Program, College of Health and Human Services, Missouri State University, Springfield, MO, USA

### **References**


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