UNCLASSIFIED// R 270300Z NOV 03 COMFIRSTNCD LITTLE CREEK VA RATUZYUW RUCOHAG0265 3310300-UUUU--RUCOFAE. ZNR UUUUU ZUI RUCOMCA2871 3351925 R 270300Z NOV 03 PSN 659835I36 FM COMFIRSTNCD LITTLE CREEK VA//N02M// TO AIG 488 INFO RUBDPLA/COMLANTFLT//N02M// RUENAAA/CNO WASHINGTON DC//N4/N434// RHDLCNE/COMUSNAVEUR LONDON UK//00// RHMFIUU/COMUSNAVEUR LONDON UK//00// RHHMHAA/COMPACFLT PEARL HARBOR HI//00// RUCOHAG/COMFIRSTNCD LITTLE CREEK VA//N00/N01/N3// RUCOFAE/NAVENVIRHLTHCEN PORTSMOUTH VA RUBDPLA/NAVENPVNTMEDUTWO NORFOLK VA BT UNCLAS MSGID/GENADMIN/DEPLOYMENT MEDICAL GUIDANCE// SUBJ/MEDICAL GUIDANCE FOR DEPLOYMENT - MALARIA AND LEISHMANIASIS// REF/A/INST/1NCD/YMD:20031009// REF/B/MSG/NAVENVIRHLTHCEN/101750ZOCT2003// REF/C/MSG/COMUSNAVCENT/181225ZSEP2003// REF/D/MSG/COMSIXTHFLT/231202ZSEP2003// REF/E/INST/NAVENVIRHLTHCEN/YMD:20000901// PAGE 02 RUCOHAG0265 UNCLAS REF/F/DOC/BUMED/YMD:19980921// NARR/ REF A IS COMFIRSTNCDINST 6000.1, THE SEABEE MEDICAL PROCEDURES MANUAL. REF B IS RMG ON LEISHMANISIS AND AVAILABLE AT HTTP://WWW-NEHC.MED.NAVY.MIL/PREVMED/EPI/NEHCLEISHGUIDE.TXT REF C IS COMNAVUSNAVCENT MALARIA PROPHYLAXIS GUIDANCE AND REQUIREMENTS FOR UNITS IN FIFTH FLEET AOR AVAILABLE AT HTTP://WWW-NEHC.MED.NAVY.MIL/PREVMED/EPI/NAVCENTSEP03.TXT REF D IS COMSIXTHFLT HEALTH PROTECTION GUIDANCE AND IS AVAILABLE AT HTTP://WWW-NEHC.MED.NAVY.MIL/PREVMED/EPI/6THFLTSEP03.TXT REF E IS NEHC MALARIA POCKET GUIDE AVAILABLE AT HTTP://WWW-NEHC.MED.NAVY.MIL/DOWNLOADS/PREVMED/MALARIA2000.PDF REF F IS BUMEDINST 6220.12A ON MEDICAL EVENT REPORTING AVAILABLE AT HTTP://WWW-NEHC.MED.NAVY.MIL/PREVMED/INDEX.HTM. POC/KOFFMAN/CAPT/FORCE MEDICAL OFFICER/LOC:1NCD/ TEL:COMM 757-462-8624/ DSN:253-8624/EMAIL:KOFFMANRL@NCF.NAVY.MIL// RMKS/1. PROTECTING UNIT PERSONNEL FROM DISEASE AND NON-BATTLE INJURY (DNBI) IS CRITICAL TO MAINTAINING OPERATIONAL READINESS. LINE COMMANDERS ARE RESPONSIBLE FOR IMPLEMENTING AN EFFECTIVE FORCE HEALTH PROTECTION (FHP) PROGRAM. PAGE 03 RUCOHAG0265 UNCLAS 2. IN THE LAST TWO WEEKS, THREE SEABEES HAVE PRESUMPTIVE EVIDENCE OF THE LEISHMANIASIS AND ONE SEABEE WAS MEDEVACED BACK FROM AFRICA WITH MALARIA. GIVEN THE POTENTIAL SERIOUSNESS OF THESE TWO DISEASES, STEPS MUST BE TAKEN TO REEMPHASIZE PROCEDURES TO REDUCE THE RISK AND TO INCREASE AWARENESS OF THESE DISEASES. REF B THROUGH E PROVIDE PREVENTIVE GUIDANCE FOR PERSONNEL DEPLOYING TO AFRICA AND THE MIDEAST. 3. PREDEPLOYMENT PLANNING. A. PER REF A, DEPLOYING MEDICAL DEPARTMENT PERSONNEL MUST PREPARE THEIR MEDICAL ANNEX TO THE OPORDER. THIS ANNEX SHOULD BE FORWARDED FOR REVIEW BY FORCE MEDICAL TO PROVIDE UNIT FEEDBACK ON THE ADEQUACY OF PRE-DEPLOYMENT PREPARATIONS. PERSONNEL PREPARING TO DEPLOY SHOULD RECEIVE BRIEFINGS ON DISEASES OF IMPORTANCE, BE PROVIDED WITH APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT INCLUDING THE USE OF 30% DEET (CHEMICAL NAME, N,N-DIETHYL-META-TOLUAMIDE), PERMETHRIN TREATED UNIFORMS, BED NETS, AND BE EDUCATED ON THE PROPER WEAR OF THE UNIFORM TO PREVENT INSECT BITES. B. FOR EACH DEPLOYMENT, THE MEDICAL OFFICER MUST DETERMINE REQUIREMENTS FOR MALARIA CHEMOPROPHYLAXIS BASED ON THE DEPLOYMENT ORDER GUIDANCE AND OTHER INFORMATION FROM AFMIC AND LOCAL PREVENTIVE PAGE 04 RUCOHAG0265 UNCLAS MEDICINE UNITS. THIS REQUIREMENT MAY BE MODIFIED DURING DEPLOYMENT TO ADJUST FOR CHANGING LOCATION AND THREAT LEVELS, AS WELL AS APPROPRIATE MEDICATION REGIMENTS. PER CHAPTER 5 SECTION 5505 OF REF A, CHEMOPROPHYLAXIS SHOULD BE PRESCRIBED BASED ON DIRECTIVES FROM THE COMBATANT COMMAND OR OTHER COMMAND AUTHORITY, AS WELL AS THE SPECIFIC CHARACTERISTICS OF THE DEPLOYMENT, INCLUDING THE DURATION OF EXPOSURE, ANTICIPATED EXPOSURE TO MOSQUITOES, TYPE OF ACTIVITIES, AND OTHER FACTORS. THE CHOICE OF CHEMO PROPHYLACTIC MEDICATION SHOULD BE BASED ON CLINICAL JUDGEMENT AND RELEVANT OFFICIAL GUIDANCE, INCLUDING RECOMMENDATIONS FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (WWW.CDC.GOV). SEE THE AFMIC INFECTIOUS DISEASE RISK ASSESSMENT FOR DETAILS ON MALARIA RISK LEVEL, RISK PERIOD, RISK DISTRIBUTION, AND DRUG RESISTANCE. C. WHEN REQUIRED BY THE COMBATANT COMMANDER, PERSONNEL MUST COMPLETE THE PRE-DEPLOYMENT HEALTH ASSESSMENT, FORM DD 2795, WHICH IS AVAILABLE AT HTTP://AMSA.ARMY.MIL OR HTTP://WWW-NEHC.MED.NAVY.MIL/POSTDEP/DODFORMS.HTM. 4. DURING DEPLOYMENT, ONGOING PREVENTIVE MEDICINE EFFORTS ARE IMPORTANT TO MINIMIZE LOSSES FROM DISEASE AND INJURY. A. EFFECTIVE PERSONAL PREVENTIVE MEASURES ARE CRITICALLY IMPORTANT. PAGE 05 RUCOHAG0265 UNCLAS INVESTIGATION INTO OUR CASES OF MALARIA AND LEISHMANIASIS SHOWED IRREGULAR USE OF DEET, OR IN PLACE OF DEET, THE USE OF OTHER NON-APPROVED INSPECT REPELLANTS SUCH AS OFF AND SKIN-SO-SOFT. PRIORITIES MUST INCLUDE THE ACTIVE INVOLVEMENT OF APPROPRIATE PREVENTIVE MEDICINE (PM) PERSONNEL IN DEPLOYMENT PLANNING. PREPARATION PER REF A IS REQUIRED. B. THE IMPORTANCE OF PERSONAL PROTECTIVE MEASURES CANNOT BE OVERSTATED. ADEQUATE QUANTITIES OF DEET FOR DAILY USE BY ALL PERSONNEL IS ESSENTIAL. TREAT FIELD UNIFORMS WITH PERMETHRIN. PROCURE BED NETS FOR ALL PERSONNEL IN FIELD CONDITIONS. BECAUSE THE FORCE MEDICAL OFFICER IS RESPONSIBLE FOR WORLDWIDE TRACKING, SURVEILLANCE, AND MONITORING, REPORTABLE CONDITIONS AS OUTLINED IN REF F, MUST BE REPORTED EARLY IN THE PROCESS (REF A CHAPTER 1, SECTION 1304). MEDICAL EVENT REPORTING SPECIFIED BY REF F SHOULD BE ACCOMPLISHED AND DISCUSSED WITH THE FORCE MEDICAL OFFICER. 5. POST DEPLOYMENT CONTINUES TO REQUIRE SURVEILLANCE AND PROTECTION. A. IF REQUIRED, PERSONNEL MUST COMPLETE THE POST DEPLOYMENT ASSESSMENT DD FORM 2796, APR 2003, AVAILABLE AT HTTP://WWW-NEHC.MED.NAVY.MIL/POSTDEP/DODFORMS.HTM THIS PROCESS INCLUDES REVIEW BY APPROPRIATE MEDICAL DEPARTMENT PAGE 06 RUCOHAG0265 UNCLAS PERSONNEL AND REFERRAL AS INDICATED. B. DISEASES SUCH AS MALARIA OR LEISHMANIASIS MAY PRESENT IN PERSONNEL MONTHS AFTER RETURN FROM DEPLOYMENT, EVEN WITH APPROPRIATE TERMINAL PROPHYLAXIS. CAREFUL MEDICAL MONITORING AND A HIGH INDEX OF SUSPICION IS WARRANTED FOR THOSE PERSONNEL. HANDLING OF PRESUMED CASES SHOULD INCLUDE REPORTING REQUIREMENTS IN REF F AS WELL AS DIRECT NOTIFICATION OF FORCE MEDICAL. 6. FINALLY, JUST AS ANTI-TERROR FORCE PROTECTION RELIES UPON CONSTANT VIGILANCE, SO TOO MUST FORCE HEALTH PROTECTION BE A CONTINUAL EFFORT. CONSIDERING THAT SEVERE ACUTE RESPIRATORY DISTRESS (SARS) IS A COMMUNICABLE DISEASE THAT PRESENTS MUCH LIKE COMMON INFLUENZA (AND WHICH MAY RE-EMERGE THIS WINTER), CASE FINDING, ACCURATE DIAGNOSIS, APPROPRIATE ISOLATION AND QUARANTINE, ALONG WITH RAPID OUTBREAK INVESTIGATION REMAIN AT THE FOREFRONT OF CONTROL EFFORTS. ILLUSTRATED BY THESE CASES OF MALARIA, LEISHMANIASIS, AND THE SPECTER OF SARS, ALL MEDICAL PERSONNEL MUST REMAIN VIGILANT, KEEPING A HIGH INDEX OF SUSPICION, AND MUST BE AWARE OF PLANNING, DEPLOYING, AND REPORTING REQUIREMENTS. 7. ADDITIONAL INFORMATION: A. NAVY ENVIRONMENTAL HEALTH CENTER (WWW-NEHC.MED.NAVY.MIL) PAGE 07 RUCOHAG0265 UNCLAS (757)953-0700, DSN 377-0700, AFTER HOURS (757)621-1967, EPI@NEHC.MAR.MED.NAVY.MIL B. NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT TWO (757)444-7671, DSN 564-7671, EPI-NEPMU2-NOR@MAR.MED.NAVY.MIL C. NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT FIVE (619)556-7070, DSN 526-7070, NEPMU5@NEPMU5.MED.NAVY.MIL D. NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT SIX (808)473-0555, DSN 473-0555, EPI@NEPMU6.MED.NAVY.MIL E. NAVY ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT SEVEN 39-095-86-9251, DSN 624-9251, NEPMU7@NEPMU7.SICILY.NAVY.MIL// BT #0265