DoD Labs on the Forefront of Fighting Infectious Diseases

May 11, 2004 -- WASHINGTON - SARS. Dengue fever. Malaria. Polio. Yellow Fever. West Nile Virus. What do these infectious disease have in common? They are either new or are re-emerging infections that are causing concern among world health organizations, including health agencies within the United States. An emerging infectious disease is either a completely and previous unknown new disease or an old disease that is occurring in a new geographical region or one that has become resistant to traditional medical treatments.

Most Americans used to believe that infectious diseases such as these only occurred in under developed countries, but today with more people traveling worldwide, all that has changed. An infected tourist or returning vacationer can potentially bring an exotic disease from a far corner of the world to the United States, where insects have the capabilities of spreading it further.

Another cause for concern about the emergence and re-emergence of infectious diseases is the role they play in the overall health and readiness of American troops serving overseas. For example, in 2003 some 80 Marines and Navy corpsmen from the Joint Task Force Liberia Quick Reaction Force contracted malaria. An investigation of this outbreak indicated that protective measures were not followed.

"To better protect the health of our troops serving overseas, we must be able to identify and understand the diseases that are endemic to that region as well what are the treatment of those diseases," said Dr. Michael E. Kilpatrick, deputy director of the deployment health support directorate in the office of the deputy assistant secretary of defense for force health protection.

One way the Defense Department is combating these new emerging or re-emerging infectious diseases is through a global network of laboratories and medical research facilities.

"These forward-based facilities are the first line of defense in gathering information on infectious diseases which allow us to better protect the health of our troops serving in remote regions of the world," continued Kilpatrick. "Additionally, the research facilities have local agreements which allow them to provide significant medical assistance to local populations.

Spanning four continents - Africa, Asia, North and South America - are three Navy and two Army medical research laboratories and a consortium of government agencies and facilities. Two other key components that are part of this network are the Walter Reed Army Institute of Research and the Naval Medical Research Center that are located in Forest Glen, Md. This global network is also the foundation for the Department of Defense's Global Emerging Infectious Surveillance and Response System, known as DoD-GEIS.

Researchers and scientists at the Walter Reed Army Institute of Research study a range of militarily relevant issues, including naturally occurring infectious diseases, combat casualty care, operational health hazards, and medical defense against biological and chemical weapons. The Walter Reed Army Institute of Research is DoD's lead agency for infectious disease research and a crucial source of research support for medical product development.

This network of research laboratories also works in tandem with the Armed Forces Institute of Pathology, the Uniformed Services University of the Health Sciences, U.S. Army Center for Health Promotion and Preventive Medicine at Aberdeen Proving Ground, Md., the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, Md., and the Naval Environmental Health Center in Norfolk, Va., and other defense department programs and systems. DoD-GEIS also has established strong working relationships with the Centers for Disease Control and Prevention and international health agencies such as the World Health Organization.

For the overseas research facilities, each has a specific medical surveillance mission in the region where they are located. In addition to monitoring the population health trends in the specific regions, the researchers also provide training to the local health agencies to help stem the outbreak of indigenous infectious diseases. Together, with medical personnel from the host nation, DoD researchers and scientists help prevent and stem a potential widespread outbreak of an infectious disease.

"It's a win-win situation for everyone involved. Our overseas research laboratories can assess health risks to U.S. personnel at the same time making significant contributions to the health of our host nations," said Kilpatrick.

The oldest of the five laboratories is the U.S. Naval Medical Research Unit Three, established in 1946 in Cairo, Egypt. While first charged with the mission of developing effective prevention measures against the spread of typhus, these researchers broadened their focus to include such diseases as cholera, smallpox and meningitis. Since the late 1960s and 1970s, the U.S. Naval Medical Research Unit No. 3 field laboratories have studied the diagnosis, treatment and prevention of leishmaniasis, malaria and other enteric diseases.

More recently in 2000, the U.S. Naval Medical Research Unit Three responded to a call for help from the World Health Organization to assist in the outbreak of Rift Valley Fever in Yemen. The U.S. team was able to confirm the cause of the outbreak and assisted Yemeni health officials conduct epidemiologic and serologic surveys to characterize the evolution and extent of the outbreaks and to help evaluate disease and vector control measures. Additionally, the team provided technical assistance to the Saudi Arabian Ministry of Health to evaluate their response to the epidemic.

"Because of the research that was done early on about diseases indigenous to the Middle East such as leishmaniasis and sandfly fever, we had better knowledge of what may affect the health of troops during the 1990-1991 Gulf War," said Kilpatrick, who spent two tours of his Navy career at Naval Medical Research Unit Three. "For instance, during the Gulf War we didn't expect to find a large number of cases of sandfly fever or leishmaniasis due to the weather at that time of year."

Other Navy laboratories include the U.S. Naval Medical ResearchUnit Two located in Jakata Pusat, Indonesia, and the U.S. Naval Medical Research Center in Lima, Peru, which just celebrated its 20th anniversary with the groundbreaking for a new research laboratory facility in Iquitos in December 2003.

One of the Army facilities is the U.S. Army Medical Research Unit in Kenya, part of the research arm of the Walter Reed Army Institute of Research in Washington, D.C. During its 23 years of existence, research has been conducted on such diseases as malaria, trypanosomiasis and leishmaniasis. Researchers at the Kenya facility have also produced large-scale epidemiological studies on malaria, leishmaniasis and HIV transmission throughout Kenya.

The other Army facility is the U.S. Army Medical Component of the Armed Forces Research Institute of Medical Sciences located in Bangkok, Thailand. Researchers there focus on research being conducted on tropical diseases endemic to Thailand and Southeast Asia. The facility emphasizes basic research on and field testing of new treatments for tropical diseases threats such as malaria, hepatitis, diarrhea, dengue fever and Japanese encephalitis. Medical researchers in Thailand have recently expanded the scope of their research to include HIV.

"The work that is being done in these places is really invaluable to protecting the health of our troops as they are deployed overseas," continued Kilpatrick. "Based on current knowledge of health trends and information provided by these medical research facilities, we can make better and informed decisions about what types of preventive measures are needed to protect our troops."

To learn more about DoD's Global Emerging Infectious Surveillance and Response System, visit its Web site at http://www.geis.ha.osd.mil/.