Medical Threats in the Korean Peninsula :1 Medical Threats in the Korean Peninsula


Agenda :2 Agenda Where Climate Public Health States of: South Korea North Korea Endemic Diseases Militarily Important Diseases and Prevention Pest and Animal Threat


Where in the World is Korea? :3 Where in the World is Korea? 43 O N 33 O N 124 O E 132 O E


Korea is :4 Korea is 525 miles 100 ~ 130 miles Rugged and mountainous (70% of land mass), mostly along the east coast and the north central interior 20% suitable for agriculture Total Area : 220.847 Km2(Same as Minnesota) North Korea same as Louisiana South Korea same as Virginia


Climate :5 Climate Continental Climate Very large temperature differences between seasons Heavy monsoon rains and typhoons June through September 4 distinct seasons Winter : cold, dry, windy Spring : warm Summer : hot, humid, rainy Autumn : mild


ClimateTemperature :6 ClimateTemperature click August Hottest High humidity Avg : 73 ~ 81 oF January Coldest Siberian air Avg : 21 ~ 45 oF Pic : oC


ClimateExtreme temperatures :7 ClimateExtreme temperatures Coldest spot (winter) Whole peninsula Sam-ji-yon Chung-gang-jin (yr : 73~94) Average : 3 oF on Jan S. Korea Chor’won Extreme : -21 oF Dae-kwon-ryong (yr : 2001) Average : -2 oF Extreme : -14 oF


ClimateExtreme temperatures (con’t) :8 ClimateExtreme temperatures (con’t) Hottest Spot (summer) Yongchon Daegu (yr : 2001) Average : 68 oF Extreme : 96 oF


ClimatePrecipitation :9 ClimatePrecipitation Winter Snowfall Icy conditions Drought Dry air  Average (mm) in Jan


ClimatePrecipitation (con’t) :10 ClimatePrecipitation (con’t) Summer 50 ~ 60 % of annual precipitation 80% humidity Flooding common due to heavy rains from June to August  Average (mm) in Jul 310 340 283 310


Climate Wind Directions :11 Climate Wind Directions Siberian air Winter Summer


Climatic Threats :12 Climatic Threats Cold Heat Humidity Yellow dust Flood Typhoon


Climatic Threats Cold Injuries :13 Climatic Threats Cold Injuries Snow Blindness Frostbite Chilblains Immersion foot (Trench foot) Hypothermia


Climatic Threats Heat Injuries :14 Climatic Threats Heat Injuries Sunburn Heat Cramps Heat Exhaustion Heat Stroke


Climatic Threats Humidity :15 Climatic Threats Humidity Winter dry air – Upper Respiratory Infections Summer humid air Molds and fungi Increasing Irritability Index


Climatic Threat Humidity (con’t) :16 Climatic Threat Humidity (con’t) Preventive Measures Low Drink plenty of water Humidify living space High Air conditioning Air exchange


Climatic Threats Yellow Dust :17 Climatic Threats Yellow Dust 21 MAR 02, Seoul 23 MAR 02, Seoul Photo by Lee, Sung-sam, http://yellow.metri.re.kr/


Climatic Threats Yellow Dust (con’t) :18 Climatic Threats Yellow Dust (con’t) Origin Deserts of China, Mongolia and Manchuria(e.g., Gobi desert and Takla Makan desert) Components Dust (10㎛) ~ sand (1000㎛) Pollutants from industrialization of China Silicon, cadmium, arsenic, lead, copper, aluminum and other heavy metals


Climatic Threats Yellow Dust (con’t) :19 Climatic Threats Yellow Dust (con’t) Season March to May Extending year round Lasts average of 3 to 5 days, up to 27 days Conveyance Westerly jet stream Higher than 5 km (≒16500 ft) above sea level in northern hemisphere May extend to Hawaii, west coast, and central U.S.


Climatic Threats Yellow Dust (con’t) :20 Climatic Threats Yellow Dust (con’t) Health effects Respiratory problems Allergic rhinitis Asthma Upper Respiratory Infections Eye problems Allergic conjunctivitis Other problems on mucous membranes and skin Virus, Bacteria and Fungi infections Foot and mouth disease


Climatic Threats Yellow Dust (con’t) :21 Climatic Threats Yellow Dust (con’t) Limit outdoor activities Close windows Wear long sleeves Cover mouth and nose Do not drink or eat food outside Wear glasses instead of contact lens Wash eyes, mouth and exposed skin after coming in from the outside Drink water frequently Preventive Measures


Climatic Threats Yellow Dust (con’t) :22  Direction Korea Climatic Threats Yellow Dust (con’t)


Climatic Threats Typhoon :23 Climatic Threats Typhoon 91% from JUL to SEP Tropical cyclone Tropical atmospheric depression Minimum central wind velocity = 17 m/sec Torrential rain Strong winds


Climatic Threat Typhoon (con’t) :24 Climatic Threat Typhoon (con’t) Typhoon research center (http://www.typhoon.or.kr/)


Public Health States of :25 Public Health States of South Korea & North Korea Population Water Pollutions Endemic Diseases


Public Health State South Korea :26 Public Health State South Korea Population 48.324 million (July 2002 est.) Water Treated water supply : 87.1% (2000) 100% at Seoul and Cheju Island Over 95% at major cities Daily water supply per person : 380 L (2000)


Public Health State South Korea (cont’d) :27 Public Health State South Korea (cont’d) Pollutions Air pollution in large cities and acid rain Water pollution Sewage, industrial effluents Ground water contamination Radiological isotopes Other chemicals


Public Health State South Korea (cont’d) :28 Public Health State South Korea (cont’d) Endemic Diseases Notifiable diseases established by Korean National Institute of Health (KNIH) Category I Category II Category III Category IV Designated diseases


Public Health StateSouth Korea – Endemic Diseases (cont’d) :29 Public Health StateSouth Korea – Endemic Diseases (cont’d) Category I Diseases Infectious diseases that require urgent investigation, control of contacts, and/or identified sources of infection Immediate notification of public health centers Immediate reporting to next superior jurisdiction


Public Health StateSouth Korea – Endemic Diseases (cont’d) :30 6 diseases Cholera * Typhoid fever * Paratyphoid fever ** Shigellosis * Enterohemorrhagic E. coli ** Plague Public Health StateSouth Korea – Endemic Diseases (cont’d) * Indicates occurrence within last 10 years ** Indicates fatal occurrence within last 10 years


Public Health StateSouth Korea – Endemic Diseases (cont’d) :31 Public Health StateSouth Korea – Endemic Diseases (cont’d) Shigellosis Typhoid Fever


Endemic Diseases in S. Korea (Con’t) :32 Endemic Diseases in S. Korea (Con’t) Cholera Paratyphoid Fever


Endemic Diseases in S. KoreaNotifiable Diseases Category II :33 Endemic Diseases in S. KoreaNotifiable Diseases Category II Infectious diseases that can be prevented by vaccination Immediate notification of public health centers Weekly reporting to next superior jurisdiction (if outbreak is suspected, report immediately)


Endemic Diseases in S. Korea (Con’t)Notifiable Diseases Category II :34 9 diseases Diphtheria - Rubella * Pertussis * - Poliomyelitis Tetanus ** - Viral hepatitis B * Measles ** - Mumps * Japanese encephalitis (JE) ** Endemic Diseases in S. Korea (Con’t)Notifiable Diseases Category II * Indicates occurrence within last 10 years ** Indicates fatal occurrence within last 10 years


Endemic Diseases in S. Korea (Con’t) :35 Endemic Diseases in S. Korea (Con’t) Measles Mumps


Endemic Diseases in S. Korea (Con’t) :36 Endemic Diseases in S. Korea (Con’t) Rubella Pertussis


Endemic Diseases in S. Korea (Con’t) :37 Endemic Diseases in S. Korea (Con’t) JE


Endemic Diseases in S. KoreaNotifiable Diseases Category III :38 Endemic Diseases in S. KoreaNotifiable Diseases Category III Infectious diseases that need to be monitored consistently Weekly notification of public health centers Weekly reporting to next superior jurisdiction


Endemic Diseases in S. Korea (Con’t)Notifiable Diseases Category III :39 Endemic Diseases in S. Korea (Con’t)Notifiable Diseases Category III 18 diseases Malaria ** - Murine typhus * Tuberculosis * * - Scrub typhus ** Epidemic typhus - Leptospirosis ** STDs * - Brucellosis Scarlet fever * - Anthrax Meningococcal meningitis ** - Rabies ** Legionellosis * - Influenza * Vibrio vulnificus sepsis ** - AIDS ** Hansen's disease(Leprosy) ** Hemorrhagic fever with renal syndrome (HFRS) ** * Indicates occurrence within last 10 years ** Indicates fatal occurrence within last 10 years


Endemic Diseases in S. Korea (Con’t) :40 Endemic Diseases in S. Korea (Con’t) Tuberculosis


Endemic Diseases in S. Korea (Con’t) :41 Endemic Diseases in S. Korea (Con’t) Malaria Scrub typhus


Endemic Diseases in S. Korea (Con’t) :42 Endemic Diseases in S. Korea (Con’t) HFRS Scarlet Fever Leptospirosis


Endemic Diseases in S. Korea (Con’t) :43 Endemic Diseases in S. Korea (Con’t) Murine typhus Meningitis Vibrio


Endemic Diseases in S. Korea (Con’t) :44 Endemic Diseases in S. Korea (Con’t) Rabies Legionellosis


Endemic Diseases in S. KoreaNotifiable Diseases Category IV :45 Endemic Diseases in S. KoreaNotifiable Diseases Category IV Emerging and imported infectious diseases Immediate notification of public health centers Immediate reporting to next superior jurisdiction


Endemic Diseases in S. Korea (Con’t)Notifiable Diseases Category IV :46 Endemic Diseases in S. Korea (Con’t)Notifiable Diseases Category IV 15 diseases Yellow fever - African Trypanosomiasis Dengue fever *** - Cryptosporidiosis Marburg fever - Schistosomiasis Ebola fever - Yaws Lassa Fever - Pinta Leishmaniasis - Smallpox Babesiosis - Botulism Newly Emerging infectious disease *** All imported cases


Endemic Diseases in S. Korea Designated diseases :47 Endemic Diseases in S. Korea Designated diseases Designated diseases requiring monitoring of occurrence and outbreak Weekly notification to public health centers Weekly reporting to next superior jurisdiction


Endemic Diseases in S. Korea (Con’t) Designated diseases :48 Endemic Diseases in S. Korea (Con’t) Designated diseases 9 Diseases Viral hepatitis A * - Gnathostomiasis Viral hepatitis C * - Filariasis Chagas disease - Hydatidosis Angiostrongyliasis Creutzfeldt-Jakob Disease (CJD) VRSA infection (Vancomycin-Resistant Staphylococus Aureus) * * Indicates occurrence within last 10 years


Endemic Diseases in S. KoreaRanked by Patient Numbers* :49 Endemic Diseases in S. KoreaRanked by Patient Numbers* 1. TB (27,458) 11. Hansen's disease (94) 2. Measles (7,978) 12. Leptospirosis (61) 3. Malaria (2,058) 13. Vibrio vulnificus sepsis (31) 4. Mumps (1,813) 14. Cholera (30) 5. Scrub Typhus (991) 15. Murine typhus (19) 6. Shigellosis (794) 16. Paratyphoid fever (15) 7. Typhoid fever (340) 17. Pertussis (14) 8. HFRS (173) 18. Enterohemorrhagic E. coli (6) 9. Rubella (118) 19. Meningococcal meningitis (5) 10. Scarlet fever (110) 20. Tetanus (4) * Average annual number of patients in S. Korea (1994~2001) Category IV and designated diseases not included due to lack of data


Endemic Diseases in S. KoreaRanked by Number of Deaths* :50 Endemic Diseases in S. KoreaRanked by Number of Deaths* 1. Hansen's disease (540.5) 2. Tuberculosis (396.8) 3. Vibrio vulnificus sepsis (3.8) 4. HFRS (2.4) 5. Scrub typhus (1.0) 6. Meningococcal meningitis(0.5) 7. Measles (0.9) 8. Leptospirosis (0.6) 9. Rabies (0.3) 9. Typhoid fever (0.3) 11. Japanese Encephalitis (0.1) 11. Enterohemorrhagic E. coli (0.1) 11. Tetanus (0.1) 11. Malaria (0.1) * Average annual fatalities in S. Korea (1994~2001) Category IV and designated diseases not included due to lack of data


Endemic Diseases in S. Korea Mortality Rates* :51 Endemic Diseases in S. Korea Mortality Rates* 1. Rabies (100.00%) 2. Vibrio vulnificus sepsis (48.39%) 3. Japanese Encephalitis (12.50%) 4. Meningococcal meningitis (8.89%) 5. Enterohemorrhagic E. coli (8.33%) 6. Tetanus (3.13%) 7. Tuberculosis (1.44%) 8. HFRS (1.38%) 9. Leptospirosis (1.02%) 10. Murine Typhus (0.1%) 11. Typhoid fever (0.07%) 12. Measles (0.01%) 12. Malaria (0.01%) *Average annual mortality rates in S. Korea (1994~2001) Category IV and designated diseases not included due to insufficient data


Public Health State North Korea :52 Public Health State North Korea Population 22,224,195 (July 2002 est.) Water Treated water supply : 75 % (1993) Daily water supply per person : 150 L Inadequate supplies of potable water Prevalence of Water-borne disease


Public Health State North Korea :53 Public Health State North Korea Pollution Air pollution Burning of poor quality coal Moderated by lack of combustion engine vehicles Water pollution (insufficient sewage system) Untreated industrial discharge Soil erosion and degradation Abandoned mines Massive deforestation of land for fuel


Public Health State North Korea :54 Public Health State North Korea Endemic Diseases Malnutrition Tuberculosis (TB) Acute respiratory infection Malaria and other vector-borne diseases Water-borne diseases Parasites


Endemic Diseases in N. Korea TB :55 Endemic Diseases in N. Korea TB Prevalence rate 5%, 1,150,000 people (est.) - a major health problem Upward trend during recent years Causes of high prevalence Severe shortage of supplies Anti-TB medicines, diagnostic equipment Untreated or partially treated patients Malnutrition - increased susceptibility to TB


Endemic Diseases in N. Korea (Con’t) TB :56 Endemic Diseases in N. Korea (Con’t) TB Number of new cases (WHO report) 150~200 per 100,000 population per year (2000)(38 per100,000, in early 1990s) About 70% of cases affect the most productive segment of the population (15~54 years)


Endemic Diseases in N. Korea Malaria :57 Endemic Diseases in N. Korea Malaria Re-emergence First reported in 1998 in North Korea (1993 in S. Korea) (probably occurred earlier) Plasmodium vivax Incidence 2,000 cases were reported in 1998 95,000 cases in 1999 The number of cases have increased annually


Militarily Important Diseases :58 Militarily Important Diseases Vector-borne diseases Highest potential for infection is while training outdoors Outbreak history within last 10 years Malaria Korean Hemorrhagic Fever (HFRS) Japanese Encephalitis Diarrheal diseases Scrub typhus, Murine typhus Leptospirosis


Militarily Important Diseases Malaria :59 Militarily Important Diseases Malaria Etiologic agent Plasmodium vivax Transmission Nocturnal Mosquito(Anopheles sinensis) Symptom Flu-like symptoms Periodic fever, chill, sweating (48-hour interval) Incubation period 12~20 days or 9~33 months (latent form)


Militarily Important Diseases Malaria (con’t) :60 Militarily Important Diseases Malaria (con’t) High risk area Along the western edge of the Demilitarized Zone (DMZ) Especially within 10km of the DMZ Cases reported throughout the ROK – Usually exported from the high risk area


Militarily Important Diseases Malaria (con’t) :61 Militarily Important Diseases Malaria (con’t) Geographical distribution


Military Important Diseases Malaria (con’t) :62 Military Important Diseases Malaria (con’t) Seasonal distribution


Military Important Diseases Malaria (con’t) :63 Military Important Diseases Malaria (con’t) Prevention Personal protective measures Insect repellent (DEET) Permethrin treated uniform Wear long pants and long-sleeved shirts rolled down with pant legs tucked inside boots Permethrin treated bed-net Mosquito control Pesticide spray from dusk to dawn Reduce standing water around bivouac site Chemoprophylaxis (anti-malarial drug)


Militarily Important Diseases HFRS :64 Militarily Important Diseases HFRS Hemorrhagic Fever with Renal Syndrome Etiologic agents Hantaan virus (Korean Hemorrhagic Fever) Seoul virus Transmission Aerosolization ofRodent excreta Striped field mouse – Hantaan virus Norwegian rat/house rat – Seoul virus


Military Important Diseases HFRS (con’t) :65 Military Important Diseases HFRS (con’t)


Militarily Important Diseases HFRS (con’t) :66 Militarily Important Diseases HFRS (con’t) Seasonal distribution Two Peaks


Militarily Important Diseases HFRS (con’t) :67 Militarily Important Diseases HFRS (con’t) Incubation period Usually 2~4 weeks, but may be a few days to as long as 2 months Clinical Signs and symptoms Fever and chills, headache, muscle ache, hemorrhage, nephropathy Specific clinical features Flushing of face, neck and chest Blood shot eyes, mouth and throat Tiny rash in soft palate and armpits Triad of severe pain: behind eyes, abdomen, & flank


Militarily Important Diseases HFRS (con’t) :68 Militarily Important Diseases HFRS (con’t) Prevention Vaccine : Hantavax®(Not approved for US personnel) Good field hygiene and sanitation Washing hands Cover trash Properly dispose of trash and food Don’t use vegetation for camouflage Avoid rodent infested areas


Militarily Important Diseases HFRS (con’t) :69 Militarily Important Diseases HFRS (con’t) Prevention - Rodents control Keep bivouac site clean and cut bushes down If possible, set 20m buffer zone from tent to vegetation Set rat poison and traps Clean traps after each use using disinfectant Do not handle rodents and their excreta with bare hands Never brush off or vacuum up rodent’s dropping, urine and nest (creates aerosolized virus particles) Wet down infested areas with bleach/disinfectant to kill the virus and put contaminated material in a hermetically tight container


Militarily Important Diseases Japanese Encephalitis :70 Militarily Important Diseases Japanese Encephalitis Etiologic agent A member of flavivirus group Transmission Nocturnal mosquito, Culex tritaeniorhynchus Prevailing season Summer(JUL ~ OCT)(peaks in AUG)


Militarily Important Diseases Japanese Encephalitis (con’t) :71 Militarily Important Diseases Japanese Encephalitis (con’t) Highest endemic area Southern provinces, bordering the coast Prevention Personal protective measures Permethrin treated uniform, bed-net Long pants and long-sleeved shirts DEET insect repellent Mosquito control JE vaccine


Militarily Important Diseases Diarrheal Diseases :72 Militarily Important Diseases Diarrheal Diseases Low endemic levels Transmission Fecal  oral Filth fly (mechanical vector) Improper food handling and hand washing Ingestion of contaminated water/food Inadequate water purification


Militarily Important Diseases Diarrheal Diseases (con’t) :73 Militarily Important Diseases Diarrheal Diseases (con’t) Bacteria Aeromonas spp. Campylobacter spp. Escherichia coli Salmonella spp. Shigella spp. Vibrio parahemolyticus Vibrio Cholerae Protozoa Cryptosporidium spp. Entamoeba histolytica Giardia lamblia Viruses Rotavirus Enteric adenovirus Astrovirus Small round structured virus


Militarily Important Diseases Diarrheal Diseases (con’t) :74 Militarily Important Diseases Diarrheal Diseases (con’t) Prevention Good sanitation and hygiene Proper hand washing Fly control, exclusion and source reduction Eliminate and cover garbage and toilet Insecticide spray Adequate water purification and storage Cook and store food at proper temperature Dangerous temperature zone : 40 OF ~ 140 OF


Militarily Important Diseases Scrub Typhus :75 Militarily Important Diseases Scrub Typhus Tsutsugamushi disease Etiologic agent (Rickettisia bacteria) Orientia tsutsugamushi Transmission Bite of larval chigger mites (Leptotrombidium) Parasite hosts : Rodents, but will also bite man Prevailing season Peak in autumn(40% of febrile patients in Korean community)


Militarily Important Diseases Scrub Typhus (con’t) :76 Incubation period 10 ~ 12 days Signs and symptoms Eschar (bite site) Headache, fever, chill Dull red maculopapular eruption, cough Prevention Conduct good personal hygiene and sanitation Vector-reduction (insecticide), Rodent-control Limit exposed skin (pant legs tucked inside boots and sleeves rolled down) Militarily Important Diseases Scrub Typhus (con’t)


Militarily Important Diseases Murine Typhus :77 Etiologic agent (Rickettisia bacteria) Rickettsia typhi (R. mooseri) Transmission Oriental rat flea (Xenopsylla cheopis)+ Parasites host : Rodents (normal), cats and dogs Infected flea fecal material rubbed into the skin Transmitted year round – Important to do flea control before rodent control to eliminate flea population Incubation period 7 ~ 10 days Militarily Important Diseases Murine Typhus


Militarily Important Diseases Murine Typhus (Cont’) :78 Militarily Important Diseases Murine Typhus (Cont’) Signs and symptoms Headache, backache, arthralgia, abdominal pain Fever (105~106 oF) Rash (the trunk  peripherally) Nausea and vomiting in most patients Hacking, dry cough Prevention Conduct good personal hygiene and sanitation Vector-reduction (insecticide), Rodent-control Limit exposed skin (pant legs tucked inside boots and long sleeves)


Militarily Important Diseases Leptospirosis :79 Militarily Important Diseases Leptospirosis Pathogen Bacteria, Leptospira spp. Transmission Urine of cattle, dogs, rodents and other wild animals Invades the eye, nose and skin abrasions/wounds Prevailing season SEP ~ OCT Geological distribution Central and western area of the Korean peninsula (Gyeong-gi, Chung-buk, Chon-nam Provinces)


Military Important Diseases Leptospirosis (con’t) :80 Military Important Diseases Leptospirosis (con’t) Incubation periods 7 ~ 10 days Signs and symptoms Fever, rigors, myalgias, headache (75 ~ 100%) Dry cough (25 ~ 35 % of cases ) Nausea, vomiting, and diarrhea (50% of cases) Prevention Avoid contact with animal urine and standing water Wear protective clothing or footwear Doxycycline chemoprophylaxis available


Other Endemic Diseases :81 Other Endemic Diseases TB STDs Other Viral Diseases Measles Mumps Rubella


Other Endemic Diseases Tuberculosis (TB) :82 Other Endemic Diseases Tuberculosis (TB) Pathogen Bacteria, Mycobacterium tuberculosis Attack the lungs and other parts of the body Is able to remain in an ‘inactive’ state in the lungs May be resistant to multiple anti-tuberculosis drugs Inactive Active


Other Endemic Diseases Tuberculosis (TB) (con’t) :83 Transmission Close contact with people with active TB Bacteria aerosolized during coughing, sneezing or talking Other Endemic Diseases Tuberculosis (TB) (con’t)


Other Endemic Diseases Tuberculosis (TB) (con’t) :84 Other Endemic Diseases Tuberculosis (TB) (con’t) Clinical Signs and Symptoms Continuous cough - Fevers Weight loss - Night sweats Constant tiredness - Loss of appetite Bloody sputum when coughing Diagnosis PPD skin test and x-ray examination Prevention Annual PPD skin tests Follow-up of close contacts of active TB patients


Other Endemic Diseases Tuberculosis (TB) (con’t) :85 Other Endemic Diseases Tuberculosis (TB) (con’t)


Other Endemic Diseases STD :86 Other Endemic Diseases STD Sexually Transmitted Diseases Chlamydia (Chlamydia trachomatis) Gonorrhea (Neisseria gonorrhoeae) 16 % Penicillin resistance (1996) Herpes Type II (Genital) HIV / AIDS Trichomonas (Trichomonas vaginalis) Syphilis


Other Endemic Diseases STD (con’t) :87 Other Endemic Diseases STD (con’t) Prevention Abstinence Mutually monogamous sexual relationship Correct use of condoms Early identification, reporting, and contact tracing


Other Endemic Diseases Other Viral Diseases :88 Other Endemic Diseases Other Viral Diseases Measles Mumps Rubella


Other Endemic Diseases Other Viral Diseases Measles :89 Other Endemic Diseases Other Viral Diseases Measles Pathogen Measles virus Transmission Aerosolized droplets Clinical signs and symptoms Spreading rash Sore throat, runny nose, cough, muscle pain, fever, bloodshot eyes, white spots on palate, photophobia Prevention Immunization to include boosters at 4~6 or 11~12 years


Other Endemic Diseases Other Viral Diseases Mumps :90 Other Endemic Diseases Other Viral Diseases Mumps Pathogen Mumps virus (RNA virus) Transmission Saliva and respiratory droplets from patients Prevailing season : Spring Incubation periods : 14~ 24 days


Other Endemic Diseases Other Viral Diseases Mumps (con’t) :91 Other Endemic Diseases Other Viral Diseases Mumps (con’t) Clinical signs and symptoms Face pain, Headache, Sore throat ,Fever Swelling of the parotid or salivary glands Swelling of the temples or jaw Treatment Symptomatic relief (ice, Tylenol) Prevention Immunization Do not share eating utensils


Other Endemic Diseases Other Viral Diseases Rubella :92 Other Endemic Diseases Other Viral Diseases Rubella Pathogen Rubella virus Transmission Respiratory droplet, direct contact, vertical infection Clinical signs and symptoms Low-grade fever (102oF or lower), rash, bloodshot eyes Headache, runny nose, muscle or joint pain, malaise Prevention Immunization


Pests and Vectors :93 Pests and Vectors Biting flies Mosquitoes, black files, horse files, biting midges House files and other filth flies Cockroaches Body, head and pubic lice Fleas, mites (Leptotrombidium spp.) Venomous arthropods bees, hornets, wasps, urticating caterpillars and spiders Ticks


Pests and Vectors (con’t) :94 Pests and Vectors (con’t) Biting flies Mosquitoes Over 60 species in Korea Malaria, Japanese encephalitis Mosquito control, Personal protective measures Bees, hornets and wasps 19 species in Korea Abundant during the summer months Similar to species found in the U.S. Use of repellents or site relocation


Pests and Vectors (con’t) :95 Pests and Vectors (con’t) House files and other filth flies Mechanical vector of diarrheal diseases Area sanitation Indoor sprays / light traps, outdoor flytraps Screens and air curtains, etc.


Pests and Vectors (con’t) :96 Pests and Vectors (con’t) Cockroaches Mechanical vector of food-borne diseases Good sanitation practice and pest control Body, head and pubic lice Epidemic typhus (body lice) Insecticide shampoos, boiling clothes, treatment of clothes with permethrin Fleas Skin irritation and murine typhus Rodent host infects fleas that feed on alternate human hosts and transmit pathogens in their feces


Pests and Vectors (con’t) :97 Pests and Vectors (con’t) Mites (Leptotrombidium spp.) Scrub typhus Grassy areas and areas of secondary growth where vegetation has been disturbed Proper wear of uniforms and use of repellents and permethrin treated uniforms Avoidance of grassy habitats and sleeping and resting directly on the ground


Pests and Vectors (con’t) :98 Pests and Vectors (con’t) Ticks Vector of numerous diseases, i.e., ehrlichiosis, Lyme disease, and tick-borne encephalitis Remove carefully with a fine forceps, being careful to not break mouthparts off from the tick – may result in a secondary infection Put removed live ticks in airtight container and ship to the Preventive Services Directorate, 18th MEDCOM, for analysis


Pests and Vectors (con’t) :99 Pests and Vectors (con’t) Moths Caterpillars of several species have sharp urticating hairs and spines that contain venom Avoid caterpillars with long hairs or spines


Pests and Vectors(con’t) :100 Centipedes Toxic and painful bites Spiders 3 species can cause painful bites All spiders entering houses seek refuge, often among boxes or clothes laying on the floor Cleanliness is on method of reducing household spider populations Pests and Vectors(con’t)


Prevention Against Insects :101 Prevention Against Insects Use repellent Use permethrin treated uniform Proper wear of the uniform Long sleeve shirts and pants Pant legs tucked into boots Use permethrin treated bed net Sleep elevated off the floor Check clothing and boots before dressing Shake bedding before entering Use “buddy inspection” for ticks


Hazardous Animals :102 Hazardous Animals Snakes Only 3 species are venomous Same precaution to avoid snakebites taken in the U.S. should be taken in Korea Rodents Major rodents in the field Norway rat, Roof rat, House mouse,Striped field mouse


Hazardous Animals Venomous Snakes :103 Hazardous Animals Venomous Snakes


Hazardous AnimalsVenomous Bites Prevention :104 Hazardous AnimalsVenomous Bites Prevention Avoid contact with snakes(inoffensive in most case) Shake boots and clothes before dressing Do not allow troops to walk barefoot, sleep on the ground or put hands into holes Prohibit keeping snakes, spiders or other native animals as pets Use caution when picking up items lying in grass or other vegetation Handle dead snakes with great caution, they are not always dead and a scratch with the fangs can inject venom


Hazardous Animals Rodents :105 Hazardous Animals Rodents Reservoirs of several diseases Korean Hemorrhagic Fever Leptospirosis Murine typhus Rickettsial pox


Hazardous Animals Rodents (con’t) :106 Hazardous Animals Rodents (con’t) Rodent detection Droppings, Burrows, Odor, Runways Rub marks Oil from their fur that accumulates on surfaces along primary paths Gnawing (teeth marks) Tracks (often seen in powders, ie. flour) Presence of dead rodents


Hazardous Animals Rodents (con’t) :107 Hazardous Animals Rodents (con’t) Rodent control Keep bivouac site clean and cut bush If possible, set 20m buffer zone from tent to vegetation Set rat poison and traps Clean traps after each use using disinfectant Do not handle rodents and its excreta with bare hands Never brush off or vacuum up rodent’s dropping, urine and nest and put it in hermetically tight container Wet down infested areas with bleach/disinfectant to kill the virus to prevent the virus from aerosolizing


Other Animal Associated Diseases Rabies :108 Other Animal Associated Diseases Rabies Fatal acute viral infection Incubation period 10 days ~ 7 yrs average 3 ~ 7 wks Specific signs Hyperesthesia Hydrophobia Photophobia


Other Animal Associated Diseases Rabies (con’t) :109 Other Animal Associated Diseases Rabies (con’t) Signs and symptoms low-grade fever (102 oF or lower) exaggerated sensation at the bite site loss of feeling in an area of the body anxiety, stress, and tension - muscle spasms positive Babinski's reflex - swallowing difficulty pain at the site of the bite - restlessness numbness and tingling - convulsions loss of muscle function - excitability drooling


Other Animal Associated Diseases Rabies (con’t) :110 Other Animal Associated Diseases Rabies (con’t) Prophylactic treatment Clean the wound well with soap and water and seek medical care Try to gather as much information about the animal as possible Immunization with rabies vaccine Prevention Vaccination of dogs and cats every 2 years Avoid contact with stray domestic animals and feral animals Consider all cats in Korea to be feral


Reference Websites :111 Reference Websites Korean National Institute of Health (ROK) (http://www.nih.go.kr) Ministry of Health and Social Welfare (ROK) (http://www.mohw.go.kr) Korea Meteorological Administration (ROK) (http://www.kma.go.kr) CDC (http://www.cdc.gov) MEDLINE plus (http://www.nlm.nih.gov/medlineplus) World Health Organization (http://www.who.int)


Reference Booklet :112 Reference Booklet Infectious diseases and countermeasures of the open age between N. Korea and S. Korea, Jongkoo Lee, MD., chief of the quarantine office, Incheon International Airport, ROK Disease Vector Ecology Profile, The Koreas, Armed Forces Pest Management Board, April 1994 Public Health guide for soldiers in Korea, Preventive Medicine Directorate, 18th Medical Command, Mar 2000 FM 4-02.33. Control of Communicable Diseases Manual. 2000, 17th Edition, James Chin editor.