A lack of prevention can leave an unsuspecting person with hundreds of bites and days of itching, not to mention the chance of catching sand fly fever and, up to a year later, leishmaniasis. Hawijah is considered ground-zero for sand fly fever. (Kevin Dougherty / Stars and Stripes)
HAWIJAH, Iraq — Last year, two out of three soldiers sent to Hawijah in north-central Iraq caught a pesky little bug called sand fly fever.
“We’re kind of holding our breath,” said Army Maj. John Dubose, the battalion field surgeon for Tasks Force Grizzly, the unit now assigned to the area. “We’ve had a mild summer so far.”
Technically, summer hasn’t started yet. But as U.S. troops who have deployed to Iraq know, the seasons down in this part of the world are somewhat of a mirage. Basically, it’s divided between cool and varying degrees of hot, from Arizona dry to oven bake.
The phlebotomus papatasi, the entomological term for sand fly, thrives in the heat. Sand flies like standing water, but they don’t need it to live and reproduce. Brush and even trash bins will do, according to Dubose, an internist and pediatrician who serves in the South Carolina National Guard.
To hear Dubose talk, Hawijah must seem like heaven to a sand fly. No other locale in Iraq reportedly has as high of an incident rate of sand fly fever as the area around Hawijah.
“They’re all around,” said Staff Sgt. John Crawford, a team leader at the aid station on McHenry, the main forward operating base for 1st Battalion, 163rd Infantry Regiment.
Base officials have taken extraordinary steps to lower the incident rate of sand fly fever, which is currently at about 7 percent, according to Dubose. Nearby brush has been burned, standing water gets treated with a solution that’ll kill the pests and trash cans get emptied on a regular basis.
Soldiers also like to put their air conditioning units — if they’re lucky enough to have one of those small hardened shelters — on full blast.
Better to freeze than to face them flies, they figure.
In addition, health officials are strongly urging the more than 500 soldiers at the base to treat their uniforms and bed nets with permethrin, and to use repellent lotion on exposed skin. Those steps plus properly wearing their uniform to cover as much skin as possible can decrease bites by 95 percent.
“It’s all about establishing a perimeter zone around your own body to keep them away,” Dubose said.
The more a person gets bitten, the more susceptible they are to sand fly fever. Symptoms can include a 103-104 degree fever, headaches, chills, muscle aches, malaise and nausea. Fortunately, the fever is not contagious.
On average, sand fly fever can sideline a soldier from three to 14 days, Dubose said. So an outbreak in a war zone like Iraq isn’t mission friendly.
Last year’s outbreak “had a huge impact on operations,” 1st Lt. Eric Rosenbaum, a medical battalion leader, said, referring to the previous unit.
A bite from a sand fly can also lead to a potentially fatal disease known as leishmaniasis, which has an incubation period of up to one year. The skin version is nasty, but it won’t kill you; the other, which manifests internally, can prove fatal if not properly treated.
“This whole country wants to either sting you, bite you or kill you,” said Sgt. 1st Class Bill Unger.
A North Carolina National Guard unit based 80 miles southeast of Kirkuk had the misfortune of being in an area where sand flies carry the parasitic disease. Of the 180 soldiers at forward operating base Rough Rider, now closed, there were 15 documented cases of leishmaniasis, Dubose said.
“It created quite an uproar,” he noted.
And all the clamor was caused by a tiny brown female fly that is one-third the size of a mosquito, makes no noise and needs blood to fertilize her eggs.
There is hope on the horizon to minimize the destructive nature of this puny, perky pest.
The Israeli medical community is testing a topical cream to treat the cutaneous (skin) version of leishmaniasis, Dubose said. That’s significant because this type, while not fatal, can cause lasting sores that leave scars.
Dubose figures the Israelis will probably put the cream on the market in a year or two. If it’s only a year, and the U.S. Food and Drug Administration accelerates the review process, it could, if approved, be available to U.S. forces by 2007-08.
While that might feel like a long way off for the scores of scratching soldiers hoofing it around McHenry, Dubose offered a sobering dose of reality.
“I got a feeling,” he said, “we’ll be here [in Iraq] for a long time.”
