The MRSN algorithms and procedures are seen as a model for the entire nation, Lesho said. In the 2015 “National Action Plan for Combating Antibiotic-Resistant Bacteria,” advanced by the White House as a roadmap to meet these challenges, MRSN is specifically recognized as a reference laboratory network for reporting data and characterizing resistance patterns in military treatment facilities.
Pathogen surveillance, identification, and sharing of information by researchers at MRSN are all identified priorities to combat this problem.
Lesho summarized other considerations. “The proper use of antibiotics is critical. We have to be mindful that widespread indiscriminate use of antibiotics in humans, in agriculture, can worsen this problem,” he said. “It’s a global problem that’s easily spread, and the world’s populations are increasingly mobile and displaced, so the potential for moving these organisms around is even greater.”
Those demographic factors significantly affect another focus of WRAIR research – that of viral disease threats. According to Col. Paul B. Keiser, M.D., director of WRAIR’s Viral Diseases Branch, viral threats in the military are situation-dependent.
Increasingly problematic since 2005, chikungunya began to spread from east Africa and southeast Asia to India, and then a few years ago to the Caribbean, where there have been more than 1.5 million cases since 2013.
In basic training environments, for example, where new recruits come together from different geographic areas and are in close contact, respiratory infections like adenovirus pose the biggest problem. For deployed soldiers, “The threat depends on the geography, whether they’re in a tropical area versus a non-tropical area, and also how mature the environment is,” said Keiser. “Are we talking about Special Forces going to an area where there are no other U.S. forces? Or are we talking about an established forward operating base in a country where we’ve had a sustained presence for 10 years and we’ve already got chow halls run by contractors?”
A digitally colorized electron micrograph of chikungunya virus particles. In late 2013, chikungunya was found for the first time in the Americas, on an island in the Caribbean. Since then there have been more than 1.5 million cases reported in the region. CDC photo by Cynthia Goldsmith
Mission-threatening viruses are the primary concern, Keiser said. “In a forward combat environment, if you lose a bunch of people to an illness at the same time, then you have to cancel missions, you have to cancel convoys, you have to adjust your personnel.”
Current research focuses on vaccine development for two mission-threatening mosquito-borne infections – dengue and chikungunya. Both cause acute fever, rash, and severe muscle or joint pain.
Increasingly problematic since 2005, chikungunya began to spread from east Africa and southeast Asia to India, and then a few years ago to the Caribbean, where there have been more than 1.5 million cases since 2013.
Although an operational U.S. troop presence in the Caribbean is relatively low, Keiser said, given the scenario of a significant mission there, a humanitarian crisis in Haiti, for example, involving large numbers of troops, “there’s a good chance that a lot of them could acquire it and it could really compromise the mission.”
“We’re tracking that as a high priority right now,” continued Keiser. “In the past, chikungunya has tended to blow through an area, infect everybody, then everybody’s immune, and it goes away. Dengue fever virus, in contrast, is something that is always there, and there are multiple serotypes circulating. Dengue is the persistent threat, whereas chikungunya is a fire that flared up recently.”