July – September 2007

Perspective 1

MG Russell J. Czerw

Healthy Animals, Healthy People: Inextricably Linked 4

BG Michael B. Cates

Emerging Roles of the US Army Veterinary Service 8

COL Gary Vroegindewey, VC, USA

Army Veterinary Food Analysis Laboratories: Past, Present, and Future 12

MAJ Scott Hanna, VC, USA; et al

The Impact of Leishmaniasis on Military Working Dogs with Mediterranean Basin Exposure 17

MAJ Jerrod W. Killian, VC, USA

The Hidden Work of a Laboratory Animal Veterinarian 26

MAJ Craig A. Koeller, VC, USA

Challenges in Biodefense Research and the Role of US Army Veterinary Pathologists 28

COL Keith E. Steele, VC, USA; MAJ Derron A. Alves, VC, USA; MAJ Jennifer L. Chapman, VC, USA

A Veterinary Comparative Medicine Officer’s Dream Assignment 38

MAJ Sam Yingst, VC, USA

Canine Hip Dysplasia: Surgical Treatment for the Military Working Dog 44

CPT Kent J. Vince, VC, USA

A Clinical Trial of Ivermectin Against Eyeworms in German Shepherd Military Working Dogs 51

COL Mack Fudge, VC, USA; LTC Sookwan Jeong, VC, ROKA; Pat McInturff, DVM, PhD

Using Predictive Microbiology to Evaluate Risk and Reduce Economic Losses 57

Associated with Raw Meats and Poultry Exposed to Temperature Abuse

CW3 Greg M. Burnham, VC, USA; et al

The US Army Veterinary Corps Reserve Component 66

CPT(P) Cristopher A. Young, VC, USA

Special Operations Forces Veterinary Personnel 69

COL Robert Vogelsang, VC, USA

Stabilization And Reconstruction Operations: The Role Of The US Army Veterinary Corps 71

LTC John C. Smith, VC, USA

UNITED STATES ARMY

VETERINARY CORPS
MG Gale S. Pollock

Acting The Surgeon General

Commander, US Army Medical Command

MG Russell J. Czerw

Commanding General

US Army Medical Department Center and School

July – September 2007 The Army Medical Department Center & School PB 8-07-7/8/9

0716302

GEORGE W. CASEY, JR

General, United States Army

Chief of Staff

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July – September 2007 1

The US Army Veterinary Corps is the centerpiece of

this month’s issue of the AMEDD Journal. Although

the majority of our Soldiers and Family members do

not often come into direct contact with Army

veterinary specialists, members of the veterinary

service are part and parcel of all of our daily lives.

Each day they can be found working in the field and

laboratories in food science and food defense,

performing research on communicable diseases and

biological weapons, or ensuring the health of the

military working dogs which have long been vital

contributors to front line combat operations. Many

readers will no doubt be surprised to learn of the

extensive variety of skills and responsibilities, and the

high levels of qualifications and education that are

typical among our veterinary professionals. This issue

of the AMEDD Journal provides a unique and long

overdue look into the achievements these professionals

have made over the years, and their continued

invaluable contributions to the health and well-being

of us all.

In this issue, the AMEDD Journal welcomes back BG

Michael Cates, this time from his perspective as Chief,

Army Veterinary Corps. BG Cates sets the stage for

this issue as he clearly and succinctly describes the

undeniable links between human health and the health

of the animals that surround us. Indeed, at no time in

history have the interrelationships of veterinary and

human medical sciences been so well understood, and

the extent of that knowledge is continually expanding.

The fact that the Army Veterinary Corps is an integral

component of the Army Medical Department, and has

been for 91 years, is a confirmation of this relationship

between the disciplines. BG Cates’ article is an

excellent overview of the roles Army veterinary

specialists play, not only in support of US military

missions, but on the larger stage of US foreign policy

efforts to stabilize our turbulent world.

Understandably, the military is an organization that is

in constant evolution as it adapts to changes dictated

by society and technology, while at the same time

contending with the dynamic nature of potential and

active threats to the United States. Not surprisingly,

the Army Veterinary Corps’ responsibilities are also

changing in concert with those demands. In his

concise, informative article, COL Gary Vroegindewey

provides a clear description of not only the emerging

roles, but also the expansion of current duties that

Army veterinary personnel are performing in support

of the Global War on Terror efforts of today.

The work of veterinary preventive medicine specialists

is featured in 2 articles. In their contribution, MAJ

Scott Hanna and his coauthors present an interesting

history of the Army’s food analysis laboratories and

their operations today. They describe how those

laboratories have changed from a Quartermaster Corps

function for contract compliance and quality control,

to their current position as keystones in the Veterinary

Corps’ force protection role of food safety and food

defense. The increasing sophistication and

formalization of testing practices and techniques, and

the quick incorporation of emerging technologies are

more examples of the Corps’ adaptations to the everchanging threats to our national security. Next, MAJ

Jerrod Killian describes a research project focused on a

serious, difficult-to-treat disease which is transmittable

to both humans and dogs. Leishmaniasis is endemic in

a large part of southern Europe and the middle east,

areas where the US military deploys large numbers of

military working dogs. MAJ Killian investigates the

potential for the disease to be translocated to other

Perspective

Major General Russell J. Czerw
2 Army Medical Department Journal

Perspective

regions, especially the United States, where it is not

currently a serious threat. This type of investigative

work by our Army veterinarians is intensive, detailed,

and absolutely vital in the management of diseases

among our increasingly mobile global populations.

The use of laboratory animals in medical research is

well understood as essential and invaluable. Less well

known is the vitally important use of animals in the

training of medical personnel. MAJ Craig Koeller’s

article provides insight to that element of training,

which would not be possible without the Army

veterinarian. He succinctly describes the protocols and

procedures that must be followed during the planning

and conduct of any training in which laboratory

animals are used, and the veterinarian’s

responsibilities in ensuring strict compliance in every

phase of that process. The veterinarian’s support of

this indispensable training contributes directly to

human lives saved in the future.

Army veterinary pathologists are highly-trained

professionals charged with the responsibilities of some

of the most demanding and potentially hazardous areas

of the Defense Department’s biomedical research

efforts. COL Keith Steele and his coauthors have

contributed a comprehensive, important article

describing this critical sector of Army veterinary

medicine. Indeed, the tools and technology for

biological warfare are very high on terrorist “wantlists” and represent a real and present danger to all

mankind. The article shows how Veterinary Corps’

experts have long been on the front lines of this very

dangerous, albeit largely unrecognized theater of the

Global War on Terror. Fortunately, Army veterinary

pathologists are hard at work every day in this domain

which is increasingly vital to our national defense.

Veterinarian Corps’ professionals are often found in

seemingly unlikely locations. MAJ Sam Yingst is one

of those, and he describes his work as a comparative

veterinary medicine officer at the US Naval Medical

Research Unit No. 3 in Cairo, Egypt, as truly a “dream

assignment.” His work focuses on influenza, one of the

most mobile and therefore potentially threatening

forms of disease in today’s highly mobile populations.

Influenza diseases have been responsible for the most

extensive and deadly pandemics in history. They are

easily communicable among people, and as such

represent a constant threat, either as naturally

occurring, constantly mutating, rapidly spreading

diseases, or as bioengineered weapons. MAJ Yingst’s

article is a fascinating look at the diverse, dynamic,

and rewarding work that not only requires keen

scientific and analytic skills, but also mandates a

global perspective and the ability to work with

multiple, geographically and politically diverse

agencies and individuals.

Veterinarians were first brought into military service

to care for the numerous large animals required for

armies to move and survive during campaigns: draft

and cavalry horses, and cattle. As technological

progress gradually eliminated the requirement for

those animals, another animal became indispensable

for US forces—the military working dog. Therefore,

among the myriad other responsibilities of the

Veterinary Corps, veterinary clinical medicine remains

a primary function, and probably the one most familiar

to the general military population. Two articles discuss

different aspects of care of these invaluable dogs. CPT

Kent Vince explores hip dysplasia, a chronic problem

that plagues several breeds of large dogs preferred for

military service. His detailed article describes the

advances in detection, diagnosis, and treatments,

especially the increasingly successful surgical repairs

of the hip joint. The extension of the military dog’s

working life made possible by the surgery is of

tremendous value, both in terms of the quick return of

an experienced dog to service, and elimination of the

expense of obtaining, training, and fielding a

replacement animal. In the following article, COL

Mack Fudge and his coauthors describe an effort to

assist a US ally, the Republic of Korea, in dealing with

a medical problem that afflicts their military working

dog population. Eyeworm infestation is widespread

within their dog population, and gradually reduces

their military usefulness. The article details a classic

clinical trial of the effectiveness of a drug which had

been used for other animal species but had not been

evaluated in a controlled study for dogs. This is

another example of the initiative and dedication of

Army veterinary specialists who continue to advance

the art and science of their profession, both at home

and abroad.

CW3 Gregg Burnham, a Veterinary Corps Food Safety

Officer, and a team of highly skilled university

researchers investigated the actual risk associated with

raw meat which had been subjected to temperature
July – September 2007 3

abuse in storage. This scientifically rigorous, complex

study to accurately quantify that risk to consumers has

the potential to significantly reduce costs of Defense

Department meat procurement and distribution.

Further, such research should inspire further

investigations within the food safety community, both

military and civilian. CW3 Burnham et al present their

research in an detailed, clearly presented, and very

informative article which demonstrates yet another

way in which Army veterinary science is benefiting

society as a whole.

In his article, CPT Cristopher Young reminds us that

the Army Veterinary Corps is well represented in the

Reserve Component. The experience, qualifications,

talent, and certifications these professionals bring into

the Army are vitally important factors in sustaining the

force readiness so important in today’s extremely fluid

mobilization environment. CPT Young’s enlightening

article is a testimony to the selfless dedication to

service that is the hallmark of Army Reservists.

The true “jacks of all trades” in the Army Veterinary

Corps are those veterinarians who serve in Special

Operations Forces units. COL Robert Vogelsang

provides us with a snapshot look at where they work

and what they do. His article describes the dynamic

nature and often spartan conditions of their operational

environment, and how their resourcefulness and

flexibility are critical in mission success of their units.

LTC John Smith closes this issue of the AMEDD

Journal with an excellent, “big-picture” discussion of

the vitally important role Army veterinary specialists

can and do play in support of US global efforts to

improve stabilization of failed and failing economies.

Instability in regional and national societies and

institutions attract those interested in fostering

calamity and sworn to the destruction of western

civilization. Weak states are fertile breeding grounds

for recruitment and training of insurgents and terrorist

organizers. LTC Smith’s article is a carefully

researched, very understandable presentation of the

situations and conditions which cause and sustain state

instability, the analysis of the societal dynamics which

must be addressed, and the role of the Army

veterinarian in US efforts to reconstruct those

economies and societies. This is an important look at

both the present and the future of global security, a

must read for all of us dedicated to the preservation of

freedom and our way of life.

COL DEBBOUN JOINS THE AMEDD JOURNAL EDITORIAL REVIEW BOARD

The AMEDD Journal welcomes COL Mustapha Debboun, MS,

USA, as a member of the Editorial Review Board. COL Debboun is

the Chief, Medical Zoology Branch, Academy of Health Sciences,

AMEDD Center & School, Fort Sam Houston, Texas.

COL Debboun joins the board replacing COL George L. Adams,

MS, USA, who has been a member of the board since April, 2006.

We thank COL Adams for his dedication to the high standards and

professional quality of this publication, and his years of service and

support to the mission of the Journal.

The Editors
4 Army Medical Department Journal

Dogs and dolphins, monkeys and cats, horses and

mules, rabbits, rodents, reptiles, and humans—

multiple species, and all are part of the focused

mission of the US Army Veterinary Corps. For over 91

years, officers in our Corps, along with support

personnel, have been an integral part of the Army

Medical Department, making critical global

contributions toward the health of animals, as well as

the health of Soldiers, Family members, and others.

The US Army Veterinary Corps was formed in 1916 at

a time when our country was just beginning to

comprehend the relationship between animal and

human health. We now know that those ties are

tremendous. With extraordinary versatility and

vigilance, our relatively small veterinary team of 3500

total personnel has continued its quest of the Army

version of “One Medicine, One Health.”

ONE MEDICINE, ONE HEALTH

Today, our nation’s medical and veterinary professions

are working closely together in a resurgence of what

we call One Medicine or One Health, that is, the

recognition and appreciation for the linkage between

human and animal health. The American Veterinary

Medical Association and the American Medical

Association have both taken formal steps toward better

collaboration and partnerships, and veterinarians and

physicians across the entire spectrum of their

professions—in academia, private practice,

government agencies, and many other aspects—have

joined them.

The 19th Century German physician and pathologist

Rudolph Virchow was one of the first medical

professionals to connect animal and human health,

stating:

Between animal and human medicine there is no

dividing line, nor should there be. The object is

different but the experience obtained constitutes the

basis of all medicine.1(piii)

Dr Calvin Schwabe, a veterinarian and epidemiologist,

and a professor at medical and veterinary medical

colleges, agreed, writing:

Impacts on human health are what most clearly delimit

veterinary medicine’s world view and best define its

broadly manifested importance as a profession.1(pp1-2)

This concept of One Medicine, One Health is

embraced by the US Army Medical Department, and

the Veterinary Corps is the cornerstone of its efforts.

HEALTHY ANIMALS

When most people think of veterinary services, they

think of the actual health care for animals. And, of

course, the roots of military veterinary medicine were

in animal care, beginning in 1776, when General

Washington demanded a farrier for a regiment of

horses. During the War Between the States, the

requirement for adequate horse health continued, and

the War Department provided each cavalry regiment

with a veterinary surgeon. Later, congress required

Healthy Animals, Healthy People:

Inextricably Linked

Brigadier General Michael B. Cates

BG Cates is the Chief, Army

Veterinary Corps; the Commanding

General, US Army Center for Health

Promotion and Preventive Medicine;

and the Functional Proponent, US

Army Preventive Medicine.
July – September 2007 5

that every applicant for these positions be graduates of

a recognized veterinary college. After the Veterinary

Corps’ inception, with passage of the National Defense

Act of 1916, equine medicine and surgery was a major

aspect of our mission.

Through the many wars since World War I, the use of

animals in the military has evolved, and with it, so has

the health care of those animals. Today, most of what

are usually considered “military working animals” are

specialty trained dogs (eg, explosive detection, mine

detection, narcotic detection, and patrol dogs), all

helping our entire Department of Defense with force

protection around the globe. Veterinary personnel

provide medical and surgical care to those military

working dogs wherever and whenever needed.

Our Corps also provides health care to horses, mules,

marine mammals, service animals, and all animals

involved with military biomedical research. These,

when combined with pets of military personnel, total

over 750,000, similar to the number of active duty

Soldiers and Civilian employees of the entire US

Army.

An additional, invaluable Veterinary Corps mission,

more readily visible in recent years, is animal care for

host nation countries—normally referred to as civil

affairs or humanitarian assistance. During these

deployments, veterinary support personnel provide

clinical and preventive veterinary care to livestock and

other animals of the native people in Afghanistan, Iraq,

Nicaragua, African countries, and the Philippines, for

example. We not only improve the health of the

animals, but also directly impact the quality of life for

the families and, many times, the economies of those

countries.

The need for veterinary personnel in the US military

began with animal health care requirements, and it

remains relevant even in today’s world. While the

diversity of animals, as well as their use in our

military, has changed over time, their health is an

essential part of military medicine.

HEALTHY PEOPLE

Shortfalls in Soldier health during the Spanish

American War were pivotal in the evolutionary

pathway leading to establishment of the Veterinary

Corps before World War I. After thousands of alleged

unnecessary casualties due to preventable illnesses, the

country demanded that something be done to preclude

such catastrophes in the future. The timing coincided

with wider acceptance of Virchow’s views of animal

and human links, and veterinarians were part of the

solution.

Over 60% of disease pathogens and 75% of the

emerging human pathogens are zoonotic, that is,

transmissible between animals and humans. The

Severe Acute Respiratory Syndrome (SARS) outbreak,

the continuing Human Immunodeficiency Virus (HIV)

epidemic and past influenza pandemics all originated

in nonhuman species. Food and water-borne illnesses

approximate a total of 76 million cases annually in the

United States, and many can be traced to animal

origins. This is especially true when the food

commodities are animal by-products, such as milk,

meat, and eggs. Protecting the food of deployed

Soldiers, Sailors, Airmen, and Marines is a key

mission for the Veterinary Service, whose members

are deployed along with these forces. Bovine

Spongiform Encephalopathy, or “mad cow disease,”

the spinach recall due to pathogenic E. coli, and the

intentional melamine contamination of pet food are

just a few examples which illustrate the necessity of

having robust food safety and defense programs to

mitigate the increased risks presented through

consolidated food manufacturing systems and the

globalization of food product distribution.

Veterinarians are uniquely qualified to provide

expertise in combating such outbreaks, not only

because of our training in zoonoses, but also because

of our “herd health” understanding and our systemic

approaches to disease prevention and control.

To accomplish this, Army Veterinary Service

personnel audit several thousand food producers in

more than 80 countries annually, to ensure safe food

for service members and beneficiaries. An example of

the benefit to the combat commander was Veterinary

Service approval of locally owned bottled water plants

in Afghanistan at a savings of more than $38 million

per year and the elimination of over 4,000 waterdelivery trips from supply routes, decreasing driver

exposure to improvised explosive devices. These water

plants are now part of the approved source audit

program which is linked with other government food

safety programs to share information, protecting

service members and contributing to the nation’s food

safety.

One other significant example of zoonoses, with

national and international prominence, is Avian

Influenza. Army veterinarians have actively
6 Army Medical Department Journal

contributed to military and interagency planning

processes. We have

 participated in developing the US Department of

Agriculture (USDA) Avian Influenza Playbook

in support of the National Response Plan,

 assigned Veterinary Corps Officers to the Joint

Task Force-Civil Support,

 developed a capacity to respond,

 initiated training and equipment requirements to

support the lead federal agency, and

 hosted interagency Avian Influenza surveillance

and response conferences.

Veterinary personnel are currently an essential piece of

overseas Avian Influenza testing and surveillance

programs. In addition, we have trained over 150

veterinarians in the Department of Homeland Security

Plum Island Foreign Animal Disease Diagnosticians

Course to support combat commanders in the field, as

well as the USDA at home. This capacity to respond to

natural or agroterrorism emergency events was

demonstrated by the deployment of veterinary

personnel to support the USDA during the 2002 Avian

Influenza outbreak in Virginia and Pennsylvania.

Veterinary Services also conducts programs to detect,

prevent and control other zoonotic diseases, such as

certain parasitic infections and rabies in pets of

military personnel, as well as government-owned

animals. Given the close association of owners with

their pets and handlers with their military working

animals, such programs are essential in the protection

of the health of all.

The physiological and psychological benefits to

humans from animals are not completely understood,

but the human-animal bond is so strong that it

sometimes transcends comprehension. Examples tying

mental and physical well being of humans to their

association with animals abound, in our country and

Healthy Animals, Healthy People: Inextricably Linked
July – September 2007 7

abroad, in civilian as well as military populations.

Katrina victims refused to leave their homes without

animals, and military noncombatant evacuations have

stalled until pets could go too. Animal assisted therapy

and visitation animals are important aspects of the

Warriors in Transition program, in addition to

inpatient programs in the Veteran’s Administration

and Department of Defense. Pets are considered

important, inseparable parts of the family, and mascots

are almost always desired among deployed units.

Again, veterinary personnel positively impact both

animal health and human health through their support.

Veterinary Service contributions to military medicine

extend past food safety, animal medicine, and zoonotic

disease control programs. Approximately 30% of

Veterinary Corps Officers are specialty trained in

laboratory animal medicine, veterinary pathology, or

veterinary comparative medicine, and assigned to

research and development positions. Their

contributions in prevention span a wide spectrum of

activities, from developing new-generation smallpox

vaccines to malaria vaccines and prophylaxes, and

evaluating Future Combat Systems for Soldier safety,

from which the derived benefits extend from the

Department of Defense to the nation to the world.

INEXTRICABLE LINK

Veterinary Corps participation in all of our nation’s

conflicts since World War I has been an essential

element in the maintenance of the health and well

being of both animals and Soldiers. The highly

technical education obtained by veterinarians has

continued to prepare them for their changing mission

requirements over the past 91 years, and we are

uniquely qualified to contribute and lead in future

efforts.

According to Zahn, Kaplan, and Steele, strategies

related to One Medicine, One Health must span the

entire spectrum of “veterinary and medical education,

clinical care, public health and biomedical research.”2

Since 1980, the Army has been the Department of

Defense Executive Agent for Veterinary Services,

providing veterinary support to all services, anytime,

any place. Our veterinary missions, dictated in

Department of Defense Directive 6400.4 3—food safety

and defense, animal medicine, zoonotic disease

prevention and control, and medical research and

training support—have been and continue to be

inextricably linked to military human medicine.

Composed of 7 areas of concentration, the Veterinary

Corps has over 750 veterinarians and warrant officers,

and our entire veterinary team includes enlisted and

civilian employees; active duty, reserve component,

and Army National Guard; in Table of Organization

and Equipment* and Table of Distribution and

Allowances†organizations. Recent events in the

national and international food safety and zoonotic

disease arenas underscore the criticality of continuing

and even building enhanced veterinary capabilities.

I am very proud that this edition of the AMEDD

Journal showcases examples of the breadth and depth

of expertise, capabilities, and support missions of

today’s Army Veterinary Corps. It is an honor to be a

part of this extraordinary team, as we continue to work

diligently, with other members of the Army medical

team, toward healthier animals and healthier people.

*Defines the structure and equipment for a military

organization or unit.

†

Prescribes the organizational structure, personnel and

equipment authorizations, and requirements of a

military unit to perform a specific mission for which

there is no appropriate table of organization and

equipment

REFERENCES

1. Schwabe CW. Veterinary Medicine and Human

Health. 3rd ed. Baltimore, MD: Williams and

Wilkins; 1984.

2. Kahn LH, Kaplan B, Steele JH. Confronting zoonoses

through clear collaboration between medicine and

veterinary medicine (as “one medicine”). Vet Ital.

2007;43(1):5-19.

3. Department of Defense Directive 6400.4, DoD

Veterinary Services Program. Washington, DC: US

Dept of Defense; August 22, 2003.
8 Army Medical Department Journal

Since 1916 the US Army Veterinary Service has

provided support to the warfighter through ensuring

the safety of the military food supplies and providing

care for government-owned animals. These are historic

and enduring core functions that are critical to mission

success of our fighting forces worldwide. In fact, the

Army is the Executive Agent for the provision of

veterinary medical care and services throughout the

Department of Defense (DoD). The Surgeon General

has delegated that responsibility directly to the Army

Veterinary Service. In that role, the importance of

medical research and development cannot be

overstated. It is one of the 3 mission pillars supporting

the overarching goal of Force Health Protection of all

US military personnel and beneficiaries, and has been

added as a primary role of the Veterinary Service.

In addition, recent national and global events have

both refined the Veterinary Service’s older missions

and expanded its role into new areas. The new areas

include disease surveillance; homeland defense;

disaster response; food defense; and security,

stabilization, transition, and reconstruction operations.

DISEASE SURVEILLANCE

Historically, disease surveillance has been a passive

system of reporting the incidence of specific diseases

as they occur. Over 60% of all infectious diseases and

75% of emerging diseases are zoonotic, those diseases

passed to humans from animals and animal vectors.

Three events triggered the recognition for the need for

active surveillance systems: Gulf War Syndrome,

West Nile virus, and the avian influenza/pandemic flu.

Gulf War Syndrome in Soldiers and the inability to

find a cause was the impetus for establishing a Gulf

War Syndrome Study in Military Working Dogs. Since

these animals are collocated in areas where

environmental and disease exposure took place and

have a shorter lifetime, they serve as a potential

sentinel for human disease. The study was responsible,

in part, for the establishment of the Electronic Medical

Record for government-owned animals, and the

creation of links among the deployment history,

medical findings,

and necropsy reports

to provide an active

surveillance system.

This DoD (Health

Affairs) funded

program has been

approved and began

development in

2007.

West Nile virus

emerged as a

p o t e n t i a l l y

significant threat.

This virus, which

affects both people

and animals, is an

example of one of many emerging zoonotic diseases.

As part of a national surveillance program, the US

Army Veterinary Service provides active surveillance

of horses owned by the military, and testing of ill and

dying birds on installations nationwide.

The latest event is the current global avian influenza

outbreak and potential pandemic flu threat. Army

veterinarians are working on a range of planning,

response, testing, and surveillance programs. To

support the DoD requirements, a veterinarian with

both a PhD in Public Health and an epidemiologic

background has been assigned to The DoD Global

Emerging Infections Surveillance and Response

System (GEIS) to direct the surveillance of both

human influenza and zoonotic diseases. Under the

sponsorship of GEIS, the DoD Veterinary Service

Activity hosted an International Avian Influenza

Surveillance Conference in 2006, along with other

training functions. Globally, Veterinary Service

personnel assigned to the Navy Area Medical

Research Unit-3 in Cairo, Egypt,* are providing

forward avian influenza surveillance in Africa and

throughout the US Central Command’s area of

responsibility.

Emerging Roles of the US Army

Veterinary Service

COL Gary Vroegindewey, VC, USA

*See related article on page 38.

An Army Veterinary Service food

inspector examining military food

supplies prior to loading.
July – September 2007 9

HOMELAND DEFENSE

Prior to the terrorist attacks of September 11, 2001, the

Veterinary Corps had recognized the vulnerability of

food to purposeful contamination. To address this

issue, the Food and Water Safety Committee was

established to evaluate

 current vulnerabilities,

 doctrine and policies to mitigate risk,

 emerging technology to detect and prevent

contamination, and

 training required to meet these needs.

The Army Medical Department (AMEDD)

Postgraduate Professional Short Course Program and

the AMEDD Center and School Department of

Veterinary Service developed a Food Safety and

Security Course which is presented yearly for

multiservice personnel, along with interagency

representation from the Federal Bureau of

Investigation (FBI), the US Department of Agriculture

(USDA), the Food and Drug Administration (FDA),

state public health personnel, commercial partners, and

educational institutions. The course continues to be

taught as part of the US Army Center for Health

Promotion and Preventive Medicine’s (CHPPM)

annual Force Health Protection Conference. The

committee also identified technology solutions for

food defense that resulted in the acquisition and

fielding of the portable food test sets as well as the

Joint Biological Agent Identification and Detection

System (JBAIDS) portable rapid polymerase chain

reaction test sets.

Army veterinarians have served as liaisons to

numerous activities in support of Homeland Defense.

These include a public health veterinarian assigned to

the Northern Command’s Surgeons Staff; DoD Liaison

to the USDA; support to the US Joint Forces

Command’s Joint Task Force-Civil Support;

participation in White House working groups on

agroterrorism; and work with the Government

Coordinating Council, comprised of Federal, state,

tribal, and local governmental agencies responsible for

a variety of activities, including agricultural, food,

veterinary, public health, laboratory, and law

enforcement programs.

Strengthening of partnerships has been accomplished

through programs for information sharing with FDA,

Department of Homeland Security (DHS), and other

federal agencies. These partnerships were proven

valuable in execution of the recent pet food recall due

to melamine that also entered the human food supply

chain and FDA canned chili product recalls.

Veterinary teams have deployed to support hurricane

recovery efforts and events such as the 2002 Olympic

Games in Salt Lake City, opening of the United

Nations General Assembly, Republican and

Democratic national conventions, the G-8 Summit, the

presidential inaugurals, presidential funerals, and other

events as part of our Defense Support to Civil

Authorities.

DISASTER MANAGEMENT

The role veterinary medicine plays in disaster

management was highlighted in the aftermath of

hurricanes Andrew, Floyd, and Katrina. After

hurricane Andrew, the Veterinary Corps initiated an

annual Veterinary Disasters course to prepare

personnel to meet the requirements of national and

international disasters. Working in conjunction with

the Uniformed Services University of Health Sciences

(USUHS) Center of Disaster and Humanitarian

Assistance Medicine, and the Center of Excellence for

Humanitarian Assistance and Disaster Relief, the

course was developed to train personnel and encourage

networking with other nongovernment agencies,

government agencies, and academic institutions.

Veterinary modules have also been developed and

incorporated into the Combined Humanitarian

Assistance Response Training (CHART) course, the

Homeland Security for Healthcare Executives course,

and in the USUHS humanitarian assistance

curriculum.

FOOD DEFENSE

Food safety, the detection and prevention of accidental

food contamination, has been a core mission of the

Veterinary Corps since its inception. Food defense, the

prevention and detection of purposeful food

contamination, has emerged as a Veterinary Corps

responsibility which is shared with military security

agencies. The Veterinary Corps has taken the lead and

assisted in a wide range of food defense activities. In

conjunction with CHPPM, the DoD Veterinary Service

Activity wrote Technical Guide 188 1and established

food defense criteria which is used in the publication

of the DoD Worldwide Directory of Sanitarily

Approved Food Establishments for Armed Forces

Procurement,* DoD’s audit program for commercial

food establishments.

*http://vets.amedd.army.mil/vetcom/directory.htm
10 Army Medical Department Journal

Veterinary Service personnel continue to participate in

the DHS and FBI led Strategic Partnership ProgramAgroterrorism to evaluate industry sector food defense

vulnerabilities and develop industry standards to

protect our nation’s food supply. This is being done

with the Veterinary Corps’ veterinary officers and

highly trained and experienced Food Safety Officers.

The DoD Veterinary Service Activity, an Army Field

Operating Agency, is working with FDA, USDA,

DHS, and commercial partners to establish food

defense guidelines and strengthen the safety of our

national food supply. These food defense initiatives

are further supported by Veterinary Service personnel

assigned to support DoD agencies outside of the US

Army Veterinary Command. These include key staff

positions with the Defense Logistics Agency, Defense

Supply Center Philadelphia, Defense Commissary

Agency, Naval Supply

Center, Army Center of

Excellence-Subsistence,

Army-Air Force Exchange

Service, and others.

S p eci ali zed Med ical

Assistance Response

T e a m s – V e t e r i n a r y

members have deployed as

part of a multifunctional

Food and Water Defense

Team to support Army

Chief of Staff high profile

events for both food safety

and defense.

The US Army Veterinary

Service has participated in

and led numerous exercises

to train participants and test

the capacity of veterinarians

to support a wide range of national significant events,

involving subjects from bioterrorism and agroterrorism

to weapons of mass destruction.

SECURITY, STABILITY, TRANSITION, AND

RECONSTRUCTION OPERATIONS

DoD Directive 3000.05 2identifies the security,

stability, transition, and reconstruction (SSTR)

activities as core DoD missions that “...shall be given

priority comparable to combat operations....” The US

Army Veterinary Service has been engaged in these

and similar activities over several years through

providing Veterinary Readiness Training Exercises,

Veterinary Civic Action Programs, and Cooperation

Afloat Readiness and Training mission support though

the Civil Affairs and Special Forces Veterinary Corps

assets, plus TOE* and TDA†personnel. While this is

not a totally new mission, the emphasis and

requirements for these activities have increased along

with combatant commander recognition of the value of

strengthening agricultural programs as a social,

political, and economic stabilizing force. Combatant

commanders’ theater engagement plans increasingly

focus on veterinary related programs.

This has resulted in an increase in both number and

scope of deployments. The Reserve Component

Veterinary Corps Officers‡provide the largest number

of assets for these programs

and are supported with

active duty Veterinary

Corps officers. Examples of

these programs include

rebuilding the Bosnian

Veterinary College in

Sarajevo, herd health

programs in the Horn of

Africa, avian influenza

p r o g r a m s i n I r a q ,

transboundary disease

programs in Afghanistan,

the establishment of

n a t i o n a l d i a g n o s t i c

laboratories, Medflag

exercises in Africa, and

other deployment activities.

In addition to the SSTR

operations, the Veterinary

Corps has been tasked to

support Department of State Provincial Reconstruction

Teams in Iraq, while continuing Civil Affairs support

to brigade combat teams and the Multinational

Emerging Roles of the US Army Veterinary Service

*Table of Organization and Equipment: Defines the

structure and equipment of a military organization or unit.

†

Table of Distribution and Allowances: Prescribes the

organizational structure, personnel and equipment

authorizations, and requirements of a military unit to

perform a specific mission for which there is no

appropriate table of organization and equipment

‡

See related article on page 66.

An Army veterinarian examines a local farmer’s

donkey during a Veterinary Civic Action Program visit

to a village in the Horn of Africa region.
July – September 2007 11

Coalition-Iraq. To prepare for these expanding roles,

the Veterinary Corps has initiated long-term health

education and training opportunities inluding master’s

level training in humanitarian assistance, combined

Master’s of Public Health programs with the focus on

international affairs and livestock management, as well

as just-in-time training for deploying Veterinary Corps

officers.

SUMMARY

When leaving office, Tommy Thompson, the former

Secretary of the Department of Health and Human

Services, indicated that the 2 things that concerned

him most were avian influenza and the safety of the

United States food supply: “I, for the life of me, I do

not know why the terrorists have not, you know,

attacked our food supply, because it is so easy to do.”

These are DoD and national concerns and are a direct

focus of the US Army Veterinary Service as part of its

emerging roles and responsibilities.

While continuing its core missions of food safety,

animal medicine, and research and development in

support of the DoD, the US Army Veterinary Service

must be able to meet its responsibilities in the new

emerging arenas. In order to meet these requirements,

additional resources in the form of authorizations,

training, equipment, and funding will be required. In

addition, innovative partnerships and collaboration

within the AMEDD, DoD, and interagency partners

will be critical.

REFERENCES

1. Technical Guide 188, US Army Food and Water

Vulnerability Assessment Guide. Aberdeen Proving

Ground, MD: US Army Center for Health Promotion

and Preventive Medicine. 2002. Available at: http://

chppm-www.apgea.army.mil/tg.htm.

2. Department of Defense Directive 3000.05: Military

Support For Stability, Security, Transition, And

Reconstruction (SSTR) Operations. Washington, DC:

US Dept of Defense; November 28, 2005.

AUTHOR

COL Vroegindewey is the Director of the Department

of Defense Veterinary Service Activity in the office of

The Surgeon General, Falls Church, VA.
12 Army Medical Department Journal

ARMY VETERINARY LABORATORY SERVICE

The three pillars that form the core force health

protection mission of the Army Veterinary Service are

food safety, animal medicine, and research and

development. Veterinary laboratory service has always

played a key role in each of these areas, and continues

to do so today. Veterinary officers hold vital positions

in medical research laboratories, particularly in areas

such as toxicology, virology, pathology, and

laboratory animal medicine. Veterinary pathologists,

clinical pathologists, and veterinary diagnosticians are

essential elements in the health maintenance of

military animals. Veterinary personnel in food analysis

laboratories, the focus of this article, help provide the

science that complements the art of food inspection.

Although an Army veterinary laboratory service has

existed almost since the inception of the Veterinary

Corps itself, its size has varied greatly throughout the

years. In December 1917, the Army Surgeon General

established a veterinary laboratory service to include 6

or 7 laboratory officers.1 By the end of World War II,

some 100 veterinary officers were serving worldwide

in the veterinary laboratory sections of 32 Army

medical laboratories.2 Veterinary laboratory personnel

have supported military conflicts throughout the latter

half of the 20th century and beyond, from testing ice

chlorination potability in Vietnam,3to providing food

testing for Operation Iraqi Freedom. They also have a

role in civil-military functions, whether supporting

missions such as Joint Task Force Bravo in Latin

America, or closer to home in the aftermath of

Hurricane Katrina.

The number of veterinary laboratories has greatly

decreased since 1945. Base Realignment and Closure,

along with the advent of overnight shipping services,

allowed various regional laboratories to be

consolidated into the current Department of Defense

(DoD) Veterinary Food Analysis and Diagnostic

Laboratory at Fort Sam Houston, Texas, and

Veterinary Laboratory Europe in Landstuhl, Germany.

Smaller food analysis laboratories in Hawaii and

Korea cover those parts of the world that cannot

quickly get samples to the 2 larger laboratories.

The mission of Army food analysis laboratories has

also changed. Most of the early focus was on quality

assurance testing and contract compliance for large

stockpiles of subsistence. Dairy testing comprised a

large portion of the food analysis laboratory work, as

did can analysis and packaging testing of operational

rations. The laboratories were often aligned under the

Quartermaster Branch, until ultimately it was decided

that food analysis is a medical mission, and the

responsibility of the Veterinary Corps.

More recently, particularly with the advent of prime

vendor contracts, food safety has become a main focus

for the food analysis laboratories. Quality assurance

checks are still performed, but more in the context of

verifying the producer’s own quality assurance

program. Detection of harmful pathogens, toxins, and

chemicals, and providing laboratory testing for

foodborne illness outbreaks has taken priority. Also,

the food analysis laboratories are becoming more and

more involved with food defense, gaining expanded

capabilities to quickly detect intentional contamination

of subsistence with either traditional foodborne threats

or with bioterrorism agents.

CURRENT ARMY VETERINARY FOOD ANALYSIS

LABORATORIES

The DoD Veterinary Food Analysis and Diagnostic

Laboratory (FADL) at Fort Sam Houston is the

Army’s largest and most robust food analysis

laboratory. The FADL is capable of performing a wide

variety of microbiological and chemical tests on food

Army Veterinary Food Analysis Laboratories:

Past, Present, and Future

MAJ Scott Hanna, VC, USA

MAJ Margery Hanfelt, VC, USA

MAJ Kelley Evans, VC, USA

LTC Robin King, VC, USA
July – September 2007 13

and water samples, supporting military and

nonmilitary customers across the globe.

Food microbiology assays at the FADL run the gamut

from basic, conventional microbiology using agar

plates, to advanced, rapid techniques such as real-time

polymerase chain reaction. The microbiology section

tests for routine quality indicators as well as specific

foodborne pathogens and toxins, screens operational

rations for potential anthrax contamination, and tests

samples associated with foodborne illness outbreaks.

Although most of the samples submitted for

microbiological testing come from North and South

America, the section also confirms laboratory results

for the surveillance laboratories in Hawaii and Korea

when needed.

The food chemistry section’s routine capabilities

include the detection of pesticides in food and water

and histamine in certain seafoods, heavy metal

analysis, antibiotic residues in food and dairy products,

and proximate analyses such as fat content of ground

beef. FADL chemists are often called upon to identify

foreign objects in food samples, and to respond to

customer complaints. The chemistry section often

receives samples from the other laboratories when

more advanced chemistry testing is needed. New

techniques currently under development include

analysis for cyanide, better and faster ways to detect

pesticides and heavy metals, and equipment and

protocols to identify and quantify radioisotopes in food

and water samples.

To ensure the validity of its results, the FADL is

accredited through the American Association of

Laboratory Accreditation (A2LA). This agency audits

the FADL against the ISO 17025 standard, the General

Requirements for the Competence of Testing and

Calibration Laboratories. External A2LA accreditation

provides further confidence in the accuracy and

reliability of the FADL laboratory results, and allows

the FADL to act as a confirmatory laboratory when

necessary.

Due to the technical nature of many of the procedures

at the FADL, most of the analysts are civilians.

Military food inspectors (military occupational

specialty [MOS] 68R) augment the civilians and

perform many of the food microbiology and several of

the food chemistry assays. This mix allows a

consistent, stable workforce of highly trained civilians,

while allowing the military food inspectors to receive

valuable training in food analysis techniques they can

apply in future assignments.

A primary mission of the US Army’s Veterinary

Laboratory Europe (VLE) in Landstuhl, Germany, is

to conduct microbiological and chemical analysis of

food and bottled water for safety and wholesomeness.

VLE is the only other accredited laboratory in the US

military to conduct this testing, and employs

conventional, rapid, and molecular methods to carry

out these tasks in support of European Command and

Central Command units. VLE customers include

Army, Air Force, Navy, and State Department assets,

with sample submissions from more than 40 countries.

Unlike the FADL, most of the food analysis

technicians at VLE are junior enlisted personnel, MOS

68R. In addition to their Advanced Individual

Training, they receive 6 months of training at the

laboratory to learn the technical standing operating

procedures and manuals, along with passing associated

proficiency testing.

The Food Safety Laboratory at the Tripler Army

Medical Center, Honolulu, Hawaii, performs

microbiological screening for food samples from

throughout the Pacific theater. They use a variety of

rapid and miniaturized methods to perform this testing.

The laboratory is staffed by a civilian microbiologist

and a noncommissioned officer, MOS 68R.

Finally, the 106th Medical Detachment (Veterinary

Services) Laboratory, Yongsan, in Seoul, South Korea,

provides microbiological screening and limited

chemical analysis of subsistence procured from the

Korean peninsula. It is staffed by a civilian

microbiologist, a Veterinary Corps officer, and MOS

68R personnel.

VETERINARY FOOD SURVEILLANCE

LABORATORIES

Despite the wide geographic dispersion of the fixed

laboratories, many food products of interest are

perishable, and the transport time may result in

samples that are not testable. In addition, there are

situations in which more immediate results are

necessary due to operational considerations, and the

time-sensitive nature may require a more expedient

preliminary result. Difficulties shipping food samples

across borders–from one country to another—may also

exist, which delay or even prevent needed testing.
14 Army Medical Department Journal

According to Army Field Manual 4-02.18:

Currently there is minimal testing that can be done at

the deployed unit level. Suspect food samples are sent

to the FADL in Fort Sam Houston, Texas, or to the US

Army Veterinary Laboratory, Germany. In the near

future the MDVS [medical detachment, veterinary

service] will be able to screen food samples for the

presence of foodborne [also water and ice borne]

pathogens and biological warfare agents. If a pathogen

or biological agent is detected through the screening

process, food samples are collected and shipped to a

confirmatory laboratory for further analysis.4

That day has finally arrived, with the fielding of 2 food

testing sets specifically designed for use on the

battlefield, in food production plants, storage facilities,

and/or prime vendor facilities. Unit Assemblage (UA)

913A Veterinary Equipment Set Field Microbiology

Diagnostic Kit will be used for rapid screening of food

samples to assist in ensuring food safety. This kit

features a handheld instrument which detects

luminescence for adensosine triphosphate (ATP)

associated with microorganisms and food/organic

residues and pesticides. The Veterinary Service

Support Team of the MDVS is authorized to use this

kit. UA 914A Veterinary Equipment Set Food Testing

Set will be used for rapid screening as well as

presumptive results of food samples to assist in

ensuring food safety and defense. This set features a

small bench top analyzer that uses liquid scintillation

counter for testing for aflatoxin and antibiotics and a

bioluminescence counter for pesticides and ATP

associated with microorganisms and food/organic

residues. The Food Procurement Team of the MDVS

is authorized to use this set.

Based on the needs, and knowing that fielding of the

new sets was imminent, VLE initiated a training

program, the Surveillance Food Laboratory Technician

Workshops. The goal is to provide the training and

references to allow a unit to stand up and run a local

surveillance food and bottled water laboratory in

support of the unit commander’s mission.

While the purpose of the surveillance laboratories is to

support the local command’s mission, they are not yet

designed to recover and identify pathogens. Instead,

their role is to rule out problems based on indicator

testing, or for referral to a reference laboratory such as

VLE. Implementation of these laboratories has greatly

enhanced local surveillance and destination

monitoring, and identified potential problems before

those problems rise to a level that would affect the

consumer.

Due to the number of training topics and the laboratory

hands-on techniques to master, the workshops are

designed with the low student-to-teacher ratio of 2:1 or

3:1. Training consists of a combination of lectures and

laboratories, and topics include proper laboratory setup

and maintenance, basic laboratory techniques,

processing food and bottled water samples, reading

and interpretation of results, followup actions to

presumptive positive results, and reporting of results.

The training emphasizes the use of rapid methods that

can be used in garrison or field laboratories, including

the following:

 Plating food products using PetrifilmTM plates (3M

Corporation, St Paul, Minnesota), a ready-made

culture medium system containing standard

methods nutrients, a cold-water-soluble gelling

agent, and additional chemicals or antibiotics as

necessary for enumeration, selectivity, or

differentiation of microorganisms.

 Testing of 100 mL subsamples of water, rinse, or

diluted food samples using a single assay capable

of selectively growing, detecting, and quantifying

coliforms, E. coli, and hydrogen sulfide producing

Enterobacteriacae (such as Proteus and

Salmonella).

 Use of a tabletop system for screening food and

bottled water samples for pesticides and an

indication of proper pasteurization. The system is

also capable of screening for antimicrobials,

aflatoxins, and other important chemical residues

and indicators.

 Use of ATP swabs to determine the presence of

ATP in water or on surfaces, reflecting the

presence of organic material and level of sanitation

in the sample. They are portable and rapid, and are

carried on site into production plants,

commissaries, and other areas where food is

processed to determine the “cleanliness” of food

processing surfaces. Results require only a 5-

second luminescent reading in a portable counter.

The Veterinary Laboratory Europe has conducted 4

workshops so far, training just over 30 personnel.

Army ranks have ranged from Private to Major,

including Warrant Officers. Students have attended

Army Veterinary Food Analysis Laboratories: Past, Present, and Future
July – September 2007 15

from the European Command, Central

Command, and Korea. In addition,

classes have included Air Force Public

Health Officers and a civilian involved

in quality assurance at a meat

processing facility.

In addition to the formal workshops,

VLE has exported the training to the

field during field training exercises to

teach and demonstrate setup and

operation of a food and bottled water

laboratory in the field. In the last 3

years, VLE has provided subject matter

experts and exportable laboratories for

3 different units on 3 field training

exercises to meet requested needs.

The first formal training course has

recently been conducted at the

Department of Veterinary Science

(DVS) at the Army Medical

Department Center and School, a

combined effort of DVS, the FADL, and VLE. The

course was designed to support Veterinary Command

personnel who are receiving one of the food analysis

sets. Additional courses are planned, and the FADL is

developing a proficiency testing program to ensure

attendees maintain their skill set. DVS continues to

update and develop training to ensure veterinary

service personnel in TOE* and TDA†units are trained

to use the equipment.

Providing these workshops, taking the training to the

field, and deploying subject matter experts are all

critical components in ensuring the wholesomeness

and safety of the food and bottled water supply for the

US military. Access to onsite laboratory testing will

allow commanders to make better informed, more

timely decisions on whether to use a particular

commodity, supplier, or producer.

EMERGING TECHNOLOGIES

The food defense mission has also taken great leaps

forward in recent years. With the increased potential

for biological agent warfare and genetically altered

biological agents, the capability to confirm the

presence of a biological agent has become essential to

preventing casualties, thus maintaining effective

combat power. One of the fastest ways to identify a

biological agent is to determine if that agent’s DNA is

present. Polymerase chain reaction (PCR) has been

used for years in fixed facility laboratories and is now

available on the battlefield. In the mid-1990s, a joint

service effort was started for the Joint Biological

Agent Identification and Diagnostic System (JBAIDS)

which uses PCR technology to identify and quantify

biological warfare agents and other biological agents

of operational significance for confirmatory and

prognostic purposes. JBAIDS will perform specialized

analytical tests on biological warfare agents or

metabolites in environmental or food samples, samples

or specimens from biological origins, or samples from

military materiel.

Currently, JBAIDS only detects a select group of the

39 agents that can be potentially used as biological

weapons. However, with the right sets of reagents,

JBAIDS has the potential to detect any living organism

*Table of Organization and Equipment: Defines the structure and equipment for a military organization or unit.

†Table of Distribution and Allowances: Prescribes the organizational structure, personnel and equipment authorizations,

and requirements of a military unit to perform a specific mission for which there is no appropriate table of organization

and equipment.

An instructor assists students in the examination of plate cultures as

part of the Food Surveillance Laboratory Course at the Army Medical

Department Center & School, Fort Sam Houston, Texas.
16 Army Medical Department Journal

that can cause illness in both humans and animals.

Since JBAIDS is a joint service program, a centralized

training program was also developed. Initial JBAIDS

operator training for authorized military specialists

consists of a 2-week course currently held at Brooks

City Base, San Antonio, Texas. Before a unit can

receive JBAIDS, 2 users from that unit must attend

this training.

The first JBAIDS fielded to the Army went to the

FADL. Army veterinary units that have or will receive

JBAIDS are the Food Procurement Teams in the

Medical Detachment, Veterinary Services, as well as

select TDA units such as the FADL and VLE. Due to

the highly complex nature of testing food samples, the

FADL has been working on refining techniques and

procedures taught in the JBAIDS operator’s course, as

well as developing methods to detect traditional

foodborne pathogens using the JBAIDS platform. If

such techniques can be validated, surveillance

laboratories could begin looking for specific pathogens

in food and water samples, in addition to quantifying

indicator organisms.

Other technologies are currently being evaluated and

developed by the FADL, the Natick Soldier Systems

Center, other DoD agencies, the Food and Drug

Administration, the Department of Homeland Security,

and numerous other public and private organizations.

The candidate technologies are diverse, such as

electrochemiluminescence, which can detect

foodborne toxins; immunomagnetic capture, which can

separate a particular bacteria or virus from the other

organisms in the food; and microarrays, which can

rapidly identify several potential pathogens using a

single, small chip. As these become more mature,

ruggedized, and exportable to the field, the

surveillance laboratories will be able to provide a

wealth of information about the microbial status of

food and water samples in a very short amount of time.

CONCLUSION

In many ways, Army food analysis laboratories have

come full circle. While fast shipping once allowed a

reduction in the numbers of laboratories, the desire for

even faster results is now increasing their numbers

once again. As technology has progressed, advanced

testing protocols are now available to the surveillance

laboratories, and more are sure to follow.

REFERENCES

1. Miller, EB. United States Army Veterinary Service in

World War II. Washington, DC: Office of The

Surgeon General, US Dept of the Army; 1961:381.

2. Randall, R. Wartime Army medical laboratory

activities: wartime activities of the Army veterinary

laboratories. Am J Pub Health. 1947;37(7):829-835.

3. Neel, S. Vietnam Studies: Medical Support of the US

Army in Vietnam 1965-1970. Washington, DC: US

Dept of the Army; 1991:137.

4. Field Manual 4-02.18: Veterinary Service Tactics,

Techniques, and Procedures. Washington, DC: US

Dept of the Army; December 2004:para 3-9.

Army Veterinary Food Analysis Laboratories: Past, Present, and Future

AUTHORS

MAJ Hanna is Deputy Commander of Veterinary Laboratory Europe, Landstuhl, Germany. Previously, he was Deputy

Director of the DoD Veterinary Food Analysis and Diagnostic Laboratory, Fort Sam Houston, Texas.

MAJ Hanfelt is Chief of the Food Protection Branch, Department of Veterinary Science, Army Medical Department

Center and School, Fort Sam Houston, TX. Previously, she was Deputy Commander of the Veterinary Laboratory

Europe, Landstuhl, Germany.

MAJ Evans is Chief, Combat Doctrine and Development, Army Veterinary Services, Fort Sam Houston, Texas.

LTC King is Commander, Veterinary Laboratory Europe, Landstuhl, Germany. Previously, she was Deputy Director of

the DOD Veterinary Food Analysis and Diagnostic Laboratory, Fort Sam Houston, Texas.
July – September 2007 17

INTRODUCTION

Leishmaniasis is transmitted to humans and animals

through the bite of the infected phlebotomine sand

fly.1 The disease is endemic in 88 countries, including

all countries bordering the Mediterranean Sea with an

estimated 12 million people worldwide affected,

2

and

the number of cases has increased in the past decade.

3

Leishmania infantum is the etiological agent of human

and canine visceral leishmaniasis (CanL) in the

Mediterranean subregion. Domestic dogs are the main

reservoir host in urban areas.4,5 Leishmaniasis

infections in both canine and human populations are

most often nonfatal and asymptomatic, but can become

fatal if left untreated.

Humans show a broad spectrum of responses to

leishmaniasis. Some individuals display severe clinical

manifestations, yet others only show positive antibody

titers. Clinical manifestations in humans are varied,

but they include weight loss and intermittent spiking

fevers. Leishmaniasis also presents a public health

problem because it is difficult to treat. Existing

chemotherapies are not wholly effective against the

disease, and drug resistance is a growing problem.6

Canine leishmaniasis is endemic in the Mediterranean

Basin. The seroprevalence of CanL ranges between

10% and 37%, and is even higher in isolated

populations.7 While leishmaniasis was once considered

primarily a rural disease, it is increasingly found in

suburban areas where small gardens create favorable

conditions for the sand fly.6In Europe, where

leishmaniasis is primarily a veterinary problem,

estimates suggest that up to 7 million dogs are

infected.8

The Impact of Leishmaniasis on Military

Working Dogs with Mediterranean Basin

Exposure

MAJ Jerrod W. Killian, VC, USA

ABSTRACT

Background

Leishmaniasis is an infectious protozoan disease of

people and domestic animals that occurs throughout

temperate, subtropical, and tropical regions of the

world. In the Mediterranean Basin, Canine

Leishmaniasis (CanL) is endemic and might pose a

risk to military working dogs (MWDs) stationed in

the area. Concerns over translocating exposed MWDs

into CanL nonendemic areas create the need to

ascertain the impact of CanL in exposed MWDs.

Objective

To determine the magnitude of CanL in exposed

MWDs.

Design

Serum/tissue examination of exposed MWDs using

polymerase chain reaction (PCR) and

immunofluorescence assay (IFAT) tests targeted to L.

infantum; abstraction of MWD medical records for

CanL-related signs.

Setting

Military bases within the Mediterranean basin.

Participants

Sixty-four MWDs located from a records search.

Main Outcome Measures

PCR results; IFAT titers; frequency and number of

CanL-related clinical signs abstracted from medical

records; case definitions.

Results

All PCR and IFAT tests were negative. No MWDs

were classified as CanL cases or CanL probable

cases. Although 16 MWDs met the CanL suspect case

definition, no correlation was found between the

length of time MWDs were exposed and the number

of CanL-related clinical signs abstracted from

medical records.

Conclusions

The results suggest that the potential for MWDs to

translocate CanL is very low.
18 Army Medical Department Journal

In Mallorca, Spain, the prevalence of canine infection

was determined by using polymerase chain reaction

(PCR) and serological tests. The results indicate that

67% of dogs might be infected by leishmaniasis and

that the prevalence of infection is much greater than

the prevalence of overt leishmaniasis-related disease.7

Leishmaniasis can also display a wide disease

spectrum in dogs ranging from clinical disease to

asymptomatic infections.9 However, successful

treatment does not completely eliminate the CanL

threat.10 Even clinically cured dogs remain

parasitologically positive and, therefore, infectious to

the sand fly vector.11

Dogs infected with CanL that have failing immune

systems can present a vague clinical picture with

nonspecific and sporadic signs (see Figure 1). The

most common clinical signs include ulcerated dermal

lesions, dry skin with desquamation/scaling (lasting

less than 2 months), lymphadenopathy, nephropathy,

facial muscle atrophy, underweight at necropsy, and

conjunctivitis. The incubation period of CanL can last

from several weeks to several years, which makes

immediate diagnosis difficult, especially if the dog is

no longer in an area where leishmaniasis is endemic.

These problems add to the long delay between sample

collection, analysis, diagnosis, and subsequent control

of outbreaks, making leishmaniasis difficult to

eradicate.3

The relationship between the prevalence of

leishmaniasis in the canine population and human

disease has direct public health implications.12,13 The

problem, in part, arises because clinical forms of

CanL, characterized by chronic evolution of

viscerocutaneous signs, occur in less than 50% of

infected dogs.14 Infected, asymptomatic dogs are

sources of the parasite for the phlebotomine vector

sand flies. Therefore, these dogs play an active role in

the transmission of leishmaniasis,15 posing a small risk

of transmission from pets to members of the owner’s

family and other people in their community.16 In

addition, it has been suggested that infected dogs

bitten by sand flies in nonendemic areas can spread the

infection, creating new endemic areas.

17

The risk for military working dogs (MWDs) to

contract CanL while stationed in the Mediterranean

Basin is undetermined. Typically, up to 60 MWDs are

stationed at bases throughout the Mediterranean area.

Some idea of exposure of MWDs to leishmaniasis can

be gained from a seroprevalence study performed on

50 dogs, which resided with US personnel assigned to

Naval Air Station Sigonella in Sicily. The data

indicated a high exposure rate to CanL, with 60% of

the study population having elevated immunoglobulin

M antibody levels. These results suggest that the dogs

were recently infected with leishmania infantum

during a 2- to 3-year tour in Sicily.18

The disease spectrum of leishmaniasis appears to

correlate with the organism load level within

individual dogs. Dogs with clinical disease have higher

tissue and serum leishmaniasis organism levels.

Testing instruments, in particular PCR and the

immunofluorescent antibody test, more easily detect

these higher organism levels. Conversely, dogs with a

lower Leishmania burden have fewer organisms for

diagnostic tests to detect and are consequently more

difficult to diagnose.

In addition to the lack of widespread testing of MWDs,

another major limitation is the inability to identify and

count asymptomatic carriers, because classic

diagnostic tests are insufficiently sensitive.2In

addition, clinical signs are not reliable, making

diagnosis of CanL difficult. These problems in

diagnosing asymptomatically infected leishmaniasispositive dogs have prevented a clear assessment of the

true risk of CanL to MWDs stationed near the

Mediterranean Basin, although there have been no Figure 1. Rottweiler with leishmaniasis

The Impact of Leishmaniasis on Military Working Dogs with Mediterranean Basin Exposure
July – September 2007 19

known reported clinical cases of leishmaniasis in

MWDs originating from that area. Accordingly, a

reliable diagnostic test for the detection of CanL, both

in symptomatic dogs and suspected animals, is

needed.19 The parasitological gold standard is isolation

of the leishmaniasis organism, but parasites are rarely

seen, and the histopathological method is

nonspecific.20

Parasitological techniques currently in use, usually

performed on bone marrow aspirates or lymph node

aspirates, lack sensitivity to direct examination.

Serological methods (immunofluorescence assay,

enzyme linked immunosorbent assay [ELISA]) are

effective in detecting active leishmaniasis when large

amounts of specific antibodies are present. However,

the usefulness of these techniques is limited in the

areas where the disease is endemic due to the high

number of animals with low levels of antibodies.21

The purpose of this study was to determine the

prevalence of CanL in MWDs stationed at selected

locations in the Mediterranean Basin using

immunofluorescence assay testing (IFAT), PCR tests,

as well as medical record abstraction and analysis.

Public health concerns regarding leishmaniasis

infections were also addressed.

METHODS

Study Population

Records, sera, and tissue samples were drawn from

MWDs stationed in the following leishmaniasisendemic locations:

 Iraklion and Souda Bay Naval Station, Crete

 Nea Makie, Greece

Egypt

Italy

 Sigonella Naval Air Station, Sicily

 Naples Naval Air Station

 Vicenza Army Base

 Palmenola Air Base

Spain

 Zaragoza Air Base

 Torrejon Air Base

 Rota Naval Air Station

Turkey

 Incirlik Air Force Base

 Ankara

Sampling and Testing Protocol

A search was conducted to identify MWDs stationed at

the selected military installations using the MWD

database at the Department of Defense Dog Center,

Lackland Air Force Base, San Antonio, TX. Of the

2,315 MWD medical records available, 64 matched

the criteria. However, the medical records of 7 MWDs

could not be located, resulting in 57 records for data

abstraction. Frozen serum was available for only 32

(56%) of these 57 MWDS. Because postMediterranean basin exposure serology samples were

used, 25 MWDs were identified as either missing

serology records after CanL exposure, or missing

frozen serum.

Thirty-six medical records had corresponding tissue

samples available at the Walter Reed Army Institute of

Research (63%). Tissue samples for 21 MWDs were

unavailable, because no necropsy was performed or

the medical record did not contain a pathology report

from the Armed Forces Institute of Pathology (AFIP)

in Washington, DC. Figure 2 illustrates how the study

population was identified, and the procedures for

obtaining tissue (PCR), serum (IFAT), and medical

records.

Serological testing was performed by Frank Seuter,

utilizing methodology developed at the Centers for

Disease Control and Prevention (CDC) by Dr Peter

Schantz, Division of Parasitic Diseases.

Immunofluorescence assay testing was configured to

detect specific antibodies to the leishmaniasis

organism. The intensity of the titer reflects both the

stage of the infection and the animal’s response to the

infection, with the antibody titer generally increasing

(from 1:16 to 1:512 or greater) as the infection

progresses.22 The interpretation of the IFAT closely

followed the CDC’s recommendations: leishmaniasispositive serum titers of 1:16 or higher were termed

possible infections, titers of 1:64 or greater were

termed highly suspected infections.

Fluorogenic polymerase chain reaction (Smart Cycler

PCR cycling protocol) tests were performed with

enhanced specificity, as the assay target incorporated a

segment of the small-subunit rRNA gene, which is

conserved among all leishmaniasis species.
20 Army Medical Department Journal

Sections (5 μm thick) were cut from the samples, while paraffin removal, DNA purification, and DNA

extraction (by column chromatography) were performed according to the manufacturer’s instructions

(QIAamp Tissue Kit; Qiagen, Valencia, CA). Specific PCR reaction mixtures incorporated water, MgCl2, PCR

beads (formerly Amersham Pharmacia Biotech, Inc., Uppsala, Sweden, now Amersham Biosciences), primers,

and the leishmaniasis probe. A Leishmania infantum probe was used for PCR testing, because it was the

dominant leishmaniasis subspecies found in the Mediterranean Basin. Samples for PCR testing were run in

groups of 10-13.

Define CanL endemic areas of interest

Identify military bases where military working dogs

are stationed within endemic areas

Locate military records of military working dogs at

the DoD Dog Center*

Military working dog record utilization: PCR†,

IFAT‡, medical history

Collate and forward

accession numbers

to the Armed Forces

Institute of Pathology

for tissue retrieval

(63% MWDs§)

Walter Reed Army

Medical Center

receives tissue

s a m p l e s a n d

performs PCR†

testing.

L o c a t e s e r u m

samples at the Fort

S a m H o u s t o n

Veterinary Laboratory

(56% MWDs§)

CDC** receives

serum samples

and perform s

IFAT‡testing.

Locate and record

necropsy accession

n u m b e r s f r o m

necropsy reports.

Locate and record

serology accession

numbers.

Abstract medical

records.

Figure 2. Process flow of military working dog tissue sampling strategy

*Department of Defense Dog Center at Lackland Air Force Base, Texas

†Polymerase chain reaction

‡Immunofluorescence assay test

§Military working dogs

**Centers for Disease Control and Prevention, Atlanta, Georgia

The Impact of Leishmaniasis on Military Working Dogs with Mediterranean Basin Exposure
July – September 2007 21

MWD MEDICAL RECORDS

Medical records were available in either hardcopy or

microfiche format. The study focused on the MWD

medical record’s Master Problem List (Form 3071),

standard form 600 (SF 600), and the record of military

dog physical examination (DD Form 1829). The

records summarized significant diagnoses, and aided

in the collation of CanL-related medical problems.

Laboratory and necropsy reports within the medical

records enhanced the clinical picture.

DATA ANALYSIS

Questions concerning the medical history of MWDs

were designed to determine the presence or absence of

specific CanL-related clinical signs. The

characteristics of MWDs in each category were

collated to derive the corresponding percentages for

MWDs having designated signs and symptoms. This

classification strategy allowed the identification of

potential CanL-positive and negative MWDs using the

relative frequencies of observed signs and symptoms.

An abstracted list of variables, including specific

clinical signs, is presented in the Table.

Information was recorded in an Excel (Microsoft Inc,

Redmond, WA) spreadsheet and stored for data

analysis. Minitab Statistical Software (Minitab Inc,

State College, PA) was used for data and statistical

analysis. The correlation of exposure months and

number of clinical signs was tested using the Pearson

correlation coefficient.

Case Definitions

Several CanL case definitions were used.

CanL Case. Military working dogs with positive CanL

parasitological test results (PCR, stained smears from

bone marrow, spleen, liver, lymph node, or blood).

CanL Probable Case. Exposed MWDs with a positive

anti-CanL antibody test (ELISA, IFAT) and any

clinical, laboratory, and necropsy finding, such as dry

skin desquamation/scaling, facial muscle atrophy,

underweight at necropsy, lymphadenopathy,

conjunctivitis, or nephropathy.

CanL Suspect Case. Exposed MWDs possessing any

two of the previously mentioned clinical, laboratory,

and necropsy findings.

Results

No MWDs satisfied either the CanL case or CanL

probable case definition criteria. Although all MWDs

displayed both negative PCR and IFAT results, 16

MWDs met the CanL suspect case definition by

displaying at least 2 CanL signs or symptoms after

exposure to the Mediterranean Basin.

All MWDs were negative for >1:16 titer serology

(N=32) and PCR results (N=36). Both negative PCR

and IFAT results were obtained for 16 of 57 MWDs

(28%), increasing the confidence that these MWDs

were negative for CanL.

Figure 3 shows the clinical signs

collated from the 57 medical records.

The most frequent signs were

lymphadenopathy (21%), nephropathy

(19%), and desquamation (18%).

Figure 4 shows the frequency of

clinical signs for the number of clinical

signs. Thirty-nine percent of the

MWDs (N=57) had no clinical signs,

while 37% had one sign, and 25% of

MWDs had 2 or more clinical signs.

Figure 5 shows a scatterplot of the

number of clinical signs versus

Mediterranean basin exposure. The

Pearson correlation coefficient of -

0.080 reflects the lack of association

between these 2 variables (P=0.553).

Abstracted list of variables collected from military working dog medical

records to use in data analysis to determine the presence or absence of

specific CanL-related clinical signs.

Demographic Variables Medical History Variables

Name Ulcerated dermal lesion(s)

Tattoo number Skin desquamation/scaling

Date of birth Underweight on necropsy

Date of death Facial muscle atrophy

Age at death Nephropathy

Breed Lymphadenopathy

Gender Conjunctivitis

Number of times reporting to Mediterranean Basin Leishmaniasis screening

Months in Mediterranean Basin Leishmaniasis diagnosis

Location(s) stationed

Report date

Departure date
22 Army Medical Department Journal

DISCUSSION

Prior to this study, the potential for MWDs to harbor

subclinical CanL appeared likely, given the prevalence

(10% to 37%) of CanL in southern Europe,7and the

close proximity of MWDs to the competent sand fly

vector. Clinical-complex masking of CanL was

considered possible because of the high level of

medical and nutritional support provided to MWDs.

Healthy MWDs are thought less likely to display

typical CanL symptoms. Stray dogs in southern

Europe frequently exhibit clinical signs, largely

due to immunosuppression arising from poor

nutrition and inadequate medical care, including

the absence of topical insecticides.

The fact that no MWDs in this study were

classified as CanL cases or CanL probable cases

suggests that the potential for MWDs to translocate

CanL is very low. Although 16 MWDs met the

CanL suspect case definition, no correlation was

found between the length of time MWDs were

exposed and the number of CanL-related clinical

signs abstracted from medical records. However,

previous studies of dogs located within the

Mediterranean Basin have clearly demonstrated a

positive correlation between length of time

exposed and the number of dogs with CanL,23

which might cast doubt on the assumption that the

abstracted clinical signs in

this study are predictive for

CanL.

The lack of diagnostically

p o s i t i v e ( P C R / I F A T )

s y m p t o m a t i c , o r

asymptomatic (based on

abstracted clinical signs)

MWDs in this study also

suggests that MWDs are less

likely to be subclinical

carriers, and were probably

never infected with CanL.

Moreover, MWDs appear less

vulnerable to the potentially

infective and ubiquitous sand

fly. A plausible explanation is

that the regular treatment of

MWDs with several topical

insecticides might produce a

sand fly antifeeding effect. Recent studies support this

assumption. For example, one study found that sand

fly blood feeding and the survival rate of both fed and

unfed flies were significantly reduced by the

permethrin, deltamethrin, and fenthion treatments.

24

Thus, insecticides applied to MWDs for external

parasite control appear to have reduced the incidence

of CanL, which would, in turn, reduce the potential for

MWDs to act as reservoirs for human leishmaniasis.

Frequency of Clinical Signs

10

2 3 4 5

5

1

0

15

20

25

Number of Clinical Signs

Figure 4. The frequency of clinical signs plotted against the

number of clinical signs determined in the data analysis of

the military working dog medical records (N=57).

The Impact of Leishmaniasis on Military Working Dogs with Mediterranean Basin Exposure

G

A

B

C

D

E

F

A.Lymphadenopathy, 21%

B.Nephropathy, 19%

C.Desquamation, 18%

D.Underweight necropsy, 14%

E.Conjunctivitis, 12%

F.Ulcerated dermal lesions, 10%

G.Facial muscle atrophy, 6%

Figure 3. CanL-related clinical signs abstracted from the medical records of military

working dogs (N=57).
July – September 2007 23

While the results of this study cannot definitively

describe the risk of CanL to MWDs in the

Mediterranean Basin, they do suggest that the potential

for MWDs to translocate CanL leishmaniasis into

nonendemic areas, or serve as a reservoir for human

leishmaniasis, is more unlikely than previously

assumed.

There are a number of limitations inherent in the

design of this study. First, the selection of MWDs with

Mediterranean Basin exposure could not be

randomized due to the limited numbers of exposed

dogs. Second, the study was descriptive in nature and

provided only quantitative estimates of the magnitude

of CanL infections in MWDs. The design of this

prevalence study fell short of identifying causation,

because the presence of CanL infections in selected

MWDs could not be ruled out prior to their exposure

in the Mediterranean Basin. Third, all medical record

abstractions were performed after the PCR and IFAT

results were collated. If any of the PCR or IFAT

results had been positive, this knowledge might have

biased the focus of the abstraction process. Finally, the

author of this study was stationed at a veterinary clinic

within the Mediterranean Basin where he diagnosed

and euthanized dogs with CanL. These experiences

might have affected his opinion on CanL’s impact in

southern Europe.

There is no 100% specific and sensitive test for CanL.

The simplest and most specific diagnostic method is

the demonstration of CanL amastigotes in stained

smears of bone marrow or in the fine needle aspirates

of lymph nodes. Utilizing these methods to find the

parasite provides an extremely specific test, but the

sensitivity of this approach is poor (30% with lymph

node smears). For this reason, IFAT (widely

considered the serology gold standard, and a 3% to 4%

false-positive rate), and PCR (proven to be highly

sensitive and specific) were employed. For the purpose

of this study, both “possibly infected” and “highly

suspected” MWDs would have been considered

serologically positive. Negative IFAT results for CanL

did not necessarily indicate the absence of CanL, but

did indicate either the absence or the inability to detect

leishmaniasis antibodies.

The causative agents of the Trypanosome Cruzi and

Leishmania spp. parasites belong to the

Trypanosomatidae family and share various antigens

that cause cross-reactivity in serological diagnosis. As

the MWD study population might have been exposed

to Trypanosoma Cruzi—it is endemic in south Texas,

and all MWDs selected for this study spent varying

lengths of time in that area—cross-reactivity concerns

were addressed by using both PCR and IFAT testing.

PCR tests provide greater specificity through

amplification of leishmaniasis

DNA. In addition, if any of the

IFAT tests had been positive,

serum samples would have been

tested for T. Cruzi to quantify

and control for potential crossreactivity. Military working

dogs that had a negative PCR

test with both a positive CanL

IFAT and T. Cruzi test result

would have been considered

cross-reactive, and not

categorized as a CanL case,

probable case, or suspected case.

Further research on the

prevalence of CanL would be

useful. Many stray dogs are

found in or near US installations

in southern Europe, and are

often adopted by US service

members and brought to the

0 20 40 60 80 100 120

1

2

3

4

0

Mediterranean Basin Exposure (months)

Number of Clinical Signs in M

W

Ds*

Figure 5. The scatterplot of the number of clinical signs against Mediterranean

basin exposure determined in the data analysis of the military working dog* medical

records. The Pearson correlation coefficient of -0.080 reflects the lack of

association between the 2 variables (P=0.553).
24 Army Medical Department Journal

United States without being tested for CanL.

According to internal US Army Veterinary Command

data, approximately 1,000 privately owned dogs are

imported annually from southern Europe with US

military families. United States entry requirements are

minimal, requiring only a current health certificate and

proof of rabies vaccination. The influx of dogs and

minimal screening requirements have raised concerns

of importing CanL into the United States and other

historically CanL nonendemic areas.

In March of 2002, the CDC, in conjunction with the

US Army Veterinary Corps, started collecting serum

from dogs owned by military service members

returning to the United States from bases around the

Mediterranean Sea. It is hoped that this project will

better define the risk of importing CanL from military

bases in southern Europe to nonendemic leishmaniasis

areas.

ACKNOWLEDGEMENT

The author thanks Dr Michelle Fleetwood at the AFIP

who retrieved the formalin-fixed and paraffinembedded liver and spleen MWD tissues for PCR

testing from storage at the Walter Reed Army Institute

of Research, and Lisa Hochenberg at the Walter Reed

Army Medical Center for her assistance with the PCR

testing.

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1. Ashford RW. Leishmaniasis reservoirs and their

significance in control. Clinical Dermatol.

1996;14:523-532.

2. Ryan JR, Smithyman AM, Rajasekariah GH,

Hochberg L, Stiteler JM, Martin SK. Enzyme-linked

immunosorbent assay based on soluble promastigote

antigen detects immunoglobulin M (IgM) and IgG

antibodies in sera from cases of visceral and

cutaneous leishmaniasis. J Clin Microbiol.

2002;40:1037-1043.

3. Reithinger R, Quinnell RJ, Alexander B, Davies CR.

Rapid detection of Leishmania infantum infection in

d o g s : c o m p a r a t i v e s t u d y u s i n g a n

immunochromatographic dipstick test, enzyme-linked

immunosorbent assay, and PCR. J Clin Microbiol.

2002;40:2352-2356.

4. Moreno J, Alvar J. Canine leishmaniasis:

epidemiological risk and the experimental model.

Trends Parasitol. 2002;18:399-405.

5. Sideris V, Papadopoulou G, Dotsika E, Karagouni E.

Asymptomatic canine Leishmaniasis in greater

Athens area, Greece. Euro J Epidemiol. 1999;15:271-

276.

6. Carrio J, Portus M. In vitro susceptibility to

pentavalent antimony in Leishmania infantum strains

is not modified during in vitro or in vivo passages but

is modified after host treatment with meglumine

antimoniate. BMC Pharmacol. 2002;2:11.

7. Solano-Gallego L, Morell P, Arboix M, Alberola J,

Ferrer, L. Prevalence of Leishmania infantum

infection in dogs living in an area of canine

leishmaniasis endemicity. J Clin Microbiol.

2001;39:560-563.

8. Gradoni L. Epizootiology of canine leishmaniasis in

southern Europe. In: Killick-Kendrick R, ed. Canine

leishmaniasis: an update. Proceedings of the Canine

Leishmaniasis forum, Barcelona, Spain. Wiesbaden,

Germany: Hoechst Roussel Vet; 1999:32-39.

9. Solano-Gallego L, Llull J, Arboix M, Ferrer L,

Alberola J. Evaluation of the efficacy of two

leishmanins in asymptomatic dogs. Vet Parasitol.

2001;102:163-166.

10. Baneth G, Shaw SE. Chemotherapy of canine

leishmaniosis. Vet Parasitol. 2002;106:315-324.

11. Reithinger R, Davies CR. American cutaneous

leishmaniasis in domestic dogs: an example of the

use of the polymerase chain reaction for mass

screening in epidemiological studies. Trans R Soc

Trop Med Hyg. 2002;96(Suppl 1):S123-S126.

12. Gavgani AS, Mohite H, Edrissian GH, Mohebali M,

Davies CR. Domestic dog ownership in Iran is a risk

factor for human infection with Leishmania infantum.

Am J Trop Med Hyg. 2002;67:511-515.

13. Marty P, Le Fichu Y, Giordana D. Leishmanin

reaction in the population of a highly endemic focus

of canine leishmaniasis in Alpes Maritimes, France.

Trans R Soc Trop Med Hyg. 1995;86:249-250.

14. Lanotte JA, Periers J, Vollhardt Y. Ecology of

leishmaniasis in the south of France. Ann Parasitol

Hum Comp. 1979;54:666-667. Available at: http://

wcentre.tours.inra.fr/sfpar/revues.htm.

15. Molina R, Amelo C, Nieto J, San-Andres M.

Infectivity of dogs naturally infected with Leishmania

infantum to colonized Phlebotomus pernicious. Trans

R Soc Trop Med Hyg. 1994;88:491-493.

16. Strauss-Ayali, D., Baneth, G.: Canine visceral

leishmaniosis. In: Carmichael L, ed. Recent Advances

in Canine Infectious Disease. Ithaca, NY:

International Veterinary Information Service; 2000.

The Impact of Leishmaniasis on Military Working Dogs with Mediterranean Basin Exposure
July – September 2007 25

17. Travi BL, Ferro C, Cadena H, Montoya-Lerma J,

Adler GH. Canine visceral leishmaniasis: dog

infectivity to sand flies from nonendemic areas. Res

Vet Sci. 2002;72:83-86.

18. Orndorff GR, Cooper BA, Smith W, Ryan JR.

Canine visceral leishmaniasis in Sicily. Military

Med. 2000;165:29-32.

19. Pozio E, Gradoni L, Bettini S, Gramiccia M. Canine

Leishmaniasis in the focus of Monte Argent Rio

(Grosseto). Acta Trop. 1981;38:383-393.

20. Schallig HD, Schoone GJ, Kroon CC, Hailu A,

Chappuis F, Veeken H. Development and

application of “simple” diagnostic tools for visceral

Leishmaniasis. Med Microbiol Immunol.

2001;190:69-71.

21. Asia MJ, Castillejo S, Gallego M, Fisa R, Riera

MC. Diagnostic potential of western blot analysis of

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AUTHOR

MAJ Killian is the Executive Officer, Japan District Veterinary Command at Camp Zama, Japan. Previously, he was

the Branch Chief, Southern Europe Veterinary Detachment, Sigonella Branch, Sicily, Italy, from August 1999 to

August 2000.
26 Army Medical Department Journal

The Hidden Work of a Laboratory

Animal Veterinarian

MAJ Craig A. Koeller, VC, USA

If one asks most people how a laboratory animal

veterinarian in the Army can make a difference to the

Soldiers in a time of war, the likely response will

concern medical product testing, vaccines, therapies

for diseases, or perhaps basic research into areas such

as limb regeneration. Another possibility, but one

more likely to be overlooked, is the provision of help

in the training of medical personnel, especially the

combat medic. This training will likely be

multifaceted, but may involve the use of animals, thus

requiring a veterinarian to oversee their use. The final

training is important and can yield great results,1but

how is such training developed and what occurs in the

hours behind the visible portion of running such

training? This article provides an inside look from the

perspective of a veterinarian, based on my experience

in assisting in the implementation of a combat trauma

course at the Madigan Army Medical Center.

The effort started in the most basic fashion, with

someone perceiving a need for Soldiers (in this case,

combat medics) to get more trauma training to help

save the lives of their comrades on the battlefield. In

my specific circumstance, it was a chance lunchtime

meeting with one of the local brigade surgeons who

asked if I knew of a group in the hospital that could

provide such training. The entire group must be

willing to support the development and execution of

the training. The group must determine exactly what

subjects should be taught, relevance of subjects trained

as related to injuries encountered, and actual method

of providing the training. The subjects taught and

relevance are mainly decided by the doctors for whom

the medics work and the surgeons who see the results

of the treatments medics provide.

Medical simulators, didactics, skill stations, and

animal models all have a role in this training. The US

Animal Welfare Act 2and Army Regulation 40-33 3

require that the veterinarian be intimately involved in

all aspects of animal use, to include helping the

responsible individual write the proposal for the

training program. The veterinarian must act as the

advocate of the animal in trying to make sure the

appropriate species will be used, only the actual

number of animals that are needed will be used, and

that the planned and performed procedures match after

the protocol has been approved. This information is

written into a proposal called an animal protocol that

must be approved by an Institutional Animal Care and

Use Committee (IACUC). This committee will review

the proposal to determine if

1. the proposal warrants using animals,

2. the procedures to be performed are appropriate

to the study or training goals,

3. the personnel that will be conducting the training

are qualified to do so,

4. there are alternatives to using animals (at least to

some extent by utilizing medical simulators),

and

5. the welfare of the animals is protected.

The Committee can accept the proposal, require

revisions before accepting the proposal, or withhold

approval. In the case of trauma training, the discussion

on such a protocol will tend to be quite involved. Items

of interest normally include:

 Appropriate anesthesia will be maintained when

animals are being used.

 The animal will be euthanized in a humane

manner.

 Maximum use of the animal.

 Training of the medics will be balanced.

 Procedures to be performed match with the people

who will perform them.

Anesthesia is simpler to maintain when the animal is

in a surgery type setting where gas anesthesia can be

used, but more difficult in a field environment. The

“casualty” will be moved and transported in a field

environment, and injectable anesthesia is used. In the

field, the veterinarian and veterinary staff must be

more vigilant in constantly assessing the animal’s
July – September 2007 27

plane of anesthesia as each animal will metabolize the

injectable anesthetic at a different rate.

After the local IACUC approves the protocol, the

protocol is submitted to the Clinical Investigations

Regulatory Office (CIRO) to ensure that all applicable

laws and regulations will be followed. After reviewing

the protocol, CIRO will address any concerns they

have to the local IACUC.

There are 2 other areas within which the veterinarian

must also interact in order to make a course such as

this possible. Public affairs officials must know about

the course and be fully briefed on what will be

occurring and how it is conducted. It is especially

important that it is well understood that the animals

will be anesthetized and monitored at all times to

ensure they feel no pain. Photographs taken of animals

used during this training could result in a large outcry

from animal rights proponents, especially if

misinformation accompanies the pictures, such as no

acknowledgement that the animals are anesthetized. It

is the job of public affairs officials to help diffuse the

misconceptions and ensure facts are disseminated if

information must be provided to outside media or in

response to questions from individuals.

The last agency that should be consulted is office of

Occupational Health and Safety. Any work around

animals carries some risks. The most common risk is

the allergens that animals carry. People can have an

allergic reaction to the fur, dander, or other aspects of

the animals. Occupational Health will help to perform

a risk assessment for exposures to potential allergens

for both participants and instructors. In cooperation

with Occupational Health, part of the veterinarian’s

briefing about the lab and field phases includes

information about possible zoonotic diseases the

animals may harbor, and as well as the potential

allergens and allergies. Students are warned about the

possibility of allergies. They are asked to inform the

instructors or Occupational Health if they suffer from

asthma or known allergies that could affect their health

during the course.

The veterinarian oversees the purchase and care of all

animals. The veterinary staff must anesthetize and

prepare the animals for the controlled skills laboratory

and the field exercise. While the instructors

demonstrate skills or assess the skills of the students,

the veterinary staff works in the background

controlling the animal’s anesthesia to ensure that no

pain is felt.

It is extremely satisfying to be a participant in a course

such as the Madigan combat trauma course, as the

growth of the medics’ skills is clearly evident as the

course progresses. Their confidence in their skills

increases as well. The hours can be long, especially

when performing field training. The US military owns

the night, therefore medics must treat patients in the

dark. We honor the creed “to train as we fight,”

accordingly, the trauma training of medics must

include training during the hours of darkness. Thus,

the final day of the field phase portion of the Madigan

combat trauma course would last from about 9 AM

until midnight.

The laboratory animal veterinarian is a vital member

of any training involving animals. The person filling

this role is not only in a highly visible position in the

conduct of the actual training, but is also very much

involved in the work required to obtain approval for

such a program. Indeed, perhaps the most important

role of the veterinarian is helping to obtain protocol

approval, and ensuring that all of the requirements of

federal law and military regulations are followed.

Although it may not be as visible or appreciated, it is

this work that makes the training possible.

REFERENCES

1. Sohn VY, Miller JP, Koeller CA, et al. From the

combat medic to the forward surgical team: the

Madigan model for improving trauma readiness of

brigade combat teams fighting the global war on

terror. J Surg Res. 2007;138(1):25-31.

2. Animal Welfare Act, 7 USC, §2131-2159 (1990).

3. Army Regulation 40-33: The Care and Use of

Laboratory Animals in DOD Programs. Washington,

DC: US Dept of the Army; February 16, 2005.

AUTHOR

MAJ Koeller is Chief, Veterinary Support Services,

Veterinary Medicine Division at the US Army Research

Institute of Infectious Disease, Fort Detrick, Maryland.

Previously, he was Chief, Laboratory Animal Resources

Service Department of Clinical Investigation, Madigan

Army Medical Center, Fort Lewis, Washington.
28 Army Medical Department Journal

INTRODUCTION

The use of infectious agents as biological weapons

dates at least as far back as the 14th century. Since that

time, there have been documented instances of the

deliberate use of biowarfare agents such as plague,

smallpox, glanders, and anthrax to achieve military

goals.1 Extensive state-sponsored biological weapons

programs were conducted in the 20th century by

Germany, Japan, and the former Soviet Union.2 The

United States also operated a program that included

the weaponization of several infectious agents until

1969, when President Richard Nixon ended the

country’s offensive weapons program. Since that time,

the United States has limited its efforts to defensive

countermeasures against biological agents. Concerns

about the threats posed by biological weapons have

intensified in recent years due to information brought

to light since the fall of the Soviet Union, attempts by

terrorist groups and others to obtain biowarfare agents,

and as a result of the anthrax murders in the United

States in 2001. Concern about biological weapons is

further increased because of an understanding of the

potential harm presented by genetically engineered

agents. Not surprisingly then, the matter of biological

weapons is of great interest to the Department of

Defense (DoD). The infectious agents typically

associated with biological weapons are also of concern

because military members may be exposed to them

naturally in areas of military deployments. The nature

of the disease that may result from exposure of troops

to biowarfare agents, whether naturally or through

deliberate spread, can vary greatly. Some biowarfare

agents cause incapacitating disease with high

morbidity, while others can be highly lethal. Either

way, they pose a major challenge for combat

commanders and support personnel, especially medical

units. There is, therefore, a great need to develop

effective countermeasures to contend with the threat

posed by biological agents.

Countermeasures against biological agents include

diagnostics, vaccines, therapeutic agents, and

operational practices. Historically, much of the

research necessary to develop such countermeasures

has fallen upon the military because it was not

considered to have much relevance to the civilian

population. That philosophy has changed in recent

years, however, especially in light of the anthrax

murders. Nonetheless, the military has played a lead

role in the nation’s biodefense research program. The

US Army Medical Research and Materiel Command is

the executive or lead agency responsible for 2 key

biodefense programs, the Medical Chemical and

Biological Defense Research Program and the Military

Infectious Diseases Research Program. Actual research

investigations under these programs are performed at a

variety of DoD and civilian institutions. The majority

of military studies that require biological containment

are performed at the US Army Medical Research

Institute of Infectious Diseases (USAMRIID), which

houses biocontainment facilities at both biosafety level

3 (BSL-3) and BSL-4 (maximum biocontainment).

Research at USAMRIID is conducted in compliance

with the Animal Welfare Act* and other federal

statutes and regulations relating to animals and

experiments involving animals, and adheres to

principles established by the Institute of Laboratory

Animal Research.3 The facility where research is

conducted at USAMRIID is fully accredited by the

Association for Assessment and Accreditation of

Laboratory Animal Care International (5283 Corporate

Drive, Suite 203, Frederick, MD 21703-2879).

The challenges to developing countermeasures to

biological agents are many and varied. The

development of vaccines, antibiotics, and other

therapeutics for use in humans is a process that, under

Challenges in Biodefense Research and the

Role of US Army Veterinary Pathologists

COL Keith E. Steele, VC, USA

MAJ Derron A. Alves, VC, USA

MAJ Jennifer L. Chapman, VC, USA

*7 USC, 2131-2159. Available at: http://www.nal.usda.

gov/awic/legislat/awa.htm.
July – September 2007 29

the best of circumstances, takes several years and costs

millions of dollars for each product. Product

development typically requires advanced knowledge

about the pathogenesis of the disease agent in humans.

It also requires that one or more appropriate animal

models exist for which the disease course is

sufficiently similar to the human condition, so that the

safety and efficacy of the vaccine or therapeutic agent

can adequately be assessed. For many biowarfare

agents, the efficacy of vaccines or therapeutics cannot

even be tested in humans, for ethical or other reasons.

This has recently led to the acceptance of the so-called

“animal rule,” which permits the Food and Drug

Administration (FDA) to rely on evidence from animal

studies to judge the likely effectiveness of vaccines or

therapeutics in humans. This approach requires that the

pathogenesis of a particular disease agent is well

demonstrated in one or more animal models and that

the nature by which a vaccine or therapeutic would

provide protection is well understood. The use of the

animal rule to facilitate development of biowarfare

countermeasures provides a key tool in biodefense

programs, however, it places even greater emphasis on

the proper conduct of animal studies, including

pathogenesis studies and vaccine or drug therapy

studies involving pathology.

Army Veterinary Corps (VC) officers are key

components of the research, support, and headquarters

staffs of USAMRIID. Several VC officers have served

as USAMRIID commanders and deputy commanders

in recent years. Veterinary Corps pathologists direct

USAMRIID’s pathology services, perform all phases

of pathology analysis for institute studies, and conduct

primary research. Veterinary Corps pathologists

represent a very small proportion of the officers in the

Army Medical Department, yet they are some of the

most highly trained professionals in the US Army and

perform some of the most demanding and potentially

hazardous portions of DoD biomedical research.

Pathology training of graduate veterinarians in the

Veterinary Corps consists of a rigorous residency

program at the Armed Forces Institute of Pathology

(AFIP), leading to board certification. Upon

completion of the residency, veterinary pathologists

(area of concentration 64D) are assigned to Army,

Navy, Air Force, and joint laboratories at a number of

sites, both in and outside of the United States. These

include the AFIP, Walter Reed Army Institute of

Research, US Army Medical Research Institute of

Chemical Defense, Air Force Research Laboratory,

and Armed Forces Research Institute of Medical

Sciences. Some VC pathologists later enter graduate

programs leading to the PhD degree. Areas of

biomedical research in which veterinary pathologists

are involved range from combat casualty care to

chemical agent countermeasures to studies of a variety

of infectious diseases. These research areas rely

heavily on animal models as surrogates for human

conditions. Pathologists at USAMRIID specifically

study countermeasures to some of the most lethal

biological agents known, including plague, anthrax,

botulinum neurotoxin, Ebola virus, and smallpox.4

Working with these agents requires that veterinary

pathologists at USAMRIID conduct research in BSL-3

and BSL-4 laboratories. Pathologists may gain

sufficient experience and knowledge to become

subject matter experts on particular agents, and are

often called upon to provide their expertise to

organizations within and external to the military. For

example, Army pathologists from USAMRIID have

played major diagnostic roles in disease outbreaks,

such as the importation into the United States of Ebola

virus in monkeys, the emergence of West Nile virus in

birds and horses, and an outbreak of monkeypox in

imported pet animals.5-8 Also, USAMRIID

pathologists have participated in field studies around

USAMRIID pathology personnel at work in a biosafetylevel-4 laboratory. Biocontainment and personal safety

considerations for research with certain pathogens

mandate a variety of preventive measures, including that

personnel wear self-contained, chemically disinfectable

suits supplied with HEPA-filtered air.
30 Army Medical Department Journal

the world related to diseases like tularemia, plague,

and Ebola virus. Such studies are either DoD

sponsored or pathologists may serve as temporary

consultants to organizations like the World Health

Organization. The role that USAMRIID pathologists

play in biodefense research has even been featured in

the popular literature.9,10

In the remainder of this article, we illustrate important

challenges in biodefense research by considering 3

important biowarfare-related diseases of concern to the

DoD. We discuss the nature of the challenge presented

by each disease, review key biological features of

each, and highlight the role of army veterinary

pathologists in biomedical research through their

contributions to the knowledge base of these disease

areas.

VENEZUELAN EQUINE ENCEPHALITIS

Venezuelan equine encephalitis (VEE) is an important

mosquito-transmitted natural disease of horses. It is

similar to 2 other members of the Alphavirus genus,

eastern equine encephalitis and western equine

encephalitis. Despite their names, however, all 3

viruses are significant natural causes of human disease,

are considered biowarfare agents, and have been the

subject of extensive vaccine development efforts at

USAMRIID. Investigations with these viruses are

conducted at BSL-3. In humans, VEE virus usually

causes an acute, febrile, incapacitating disease. On

occasion, VEE causes large outbreaks, such as the

1995 epidemic in Columbia and Venezuela that

infected as many as 100,000 people.11 The virus is also

highly infectious by aerosol, having caused at least

150 infections in lab workers, most of which were

probably the result of aerosol infection.12 The VEE

virus is also easily grown to high titer in culture and is

relatively stable in storage, conditions that facilitate

weaponization. Although VEE is rarely lethal in

adults, the virus could serve as a significant

incapacitating agent if used in a biological attack. The

VEE vaccine program at USAMRIID has been active

for several years, but efforts have been confounded by

2 important factors. One is the need for a vaccine that

demonstrates effective immunity against aerosol

infection, a more difficult standard to achieve than

immunity against natural infection by mosquitoes.

Further, multiple serotypes of VEE viruses exist and

the virus is readily amenable to genetic manipulation,

so a vaccine must be capable of providing a significant

degree of cross-protection against a number of virus

strains.

From investigations of VEE outbreaks together with

experimental animal studies, there is a fair amount

known about the pathogenesis of VEE. The incubation

period of VEE virus in humans is about 1 to 4 days,

after which patients develop fever, severe headache,

myalgia, and chills, lasting from a few days to 2

weeks.11,13,14 Infection of the central nervous system

develops in a minority of VEE cases, resulting in

convulsions, paralysis, and sometimes death. A

number of animal species are susceptible to VEE virus

and they mimic important aspects of the human

disease.15 Rhesus and cynomolgus macaques are both

susceptible to infection with VEE virus and exhibit

disease much like that of humans.16 Their usefulness is

limited though by their cost, availability, size, and

animal-use concerns. Therefore, mice have been the

most extensively used animal model for VEE. Like

humans, mice also exhibit a biphasic illness with

infection of peripheral tissues preceding

neuroinvasion. In mice, though, 100% of susceptible

strains develop central nervous system infection and

die.

In the mouse model of VEE that mimics mosquito

transmission of virus, so-called dendritic cells in the

skin are the first type of cell infected.17 The mobile

dendritic cells transport virus to the draining lymph

Challenges in Biodefense Research and the Role of US Army Veterinary Pathologists

A USAMRIID pathologist (facing) processing samples in a

jungle laboratory. USAMRIID pathologists have deployed

in a variety of scientific roles, including investigations to

discover the natural reservoir of Ebola virus in the

Democratic Republic of the Congo and the Ivory Coast

(shown above).
July – September 2007 31

node, where initial replication occurs.18 This results in

viremia, after which virions in the blood appear to gain

access to the brain by way of the olfactory nerves.19

Virus then spreads throughout the brain and into the

spinal cord.20,21 Neurons are the primary target of viral

infection in the brain, and they suffer massive cell

death.20-22 At USAMRIID, aerosol studies of VEE in

mice have been used to study the course of disease

expected in a biowarfare event. By the aerosol route,

VEE virus first infects the olfactory neurons of the

nasal tract.20,21 Because the olfactory neurons project

axons directly to the brain, VEE virus rapidly invades

the brain by this route of inoculation, independent of

the development of viremia. Although other tissues are

also infected after aerosol administration, the rapid and

overwhelming infection of the brain is the key event.

By comparison, macaques infected with VEE virus by

both peripheral and aerosol routes develop fever,

viremia, lymphopenia, and occasionally encephalitis,

but rarely die.16

Neuroinvasion by VEE virus independent of viremia

illustrates a key challenge in developing vaccines

effective against aerosolized virus. Viremia appears to

be an obligatory step in the pathogenesis of natural

VEE infection, therefore the development of serum

neutralizing antibodies (IgG) protects against a

peripheral infection, as is also the case for other

alphaviruses.23,24 However, neutralizing IgA antibody,

not serum IgG antibody, is required to protect mice

against aerosol challenge with VEE virus.23,25

An effective VEE vaccine must therefore be able to

stimulate sufficient mucosal IgA antibodies to protect

against aerosol infection of the nasal tract, as would be

expected in a biowarfare event.

TC-83, a live-attenuated VEE vaccine developed at

USAMRIID, is used to vaccinate laboratory workers

who handle VEE virus under Investigational New

Drug status. TC-83 is limited in its broader usefulness,

though, because it causes adverse side effects in

approximately 23% of human recipients, an additional

18% of recipients fail to develop protective serum

antibodies, and the vaccine does not provide sufficient

protection against aerosol infection in animals.23,25

V3526 is a rationally designed, genetically engineered

VEE vaccine, under development for several years.26

Studies at USAMRIID comparing V3526 and TC-83

showed that V3526 induced protective serum and

mucosal antibody titers with fewer nonresponders in

mice and demonstrated better protection against

aerosol infection of mice and nonhuman primates.25,27

It also protected mice and nonhuman primates against

challenge with a heterologous strain of VEE virus.28,29

Additional USAMRIID studies showed that V3526

appeared safer than TC-83 in rodents, being less

reactogenic and exhibiting significantly reduced

neurovirulence and decreased reversion potential.20,25,28 By several measures based on animal

studies, V3526 appears to be a safer and more

effective vaccine candidate than TC-83.16,30

Completion of human trials with V3526 required for

FDA approval and licensure remains a significant

hurdle before this vaccine can be used in its target

population.

SMALLPOX

Smallpox virus is an agent of potentially devastating

impact to both the military and the civilian

communities. The virus is easily transmitted from

person to person and produces disease with a mortality

rate around 30%.31 For centuries the scourge of

mankind, smallpox was officially considered

eradicated in 1980, providing perhaps the greatest

public health achievement against an infectious disease

in history. Official repositories of variola virus, the

agent of smallpox, continue to exist; however, they are

confined to biocontainment facilities at the Centers for

Disease Control and Prevention (CDC) in Atlanta, GA,

and at the State Research Centre of Virology and

Biotechnology in Russia.32 Additional clandestine

sources may also continue to exist in other locations

around the world.33 The Soviet Union is reported to

have manufactured large quantities of variola virus for

military purposes.1,34 Variola virus is considered

relatively stable in aerosols, making it amenable to

weaponization. For these reasons, smallpox remains a

serious concern as an agent of biowarfare or

bioterrorism. This concern is made greater because

population immunity to variola virus has greatly

waned since active vaccination of people ceased after

the eradication of smallpox. Efforts to reconstitute the

smallpox vaccination program for individuals

considered at risk have been met with resistance, due

to concerns about the adverse events that may be

associated with the vaccine. Complications such as

postvaccinal encephalitis and generalized vaccinia are

a particular risk for people with immunosuppression or

existing skin disease such as eczema.33 For various

reasons then, any deliberate use of smallpox virus
32 Army Medical Department Journal

would place great demands on our abilities to quickly

detect its introduction, to treat affected individuals,

and to limit its spread.

Animal models of smallpox are therefore needed to

develop improved countermeasures like antiviral

drugs, an effective and safe vaccine, and rapid

diagnostic tests. In addition, there is a need to better

understand many of the basic pathophysiological and

immunological aspects of smallpox in humans, as the

disease was eradicated before many modern scientific

techniques could be applied to human infections.35,36

Variola virus is one of 5 species in the genus

Orthopoxvirus that may cause active infection in

humans. The others are monkeypox virus, cowpox

virus, and to a lesser extent, camelpox and vaccinia

viruses, the latter being the virus used for smallpox

vaccination. Additional orthopoxviruses, such as

rabbitpox and ectromelia virus (mousepox), are not

pathogenic for humans, yet like the other

orthopoxviruses, they can serve as useful animal

models for understanding smallpox. While

monkeypox, cowpox, and camelpox are zoonotic

diseases, variola virus was strictly a human pathogen

in nature. In fact, the eradication of smallpox from the

world was successful much due to the fact that animal

reservoirs of the virus did not exist to reintroduce the

virus into the human population. The development of

an animal model for smallpox research is a very

difficult endeavor because of the resistance of animals

to infection, a challenge made even greater by the

logistical complications of working with variola virus.

Not only is variola virus a BSL-4 agent, but laboratory

work with the virus in the United States can only be

performed under maximum biocontainment at the

CDC. To meet these challenges, research at

USAMRIID makes use of a variety of animal models

of orthopox disease aimed at fulfilling the animal rule.

There are 2 varieties of smallpox, variola major and

variola minor, based on severity of disease and

mortality rate. Variola major has a case-fatality rate of

30% among unvaccinated persons, whereas variola

minor has a 1% case-fatality rate. Factors that affect

mortality include age, viral strain, immune response,

and nutritional status. Both humoral and cell-mediated

immunity are important in recovery from this

disease.31 The classic, or ordinary, form of smallpox is

a febrile disease with a characteristic vesiculopustular

skin rash. It is naturally spread through aerosol or

droplets from oropharyngeal secretions, or by direct

contact with infected persons or fomites.37 The cause

of death from smallpox appears to be the result of a

cytokine storm, a host response to viral infection

previously referred to as “toxemia,” as well as by

direct virus tissue damage.35,37,38 Other clinical forms

of smallpox, such as the hemorrhagic and flat-type, are

less common but highly pathogenic. USAMRIID

investigators and pathologists working at the CDC

have recently established a nonhuman primate model

of smallpox by infecting cynomolgus macaques

(Macaca fascicularis) with strains of variola

intravenously. Using high doses of virus, monkeys

develop systemic disease that closely resembles the

hemorrhagic form of human smallpox, and exhibit

uniform lethality.38 Pathology demonstrated viral

infection and organ dysfunction affecting the lymphoid

tissues, skin, oral mucosa, gastrointestinal tract,

reproductive system, and liver. Elaboration of

cytokines was also shown in these monkeys.

Inoculation of cynomolgus monkeys with high doses

of variola by aerosol produces a nonlethal illness in

which the monkeys develop a mild skin eruption but

do not develop lesions typical of classic smallpox.39

The nonhuman primate model of variola infection has

already been used to evaluate the efficacy of the

antiviral drug cidofovir, showing that the drug can

significantly lower viremias and the development of

skin lesions, as well as prevent death.35

Monkeypox is not only a very useful animal model for

smallpox, it is sometimes a fatal human pathogen as

well. Several human cases of monkeypox occurred in

the United States in 2003 after introduction of the

virus by imported rodents from Ghana.6 Monkeypox is

generally very similar clinically to smallpox but the

virus does not spread as easily among humans, likely

decreasing its effectiveness as a biowarfare agent. The

route of infection by monkeypox virus is also similar

to that of smallpox, including by the respiratory

route.31 A significant benefit of the monkeypox model

is that experiments can be conducted under BSL-3 at

USAMRIID. In particular, the aerosol model of

monkeypox is relevant to the disease expected after a

biowarfare release. A key USAMRIID pathology

study showed that aerosol infection of cynomolgus

monkeys produced lethal multisystemic disease and

that viral infection of the lower airways causing

bronchopneumonia was prominent.40 Monkeys have

also been shown to be susceptible to monkeypox virus

Challenges in Biodefense Research and the Role of US Army Veterinary Pathologists
July – September 2007 33

by the intravenous (IV) route.35 The IV and aerosol

models of monkeypox have both been used to

investigate alternative methods of vaccination, with

promising results.35 The IV monkeypox model has

been used to show the efficacy of cidofovir treatment,

similar to the smallpox model.

A variety of additional animal models, including

infection of mice with ectromelia and vaccinia viruses,

have been used to study mechanisms of orthopoxvirus

infection. Another USAMRIID pathology study

relevant to biowarfare concerns showed that infecting

mice with aerosolized cowpox virus reproduced key

features of orthopoxvirus disease and specifically

targeted the respiratory system.41 This model was used

to show that aerosolized cidofovir administration could

provide a useful therapy for aerosol infections by

smallpox and monkeypox while limiting some of the

potential toxic side effects of this drug.42 Many

challenges remain in the use of animal models to

develop countermeasures to smallpox, including a

more thorough understanding of poxvirus virulence

factors, host-pathogen interactions, and the basic

pathophysiology of infection. In particular, it remains

to be determined which of the monkey models,

monkeypox or variola, better recapitulate smallpox

infection in humans and how appropriate either of

these models is to infection with smallpox virus in the

event of a biowarfare release or the subsequent human

to human transmission that might follow a biowarfare

release.

EBOLA VIRUS

Ebola hemorrhagic fever is one of the most lethal

diseases of humans, with mortality rates in natural

outbreaks approaching 90%.43,44 A number of

confirmed outbreaks of Ebola virus (EBOV) have been

documented since the virus was first recognized in

1976, most of these arising in central Africa. Human

outbreaks appear to be initiated through the handling

of infected wild animals, in particular chimpanzees

and gorillas.45,46 Subsequent human to human

transmission then occurs through contact with infected

bodily fluids, secretions or tissues, usually among

family members or from infected patients to medical

personnel. With regard to the potential for

weaponization and biowarfare use, EBOV is fairly

stable under harsh environmental conditions and is

highly infectious and stable as fine aerosols.44 Ebola

virus is a BSL-4 pathogen.

The incubation period of Ebola virus infection in

humans is relatively broad at 2 to 21 days, however,

most cases probably involve a much shorter incubation

period with death around 7 to 10 days after infection.

Infection is characterized initially as an acute, severe,

febrile illness with evidence of vascular

involvement.47,48 Later in the disease course, immune

suppression, multisystem dysfunction, shock, and

coagulopathy occur. Patients often begin to develop

disseminated intravascular coagulopathy (DIC) by day

5 postinfection. The key targets of Ebola virus are cells

of the mononuclear phagocyte system, hepatocytes,

and possibly endothelial cells.

Pathologists at USAMRIID have worked extensively

with other investigators to characterize animal models

of Ebola virus to begin to understand its extreme

virulence. To date, mouse, hamster, guinea pig, and

nonhuman primate models of Ebola virus infection

have been developed and used to investigate a variety

of pathogenetic factors that contribute to virulence. As

is the case with both VEE virus and smallpox, the

nonhuman primate model of Ebola virus infection

more closely resembles the human condition.

Nonhuman primate studies have shown that Ebola

virus can be transmitted by a variety of routes,

including intramuscular inoculation, aerosol

administration, and by the oral and conjunctival

routes.18 Studies of mice, guinea pigs, and nonhuman

primates have all shown that monocytes and

macrophages together represent an early and sustained

target of EBOV and are the main means by which the

virus is disseminated throughout the body.18,49-52 These

findings help confirm the importance of infected

macrophages in human Ebola hemorrhagic fever .

Dendritic cells in animals appear to be key early

targets as well.53 Ebola virus also targets and causes

extensive damage to hepatocytes, adrenal cells,

fibroblasts, and a variety of epithelial cell types later in

the course of disease. Lymphoid damage and

thrombocytopenia are also prominent features of Ebola

virus infection, but these are indirect effects of viral

infection. While endothelial cells have been

considered important in the pathogenesis of human

Ebola hemorrhagic fever, the animal studies have

questioned this paradigm, suggesting that the

hemorrhagic manifestation of Ebola hemorrhagic fever

is more likely the result of a cytokine storm

subsequent to infection of mononuclear phagocytes

than a direct effect of virus-induced cytolysis of
34 Army Medical Department Journal

endothelial cells.49,53 Virus-mediated alteration of

mononuclear phagocytes and dendritic cells also

appears critical to the immune system disruption that is

another key feature of Ebola infection.

While the mouse and guinea pig models share the key

features of Ebola virus infection with respect to viral

tropism, organ damage, and lethal disease course, they

do not exhibit other important features of the disease.

The mouse model of Ebola virus characteristically

lacks tissue fibrin deposition and DIC, and infected

mice fail to develop the characteristic maculopapular

rash or overt hemorrhage seen in human and

nonhuman primate Ebola virus infections.51

Experimentally infected guinea pigs exhibit variable

tissue fibrin deposition and only limited hemorrhagic

lesions.49 Nonhuman primates, however, develop

fibrin deposition, DIC, and hemorrhage similar to

humans. Thus, nonhuman primates exhibit a variety of

the features of Ebola hemorrhagic fever seen in

humans and generally constitute a more relevant

animal model.

One of the important benefits of pathogenesis studies

is that they can identify avenues to develop therapeutic

countermeasures. Therefore, the various animal

models of Ebola hemorrhagic fever continue to be

used to explore the molecular mechanisms that

underlie the severe nature of this disease. As a direct

result of such research, the development of a potential

therapy to mitigate coagulopathy by treatment with a

recombinant inhibitor of tissue factor VIIA has shown

promise in nonhuman primates infected with Ebola

virus at USAMRIID.54 A variety of other mediators of

coagulopathy and inflammation remain to be explored.

In addition, animal models of Ebola virus have been

extensively utilized in vaccine development. The

development of a safe and effective Ebola virus

vaccine represents another difficult challenge of

biodefense research. Inactivated vaccines have not

shown much promise in animal studies.55,56 Attenuated

vaccines for an agent like Ebola virus make poor

candidates because of concerns over reversion to

virulence. As a result of these concerns, a number of

novel alternative methods have been recently studied,

with varying success in animals. These include DNA

vaccines, virus-like particle vaccines, and vesicular

stomatitis virus-based vaccines.56 Recently, a DNA

vaccine for Ebola virus was shown safe and

immunogenic in human testing.57 Many hurdles remain

in the search for effective Ebola virus vaccines and

therapies, and ultimately the testing of such

countermeasures for efficacy will require the use of

appropriate animal models in order to fulfill the FDA’s

“animal rule.”

SUMMARY

For years the nation’s development of medical

countermeasures to biowarfare agents has primarily

existed as the domain of the United States military, but

it has taken on increased urgency in the last few years.

The realization that the civilian population is also at

risk from biological agents has resulted in the

institution of new biodefense programs at a variety of

nonmilitary organizations. USAMRIID, a long-time

leader in the nation’s biodefense effort, will soon be

joined by other US government agencies as part of a

planned National Interagency Biodefense Campus at

Fort Detrick Maryland.* US Army veterinary

pathologists at USAMRIID have played an important

role in the nation’s biodefense effort, along with our

veterinary colleagues representing other specialties,

our military colleagues in other Army Medical

Department corps, and our civilian colleagues.

Together, we will continue to strive to develop the

diagnostics, vaccines, therapeutic agents, and

operational practices that are required to meet the great

demands posed by the threat of biowarfare agents.

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AUTHORS

COL Steele is Chief, Division of Pathology at the US

Army Medical Research Institute of Infectious Diseases,

Fort Detrick, Maryland.

MAJ Alves is Assistant Chief, Ultrastructural Pathology,

in the Pathology Division at the US Army Medical

Research Institute of Infectious Diseases, Fort Detrick,

Maryland.

MAJ Chapman is Assistant Chief, Molecular Pathology,

in the Pathology Division at the US Army Medical

Research Institute of Infectious Diseases, Fort Detrick,

Maryland.
38 Army Medical Department Journal

BACKGROUND

The World Health Organization (WHO) global

influenza surveillance system is comprised of

approximately 110 National Influenza Centers (NIC)

and 4 WHO Collaborating Centers (WHOCC) for

Influenza. The 4 WHOCCs are located in the United

Kingdom,* Japan,† Australia,‡and the United States

(CDC§). The intent of the system is that NICs take

samples from a cross section of the population

suffering from “influenza-like illness,” isolate viruses,

conduct initial subtyping, and forward representative

isolates—especially any that cannot be subtyped—to a

WHOCC. For much of the world, “ordinary” seasonal

influenza is not seen as a public health priority, so

internal funding is not available. The currently

recognized NICs throughout the world are shown in

the Figure. NAMRU-3 is situated within one of the

largest regional gaps in this surveillance network.

NAMRU-3 is now funded by CDC, the DoD Global

Emerging Infections Surveillance and Response

System, and others to enhance NIC productivity in its

region. These agencies fund NAMRU-3 because of the

facility’s inherent laboratory capacity (including a

biosafety level [BL] 3 that can be used as a BL4 in

need), strategic location, and, most important, its

demonstrated ability to build international

relationships and, through these, to enhance host

country laboratory, surveillance system, and research

capacity. NAMRU-3 has a long history of working

with zoonotic disease, and an equally long history of

including veterinarians in its public health team, a

critical reason that the institution is capable of

responding to emerging disease threats such as avian

influenza.

The force protection benefit of enhanced influenza

surveillance is twofold:

1. Greater refinement of information leading to the

biannual vaccine decision such that the vaccine

used is more optimal.

2. Actionable information about novel strains

circulating in regions in which troops are

deployed.

Currently, donors and even public health professionals

frequently talk about avian influenza (AI) as a human

disease. Indeed, there have been over 300 cases of

influenza in humans caused by H5N1, and over half

have died, but it is eminently clear that the virus in its

current form requires a very high dose to infect

humans and remains first and foremost a disease of

(primarily gallinaceous) poultry. However, about

30,000 people die each year in the United States from

seasonal influenza, and the world wide annual death

toll from seasonal influenza may range into the

hundreds of thousands. A pandemic virus is widely

viewed as having the potential to kill millions, and this

A Veterinary Comparative Medicine Officer’s

Dream Assignment

MAJ Sam Yingst, VC, USA

ABSTRACT

The 5 Department of Defense (DoD) overseas laboratories conduct research on a vast array of infectious

diseases.1,2 This commentary focuses on the role of the Naval Medical Research Unit No. 3 (NAMRU-3, Cairo,

Egypt) in influenza surveillance and research, with emphasis on the role of the comparative medicine (US Army

military occupational specialty 64E) veterinarian assigned there. Every year, tens of thousands of members of

the US Armed Forces are vaccinated for so-called “seasonal influenza.” The vaccine used is reformulated

annually, based on antigenic characterization of viral isolates generated through global surveillance. NAMRU-3

contributes to this global surveillance for the Eastern Mediterranean region. The emergence of H5N1 Highlypathogenic Avian Influenza (HPAI) and concerns over its possible role in precipitating a pandemic have

accentuated the role of veterinarians with field and laboratory diagnostics experience in this system.

*National Institute for Medical Research (London)

†National Institute of Infectious Diseases (Tokyo)

‡Centre for Reference and Research on Influenza (Victoria)

§Centers for Disease Control and Prevention
July – September 2007 39

Country with recognized National Influenza Center

No National Influenza Center

Global coverage of the 110 recognized National Influenza Centers.

is the valid basis for concern about the continued

circulation of H5N1 viruses. Approximately a billion

birds have been affected by H5N1 and the virus

probably replicates trillions of times in each infected

animal. A simple mutation could lead toward increased

human to human transmissibility, and also raise the

chances for a reassortment* event in some animal that

is coinfected with H5N1 and another influenza virus.

This is the reason that it is essential to have as many

health care workers as possible immunized with

seasonal influenza vaccine. Wide-reaching influenza

surveillance raises the chances that seasonal influenza

vaccines are efficacious, and this reduces the chances

of an RNA reassortment event between human

influenza and H5N1.

Although NAMRU-3 continues to emphasize the

importance of seasonal influenza surveillance, the

increased pandemic threat posed by H5N1 demands

action. Avian influenza was already a major problem 3

years ago, but only for southeast Asia. WHO worked

hard to encourage national public health authorities

outside southeast Asia to recognize that the virus

posed a threat to become a pandemic, but most nations

had other priorities. NAMRU-3 prepared in advance

for the virus, and the panic, to reach our region. Rapid

diagnostics are essential to guide veterinary or human

public health response. Currently, only polymerase

chain reaction (PCR) represents a well-tested means to

diagnose acute cases in avians or humans. Testing with

PCR requires extensive training, experience, and

consultation, but we have shown that these are not

insurmountable obstacles, even in Afghanistan despite

the ongoing conflict. Such places cannot be neglected

because they are difficult. On the contrary, this

difficulty should stimulate even greater emphasis, but

to meet that need sometimes incurs significant risk.

Such an effort is therefore the clear purview of

uniformed laboratory diagnostic specialists. The US

Army comparative medicine veterinarian is uniquely

qualified to fulfill all aspects of this need.

It should be obvious that this work is also a critical

element in our effort to maintain the image of the

United States as a partner in peace. NAMRU-3

acknowledges that a major impetus for our work is to

serve as an advocate of US foreign policy, not

necessarily in a purely scientific capacity.

While the conversation among laypeople about AI,

pandemic influenza, and seasonal influenza often

becomes clouded, the current situation in which H5N1

HPAI is viewed as the greatest threat for precipitating

a pandemic in humans is beneficial in terms of

providing impetus for funding that can then be used

more broadly. Constant effort is required to keep the

focus on the fact that currently this is fundamentally a

disease of animals, and its greatest impact is on

nutrition and income of poultry owners, not directly on

their health.4 This is another reason that it is a *The mix of 2 different influenza viruses
40 Army Medical Department Journal

fortunate time for veterinary public health

professionals. Leaders at all levels now recognize the

importance of having a multidisciplinary team to

tackle this multifaceted issue. This has allowed

veterinarians, especially those with laboratory

diagnostics skills, to serve in a unique capacity as

medical diplomats.

APPROACH

Because the military staff of the overseas laboratories

occupy a position that would otherwise be available

for an additional, currently much-needed line Soldier

or Sailor, and because the research and surveillance

role is widely seen as similar or even duplicative with

the role of internationally-projected laboratories like

the CDC, the cost effectiveness of the institutions

themselves are occasionally questioned. Also, a similar

question is often asked, especially by international

health professional colleagues in regard to the overseas

laboratories’ role in influenza surveillance: why DoD?

In 1996, Presidential Directive NSTC-7 directed

federal agencies, including DoD, to develop a global

surveillance network, enhancing research and training,

engaging our international partners, and strengthening

public outreach. There is an element of risk in studying

and conducting surveillance for influenza (avian or

otherwise). There is inherent risk (in terms of the

biohazard risk of working with dangerous pathogens),

and also occasionally in terms of security. It is

important to have people with a Soldier’s mindset,

commitment, drive, and sense of duty to accomplish

what must be done. Circumstances such as a pandemic

may require that individuals or a force are ordered to

respond in order to diagnose, attempt to contain

outbreaks, or maintain order. Military transport,

communications, and logistics systems may be the

only such systems that remain operational, and we can

rest assured that DoD public health professionals will

execute such orders. With these facts in mind, the

overseas laboratories have always practiced projection,

engagement, and collaboration, and are experts unlike

any others in the area.

With this sense of necessity, NAMRU-3 began

working with host countries to enhance seasonal

influenza surveillance in 1998. The following list of

initiations of collaborations illustrates the exponential

growth of the effort:

1998 Egypt

1999 Syria, Oman

2000 Djibouti

2001 Kazakhstan

2002 Ukraine

2003 Kyrgyzstan

2004 Saudi Arabia, Kenya, Uzbekistan

2005 Pakistan, Nigeria, Georgia, Azerbaijan

2006 Afghanistan, Bulgaria, Macedonia, Iraq

2007 Tajikistan, Turkmenistan, Ghana, Sudan,

Jordan, Libya

The purpose of the effort is to identify mutated

influenza viruses that have begun to circulate widely

because this would compel WHO and its WHOCCs to

recommend a change in the seasonal epidemic vaccine

composition. Initially, we worked slowly and

selectively, choosing countries with dense populations

and significant human movement that we thought

might be flash points for the emergence of new strains

of influenza. The composition of the vaccine directly

affects the health of deployed troops and Americans at

home. Because only wealthy western nations had

formerly conducted influenza surveillance, we had to

initiate the surveillance ourselves as the only means to

determine whether existing vaccines would protect

troops against viruses circulating in areas in which

they are deployed. However, conducting meaningful

influenza surveillance is a time-consuming proposition

which requires access to civilian, especially pediatric,

populations in order to gain the best sense of

introduction of new viruses. In other words, this is a

job for on-the-ground, daily-engaged officials of

national departments or ministries of health. Thus, it is

only by working in true collaboration with such

governmental agencies that we can achieve the goal, in

other words, employing the “teach a man to fish”

concept.

In general terms, the effort entails an approximate

scenario of:

Year 1: Initiation, training, capacity building

Year 2: Technology transfer

Year 3: Technical support

A Veterinary Comparative Medicine Officer’s Dream Assignment
July – September 2007 41

NAMRU-3’s work in enhancing regional seasonal

influenza surveillance has always been led by a

comparative medicine specialist and has involved

veterinarians in many roles. This is because NAMRU3 recognized influenza as a zoonosis before this view

was common. The increased emphasis on avian

influenza required only that veterinarians already

working in influenza diagnostics change focus slightly.

This slight change in emphasis has dictated that

NAMRU-3 take on an increased role in capacity

enhancement in the region. We recognized early on

that each sovereign nation needs the tools to diagnose

acute avian influenza as well as influenza in humans

caused by a virus of avian origin. Serologic methods

cannot meet this need; the only options are PCR or

virus isolation and subtyping. Of these, only PCR

provides the same day diagnosis that is essential in this

area. This argument is now widely accepted by major

donors, such as the World Bank, which had previously

countered that donor provided PCR machines are

gathering dust in many national laboratories.

NAMRU-3 has always recognized that technology

transfer is not a matter of simply providing

equipment—it is a long-term relationship between

teacher and student. Veterinarians have always served

as primary trainers in NAMRU-3 capacity-building

engagements.

RESULTS

NAMRU-3 has provided avian influenza-focused,

PCR diagnostics training to public health or veterinary

central laboratory staff in over 40 countries, and

maintains very close collaborative support for the PCR

laboratories in Afghanistan, Jordan, Egypt, Libya, and

Ghana. NAMRU-3 veterinarians have deployed to

Bulgaria, Djibouti, Pakistan, Palestine, Sudan, Kenya,

Nigeria, Ghana, Yemen, Ethiopia, Iraq (twice),

Afghanistan, Ukraine, Azerbaijan, Armenia, Georgia,

Turkey, and Kazakhstan to followup on suspected

HPAI outbreaks. In some cases, this involves civilian

veterinarians, but only uniformed staff are deployed to

combat zones. Comparative medicine veterinarians

have provided laboratory, biosafety, and outbreak

investigation training to other veterinarians

participating in these responses.

NAMRU-3 has never lost focus on the importance of

surveillance for seasonal influenza. Our efforts have

resulted in the characterization of thousands of isolates

which otherwise would not have reached a WHO

Collaborating Center. Most importantly, isolates have

been obtained from countries and regions from which

no information was previously available (eg, all of

central Asia). Two laboratories that were inactive prior

to NAMRU-3 assistance, Ukraine and Kazakhstan, are

now independently functioning WHO recognized

NICs.

With the new emphasis on avian influenza, NAMRU-3

surveillance efforts also resulted in critical virus

characterizations that otherwise would not have

occurred. For example, viruses from Iraq, Djibouti,

and Kazakhstan were fully characterized and

sequenced. NAMRU-3 led the way in sharing

phylogenetic information. While many institutions

retained sequencing data pending completion of their

own manuscripts, on the day we received host country

permission, we published the sequence of the first

H5N1 isolate we obtained. In August 2006, a

consortium including influenza researchers at US CDC

and global International Office of Epizootics*/Food

and Agriculture Organization†(OIE/FAO) reference

laboratories called on others to do so.5

The first H5N1 outbreak in Afghanistan occurred in

March 2006. NAMRU-3 deployed a mobile PCR

laboratory which was able to diagnose the cause of the

outbreak as H5 avian influenza, but government

systems were not in place to respond. The government

did not attempt to contain outbreaks until it received

reference laboratory confirmation. Results were indeed

confirmed, but the wait for confirmation caused a

delay in response of over a week, during which the

outbreak continued to spread. Several thousand birds

in the infected villages were eventually culled, perhaps

unnecessarily, given the long delay. This had a

significant impact on livelihoods and confidence in the

government. There is no definitive information, but the

temporal and geographical spread was suggestive of

introduction from Pakistan, and spread within

Afghanistan through the live bird market system.

Eventually the virus spread to more than 6 provinces

in Afghanistan.

*An organization of 127 member countries headquartered

in Paris, France. Information available at http://

www.oie.int.

†An agency of the United Nations which was founded in

1946 to lead international efforts to defeat hunger.

Information available at http://www.fao.org.
42 Army Medical Department Journal

Over the next year, NAMRU-3 worked with the

Ministry of Agriculture, Irrigation, and Livestock to

establish a permanent PCR laboratory in the Central

Veterinary Diagnostic and Research Laboratory in

Kabul. This laboratory diagnosed H5N1 reintroduction

into Afghanistan in February 2007. In contrast to last

year’s hesitation, the government now shows total

confidence in the laboratory, and immediate action

was taken when positive results were obtained. Thus

the novel capability of the laboratory to provide realtime results was well used. Outbreaks this year were

limited to 3 provinces, and only a few hundred birds

were culled. Thus, this is a success story, not merely in

physically establishing laboratory capacity, but in

integrating the physical capacity with government

systems.

In January 2006, unusual mortality was noted in

backyard chickens in Sulymaniyah, Iraq, with clinical

signs consistent with avian influenza. Samples were

tested with a rapid antigen detection purported to be

able to specifically detect H5. The assay is a 2-step

process:

1. Test for influenza A antigen and, if positive,

2. Test for H5 antigen.

The test was positive for influenza A, but not positive

for H5 antigen. The villagers were advised that this

was not an outbreak of H5. Approximately one week

later, a young girl and her uncle, who had slaughtered

sick birds, died of H5N1. As part of the followup to

the outbreak investigation, NAMRU-3 examined the

antigen detection assay that was used to diagnose

influenza A, but did not detect H5. The influenza A

antigen detection component of the assay appears to be

more sensitive than the H5 component, and the H5

component does not detect all H5 viruses. Thus, there

is the possibility that the assay may result in false

negatives for H5 through 2 mechanisms, with the

former being extremely misleading because it results

in the appearance that an outbreak is due to a non-H5

avian influenza. Many non-H5 avian influenza viruses

are common in the Middle East, and do not appear to

be serious human pathogens.

Additional poultry samples from Sulymaniyah were

submitted to NAMRU-3. The samples had been tested

in Baghdad to the extent possible according to current

OIE/FAO recommendations. Under the circumstances,

this was limited to serologic testing. Unfortunately,

most chickens that are exposed to H5N1 die before

developing antibody, so a major outbreak in a broiler

barn was diagnosed as “not avian influenza” because

antibody could not be detected. Samples contained

high titers of H5N1 virus which are detectable by

PCR.

NAMRU-3 diagnosed the cases of influenza in

humans caused by H5N1 virus, and NAMRU-3

veterinarians participated in a WHO-led followup of

the outbreak. The investigation resulted in diagnosis of

H5N1 in poultry and cats in another Iraqi governorate,

and provided opportunities to link the H5 cases in

humans to disease in animals.

LESSONS LEARNED

Comparative medicine veterinarians are uniquely

capable of providing the broad array of expertise

necessary to support all aspects of influenza

surveillance, research, and response capabilities. They

can address public health and infection control issues,

vaccination and biosecurity policy in poultry, as well

as diagnostic techniques. Veterinarians play an

important role in keeping the focus of the response to

the current H5N1 outbreak where it belongs—on the

impact on agricultural economies, while providing a

balanced approach in light of the fact that there is a

potential role of this pan-zootic in precipitating a

pandemic.

NAMRU-3 has made direct contributions to the body

of scientific knowledge concerning avian influenza.

Most virology books in print still highlight the role of

migratory birds as “reservoirs” of avian influenza.

NAMRU-3 work has shown that although migratory

birds have probably had a role in some introductions

of avian influenza into previously naïve places, poultry

trade is almost certainly the predominant mechanism

of transmission.

Through its training programs and collaborations,

NAMRU-3 efforts bring scientists together and build

bridges that may be key in responding regionally and

globally to a pandemic. This effort has not only

provided opportunities for exchange between host

country and US scientists, but also serves to forge

regional and even intercontinental relationships and

understanding.

A Veterinary Comparative Medicine Officer’s Dream Assignment
July – September 2007 43

Our work builds on existing structures; we work

within the WHO system internationally, and within the

ministry of health or agriculture system in a given

country.

CONCLUSION

NAMRU-3 has a unique relationship with the WHO

Eastern Mediterranean Region (serving as its influenza

reference laboratory), and is one of the 9 global,

WHO-recognized H5 reference laboratories. NAMRU3 has unique diagnostic capacity that US Army

veterinary microbiologists and other veterinarians have

established, including virus isolation and subtyping in

tissue culture and eggs; PCR for influenza A, B, H1,

H3, H5, H7, H9, N1; full genome sequencing of

influenza A viruses; neuraminidase resistance testing;

and microneutralization and diagnosis of other

respiratory disease (eg, severe acute respiratory

syndrome).

Because the Army Veterinary Corps provides the

veterinary mission for the entire DoD, US Army

veterinarians already have the good fortune to work in

numerous joint assignments. However, assignment to

one of the overseas laboratories provides an

opportunity for a vastly expanded degree of

interagency experience. The comparative medicine

veterinarian assigned to NAMRU-3 is expected to

consult and collaborate with the US Departments of

State (directly and through the US Agency for

International Development and the embassies),

Agriculture, and Health and Human Services (directly

and through the US CDC). International agencies with

which routine contact is essential include the World

Health Organization, the UN Food and Agriculture

Organization, and the World Bank. The most

important relationships of all are with host country

officials from ministries of health, agriculture, and

others who have assigned roles in public health.

The next pandemic may be insidious and may be

detected first through routine “seasonal influenza”

surveillance. The next pandemic will probably not be

associated with disease in poultry. “Ordinary”

influenza and “ordinary” surveillance systems cannot

be neglected in favor of a focus on avian influenza.

NAMRU-3 is essential in implementing the National

Strategy for Pandemic Influenza,6and the comparative

medicine veterinarian assignment there is key in that

facilitation. The strategy emphasizes the importance of

capacity building, coordination, rapid response teams,

and transparency. NAMRU-3 has a decade of

experience implementing those themes in the area of

influenza.

REFERENCES

1. Chretien JP, Blazes DL, Gaydos JC, et al. Experience

of a global laboratory network in responding to

infectious disease epidemics. Lancet Infect Dis.

2006;6(9):538-540.

2. Chretien JP, Gaydos JC, Malone JL, Blazes DL.

Global network could avert pandemics. Nature.

2006;440(7080):25-26.

3. National Center for Immunization and Respiratory

Diseases Advisory Committee on Immunization

Practices. Prevention and Control of Influenza.

MMWR Recomm Rep. 2006;55(RR10).

4. Capua I, Alexander DJ. The challenge of avian

influenza to the veterinary community. Avian Pathol.

2006;35(3):189-205.

5. Bogner P, Capua I, Cox NJ, et al. A global initiative

on sharing avian flu data. Nature. 2006;442

(7106):981.

6. National Strategy for Pandemic Influenza.

Washington, DC: Homeland Security Council, The

White House; November 2005. Available at http://

www.whitehouse.gov/homeland/nspi.pdf. Accessed

June 5, 2007.

AUTHOR

MAJ Yingst is the Influenza Surveillance and Central

Asia Projects Coordinator at Naval Medical Research

Unit No. 3 in Cairo, Egypt.
44 Army Medical Department Journal

Hip dysplasia is one of the most common orthopedic

diseases in dogs. All breeds of dogs can be affected by

this developmental disease. However, it mainly affects

medium and large breed dogs such as the German

Shepherd Dog. Pain and decreased hind limb mobility

and function are the end result of this complex disease

process. Severe canine hip dysplasia (CHD) can be

career-ending for the Military Working Dog (MWD).

The German Shepherd Dog and Belgian Malinois

make up the overwhelming majority of MWDs in

America. Their high energy, trainability, intelligence,

physical stature, and ideal personalities make them

excellent working dogs. Unfortunately, these large

breeds are often afflicted with orthopedic

developmental diseases such as hip and elbow

dysplasia. The Department of Defense Military

Working Dog Center (DoDMWD) performs a variety

of screening tests prior to the purchase of potential

MWDs. Over 60% of all dogs evaluated are rejected

because of behavioral or medical problems.1 As one

part of the screening process, radiographs of the pelvis

are performed to look for signs of hip dysplasia. Dogs

with signs of hip laxity or degenerative joint disease

based on these radiographs or physical exam are

rejected from purchase.

Several retrospective studies have evaluated the cause

for retirement or euthanasia of the MWD. From 1993

to 1996, 19.5% (178/927) of all MWD removals from

service were due to appendicular degenerative joint

disease (DJD), primarily hip and elbow dysplasia.2

From 2000 through 2004, that figure improved to 8.2%

(22/268).3Several conclusions can be drawn from

these figures:

1. Medical management of DJD has improved

significantly to keep the MWD working longer.

2. More stringent physical exam and radiographic

screening tests are performed prior to purchase,

thus the DoDMWD purchases fewer dogs with

developmental problems.

3. Breeders are culling undesirable developmental

conditions from their breeding programs, thus

producing a healthier dog for sale.

In any case, the fact that fewer MWDs are forced into

retirement due to canine hip dysplasia is in the best

interest of the DoD.

DIAGNOSIS

The diagnosis of CHD is based on history, clinical

signs, physical examination findings, and radiographs

of the coxofemoral joint(s). Hip dysplasia often

clinically presents in a biphasic process. Lameness

develops initially at 3 to 10 months of age during the

early phase of the disease. This pain is due to

subluxation, inflammation, and synovitis induced from

the hip joint laxity. Most young dogs suffering from

CHD will “grow out” of their lameness close to a year

of age. The pain usually returns during midlife of the

dog, starting around 4 to 5 years of age. This second

phase of pain is again associated with inflammation

and synovitis, but in addition, the coxofemoral joint

has undergone erosive cartilage changes, thickening of

the joint capsule, osteophyte formation, and bony

remodeling changes. The exhibited lameness can range

from very mild only after strenuous activity, to very

severe, such as the inability to bear significant weight

or walk on the affected pelvic limb. Some owners

report a “bunny hopping” run as the dog limits its

coxofemoral joint range of motion to prevent

exacerbation of the pain.

Physical exam findings most often elicit pain of the

hip region during extension, external rotation, and

Canine Hip Dysplasia:

Surgical Treatment for the

Military Working Dog

CPT Kent J. Vince, VC, USA
July – September 2007 45

abduction of the coxofemoral joint. Some dogs will

become fearful and potentially aggressive when the

examiner attempts to palpate or manipulate the hip

joint. Crepitus is usually felt during the later phase of

the disease as the joint has undergone significant

degenerative changes. Subluxation can be felt in many

young dogs. A low “clunk” is usually felt or heard

during the abduction of the coxofemoral joint in young

dogs as a result of the reduction of the subluxated

femoral head. This clunk is referred to as an Ortolani

sign and is highly suggestive for hip joint laxity.

Muscle atrophy of the thigh is commonly seen in cases

of CHD, but most obvious when only one leg is

affected.

Several radiographic techniques have been described

to screen for signs of canine hip dysplasia. The

PennHIP* distraction radiograph technique, the dorsal

acetabular rim view, and the ventrodorsal pelvic view

are all routinely performed. However, the most

commonly performed radiograph is the ventrodorsal

pelvic extended view (Figure 1, Figure 2) for diagnosis

of CHD. The radiographic changes seen with canine

hip dysplasia can include subluxation of the femoral

head; flattening of the femoral head; osteophytosis of

the femoral head, neck, or acetabulum; sclerosis of the

femoral neck; and evidence of the insertion of the joint

capsule on the femoral neck.

CONSERVATIVE TREATMENT

The goal of standard conservative management of

CHD is the alleviation of hip pain. The pillars of

conservative management include exercise

modification, weight management and diet, pain

relieving drugs, and chrondroprotective agents.

Adequate exercise is important for maintaining and

improving muscle mass and function. This can be

achieved through daily leash walk activity, moderate

running, and veterinary physical rehabilitation

exercises, including the use of treadmills or

underwater treadmills. Disuse atrophy can often be

remedied with the addition of an appropriate exercise

program.

Weight management and dietary intake are two of the

most important external contributing factors in CHD.

It is well known that overweight or obese dogs are Figure 1. A ventrodorsal extended pelvic view

radiograph from a 2-year-old dog without any

evidence of degenerative joint disease or

canine hip dysplasia.

Figure 2. A ventrodorsal extended pelvic view

radiograph of a 6-year-old female German

Shepherd Dog with severe degenerative joint

*University of Pennsylvania Hip Improvement Program disease from canine hip dysplasia.
46 Army Medical Department Journal

often less active than normal weight dogs and the

added weight puts significant strain on ligaments and

joints. A lifelong study evaluated the affect of a

restricted diet on the onset of radiographic evidence of

hip osteoarthritis in dogs. The median age for onset of

radiographic signs of osteoarthritis in dogs fed ad

libitum was 6 years versus 12 years for dogs fed a 25%

reduced diet. The investigators concluded that dietary

restriction by 25% resulted in significant delay of the

onset of radiographic signs of hip arthritis.4

Pain relieving drugs are an important weapon in the

treatment of CHD. A multimodal approach to treating

the pain of hip dysplasia has been used with a variety

of classes of drugs. Nonsteroidal anti-inflammatories

(NSAID), such as carprofen, deracoxib, meloxicam,

and tepoxalin, are usually the first line of defense.

They work well at reducing the inflammation within

the joint which reduces the sensitivity of the nerves

and results in decreased pain. Extensive research has

been performed and determined that several of these

NSAIDs can be safely used for long-term therapy.

Tramadol is a synthetic opioid that has great benefit in

relieving pain in dogs. Amantadine is an NMDA

antagonist that can be used in the treatment of chronic

pain. In addition, gabapentin, an antiepileptic drug, has

been successfully used to treat presumed pain in dogs.

A combination of an NSAID and these additional

drugs can be useful in alleviating the pain induced by

CHD.

Chondroprotective agents have become quite popular

in the treatment of arthritic disease in dogs. These

drugs aim to protect and provide the building blocks of

cartilage and synovial fluid to help promote the ideal

joint health. There are several glucosamine containing

veterinary products available including Cosequin®,

GLC 5500, and Glyco-Flex®, all aimed at promoting

joint health. Adequan®is an injectable polysulfated

glycosaminoglycan that helps prevent the breakdown

of joint cartilage. Veterinary research showing

significant improvement in dogs suffering from CHD

with the administration of these chrondroprotective

agents is limited. Because some dogs appear to

improve clinically, many clinicians advocate a trial to

see if they help a specific individual.

SURGICAL TREATMENT

The primary goals of surgical treatment for CHD are

alleviation of hip pain and return to normal function of

the affected leg. Surgery is often used in conjunction

with medical management. Total hip replacement

(THR) and femoral head ostectomy are the 2 primary

surgical options for treatment of hip dysplasia. Surgery

is usually performed when medical and conservative

management of the disease is no longer successful.

Femoral head ostectomy is typically thought of as a

last resort salvage procedure in dogs suffering from

severe hip dysplasia. In this surgery, the femoral head

and portions of the neck are cut and removed thus

eliminating the bone on bone contact of the

coxofemoral joint. The muscles and soft tissues

surrounding the proximal femur and acetabulum will

form a “false” joint. The long-term return to function

of the affected leg is variable and often dependent on

several factors including the size and body condition

of the dog. While dogs undergoing femoral head

ostectomy will not have 100% normal function of the

affected leg, nearly 90% of owners reported a good

outcome with this procedure.5

Canine total hip replacement is the best surgical option

for returning an affected coxofemoral joint to normal

function. THR has been performed in both a research

and commercial setting in canine patients for several

decades. Initial metal implants were fixed with bone

cement into the femur and acetabulum. This

technology has gone under several improvements and

advancements over the past 30 years and is still used

today in both dogs and humans. Newer technology has

led to the development of uncemented implants.

Porous-coated implants are press fitted into the

proximal femur and acetabulum. The bone grows into

the porous coating, permanently stabilizing the implant

in approximately 2 to 4 weeks. A long-term study

evaluating the use of uncemented porous-coated THR

implants in dogs revealed an 87% success rate. The

authors concluded that after a 6-year follow up,

uncemented fixation of femoral stem and acetabular

cup implants was successful.6

At the North Carolina State University Veterinary

Teaching Hospital, the implant of choice is the BFXTM

(biological fixation) total hip replacement system by

BioMedtrix (Boonton, New Jersey). This system uses

a cobalt chrome femoral stem with 3 layers of micro

beads surrounding the proximal third of the implant

(Figure 3). The femoral head component is a highly

polished cobalt chrome sphere that is lightly

Canine Hip Dysplasia: Surgical Treatment for the Military Working Dog
July – September 2007 47

hammered onto the femoral stem

component. The acetabular cup

component has an outer shell made

of titanium with 3 layers of micro

beads and an ultrahigh molecular

weight polyethylene liner (Figure

4). The layers of micro beads create

a porous coating on the implants

that allow for bony ingrowth and

when healed, a very stable implantbone interface. In human total hip

replacements, the implants are

expected to last greater than 20

years. Thus, the BFX total hip

replacement implants are expected

to last the lifetime of the dog.

Proper patient selection and

surgical planning are imperative for

surgical success. The patient must

be free of any systemic diseases or

infections that could potentially

spread to the implants, as implant

associated infection would result in

failure. The patient must be welltrained and sensible so as to tolerate

small cage/kennel confinement and

controlled activity during recovery.

Any excessive activity too early in

the postoperative recovery phase

could lead to implant movement, or, even worse,

implant associated bone fracture or luxation. While

there are a variety of implant sizes to accommodate

most medium and large breed dogs, the patient must be

of appropriate size to ensure proper implant fit.

Preoperative radiographs are used to estimate the size

of femoral and acetabular implant and to give the

surgeon an idea of how much bone to remove during

the preparation of the bone bed. The patient should be

free of any neurological conditions that might affect

the use of the hind limbs such as lumbosacral disease.

The patient should also be free of any

other orthopedic disease affecting

either one of the pelvic limbs, such as

cranial cruciate ligament rupture.

The surgical procedure for canine

total hip replacement is technically

challenging and should only be

performed by a highly qualified

veterinary surgeon. During the

procedure, the anesthetized patient

is placed in a pelvic positioning

device to aid in appropriate implant

alignment. Strict aseptic technique,

perioperative antibiotics, and

surgeon sterility are vital in

preventing surgical associated

infection. A craniolateral surgical

approach is made to the

coxofemoral joint. The head of the

femur is precisely cut to expose the

femoral canal and also to provide

increased exposure to the

acetabulum. The acetabulum is

sequentially reamed and shaped to

accurately prepare the bone bed for

the implant. Once the bone bed is

prepared to the proper size, the

porous-coated titanium acetabular

implant is seated and hammered

into position and correct orientation.

The femoral canal is then drilled

and shaped with a series of

graduated broaches to prepare the

femoral bone bed. Once the

appropriate canal preparation is

attained, the femoral stem is

impacted into the proximal femoral

canal. A trial size femoral head is

then placed on the femoral stem to

determine the appropriate femoral head implant.

Different femoral heads allow the surgeon to lengthen

or shorten the femoral neck, thus helping to minimize

the possibility of postoperative coxofemoral luxation.

Once the appropriately sized head has been placed, the

femur is reduced and the joint capsule is closed. The

muscles, soft tissues, and skin are closed in a routine

manner and an adhesive bandage is applied over the

surgical incision. Postoperative radiographs are made

to ensure appropriate orientation and alignment of the

implants.

The postoperative recovery period is

imperative to surgical success of the

total hip replacement procedure. All

dogs are administered at least 2 types

of drugs to aid in pain relief during the

first 2 to 4 weeks of recovery. Most

dogs are toe-touching lame the day

after surgery. The patient will often

bear significant weight on the affected

Figure 3. The BFX femoral stem

implant

Figure 4. The BFX acetabular

cup implant
48 Army Medical Department Journal

limb the second day after surgery. Owners are

instructed to use a sling placed under the dog’s

abdomen to help prevent a fall while the dog is

walking and to help control the patient if they try to be

too active. The dog is strictly confined and only

allowed to go outside on leash for bathroom use for the

first 4 weeks. During the second month, short 5-minute

leash walks are performed twice daily and gradually

increased to 30 minutes by the end of the month.

During the third month, the leash walk activity is

continued and a small amount of supervised off-leash

running is permitted. Postoperative recheck

examinations are performed at 3, 6, and 12 months.

Radiographs are made to evaluate the implants for any

signs of movement, bone reaction, or possible

infection. If no problems are detected on physical

exam or radiographs at 3 months, the dog is permitted

to return to normal activity and training.

While the complication rate with the BFX total hip

replacement system is low, the complications can be

significant. Postoperative coxofemoral luxation, femur

or pelvic fracture, implant subsidence or movement,

and implant infection are all possible THR

complications. Coxofemoral luxation is usually treated

with reoperation and the placement of an iliofemoral

suture to help prevent craniodorsal luxation. Femur or

pelvic fractures are usually treated with reoperation

and internal fixation with a bone plate and screws.

Depending on the degree and severity of the implant

movement or subsidence, surgery may not be

indicated. In extreme cases of implant movement,

reoperation is usually performed, and either a larger

implant is placed or a cemented implant is used. In the

very rare case that an implant associated infection

develops, bacterial culture is performed and antibiotic

therapy instituted. If the infection fails to resolve, the

implants usually must be surgically removed.

CASE REPORT: MWD BENNY

At the time of original presentation to the North

Carolina State University Veterinary Teaching

Hospital (NCSU VTH), MWD Benny was a 5-yearold, male, German Shepherd Dog certified in patrol

and explosives detection stationed at Marine Corps Air

Station, Beaufort. He had a 3-month history of right

hind limb lameness during training and working. He

had been previously treated by the attending

Veterinary Corps Officer at the Marine Corps Recruit

Depot, Parris Island, with carprofen (Rimadyl®)

100mg orally every 12 hours, Cosequin 2 tablets twice

daily, and exercise restriction. His physical exam

findings at the NCSU VTH included mild lameness of

the right hind leg while walking, pain on extension of

the right coxofemoral joint, slight pain on extension of

the left coxofemoral joint, positive Ortolani sign of the

right coxofemoral joint, and mild right hind leg muscle

atrophy when compared to the left hind leg. Complete

blood count and blood serum chemistry indicated

elevated cholesterol (454mg/dL ref. range 92-324)

with all other values within normal limits. Radiographs

performed at NCSU VTH revealed pronounced left

coxofemoral DJD with osteochondral fragments,

bilateral mild coxofemoral subluxation, and mild right

femoral head remodeling (Figure 5). On the basis of

physical exam and radiographic findings, the diagnosis

of coxofemoral DJD and hip dysplasia was made.

Since MWD Benny’s lameness and pain response

were more severe on the right hind leg, a total hip

Figure 5. Preoperative ventrodorsal extended

pelvic view of MWD Benny. Despite the

moderate degenerative joint disease changes in

head of the left femur, there is radiographic

evidence of disuse muscle mass atrophy in the

right leg compared to the left.

Canine Hip Dysplasia: Surgical Treatment for the Military Working Dog
July – September 2007 49

replacement was performed only on the right

coxofemoral joint.

A BFX modular total hip replacement system was used

in MWD Benny. His ideal temperament, outstanding

drive, and excellent detection abilities made him the

ideal patient. The anesthetized patient was placed in a

pelvic positioning device on the surgery table to ensure

appropriate alignment. A modified craniolateral

approach to the right coxofemoral joint was made. The

femur was externally rotated, the round ligament was

cut, and the femur luxated to expose the femoral head.

The neck cutting guide was positioned and a femoral

neck cut was made at the level of the lesser trochanter

with an oscillating bone saw. The femoral head was

removed. With the acetabular cup exposed, a set of

sequentially sized reaming devices were used until the

medial acetabular cortex was identified. A 26mm BFX

acetabular cup was placed and seated within the right

acetabulum. The femur was then elevated and the

caudal and lateral femoral neck was removed with

rongeurs. The femoral canal was opened with a 5mm

drill bit and then sequentienally enlarged with #6, #7,

#8, and #9 broaches. A #9 BFX femoral stem was

impacted and firmly seated in the right femur. A +3

femoral head was lightly hammered onto the femoral

neck. The joint was reduced and the limb could

externally rotate 90o without luxation. The joint

capsule, muscles, subcutaneous tissues, and skin were

closed in a routine manner. Postoperative radiographs

were taken to assess implant placement and

positioning. The patient recovered from anesthesia

without complications. Hydromorphone and

medetomidine were administered postoperative for 24

hours as needed for pain relief.

MWD Benny was discharged approximately 48 hours

after surgery. Carprofen 75mg orally every 12 hours

and Cosequin 2 tablets twice daily were prescribed.

Strict kennel confinement and activity restriction was

mandated for 4 weeks. During the second month of

recovery, MWD Benny’s activity included leash walks

2 to 3 times a day, starting at 5 minutes and increasing

progressively to 30 minutes by the end of the month.

During the third month, activity continued to increase

to allow for short periods of off-leash running on a

daily basis and continually working up to resume a

near normal presurgery level of exercise.

At the recheck examination 3 months postoperative,

MWD Benny was using the right leg with no observed

lameness in either limb. There was no pain on

palpation or manipulation of the right pelvic limb with

range of motion within normal limits. There was mild

muscle atrophy of the right hind leg compared to the

left. Radiographs did not detect any significant change

in the implants or the bone from the radiographs taken

immediately after surgery. MWD Benny was

authorized to return to full activity.

At the 6-month recheck examination, MWD Benny

had returned to normal training (obstacle course) and

activity (patrol/attack work) without any lameness or

problems noted by the handler. There was no lameness

or pain detected in the pelvic limbs on physical exam.

Current radiographs did not detect any significant

change from the radiographs taken immediately after

surgery. Figure 6. Ventrodorsal extended pelvic view of

MWD Benny at 17 months postoperative
50 Army Medical Department Journal

MWD Benny returned to the NCSU VTH 17 months

postoperative for a recheck examination. He had just

returned from an 8-month deployment to Iraq and

performed without complications during his tour of

duty. Physical exam again did not detect any

abnormalities, lameness, or pain in either pelvic limb.

Radiographs did not detect any changes from the

radiographs made 11 months earlier (Figure 6). DJD of

the left coxofemoral joint was still present but

unchanged from earlier radiographs.

MWD Benny made a total of 3 deployments to Iraq

after his total hip replacement in February 2004. He

has not developed any clinical lameness affecting his

right hind leg associated with the total hip

replacement. Unfortunately, MWD Benny developed

significant lameness of his left pelvic limb due to the

progression of degenerative joint disease and hip

dysplasia during his third deployment and returned

home early.

CONCLUSIONS

Total hip replacement for the treatment of canine hip

dysplasia is highly successful at alleviating pain and

returning the affected limb to normal function. Canine

hip dysplasia has been the most common medical

cause of early retirement for MWDs. The BFX

uncemented total hip replacement provides a pain free

normal functioning coxofemoral joint in the dog. In

special cases of well-mannered, highly skilled, and

technically proficient MWDs afflicted with severe

canine hip dysplasia, total hip replacement surgery can

be successfully performed to significantly extend the

pain-free working career of the dog.

ACKNOWLEDGEMENTS

I thank Dr Simon Roe for his review of this manuscript

and BioMedtrix for the photographs of the BFX

implant products.

REFERENCES

1. Olson RC. Physical evaluation and selection of

military dogs. J Am Vet Med Assoc. 1971;159:1444-

1446.

2. Moore GE, Burkman KD, Carter MN, et al. Causes of

death or reasons for euthanasia in military working

dogs: 927 cases (1993-1996). J Am Vet Med Assoc.

2001;219:209-214.

3. Evans RI. Causes for the discharge of military

working dogs from service [master’s thesis]. Houston,

TX: University of Texas Health Science Center,

School of Public Health; 2005.

4. Smith GK, Paster ER, Powers MY, et al. Lifelong

diet restriction and radiographic evidence of

osteoarthritis of the hip joint in dogs. J Am Vet Med

Assoc. 2006;229:690-693.

5. Lippincott CL. Excision arthroplasty of the femoral

head and neck utilizing a biceps femoris muscle sling.

Part II. The caudal pass. J Am Anim Hosp Assoc.

1984;20:377-384.

6. Marcellin-Little DJ, DeYoung BA, Doyens DH, et al.

Canine uncemented porous-coated anatomical total

hip arthroplasty: results of a long-term prospective

evaluation of 50 consecutive cases. Vet Surg.

1999;28:10-20.

AUTHOR

CPT Vince is a Resident in Small Animal Surgery at the

College of Veterinary Medicine, North Carolina State

University, Raleigh, North Carolina.

Canine Hip Dysplasia: Surgical Treatment for the Military Working Dog
July – September 2007 51

INTRODUCTION

Military working dogs (MWDs) have long been used

as an effective and reliable force multiplier for military

ground forces. As with any other combat system,

maintenance is essential to assuring sustained peak

effectiveness. In the case of MWDs, this maintenance

is their medical care and management. Surveys made

of the most common medical problems encountered in

Republic of Korea (ROK) Army MWDs reveal several

conditions that potentially can be efficiently medically

managed (Table 1). Among these medical problems is

an eyeworm infestation, Thelazia callipaeda. Medical

reviews of the ROK Army MWD population suggest a

90% incidence of eyeworms. These dogs also maintain

a high incidence of tick infestation.

Thelazia species eyeworms are a species of small

round worms principally found in or around the eyes

of several animals.1(p80) The worm’s cuticle shows

well-marked, coarse transverse striations, which look

tooth-like in profile.2 Thelazia callipaeda occurs in

Asia in the membrana nictitans of the dogs, and less

frequently in rabbits and man.3-6 The life cycle of most

Thealzia species depends upon flies as intermediate

hosts and vectors. The intermediate hosts and vectors

for Thelazia callipaeda are generally unknown3;

however, the houseflies of genus Muscus or Fannia

probably serve as the intermediate host.7 Eyeworm

A Clinical Trial of Ivermectin Against

Eyeworms in German Shepherd Military

Working Dogs

COL Mack Fudge, VC, USA

LTC Sookwan Jeong, VC, ROKA

Pat McInturff, DVM, PhD

ABSTRACT

Objective: To determine if monthly ivermectin was efficacious in reducing the observed incidence of eyeworms

over a period of 2 months as compared with normal husbandry practices in a population of Republic of Korea

Army military working dogs (MWDs).

Methods: Prospective observation of 114 German Shepherd MWDs in a randomized, double-blind, controlled

clinical trial. MWDs were randomly assigned to either a treatment group receiving a monthly dose of 0.2 mg/kg

BW ivermectin orally, or to a control group given an equivalent dose volume and frequency of a saline placebo.

A quantitative numerical count of eyeworms found in the eyes of MWDs was conducted at 25-day intervals.

Results: The prevalence of eyeworms in the treatment group went to zero at 25 days and remained lower at 50

days (5%) than baseline (24%). Prevalence in the controls remained approximately constant over all treatment

times (14% to 18%).

Conclusion: Although ivermectin does not prevent dogs from being infected with eyeworms, the study suggests

that ivermectin administered orally at a dose of 0.2 mg/kg every 3 weeks significantly reduces the prevalence of

Thelazia species eyeworms in dogs.

Table 1. Most Common Medical Problems

Found in Korean Army Military Working Dogs

Trauma

Gastroenteritis with diarrhea

ENT (Conjunctivitis)

Fungal infection/bacterial infection

Hip dysplasia (usually under 6 years of age)

Heartworms (20%)

Eyeworms (90%)

Ticks
52 Army Medical Department Journal

A Clinical Trial of Ivermectin Against Eyeworms in German Shepherd Military Working Dogs

presence in the conjunctival sac can result in clinically

relevant photophobia, blepharospasm, excessive

lacrimation or a mucopurulent ocular discharge,

keratitis, or corneal ulcer.7 Mechanical damage to the

infected dog’s eyes is likely caused from the worm’s

coarse cuticle as it moves about the ocular tissues. If

not removed, eyeworms are reported to cause

blindness, presumably through production of corneal

opacity. The diagnosis is made by finding and

identifying the parasites in the conjunctiva.3 Treatment

involves manual removal of the worms with forceps or

flushing after application of topical anesthesia.

Aftercare consists of symptomatic treatment of the

conjunctivitis and keratitis, if present.1(p80),7

Ivermectin is an avermectin class anthelmintic

commonly used for roundworms (nematodes) and

arthropods. Its mode of action involves the

neurotransmitter gamma-aminobutyric acid (GABA).

In roundworms, ivermectin stimulates the release of

GABA from nerve endings and enhances binding of

GABA to special receptors at nerve junctions, thus

interrupting nerve impulses. This action paralyzes and

kills the parasite. The enhancement of the GABA

effect in arthropods such as mites and lice resembles

that in roundworms except that nerve impulses are

interrupted at the neuromuscular junction. This also

leads to paralysis and death of the parasite.8,1(p263)

The principal peripheral neurotransmitter in mammals,

acetylcholine, is unaffected by ivermectin. Ivermectin

does not readily penetrate the central nervous system

of most mammals where GABA functions as a

neurotransmitter. Recommended doses of ivermectin

have a wide safety margin in most mammals,

including dogs. In certain dogs, particularly Collie

breeds, the concentration of ivermectin in the central

nervous system following treatment is greater than it is

in other dogs. This is possibly due to a more readily

penetrated blood-brain barrier in Collies, or to

sequestration. In these dogs, the apparent potentiation

of inhibitory neurotransmitter, GABA, by ivermectin

has resulted in adverse reactions: mydriasis,

depression, ataxia, drooling, paresis, recumbency,

excitability, stupor, coma, and death.8

Ivermectin was shown to significantly reduce the

geometric mean in the number of eye worms (Thelazia

species) collected from the surface of eyes in treated

cattle.9 Kennedy10 and Soll et al11 demonstrated >99%

efficacy of the injectable formulation of ivermectin

against Thelazia skrjabini in cattle. Kennedy12 later

demonstrated >99% efficacy of topical ivermectin

against the same species eyeworm in cattle. We

theorized that ivermectin would be similarly effective

in working dogs.

The primary objective of this study was to determine if

monthly ivermectin was efficacious in reducing the

observed incidence of eyeworms over a period of 2

months as compared with normal husbandry practices

without the use of ivermectin in a population of ROK

Army MWDs. Secondary objectives of this study were

to ascertain, in this same population of MWDs, if the

same monthly administration of ivermectin would

reduce the number of ticks found on the MWDs.

Lastly we hoped to estimate the heartworm prevalence

in ROK Army MWDs.

MATERIALS AND METHODS

Study Population and Setting. The study population

consisted of MWDs stationed in the First Republic of

Korea Army (FROKA) near Chunchon, ROK. All

studied FROKA MWDs were German Shepherds. This

study was performed in the medical facilities of the

FROKA Military Working Dog Training Center.

Approval for this study was obtained from ad hoc

medical review committees from both the US Army

18th Medical Command and the FROKA General

Staff.

Inclusion and Exclusion Criteria. All MWDs which

were assigned to the FROKA and were greater than 6

months of age were considered for enrollment as

subjects in this study. Dogs were excluded if they were

unable to complete the study.

Group Assignments/Treatments. Dogs were assigned

via simple computer randomization into either a

treatment or control group. Treatment was defined as

the oral administration of 0.2 mg of ivermectin per kg

body weight. The control group was given an

equivalent dose volume and frequency of a saline

placebo. All monthly doses were administered by

trained US Army Animal Care Specialists.

Data Collection and Quality. We prospectively

observed 114 MWDs in a randomized, double-blind,

controlled clinical trial. Baseline data consisting of

sex, age, weight, and general medical condition of the
July – September 2007 53

dogs was collected at the start of the study. Each

MWD selected was examined for the presence of

eyeworms. If observed, the worms were mechanically

removed and the eye was lavaged with saline. A

quantitative numerical count of eyeworms found in the

eyes of MWDs was conducted at 25-day intervals,

days 0, 25, and 50. A similar count was taken of ticks

found on the body of the MWDs at the same interval.

Ticks were left on the dogs. Blood was drawn upon

entry into the study and examined for the presence of

heartworm antigen and larvae. After all numerical

counts were taken, drug (saline or ivermectin) was

administered and dogs were observed for any potential

adverse reactions. All medical interventions and

numerical counts of parasites were conducted by

trained US Army animal care specialists. Handling and

restraint of MWDs were conducted in the usual

manner by trained ROK Army Soldiers. Neither the

technicians nor the handlers were aware of group

assignment or medication administered to the dogs.

Dogs were positively reassured throughout the

intervention period. Administrative recording of data

and blinding were conducted by separate US Army

administrative and logistic specialists. On-site

oversight of the entire study was performed by

Veterinary Corps officers from both the US and ROK

Armies.

Baseline Comparisons. Baseline data included: age,

sex, body weight, presence and number of eyeworms,

presence and number of ticks, presence of heartworm

serum antigen (SNAP Canine Heartworm PF Antigen

Test*), and presence of heartworm microfilaria (Difil

test†).

Response Variables

 Eyeworms—The response variable was

continuous, a quantitative numerical count of

eyeworms found in the eyes of MWDs at 25 days

intervals.

 Ticks—The response variable was continuous, a

quantitative numerical count of ticks found on

MWDs at the same 25 day intervals.

 Heartworm—The response variable was

qualitative, a dichotomous (positive or negative)

presence of serum heartworm antigen as

determined by assay or microfilaria as determined

by Difil test.

Data Analysis. Baseline data was analyzed using a Ztest for difference of proportions and a Student’s T-test

for difference of means. Eyeworms were analyzed

using graphic proportions (proportion infected). Drug

efficacy was based on a geometric mean, and eyeworm

burden was assessed using a Wilcoxon nonparametric

test. Cure rate was determined by the proportion

infected. Heartworms and ticks were analyzed using a

Z-test for difference of proportions. Significance was

set at P<0.05.

RESULTS

One hundred twenty-one MWDs were enrolled into

the study with 114 being analyzed. Of those, 3 MWDs

died of unrelated disease, 2 dogs became ill from

unrelated illness and were excluded, one dog departed

the study early to return to duty, and one dog was

removed from the study due to disposition. With the

exception of males to females, the 2 groups were

absolutely comparable. Male dogs made up 63% of the

treatment group (SEM‡6.4%) as compared to 46%

male population of the control group (SEM 6.7%). The

proportion of males to females was not significantly

different at =0.05, but was close with a p=0.067.

There were no suspected biological implications to

canine hosts with regard to eyeworms, ticks, or

heartworms and the sex of the host. Treatment dogs

had a mean age of 30.5 months (SEM 3.0). Control

group mean age was 31.7 months (SEM 3.4). Mean

weights for the treatment group were 28.4 kg for the

treatment group (SEM 0.7) and 28.3 kg for controls

(SEM 0.7).

Eyeworms. Prevalence of eyeworms in MWDs of each

group is shown in the Figure. No difference in

numbers of eyeworms between groups was observed at

day 0 (p=0.16). Prevalence in the controls remained

approximately constant over all treatment times (14%

to 18%) with no significant difference observed in

overall baseline proportions. The prevalence of

eyeworms in the treatment group went to zero at 25

days and remained lower at 50 days (5%) than the 24%

seen at baseline. Combined treatment proportions were

significantly less than both combined baseline and

control proportions (p<0.005).

‡

Standard Error of the Mean

*IDEXX Labs, One IDEXX Drive, Westbrook, Maine 04092

†

EVSCO Pharmaceuticals, Buena, New Jersey 08310
54 Army Medical Department Journal

Due to the lack of independence between groups, the

number (or proportion) of dogs who, over a given time

interval, recover (eg, they had greater than one

eyeworm at time X, but had zero eyeworms at time

X+1), and develop the infection (eg, they did not have

eyeworms at time X, but had greater than one

eyeworm at time X+1) were observed. These

observations, depicted in Table 2, present the number

of animals that would normally recover over an

interval, and the number of animals expected to

become infected over an interval. In the treatment

group, 4 new cases of eyeworms were observed

between day 25 and day 50. Only one of these four

was reinfected (ie, initially had

eyeworms at the start of the study,

then had no eyeworms during the

first interval, and subsequently did

have eyeworms again during the

last interval). Of the control dogs,

there were 7 dogs that developed

eyeworms between day 25 and

day 50. Three of these seven were

reinfections.

Ivermectin efficacy was 100% at

Day 25 and 71.5% at Day 50.

Cure rate at Day 25 showed 100%

recovery with ivermectin in the

treatment group, with 14 MWDs

initially infected with eyeworms

and 14 improved. Control dogs

showed a 25% recovery with the

placebo over the same period,

with 8 MWDs initially infected with eyeworms and 2

improved.

The mean number of eyeworms per dog, given that the

dog had one or more eyeworms, did not appear

different between groups, with the exception of the

treatment group at Day 25 as no infected dogs were

observed (Table 3).

Ticks. There was no significant difference between

groups regarding ticks. Prevalence and number of ticks

per dog increased over time in both groups. No

association was found between the number of ticks or

presence of ticks and eyeworms.

Heartworms. Heartworm seroprevalence was 16% in

treatment dogs and 18% in controls. Only one control

dog was positive for heartworm

microfilaria at the beginning of the

study. No association was found

between the presence of

heartworms or presence of

heartworms and eyeworms or

treatment groups. Animals with

heartworms were not more likely

to have eyeworms, whether

receiving ivermectin or not.

DISCUSSION

The results of this study suggest

that ivermectin administered orally

at 0.2 mg/kg every 3 weeks

appears to be effective in reducing

the prevalence of Thelazia

callipaeda in dogs. These findings

are consistent with similar studies

Table 2. Proportion of New Cases*

and Recoveries†per Study Interval

Interval 1 (Day 0 to Day 25)

New Cases Recoveries

Control 7.1 (3.4) 5.4 (3.0)

Treatment 0 (NA) 22.4 (3.4)‡

Interval 2 (Day 25 to Day 50)

New Cases Recoveries

Control 8.9 (3.8) 14.3 (4.7)

Treatment 6.9 (3.3) NA§

*New cases were defined as zero eyeworms at

time X, but at least one eyeworm at time X=1.

† Recovery was defined as the presence of at least

one eyeworm at time X, but zero eyeworms at

time X=1.

‡ All dogs that initially had eyeworms recovered.

§Since no treatment dogs were infected at Day 25,

none could have recovered in the succeeding

interval.

Percentage of dogs with eyeworm infestation

(with 95% Cls) at Day 0, Day 25, and Day 50.

0%

5%

10%

15%

20%

25%

30%

Day 0 Day 25 Day 50

Percentage of Infected M

W

Ds

Control

Treatment

0%

5%

16%

18%

14%

24%

Table 3. Mean Number of Eyeworms Per

Dog With Eye Infestation*

Control Group

Baseline Day 25 Day 50

Number 9 11 8

Mean 16.6 (8.7) 3.2 (0.8) 3.4 (0.9)

Treatment Group

Baseline Day 25 Day 50

Number 13 NA 4

Mean 18.8 (8.4) NA 3.3 (1.7)

*At least one eyeworm in the dog

A Clinical Trial of Ivermectin Against Eyeworms in German Shepherd Military Working Dogs
July – September 2007 55

in cattle involving Thelazia species where the efficacy

of ivermectin in the medical treatment of the

eyeworms was demonstrated. These studies showed a

97% to 100% efficacy in cattle at 8 to 14 days post

treatment with ivermectin. Immature worms typically

returned at 22 days post-treatment. Multiple routes of

administration were used (subcutaneous injection and

topical pour-on) over a dosage range from 0.2 to 0.5

mg/kg body. Soll et al noted that although ivermectin

administered subcutaneously was >99% effective

against Thelazia rhodesii, 7 of 16 cattle they examined

became reinfected 22 days following treatment.11

The high efficacy of the injectable formulation of

ivermectin also demonstrated in other studies in

cattle8,1(p263) suggests infection was reestablished by

immigrating infected flies. Face flies can migrate 1-2

kilometers within 24 hours, implying that an effective

fly abatement program would be a necessary

component of an overall eyeworm control program for

working dogs housed and worked outdoors.

An added benefit of using ivermectin as a part of an

eyeworm prevention program is that it would be

coincidentally effective as a heartworm preventive.

The dosage of ivermectin reported here is

approximately 10 times the usual dosage used for

heartworm prevention. The observed dogs had a

notable sero-prevalence suggesting a heartworm

prevention program would be beneficial.

Ivermectin, and the avermectins as a group, are

relatively inexpensive, widely available, and easy to

use veterinary drugs. Effective over a wide dosage

range and via multiple routes of administration,

ivermectin provides multiple therapeutic modality

options for the care provider. Although a relatively

older drug, and somewhat limited in use in some

canine breeds, ivermectin offers a good management

choice/alternative for German Shepard working dogs.

Further study should explore the potential use and

efficacy of newer, safer, and even easier to use

avermectin class drugs.

It should be noted that, although not common,

Thelazia infestations are possible in humans. This

makes eyeworm control a potential consideration for

those working in areas of increased likelihood of

exposure.

LIMITATIONS

This study was significantly limited in regard to its

observations of ticks. Better observations as supported

by similar studies in other animal species would have

been in noting the genus/species of ticks found on the

MWDs, volume of blood consumed by the ticks,

average body weight of ticks after ivermectin

treatment, and perhaps tick egg production after

ivermectin. Although ivermectin use in animals has

been shown to reduce the abundance of all stages of

ticks in pastures,13 reduce the body weight and amount

of blood consumed by ticks,14 and reduce subsequent

egg production of ticks,15 reduction in tick numbers on

treated animals were not readily apparent.16

CONCLUSION

Although ivermectin does not prevent dogs from being

infected with eyeworms, this study suggests that

ivermectin administered orally at a dose of 0.2 mg/kg

every 3 weeks reduces the prevalence of Thelazia

species eyeworms in dogs. Used in concert with a

practical fly abatement program in endemic areas,

ivermectin could effectively manage eyeworms in

working dog populations.

ACKNOWLEDGEMENT

The successful outcome of this study is in large part

due the diligent efforts of the Soldiers on the FROKA

Military Working Dog Center and the 129th Medical

Detachment (Veterinary Medicine). Of particular note

is the work of MSG (Ret) Frank Rinker in

coordinating the logistics and movement of personnel,

and SGT Kim Yong in providing interagency

translation and coordination support.

REFERENCES

1. Urquhart GM, Armour J, Duncan JL, Dunn AM,

Jennings FW. Veterinary Parasitology. Harlow, Essex,

England: Longman Scientific & Technical; 1987.

2. Lapage G. Veterinary Parasitology. 2nd rev ed.

Springfield, Illinois: Charles C Thomas Publisher LTD;

1968:275-276.

3. Jones TC, Hunt RD. Veterinary Pathology. 5th ed.

Philadelphia: Lea & Febiger; 1983:836.
56 Army Medical Department Journal

4. Hong ST, Park YK, Lee SK, Yoo JH, Kim AS, Chung

YH, Hong SJ. Two human cases of Thelazia callipaeda

infection in Korea. Korean J Parasitol. 1995;33(2):139-

144.

5. Cheung WK, Lu HJ, Liang CH, Peng ML, Lee HH.

Conjunctivitis caused by Thelazia callipaeda

infestation in a woman. J Formos Med Assoc.

1998;97(6):425-427.

6. Choi WY, Youn JH, Nam HW, Kim WS, Kim WK,

Park SY, Oh YW. Scanning electron microscopic

observations of Thelazia callipaeda from human.

Kisaengchunghak Chapchi. 1989;27(3):217-223.

7. Helper LC. Magrane’s Canine Ophthalmology. 4th

ed. Philadelphia: Lea &Febiger; 1989:98-99.

8. Plumb DC. Veterinary Drug Handbook. 5th ed.

Boston: Blackwell Publishing; 2005:433-437.

9. Kennedy MJ, Holste JE, Jacobsen JA. The efficacy of

ivermectin (pour-on) against the eyeworms, Thelazia

gulosa and Thelazia skrjabini in naturally infected

cattle. Vet Parasitol. November 1994;55:263-266.

10. Kennedy MJ. The efficacy of ivermectin against the

eyeworm, Thelazia skrjabini, in experimentally

infected cattle. Vet Parasitol. December

1992;45:127-131.

11. Soll MD, Carmichael, I.H, Scherer HR, Gross SJ..

The efficacy of ivermectin against Thelazia rhodesii

(Desmarest, 1828) in the eyes of cattle. Vet Parasitol.

April 1992;42:67-71.

12. Kennedy MJ. The effect of treating beef cattle on

pasture with ivermectin on the prevalence and

intensity of Thelazia species (Nematoda:

Thelaziodea) in the vector, Musca autumnalis

(Diptera: Muscidae). J Parasitol. 1994;80(2):321-

326.

13. Pound JM, Miller JA, George JE, Oehler DD, Harmel

DE. Systemic treatment of white-tailed deer with

ivermectin-medicated bait to control free-living

populations of lone star ticks (Acari:Ixodidae). J Med

Entomol. 1996;33(3):385-394.

14. Wilson KJ, Hair JA, Sauer JR, Weeks DL. Effect of

ivermectin on the volume of blood ingested by two

species of ticks (Acari:Ixodidae) feeding on cattle. J

Med Entomol. 1991;28(3):465-468.

15. Taylor SM, Kenny J. An ivermectin sustained release

bolus in cattle: its effects on the tick Ixodes ricinus.

Med Vet Entomol. 1990;4(2):147-150.

16. Soll MD, Benz GW, Carmichael IH, Gross SJ.

Efficacy of ivermectin delivered from an intraruminal

sustained-release bolus against natural infestations of

five African tick species on cattle. Vet Parasitol.

November 1990;37:28-96.

AUTHORS

COL Fudge is the Commander of the Central Pacific

District Veterinary Command located on Fort Shafter,

Hawaii. At the time the article was written, he was the

Commander of the 129th Medical Detachment

(Veterinary Medicine), located at the Yongsan Base,

Seoul, Republic of Korea.

LTC Jeong is Chief, Veterinary Research Section with

the Ministry of National Defense at Yongsan Base,

Seoul, Republic of Korea. At the time the article was

written, he was the Veterinary Officer of the First ROK

Army Military Working Dog Training Center,

Chunchon, Republic of Korea.

Dr McInturff obtained his PhD in Epidemiology and a

DVM from the University of California, Davis. He was

a practicing veterinarian serving the dairy industry. Dr

McInturff died in October, 2006.

A Clinical Trial of Ivermectin Against Eyeworms in German Shepherd Military Working Dogs
July – September 2007 57

INTRODUCTION

The US Army Veterinary Service, the Department of

Defense Executive Agent for Food Safety, reports tens

of thousands of dollars in condemned raw meat (beef

and pork) and poultry losses each year. This estimate

is likely considerably lower than the actual losses.

Most often condemnation results from refrigeration

failure or poor transportation and warehousing/storage

practices which allow the product temperature to rise

above the 5oC (41oF) cold-holding requirement. The

primary reference for this cold-holding requirement is

the Food and Drug Administration’s Food Code,1

which is cited in the food safety regulations of all

branches of the US armed forces. Another criterion

often tied to this cold-holding requirement is that

exposure of potentially hazardous foods (raw meat and

poultry) to an out-of-temperature condition should not

exceed 4 hours, though this is not specifically detailed

in the section of the Food Code covering cold-holding

of potentially hazardous food. The 4-hour criterion

likely comes from another section of the Food Code

addressing the use of time only as a public health

control rather than time in conjunction with

temperature. However, this section applies specifically

to ready-to-eat foods or to a working supply of raw

foods just before cooking, both intended for immediate

consumption. Thus the criterion does not apply to

situations such as refrigeration failures or improper

transportation/storage practices in which raw meat and

poultry have been exposed to temperatures above 5oC

(41oF) for any period of time. Since the Food Code is

written in a manner that establishes inflexible limits

for regulatory control, it does not offer any deviation

guidance which would be required to make appropriate

disposition decisions in these out-of-temperature

situations. The current decision making tool for this

purpose, historically referred to as the “Natick

Refrigeration Failures Guide” (The Guide), has been

incorporated into chapter 5 of the US Army Medical

Command’s Pamphlet 40-13.

2

It categorizes

temperature-abused foods as either SAFE or RISK.

SAFE foods are those items for which refrigeration is

used as a quality control measure and not for the

control of pathogen growth. Examples include fresh

fruits and vegetables, frozen bakery items, processed

Using Predictive Microbiology to Evaluate

Risk and Reduce Economic Losses Associated

with Raw Meats and Poultry Exposed to

Temperature Abuse

CW3 Greg M. Burnham, VC, USA

Steven C. Ingham, PhD

Melody A. Fanslau, MS

Barbara H. Ingham, PhD

John P. Norback, PhD

Donald W. Schaffner, PhD

ABSTRACT

The Department of Defense suffers economic losses when temperature-abused raw meat and poultry are

condemned. Current US Army guidance regarding time/temperature limits associated with these foods (RISK-3

category) is ultraconservative, especially at lower temperatures. We have developed a more accurate, yet

conservative or “fail-safe” computer-based tool for predicting pathogen growth in raw meat and poultry. In 20

trials of this tool, growth (>0.3 log colony-forming unit increase) or no growth of Salmonella serovars,

Escherichia coli O157:H7, and Staphylococcus aureus was accurately predicted 67% to 95% of the time for

inoculated and temperature-abused poultry products and ground beef. Fail-safe predictions were obtained in

trials for which the tool was inaccurate. The predictive tool is ready for further validation trials and field testing.

Using this tool as a supplement to the current guidance will decrease losses associated with the condemnation of

raw meat and poultry products exposed to short-term temperature abuse.
58 Army Medical Department Journal

and hard cheeses, etc. RISK category foods

(refrigeration controls pathogen growth) are broken

down into 3 groups and a flow chart to determine an

item’s RISK group is in The Guide. Raw meat and

poultry would be classified as subgroups of RISK-3

foods. Time/temperature limits for the 3 RISK groups

are also in The Guide and provide a maximum

exposure time (in hours) for each RISK group given in

1oC intervals for a 6oC to 25oC (42oF to 77oF) range. In

summary, the time/temperature guidelines for RISK-3

foods (meat and poultry) are exposure for not more

than 4 hours at temperatures of 6oC to 22oC (42oF to

72oF) or not more than 3 hours at temperatures of 23oC

to 25oC (72oF to 77oF). Our research suggests that

these guidelines are ultraconservative for raw meat and

poultry products, especially at the lower temperature

range. Having a tool to accurately predict pathogen

behavior in raw meat and poultry could drastically

reduce losses associated with condemnation of these

temperature-abused foods. We developed such a tool,

THERM (Temperature History Evaluation of Raw

Meats), to address the need for small and very small

meat and poultry processors to validate their Hazard

Analysis and Critical Control Point* critical limits and

to provide them with a decision-making tool for

process deviations.

TOOL DEVELOPMENT

The development of THERM was described in

Ingham, et al.3It is based on isothermal inoculation

experiments in raw meat. The meats used in the

isothermal studies were raw whole muscle pork, beef,

and turkey obtained from a local retail store or directly

from a local wholesale distributor. The meat was

trimmed of fat and ground in our laboratory. Levels of

indigenous microflora, fat, protein, water, and salt

were determined. Then the ground meat was portioned

and frozen at -20oC until used in isothermal studies.

Inocula were prepared by combining each of 5

cultured (stationary phase) strains of Escherichia coli

O157:H7, Salmonella serovars and Staphylococcus

aureus. For the pork and beef isothermal studies E.

coli O157:H7 and Salmonella serovars were combined

into one inoculum and S. aureus was a separate

inoculum. For isothermal studies using turkey,

separate inocula of Salmonella serovars and S. aureus

were used; E. coli O157:H7 was not used. Isothermal

studies were conducted at approximately 2.8oC (5oF)

intervals over a 10oC to 43.3oC (50oF to 110oF) range.

Ground raw pork, beef, and turkey were weighed

(about 25 g) into small sample bags and allowed to

reach the test temperature either in a static water-bath

(temperatures above room temperature) or an

incubator (temperatures at, or below, room

temperature). When the test temperature was reached,

each meat sample was inoculated with 100 μL of the

appropriate inoculum. Each inoculated sample bag was

sealed and manually massaged for 20 seconds to

distribute the inoculum throughout the meat mass.

Bags of inoculated product were returned to the

isothermal experiment temperature as quickly as

possible (<5 minutes). Three concurrent trials were

conducted at each test temperature for all meat/

pathogen combinations. Three bags per inoculum type

(one per trial) were removed at each sampling time

from the water bath or incubator. The outer surface of

each bag was sanitized with 70% ethanol and allowed

to dry. Once dry, the contents of each sample bag were

transferred to a separate, large, filtered bag. The

original sample bag was everted to expose any

inoculum still on the bag, and was then placed into the

filtered bag. The ground meat sample and original

sample bag were diluted, stomached at normal speed

for 30 seconds, and the resulting meat homogenate

was serially diluted. Similar sampling and initial

sample homogenization was done at each sampling

time in experiments to test THERM, as detailed later

in this article. For each dilution, 100 μL of

appropriately diluted sample was spread on a single

plate. The selective medium used for E. coli O157:H7

was Sorbitol MacConkey agar on which typical

colonies are colorless-to-white and opaque. The

selective medium used for Salmonella serovars was

Xylose Lysine Deoxycholate agar on which typical

colonies have a black center and a well defined clearto-opaque halo. The selective medium used for S.

aureus was Baird-Parker agar base with tellurite egg

yolk supplement on which typical colonies are shiny

black with a distinctive clear zone in the surrounding

agar. For each meat/pathogen combination and test

temperature, the log colony-forming unit (CFU)/

sample was determined at each sampling time for each

of the 3 trials. The sampling time and log CFU/sample

data were then entered into the DMFit©2.0 program

(J. Baranyi,4Institute of Food Research, Norwich

Research Park, Norwich NR4 7UA, UK) which

generated a best-fit growth curve, with an estimated

Using Predictive Microbiology to Evaluate Risk and Reduce Economic Losses Associated with Raw

eats and Poultry Exposed to Temperature Abuse

*A program of the US Food and Drug Administration to

institute a uniform standard for food safety tests and

inspections. Information available at http://

www.cfsan.fda.gov/~comm/haccpov.html.
July – September 2007 59

lag phase duration (LPD), growth rate (GR), and

corresponding R-squared value. The LPD and GR

values for each meat/pathogen combination were used

to develop the THERM tool. A software application

was written which allows the user to enter up to 20

elapsed-time (minutes) and temperature (°F) data

pairs. The application uses an interval accumulation

strategy to estimate the percent of LPD elapsing in

each time interval (constant temperature assumed) by

dividing the interval time by the LPD and multiplying

the resulting value by 100. The percent LPD

contributed by each interval is accumulated and

displayed interval-by-interval until 100% of the time

in lag phase has elapsed as shown in the following

formula:

After lag phase is complete, interval accumulation is

used to estimate subsequent growth, in log CFU. As

shown in the following formula, the log CFU of

growth is computed by multiplying GR (log CFU/

minute) by either the time (minutes) remaining in the

interval during which lag phase ended, or by the total

time of the interval (for all intervals thereafter).

When temperature values entered by the user do not

coincide with experimental temperatures used (2.8°C

intervals from 10°C to 43.3°C), linear interpolation is

performed between DMFit-derived LPD and GR

values to obtain LPD and GR values for use in

calculating the prediction.

TESTING THE TOOL

The accuracy of THERM was tested, as described in

Ingham et al,3and summarized here, in 20 inoculation

studies with coarse-ground beef or poultry products.

These products were inoculated, subjected to various

short-term temperature-abuse regimes, and analyzed to

determine pathogen populations at predetermined time

points during the temperature abuse. A time/

temperature history for either the product (4.5 kg

chubs of coarse-ground beef) or the storage

environment (poultry products) was also obtained in

each experiment to enter into THERM and obtain a

growth prediction.

Coarse-ground beef in 4.5 kg sealed cylindrical

packages (chubs) was obtained from a local wholesale

distributor. Compositional and microbiological

analyses were done as described above. To inoculate

the chubs, 12 samples (25 g each) were removed by

cutting incisions through the packaging material on the

top half of the long axis of the chub. The 25 g samples

were placed in small sampling bags, inoculated, and

the inoculum was dispersed as described earlier. The

bagged inoculated samples were placed back into the

chubs just underneath the packaging and secured. For

each coarse-ground beef experiment (Table 1,

experiments 1 through 12), a temperature probe

attached to a data logger was inserted just under the

surface in the center of the chub to record time/

temperature data that was then entered into THERM.

Data points were selected by dividing the experiment

time into 20 equal intervals, and determining the

temperature at each of the times from the data logger

output. Inoculated coarse-ground beef chubs were

subjected to one of 3 temperature-abuse situations:

1. Pathogen contamination of refrigerated raw meat

followed by short-term holding (3 hours to 6

hours) at room temperature or 35°C

(experiments 1 through 4).

2. Thawing previously contaminated and frozen

product at room temperature or 35°C (12 hours

to 15 hours; experiments 5 through 8).

3. Holding previously contaminated, frozen, and

thawed meat at room temperature or 35°C for 12

hours (experiments 9 through 12).

Sampling (one sample bag per inoculum) and

pathogen enumeration were done as described earlier

at predetermined times throughout each experiment.

Frozen or frozen/thawed samples were spread-plated

on Nutrient Agar and incubated at 35°C for one hour

to encourage repair of freeze/thaw-induced injury. The

Nutrient Agar was then overlaid with the appropriate

selective medium (tempered at 48°C). Incubation then

continued at 35°C for the usual 24 or 48 hour period.

For the poultry experiments (Table 1, experiments 13

through 20), fresh skinless chicken breasts and ground

turkey meat from 2 different processors were obtained

at a local retail store, stored frozen, and then thawed at

5°C before use. Frozen turkey scapula meat was

N

Total percent LPD = ∑ interval time/LPDi x 100

i=1

N

Total Growth = ∑ GR for intervali x interval timei

i=1
60 Army Medical Department Journal

obtained from a local wholesale distributor, stored

frozen, and then thawed at 5°C before use. Both

compositional and microbiological analyses were done

as described above. Each type of poultry product was

subdivided into small portions, inoculated as described

earlier, and then exposed to 2 different temperatureabuse storage conditions. Storage treatments were

either 13°C for 8 hours (experiments 13 through 16),

mimicking a processing environment barely

complying with USDA regulations,5or sequentially

for 3 hours at 13°C, 3 hours at 21°C, and 4 hours at

30°C (experiments 17 through 20). The latter

experiments mimicked an extreme loss of temperature

control (eg, product inadvertently left on a loading

dock, cooler failure). Small pieces of meat were

excised from the surface of the skinless chicken

breasts and the turkey scapula meat, placed into a

small sample bag and inoculated with 100 μL of the

appropriate inoculum, which was then distributed over

the surface of each piece. Ground turkey meat (25 g)

was weighed into a small sample bag, inoculated, and

the inoculum was manually dispersed as described

earlier. A data logger again was used to monitor

storage temperature and provide data to enter into

THERM. Data points were selected by dividing the

experiment time into 20 equal intervals, and

determining the temperature at each of the times from

the data logger output. One sample of each product

type was analyzed at 3 hours, 6 hours, and 8 hours

(experiments 13 through 16) or at 3 hours, 6 hours, and

10 hours (experiments 17 through 20). Microbiological

analyses were conducted as described earlier.

STATISTICAL ANALYSIS

The paired t-test, with a 5% significance level was

used to compare LPD and GR values for a given

pathogen between products (ground pork, ground beef,

ground turkey) and for a given product between

pathogens (E. coli O157:H7, Salmonella serovars, and

S. aureus). In experiments to test THERM, each log

CFU value obtained in an experiment was subtracted

from its corresponding time-zero value to obtain

observed change in log CFU values. Time/temperature

data from each experiment were entered into THERM

to obtain predicted change in log CFU values. The

observed values were compared to the predicted values

using the paired t-test and regression analysis.

RESULTS AND DISCUSSION

Preliminary experiments showed that the level of

indigenous microorganisms had a significant effect on

LPD values for S. aureus but not E. coli O157:H7 and

Salmonella serovars, with larger S. aureus LPD values

resulting when there were greater numbers of

indigenous organisms. Therefore, in order to develop a

conservative predictive tool, all development

experiments used meat products which had what we

considered to be low, but realistic, levels of

background organisms—Aerobic Plate Count <3.5 log

CFU/g. This level was slightly lower than mean

Aerobic Plate Count values reported in United States

Department of Agriculture baseline surveys of ground

beef, turkey, and chicken.6-8

Experiment Product Storage

Temperatures

Holding

Time

1 GB RT* 340 minutes†

2 GB RT* 360 minutes†

3 GB 35°C 180 minutes†

4 GB 35°C 240 minutes†

5 GB -20°C/RT 15 hours†

6 GB -20°C/RT 15 hours†

7 GB -20°C/35°C 12 hours†

8 GB -20°C/35°C 12 hours†

9 GB -20°C/5°C/RT 12 hours†‡

10 GB -20°C/5°C/RT 12 hours†‡

11 GB -20°C/5°C/35°C 12 hours†‡

12 GB -20°C/5°C/35°C 12 hours†‡

13 C 5°C/13°C 8 hours†

14 T 5°C/13°C 8 hours†

15 GT-A 5°C/13°C 8 hours†

16 GT-B 5°C/13°C 8 hours†

17 C 5°C/13°C/21°C/30°C 10 hours§

18 T 5°C/13°C/21°C/30°C 10 hours§

19 GT-A 5°C/13°C/21°C/30°C 10 hours§

20 GT-B 5°C/13°C/21°C/30°C 10 hours§

*RT – room temperature (≈21°C)

†Holding time at room temperature (≈21°C), 13°C, or 35°C. Initial

sampling occurred on inoculation (for nonfrozen coarse-ground

beef samples), when inoculated poultry products were moved to 13°

C storage, or when frozen coarse-ground beef was removed from

the freezer.

‡Sampling done once center of the meat mass reached 5°C and

periodically during storage at RT or 35°C.

§Product held at 13°C for 3 hours, 21°C for 3 hours, and at 30°C for

4 hours. Initial sampling was done when product was moved to 13°

C storage.

Table 1. Outline of temperature-abuse experiments with

inoculated coarse-ground beef (GB), skinless chicken

breasts (C), turkey scapula meat (T), ground turkey meat

from plant A (GT-A) and ground turkey meat from plant B

(GT-B).

Using Predictive Microbiology to Evaluate Risk and Reduce Economic Losses Associated with Raw

eats and Poultry Exposed to Temperature Abuse
July – September 2007 61

The DMFit-derived R-squared value is a number from

0 to 1 that represents the relative predictive power of

the model. The closer the R-squared value is to 1, the

greater the model’s accuracy. All R-squared values for

each meat/pathogen combination were >0.70 with 73%

≥0.90. The only statistically significant (ρ<0.05)

differences in LPD or GR values were:

1. LPD values for Salmonella serovars were lower

in beef than in pork.

2. LPD values for S. aureus were higher than those

for E. coli O157:H7 and Salmonella serovars in

beef, and higher than those for E. coli O157:H7

in pork.

3. GR values for S. aureus were lower than those

for E. coli O157:H7 and Salmonella serovars in

beef and turkey, respectively.

As expected, LPD decreased and GR increased as

temperature increased to an optimum for growth

(illustrated in the Figure).

As concluded in Ingham et al,3the THERM tool was

accurate or fail-safe in predicting whether E.coli

O157:H7, Salmonella serovars, and S. aureus grew in

raw beef and poultry products during experiments

designed to test the tool’s performance. To reach this

conclusion, we qualitatively evaluated the predicted

and observed change in log CFU values, ie, described

predictions and observations as either “growth” or “no

growth”. We used the criteria of growth equals a

change in log CFU>0.3 (more than one doubling) and

no growth equals a change in log CFU≤0.3. As shown

in Table 2, the THERM tool accurately predicted

whether growth would occur in 67%, 85%, and 95% of

experiments involving E. coli O157, Salmonella

serovars, and S. aureus, respectively. In all other

experiments, THERM predicted pathogen growth

when it was not observed experimentally, ie, made a

fail-safe prediction. Notably, THERM never made a

“fail-dangerous” prediction, ie, THERM never failed

to predict growth when it was observed

experimentally. In addition to comparing the predicted

and observed change in log CFU values for each

pathogen in each individual experiment, the paired ttest was used to compare predicted and observed

change in log CFU values for each pathogen for all

experiments combined. This analysis

showed that the predicted changes in

log CFU values were significantly

higher than the observed change in

log CFU values for E. coli O157:H7

(ρ=0.007) and Salmonella serovars

(ρ=0.02). The R-squared values from

regression analysis were 0.94 and

0.89, respectively for these 2

pathogens, indicating a very

consistent relationship between

predicted and observed values. The

R-squared value for S. aureus was

only 0.43, reflecting the divergence

of predicted and observed values in

poultry product experiments 17

through 20. The paired t-test analysis

did not show any statistically

significant difference between

predicted and observed values for S.

aureus for all experiments combined

(ρ=0.49), perhaps reflecting the inconsistent

relationship between predicted and observed results.

An additional way of testing the accuracy of THERM

is to compare its pathogen growth predictions to

experimental pathogen growth observed in

experiments in other laboratories. For example, a

recent study by Mann et al9suggested a critical limit

for ground beef processors of “time in the processing

area of 6 hours or less” with the processing area

temperature defined as 22°C to 23°C. For 22.5°C

storage of ground beef for 6 hours, with no additional

Growth rates and lag phase duration values for E. coli O157:H7 in ground

beef in the temperature range 50°F to 110oF.

0

0.005

0.01

0.015

0.02

0.025

0.03

50 55 60 65 70 75 80 85 90 95 100 105 110

0

200

400

600

800

1000

1200

1400

1600

1800

Lag Phase Duration (min

Growth Rate )

Lag Phase Duration

Growth Rate

Lag Phase Duration

Growth Rate

Lag Phase Duration

Growth Rate (log CFU/minute)

Lag Phase Duration (minutes)

Temperature (°F)
62 Army Medical Department Journal

Table 2. Accuracy of qualitative predictions (THERM*) for growth (>0.3 log CFU†increase) or no growth (<0.3 log

CFU increase) of Escherichia coli O157:H7 (EC), Salmonella serovars (SALM), and Staphylococcus aureus (SA) in

coarse-ground beef, on skinless chicken breasts and turkey scapula meat, or in ground turkey from plants A and B

during storage at abusive temperatures.

Product

&

Experiment

EC growth >0.3 log CFU?

+ = yes – = no

SALM growth >0.3 log CFU?

+ = yes – = no

Observed Predicted Accuracy Observed Predicted Accuracy Observed Predicted Accuracy

Coarse-Ground

Beef

1 – – Acc‡

– – Acc – – Acc

2 – + F–S

§

– + F–S – – Acc

3 – – Acc – – Acc – – Acc

4 – + F–S + + Acc – – Acc

5 – + F–S – + F–S – – Acc

6 – – Acc – – Acc – – Acc

7 + + Acc – + F–S – – Acc

8 + + Acc + + Acc – + F–S

9 – + F–S – – Acc – – Acc

10 + + Acc + + Acc – – Acc

11 + + Acc + + Acc + + Acc

12 + + Acc + + Acc + + Acc

Ground Beef

Totals

67% Acc

33% F-S

75% Acc

25% F-S

91% Acc

9% F–S

Chicken Breast

13 NT** NT NT – – Acc – – Acc

17 NT NT NT + + Acc + + Acc

Turkey Scapula

14 NT NT NT – – Acc – – Acc

18 NT NT NT + + Acc + + Acc

Ground Turkey A

15 NT NT NT – – Acc – – Acc

19 NT NT NT + + Acc + + Acc

Ground Turkey B

16 NT NT NT – – Acc – – Acc

20 NT NT NT + + Acc + + Acc

Total for Poultry 100% Acc 100% Acc

Overall Total 67% Acc

33% F-S

85% Acc

15% F-S

95% Acc

5% F-S

*Temperature History Evaluation of Raw Meats

†Colony Forming Unit

‡Accurate

§Fail-safe, ie, predicted growth >0.3 log CFU, and observed growth <0.3 log CFU

**Not tested

SA growth >0.3 log CFU?

+ = yes – = no

Using Predictive Microbiology to Evaluate Risk and Reduce Economic Losses Associated with Raw

eats and Poultry Exposed to Temperature Abuse
July – September 2007 63

warm-up and cool-down times

(the same conditions as laid out

by Mann et al9), the THERM

tool predicted a 0.54 log CFU

increase of E. coli O157:H7. The

experimentally determined

change in log CFU value was

0.49, indicating good agreement

between THERM and the

inoculation study. With longer

room-temperature incubation,

Mann et al9observed a change

in log CFU values (rounded) of

1.0, 1.4, and 1.8 for E. coli

O157:H7 stored for 8 hours, 10

h o u r s , a n d 1 2 h o u r s ,

respectively. The corresponding

changes in log CFU values

predicted by THERM for these

times were 0.9, 1.3, and 1.7. For

ground beef stored at 10°C,

Mann et al9observed changes in

l o g C F U v a l u e s o f

approximately 0.1, 0.1, 0.2, 0.4, 0.8, and 1.0 at 4

hours, 8 hours, 12 hours, 24 hours, 48 hours, and 72

hours, respectively. The THERM tool predicted no

growth of E. coli O157:H7 through 27 hours, with

changes in log CFU values of 0.5 at 48 hours and 1.1

at 72 hours. Using the qualitative approach discussed

earlier, we conclude that the THERM tool predictions

are consistent with those from the Mann et al study.9

Experimentally determined critical limits, as in the

first Mann et al9example above, expressed in

maximum safe time at a given temperature, are useful

for processors, so critical limit tables were developed

for each meat type based on the shortest LPD time of

the 3 pathogens. Table 3 was used to evaluate several

out-of-temperature situations reported in the US Army

Veterinary Command’s Installation Support Plan

database.10 In one example, raw beef and poultry items

were exposed to an out-of temperature situation for 7

hours and had reached internal temperatures of 50oF.

Based on our critical limit table, raw beef can be safely

exposed to this temperature for up to 27 hours and raw

poultry up to 22.5 hours. Another example was a

reported out-of-temperature situation involving a rawmeats display case (meat type not reported) in which

items were temperature-abused for 5 hours and

reached a temperature of 57oF. The THERM critical

limit table reports safe exposure times at this

temperature of 9 hours, 6 hours,

and more than 13 hours for pork,

beef, and poultry respectively.

When several time and

temperature measurements are

available from a refrigeration

failure situation, a more specific

THERM prediction is possible.

For example, in a recently

reported out-of-temperature

situation, internal product

temperatures at 2 hours, 4 hours,

8 hours, and 12 hours were 42oF,

48oF, 60oF, and 38oF. For all meat

types THERM predicted that 67%

or less of LPD elapsed for E. coli

O157:H7 and 58% or less of LPD

elapsed for Salmonella serovars.

Because no S. aureus growth

occurred during 240-hour

experiments at temperatures

below 60oF in our isothermal

studies, THERM did not predict

any LPD elapsing for S. aureus during this out-oftemperature situation.

One conservative feature of THERM is that it does not

account for a variety of inhibitory ingredients (eg, fat,

sodium chloride, sodium nitrite, liquid smoke) or

inhibitory processing conditions (eg, dry-curing, coldsmoking, or drying) to which pathogens or competing

microorganisms may be exposed during temperature

abuse of raw meat products. For example, in 2

independent industry challenge studies involving

partially cooked bacon and finished biltong and

droëwors* conducted by our laboratory,11,12 THERM

always predicted growth of all 3 pathogens when

experimental time/temperature data were entered. Yet,

no growth of inoculated pathogens was observed in

any of the trials. To make the most accurate

predictions for critical limit validation or process

Critical Limit

(hours:minutes)

Temperature (°F) Pork Beef Poultry

50 54:45 27:00 22:30

55 17:30 9:00 14:45

60 9:00 6:00 13:45

65 8:15 3:45 8:15

70 5:45 3:30 4:45

75 4:15 2:30 3:00

80 4:15 2:00 3:00

85 1:30 1:45 2:00

90 1:30 1:30 2:00

95 1:30 1:15 2:00

100 1:30 1:15 1:30

105 0:45 1:00 0:45

110 0:45 1:00 0:45

Table 3. Critical limit table expressed in

maximum safe time, in hours and

minutes, at a given temperature for pork,

beef, and poultry

*Biltong and droëwors are 2 shelf-stable, ready-to-eat, dried

beef products developed in South Africa. Traditionally

these products were made by drying under ambient

conditions. To make biltong, beef strips are seasoned

(high-salt) and dried. To make droëwors, small pieces of

beef are obtained from trimming and/or grinding, seasoned

(high-salt), stuffed into casings, and dried. In essence,

these two products could be viewed as very thick versions

of whole-muscle and ground-and-formed beef jerky, made

without elevated heat.
64 Army Medical Department Journal

deviation decision making for these products,

additional versions of THERM would have to be

developed using meats containing representative

amounts of salt, nitrite, and/or other inhibitory

compounds. Other researchers have attempted to

account for inhibitors of microbial growth and have

modeled the temperature, pH, and water activity

conditions at the growth/no growth boundary for

Salmonella Typhimurium in laboratory media.13

However, analogous work with meat systems has not

been published. We are currently working on a version

of THERM using a standardized pork-based bratwurst

batter. Another restriction of THERM is its limited

temperature range. However, growth at temperatures

below the THERM lower limits would likely have

little effect on the accuracy of THERM predictions

because of the extremely long lag phase duration

values expected at such low temperatures. However,

THERM growth predictions could be erroneously low

if growth occurred at temperatures above the 43.3°C

upper limit of THERM. Furthermore, at even higher

temperatures, such as those employed in slow-cooking,

pathogens will begin to die. We are currently studying

the expansion of THERM beyond the 43.3°C upper

limit. However, many physiological and

environmental factors must first be considered before

developing a tool that predicts pathogen behavior at

the upper growth/no growth temperature boundary,

and when temperature is high enough to cause cell

death.

CONCLUSIONS

THERM is an effective prototype tool for qualitatively

predicting pathogen behavior in raw meat and poultry.

Its application in Department of Defense temperature

deviation evaluation could reduce economic losses

associated with temperature-abused meats without

jeopardizing the health of armed forces personnel.

Ongoing extensions of the THERM prototype will

enhance its applicability. The current downloadable

version of THERM, as well as a web-based betaversion, may be found on the website, http://

www.meathaccp.wisc.edu.

REFERENCES

1. Food Code. Food and Drug Administration Web site.

Available at: http://www.cfsan.fda.gov/~dms/fc05-

toc.html. Accessed 3 April, 2007.

2. MEDCOM Pamphlet 40-13: US Army Veterinary

Command Guidelines and Procedures. Fort Sam

Houston, TX. US Army Medical Command, US Dept

of the Army; February 13, 2006.

3. Ingham SC, Fanslau MA, Burnham GM, Ingham BH,

Norback JP, Schaffner DW. Predicting pathogen

growth during short-term temperature abuse of raw

pork, beef and poultry: use of an isothermal based

predictive tool. J Food Prot. 2007;70:1146-1456.

4. Baranyi J, Roberts TA. A dynamic approach to

predicting bacterial growth in food. Int J Food

Microbiol. 1994;23:277-294.

5. Animals and Animal Products, 9 CFR vol 2 ch 3, part

381.66 (2003).

6. Food Safety and Inspection Service. Nationwide

Federal Plant Raw Ground Beef Microbiological

Survey; August 1993-March 1994. US Dept of

Agriculture; April 1994. Available at: http://

www.fsis.usda.gov/OPHS/baseline/rwgrbeef.pdf.

Accessed May 26, 2006.

7. Food Safety and Inspection Service. Nationwide Raw

Ground Turkey Microbiological Survey. US Dept of

Agriculture; May 1996. Available at: http://

www.fsis.usda.gov/OPHS/baseline/rwgrturk.pdf.

Accessed May 26, 2006.

8. Food Safety and Inspection Service. Nationwide Raw

Ground Chicken Microbiological Survey. US Dept of

Agriculture; May 1996. Available at: http://

www.fsis.usda.gov/OPHS/baseline/rwgrchck.pdf.

Accessed May 26, 2006.

9. Mann JE, Brashears MM. Validation of time and

temperature values as critical limits for the control of

Escherichia coli O157:H7 during the production of

fresh ground beef. J Food Prot. 2006;69:1978-1982.

10. Installation Support Plan Database. US Army

Veterinary Command. Available at: https://

vet1 .a med d .army. mil/8 6 2 57 0 23 00 7 ECD8 C

(restricted access). Accessed April 17, 2007.

11. Burnham GM, Fanslau MA, Ingham SC. Evaluating

microbial safety of slow partial-cooking processes for

bacon: use of a predictive tool based on small-scale

isothermal meat inoculation studies. J Food Prot.

2006;69:602-608.

12. Burnham GM, Hanson DJ, Koshick CM, Ingham SC.

Death of Salmonella serovars, Escherichia coli

O157:H7, Staphylococcus aureus and Listeria

monocytogenes during the drying of meat: a case

study using Biltong and Droëwors. J Food Saf. In

press.

Using Predictive Microbiology to Evaluate Risk and Reduce Economic Losses Associated with Raw

eats and Poultry Exposed to Temperature Abuse
July – September 2007 65

13. Koutsoumanis KP, Kendall PM, Sofos JN. Modeling the boundaries of growth of Salmonella Typhimurium in broth

as a function of temperature, water activity, and pH. J Food Prot. 2004;67:53-59.

AUTHORS

CW3 Burnham is the Veterinary Liaison at the US Army Natick Soldier Research, Development and Engineering

Center at Natick, Massachusetts. When this article was written, he was completing the requirements for a PhD (Food

Science) at the University of Wisconsin-Madison.

Dr Steven Ingham is a Professor in the Department of Food Science at the University of Wisconsin-Madison.

Ms Fanslau is a Research Assistant in the Department of Food Science at the University of Wisconsin-Madison.

Dr Barbara Ingham is a Professor in the Department of Food Science at the University of Wisconsin-Madison.

Dr Norback is a Professor in the Department of Food Science at the University of Wisconsin-Madison.

Dr Schaffner is a Professor in the Department of Food Science at Rutgers, the State University of New Jersey, New

Brunswick, New Jersey.
66 Army Medical Department Journal

The US Army Veterinary Corps Reserve Component

(VC RC) is composed of Citizen Soldiers who are

leaders and experts in the civilian veterinary medical

community, as well as leaders in their communities.

This article briefly explains the Veterinary Corps’

mission as defined by Army doctrine and demonstrates

the Veterinary Corps’ role in Force Health Protection

as described in the Force Health Protection Capstone

Document,1prepared by the Medical Readiness

Division, J-4, Joint Forces Command. The diverse

composition of the VC RC is featured through

highlighting the military education, civilian education,

military assignments, and deployments of its Soldiers.

An overview of the responsibilities of US Army

Veterinarians is stated in Field Manual 4-02.18 2:

The US Army Veterinary Corps Reserve

Component

CPT(P) Cristopher A. Young, VC, USA

1-3. Veterinary Concept of Operations

Veterinary services function in three broad categories. These categories include:

 Food safety, food defense, and quality assurance

 Veterinary medical care

 Veterinary preventive medicine

a. Food Safety, Food Defense, and Quality Assurance Services. Food safety includes hygiene and

sanitation, defense, and quality assurance services as a primary component of preventing disease and

nonbattle injury (DNBI) within an AO [area of operations].

b. Veterinary Medical Care. Level I and II veterinary care for MWDs [military working dog] includes

emergency treatment, stabilization, and evacuation. There is no Level IV veterinary care and Level V

veterinary care is found in CONUS [continental United States] at the DoD MWD Center. Level III

veterinary medical and animal hospital care is provided by the MDVM. Level III veterinary hospital

care includes comprehensive veterinary medical and surgical animal hospital care. The levels of

veterinary medical care and the number of veterinary detachments deployed to an AO are determined

by mission, enemy, terrain and weather, troops and support available, time available, and civil

considerations (METT-TC). At all levels of veterinary medical care, surveillance, prevention, and

control programs for diseases common to both animal and man are implemented. The senior

veterinary staff officer provides advice and guidance on these threats to the medical commanders and

command surgeons.

c. Veterinary Preventive Medicine.

 Support prevention and control programs to protect soldiers from foodborne diseases.

 Evaluate zoonotic disease data collected in the AO and advise PVNTMED [preventive medicine]

elements and higher headquarters on potential hazard(s) to humans.

 Establish animal disease prevention and control programs to protect soldiers and their families

and other DoD and Allied personnel from zoonotic diseases.

 Assess the presence of animal diseases that may impact the CONUS agriculture system if

contaminated equipment or personnel are allowed to redeploy.

 Perform investigations of unexplained animal deaths to include livestock and wildlife.
July – September 2007 67

The military veterinarian’s doctrinal mission is

described above, but Reserve Component Veterinary

Corps officers (VCO) are not limited to assignments in

Medical Detachment (Veterinary Service) units. VCOs

may be assigned to Civil Affairs units where they may

participate in agricultural and/or preventive medicine

teams. Veterinarians participating in these missions

work on a wide range of activities from developing

infrastructure to designing and implementing

veterinary preventive medicine programs for host

nation livestock. Another potential VCO assignment is

the newly created Medical Readiness Training

Command. Assigned veterinarians are working to

integrate Active Army and Reserve Component

training opportunities and to appropriately utilize the

Medical Training Brigades and RTS Meds. VCOs can

accept assignments as Drilling Individual Mobilization

Augmentees, who serve as resources for both District

Veterinary and Regional Veterinary Commands. There

are several colonel level assignments within the

structure, including medical brigades, the Army

Medical Command, and Office of The Surgeon

General. There are currently 12 Veterinary Corps

officers serving in the National Guard. Regardless of

assignment, the small family of approximately 173

Reserve Component VCOs is a tight-knit group that

represents tremendous experience in many facets of

veterinary medicine.

The relevance of the veterinary mission is as strong

today as it was at the origin of the Army Veterinary

Corps, when the horse played a fundamental role in the

logistics apparatus of the military. As such, animal

medicine was the key mission. Eventually, however,

the Veterinary Corps’ role grew to encompass

procurement of subsistence. The focus on food safety

evolved from the findings by the military that the

foodstuffs procured for the soldiers fighting the

Spanish-American War were substandard and filled

with vermin and contaminants. In addition, Upton

Sinclair’s novel The Jungle,3 with its exposé of the

horrendous conditions in the meat packing industry,

led to congressional passage of both the Pure Food and

Drug Act and the Meat Inspection Act in 1906. The

Veterinary Corps mandate expanded to ensure that

government food procurement contracts were fulfilled

with integrity, as is still the case today. In fact, today

the Veterinary Corps is the Department of Defense

Executive Agency for fulfilling the veterinary mission

for all branches of the Armed Forces, plus supporting

numerous executive branch agencies. Further, the

Veterinary Corps role in force health protection is a

critical mission. In 2006, the Medical Readiness

Division (J4) of the US Joint Staff prepared the Force

Health Protection Capstone Document.1 The document

prioritizes 10 critical success factors. The top priority

is in the category of Healthy and Fit Force, of which

item one is:

Occupational and environmental health

 Identify, evaluate, and control potential

chemical, biological, and physical hazards.

The fourth listed priority is again in the category of

Healthy and Fit Force. The selected items are

relevant to military veterinary medicine:

Injury/disease prevention. Goal: in prevalence/

incidence

 Identify preventable injuries and disease

affecting mission readiness.

 Establish standards for occurrence rates and

acceptable behaviors.

 Develop prevention strategies.

The final category relevant to the veterinary mission is

Surveillance. The following items are impacted by

military veterinarians:

Develop a joint comprehensive standard health

surveillance system

 Environmental/occupational capability

 DNBI capability

 Operational casualties capability

 Linkages to personnel exposure (location

and duration information)

 Seamless garrison/field capability

With the priorities of the Capstone Document2as a

backdrop, consider the context of a deployment. No

medical professional is better prepared to address the

complex interface between the Soldier, wildlife,

domestic animals, and the environment than veterinary

specialists. Zoonotic agents make up 65% or more of

the agents that cause infectious disease. Many of these

are foreign animal diseases, which, by definition, are

caused by agents that do not occur in CONUS. To

address these concerns, a majority of the officers in the

Veterinary Corps are Preventive Veterinary Medicine

specialists. Further, many officers are trained Foreign
68 Army Medical Department Journal

Animal Disease Diagnosticians, veterinarians that have

specialized training in diagnosing the clinical signs

and gross pathology of foreign animal diseases.

The Reserve Component has the additional benefit of

bringing the civilian job skills and experience of its

members to bear when deployed. Such value-added

contribution by the Reserve Component veterinarians

is especially profound. As mentioned earlier, there are

approximately 173 RC VCOs. Indicative of the level

of professionalism and skill represented within the

ranks of those officers are the number of board

certifications and diversity of specialties, displayed in

the Table.

Fifteen officers hold post-doctoral degrees, including

11 master’s and 4 PhDs. At the writing of this article,

4 RC VCOs are completing residency programs in

theriogenology, pathology, internal medicine, and

anesthesiology, respectively. Degrees and board

certifications are important, but there are other metrics

that demonstrate the exceptional caliber of the officers

in the Veterinary Corps Reserve Component, whose

ranks include:

 2003 Kentucky Veterinarian of the Year

 2002 Oklahoma Veterinarian of the Year

 2003 Texas Specialty Veterinarian of the Year

 2003 Kansas Veterinarian of the Year

 2006 Washington State University College of

Veterinary Medicine Outstanding Service Award

winner

 One of the Auburn University College of

Veterinary Medicine Class of 1994 Young

Achievers.

Such honors speak volumes about the quality of the

officers. The RC VCOs are engaged in a wide range of

civilian veterinary careers, including epidemiology,

laboratory pathology, lab animal medicine, colleges of

veterinary medicine, mixed animal practice, large

animal practice, small animal practice, specialty

practices, among others. RC VCOs hold positions of

leadership in organized veterinary medicine at both

state and national levels. The officers are involved at

the community level with hospital boards, religious

organizations, charities, local government offices, Boy

Scouts, Cub Scouts, sports teams, and more.

The following characterization of excellence truly

exemplifies the Veterinary Corps Reserve Component:

Excellence is the result of caring more than others think

is wise, risking more than others think is safe, dreaming

more than others think is practical, and expecting more

than others think is possible. (anonymous)

REFERENCES

1. Force Health Protection Capstone Document. Falls

Church, VA: US Dept of Defense, Office of the

Assistant Secretary of Defense (Health Affairs),

TRICARE Management Activity; 2004. Available at:

http://www.ha.osd.mil/forcehealth/library/main.html.

2. Field Manual 4-02.18: Veterinary Service Tactics,

Techniques, and Procedures. Washington, DC: US

Dept of the Army; 30 December 2004:para 1-3.

3. Sinclair UB. The Jungle: The Uncensored Original

Edition. Tucson, Arizona: Sharp Press; 2003.

AUTHOR

CPT(P) Young is Commander, 358th Medical

Detachment (Veterinary Service), Tuskegee, Alabama.

Board of Certification Number

Certified

Veterinary Pathology 10

Laboratory Animal Medicine 4

Veterinary Preventive Medicine 8

Veterinary Internal Medicine 5

Veterinary Practitioner 1

American Board of Toxicology 1

Veterinary Surgery 1

Specialty certifications of US Army Reserve

Veterinary Corps Officers

The US Army Veterinary Corps Reserve Component
July – September 2007 69

There is no Additional Skill Identifier or Area of

Concentration designating US Army Veterinary Corps

Soldiers as “Special Operations.” However, members

of the Corps currently serve in and support Special

Operations Forces (SOF) units. Veterinary Corps

officers and enlisted animal technicians have been part

of SOF since at least World War II. Due to the heavy

use of pack animals, veterinary personnel were part of

Merrill’s Marauders and the MARS Task Force,

employed in the China-Burma-India theater of

operations. The MARS Task Force included the

reorganized remainder of the Marauders (redesignated

the 475th Infantry Regiment), the 124th Cavalry

Regiment, as well as some Quartermaster Pack

Troops. The 475th Infantry Regiment was

redesignated the 75th Infantry Regiment in 1954, the

direct ancestor of which is the now the 75th Ranger

Regiment.

Army Veterinary Corps involvement in Army Special

Forces goes back to at least the early 1960s when

veterinarians were assigned to Civil Affairs Groups in

Okinawa (97th) and Panama (3rd). At that time,

however, even though veterinarians were going

through the Special Forces Qualification Course, they

were not assigned to Special Forces Groups

(Airborne). Such assignment did not begin until the

mid-1960s. The association of Veterinary Corps

personnel with Civil Affairs and Special Forces units

continues to the present day.

Veterinarians in Special Forces Groups (SFG) assist in

planning and executing preventive medicine tasks to

preserve the health of the Group, and participate in

veterinary civic action programs, also known as

“hearts and minds,” during exercises and deployments.

Group veterinarians also assist in the training of

Special Forces Medical Sergeants (Army military

occupational specialty [MOS] 18D) through activities

such as didactic and hands-on instruction in small and

large animal emergency treatment, food safety,

zoonotic and foreign animal disease recognition, pack

animal operations, animal husbandry and general

veterinary care, and field slaughter and carcass

evaluation. There are 5 Active Army and 2 National

Guard SFGs.

Although the Army Reserve Civil Affairs units were

taken out of US Army Special Operations Command

(USASOC) in October 2006 and placed under US

Army Reserve Command, the Active Army 95th Civil

Affairs Brigade remains under USASOC. The 95th

and its 4 subordinate battalions each have a Veterinary

Corps officer on their Table of Organization and

Equipment.

The mission of the Civil Affairs (CA) veterinarian is to

work with indigenous military assets and allied,

coalition, or foreign government agencies. They assist

in planning and executing population and resource

control, civic action, and other security development

and stability programs. During military and

paramilitary operations, they assist in planning and

executing civic action, humanitarian assistance, and

other programs designed to expand the host nation

government’s legitimacy. The CA veterinarian also

provides estimates and data on the resources essential

to build an effective infrastructure for civil health and

agricultural administration operations.

The CA veterinarian offers technical advice to the

commander on issues of agricultural production

systems; effects of large-scale, cross-border livestock

movements; effects from outbreaks of endemic and

foreign animal diseases; and cooperation with nongovernmental organizations.

Additionally, veterinarians are part of the Special

Operations Sustainment Brigade and the John F.

Kennedy Special Warfare Center and School. Animal

Care (MOS 68T) noncommissioned officers (NCO)

are also authorized and assigned to the school. All

SOF positions require parachute qualification.

There are veterinarians on the Surgeon’s staff at both

USASOC and US Special Operations Command

(USSOCOM). Though all SOF veterinary personnel

currently serve in Army units except USSOCOM, a

Veterinary Corps officer and Animal Care NCO are

Special Operations Forces Veterinary

Personnel

COL Robert Vogelsang, VC, USA
70 Army Medical Department Journal

expected to become authorized and assigned to the US

Marine Corps Force Special Operations Command

(MARSOC) in CY08. These personnel will care for

Military Working Dogs (MWD) assigned to MARSOC

as well as perform a role similar to that of the SFG

veterinarian when the unit is deployed. The 75th

Ranger Regiment has indicated an interest in obtaining

a veterinary support capability which, if approved,

would authorize assignment of one Veterinary Corps

officer and at least one Animal Care NCO.

SOF veterinary personnel have been awarded or

qualified for the Combat Action Badge, as Special

Operations Combat Diver, and Pathfinder. A number

are Senior and Master Parachutists, and some have

foreign jump wings. One National Guard SFG

veterinarian is a member of the World War II Airborne

Demonstration Team, a civilian reenactment group.

All SFG veterinarians and most of the other SOF

personnel have been deployed in support of Operations

Iraqi Freedom and Enduring Freedom. Due to the

sometimes remote locations in which SOF operates,

the unit Veterinary Corps officer may be the only

veterinarian in a particular area. As such, they will

work with host nation public health personnel to

improve local capabilities. SOF veterinarians have

responded to suspected animal diseases, and,

specifically in Afghanistan, worked with a local

veterinarian to collect and submit samples to the

Ministry of Agriculture and Animal Health for

diagnosis. Also, at the request of the Afghan

agricultural ministry, a SOF veterinarian gave lectures

on Highly Pathogenic Avian Influenza (HPAI) and

other animal diseases to a group of local veterinarians.

Shortly thereafter, the first reported case of HPAI

occurred in Afghanistan and a Group Veterinarian

assisted in the collection and distribution of essential

veterinary medical supplies to veterinarians in outlying

areas. The Group Veterinarian helped to educate

personnel working at veterinary diagnostic labs in the

proper application and use of the Brucellosis card tests

that were provided by the US Department of

Agriculture through the efforts of other Army

veterinarians deployed to Afghanistan.

The Group Veterinarians participated in numerous

veterinary civic action programs throughout the

deployments. Several thousand animals were

vaccinated and dewormed during these missions,

improving relations with local livestock owners and

government officials. Whenever possible, local

veterinarians were encouraged to participate in these

missions to help build a trust in the local infrastructure

and services available. This interaction also provided

excellent opportunities for the sharing of knowledge

between American and local veterinarians.

To provide alternative modes of transportation in areas

where vehicular travel was not practical, several

firebases obtained horses, mules, and donkeys from

local stock. Group Veterinarians assisted in the

purchase of and care for these animals, one VCO

performed castrations on several stallions and assisted

during the foaling season when 6 mares gave birth on

one firebase.

Group Veterinarians conducted spay and neuter

surgeries on animals owned by local nationals that

were in close proximity to coalition personnel. These

animals were also vaccinated against rabies and

dewormed to reduce the risk to human health in those

areas.

Group Veterinarians worked with Preventive Medicine

Officers to ensure that dining facilities were properly

maintained and that the risk of food-borne illness was

minimized at bases throughout Afghanistan. One

Group Veterinarian also assisted in human trauma

cases at a Forward Surgical Element’s local trauma

center in southern Afghanistan.

Veterinary support of special operations forces has

grown significantly in the last decade and will likely

continue to do so within the current operational

climate. Despite the fact that there is no veterinary

Area of Concentration for special operations, there are

now a sufficient number of higher ranking positions

that may allow a Veterinary Corps officer to have a

type of career progression within the Special

Operations environment. SOF assignments are

generally considered one of the best and most

rewarding tours of duty within the career of a

Veterinary Corps officer. Remember, there’s no

greater threat than an Airborne Vet!

AUTHOR

COL Vogelsang is the Deputy Surgeon for Clinical

Operations, United States Special Operations Command

at MacDill Air Force Base, Florida.

Special Operations Forces Veterinary Personnel
July – September 2007 71

Stabilization and reconstruction operations in failed or

failing states are vital to US security interests.

Diminishing the conditions that permit terrorism to

flourish and denying terrorists safe haven in failed

states are among the objectives of the National

Military Strategy to protect the United States.1In his

foreword to the 2005 National Defense Strategy,

Defense Secretary Rumsfeld emphasized that the

United States must take actions to influence events

before they become more dangerous and less

manageable. He also suggested that we must transform

how we think about security to achieve the favorable

security conditions required to protect the homeland

and US interests around the world.2

CAUSES OF STATE INSTABILITY

Economic distress, including food insecurity,

urbanization, refugee and displaced persons

movements, incapacitated and/or corrupt governments,

infectious diseases, and socioeconomic disparity

challenge the security and survival of individuals and

communities, and are primary destabilizing factors

leading to weakened and failed states.3-5 These longterm factors are closely interrelated, and the presence

of multiple factors results in synergistic negative

effects on the population, creating or exacerbating

state instability.3 Early identification, intervention, and

improvement in the state’s agricultural sector can

Stabilization And Reconstruction Operations:

The Role Of The US Army Veterinary Corps

LTC John C. Smith, VC, USA

ABSTRACT

Stabilization and reconstruction operations in failed or failing states are vital to US security interests. These

operations require a bottom-up approach, focusing on the population as the strategic center of gravity. This

bottom-up approach must address the population’s basic needs, as defined by Dr Abraham Maslow’s hierarchy

of needs, and provide a long-term means of self-sufficiency, rather than creating an “aid dependent economy.”

Focusing operations on agricultural projects provides relief from donor dependency, stimulates economic

growth, and thwarts the power of spoilers.

US Army Veterinary Corps personnel provide essential services ensuring the procurement of safe and

wholesome subsistence and provision of medical care to government-owned animals. Veterinary Corps

officers are also uniquely qualified to design and implement agricultural stabilization and reconstruction

programs in conjunction with host-state ministries and agencies across the full range of military operations.

Early, sustained engagement by veterinarians stimulates agricultural productivity, improves animal and human

health, directly supports the population’s hierarchy of needs on all levels, and accelerates stabilization

operations by reducing the population’s susceptibility to spoilers.

The events of September 11, 2001, taught us that weak states, like

Afghanistan, can pose as great a danger to our national interests as strong

states. Poverty does not make poor people into terrorists and murderers.

Yet poverty, weak institutions, and corruption can make weak states

vulnerable to terrorist networks and drug cartels within their borders.

President George W. Bush
72 Army Medical Department Journal

reduce the possibility of a humanitarian crisis or

mounting insurgency.7

Between 70% and 75% of the world’s poor live in

rural areas and earn their income directly or indirectly

from agriculture and agriculture-related activities.6,7

The majority of these poor agriculturalists reside in

weak states and are highly subject to insurgent and

terrorist influences. In developing states, the

performance of the agricultural sector determines the

state’s overall economic growth, expansion of trade,

and income-earning opportunities.6,7 Improving

agricultural productivity reduces poverty and

stimulates economic growth in all sectors. In fragile

states, the assistance objectives of the United States

must focus on stabilization, recovery, and reform.8 A

goal of agricultural programs is to tie the population to

their homes and land where they are interdependent on

the land for their livelihood and cannot afford to leave

it. Food donations countermine this concept, requiring

people to leave the farm and increasing their

susceptibility to insurgents and terrorists.

STABILITY AND RECONSTRUCTION OPERATIONS

During stability and reconstruction operations, the goal

is not to return the state to “status quo antebellum,” but

to improve the conditions for the population in order to

eliminate the root causes of the instability.9(p2) During

stability and reconstruction operations, there will be

“spoilers” to that effort, be they insurgents, terrorists,

religious or political factions, drug cartels, warlords, or

individuals seeking to benefit themselves or their

particular cause.9(pp11-15) Spoilers use the state’s

instability to further their causes and have little to gain

should the needs of the population be met. As

individual needs are met and state stability improves,

the spoilers’ active and passive support within the

population providing recruits, supplies, and safe haven

is diminished.10(pp16-20) Combat operations are focused

on defeating the enemy strategic center of gravity. The

same objective applies to stabilization and

reconstruction operations. Current methods of

stabilization and reconstruction are focused at the state

level, working to improve the state as a whole, with

wide-sweeping programs and projects. States cannot

be stabilized from the top down, the center of gravity

for stabilization and reconstruction operations is the

state’s population. State stabilization requires a sound

foundation to build upon, and that foundation is a

population that has its basic needs met and therefore

can concentrate on the greater issues of state.3,4

MASLOW’S HIERARCHY OF NEEDS

Dr Abraham Maslow, during the 1940s and 1950s,

developed a theory of human motivation and

advocated a personal hierarchy of needs. His theories

generally have been accepted, with some criticism, and

continue to be used as a basis of human motivational

theory yet today. Many scholars have enhanced and

added to Maslow’s hierarchical needs concept over the

years, but his basic building blocks remain steadfast.

Maslow believed that humans are motivated,

positively or negatively, by their unsatisfied needs and

until the hierarchy’s lower needs are satiated, the

higher needs are unfulfilling and immaterial. Maslow

considered humans to be generally nonviolent,

trustworthy, self-protecting, and self-governing.

People who are unable to meet their basic needs are

motivated into actions to achieve fulfillment; their

standards and morals may give way to survival

instincts.11 While many examples of deviant behavior

exist in all societies, they are the exception rather than

the norm. Rational individuals steal, lie, or murder not

because they find pleasure in these activities, but

because they have deficiencies in their basic needs.

Maslow also identified conditions that are

prerequisites for the basic needs to be satisfied. These

conditions include the freedoms of speech, expression,

and self-defense. Deficiencies in the individual basic

needs must be satisfied before a person can begin to

act unselfishly and be a fully productive member of

society. Needs deficiencies also may occur on a

society-wide level. Thus, when many people are

hungry they look for relief outside their family, clan,

or community. When this happens, the region is highly

susceptible to influences from spoilers, whether or not

they can truly affect the plight of the individuals. A

strong leader’s promises of a better life provide the

population hope and allow the leader to gain influence

over them.

Dr Maslow espoused that individual’s needs are

centered on 5 primary areas: biological and

physiological needs, safety needs, belongingness and

love needs, esteem needs, and the need for selfactualization.12-16

BIOLOGICAL AND PHYSIOLOGICAL

Biological and physiological needs represent the most

basic needs of an individual, and the population as a

whole. At the nucleus of these needs are those that

Stabilization And Reconstruction Operations: The Role Of The US Army Veterinary Corps
July – September 2007 73

keep an individual alive: food, water, and shelter from

the elements. Until these needs are met, individuals

cannot move to the higher levels of needs. Maslow

hypothesized that even with the higher needs met,

individuals cannot overcome their concerns for the

lower-level needs. Military forces support host states

in providing security to their populations and often

facilitate the delivery of American and internationally

donated humanitarian aid. However, this aid does not

adequately address the basic need because it fails to

provide the population the ability to meet biological

and physiological needs for themselves. An often-used

Chinese proverb is applicable to these situations:

Give a man a fish; you have fed him for today. Teach a

man how to fish; and you have fed him for a lifetime.17

Food is an indispensable commodity even in the

poorest of states, and the lack of food creates tension

between the rich and the poor both within a state and

among states.18

Support for struggling states in their efforts to develop

sound agricultural programs reduces the threat of local

and regional food crises, and creates the germinal

conditions for continued economic growth—at a

reasonable pace. As the 2002 US National Defense

Strategy states:

Decades of massive development assistance have failed

to spur economic growth in the poorest countries.

Worse, development aid has often served to prop up

failed policies, relieving the pressure for reform and

perpetuating misery. Results of aid are typically

measured in dollars spent by donors, not in the rates of

growth and poverty reduction achieved by recipients.

These are the indicators of a failed strategy.19(p21)

States, and their populations, become dependent and

develop “aid economies” rather than developing their

own agricultural or industrial capabilities.11 Aid

economies do provide jobs within the transportation,

warehousing, distribution, and related fields, but these

same jobs are available within an agricultural economy

and are less subject to the abuse, graft, and economic

inflation seen in aid economies.11 Developmental

assistance has focused on rapid transformation of poor

states to bring them up to Western standards. What

poor states need are structured programs of progress

that likely will take years to fully mature; they need to

be able to ride a bicycle before they can ride a

Harley.20

SAFETY

Safety needs is the second tier requirement that

includes security; stability; protection; freedom from

fear, anxiety, and chaos; and a desire for structure with

law and order. Within safety needs, the ability to

safely access the required biological and physiological

needs may become a primary driving force to the

individual or population. Security operations are a

natural mission for US military forces during

stabilization and reconstruction operations. However,

without the population’s biological and physiological

needs being met, they remain discontent and subject to

spoiler influences.

During the Vietnam War, the Marine Corps conducted

Operation Golden Fleece, designed to sever the Viet

Cong from their source of food in the south.10(pp109-110)

Marines provided security to Vietnamese villages and

surrounding farmland during harvest season, allowing

farmers to safely harvest and sell their crops without

“taxation” by the Viet Cong. This program was

successful on several Maslow levels. Besides the

obvious biological and security needs, it provided the

Vietnamese self-esteem in their ability to grow and

harvest their own crops, maintained their sense of

belonging by allowing them to remain in their homes

and villages, and may have provided self-actualization.

Another less successful US security program directly

affecting agriculture in Vietnam was Operation Ranch

Hand.10(pp109-110) This was a defoliation program with

the intent of denying cover and concealment to the

insurgents and thus reducing access to local

Vietnamese villages and crops. While Operation

Golden Fleece improved the situation for the local

population, Operation Ranch Hand deteriorated it.

Frequently, the application drift of Agent Orange

killed the crops it was intended to protect. The loss of

crop production alienated the local population and

created strong resentment of US forces, which in turn

strengthened the local support to the Viet Cong, as

they were only demanding taxation, not the loss of an

entire harvest.

BELONGINGNESS AND LOVE

The third order of needs are the belongingness and

love needs. These needs may be met with a sense of

neighborhood, clan, or community belonging. People

require a sense of belonging to their roots and origin

where they can find security and stability. Refugees

and displaced persons residing in artificial
74 Army Medical Department Journal

communities or fleeing into urban population centers

lack that sense of belonging and easily may be enticed

by spoilers’ rhetoric to join them to achieve

belongingness. Maintaining the population in rural

areas by increasing their ability to produce their own

subsistence, and then increasing production in order

for them to create income reduces urbanization and

overcrowding in the state’s cities where they are less

able to find work and are more susceptible to

spoilers.21(pp217-218,227) Urbanization worsens

environmental problems such as air and water

pollution and creates a nidus for epidemics of

infectious diseases, which may expand into

international pandemics.22 Land ownership provides a

sense of belongingness, and the lack of land ownership

often is among the root causes of civil unrest and

insurgency, as was seen in the Philippines following

World War II and recently in southern Africa. Land

ownership provides individuals and family units a

means of providing for their biological and

physiological needs, gives them a sense of security and

belongingness, and allows them to garner self-esteem

and possibly achieve self-actualization. In the

Philippines, granting land ownership was a successful

method of disarming the insurgents and returning them

to productive members of society.10(pp75-82) Trading

guns for land ownership can be a successful method to

support individuals in their quest to meet their basic

needs and for the state to increase its influence and

increase the local and national economic base.

ESTEEM

Esteem needs are met by an individual’s sense of selfesteem and self-respect along with the esteem derived

from others in the form of respect, reputation, prestige,

and praise. A man who cannot feed his family loses

self-respect when standing in a humanitarian rations

line, dependent on the mercy and goodwill of others.

The dwindling self-respect leads to feelings of lowered

self-worth and self-confidence. When individuals feel

inadequate they are increasingly susceptible to the

influence of spoilers promising them fame, glory, or

status. Spoilers provide individuals with a sense of

improvement in their self-worth, strength, and

capability to improve their usefulness. Spoilers often

have greater access to humanitarian aid shipments

through coercion, theft, or graft and thus enable their

followers to better provide for their families’ needs.

Frequently, international donations of subsistence fall

prey to the black market and profiteers, who often are

insurgents or supporters of the insurgency, or to

governmental corruption. In either case, the citizen

does not gain from these humanitarian shipments.

Only when the subsistence can be produced locally

and sold openly on local free markets can the basic

needs of the individual citizen be addressed.

SELF-ACTUALIZATION

At the top of Maslow’s hierarchical pyramid is selfactualization. Self-actualization is an individual’s need

to do what he strongly desires to do and is fitted to do,

“what a man can be, he must be.”23 An individual

cannot achieve self-actualization until the 4 previous

needs have been fulfilled. A carpenter may find great

satisfaction in his abilities and quality of work, but if

he is hungry and afraid for his life and that of his

family, he will not achieve self-actualization.

In order to deflate the power and influence of the

spoilers, the population’s basic needs must be met. It

may require coordinated psychological operations

efforts to bring the population to a solid realization

that it is their basic needs that they desire, not the

spoilers’ rhetoric of meeting their “pie-in-the-sky”

dreams. In many unstable states, international and

nongovernmental organizations are trying to “improve

the plight” of the citizens by bringing them into the

modern world and providing them with all of the

modern conveniences of the western world. Where

concentration is really needed is on the individuals’

and communities’ first 4 basic needs. When the

population is capable of meeting and maintaining

those 4 needs, they will themselves develop into the

modern world by seeking self-actualization.

US NATIONAL SECURITY STRATEGY

Among the goals of the US national security strategy

are championing aspirations for human dignity and

defusing regional conflicts.19(p1) These goals are

harmonious with Maslow’s concepts and the needs for

self-esteem, self-actualization, and security. Therefore,

our national security strategy sets the implied task to

focus our stabilization and reconstruction operations

on developing methods to meet Maslow’s hierarchy of

needs within the state’s population. Because the

hierarchy of needs must be met in the order given,

appropriate attention must be applied to meet each

level before an individual or population can truly

accept the higher needs. Stabilization and

Stabilization And Reconstruction Operations: The Role Of The US Army Veterinary Corps
July – September 2007 75

reconstruction operational plans must incorporate both

the ways and means of addressing all of Maslow’s

needs to return the population to a peaceful and

productive society. To meet this implied task, a

methodology must be developed to assess the

population’s ability to meet their needs based on

Maslow’s hierarchical concept.

ASSESSING STABILIZATION AND

RECONSTRUCTION NEEDS

There are numerous models, surveys, and evaluation

methods currently used by military, governmental,

international, and nongovernmental organizations to

determine the needs of a state during stabilization and

reconstruction operations.24 While similarities exist

among these survey and evaluation methods, they also

are diverse in their content and scope. Each

organization’s survey and evaluation scheme is

designed to evaluate the needs that their particular

organization can provide: medical, nutritional,

engineering, educational, political, financial,

agricultural, etc. This is, of course, a reasonable

approach for the individual organizations to identify

and provide the support that is within their capacity.

What is lacking is an overall assessment looking at the

state as a whole based on Maslow’s hierarchy of

needs.

Interviews with individuals and communities, not just

government officials, will lead to a more

comprehensive and reasonable assessment of

Maslow’s needs. The “man on the street” type

interviews are extremely effective in determining what

the “common man” desires. From interviews in

Afghanistan, Djibouti, and Honduras, average people

have the same desires as most Americans. They want

to have a job, earn a living, provide for their families,

and give their children more than they had, with a

brighter future. The coalition forces’ provincial

reconstruction teams in Afghanistan are successfully

using community meetings to connect with the

population. They are finding that some communities

desire little more than shovels, axes, and wheelbarrows

while others desire wells, textbooks, or crop seeds.25

It is easy to visualize that in many stabilization and

reconstruction operations, the biological and

physiological needs will be the primary requirement to

be met. The states where we are currently involved in

substantial stabilization and reconstruction operations,

Afghanistan and Iraq, previously were agricultural

based economies. Iraq, prior to Saddam Hussein, was

the world’s sixth largest agricultural exporter; today it

is a food dependent state. Coupled with its current

dependence on the Oil for Food program, Iraqi

agriculture lacks economic viability. Under Saddam,

Iraq’s agriculture productivity rapidly decreased due to

lack of investment capital and poor land management,

resulting in a requirement to import over 60% of its

food.26 Afghanistan, with limited natural resources,

remains a subsistence agriculture state. In both of these

states, as in the majority of other states where

instability poses a threat to US interests, the state’s

economy and overall public health are closely tied to

agriculture.

AGRICULTURAL ECONOMICS 101

Food shortages leading to humanitarian disasters

requiring international relief response are often

thought to be the result of drought or other natural

phenomenon. In part, they are, but the reality is that

many states fail to provide adequate investment and

resources to development of an agricultural economy,

focusing instead on development of an industrial

economy.27 Interventions in the supply of food, while

meeting the immediate needs of the at-risk population,

lead to destabilization of the state’s agricultural

economy. Provision of free food supplies reduces the

marketability of locally grown commodities, while

governmental programs to keep consumer costs low

bankrupts the producers.27

Promoting a strong world economy enhances US

national security and advances prosperity and freedom

throughout the world. Enhancing economic growth in

a world where the majority of the population lives on

less than $2 a day allows people to meet their basic

hierarchy of needs and lead healthier lives, creates

jobs, and raises incomes. Lifting the veil of poverty

stimulates social, economic, and legal reform, deters

spoilers, and reinforces liberty.19(p17) The United States

and other donor states have provided billions of dollars

in developmental assistance to poor states and yet have

failed to spur economic growth and, in many cases,

have created dependent societies.19(p21) Often, the aid

provided hindered the recipient state’s economic

development. The provision of free grain and other

subsistence products destroys the market for locally

produced products. In Afghanistan, the provision of

free grain to the general population has destroyed the
76 Army Medical Department Journal

local grain market, forcing farmers to return to raising

opium poppies as a cash crop. This is a case where a

helping hand is a slap in the face. Cultivation of opium

poppies continues the cycle of smuggling, trafficking,

and organized crime in Afghanistan, reducing the

ability of the central government to achieve an

economic and political base for stabilization and

reconstruction. A rapid influx of international and

nongovernmental organizations into a destabilized

state does not necessarily improve the ability of

individuals to meet their basic needs. Frequently, these

aid organizations compete with the local population

for food and shelter and create inflation in the labor

and housing markets, much to the detriment of the

state’s economic stabilization and reconstruction

programs.10(pp92-96)

Historically, traditional societies were based on

agriculture, today’s modern societies are based on

industry.28 The transition from subsistence agriculture

to the development and manufacture of microchips is

an evolutionary process requiring many years of small

sequential changes. Promoting agricultural projects

promotes a sustainable development in developing or

transitional states. For the majority of the western

states, agriculture was the building block of their

beginning. A state must be able to provide sustenance

for its own populace before it can move on to

becoming an international player. Today, third world

states readily see what the West has to offer and want

to leap forward into “instant Westernization.” In their

eagerness, they fail to realize that the West did not just

happen in a year, or a decade; it took centuries for

Western countries to achieve the wealth and prosperity

they now enjoy. Westerners may have forgotten that

our ancestors struggled through the crawl→walk→run

stages of development to achieve our prosperous

societies. Many Western organizations wish to bring

the third world into the modern age without working

through the growing pains, struggles, and selfsatisfaction of the crawl→walk→run scenario. The

United States, while extremely successful, was not

born rich and famous—Americans worked for it,

starting out as agriculturalists. Once they were capable

of meeting their biological needs they progressed by

moving to industrial enterprises and beyond.

Focusing on agricultural projects provides relief from

dependency on donor countries to the farmer and his

family, and creates long-term employment in

agricultural related occupations such as milling,

processing, food production, and distribution. As a

single industry, agriculture is the most capable of

providing the population with a means of achieving its

basic needs with minimal investment required from

donor countries.

INTERRELATIONSHIP BETWEEN HUMAN AND

ANIMAL HEALTH

The complex interrelationships between human and

animal health, transmission of disease, food production

and processing, and economic health at all levels

significantly affect the overall physical and economic

health of a state. The raising and maintenance of

livestock for food and milk production (camels, cattle,

sheep, goats, swine, and poultry) and as transportation

and labor (camels, cattle, and equines) is a vital

component of the individual’s and state’s economy

and public health. Even the poorest subsistence

farmers regard livestock as key investments that will

provide support through droughts and crop failure.

In developing and transition countries, animal

husbandry is the largest single sector of agricultural

economics, and, as the state develops, the importance

of livestock increases.29 In developing countries, much

of the agricultural enterprise consists of family farms

growing crops and raising livestock to provide their

own subsistence. As a state develops, farmers and

livestock producers must increase their production

capabilities to meet the needs of a growing

population.30 There are many examples of agriculturalbased programs in counter-insurgency operations. In

the 1970s, the British Army was performing counterinsurgency operations in Oman. One of their

successful programs was veterinary support to local

cattle owners, improving their herds, providing wells

to water them, and providing veterinary medical

support. The condition of the area’s livestock

improved, resulting in increases in both the availability

of food and amount of income. This in turn led to

greater ability to purchase consumer goods, reducing

insurgent recruiting among local population.21(pp217-218)

US ARMY VETERINARY CORPS

The US Army Veterinary Corps does not include the

performance of stability and reconstruction operations

in its current mission statement.31 However, Veterinary

Corps personnel frequently are engaged in these

Stabilization And Reconstruction Operations: The Role Of The US Army Veterinary Corps
July – September 2007 77

operations as members of special operations forces,

civil affairs units, and civil-military operations task

forces.

Utilization of Veterinary Corps Personnel

Veterinary Corps personnel, in limited numbers, are

assigned or attached to special operations forces and

civil affairs units at various command levels. In these

assignments, they work closely with host state’s

military counterparts and government ministries and

agencies. Special operations forces veterinary assets

assist in the planning and execution of population and

resource control, civic action, humanitarian assistance

and other security, development, and stability

programs. In these positions, Veterinary Corps

personnel perform assessments and collect data on the

host state’s available health and agricultural

administration and operations infrastructure,

developing support and assistance programs to expand

the legitimacy of the host state’s government.

Civil affairs Veterinary Corps assets frequently are

involved in humanitarian and disaster relief programs

in coordination with US governmental agencies, other

DoD elements, coalition partner governmental

agencies, international and nongovernmental

organizations, and the host state ministries and

agencies. Civil affairs veterinarians perform a wide

range of public health and veterinary preventive

medicine activities and programs in concert with the

host state’s ministries and agencies.

Veterinary Corps officers are versatile and capable of

working closely with a wide variety of host state

ministries, and governmental, international, and

nongovernmental agencies. The Coalition Joint CivilMilitary Operations Task Force-Kabul (CJCMOTFKabul) Veterinary Corps officers worked not only with

the Afghan Ministry of Agriculture and Animal

Husbandry, but also with the Ministries of Higher

Education, Public Health, and Defense. They

coordinated with international and nongovernmental

organizations such as the United Nations’ Food and

Agriculture Organization and World Health

Organization, the Dutch Committee for Afghanistan,

and the Mayhew Animal Home of London on a variety

of projects to improve the health of both the animal

and human populations. Improvement of agricultural

programs and national food production capabilities

directly supports Maslow’s hierarchy of needs.

During stability and reconstruction operations,

veterinary service support operations to US and

coalition forces include subsistence inspections to

ensure safety, security, and wholesomeness; and the

provision of veterinary medical services to military

working dogs and other government-owned animals.

The local procurement of food and water, providing

adequate sources are available without inhibiting the

availability to the local populace, is a means of

stimulating the local economy. Veterinary service

inspections of local commercial subsistence operations

not only serves to determine if they are capable of

meeting US procurement standards, but also provide

the operators a set of goals to improve their facilities.

While it is not currently in the scope of the Veterinary

Corps to inspect commercial operations with the intent

of providing guidance and training, that area should be

explored. Veterinary Corps personnel could provide

training in food industry good manufacturing

processes, food sanitation and hygiene, inspection

procedures and techniques, hazardous and critical

control points program, and food handling and storage

procedures. Improving the state’s ability to produce

safe and wholesome subsistence leads to an overall

improvement in public health, reducing the burden on

donors for food and health care.

Working alongside the host state government’s

ministries of agriculture, animal husbandry, and public

health personnel, Army Veterinary Corps personnel

design and execute local, regional, and national

support programs to improve the health of the

domestic animal population. Improving the health of

the domestic animal population, while manpower

intensive, is generally a cost effective method to

improve the health of the human population. Reducing

enzootic (animal diseases that circulate among and

affect only the animal population) and zoonotic

(animal diseases that circulate among the animal

population and create disease in humans) diseases

leads to an improvement in overall public health.

Veterinary corps personnel, working with host state

veterinarians, can develop animal vaccination

programs, herd health programs, and animal husbandry

programs. Healthier animals produce more meat and

milk, have increased reproductive capacity, and cost

less to maintain. These gains can be seen without a

change in the availability of livestock feed and may

even reduce the feed requirements based on

productivity.
78 Army Medical Department Journal

Veterinarians frequently conduct domestic animal

vaccination programs to reduce the prevalence of

enzootic and zoonotic disease in support of host state

governments. These programs provide a deep-rooted

positive impression of the United States and its

commitment to the host state’s government. Currently,

veterinary programs are ongoing in Afghanistan, Iraq,

and the Horn of Africa region to improve animal

health and provide training to local producers,

veterinarians, and veterinary technicians. When

available, these programs may be conducted in

concurrence with international or nongovernmental

organizations to increase the support provided.

In Honduras, mountain dwellers often traveled 2 days

to bring their animals to Army Veterinarians who were

providing vaccinations and deworming medications.

When combined medical, dental, and veterinary

services were offered in Honduran villages, it was the

veterinarian who had the most patients and longest

lines. When asked why they were more concerned

with having their livestock immunized than their

children, the Hondurans’ standard reply was “it is easy

to get more children, but I only have one horse (cow,

goat, etc) and my family cannot survive without it.”

Programs in Afghanistan initiated by the CJCMOTFKabul Veterinary Corps officers included

reinvigoration of the Afghan Ministry of Agriculture

and Animal Husbandry’s veterinary infrastructure,

rebuilding the national veterinary diagnostic laboratory

and national vaccine laboratory; working with

nongovernmental organizations to build veterinary

clinics to improve access to veterinary services and to

serve as veterinary training facilities. Other

CJCMOTF-Kabul veterinary projects included

rebuilding greenhouses to provide the population with

garden plant starts for self-sufficiency; developing

resources to improve dairy herd genetics; rebuilding

the national animal and crop production research

facilities; rebuilding the national poultry industry

infrastructure; and providing supplies to regional

veterinary clinics to service local populations.

Programs developed with the Afghan Ministry of

Higher Education included rebuilding and providing

water and electricity to the Schools of Veterinary

Science and Pharmacy; provision of supplies and

equipment to the Schools of Veterinary Science,

Pharmacy, and Education; supplying animals and

teaching anatomy at the School of Veterinary Science;

and developing a self-sustaining poultry cooperative at

the veterinary school to both teach and feed students

and faculty members. The CJCMOTF-Kabul

veterinary officers also were responsible for

assessments of Afghan medical facilities and coalition

partners’ medical support to the Afghan population,

and collection and reporting of human and animal

disease prevalence data. They also promoted

infrastructure projects to improve crop irrigation,

develop wells to water livestock, and roads to improve

agricultural commerce.

MEETING MASLOW’S HIERARCHY OF NEEDS

Army Veterinary Corps officers can design and

conduct stabilization and reconstruction operations to

support all of Maslow’s hierarchy of needs. Increasing

animal and crop food production and food safety

increases the populations’ ability to meet their

biological and physiological needs. The presence of

Army Veterinary Corps personnel working with hoststate personnel in local communities is a sign of US

military presence, stimulates faith and allegiance to the

US-supported government, and supports safety needs.

Maintaining or returning the population to rural

environs where they can become self-sufficient, rather

than in displaced persons camps or in urban slums

without jobs or resources, improves the sense of

belongingness and supports the concept of families

working closely together for a common future.

Supporting the ability of the population to provide for

themselves and their families and reducing their daily

dependence on donor organizations for their

subsistence elevates their self-esteem. By meeting and

sustaining the 4 lower hierarchical needs, individuals

can now seek self-actualization, be that maintaining an

agrarian lifestyle or developing other industries.

OTHER ORGANIZATIONS

Many organizations, independently or as a coalition,

develop and execute programs similar to those

commonly developed by Army Veterinary Corps

officers. However, those organizations generally are

absent during armed conflict and do not return until

the state’s internal security has stabilized. As a part of

the US force, the Veterinary Corps can operate in

hostile environments where the early establishment of

stabilization and reconstruction programs is critical to

the overall outcome of the operation. Unlike some

Stabilization And Reconstruction Operations: The Role Of The US Army Veterinary Corps
July – September 2007 79

international and nongovernmental organizations,

Army Veterinary Corps personnel are not trying to

establish dependency on outside organizations, but are

supporting the host state and enhancing its legitimacy

to the population.

CONCLUSION

Stabilization and reconstruction operations are integral

components of both peace and war, and therefore

cannot be overlooked in the planning cycle for

peacetime engagement and combat operations. In the

war on terrorism, the United States must promptly

address the internal concerns of troubled and failing

states to reduce the potential for terrorist organizations

to achieve a foothold in these states.32,33 United States

intervention in these failed or failing states must be

proactive and address the population’s basic needs.

Focusing on agricultural production can be an efficient

and cost-effective mechanism for early intervention.32

The incorporation of agricultural programs, led by

Veterinary Corps officers, into theater engagement

plans may reduce the occurrence of a greater

humanitarian crisis that could require a larger US

military presence to alleviate.34 The Army Veterinary

Corps can provide substantial assistance as a leading

component in stability and reconstruction operations to

stimulate the agricultural systems and economy of the

state. The inclusion of Veterinary Corps personnel in

the early stages of operational planning and the early

deployment of veterinary assets can improve the Joint

Force Commanders’ ability to negate spoilers within

the population, and provide the population a means of

self-sufficiency requiring less international and

nongovernmental aid, and reduce the time required to

complete such operations. The promotion and

initiation of sustainable agricultural programs within

the state will significantly improve the status quo and

lead to overall national economic and social growth.

Effective utilization of US Army Veterinary Corps

officers in stabilization and reconstruction operations

can reduce the possibility of a humanitarian crisis or

mounting insurgency, and thus achieve the favorable

security conditions required to protect the homeland

and United States’ interests around the world.

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AUTHOR

LTC Smith is the Senior Veterinarian at the Defense

Supply Center Philadelphia, in Philadelphia,

Pennsylvania.

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military medical issues and technological advances; promote collaborative partnerships among the Services, components, Corps, 

and specialties; convey clinical and health service support information; and provide a professional, high quality, peer reviewed 

print medium to encourage dialogue concerning health care issues and initiatives. 

REVIEW POLICY

All manuscripts will be reviewed by the AMEDD Journal’s Editorial Review Board and, if required, forwarded to the appropriate 

subject matter expert for further review and assessment. 

IDENTIFICATION OF POTENTIAL CONFLICTS OF INTEREST

1. Related to individual authors’ commitments: Each author is responsible for the full disclosure of all financial and personal 

relationships that might bias the work or information presented in the manuscript. To prevent ambiguity, authors must state 

explicitly whether potential conflicts do or do not exist. Authors should do so in the manuscript on a conflict-of-interest 

notification section on the title page, providing additional detail, if necessary, in a cover letter that accompanies the 

manuscript. 

2. Assistance: Authors should identify Individuals who provide writing or other assistance and disclose the funding source for this 

assistance, if any. 

3. Investigators: Potential conflicts must be disclosed to study participants. Authors must clearly state whether they have done 

so in the manuscript. 

4. Related to project support: Authors should describe the role of the study sponsor, if any, in study design; collection, analysis, 

and interpretation of data; writing the report; and the decision to submit the report for publication. If the supporting source

had no such involvement, the authors should so state. 

PROTECTION OF HUMAN SUBJECTS AND ANIMALS IN RESEARCH

When reporting experiments on human subjects, authors must indicate whether the procedures followed were in accordance with 

the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki 

Declaration of 1975, as revised in 2000. If doubt exists whether the research was conducted in accordance with the Helsinki 

Declaration, the authors must explain the rationale for their approach and demonstrate that the institutional review body 

explicitly approved the doubtful aspects of the study. When reporting experiments on animals, authors should indicate whether the 

institutional and national guide for the care and use of laboratory animals was followed. 

GUIDELINES FOR MANUSCRIPT SUBMISSIONS

1. Articles should be submitted in digital format, preferably an MS Word document, either as an email attachment (with 

illustrations, etc), or by mail on CD or floppy disk accompanied by one printed copy of the manuscript. Ideally, a manuscript 

should be no longer than 24 double-spaced pages. However, exceptions will always be considered on a case-by-case basis. In 

general, 4 double-spaced MS Word pages produce a single page of 2 column text in the AMEDD Journal production format. 

2. The American Medical Association Manual of Style governs formatting in the preparation of text and references. All articles 

should conform to those guidelines as closely as possible. Abbreviations/acronyms should be limited as much as possible. 

Inclusion of a list of article acronyms and abbreviations can be very helpful in the review process and is strongly encouraged.

3. A complete list of references cited in the article must be provided with the manuscript. The following is a synopsis of the 

American Medical Association reference format: 

 Reference citations of published articles must include the authors’ surnames and initials, article title, publication title, 

year of publication, volume, and page numbers. 

 Reference citations of books must include the authors’ surnames and initials, book title, volume and/or edition if 

appropriate, place of publication, publisher, year of copyright, and specific page numbers if cited. 

 Reference citations for presentations, unpublished papers, conferences, symposia, etc, must include as much identifying 

information as possible (location, dates, presenters, sponsors, titles). 

4. Either color or black and white photographs may be submitted with the manuscript. Color produces the best print reproduction

quality, but please avoid excessive use of multiple colors and shading. Digital graphic formats (JPG, GIF, BMP) and MS Word 

photo files are preferred. Prints of photographs are acceptable. Please do not send photos embedded in PowerPoint. Images 

submitted on slides, negatives, or copies of X-ray film will not be published. For clarity, please mark the top of each 

photographic print on the back. Tape captions to the back of photos or submit them on a separate sheet. Ensure captions and 

photos are indexed to each other. Clearly indicate the desired position of each photo within the manuscript. 

5. The authors’ names, ranks or academic/certification credentials, titles or positions, current unit of assignment, and contact 

information must be included on the title page of the manuscript. 

6. Submit manuscripts to: 

EDITOR, AMEDD JOURNAL 

ATTN MCCS DT 

2419 HOOD ST STE C 

FORT SAM HOUSTON, TX 78234-7584 

DSN 471-6301 

Comm 210-221-6301 

Email: amedd.journal@amedd.army.mil