Page 138 - JSOM Summer 2018

An Ongoing Series

Arthropod-Borne and Zoonotic Infections
Among Military Personnel in Georgia

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Nazibrola Chitadze, MD ; Nino Gureshidze, MD ; Nino Rostiashvili, MD ; Nargiza Danelia, MD ;
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Ketevan Dalakishvili, MD ; Liana Durglishvili, MD ; Revaz Kuchukhidze, MD ; Paata Imnadze, MD ;
Rusudan Chlikadze, MD ; Medea Betashvili, MD ; Tinatin Kuchuloria, MD, MS, PhD ;
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Nino Akhvlediani, MD ; Robert Rivard, MD ; Mikeljon Nikolich, PhD ; Christian T. Bautista, PhD ;
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Michael A. Washington, PhD *; Tamar Akhvlediani, MD, MS, PhD 1,6
ABSTRACT
Military personnel are at an increased risk for exposure to ar- these infections at the population level. Increased knowledge
thropod-borne and zoonotic pathogens. The prevalence of these regarding the burden and distribution of pathogens in the ac-
pathogens has not been adequately described in the country of tive-duty military population will provide valuable informa-
Georgia. As the Georgian military moves toward an increased tion for the development and implementation of force health
level of capability and the adoption of European Union and protection plans and aid in the formation of the situational
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North Atlantic Treaty Organization standards, international awareness of military decision makers. In addition, military
field exercises will become more frequent and will likely involve personnel represent ideal surrogates for estimating the preva-
an increasing number of international partners. This study was lence of zoonotic and arthropod-borne infections in the gen-
undertaken with the goal of defining the arthropod-borne and eral population, because they are typically young, active, and
zoonotic pathogen threat in Georgia so force health protection healthy. Such a population is capable of mounting a robust im-
planning can proceed in a rational and data-driven manner. To mune response to pathogen exposure and, therefore, is likely
estimate disease burden, blood was taken from 1,000 Georgian to have a reasonably intact immunologic memory facilitating
military recruits between October 2014 and February 2016 serologic analysis. Also, because recruits are drawn from
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and screened for previous exposure to a set of bacterial and vi- throughout the country, the military recruit population has
ral pathogens using a antibody-based, serologic procedure. The a diverse geographic and demographic profile that is broadly
highest rate of exposure was to Salmonella enterica serovar Ty- representative of the population as a whole.
phi, and the lowest rate of exposure was to Coxiella burnettii
(the causative agent of Q fever). These data provide insight into Thus, we conducted a pathogen-specific, antibody seroprev-
the prevalence of arthropod-borne infections in Georgia, fill a alence study among military recruits as they underwent pre-
critical knowledge gap, will help guide future surveillance ef- contract medical and health assessment at the Central Military
forts, and will inform force health protection planning. Hospital in Gori, the primary military hospital of the Geor-
gian armed forces. Study participants were serologically tested
Keywords: arthropod-borne infection; zoonotic infection; for prior exposure to a select group of arthropod-borne and
zoonoses; epidemiology; Georgian military zoonotic infections, including Crimean-Congo hemorrhagic
fever, hemorrhagic fever with renal syndrome, tick-borne en-
cephalitis, West Nile virus (WNV), brucellosis, leptospirosis,
Introduction tularemia, anthrax, rickettsia, Q fever, and Salmonella enter-
ica serovar Typhi. 3–5
The prevalence of human exposure to arthropod-borne and
zoonotic infectious agents in the country of Georgia has not To our knowledge, a military-recruit specific seroprevalence
been adequately described. A greater understanding of the study has not been conducted of most of these diseases in Geor-
temporal and spatial patterns of infection will provide sub- gia. In this study, previous infection was defined as prior expo-
stantial insight into the epidemiology and possible control of sure to the infectious agent and a detectable pathogen-specific
*Correspondence to michael.a.washington120.mil@mail.mil
1 Drs Chitadze, Imnadze, Chlikadze, Kuchuloria, N. Akhvlediani, and T. Akhvlediani are at The National Center for Disease Control and Public
Health, Tbilisi, Georgia. Drs Gureshidze, Rostiashvili, Danelia, Dalakishvili, Durglishvili, and Kuchukhidze are at The Military Hospital of
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the Ministry of Defense of Georgia, Gori, Georgia. Dr Betashvili is at Medical Department, Ministry of Defense of Georgia, Tbilisi, Georgia.
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4 Dr Rivard is at US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD. Drs Nikolich and Bautista are at Walter Reed
Army Institute of Research, Silver Spring, MD. Drs Kuchuloria, N. Akhvlediani, Washington, and T. Akhvlediani are at US Army Medical Re-
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search Directorate-Georgia, Tbilisi, Georgia.
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