MilitaryDeployment - PDF document

1 MilitaryDeployment PeriodicOccupationala
MilitaryDeployment PeriodicOccupationalandEnvironmentalMonitoringSummary(POEMS): ThumraitAirBase(TRAB),OMAN, CalendarYears:April2010toAugust2012 AUTHORITY: Thisperiodicoccupationalandenvironmentalmonitoringsummary(POEMS)hasbeendevelopedinaccordancewithDepartmentof Defense(DoD)Instructions6490.03,6055.05,andJCSM(MCM)0028-07,SeeREFERENCES. PURPOSE: ThisPOEMSdocumentstheDoDassessmentofbasecamplevelOccupationaland EnvironmentalHealthSurveillance(OEHS)exposuredataforTRAB.Itpresentstheidentifiedhealth risksandassessmentsalongwiththepossibleassociatedmedicalimplications.Thefindingswere basedoninformationcollectedfromApril2010throughAugust2012toincludedeploymentOEHS samplingandmonitoringdata(e.g.air,water,andsoil),fieldinvestigationandhealthassessment reports,aswellascountryandarea-specificinformationonendemicdiseases.Whilethisassessment mayreflectsimilarexposuresandhealthriskspertainingtohistoricorfutureconditionsatthissite,the underlyingdatawerelimitedtothetimeperiod(s)andarea(s)sampledandthusmaynotreflect fluctuationsoruniqueoccurrences.Italsomaynothavebeenfullyrepresentativeofallthefluctuations duringthetimeframe.Totheextentthatthedataallowed,thissummarydescribesthegeneralambient conditionsatthesiteandcharacterizesthehealthrisksatthepopulation–level.Whileusefultoinform providersandothersofpotentialhealtheffectsandassociatedmedicalimplications,itdoesnot representanindividualexposureprofile.Actualindividualexposuresandspecificresultinghealth effectsdependonmanyvariablesand,shouldbeaddressedinindividualmedicalrecordsbyproviders asappropriateatthetimeofanevaluationofauniqueexposure. SITEDESCRIPTION : TRABislocatedincentralOman,approximately71kilometers(km)northof Salalah(nearestcoastalcity).TheAmericanencampmentisinsidetheRoyalAFofOman(RAFO) base.Inaddition,theRAFObaseincludesDyncorpInc,whichhasawarreadinessmaterial(WRM) maintenancemission.TheairfieldhasonerunwayandisusedforAirForceC-17andKC-10aircrafts andRAFOF-16fighters.TRABhasapproximately700USmilitaryandcivilianpersonnel.Thereare approximately237structuresonTRABincludingtentcity,administrativetown,OpsTown,and Maintenance.Theadjacentpropertyisprimarilydesertandusedforagriculture. SUMMARY : Summarizedbelowarethekeyhealthrisksestimatesalongwithrecommendedfollow-on medicalactions,ifany,thatprovidersshouldbeawareof.Thefollowingpagesprovidealistofallthe identifiedhealthrisksatTRAB(Table1).Asindicatedinthedetailedsectionsthatfollowthetable, controlsthathavebeeneffectivelyestablishedtoreducehealthrisklevelshavebeenfactoredintothis overallass

2 essment. TRAB,OMAN:2010to2012 Page2of20
essment. TRAB,OMAN:2010to2012 Page2of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) Short-termhealthrisks&medicalimplications: ThefollowingmayhavecausedacutehealtheffectsinsomepersonnelduringdeploymentatTRAB: Food/waterbornediseases(e.g.,bacterialdiarrhea,hepatitisA,typhoid/paratyphoidfever,brucellosis,diarrhea-protozoal, hepatitisE);otherendemicdiseases(cutaneous/visceralleishmaniasis,Crimean-Congohemorrhagicfever,sandflyfever, typhus-fleaborn,denguefever,westnilefever,tick-bornerickettsioses,sindbis,leptospirosis,schistosomiasis,Tuberculosis (TB),meningoccalmeningitis,rabies,Qfever);venomousanimals/insects;andheatstress.Forfood/waterbornediseases (e.g.,bacterialdiarrhea,hepatitisA,typhoidfever,brucellosis,diarrhea-protozoal,hepatitisE),ifingestinglocalfoodand water,thehealtheffectscantemporarilyincapacitatepersonnel(diarrhea)orresultinprolongedillness(hepatitisA,typhoid fever,brucellosis,hepatitisE).Risksfromfood/waterbornediseasesmayhavebeenreducedwithpreventivemedicine controlsandmitigation,whichincludeshepatitisAandtyphoidfevervaccinationsandonlydrinkingfromapprovedwater sourcesinaccordancewithstandingCENTCOMpolicy.Forothervector-borneendemicdiseases(cutaneousleishmaniasis, Crimean-Congohemorrhagicfever,sandflyfever,typhus-fleaborn,denguefever,westnilefever,tick-bornerickettsioses, sindbis),thesediseasesmayconstituteasignificantriskduetoexposuretobitingvectors;riskreducedtolowbyproperwear ofthetreateduniform,applicationofrepellenttoexposedskinandbednet,andappropriatechemoprophylaxis.Forwater contactdiseases(leptospirosis,schistosomiasis)activitiesinvolvingextensivecontactwithsurfacewaterincreaserisk.For respiratorydiseases(tuberculosis,meningococcalmeningitis)personnelinclose-quarterconditionscouldhavebeenatriskfor person-to-personspread.Animalcontactdiseases(rabies,Qfever),poseyear-roundrisk.Forvenomousanimalsand insects,ifencountered,effectsofvenomvariedwithspeciesfrommildlocalizedswellingtopotentiallylethaleffects;risks reducedbyavoidingcontactandproperandtimelytreatment.Forheatstress,riskcanbegreaterforsusceptiblepersons includingthoseolderthan45,oflowfitnesslevel,unacclimatized,orwithunderlyingmedicalconditions.Risksfromheat stressmayhavebeenreducedwithpreventivemedicinecontrols,work-restcycles,andmitigation. Airquality:Exposuresmayresultinmildtomoreseriousshort-termhealtheffects(e.g.,eye,noseorthroatandlungirritation) insomepersonnelwhileatthissite.Forcertainsubgroupsofthedeployedforces(e.g.,thosewithpre-existingasthma/cardio- pulmonaryconditions)areatgreatestr

3 iskofdevelopingnotablehealtheffects. Alt
iskofdevelopingnotablehealtheffects. Althoughmosteffectsfromexposuretoparticulatemattershouldhaveresolvedpost-deployment,providersshouldbe preparedtoconsidertherelationshipbetweendeploymentexposuresandcurrentcomplaints.Someindividualsmayhave soughttreatmentforacuterespiratoryirritationduringtheirtimeatTRAB.Personnelwhoreportedwithsymptomsorrequired treatmentwhileatthissiteshouldhaveexposure/treatmentnotedinmedicalrecord(e.g.,electronicmedicalrecordand/oron aStandardForm(SF)600(ChronologicalRecordofMedicalCare). TRAB,OMAN:2010to2012 Page3of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) POEMS Table1.Population-BasedHealthRiskEstimates- TRAB,Oman 1,2 SourceofIdentified HealthRisk 3 UnmitigatedHealthRiskEstimate 4 ControlMeasures Implemented ResidualHealthRisk Estimate 4 AIR PM 10 Short-term:NoDataAvailable Watersprayedon unpaved/dirtroads Short-term:NoDataAvailable Long-term:NohealthguidelinesLong-term:Nohealthguidelines PM 2.5 Short-term:NoDataAvailable Watersprayedon unpaved/dirtroads Short-term:NoDataAvailable Long-term:NoDataAvailableLong-term:NoDataAvailable Metals Short-term:NoDataAvailable Short-term:NoDataAvailable Long-term:NoDataAvailableLong-term:NoDataAvailable VOCs Short-term:NoDataAvailable Short-term:NoDataAvailable Long-term:NoDataAvailableLong-term:NoDataAvailable Soil VariousAnalytes Short-term:Nohealthguidelines Short-term:Nohealth guidelines Long-term:NoDataAvailable Long-term:NoDataAvailable Water Consumedwater Short-term:NoneIdentified Potablewaterusedfrom approvedsources Short-term:NoneIdentified Long-term:NoneIdentifiedLong-term:NoneIdentified Waterusedforother purposes Short-Term:NoneIdentified Short-term:NoneIdentified Long-Term:NoneIdentifiedLong-term:NoneIdentified ENDEMICDISEASE Foodborne/ Waterborne Short-term:Variable:High(Bacterial Diarrhea,HepatitisA, Typhoid/Paratyphoidfever)toModerate (Diarrhea-Protozoal,Brucellosisand HepatitisE).Ifingestinglocal food/water,thehealtheffectscould havebeentemporarilyincapacitatingto personnel(Diarrhea)orresultedin prolongedillness(HepatitisA,Typhoid Fever,Brucellosis,HepatitisE). Preventivemeasures includedHepatitisAand Typhoidfevervaccination, consumptionoffoodand waterusedonlyfrom approvedsourcesand routinelymonitored.(MOD 11) Short-term:Low Long-term:NoneIdentifiedLong-term:NoneIdentified ArthropodVector Borne Short-term:Moderate(Leishmaniasis- Cutaneous/Visceral,Crimean-Congo hemorrhagicfever),Low(Sandfly Fever,Typhus-Fleaborn,Dengue Fever,WestNileFever,Tick-borne Rickettsioses,Sindbis). Preventivemeasur

4 es includedproperwearofthe treatedunifor
es includedproperwearofthe treateduniformand applicationofrepellentto exposedskinandappropriate chemoprophylaxis. Short-term:Low Long-term:Low(Leishmaniasis-Visceral infection) Long-term:Low Water-Contact (e.g.wading, swimming) Short-term:Moderate(Leptospirosis, Schistosomiasis) Short-term:Moderate Long-term:NoneIdentifiedLong-term:NoneIdentified Respiratory Short-term:Low(Tuberculosis(TB), MeningococcalMeningitis). TBevaluatedaspartofthe PDHA(PostDeployment HealthAssessment).ATB skintestwasrequiredpost- deploymentifpotentially exposed. Short-term:Low Long-term:NoneIdentifiedLong-term:NoneIdentified TRAB,OMAN:2010to2012 Page4of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) AnimalContact Short-term:Moderate(Q-Fever),Low (Rabies) CENTCOMGeneralOrder1B mitigatesrabiesexposure risksbyprohibitingcontact with,adoption,orfeedingof feralanimals.Risksare furtherreducedintheevent ofassessedcontactby promptpost-exposurerabies prophylaxisIAWtheCDC’s ACIPguidelines. Short-term:Moderate(Q- Fever),Low(Rabies) Long-term:Low(Rabies)Long-term:Low(Rabies) VENOMOUSANIMAL/ INSECTS Snakes,Scorpions, Fish,Snails Short-term:LowtoHigh Risksreducedbyavoiding contactandproperandtimely treatment. Short-term:LowtoHigh(If encountered,effectsofvenom variedwithspeciesfrommild localizedswellingtopotentially lethal) Long-term:NoneIdentified Long-term:NoneIdentified HEAT/COLDSTRESS Heat Short-term:LowtoHigh Risksfromheatstressare reducedwithpreventive medicinecontrols,work-rest cycles,hydration recommendationsand awarenesstraining. Short-term:LowtoHigh Long-term:LowLong-term:Low Cold Short-term:Low Risksfromcoldstressare reducedwithprotective measuressuchasproper wearofprotectiveclothing. Short-term:Low Long-term:LowLong-term:Low NOISE Intermittent (Flightline,AGE, Equipment/Tools) Short-term:Low Hearingprotectionusedby personnelinhigherriskareas Short-term:Low Long-term:Low-ModerateLong-term:Low-Moderate 1 ThisSummaryTableprovidesaqualitativeestimateofpopulation-basedshort-andlong-termhealthrisksassociatedwiththegeneralambientand occupationalenvironmentconditionsatTRAB.Itdoesnotrepresentauniqueindividualexposureprofile.Actualindividualexposuresandhealth effectsdependonmanyvariables.Forexample,whileachemicalmayhavebeenpresentintheenvironment,ifapersondidnotinhale,ingest,or contactaspecificdoseofthechemicalforadequatedurationandfrequency,thentheremayhavebeennohealthrisk.Alternatively,apersonata specificlocationmayhaveexperiencedauniqueexposurewhichcouldhaveresultedinasignificantindividualexposure.Anysu

5 chpersonseeking medicalcareshouldhavethe
chpersonseeking medicalcareshouldhavetheirspecificexposuredocumentedinanSF600. 2 ThisassessmentwasbasedonspecificdataandreportsobtainedfromtheApril2010throughAugust2012timeframe.Itwasconsideredacurrent representationofgeneralsiteconditionsbutmaynotreflectcertainfluctuationsoruniqueexposureincidents.Acutehealthriskestimateswere generallyconsistentwithfield-observedhealtheffects. 3 ThisSummaryTablewasorganizedbymajorcategoriesofidentifiedsourcesofhealthrisk.Itonlyliststhosesub-categoriesspecificallyidentified andaddressedatthesite(s)evaluated.ThehealthriskswerepresentedasLow,Moderate,HighorExtremelyHighforbothacuteandchronichealth effects.Thehealthrisklevelwasbasedonanassessmentofboththepotentialseverityofthehealtheffectsthatcouldbecausedandprobabilityof theexposurethatwouldproducesuchhealtheffects.DetailscanbeobtainedfromtheAPHC/AIPH.Whereapplicable,“NoneIdentified”wasused whenanexposurewasidentifiedandnohealthriskofeitheraspecificacuteorchronichealtheffectsweredetermined.Moredetaileddescriptionsof OEHexposuresthatwereevaluatedbutdeterminedtoposenohealthriskarediscussedinthefollowingsectionsofthisreport. 4 HealthrisksinthisSummaryTablewerebasedonquantitativesurveillancethresholds(e.g.endemicdiseaserates;host/vector/pathogen surveillance)orscreeninglevels,e.g.MilitaryExposureGuidelines(MEGs)forchemicals. Somepreviousassessmentreportsmayprovideslightly inconsistenthealthriskestimatesbecausequantitativecriteriasuchasMEGsmayhavechangedsincethesampleswereoriginallyevaluatedand/or becausethisassessmentmakesuseofallhistoricsitedatawhilepreviousreportsmayhaveonlybeenbasedonaselectfewsamples. TRAB,OMAN:2010to2012 Page5of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 1 DiscussionofHealthRisksat T RAB , Oman bySource Thefollowingsectionsdescribethemajorsourcecategoriesofpotentialhealthriskthatwereevaluated atTRAB.Foreachcategory,theevaluationprocessincludesidentifyingwhat,ifany,specificsub- categories/healthconcernswerepresent. 2Air 2.1Site-SpecificSourcesIdentified TRABissituatedinadustysemi-ariddesertenvironment.Inhalationalexposuretohighlevelsofdust andparticulatematter,suchasduringhighwindsorduststormsmayhaveresultedinmildtomore seriousshort-termhealtheffects(e.g.,eye,noseorthroatandlungirritation)insomepersonnel. Additionally,certainsubgroupsofthedeployedforces(e.g.,thosewithpre-existingasthma/cardio pulmonaryconditions)wereatgreatestriskofdevelopingnotablehealtheffects. 2.2Particulatematter,lessthan10micrometers(PM 10 ) 2.2.1Sampledata/Notes: ExposureGuidelines: Short

6 -term(24-hour)PM 10 3 ):NegligibleMEG=25
-term(24-hour)PM 10 3 ):NegligibleMEG=250,MarginalMEG=420,CriticalMEG=600. Long-termPM 10 3 ):NotAvailable. TherewerenoPM 10 samplescollectedatTRABfromApril2010throughAugust2012. 2.2.2Short-termhealthrisks: Notevaluated,nosamplescollected. 2.2.3Long-termhealthrisk: NotEvaluated-noavailablehealthguidelines .TheEnvironmentalProtectionAgencyhasretracted itslong-termstandard(NAAQS)forPM 10 duetoaninabilitytoclearlylinkchronichealtheffectswith chronicPM 10 exposurelevels. 2.3ParticulateMatter,lessthan2.5micrometers(PM 2.5 ) 2.3.1Sampledata/Notes: ExposureGuidelines: Short-term(24-hour)PM 2.5 3 ):NegligibleMEG=65,MarginalMEG=250,CriticalMEG=500. Long-termPM 2.5 MEGs:NegligibleMEG=15,MarginalMEG=65. TherewerenoPM 2.5 samplescollectedatTRABfromApril2010throughAugust2012. 2.3.2Short-termandlong-termhealthrisks: Notevaluated,nosamplescollected. TRAB,OMAN:2010to2012 Page6of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 2.4AirborneMetalsfromPM 10 2.4.1Sampledata/Notes: Therewerenoairbornemetal samplescollectedatTRABfromApril2010throughAugust2012. 2.4.2Short-termandLong-termhealthrisks: Notevaluated,nosamplescollected. 2.5VolatileOrganicCompounds(VOC) 2.5.1Sampledata/Notes: TherewerenoVOC samplescollectedatTRABfromApril2010throughAugust2012. 2.5.2Shortandlong-termhealthrisks: Notevaluated,nosamplescollected. 3Soil 3.1Site-SpecificSourcesIdentified 3.2Sampledata/Notes: Nosoil sampleswerecollectedatTRABfromApril2010throughAugust2012. 3.3Short-termhealthrisk: Notanidentifiedsourceofhealthrisk .Currently,samplingdataforsoilisnotevaluatedforshort term(acute)healthrisks . 3.4Long-termhealthrisk: Notevaluated,nosamplescollected. 4Water InordertoassessthehealthrisktoUSpersonnelfromexposuretowaterintheater,theAPHC identifiedthemostprobableexposurepathways.Thesewerebasedontheadministrativeinformation providedonthefielddatasheetssubmittedwiththesamplestakenoverthetimeperiodbeing evaluated.BottledwateristheprimarysourceofdrinkingwaterforalldeployedpersonnelatTRAB. WaterispipedfromtheRoyalAirForceofOman(RAFO)watertreatmentplant(WTP)tohardened showersandlatrinefacilitieslocatedinsidethecantonmentarea.Anotherwatersourceisfromthe ThumraitMunicipalUtilityCompanywherewateristransportedbytrucktoholdingtankssupplying watertohardenedshowersandlatrines.Thesefacilitiesarelocatedoutsidethecantonmentareaand bytheflightline. 4.1DrinkingWater:Bottled 4.1.1Site-SpecificSourcesIdentified TRAB,OMAN:2010to2012 Page7of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) Thedistributorsandallbrandsofbottledwa

7 terutilizedonTRABareapprovedbytheU.S.A.P
terutilizedonTRABareapprovedbytheU.S.A.Public HealthCommand.ThecurrentbottleswatercontractsareprovidedbySevenSeasShiphandlersand TanufWater.EachshipmentofbottledwaterpurchasedforTRABistesteduponreceiptIAWAFMAN 48-138.Themonitoringincludestotalcoliformpresence/absenceandE.coli.Inaddition,1broad spectrumanalysissamplewascollectedMay2011. 4.1.2Sampledata/Notes: AllbroadspectrumanalysisfromtheMay2011samplewasbelowtheshortandlong-termNegligible MEGs.Routinemonitoringresultsarewithinacceptablelimits.Recordsofthesemeasurementsare availableinDOEHRS. 4.1.3Short-termandlong-termhealthrisks: Noneidentifiedbasedonavailablesampledata. 4.2Non-DrinkingWater:Treated/Disinfected 4.2.1Site-SpecificSourcesIdentified WaterfromtheRAFOWTPismonitoredtoensurecompliancewithAFMAN48-138andtheSultanate ofOmanFinalGoverningStandards.DuringtheWaterVulnerabilityAssessment(WVA),monthly compliancereportskeptbytheWTPmanagerarereviewedtoensurewaterqualityparametersare withinthesestandards.Routinemonitoringconductedby405AEG/EMDF/SGPB includes bacteriological,freeavailablechlorine(FAC)andothersanitationsurveillanceparametersperAFMAN 48-138. Althoughprimaryrouteofexposureformostmicroorganismsisingestion,dermalexposuretosome microorganisms,chemicalsandbiologicalcontaminantsmaycauseadversehealtheffects.Complete exposurepathwaysincludedrinking,brushingteeth,personalhygiene,cookingorprovidingmedicalor dentalcareoffbaseusingacontaminatedwatersupply. 4.2.2Sampledata/Notes: ExposureGuidelines: 2samplesfrom1samplingeventinMay2011wereevaluatedforthishealthriskassessment. AllanalyteswerenotdetectedatlevelsabovetheshortorlongtermMEGs. Recordsindicatethattheroutinelymonitoredparameters(pH,chlorine,bacteriological)aretypically withinacceptablelimits.Deviationsfromacceptablelimitsareinvestigatedandcorrectedastheyoccur. RecordsofthesemeasurementsareavailableinDOEHRS. 4.2.3Shortandlong-termhealthrisks: Noneidentifiedbasedonavailablesampledata: Allsampleanalyteswerebelowtheshortand long-termNegligibleMEGs. 5Military Unique TRAB,OMAN:2010to2012 Page8of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 5.1ChemicalBiological,RadiologicalNuclear(CBRN)Weapons NospecifichazardsourcesweredocumentedinDefenseOccupationalandEnvironmentalHealth ReadinessSystem(DOEHRS),ortheMilitaryExposureSurveillanceLibrary(MESL)dataportal betweenApril2010andAugust2012. 5.2DepletedUranium(DU) NospecifichazardsourcesweredocumentedinDOEHRSorMESLdataportalbetweenApril2010and August2012. 5.3IonizingRadiation Ionizingradiationsourcesinclude1portableX-rayunitloc

8 atedatthemedicalclinic,1portablex-ray un
atedatthemedicalclinic,1portablex-ray unitusedbyExplosiveOrdnanceDisposal(EOD)personnel,1stationaryunitlocatedatthe CommercialProcessingArea(CPA)and1portableunitusedbySecurityForces(SF)personnel.). SafetyOperatingInstructionandunitspecificadministrativeandpersonalprotectiveequipment(PPE) controlsareinplacetoprotectservicemembers. 5.4Non-IonizingRadiation 5.4.1Lasers: C-17aircraftareequippedwithInfraredCountermeasureSystemsandaircraftmaintenancepersonnel onlycleanthesensoraspartofthepreventivemaintenanceinspection.Thesesystemsarenowhen aircraftareontheground.Thereisnopotentialexposuretothesesystems.ThereareClass3Alasers utilizedbypersonnelin2workcenters.EODhaveaboresightfinderontheirrobotandEmergency ManagementpersonneluseaCBRNdetector,FirstDefendercontainingalaser.Administrative proceduresandoperatingproceduresareinplacetoprotectservicemembers. 5.4.2RadioFrequency(RF)Radiation: Aircraftandground-basedemittershaveadministrativeproceduresinplacetoreducethepotentialfor exposuresandensurepersonnelarenotwithintheuncontrolledenvironmenthazarddistance. 6Endemic Disease 1 AllinformationwastakendirectlyfromtheNationalCenterforMedicalIntelligence(NCMI) (https://www.intelink.gov/ncmi).BaselineInfectiousDiseaseRiskAssessmentforOman-datedin27 May2010.Thisdocumentliststheendemicdiseasereportedintheregion,itsspecificrisksand severityandgeneralhealthinformationaboutthedisease.Thegeneralinformationonmeningococcal meningitisregardinghowitistransmittedfrompersontopersoncamefromtheWorldHealth Organization’sFactSheetNo.141onMeningococcalMeningitis.USCENTCOMMOD11(Reference 12ofthisdocument)listsdeploymentrequirements,toincludeimmunizationandchemoprophylaxis,in effectduringthetimeframecoveredbythisPOEMS. 1 NOTE:“Risk”levelreferstobothseverityofdisease(withoutcontrols,forexamplevaccinations)andprobabilityofdisease basedonlocalrates/endemicstatus.DiseasesdescribedarethosepresentinggreaterriskwhencomparedwithU.S. conditions.Mostidentifieddiseaseriskscanandarebeingmitigatedwithmilitarypreventivemedicinemeasures/policies. TRAB,OMAN:2010to2012 Page9of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 6.1FoodborneandWaterborneDiseases Foodborneandwaterbornediseasesintheareawerepotentiallytransmittedthroughtheconsumption oflocalfoodandwater.Sanitationwaspoorthroughoutthecountry,includingmajorurbanareas. Localfoodandwatersourceswereheavilycontaminatedwithpathogenicbacteria,parasites,and virusestowhichmostU.S.Servicemembershavelittleornonaturalimmunity.Effectivehostnation diseasesurveillancedi

9 dnotexistwithinthecountry.Onlyasmallfrac
dnotexistwithinthecountry.Onlyasmallfractionofdiseaseswereidentifiedor reportedinhostnationpersonnel.Diarrhealdiseasescouldhavebeenexpectedtotemporarily incapacitateaveryhighpercentageofU.S.personnelwithindaysiflocalfoodorwaterwasconsumed. HepatitisAandtyphoidfevercouldhavecausedprolongedillnessinasmallerpercentageof unvaccinatedpersonnel.VaccinationwasrequiredforDODpersonnelandcontractors.Inaddition, althoughnotspecificallyassessedinthisdocument,viralgastroenteritis(e.g.,norovirus)andfood poisoning(e.g.,Bacilluscereus,Clostridiumperfringens,andStaphylococcus)mayhavecaused significantoutbreaks.Keydiseaserisksaresummarizedbelow: 6.1.1DiarrhealDiseases(Bacteriological) UnmitigatedHigh-MitigatedLow: Mitigationwasinplace,U.S.Forceswereprovidedfoodand waterfromapprovedsources.Diarrhealdiseasescanbeexpectedtotemporarilyincapacitateavery highpercentageofpersonnel(potentiallyover50percentpermonth)withindaysiflocalfood,water,or iceisconsumed.Fieldconditions(includinglackofhandwashingandprimitivesanitation)may facilitateperson-to-personspreadandepidemics.Typicallymilddiseasetreatedinoutpatientsetting; recoveryandreturntodutyinlessthan72hourswithappropriatetherapy.Asmallproportionof infectionsmayrequiregreaterthan72hourslimitedduty,orhospitalization. 6.1.2HepatitisA UnmitigatedHigh-MitigatedLow: UnmitigatedhealthrisktoU.S.personnelwashighyearround. Mitigationwasinplace,USPersonneldidnotdrinkuntreatedwaterandvaccinationwithHepatitisA vaccineisrequiredfordeploymentintotheCENTCOMAOR.WaterconsumedbyUS/DODpersonnel wastreatedonmilitarycamps.Typicalcaseinvolves1to3weeksofdebilitatingsymptoms,sometimes initiallyrequiringinpatientcare;recoveryandreturntodutymayrequireamonthormore. 6.1.3Typhoid/ParatyphoidFever UnmitigatedHigh–MitigatedLow: UnmitigatedhealthrisktoU.S.personnelwashighyearround. MitigationmeasuresincludemandatoryTyphoidvaccinationforUSdeployerstotheCENTCOMAOR. Riskwastypicallyhighestfollowingspringfloods.Typhoidandparatyphoidwerepotentiallyacquired throughtheconsumptionoffecallycontaminatedfoodorwater.Asymptomaticcarriersarecommon withtyphoidandcontributetosustainedtransmission.Asmallnumberofcases(lessthan1%per monthattackrate)couldhaveoccurredamongunvaccinatedpersonnelwhoconsumedlocalfood, water,orice.Commonsourceoutbreaksmayhaveoccurred.Mitigationwasinplace,USpersonnel didnotdrinkuntreatedwater.Withappropriatetreatment,typhoidandparatyphoidfeverare debilitatingfebrileillnessestypicallyrequiring1to7daysofsupportivecare,followedbyreturntoduty. 6.1.4Diarrhea-Protozoal UnmitigatedModerat

10 e–MitigatedLow: Mitigationwasinplac
e–MitigatedLow: Mitigationwasinplace,USpersonneldodidnotdrink untreatedwater.Riskwastypicallyhighestfollowingspringfloods.Ingeneral,Cryptosporidiumspp., entamoebahistolytica,andgiardialambliawerethemostcommonprotozoalcausesofdiarrhea whereversanitaryconditionsaresignificantlybelowU.S.standards.Asmallnumberofcases(less than1%permonthattackrate)couldhaveoccurredamongpersonnelconsuminglocalfood,water,or TRAB,OMAN:2010to2012 Page10of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) ice.OutbreaksaffectingahigherpercentageofpersonnelwerepossiblewithCryptosporidium. Symptomaticcasesvariedinseverity;typicallymilddiseasedemonstratingrecoveryandreturntoduty inlessthan72hourswithappropriatetherapy;severecasesmayrequire1to7daysofsupportive care,followedbyreturntoduty. 6.1.5Brucellosis UnmitigatedModerate–MitigatedLow: Mitigationwasinplace,U.S.Forceswereprovidedfoodand waterfromapprovedsources.Brucellosiswasacommondiseaseincattle,sheep,goats,swine,and somewildlifespeciesinmostdevelopingcountries.Humansmayhavecontractedbrucellosisthrough consumptionofcontaminateddairyproducts(orfoodsmadewithsuchproducts)orbyoccupational exposurestoinfectedanimals.Thehealthriskfromdirectanimalcontactwaslikelytobehighestin ruralareaswherelivestockarepresent.However,thehealthriskfromcontaminateddairyproducts waspresentedcountrywide,includingurbanareas.Rarecases(lessthan0.1%permonthattackrate) couldhaveoccurredamongpersonnelconsuminglocaldairyproductsorhavingdirectcontactwith livestock.Withappropriatetreatment,brucellosisisafebrileillnessofvariableseverity,potentially requiringinpatientcare;convalescenceisusuallyover7daysevenwithappropriatetreatment. 6.1.6HepatitisE UnmitigatedModerate–MitigatedLow: Mitigationwasinplacetoreducetheresidualhealthriskto low,USpersonneldidnotdrinkuntreatedwater.PotentialhealthrisktoU.S.personnelwasModerate yearround.Riskwastypicallyhighestfollowingspringfloods.HepatitisEoccursin4majorgenotypes. Genotypes1and2,foundprimarilyinAfricaandAsia,causelargenumbersofsporadiccases,aswell aslargeoutbreaks.Fecalcontaminationofdrinkingwateristhemostcommonsourceofexposurefor thesegenotypes.Largeoutbreaksareusuallyassociatedwithparticularlyseverebreakdownsin baselinesanitation,asoftenoccursduringheavyrainfallwhichincreasesmixingofsewageand drinkingwatersources.Secondaryhouseholdcasesfromperson-to-persontransmissionare uncommon.UnlikehepatitisA,wherelocalpopulationslivinginpoorsanitaryconditionsareusually highlyimmunefromchildhoodexposures,immunitylevelsforhepatitisEareoftenmuchlo

11 wer,evenin areasofextremelypoorsanitatio
wer,evenin areasofextremelypoorsanitation.Typically,outbreaksofhepatitisEoccurprimarilyamongadults. Althoughdataisinsufficienttoassesspotentialdiseaserates,wecouldnotruleoutratesapproaching 1percentpermonthamongpersonnelconsuminglocalfood,water,orice.Ratesmayhaveexceeded 1percentpermonthforpersonnelheavilyexposedduringoutbreaksinthelocalpopulation.Typical casesinvolve1to3weeksofdebilitatingsymptoms,sometimesinitiallyrequiringinpatientcare; recoveryandreturntodutymayrequireamonthormore. 6.1.7Short-termHealthRisks: UnmitigatedModeratetoHigh–MitigatedLow :Theoverallshort-termunmitigatedriskassociated withfoodborneandwaterbornediseaseswasconsideredHigh(forbacterialdiarrhea,hepatitisA, typhoidfever/paratyphoidfever)toModerate(fordiarrhea-protozoal,brucellosis,hepatitisE)iflocal foodorwaterisconsumed.PreventiveMedicinemeasuressuchasvaccinationsreducetherisk estimatetonone(forHepatitisAandTyphoidfever). Additionally,U.S.Forceswereprovidedfoodand waterfromapprovedsources.ConfidenceinthehealthriskestimatewasMedium 6.1.8Long-termHealthRisks: Noneidentifiedbasedonavailabledata. 6.2ArthropodVector-BorneDiseases TRAB,OMAN:2010to2012 Page11of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) Duringwarmermonths(approximatelyMarchtoOctober),ecologicalconditionsinruralandperiurban areassupportarthropodvectors,includingmosquitoes,ticks,andsandflies,withvariableratesof diseasetransmission.BecauseOmanlacksadequatediagnosticcapability,vector-bornediseases frequentlyareunderreported,andthereisarelianceonclinical(symptom-based,vs.laboratory confirmation-based)diagnosis.Vector-bornediseasesweretransmittedatloworunknownlevelsand mayhaveconstitutedasignificanthealthriskintheabsenceofmitigationmeasures.SeeSection10.4 formoreinformationaboutpesticidesandpestcontrolmeasures. 6.2.1Leishmaniasis–Cutaneous/Visceral UnmitigatedModerate–MitigatedLow: PotentialunmitigatedhealthrisktoU.S.personnelwas Moderateyearround.ForU.S.personnel,riskmitigationincludedproperwearoftreateduniforms, applicationofrepellenttoexposedskin,andminimizingoutdooractivities(whenpossible)between duskanddawn.Leishmaniasisistransmittedbysandflies.Transmissiongenerallywaslimitedtothe warmermonths.Asmallnumberofcases(lessthan1%permonthattackrate)couldoccuramong personnelexposedtosandflybitesinareaswithinfectedpeople,rodents,dogs,orotherreservoir animals.Asymptomaticchronicinfectionsmayhaveoccurred,whichmaybecomesymptomaticyears later. Cutaneousinfectionwasunlikelytobedebilitating,thoughlesionscanbedisfiguring.Definitive trea

12 tmentpreviouslyrequirednon-urgentevacuat
tmentpreviouslyrequirednon-urgentevacuationtothecontinentalUnitedStates;currently,notall casesrequireevacuation. 6.2.2Crimean-CongoHemorrhagicFever UnmitigatedModerate–MitigatedLow: PotentialunmitigatedhealthrisktoU.S.personnelwas ModerateyearroundwithpeaktransmissionfromMarchthroughNovember,butreducedtolowwith mitigationmeasures.ForU.S.personnel,riskmitigationincludedproperwearoftreateduniformsand applicationofrepellenttoexposedskin.Riskfromtick-bornetransmissionwaslimitedprimarilyto warmermonths.Riskoftransmissionfromanimalcontactwaspresentyear-round.Mostprimary Crimean-Congohemorrhagicfever(CCHF)infectionsoccurassporadiccasesorclustersofcases,and areassociatedwithtickbitesoroccupationalcontactwithbloodorsecretionsfrominfectedanimals. OutbreaksofCCHFoccurinfrequently,butmaybeassociatedwithchangesinagriculturallanduse thatincreasetickcontactorincursionsofsusceptiblepopulationsintoareaswherethediseaseis endemic.Rarecases(lessthan0.1%permonthattackrate)couldhaveoccurredamongpersonnel exposedtotickbites.Directcontactwithbloodandbodyfluidsofaninfectedanimalorpersonmay alsohavetransmittedinfection . Itisaverysevereillnesstypicallyrequiringintensivecarewithfatality ratesfromfivetofiftypercent. 6.2.3SandflyFever UnmitigatedLow–MitigatedNegligible: Sandflyfeverhadalowhealthrisk,andtransmission generallywaslimitedtothewarmermonths.Thediseaseistransmittedbysandflies,whichtypically biteatnightandbreedindarkplacesrichinorganicmatter,particularlyinrodentorotheranimal burrows.Othersuitablehabitatsincludeleaflitter,rubble,looseearth,caves,androckholes. Sandfliesmaybecommoninperidomesticsettings.Abandoneddwellings,sometimesusedbytroops astemporaryquarters,alsocanharborsignificantnumbersofsandflies.Stablesandpoultrypensin peridomesticareasalsomayharborsandflies.Althoughdatawereinsufficienttoassesspotential diseaserates,1to10percentofpersonnelcouldhavebeenaffectedpermonthunderworstcase conditions.Insmallgroups,exposedtoheavilyinfectedsandflypopulationsinfocalareas,attackrates couldhavebeenveryhigh(over50percent).Incidentscanresultindebilitatingfebrileillnesstypically requiring1to7daysofsupportivecarefollowedbyreturntoduty. 6.2.4Typhus-Fleaborn TRAB,OMAN:2010to2012 Page12of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) UnmitigatedLow–MitigatedNegligible: Thediseaseistransmittedbyfleas,usuallyonrats.While ratfleasarethemostcommonvectors,catfleasandmousefleasarelesscommonmodesof transmission.Thesefleasarenotaffectedbytheinfection.Humaninfectionoccursbecauseofflea- fecalcontami

13 nationofthebitesonhumanskin. 6.2.5Dengue
nationofthebitesonhumanskin. 6.2.5DengueFever UnmitigatedLow–MitigatedNegligible: Denguefeverisalowriskwithsporadicoutbreaks possible.Denguefeveristransmittedtohumansbythebiteofan Aedes mosquitothatisinfectedwith adenguevirus.Theprincipalsymptomsofdenguefeverarehighfever,severeheadache,severepain behindtheeyes,jointpain,muscleandbonepain,rash,andmildbleeding(e.g.,noseorgumsbleed, easybruising). 6.2.6WestNileFever UnmitigatedLow–MitigatedNegligible: PotentialunmitigatedhealthrisktoU.S.personnelwas Lowwithtransmissiongenerallylimitedtothewarmermonths.WestNilefeverwaspresentandwas maintainedbybirdpopulationsandmultiplespeciesofCulexmosquitoesthathelptotransferthe diseasesfrombirdstohumans.Themajorityofinfectionsinyoung,healthyadultsareasymptomatic althoughitcanresultinfever,headache,tiredness,andbodyaches,occasionallywithaskinrash(on thetrunkofthebody)andswollenlymphglands. 6.2.7Tick-borneRickettsioses(Spottedfevergroup) UnmitigatedLow–MitigatedNegligible: Tick-bornerickettsiosesarealowriskwithrarecases present.Thediseaseistransmittedtohumansthroughbitesofcertainspeciesofticks. 6.2.8Sindbis(andSindbis-likevirus) UnmitigatedLow–MitigatedNegligible: Sindbisisalowriskwithrarecasespresent.Thevirusis transmittedbymosquitoesandismaintainedinnaturebytransmissionbetweenvertebrate(bird)hosts andinvertebrate(mosquito)vectors.HumansareinfectedwithSindbisviruswhenbittenbyaninfected mosquito. 6.2.9Shortandlong-termhealthrisks: UnmitigatedLowtoModerate–MitigatedNegligible: Theunmitigatedhealthriskestimatewaslow tomoderate.Healthriskwasreducedtolowbyproperwearoftheuniform,applicationofrepellentto exposedskin,andappropriatechemoprophylaxis.Confidenceinhealthriskestimatewasmedium. 6.3WaterContactDiseases Operationsoractivitiesthatinvolvedextensivewatercontactmayhaveresultedinpersonnelbeing temporarilydebilitatedwithleptospirosisinsomelocations.Leptospirosishealthrisktypicallyincreases duringflooding.Inaddition,althoughnotspecificallyassessedinthisdocument,bodiesofsurface waterwerelikelytobecontaminatedwithhumanandanimalwaste.Activitiessuchaswadingor swimmingmayhaveresultedinexposurestoentericdiseasessuchasdiarrheaandhepatitisvia incidentalingestionofwater.Prolongedwatercontactalsomayhavealsoleadtothedevelopmentofa varietyofpotentiallydebilitatingskinconditionssuchasbacterialorfungaldermatitis. TRAB,OMAN:2010to2012 Page13of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 6.3.1Leptospirosis Moderate: Leptospirosisunmitigatedriskismoderateyear-roundwithpeakseasonAprilthro

14 ugh October.ThediseaseispresentinOman,bu
ugh October.ThediseaseispresentinOman,butatunknownlevels.Dataareinsufficienttoassess potentialdiseaserates,upto1-10percentofpersonnelwadingorswimminginbodiesofwatersuchas lakes,streams,orirrigatedfieldscouldbeaffectedpermonth.Humaninfectionoccursthrough exposuretowaterorsoilcontaminatedbyinfectedanimalsandhasbeenassociatedwithwading,and swimmingincontaminated,untreatedopenwater. Leptospirosiscanenterthebodythroughcutor abradedskin,mucousmembranes,andconjunctivae.Ingestionofcontaminatedwatercanalsoleadto infection.Theacutegeneralizedillnessassociatedwithinfectioncanmimicothertropicaldiseases(for example,denguefever,malaria,andtyphus),andcommonsymptomsincludefever,chills,myalgia, nausea,diarrhea,cough,andconjunctivalsuffusion.Manifestationsofseverediseasecaninclude jaundice,renalfailure,hemorrhage,pneumonitis,andhemodynamiccollapse.Recreationalactivities involvingextensivewatercontactmayresultinpersonnelbeingtemporarilydebilitatedwith leptospirosis. 6.3.2Schistosomiasis Moderate: SchistosomiasisunmitigatedriskismoderatewithpeakseasonAprilthroughNovember. Humanreleaseschistosomeeggsthroughurineandfeces,whichmaybecontaminatingsurfacewater. Whenwatertemperaturesinlakes,streams,andriversareatorabove68 o F,theeggshatchand releasethelarvaeintothewater.Iftherighttypeoffreshwatersnailispresent,thelarvaepenetratethe snail,develop,andemergeasfree-swimmingcercariaethatcaninfecthumansbypenetratingtheskin ofpeoplewhilewadingorswimming. 6.3.3Short-termhealthrisks: Moderate: HealthriskofleptospirosisandSchistosomiasiswasmoderatewithoutmitigationstrategies inplace.Confidenceinthehealthriskestimatewasmedium 6.3.4Long-termhealthrisks: Noneidentifiedbasedonavailabledata. 6.4RespiratoryDiseases Althoughnotspecificallyassessedinthisdocument,deployedU.S.forcesmayhavebeenexposedtoa widevarietyofcommonrespiratoryinfectionsinthelocalpopulation.Theseincludedinfluenza, pertussis,viralupperrespiratoryinfections,viralandbacterialpneumonia,andothers.U.S.military populationslivinginclose-quarterconditionswereatriskforsubstantialperson-to-personspreadof respiratorypathogens.Influenzawasofparticularconcernbecauseofitsabilitytodebilitatelarge numbersofunvaccinatedpersonnelforseveraldays. 6.4.1Tuberculosis(TB) Low: PotentialunmitigatedhealthrisktoU.S.personnelwasLowyearround.Transmissiontypically requirescloseandprolongedcontactwithanactivecaseofpulmonaryorlaryngealtuberculosis(TB), althoughitalsocanoccurwithmoreincidentalcontact.Thelikelihoodofexposuretoanactivecase varieswiththeoverallincidenceandthedegreeofcontactwitht

15 helocalpopulation,particularlythose livi
helocalpopulation,particularlythose livinginconditionsofcrowdingandpoverty.Tuberculinskintest(TST)conversionratesmayhave TRAB,OMAN:2010to2012 Page14of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) beenelevatedoverbaselineforpersonnelwithprolongedcloseexposuretolocalpopulations.ATST screeningtodetectlatentinfectionmayhavebeenwarrantedinpersonnelwithahistoryofprolonged closeexposuretolocalpopulations.Tuberculosisexposureandinfectionisevaluatedaspartofthe PostDeploymentHealthAssessment(PDHA)process. 6.4.2MeningococcalMeningitis Low: PotentialunmitigatedhealthrisktoU.S.personnelwasLowyearround.However,thehealthrisk mayhavebeenelevatedduringcoolermonths.Asymptomaticcolonizationandcarriageof meningococcalbacteriawascommonworldwide,includingwithinU.S.militarypopulations;rare symptomaticcasesmayhaveoccurredperiodicallyinmilitarypopulations,regardlessofgeographic location.Meningococcalmeningitisispotentiallyaveryseverediseasetypicallyrequiringintensive care;fatalitiesmayoccurin5-15%ofcases. 6.4.3Short-termhealthrisks: Low: ConfidenceinthehealthriskestimatewasMedium 6.4.4Long-termhealthrisks: Noneidentifiedbasedonavailabledata. 6.5Animal-ContactDiseases 6.5.1Q-Fever Moderate: PotentialunmitigatedhealthrisktoU.S.personnelwasModerateyearround.Rarecases werepossibleamongpersonnelexposedtoaerosolsfrominfectedanimals,withclustersofcases possibleinsomesituations.Significantoutbreaks(affecting1-50%)couldhaveoccurredinpersonnel withheavyexposuretobarnyardsorotherareaswhereanimalsarekept.Unpasteurizedmilkmayalso havetransmittedinfection.Theprimaryrouteofexposureisrespiratory,withaninfectiousdoseaslow asasingleorganism.Incidencecouldresultindebilitatingfebrileillness,sometimespresentingas pneumonia,typicallyrequiring1to7daysofinpatientcarefollowedbyreturntoduty. 6.5.2Rabies Low: PotentialunmitigatedhealthrisktoU.S.personnelwasLowyearround.Rabiesistransmittedby exposuretovirus-ladensalivaofaninfectedanimal,typicallythroughbites.Prevalenceinferaland wildlifepopulationswaswellaboveU.S.levelsduetothelackoforganizedcontrolprograms. Personnelbittenbypotentiallyinfectedreservoirspeciesmayhavedevelopedrabiesintheabsenceof appropriateprophylaxis.Thecircumstancesofthebiteshouldhavebeenconsideredinevaluating individualhealthrisk;inadditiontodogsandcats,batsorwildcarnivoresshouldalsohavebeen regardedasrabidunlessprovenotherwise.GeneralOrder1Bmitigatedrabiesriskbyprohibiting contactwithoradoptionorfeedingofferalanimals.Verysevereillnesswithnear100%fatalityrate couldhaveoccurredintheabsenceofpost-exposure

16 prophylaxis.Typicallythetimeperiodfrom e
prophylaxis.Typicallythetimeperiodfrom exposuretotheonsetofsymptomsis2–12weeks,butcanrarelytakeseveralyears. 6.5.3Short-termhealthrisks: Variable(LowtoModerate): LowforrabiesandModerateforQ-fever.Confidenceinthehealthrisk estimatewasMedium. TRAB,OMAN:2010to2012 Page15of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 6.5.4Long-termhealthrisks: Low: ThelongtermriskforrabieswasLow. 7VenomousAnimal/Insect AllinformationwastakendirectlyfromtheClinicalToxicologyResourceswebsite(Cfromthe UniversityofAdelaide,AustraliaandfromtheArmedForcesPestManagementBoardLivingHazards Database(http://www.afpmb.org/content/living-hazards-database).Thespecieslistedbelowhave homerangesthatoverlapthelocationofOmanandmayhavepresentedahealthriskiftheywere encounteredbypersonnel.PersonnelatTRABexperienceminimalsightingsorcontact. 7.1Scorpions Androctonuscrassicauda(BlackScorpion):Severeenvenomingpossible,potentiallylethal. Cardiotoxicitymaybedirectorindirect,butisafeatureofsevereenvenoming,withcardiac arrhythmias,cardiacfailure. Nebofranckei,Neboomanensis,Nebowhitei:Severeenvenomingpossible,potentiallylethal. Stinglikelytocauselocalpain,thenvariabledevelopmentofsystemiceffects,whichcould includerespiratoryfailure,cardiacfailureandevidenceofhaemorrhageintovitalorgans. Apistobuthuspterygocercus,Babycurusexquisitus,Buthacusyotvatensis,Butheolusgallagheri, Compsobuthusacutecarinatus,Compsobuthusarabicus,Compsobuthusmaindroni, Compsobuthuspolisi,Microbuthuspusillus,Odontobuthusodonturus,Orthochirusinnesi, Paraorthochirusglabifrons,Paraorthochiruskinzelbachi,Vachoniolusglobimanus: Therearea numberofdangerousButhidscorpions,butalsoothersknowntocauseminimaleffectsonly. Withoutclinicaldataitisunclearwherethisspeciesfitswithinthatspectrum. 7.2Snakes Astrotiastokesii(Stokes'SeaSnake),Enhydrinaschistose(BeakedSeaSnake),Hydrophis cyanocinctus(AsianAnnulatedSeaSnake),Hydrophisgracilis(GracefulSmall-headedSeaSnake) Hydrophislapemoides(PersianGulfSeaSnake)Hydrophisornatus(ReefSeaSnake),Hydrophis spiralis(YellowSeaSnake),Lapemiscurtus(Shaw’sSeaSnake),Pelamisplaturus(YellowBelliedSea Snake),Thalassophinaviperina(OliveSeaSnake):Seasnakebitesvaryfromtrivialtolethal envenoming. Atractaspismicrolepidota(BurrowingAsp),Aspismicropholis(SahelianBurrowingAsp): Burrowingaspbitesmostlycauseminoreffects,butseverelocaleffects,includingnecrosis,canoccur, ascanpotentiallylethalsystemiceffects . Cerastescerastes(HornedViper),Cerastesgasperettii(Gasperetti'sHornedSandViper):Both significantlocaleffectsandsystemiceffects,incl

17 udingcoagulopathycanoccur. Bitisarietans
udingcoagulopathycanoccur. Bitisarietans(PuffAdder):Echiskhosatskii(DhofarCarperViper),Echisomanensis(Oman Saw-scaledViper),Echispyramidum(Geoffroy'sCarpetViper),Echissochureki(Sochurek’sSaw- scaledViper),Najahaje(ArabianCobra):Severeenvenomingpossible,potentiallylethal. 7.3Fish/Snails Conusgeographus,ConusTextile(snails):Serious&painfulenvenomations(sometimesfatal) TRAB,OMAN:2010to2012 Page16of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) usuallyoccurwhenswimmers(waders)pickupshellswithlivesnailsstillinside Pteroisvolitans(LionFish),Synacejatrachynis(StoneFish):Serious&painfulenvenomations (sometimesfatal) 7.4Short-termhealthrisk: LowtoHigh: Ifencountered,effectsofvenomvariedwithspeciesfrommildlocalizedswelling(to potentiallylethaleffects.Seeeffectsofvenomabove.Confidenceinthehealthriskestimatewaslow (TG230Table3-6). 7.5Long-termhealthrisk: Noneidentified. 8Heat/ColdStress Oman'sclimate ishotanddryintheinteriorandhumidalongthecoast .TRABislocatedinsouthern Oman,Dhofarregion,approximately71kilometers(km)northofSalalah(nearestcoastalcity).The Dhofarregion’sclimateisdramaticallydifferenttotherestofOmanduetotheeffectsofthemonsoon rainswhicharriveduringthesummermonths,creatinghumidityandmoderatetemperaturesofaround 86°F. 8.1Heat Thehealthriskofheatstress/injurybasedontemperaturesaloneisLow(78°F)inJanuaryand October.ThemonsoonseasonlastsfromtheendofJunethroughtheendofAugust.Duringthistime, temperaturescanbeupto10degreeslower.However,workintensityandclothing/equipmentworn posegreaterhealthriskofheatstress/injurythanenvironmentalfactorsalone(Goldman,2001). Personnelareeducatedondangersofheatstress,waterintakeandwork/restcycles. 8.1.1Short-termhealthrisk: LowtoHigh: HighhealthriskofheatinjuryinunacclimatizedpersonnelfromMarchtoOctober,and LowfromNovembertoFebruary.Theriskofheatinjurywasreducedthroughpreventivemeasures. Becausetheoccurrenceofheatstress/injuryisstronglydependentonoperationalfactors(work intensityandclothing),confidenceinthehealthriskestimatewaslow(TG230,Table3-6). 8.1.2Long-termhealthrisk: Low: Long-termhealthimplicationsfromheatinjuriesarerarebutcanoccur,especiallyfrommore seriousinjuriessuchasheatstroke.However,thehealthriskmaybegreatertocertainsusceptible persons–thoseolder(i.e.,greaterthan45years),inlesserphysicalshape,orwithunderlying medical/healthconditions.Thelong-termhealthriskwasLow;confidenceinthehealthriskestimates wasmedium(TG230,Table3-6). 8.2Cold TRAB,OMAN:2010to2012 Page17of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov201

18 2) Evenonwarmdaystherecanbeasignificantd
2) Evenonwarmdaystherecanbeasignificantdropintemperatureaftersunsetbyasmuchas40°F. Thereisariskofcoldstress/injurywhentemperaturesfallbelow60°F,whichcanoccurfrom NovembertoFebruary.Thehealthriskassessmentfornon-freezingcoldinjuries(chilblain,trenchfoot, andhypothermia)isLowbasedonhistoricaltemperatureandprecipitationdata.Frostbiteisunlikelyto occurbecausetemperaturesrarelydropbelowfreezing.Aswithheatstress/injuries,cold stress/injuriesarelargelydependentonoperationalandindividualfactorsinsteadofenvironmental factorsalone.Withprotectivemeasuresinplacethehealthriskassessmentislowforcold stress/injury;confidenceinthehealthriskestimateismedium. 8.2.1Short-termhealthrisks: Low: ThehealthriskofcoldinjuryisLow.Confidenceinthehealthriskestimateismedium. 8.2.2Long-termhealthrisk: Low: ThehealthriskofcoldinjuryisLow.Confidenceinthehealthriskestimateishigh 9Noise 9.1Continuous OccupationalandEnvironmentalHealthAssessmentsatTRABindicatethepotentialfornoise exposurewhenworkingonorneartheflightlineand/orindustrialshops.Appropriatehearingprotection isprovidedforallindividualsinshopswhichgenerateorareexposedtohazardousnoise. 9.1.1Short-termhealthrisks: Low: Short-termriskofnoiseinjurywithappropriatehearingprotectionuseisLow.Confidenceinthe healthriskassessmentismedium(TG230,Table3-6). 9.1.2Long-termhealthrisks: Low-Moderate :Long-termriskofnoiseinjurywithappropriatehearingprotectionuseisLowto Moderate.Confidenceinthehealthriskassessmentismedium(TG230,Table3-6). 9.2Impulse NospecifichazardsourcesweredocumentedinDOEHRSorMESLdataportalbetweenApril2010and August2012. 10UniqueIncidents/Concerns 10.1Potentialenvironmentalcontaminationsources DoDpersonnelareexposedtovariouschemical,physical,ergonomic,andbiologicalhazardsinthe courseofperformingtheirmission.Thesetypesofhazardsdependonthemissionoftheunitandthe operationsandtaskswhichthepersonnelarerequiredtoperformtocompletetheirmission.Thehealth riskassociatedwiththesehazardsdependsonanumberofelementsincludingwhatmaterialsare used,howlongtheexposurelast,whatisdonetothematerial,theenvironmentwherethetaskor operationisperformed,andwhatcontrolsareused.Theseprocessandhazardsareidentifiedand evaluatedinDOEHRSforthecorrespondingworkcenters.Exposurestotheseoccupationalhazards TRAB,OMAN:2010to2012 Page18of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) canoccurthroughinhalation(air),skincontact,oringestion;howeverexposuresthroughairare generallyassociatedwiththehighesthealthrisk. 10.2WasteSites/WasteDisposal Asofthe2010OccupationalandEnvironmentalHealt

19 hSiteAssessment,hazardousmaterialsdispos
hSiteAssessment,hazardousmaterialsdisposal wasstillintheplanningphase.Severalunitcontrolledsatellitecollectionpointsexistonbaseincluding onemaintainedbyacontractor.Thiswasteisthentransferredtoacentralwastecollectionareafor finaldisposition.Trashiscollectedbyacontractorandtakentoanoff-baselandfillfordisposal. Whenneeded,expiredmedicineswereburnedatanOmaniAirForceburnsiteonbase.Burning occurredneartheflightlineontheOmanisideofthebaseintheburnpit.AFFireDepartment personnelconductAFburningoperations.Thispracticewasdiscontinuedin2011. Nospecifichealthrisksassociatedwiththesewastemanagementoperationshavebeenidentified. 10.3Fuel/petroleumproducts/industrialchemicalspills: NosignificantincidentshaveoccurredatTRABregardingfuel,petroleumorindustrialchemicalspills. 10.4Pesticides/PestControl: TRABhasanEntomologyshop.Minimalamountsofpesticidesareusedandsmallamountsare maintainedattheCEK-Span.Insecttrapsandbaitsaremainlyusedforpestcontrol.Roguecatsare trappedbyEntomologypersonnelandreleasedinareasthatarenotpopulatedbybasepersonnel. 10.4.1Short-termandLong-termhealthrisks Low: LongtermhealthriskisLow.Confidenceinthehealthriskassessmentismedium(TG230Table 3-6). 10.5Asbestos 3sampleswerecollectedinMay2011todeterminethepresenceofasbestosinfloortileslocated insideofahostnationbuilding(bldg542).Sampledmaterialis12"x12"floortileandassociated mastic,materialwasnon-friableandingoodcondition.Noasbestoswasidentifiedinsampledtiles. 10.5.1Short-termandLong-termhealthrisks Low: LongtermhealthriskisLow.Confidenceinthehealthriskassessmentismedium(TG230Table 3-6). TRAB,OMAN:2010to2012 Page19of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 11References 2 1.ArmedForcesPestManagementBoardLivingHazardsDatabase: http://www.afpmb.org/content/living-hazards-database 2.CasarettandDoull’sToxicology:theBasicScienceofExposures,Chapter2-Principlesof Toxicology;FifthEdition,McGrawHill,NewYork. 3.ClinicalToxicologyResources: http://www.toxinology.com/ .UniversityofAdelaide,Australia. 4.DefenseOccupationalandEnvironmentalHealthReadinessSystem(referredtoastheDOEHRS- EHdatabase)at https://doehrs-ih.csd.disa.mil/Doehrs/ . 5.DepartmentofDefense(DoD)Instruction6490.03,DeploymentHealth,2006. 6.DoDI6055.05,OccupationalandEnvironmentalHealth,2008. 7.DoDMESLDataPortal: https://mesl.apgea.army.mil/mesl/ . Someofthedataandreportsusedmay beclassifiedorotherwisehavesomerestricteddistribution. 8.GoldmanRF.2001.Introductiontoheat-relatedproblemsinmilitaryoperations.In:Textbookof militarymedicine:medicalaspectsofharshenvironme

20 ntsVol.1,PandolfKB,andBurrRE (Eds.),Offi
ntsVol.1,PandolfKB,andBurrRE (Eds.),OfficeoftheSurgeonGeneral,DepartmentoftheArmy,WashingtonDC. 9.JointStaffMemorandum(MCM)0028-07,ProceduresforDeploymentHealthSurveillance,2007. 10.OccupationalandEnvironmentalHealthSiteAssessment(OEHSA),ThumraitAirBase,April2011. 11.NationalCenterforMedicalIntelligence(NCMI): https://www.intelink.gov/ncmi/index.php . 12.Modification11toUnitedStatesCentralCommandIndividualProtectionandIndividual,Unit DeploymentPolicy,2December2011. 13.USAPHCTG230,June2010Revision. 14.USACHPPM2008ParticulateMatterFactsheet;64-009-0708,2008. 2 NOTE.Thedataarecurrentlyassessedusingthe2010TG230.Thegeneralmethodinvolvesaninitialreviewofthedata whicheliminatesallchemicalsubstancesnotdetectedabove1-yrnegligibleMEGs.Thosesubstancesscreenedoutarenot consideredacuteorchronichealthhazardssoarenotassessedfurther.Forremainingsubstances,acuteandchronichealth effectsareevaluatedseparatelyforairwater(soilisonlyevaluatedforlongtermrisk).Thisisperformedbyderivingseparate short-termandlongtermpopulationexposurelevelandestimates(referredtoaspopulationexposurepointconcentrations (PEPC))thatarecomparedtoMEGsderivedforsimilarexposuredurations.IflessthanorequaltonegligibleMEGtheriskis Low.Iflevelsarehigherthannegligiblethenthereisachemical-specifictoxicityandexposureevaluationbyappropriate SMEs,whichincludescomparisontoanyavailablemarginal,criticalorcatastrophicMEGs.Fordrinkingwater15L/dayMEGs areusedforthescreeningwhilesitespecific5-15L/dayareusedformoredetailedassessment.Fornondrinkingwater(such asthatusedforpersonalhygieneorcooking)the‘consumptionrate’islimitedto2L/day(similartotheEPA)whichisderived bymultiplyingthe5L/dayMEGbyafactorof2.5.Thisvalueisusedtoconservativelyassessnondrinkingusesofwater. TRAB,OMAN:2010to2012 Page20of20 ReviewedbyCENTCOMSG(1Nov2012) FinalApprovalDate(2Nov2012) 12WhereDoIGetMoreInformation? IfaproviderfeelsthattheServicemember’sorVeteran’scurrentmedicalconditionmaybeattributed tospecificOEHexposuresatthisdeploymentlocation,he/shecancontacttheService-specific organizationbelow.OrganizationsexternaltoDoDshouldcontactDoDForceHealthProtectionand Readiness(FHP&R). ArmyInstituteofPublicHealth Phone:(800)222-9698. http://phc.amedd.army.mil/ NavyandMarineCorpsPublicHealthCenter(NMCPHC) (formerlyNEHC)Phone:(757)953-0700. http://www-nehc.med.navy.mil U.S.AirForceSchoolofAerospaceMedicine(USAFSAM) (formerlyAFIOH)Phone:(888)232- 3764. http://www.wpafb.af.mil/afrl/711hpw/usafsam.asp DoDForceHealthPro tectionandReadiness(FHP&R) Phone:(800)497-6261. http://fh