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Water Contact Diseases Hazardous Animals and Plants (Continued) DEPLOYMENT HEALTH GUIDE:

Leptospirosis – Wading, swimming, other contact with Prevention – Swim at approved beaches; do not handle; PAKISTAN
water/mud contaminated with infected animal urine; seek medical attention if stung/bitten.
worst-case, 1–-10 percent affected per month
• Threat year-round; countrywide Hazardous Plants – Numerous toxic plants can cause
• Symptoms – fever, chills, nausea skin/lung irritation if touched/burned and poisoning if
• Hospitalization of 1-7 days chewed/eaten.
Prevention – Do not swim/wade in unapproved water; Prevention – Do not touch, chew, eat, or burn
wash skin and clothing after exposure to freshwater unfamiliar plants; wash contaminated skin/clothing
streams/ponds. after contact.
Short-term health risks Operations at 6,000 feet can impact unit and individual
• Food contaminated with fecal pathogens effectiveness.
• Water contaminated with raw sewage
• Extreme heat, high altitude, airborne sand Signs of altitude sickness: headache, nausea,
vomiting, dizziness, fatigue, irritability, coughing
Long-term health risks
• Air contamination Acclimatization:
• Chemical contamination of food and water • Staged Ascent – Ascend to moderate altitude
(5,000–8,000 feet) and remain there for 3 days
HAZARDOUS ANIMALS AND PLANTS before ascending higher.
• Graded Ascent – Limit daily altitude to allow
Venomous Snakes – Aggressive cobras, kraits, pit partial acclimatization. Spend 2 nights at 9,000
vipers, and vipers are present country-wide; some feet and limit to no more than 1,000 feet per
have venom which can cause death within hours. If day above each night’s sleep. This country-specific guide should be used in
bitten, seek urgent medical attention!
Treatment – The preferred method to treat any high conjunction with GTA 08-05-062, Guide to
Prevention – Do not handle any snake. altitude illness is to evacuate the individual to a lower Staying Healthy, and is intended to provide
Centipedes, Millipedes, and Solifugids – None with altitude. See GTA 08-05-060, A Soldier’s Guide to information that can help reduce your risk of
deadly venom but capable of inflicting painful bites or Staying Healthy at High Elevations. Disease and Non-battle Injuries (DNBI) when
secreting fluids that can blister skin DISTRIBUTION UNLIMITED
deployed. This health threat and
countermeasure information is based on the
Prevention – Shake out boots/bedding/clothing prior to Prepared by: most current data available from U.S.
use; never walk barefoot; avoid sleeping on the
Department of Defense medical agencies at
ground; seek medical attention if bitten.
the time of production. In addition to the
Scorpions and Spiders – Some scorpions have information in this guide, you should also
potentially lethal venom; tarantulas and black widow receive force health protection, health threat,
spiders can deliver painful bites. U.S. Army Center for Health Promotion & Preventive
and preventive medicine countermeasures
Prevention – Shake out boots/bedding/clothing prior to http://chppm-www.apgea.army.mil
training/briefings prior to and, as required,
use; never walk barefoot; avoid sleeping on the SIPRNet: http://usachppm1.army.smil.mil
throughout the length of your deployment.
ground; use caution when entering abandoned (800) 222-9698/ DSN 584-4375/ (410) 436-4375
buildings or bunkers; seek medical attention if SHG 041-1105
Marine Animals – Numerous venomous sea snakes,
rays, fish, starfish, shellfish, jellyfish, anemones, sea Deployment Health Guide Series
nettles/urchins in coastal waters January 2006
PAKISTAN OVERVIEW Food-borne and Water-borne Diseases (Continued) Vector-borne Diseases (Continued)
Location – Pakistan is located in Southern Asia, • Symptoms – loose, watery or explosive bowel Prevention – DEET on exposed skin; permethrin-
bordering the Arabian Sea, between India on the east, movements treated uniforms; permethrin-treated bed nets; malaria
Iran and Afghanistan on the west, and China on the • Recovery of 1–3 days with antibiotics prevention pills as prescribed (critical)
North. Pakistan is about twice the size of California.
Typhoid/Paratyphoid fever– A potential attack rate of 1– Animal Contact Diseases
Climate – Mostly hot, dry desert; temperate in the 10 percent among unvaccinated personnel consuming Rabies – Exposure to virus-laden saliva of an infected
northwest. During the winter, temperatures range from local food, water, or ice animal through a bite, scratch, or breathing airborne
57° F in the Indus Plain to 68° F along the coast and - • Threat year-round; countrywide droplets; risk is among the highest in the world
4° F in the mountains. During the summer, • Symptoms – fever, constipation, headache • Threat year-round; countrywide
temperatures can reach as high as 124° F. • Hospitalization of 1–7 days • Initial symptoms – pain, tingling, or itching from
Rainfall – Rainfall is 60 inches in the northern Hepatitis E – A potential attack rate of less than 1 bite site; chills, fever, muscle aches
highlands, 6–8 inches along the coast, and 4 inches in percent a month if local food, water, or ice is • Death likely in the absence of post-exposure
the desert. consumed prophylaxis
• Threat year-round; countrywide Prevention – Avoid all animals; if scratched or bitten,
Terrain – One-third of Pakistan consists of the
• Symptoms – jaundice, fatigue, nausea, vomiting seek medical attention immediately; pre- and/or post-
Himalayan and Trans-Himalayan Mountains (8,000–
• Severe, 1–4 weeks recovery, sometimes initially exposure vaccinations if prescribed by medical
15,000+ feet). The Indus Plain, located in south and
requiring hospitalization authority.
central Pakistan, is approximately 200,000 square
miles and is the country’s most prosperous agricultural Prevention – Consume only U.S. military-approved Others – Anthrax, Q fever
region. food, water, ice; hepatitis A vaccine and/or typhoid
vaccine if directed by medical authority. Respiratory Diseases
Forces of Nature – Cyclones, periodic flooding,
sandstorms and dust storms Vector-borne Diseases Tuberculosis – Breathing contaminated air droplets
from other people (coughing/sneezing)
RISK ASSESSMENT Greatest concern: • Highest threat from prolonged close contact with
Pakistan is at HIGH RISK* for infectious diseases. Dengue fever – Significant number of cases possible local populations
Without force health protection measures, mission • Transmission – day-biting mosquitoes • Threat year-round; countrywide
effectiveness will be seriously jeopardized. • Threat year-round; countrywide, but greatest in • Symptoms – none to cough, chest pain,
southern Pakistan breathlessness, night sweats
*Based on a combination of all major infectious • Symptoms – high fever, severe muscle pain, • Severe illness or death if not treated
diseases that occur in a country, the Armed Forces severe headache, rash Prevention – Avoid close contact with local populations;
Medical Intelligence Center (AFMIC) assigns an overall • Hospitalization of 1-7 days likely early detection/treatment reduces severity.
country risk level of low, intermediate, high, or very
Malaria – Significant number of cases possible
high risk, as compared to other countries. Sexually Transmitted Diseases
• Transmission – night-biting mosquitoes
INFECTIOUS DISEASES • Threat year-round, greatest after the July– Gonorrhea/Chlamydia – Unprotected sexual contact
August monsoon; countrywide below 2,000 with infected person; potential attack rate of 1–50
Food-borne and Water-borne Diseases meters percent
Consuming contaminated food, water, or ice • Symptoms – fever, chills, sweats; mild to • Threat year-round; countrywide
Hepatitis A – A potential attack rate of 1–10 percent severe, including coma and death • Symptoms (in men) – None to burning sensation
per month among unvaccinated personnel could occur • Hospitalization of 1-7 days likely; prolonged when urinating or discharge
if local food, water, or ice is consumed. recovery or death possible • Symptoms (in women) – None to burning when
• Threat year-round; countrywide Others – A small or undetermined number of cases could urinating to increased vaginal discharge
• Symptoms – none to flu-like illness occur: Chikungunya (mosquito-borne); Crimean-Congo • Mild; outpatient treatment
• Severe, 1–4 weeks recovery, sometimes initially hemorrhagic fever (tick-borne); Japanese encephalitis Others – HIV/AIDS, hepatitis B
requiring hospitalization (mosquito-borne); leishmaniasis (cutaneous and visceral,
sand fly-borne); rickettsioses (Boutonneuse fever and Prevention – Abstinence; latex condoms; not sharing
Diarrhea, bacterial – A potential attack rate over 50
Siberian tick typhus, tick-borne); sandfly fever (sand fly- needles; hepatitis B vaccine
percent a month if local food, water, or ice is
consumed borne); typhus (scrub typhus, mite-borne); and West Nile
• Threat year-round; countrywide fever (mosquito-borne)