MILITARY VETERINARY SERVICES

The Coat of Arms
1818
Medical Department of the Army

A 1976 etching by Vassil Ekimov of an
original color print that appeared in
The Military Surgeon, Vol XLI, No 2, 1917

Textbooks of Military Medicine

Published by the

Office of The Surgeon General
Borden Institute
US Army Medical Department Center and School
Health Readiness Center of Excellence
Fort Sam Houston, Texas

Edward A. Lindeke
Colonel (Retired), MS, US Army
Director, Borden Institute

The TMM Series

Published Textbooks

Medical Consequences of Nuclear Warfare (1989)

Conventional Warfare: Ballistic, Blast, and Burn Injuries (1991)

Occupational Health: The Soldier and the Industrial Base (1993)

Military Dermatology (1994)

Military Psychiatry: Preparing in Peace for War (1994)

Anesthesia and Perioperative Care of the Combat Casualty (1995)

War Psychiatry (1995)

Medical Aspects of Chemical and Biological Warfare (1997)

Rehabilitation of the Injured Soldier, Volume 1 (1998)

Rehabilitation of the Injured Soldier, Volume 2 (1999)

Medical Aspects of Harsh Environments, Volume 1 (2002)

Medical Aspects of Harsh Environments, Volume 2 (2002)

Ophthalmic Care of the Combat Casualty (2003)

Military Medical Ethics, Volume 1 (2003)

Military Medical Ethics, Volume 2 (2003)

Military Preventive Medicine, Volume 1 (2003)

Military Preventive Medicine, Volume 2 (2005)

Recruit Medicine (2006)

Medical Aspects of Biological Warfare (2007)

Medical Aspects of Chemical Warfare (2008)

Care of the Combat Amputee (2009)

Combat and Operational Behavioral Health (2011)

Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine (2012)

Medical Consequences of Radiological and Nuclear Weapons (2013)

Forensic and Ethical Issues in Military Behavioral Health (2014)

Combat Anesthesia: The First 24 Hours (2015)

Otolaryngology/Head and Neck Surgery Combat Casualty Care in Operation Iraqi Freedom and Operation Enduring Freedom (2015)

Medical Aspects of Biological Warfare (2018)

Military Veterinary Services (2019)

An image first used by the US Army Medical Service Veterinary School, Chicago, Illinois. Although this veterinary school no longer operates, the crest featured in the center of the image was later adopted by the US Army Veterinary Command (VETCOM), now inactivated and joined with forces of the US Army Public Health Command. The VETCOM “crest” is also referred to as a “distinctive unit insignia” (DUI); the Army Institute of Heraldry is responsible for the production and authorization of any DUI.

Image: Courtesy of the US Army Medical Department Center of History and Heritage Archival Collection, Joint Base San Antonio-Ft Sam Houston, Texas.

MILITARY VETERINARY SERVICES

Senior Editors

Colonel (Retired) Leslie G. Huck, DVM, MS, MSS
Department of Veterinary Science
US Army Medical Department Center and School
Health Readiness Center of Excellence
Fort Sam Houston, Texas

Lieutenant Colonel Ronald L. Burke, DVM, DRPH
Veterinary Health Services, Public Health Command, Pacific
Tripler Army Medical Center
Honolulu, Hawaii

Office of The Surgeon General
Borden Institute
US Army Medical Department Center and School
Health Readiness Center of Excellence
Fort Sam Houston, Texas

2019

Editorial Staff:

Darla Huck
Volume Editor

Venetia Valiga
Illustrator

Douglas Wise
Senior Layout Editor

This volume was prepared for military medical educational use. The focus of the information is to foster discussion that may form the basis of doctrine and policy. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Dosage Selection:

The authors and publisher have made every effort to ensure the accuracy of dosages cited herein. However, it is the responsibility of every practitioner to consult appropriate information sources to ascertain correct dosages for each clinical situation, especially for new or unfamiliar drugs and procedures. The authors, editors, publisher, and the Department of Defense cannot be held responsible for any errors found in this book.

Use of Trade or Brand Names:

Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense.

Neutral Language:

Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.

CERTAIN PARTS OF THIS PUBLICATION PERTAIN TO COPYRIGHT RESTRICTIONS.

ALL RIGHTS RESERVED.

NO COPYRIGHTED PARTS OF THIS PUBLICATION MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM OR BY ANY MEANS, ELECTRONIC OR MECHANICAL (INCLUDING PHOTOCOPY, RECORDING, OR ANY INFORMATION STORAGE AND RETRIEVAL SYSTEM), WITHOUT PERMISSION IN WRITING FROM THE PUBLISHER OR COPYRIGHT OWNER.

Published by the Office of The Surgeon General

Borden Institute

US Army Medical Department Center and School

Health Readiness Center of Excellence

Fort Sam Houston, Texas

Library of Congress Cataloging-in-Publication Data

Names: Huck, Leslie G., editor. | Burke, Ronald L., editor. | Borden Institute (U.S.), issuing body.

Title: Military veterinary services / senior editors, Colonel (Retired) Leslie G. Huck, Lieutenant Colonel Ronald L. Burke.

Description: Fort Sam Houston, Texas : The Office of The Surgeon General, Borden Institute, US Army Medical Department Center and School, Health Readiness Center of Excellence, 2019. | Series: Textbooks of military medicine | Includes bibliographical references and index.

Identifiers: LCCN 2018048940 (print) | LCCN 2018050312 (ebook) | ISBN 9780160789830 (ebook) | ISBN 9780160789847 | ISBN 9780160789854 | ISBN 9780160949388 (print)

Subjects: | MESH: Veterinary Service, Military | United States

Classification: LCC SF610 (ebook) | LCC SF610 (print) | NLM UH 653 | DDC 636.089--dc23

LC record available at https://lccn.loc.gov/2018048940

PRINTED IN THE UNITED STATES OF AMERICA

26,  25,  24,  23,  22,  21,  20,  19          5  4  3  2  1

Contents

Copyright

Contributors

Foreword by The Surgeon General

Preface

Section I: Historic Contributions

1.   Military Veterinary Support Before and After 1916

Section II: Military and Family-Owned Animal Services

2.   Military Working Dog History

3.   Military Working Dog Procurement, Veterinary Care, and Behavioral Services

4.   Medical Evacuation of the Military Working Dog

5.   Family-Owned Animal Health Services

6.   Human-Animal Bond Programs

7.   Marine Mammal Program

8.   Military Equine Programs

Section III: Food Protection and Public Health Services

9.   Food Safety and Food Defense

10.   Army Veterinary Laboratory Service

Section IV: Preventive Medicine and Public Health Services

11.   Zoonotic and Animal Disease of Military Importance

12.   Rabies and Continued Military Concerns

13.   Global Zoonotic Disease Surveillance and Control

Section V: Research, Development, and Public Health Services

14.   Laboratory Animal Medicine

15.   Veterinary Pathology

16.   Veterinary Biomedical Science

Section VI: Unconventional Missions and Other Evolving Services

17.   Veterinary Support in the Irregular Warfare Environment

Acronyms and Abbreviations

Index

Contributors

A. RICK ALLEMAN, DVM, PHD

Professor, University of Florida College of Veterinary Medicine; Service Chief, Clinical Pathology Service, 2015 Southwest 16th Avenue, Room V2-151, Gainesville, Florida 32610

DERRON A. ALVES, DVM, DACVP

Colonel, Veterinary Corps, US Army; Chief, Operations and Animal Medicine, Defense Health Agency Veterinary Service, Defense Health Headquarters, 7700 Arlington Boulevard, Falls Church, Virginia 22042

CHESSLEY R. ATCHISON, DVM, PHD

Lieutenant Colonel, Veterinary Corps, US Army, Director Sponsored Programs, Research Directorate, US Army Institute of Surgical Research, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas 78234

JANICE BAKER, DVM, MS

Colonel, Veterinary Corps, US Army; Command Veterinarian, Joint Special Operations Command, Malvesti Road, Fort Bragg, North Carolina 28313

REBECCA L. BAXTER, DVM

Captain, Veterinary Corps, US Army; Battalion Veterinary Surgeon, 98th Civil Affairs Battalion (Airborne), Building D-2815 Street, Fort Bragg, North Carolina 28310

JENNIFER BECK, DVM

Lieutenant Colonel, Veterinary Corps, US Army; Clinical Instructor, Fort Belvoir First-Year Graduate Veterinary Education Program; Fort Belvoir Veterinary Medical Center, 10015 Theote Road, Building 610, Fort Belvoir, Virginia 22060

MARY JO BECKMAN

Commander, US Navy (Retired); formerly, Communications Officer, Naval Telecommunications Command, Washington, DC; currently, Co-founder and Volunteer, Therapeutic Riding Instructor, Caisson Platoon Equine-Assisted Program, 268 Old Cropps Mill Road, Fredericksburg, Virginia 22406

DALE R. BEEBE, DVM, MS

Lieutenant Colonel, Veterinary Corps, US Army; Command Veterinarian, US Army Special Operations Command, 2929 Desert Storm Drive, Building E-3525, Fort Bragg, North Carolina 28310

RICHARD A. BELCHER

Chief Warrant Officer 3, Veterinary Corps, US Army; Chief, Food Safety, Food Defense, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

TODD MICHAEL BELL, DVM, DACVP

Major (P), Veterinary Corps, US Army, Biodefense Research Pathologist, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Room 901B, Frederick, Maryland 21702

TERRY BESCH, DVM, MS

Colonel, Veterinary Corps, US Army, (Retired); formerly, Consultant to the Army Surgeon General for Laboratory Animal Medicine, Fort Detrick, Maryland; currently, Veterinary Advisor, Nonclinical Studies, Joint Program Executive Office-Medical Countermeasure Systems, 1564 Freedman Drive, Fort Detrick, Maryland 21702

RONALD BIDDLE

Chief Warrant Officer 5, Veterinary Corps, US Army (Retired); formerly, Master Veterinary Service Technician, Veterinary Services Portfolio Department, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

CHAD C. BLACK, DVM, PHD

Major, Veterinary Corps, US Army, Chief, Drug Development Department, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910

JAMES W. BOLES, DVM, PHD

Colonel, Veterinary Corps, US Army (Retired), Associate, Payson Pet Care Veterinary Clinic, 1010 North Beeline Highway, Payson, Arizona 85541

BORIS BRGLEZ, DVM, MPH

Lieutenant Colonel, Veterinary Corps, US Army; Veterinary Plans Officer, 248th Medical Detachment Small Animal Veterinary, Fort Bragg, North Carolina 28310

NOAH L. BRISCOE, MA, OTR/L

Occupational Therapist, Warrior Transition Brigade, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 62, Bethesda, Maryland 20889

SARAH L. BRO, DVM, MPH

Lieutenant Colonel, Veterinary Corps, US Army; Executive Officer, Animal Care and Use Review Office, US Army Medical Research and Material Command, 504 Scott Street, Fort Detrick, Maryland 21702; formerly, Attending Veterinarian, Madigan Army Medical Center, Fort Lewis, Washington

JAMIE BROWN, DVM

Major, Veterinary Corps, US Army; Regimental Veterinarian, 75th Ranger Regiment, 6420 Dawson Loop, Fort Benning, Georgia 31905

WALTER BURGHARDT, DVM, PHD

Chief, Department of Defense Military Working Dog Veterinary Service, Behavioral Medicine and Military Working Dog Studies, Lieutenant Colonel Daniel E. Holland Military Working Dog Hospital, 1219 Knight Street, Joint Base San Antonio-Lackland Air Force Base, Texas 78236

ROBIN L. BURKE, DVM, MPH

Major, Veterinary Corps, US Army; Chief, Veterinary Medicine Department, US Army Medical Component-Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi, Bangkok, 10400 Thailand

RONALD L. BURKE, DVM, DRPH

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Service Division, Public Health Command-Pacific (Provisional), Box 339500, MS 115, Joint Base Lewis-McChord, Washington 98431

KAY D. BURKMAN, DVM, MPH

Lieutenant Colonel, Veterinary Corps, US Army (Retired); Subject Matter Expert, US Army Public Health Command, Veterinary Services Systems Management Program, 4270 Gorgas Circle, San Antonio, Texas 78234-2639

MYRNA CALLISON, PHD, OTR/L

Colonel, Medical Specialist Corps, US Army, Executive Officer, Occupational Health Sciences, Army Institute of Public Health, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

WINIFRED M. CAREY, MS, OTR/L

Occupational Therapist, Warrior Transition Brigade, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 62, Bethesda, Maryland 20889

TAYLOR B. CHANCE, DVM

Lieutenant Colonel, Veterinary Corps, US Army; Biodefense Research Pathologist, Pathology Division, United States Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Building 1425, Fort Detrick, Maryland 21702

JENNIFER LYNN CHAPMAN, DVM, DACVP

Lieutenant Colonel, Veterinary Corps, US Army, Director, Overseas Operations, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Room 1W43, Silver Spring, Maryland 20910

NICOLE CHEVALIER, DVM

Lieutenant Colonel, Veterinary Corps, US Army; Veterinary Capabilities Developer, Directorate of Combat and Doctrine Development, 2377 Greeley Road, Building 4011, Joint Base San Antonio-Fort Sam Houston, Texas 78234

PERRY CHUMLEY, DVM, MPH

Colonel, Veterinary Corps, US Army; Chief of Human Animal Bond Programs, Department of Defense Veterinary Service Activity, 7700 Arlington Boulevard, Falls Church, Virginia 22042

EMILY M. CORBIN, DVM

Captain, Veterinary Corps, US Army; Chief, Public Health Command District-Fort Belvoir, Fort Meade Branch Veterinary Services, 2018 Annapolis Road, Fort Meade, Maryland 20755; formerly, Chief, Fort Shafter Branch Veterinary Services, Honolulu, Hawaii

CLAIRE A. CORNELIUS, DVM, PHD

Lieutenant Colonel, Veterinary Corps, US Army; Deputy Commander/Operations Officer, 218th Medical Detachment Veterinary Service Support, 3369 Evergreen Boulevard, Joint Base Lewis-McChord, Washington 98433

LARA S. COTTE, DVM

Captain, Veterinary Corps, US Army; Chief, Clinical Veterinary Services, Navy Marine Mammal Program, 49620 Beluga Road, Room 204, San Diego, California 92152

JERRY R. COWART, DVM

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Pathology Division, Laboratory Sciences, US Army Public Health Command Region-Europe, CMR 402, Box 910, APO AE 09180

JASON R. CRAWFORD, DVM, MPH

Major, Veterinary Corps, US Army; Resident, Veterinary Pathology, Joint Pathology Center, 606 Stephen Sitter Avenue, Silver Spring, Maryland 20910

JOHN M. CRAWFORD, DVM, PhD

Major, Veterinary Corps, US Army, Director of Field Operations, Armed Forces Institute of Medical Sciences, Enteric Diseases Department, US Army Medical Directorate-AFRIMS, APO AP 96546

KAREN DEAVER

Statistician, Health Operations Directorate, Public Health Division, Defense Health Agency, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010; formerly, Senior Command Statistician, Army Public Health Center (Provisional), Aberdeen Proving Ground, Maryland

ADRIENNE T. DENHAM

Chief Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, Public Health Command District-North Europe, Rhine Ordnance Barracks, Building 2928, APO AE 09067; formerly, Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas

CHARLES DODD, DVM, PHD

Colonel, Veterinary Corps, US Army; Commander, 248th Medical Detachment (Veterinary Service Support), Building M-3019, Service Street, Fort Bragg, North Carolina 28310

ROBERT S. DOLE, DVM, MPH

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Services Division, US Army Public Health Command Region-South, 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

CHRISTINE A. EGE, DVM

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Department of Veterinary Medicine, Armed Forces Medical Research Institute of Medical Sciences, 315/6 Rajvithi, Bangkok, 10400 Thailand; formerly, Infectious Disease Analyst, National Center for Medical Intelligence, Defense Intelligence Agency, Washington, DC

JAMES SCOTT ESTEP, DVM, DACVP

Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Chief of Comparative Pathology, Triservice Research Laboratory, US Army Institute of Surgical Research, 1210 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

KELLEY L. EVANS, DVM

Major, Veterinary Corps, US Army; Staff Officer, Headquarters, Public Health Command-San Antonio, 2748 Worth Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

REBECCA I. EVANS, DVM, MPH

Lieutenant Colonel, Veterinary Corps, US Army; Doctoral Student of Epidemiology, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, 300 West Drake, 1678 Campus Delivery, Fort Collins, Colorado 80523

PAUL R. FACEMIRE, DVM

Major, Veterinary Corps, US Army; Director of Pathology, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, Maryland 20910

STEPHANIE E. FONSECA, DVM

Major, Veterinary Corps, US Army; Chief, Veterinary Specialist Branch, Army Medical Department Center & School, 2310 Hardee Road, Suite 47, Joint Base San Antonio-Fort Sam Houston, Texas 78234

DIANE R. FORBES, DVM

Veterinary Medical Officer, US Department of Agriculture, Animal and Plant Health Inspection Service, Animal Care, 2150 Centre Avenue, Building B, Mail Stop #3W11, Fort Collins, Colorado 80526; formerly, Colonel, Veterinary Corps, US Army Reserve; Chief Editor, Curriculum Development, Department of Veterinary Science, Army Medical Department Center and School, 3630 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

CHAD D. FOSTER, DVM

Lieutenant Colonel, Veterinary Corps, US Army; Director, Center for Laboratory Animal Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814; formerly, Major, Chief, Research Support Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland

JAMES T. GILES III, DVM, MS

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Advanced Animal Health Branch, US Army Medical Department Center and School, 3630 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas 78204

KEVIN M. GILL

Sergeant First Class, Veterinary Services, US Army; Senior Noncommissioned Officer, Army Public Health Center (Provisional), Veterinary Services Portfolio Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

JOSEPH A. GOLDSMITH, MS

Chief Warrant Officer 5, Veterinary Corps, US Army; Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, 2250 Taylor Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

KARIN HAMILTON, DVM, MPH

Major, Veterinary Corps, US Army Reserve; formerly, Veterinary Preventive Medicine Officer, 407th Civil Affairs Battalion, Arden Hills, MN 55112; currently, Ecosystem Health Fellow, University of Minnesota College of Veterinary Medicine, 1988 Fitch Avenue, 385 Animal Science/Veterinary Medicine, Saint Paul, Minnesota 55108

MARGERY M. HANFELT, DVM, MS

Lieutenant Colonel, Veterinary Corps, US Army; Commander, 463rd Medical Detachment Veterinary Service Support, PO Box 53571, Fort Benning, Georgia 31905

SCOTT E. HANNA, DVM, MS

Lieutenant Colonel, Veterinary Corps, US Army; Director, Department of Defense Food Analysis and Diagnostic Laboratory, 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

JOSEPH G. HARRE, DVM, MPH

Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Chief, Veterinary Resources, Keesler Clinical Research Laboratory, 301 Fisher Street, Keesler Air Force Base, Mississippi; currently, Veterinary Medical Officer, 724th Special Tactics Squadron, Building 3-1947, Pope Army Airfield, North Carolina 28308

KARYN A. HAVAS, DVM, PHD

Major, Veterinary Corps, US Army; formerly, Veterinary Epidemiologist, US Army Public Health Command, Aberdeen Proving Ground, Maryland 21010; currently, Deputy Director, Division of Integrated Biosurveillance, Armed Forces Health Surveillance Center, 11800 Tech Road, Silver Spring, Maryland 20904

CURTIS F. HAYES

Chief Warrant Officer 4, Veterinary Corps, US Army; currently, Senior Food Protection Officer, Quality Assurance Division, Joint Culinary Center of Excellence, 1831 A Avenue, Building 4225, Fort Lee, Virginia 23801; formerly, Supervisory Consumer Safety Officer, Defense Commissary Agency, Fort Lee, Virginia

TONY D. HEMPHILL

Chief Warrant Officer 4, Veterinary Corps, US Army; Consumer Safety Officer, US Department of Defense, Defense Logistics Agency-Troop Support (Philadelphia), 700 Robbins Avenue, Philadelphia, Pennsylvania 19111

PAUL HOLLIER, DVM, MPH, MPA

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Support to Stability Operations, Department of Defense Veterinary Service Activity, 7700 Arlington Boulevard, Suite 5140, Falls Church, Virginia 22042

SHELLEY P. HONNOLD, DVM, PHD

Colonel, Veterinary Corps, US Army; Director, Research Support and Chief, Pathology Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, Maryland 21702

SARA M. HOOK, OTR/L

Rehabilitation Manager, Warrior Transition Brigade, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 62, Bethesda, Maryland 20889

LESLIE G. HUCK, DVM, MS, MSS

Colonel, Veterinary Corps, US Army (Retired); formerly Chief, Department of Veterinary Science, Army Medical Department Center and School, 3630 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

JERRY P. JAAX, DVM

Colonel, Veterinary Corps, US Army (Retired); formerly, Director, Biological Arms Control Treaty Office, US Army Medical Research and Materiel Command, 810 Schreider Street, Fort Detrick, Maryland 21702-5000

NANCY K. JAAX, DVM

Colonel, Veterinary Corps, US Army (Retired); formerly, Chief, Pathology Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, Maryland 21702

KENNETH R. JAMES

Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, 218th Medical Detachment (Veterinary Service Support), Building 3070B Evergreen Avenue, Joint Base Lewis McChord, Washington 98433

RONALD R. JECH

Chief Warrant Officer 5, Veterinary Corps, US Army (Retired); Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, 2250 Taylor Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

NIKKI N. JORDAN, MPH

Senior Epidemiologist, Army Public Health Center (Provisional), Epidemiology and Disease Surveillance Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

CAROLINE M. KALINOWSKI, MS

Sanitarian, Drinking Water and Sanitation Program, Army Public Health Center (Provisional), Environmental Health Engineering Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

PATRICIA B. KENNEDY

Director of Communications and Government Relations, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

CARRIE A. KILBY, MSN

Health Analyst, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

JERROD KILLIAN, DVM, MPH

Colonel, Veterinary Corps, US Army; Commander, 264th Medical Battalion, Army Medical Department Center and School, 2745 Harney Path, Joint Base San Antonio-Fort Sam Houston, Texas 78234; formerly, Chief, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas

MICHAEL P. KILLIAN

Chief Warrant Officer 5, Veterinary Corps, US Army (Retired); formerly, Chief, Training Programs Manager, Department of Veterinary Science, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas; currently, Department of Defense Food Protection Officer, Defense Health Agency, 4270 Gorgas Circle, Building 1070, Joint Base San Antonio-Fort Sam Houston, Texas 78234

ROBIN K. KING, DVM, MSS

Colonel, Veterinary Corps, US Army; Commander, Public Health Command Region-West, Building 9783, McKinley Avenue, Joint Base Lewis-McChord, Washington 98433

JENNIFER M. KISHIMORI, DVM, PHD

Lieutenant Colonel, Veterinary Corps, US Army; Director, Force Health Protection, US Army Medical Materiel Development Activity, 1430 Veterans Drive, Fort Detrick, Maryland 21702

JAMES F. KOTERSKI, DVM, PHD

Colonel, Veterinary Corps, US Army, Director, Chemical, Biological, Radiological, and Nuclear Medical Countermeasures, Office of the Assistant Secretary of Defense, Health Affairs, Health Readiness, Policy and Oversight, 3M611, 7700 Arlington Boulevard, Falls Church, Virginia 22042

SHANNON HAROLD LACY, DVM, DACVPM, DACVP

Major (P), Veterinary Corps, US Army, Chief, Education Operations, Joint Pathology Center, 2460 Linden Lane, Building 161, Room 102, Silver Spring, Maryland 20910

MARTIN M. LAGODNA, DVM

Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Command Veterinarian, Office of the Command Surgeon, US Army Europe, Unit 29351 Box 95, APO, AE 09014-9355

CINDY A. LANDGREN, DVM, PHD

Lieutenant Colonel, Veterinary Corps, US Army, Division Chief (Acting), Warfighter Integration Division Chemical and Biological Technologies Department Defense Threat Reduction Agency, 8725 John J. Kingman Drive, Fort Belvoir, Virginia 22060

ERIC DESOMBRE LOMBARDINI, VMD, MSc, DACVPM, DACVP

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Divisions of Comparative Pathology and Veterinary Medical Research, Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok 10400, Thailand

ERIN M. LONG, DVM

Captain, Veterinary Corps, US Army; Battalion Veterinary Surgeon, 92nd Civil Affairs Battalion (Airborne), Building 2-4059, South Post Road, Fort Bragg, North Carolina 28310

SEAN M. LONNECKER, MS

Chief Warrant Officer 5, Veterinary Corps, US Army; Food Safety Officer, US Army Central Command-Surgeon, 1 Gabreski Drive, Building 1947, Shaw Air Force Base, South Carolina 29152; formerly, Food Safety Officer, Quartermaster Academy, Joint Culinary Center of Excellence-Quality Assurance Division, Fort Lee, Virginia

JOHN ANTHONY O. MANGLONA

Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, 463rd Medical Detachment (Veterinary Services Support), 6603 Welsh Avenue, Fort Benning, Georgia 31905

JUAN A. MARIN

Chief Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, US Army Public Health Command District-Fort Knox, Naval Station Great Lakes Branch, 305 West A Street, Building 43H, Naval Station Great Lakes, Illinois 60088

TERRY M. MARTINEZ, MSW, LCSW

Lieutenant Colonel, US Army (Retired); formerly, Medical Specialist Corps, Social Worker, Evans Army Community Hospital, 1650 Cochrane Circle, Fort Carson, Colorado 80913

MICHAEL E. MCCOWN, DVM, MPH

Major, Veterinary Corps, US Army; Chief of Operations, US Army Public Health Command-Europe, CMR 402, Box 172, APO, AE 09180

ANDREW L. MCGRAW, DVM

Lieutenant Colonel, Veterinary Corps, US Army; formerly, Chief, Internal Medicine and Outpatient Clinics, Department of Defense Military Working Dog Center, Joint Base San Antonio-Lackland Air Force Base, Texas; currently, Commander, 218th Medical Detachment (Veterinary Service Support), Joint Base Lewis-Mc-Chord, WA 98433

AUDREY C. MCMILLAN-COLE, DVM, MPVM

Major, Veterinary Corps, US Army; Chief of Operations, Public Health Command Region-Pacific, 1 Jarrett White Road, Building 102, Room 102, Tripler Army Medical Center, Honolulu, Hawaii 96859

THOMAS J. MCNEIL, MS

Sanitarian, Drinking Water and Environmental Sanitation Program, Army Public Health Center (Provisional), Environmental Health Engineering Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

LAURA MILLER

Master Sergeant, Veterinary Services, US Army; Canine Operations Sergeant Major, US Army Special Operations Command, Post Office Box 70660, Fort Bragg, North Carolina 28307

JAMES T. MILLS, MS, PT

Lieutenant Colonel, Medical Specialist Corps, US Army; Physical Therapy Clinical Staff Officer, Rehabilitation and Reintegration Division, 7700 Arlington Boulevard, Suite 112 Defense Health Headquarters (DHHQ), Falls Church, Virginia 22042

STACI L. MITCHELL

Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas 78234

ERIK W. MONTGOMERY

Chief Warrant Officer 2, Veterinary Corps, US Army; Food Protection Officer, US Army Public Health Command District-Fort Gordon, Jackson Branch, 2498 Knight Road, Fort Jackson, South Carolina 29207

BRIAN D. MOORE, DVM, PHD

Lieutenant Colonel, Veterinary Corps, US Army, Director, Biocontainment, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, Maryland 21702

MOLLY A. MORELLI

Director of Dog Program, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

CECILIA NAJERA, MS, OTR/L

Major, Medical Specialist Corps, US Army; Occupational Therapist, US Army 1st Medical Recruiting Battalion, 4550 Parade Field Lane, Suite 5502, Fort George G. Meade, Maryland 20755

MICHELLE NORDSTROM, MS, OTR/L

Research Occupational Therapist, Henry M. Jackson Foundation and the Center for Rehabilitation Sciences Research, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889

MEG D. OLMERT

Director of Research and Development, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

LAURA A. PACHA, MD, MPH

Lieutenant Colonel, Preventive Medicine, US Army; Manager, Disease Epidemiology Program, Army Public Health Center (Provisional), Epidemiology and Disease Surveillance Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

SANDI K. PARRIOTT, DVM, PHD

Lieutenant Colonel, Veterinary Corps, US Army; Director, Force Health Protection/Command Veterinarian Clinical Operations Section 30th Medical Brigade, Sembach, Germany, Unit 29218, APO AE 09136-9218

SARAHJOY P. PATRICK

Staff Sergeant, Veterinary Services, US Army; Training/Advisor/Counselor (TAC), A-Company, 187th Medical Battalion, 2355 Harney Path, Joint Base San Antonio-Fort Sam Houston, Texas 78234

LARRY PENCE

Command Sergeant Major, US Army, (Retired); formerly, 5th Command Sergeant Major of the Army National Guard, Washington, DC; currently, Co-founder, Caisson Platoon Equine-Assisted Program, 268 Old Cropps Mill Road, Fredericksburg, Virginia 22406

ESTHER J. PFAU, MPH

Health Analyst, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

KEITH A. PRITTS, MS

Chief Warrant Officer 4, Veterinary Corps, US Army (Retired); formerly, Deputy Director Field Operations, Food Analysis and Diagnostic Lab, US Army Public Health Command, Joint Base San Antonio-Fort Sam Houston, Texas; currently, Food Technologist, Defense Logistics Agency Troop Support, 700 Robbins Avenue, Building 6 (6B109), Philadelphia, Pennsylvania 19111

KAMALA J. RAPP-SANTOS, DVM, MPH, DACVPM

Major, Veterinary Corps, US Army; currently, Laboratory Animal Medicine Resident, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland 21702; formerly, Captain, Veterinary Corps, US Army, Clinical Veterinarian, US Navy Marine Mammal Program, San Diego, California

EILEEN RESTA, MS

Health Communication Specialist, Health Information Program, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

CYNTHIA E. RHODES, CTRS

Recreational Therapist, Inpatient Behavioral Health, Dwight D. Eisenhower Army Medical Center, Fort Gordon, 300 East Hospital Road, Augusta, Georgia 30905

QWENTINA R. RIDEOUTT

Sergeant First Class, Veterinary Services, US Army; Noncommissioned Officer in Charge, US Army Public Health Central Pacific Command-Fort Shatner Branch, 936 Duck Road, Schofield Barracks, Hawaii 96857; formerly, Writer/Instructor, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas

KATHERINE A. SAYLER

Senior Biological Scientist, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, Room V2-240, Gainesville, Florida 32610

ANN SCHIAVETTA, DVM, MS

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Research Support Division, US Army Medical Research Institute of Chemical Defense, 3100 Ricketts Point Road, Aberdeen Proving Ground, Maryland 21010; formerly, Executive Officer, Veterinary Services Portfolio, US Army Public Health Command, Aberdeen Proving Ground, Maryland

CONNIE W. SCHMITT, DVM

Major, Veterinary Corps, US Army; Veterinary Pathologist, Veterinary Services Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Building 503, Room 1505, Silver Spring, Maryland 20910

DONALD SCOTT

Chief Warrant Officer 2, Veterinary Corps, US Army; Food Protection Officer, US Army Public Health Command Region-Central (Provisional), 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

HAROLD E. SHERIDAN, JR

Senior Quality Assurance Specialist, US Army Public Health Command District-Fort Bragg, 1938 Gilbert Street, Norfolk Naval Station, Norfolk, Virginia 23511

CHERYL D. SOFALY, DVM, MS

Colonel, Veterinary Corps, US Army; Director, Department of Defense Military Working Dog Veterinary Service, 1219 Knight Street, Joint Base San Antonio-Lackland Air Force Base, Texas 78236

MATTHEW G. ST LAURENT, MS, OTR/L

Lieutenant Colonel, Medical Service Corps, US Army; Assistant Chief of Occupational Therapy, Department of Orthopedics and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889

BRETT J. TAYLOR, DVM, MPH

Lieutenant Colonel, Veterinary Corps, US Army; Instructor, Army Medical Department Center & School, 2250 Stanley Road, Building 2841, Room 1108, Joint Base San Antonio-Fort Sam Houston, Texas 78234

KELLY G. VEST, DVM, MPH, DRPH

Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Assistant Director, Global Emerging Infections Surveillance and Response System, Silver Spring, Maryland 20910; currently, Deputy Chief of Staff, Armed Forces Health Surveillance Center, 11800 Tech Road, Silver Spring, Maryland 20904

NANCY A. VINCENT-JOHNSON, DVM, MS

Lieutenant Colonel (Retired); formerly, US Army Veterinary Corps; currently, General Schedule Veterinary Medical Officer, 10015 Theote Road, Building 610, Fort Belvoir Veterinary Center, Fort Belvoir, Virginia 22060

WILLIAM D. WARREN

Chief Warrant Officer 4, Veterinary Corps, US Army; Chief, Operational Rations, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

NOLAN A. WATSON, MLA

Army Medical Department Regimental Historian; currently, AMEDD Center of History and Heritage, Medical Command, 2748 Worth Road, Suite 28, Joint Base San Antonio-Fort Sam Houston, Texas 78234; formerly, Branch Historian, Military Police Corps, US Army Military Police School, Fort Leonard Wood, Missouri

MATT WATTERSON, MS

Chief Warrant Officer 4, Veterinary Corps, US Army; Food Protection Officer, 1st Medical Brigade, Clinical Operations, Building 33026, 72nd and Support Avenue, Fort Hood, Texas 76544

JAMES E. WESTOVER, JR, BBM

Food Defense Officer, US Army Public Health Command-Central, 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

DEBORAH L. WHITMER, DVM, PHD

Colonel, Veterinary Corps, US Army (Retired); Associate, Payson Pet Care Veterinary Clinic, 1010 North Beeline Highway, Payson, Arizona 85541; formerly, Commander, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland, 20910

ARTHUR F. YEAGER, MSOT

Lieutenant Colonel, Medical Specialist Corps, US Army; Chief of Occupational Therapy, Rehabilitative Services, Reynolds Army Community Hospital, 4301 Wilson Street, Fort Sill, Oklahoma 73503

SAMUEL YINGST, DVM, PHD

Lieutenant Colonel, Veterinary Corps, US Army; Chief, Epidemiology and Disease Surveillance, US Army Medical Component-Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi, Bangkok, 10400 Thailand

RICK A. YOUNT, MS, LSW

Executive Director, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

Foreword

Although the US Army Veterinary Corps has been an integral component of the US Army Medical Department since June 3, 1916, the history and contributions of veterinary support to military operations extends back to our country’s inception. I would like to congratulate every author for contributing to the first textbook in this series of Textbooks of Military Medicine to capture the unique aspects of military veterinary service support. In my responsibility to provide veterinary services throughout the Department of Defense, it gives me great pride to sponsor this distinctive textbook, one that elucidates the significant impact military veterinary services continue to have on the health of our Army, our Department of Defense, and our Nation.

This textbook highlights the overlapping mission pillars of the veterinary services—food protection; animal health; veterinary public health; and support to research, development, training and education—all of which contribute daily to the overall readiness of our Army and the Department of Defense. Through performance of these missions, the Army Veterinary Service supports the following four strategic themes and ensures that Army Medicine will remain a vibrant organization, contributing to our Nation’s security:

- Readiness and Health: Army Veterinary Service personnel and the services they provide maintain, restore, and improve the deployability, resiliency, and performance of service members through a variety of programs. They prevent zoonotic diseases such as rabies; provide food safety and defense services; and support research and development that delivers the latest material solutions to save the lives of Service Members and Department of Defense Civilians in addition to enhancing and maintaining their health in all operational environments.

- Healthcare Delivery: Our veterinary service is entrusted with diverse animal health missions that cross service branches and including military working dog care for all services, the US Navy marine mammal program, and a variety of working equine programs. Our animal health programs provide a continuum of care from the battlefield, through referral centers, to rehabilitative care at the world-renowned Lieutenant Colonel Daniel E. Holland Military Working Dog Hospital.

- Force Development: Army Veterinary Service personnel currently serve in both Active and Reserve Component veterinary detachments as well as Special Operation units of multiple services, providing the highest level of military veterinary support and expertise. These ready and deployable expeditionary veterinary assets serve as the center of gravity for the Army Veterinary Services.

- Taking Care of Ourselves, Soldiers for Life, & DA Civilians: Army veterinary service personnel ensure the safety of food to optimize the health and resilience of Families and retirees. They also support the human–animal bond and provide high quality veterinary care for Family-owned animals.

In short, the mission of the US Army Veterinary Service is to provide responsive and reliable military veterinary services; improve readiness and resilience positively and proactively; and advance the overall health of humans, animals, and the environment. As we look to the future operational environment, our Veterinary Service will continue to maintain, restore, and improve readiness; save lives; and advance wellness of all our partners while strengthening the health of our Nation through the continued provision of the exemplary veterinary services represented in this textbook.

One Team, One Purpose … conserving the fighting strength since 1775!

Lieutenant General Nadja Y. West, MD
The Surgeon General
US Army

Washington, DC
February 2019

Preface

As the 25th Chief of the US Army Veterinary Corps, I would like to dedicate this textbook to all those who have preceded me, all those who are currently serving, as well as all those who will serve in the future, making continued excellence in veterinary services possible throughout the Department of Defense. As the Surgeon General mentioned, this is the first textbook that addresses the practice of military veterinary services and support by the Veterinary Corps and the Veterinary Service (eg, food protection, animal health, and research and development).

The US Army Veterinary Corps is comprised of our officers, both veterinarians and warrants, and is represented by the caduceus with a black V. The US Army Veterinary Service is comprised of several outstanding groups of personnel: our officers, previously mentioned; our enlisted soldiers, both animal care specialists and veterinary food inspection specialists; and our civilians, who span the professional spectrum from administrators to veterinarians. The Veterinary Service is represented by a distinctive insignia; its banner foundation, which reads “Knowledge and Integrity,” is crowned with a unicorn, symbolizing the uniqueness of our veterinary practice.

On June 3, 1916, the National Defense Authorization Act of 1916 created the US Army Veterinary Corps and placed all its personnel with the Army Medical department, making us an early model for the more modern health initiative. Prior to the 1916 act, all Army veterinary personnel had only served with the Cavalry, Artillery, or Quartermaster Corps. Our unique Department of Defense mission is represented by the green cross, which distinguishes us from the five other Army Medical Department corps serving under the red cross. (Veterinary personnel are not considered “protected” personnel under the Geneva Conventions because veterinary forces were the only armed medical personnel on the battlefield during World War I.)

Our first chapter is a concise history of our profession, which has transformed over time to support the changing needs of our military. Our primary animal care mission evolved from horses to dogs and is coupled with our constant mission of food protection and our ever-expanding support of research, development, testing, and evaluation. Our subsequent chapters capture the wide scope of practice provided by our specialists in veterinary preventive medicine, laboratory animal medicine, veterinary pathology, clinical specialties, and PhD research. Our food protection programs fall within the field of veterinary preventive medicine and encompass food safety (unintentional food contamination) and the emerging field of food defense (defense against intentional food contamination). Veterinary preventive medicine also supports irregular operations, including our veterinary support of stability operations. Our animal health programs provide healthcare not only for military working dogs and other government-owned animals, but also for family-owned animals. This broad spectrum of care offers critical support to the Army Family Covenant and to the Surgeon General’s initiatives concerning the health of the military service members and civilians living on our supported installations and the well-being of all our global partners.

I am particularly pleased with the timing of this textbook’s publication, first printed at a time when the long-lasting combat operations in Iraq and Afghanistan seem to be coming to an end. This book recognizes the Veterinary Service’s significant contributions and exemplary service since the horrific acts of September 11, 2001. Even as current combat operations may diminish, the Veterinary Corps and Veterinary Service will continue to make significant and long-lasting contributions to any future operations vital to our nation’s security and health.

Thank you to our authors for taking time to share their expertise and knowledge about the truly unique–and, sometimes, less understood–practice of veterinary medicine.

John L. Poppe
Brigadier General, US Army
Chief, Veterinary Corps

Fort Sam Houston, Texas
December 2015

Section I: Historic Contributions

The Centennial Time Capsule plaque, marking the 100-year anniversary of the Army Veterinary Corps, is displayed outside the US Army Medical Department Museum at Joint Base San Antonio-Ft Sam Houston, Texas.

Photograph: Courtesy of Nolan A. Watson.

Chapter 1

MILITARY VETERINARY SUPPORT BEFORE AND AFTER 1916

LESLIE G. HUCK, DVM, MS, MSS*; DIANE R. FORBES, DVM†; NOLAN A. WATSON, MLA‡; JERRY P. JAAX, DVM§; NANCY K. JAAX, DVM¥; SHELLEY P. HONNOLD, DVM, PHD¶; AND DERRON A. ALVES, DVM**

INTRODUCTION

VETERINARY SUPPORT OF THE US MILITARY PRIOR TO JUNE 3, 1916

American Revolutionary War to Pre-Civil War

Civil War to Spanish-American War

Spanish-American War to Pre-World War I

VETERINARY SUPPORT OF THE US MILITARY JUNE 3, 1916, TO PRESENT

World War I to Pre-World War II

World War II to Pre-Korean War

Korean War and the Early Years of the Cold War

Vietnam War

Pre-Persian Gulf War

Persian Gulf War

Post-Persian Gulf War to Present

VETERINARY SERVICE’S RECENT AND SIGNIFICANT MILITARY AND PUBLIC CONTRIBUTIONS

A Broad Review of Current Veterinary Service’s Military Missions and Research Efforts

A More Specific Review of Veterinary Service’s Recent Research Efforts

The Veterinary Service’s Impact Beyond Department of Defense Missions

SUMMARY

*Colonel, Veterinary Corps, US Army (Retired); formerly Chief, Department of Veterinary Science, Army Medical Department Center and School, 3630 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

†Veterinary Medical Officer, US Department of Agriculture, Animal and Plant Health Inspection Service, Animal Care, 2150 Centre Avenue, Building B, Mail Stop #3W11, Fort Collins, Colorado 80526; formerly, Colonel, Veterinary Corps, US Army Reserve; Chief Editor, Curriculum Development, Department of Veterinary Science, Army Medical Department Center and School, 3630 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas

‡Army Medical Department Regimental Historian; currently, AMEDD Center of History and Heritage, Medical Command, 2748 Worth Road, Suite 28, Joint Base San Antonio-Fort Sam Houston, Texas 78234; formerly, Branch Historian, Military Police Corps, US Army Military Police School, Fort Leonard Wood, Missouri

§Colonel, Veterinary Corps, US Army (Retired); formerly, Director, Biological Arms Control Treaty Office, US Army Medical Research and Materiel Command, 810 Schreider Street, Fort Detrick, Maryland 21702-5000

¥Colonel, Veterinary Corps, US Army (Retired); formerly, Chief, Pathology Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, Maryland 21702

¶Colonel, Veterinary Corps, US Army; Director, Research Support and Chief, Pathology Division, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, Maryland 21702

**Colonel, Veterinary Corps, US Army; Chief, Operations and Animal Medicine, Defense Health Agency Veterinary Service, Defense Health Headquarters, 7700 Arlington Boulevard, Falls Church, Virginia 22042

INTRODUCTION

The history of US military veterinary service parallels the development of the veterinary profession and the emergence of the American Army as a profession. The US Army’s creation on June 14, 1775, precedes what many consider the official birthdate of the United States of America (the signing of the Declaration of Independence) in July 1776. At the time of the Revolutionary War, veterinary medical roles were limited to “animal nurses” with no formal training.1(p1) In 1776, the newly declared United States of America had considerable livestock and animal care needs but no veterinary school.

The world’s first veterinary school, the Royal Veterinary School of Lyon, had started in France in 1761, just 15 years prior. However, French horseshoers (farriers) wanted to continue treating lame and sick animals and opposed more veterinary schools. Nonetheless, another royal veterinary school was founded in 1765 in Paris.2(p36) England’s first veterinary college, the Veterinary College of London, began training students in 1791 and served as the model for future training in America in 1863.2(p38) (For more information about the growth of veterinary colleges, especially those educational institutions relevant to the field of veterinary pathology, see Chapter 15, Veterinary Pathology).

VETERINARY SUPPORT OF THE US MILITARY PRIOR TO JUNE 3, 1916

American Revolutionary War to Pre-Civil War

The origin of the Army Veterinary Service can be traced to a letter from General George Washington, dated December 16, 1776, which mentions the inclusion of farriers in the “regiment of horses.”3(p111),4 In 1792, Congress provided for two regiments of dragoons, along with farriers to care for the animals.1(p1) More specifically, Congress requested one farrier for each of four troops of dragoons.1(p1) The Army, without having a ready pool of trained veterinarians, expected horseshoers and blacksmiths to also perform the work of animal doctors.2(p118) The Army’s lack of properly educated veterinarians, proper horse management, and veterinary preventive medicine led to high loss rates and the spread of costly epizootics.2(p124)

Veterinary medicine in America was largely neglected by both the civilian and military communities up to the Civil War. Still, there are some historic documents such as journals that mention animal care in the US military prior to the Civil War (Figure 1-1) as well as some early records about military farrier contributions. For example, the horse (later, field) artillery, which needed more mobility, had farriers in service during the War of 1812. After this war ended and the Army was once again dispersed, farriers were removed from the military until 1833, when 10 farriers were assigned to a cavalry regiment. Ten more farriers were assigned to another regiment in 1836.1(p1)

An 1834 to 1835 Inspector General report with little documentation also referenced the Army “veterinary surgeon,” but, at that time, “veterinary surgeon” and “farrier” were most probably interchangeable names for the same profession.1(p1) The report questioned the duty competency of these individuals and if they were properly trained.1(p1) At that time, although Army regulations required inspectors to watch “veterinarians” do their duties, it is questionable whether the Army actually had any trained active duty veterinarians in service. These regulations could have been referring to farriers or temporarily hired civilian veterinarians whose services were paid as needed out of unit funds.2(p119)

During the Mexican War and various Indian War campaigns from 1846 up until 1848, farriers—with no noted improvement in training or competency—were still considered “veterinary surgeons.”1(p1) Military units had no set standards for the number of farriers needed to support a designated number of horses. As a result, horses were often overworked and underfed. Showing forethought and an elevation of the profession in general, Congress authorized the hiring of bona fide civilian “veterinary surgeons” for long-term Army service in 1848.2(p119)

Figure 1-1. Although veterinary medicine struggled for early recognition, farriers were already recognized as part of the Army, as shown in this detail from An Act, Establishing Rules and Articles for the Government of the Armies of the United States (1812), page 79.
Reproduced from Google Books. https://books.google.com/books?id=uns0AQAAMAAJ&printsec=frontcover&dq=An+Act,+Establishing+Rules+and+Articles+for+the+Government+of+the+Armies+of+the+United+States&hl=en&sa=X&ved=0ahUKEwjkvezGrdrWAhVLjlQKHS_
eDdYQ6AEIMTAC#v=onepage&q=An%20Act%2C%20Establishing%20Rules%20and%20Articles%20for%20the%20Government%20of%20the%20Armies%20of%20the%20United%20States&f=false. Accessed October 23, 2017.

Congress’s action and naming convention mirrored a growing sense of change within the country. Previously, the United States was generally indifferent to the diseases of animals. Before the founding of US veterinary schools, the majority of veterinary care in the United States was based on what people could learn from books. Very few school-trained veterinarians were available, and veterinary quacks were abundant.2(p132) Congress made liberal appropriations for veterinary education starting in the 1840s, but the states, in general, misapplied the funds. In other words, it wasn’t the federal government that failed to protect the livestock industry of the time (ie, by failing to provide nationwide standards and inspection capabilities), but rather it was the fault of the state governments, as they believed veterinarians impeded the free trade of diseased animals and unwholesome animal products, which would negatively impact their economies.2(p134)

As mentioned earlier in this chapter, the US veterinary education system started much later than European systems. In the 1840s, after veterinary medical textbooks became available, veterinary lectures started in medical colleges. Since many physicians at that time also treated animals, it made sense that animal medicine lectures were held at medical colleges. During this time, most of the American public also had little understanding of what an educated veterinarian could do, so a college diploma didn’t mean much until the 1870s. Even then, one college-educated veterinarian urged graduates of his school to obtain the doctor of medicine degree, so they would have a better recognized professional standing in the community.2(p173)

By the 1860s, some American colleges and universities taught veterinary science, but instruction at these schools was usually not given by a veterinarian, unless the animal doctor had received a veterinary education in Europe. One of the first veterinary lecturers was Robert Jennings Sr, a self-educated veterinarian and successful practitioner, who gave presentations in Philadelphia and later worked toward chartering a veterinary college.2(139) Slowly, as more American veterinary students studied in US medical institutions, US courses and lectures evolved into full degrees of veterinary medicine. This evolution in US veterinary medicine soon led to improved US military veterinary services.

George B. McClellan (famously known as the “Commander of the Army of the Potomac” during the Civil War) recognized the benefits and the need for having well-trained veterinarians long before the majority of his senior leaders and military decision makers. In 1856, McClellan was sent to Europe as a captain to study the European armies and observe the Crimean War. He reported that the US Army could benefit by following the veterinary systems he observed at the Berlin and Vienna veterinary schools. McClellan also recommended the Army create a veterinary school as well as a farrier school, clearly separating the schooling and duties of the veterinarian from those of the farrier in his report.2(p123)

McClellan further stated that students for the veterinary school should be selected from the best recruits and recommended both the veterinarian and farrier receive extra duty pay. He proposed one veterinary sergeant and one farrier for each cavalry company, and each regimental staff should have a chief veterinarian with the rank of sergeant major or commissioned officer.[5]

Although the Army didn’t create a veterinary school as McClellan recommended, (the military didn’t have a large standing force or the budget for the desired school), it can be inferred from McClellan’s report that he realized veterinarians needed specific skills that farriers could not adequately provide. McClellan’s concern for the Army and its horses was also made evident by his invention of a light but sturdy saddle design. Named the “McClellan Saddle,” it would be used in various versions by the Army from 1859 to present.[6] (For more information about the evolution of veterinary medicine schooling and the collaboration of human and animal doctors during the emergence of US veterinary medicine, see Chapter 15, Veterinary Pathology.)

Civil War to Spanish-American War

At the start of the Civil War (April 1861), two dragoon, one mounted infantry, and two cavalry regiments were composed of 10 companies for each regiment, with one farrier assigned per company. Federal forces had few university-qualified veterinarians in service and, consequently, experienced a high death rate in horses.7(p249)

However, General Orders 16, May 4, 1861, authorized a veterinary sergeant to each battalion in the cavalry regiments, presumably to supervise the farriers and improve the standard of care for horses.2(p147) Early in the war, the Army also recognized the need for veterinarians and tried to improve the situation with increasing pay.1(p2),7(p249) Cavalry soldiers with the rank of sergeant earned 17 dollars per month, which was more pay than infantry soldiers received.2(p147)

An important change regarding military veterinary medical history occurred when the Enrollment Act of March 3, 1863, was passed. From this act, General Orders 73, March 24, 1863, stipulated that each federal cavalry regiment receive a veterinary surgeon with the rank of regimental sergeant major, and pay was set at 75 dollars per month.8(p3) Each of the regiments’ 12 companies was to have two farriers or blacksmiths.8(p2) In addition, after April 29, 1863, the volunteer cavalry regiments were each to have a veterinary surgeon, like the six regular (not raised for the war) cavalry regiments. The number of volunteer regiments has been estimated to be between 232 to 272 regiments, which indicates a larger number of veterinarians served in the Union than previously thought. Another dozen or so veterinarians worked for the Quartermaster in various roles such as inspecting animals8(p3) (Figure 1-2).

It is important to note that these veterinary surgeons were not considered commissioned or noncommissioned officers; they were perceived as civilians with the equivalency of sergeant major rank. Therefore, their names usually do not appear on any official military rosters.8(p3) General Orders 259, dated August 1, 1863, provided selection and appointment criteria for veterinary surgeons to be assigned to six regular cavalry regiments.2(p152) However, no type of skill qualification standard was required:

Veterinary surgeons of Cavalry under the Act of March 3rd, 1863, will be selected by the Chief of the Cavalry Bureau upon the nomination of the regimental commanders. These nominations will be founded upon the recommendation of the candidate by a regimental board of officers to consist of the three officers present next in rank to the commander of the regiment. The names of the candidates so recommended and nominated to the Chief of the Bureau of Cavalry will be submitted by him to the Secretary of War for appointment. A record of the appointments so made shall be kept in the Adjutant General’s office.2(p152)

Despite improvements, a quartermaster report (QMG Orders 21, 1863) mentioned the waste of horses during the war and the cost to taxpayers.1(p2),2(p149) The report blames improper knowledge of horses and mules and their uses, leading to the animals’ quick and needless demise. At the beginning of the Civil War, the Union and Confederate states had about 3.4 million and 1.7 million horses, respectively.[9] The border states of Missouri and Kentucky had another 800,000 horses.[9] All states combined had approximately 1.1 million mules.[9] The North acquired many horses from the South by seizing them while occupying large areas of territory.[9] As the war continued, severe grain and hay shortages developed. Many horses died of disease (glanders was the most prevalent) or from exhaustion. Also, a considerable number were killed in battle.[9] The general lack of organization and support from senior leadership contributed to the loss of more than 1.2 million horses and mules.[10] Thus, as an estimated 620,000 soldiers died during the Civil War, almost twice as many horses and mules were lost.[11] (For more information about equine history and the use of horses in the US military, see Chapter 8, Military Equine Programs.)

Figure 1-2. “George F. Parry Standing Portrait.” George F. Parry (1838–1886), veterinary surgeon for the 7th Pennsylvania Cavalry during the Civil War. Parry graduated from the Boston Veterinary Institute in 1859. His wartime diaries mention some of the problems faced by veterinarians in service at the time, including poor animal nutrition and glanders in horses. Parry is shown in an approximation of a uniform. While veterinarians were not “officially” in the Army at the time and did not have a uniform, Parry did have the Union Kepi (head gear).
Reproduced with permission from the Historical Society of Pennsylvania, Philadelphia, Pennsylvania; George F. Parry Family Volumes [3694] (DAMS #94-3).

In 1863, leading civilian and military veterinarians met in New York City to better organize and improve professional veterinary service, partly because of the costly losses of animals that the Union was experiencing and partly because of the lack of standardized veterinary hiring and medicine practices in the Army. Conference attendees chartered the US Veterinary Medical Association in 1863, which became the American Veterinary Medical Association (AVMA) in 1898.2(p172) A product of the time of its formation, the US Veterinary Medical Association’s name signifies preservation of the Union while the American Veterinary Medical Association (formed during the Spanish-American War) denotes consolidated patriotism. The AVMA became a strong proponent for military veterinary medicine and the creation of the Army Veterinary Corps, as well as initiated setting standards for the veterinary profession within the United States.

After the Civil War ended, the Army decreased in size but also established four new cavalry regiments in 1866. Each of these regiments was given two veterinary surgeons; the more senior surgeon received $100 per month while the assistant surgeon received $75 per month.1(p2),2(p155)

Despite some progress in the profession and recognition within the Army, there were still some contemporary military and governmental setbacks that deterred the growth of veterinary medicine. Although there is no evidence of glanders being a significant problem in America before the Civil War, it became a serious problem during the war and continued for almost a half century afterwards.2(p164) At the end of the Civil War, the Army sold glanders-infected horses to civilians, which helped spread the deadly zoonotic disease all over the United States.

When glanders became problematic, there was also active resistance to hiring qualified veterinarians. Trained veterinarians realized that glanders could not be adequately treated and would euthanize infected horses. Nontrained veterinarians would treat infected horses with ineffective methods, which only kept the diseased horses alive longer and spread the disease to others. This difference of opinions regarding glanders treatment methods indicates that, at times, the establishment resisted proper preventive medicine based on limited knowledge and a short-term focus. In the long run, failure to embrace proper preventive care was more costly (personal knowledge, Colonel Timothy H. Stevenson, US Army, Assistant Veterinary Corps Chief, from presentation by Thomas Frezza, formerly of the National Museum of Civil War Medicine, Washington, DC, April 30, 2016).

Similarly, not recognizing the need and importance of hiring qualified veterinarians, in 1868, Congress hired a farmer, not a veterinarian, to treat the Army’s horses specifically for lameness by trimming the hooves in a special way.2(p158) The farmer received $10,000 for his services.2(p158) Per War Department General Orders 84, August 20, 1873, the Quartermaster furnished horse medicines and instruments to the mounted artillery with the intent of these supplies being used by nonveterinarians.2(p159) In 1875, another general order directed horse medicines and dressings be issued quarterly to artillery and cavalry company commanders, not qualified veterinarians.2(p159)

Although the conditions started improving for Army veterinarians from 1861 to 1879, they were still considered civilian employees for the Army in 1866, which prevented them from receiving allowances and retirement privileges. In addition, Army veterinarians had no authority over enlisted men, even the ones that were supposed to assist them.2(p166)

However, when qualified veterinarians were appointed into the Army—such as Samuel G. Going (educated at the Royal Veterinary College in Edinburgh)—they could achieve excellent results. In 1875, shortly after arriving at Benicia Barracks, California, Going recognized and quickly eradicated a serious outbreak of glanders.[2] He drafted a bill to be presented to Congress to show the value of veterinary service and to give Army veterinarians commissioned rank, but the bill didn’t materialize, and Going died during the Nez Perce War (1877).2(pp160-161)

Many veterinarians were on the front lines of the Army’s wars. One of Lieutenant Colonel George A. Custer’s 7th Cavalry Regiment veterinary surgeons, Dr John Honsinger, was killed by Sioux Indians on August 4, 1873.2(p232) After the Battle of Little Big Horn on June 25, 1876, one of the few, (and only officially accepted) Army survivors, was Comanche, the horse ridden by Captain Myles Keogh, who was killed in the battle. Suffering from at least seven gunshot wounds, Comanche became the most famous recipient of veterinary care in the Army before the world wars; he was saved by the efforts of the veterinary surgeon, Dr Charles A. Stein.7(pp258-259) As veterinarians became more proficient and performed successful surgeries (as in Dr Stein’s case), they started being recognized more by the US Army, as well as by the US public. For example, on May 31, 1877, General Orders 52 established examinations and a board of officers to nominate veterinary surgeons; unfortunately, the orders didn’t spell out what were considered minimum standards for qualification.2(p159) Several private US institutions were training veterinarians, but academic content and standards were not consistent. The 1870 national census noted that there were 1,166 veterinarians.[12] It also recorded that most of the “practitioners” had no formal education or were educated in other countries[12] (Figure 1-3).

Figure 1-3. An equine anatomy course possibly at the University of Georgia’s first version of their School of Veterinary Medicine, circa 1915. Veterinary medicine advanced as several universities in America began instruction in the latter part of the 19th century. Similarly, the requirement for Army veterinarians to be graduates of formal study improved their standing and perceptions of skill in animal care.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Thus, during this time, many positions were filled with farriers or veterinary quacks who the selecting official liked. The poor medical skills of the charlatan “veterinary surgeons” hindered the process of obtaining genuinely qualified veterinarians. Senior Army officials viewed them and their inadequate animal care as a good reason to oppose giving veterinarians a commissioned rank in the Army.2(p160)

An important milestone towards the advancement of US military veterinary service took place with an Act of Congress and subsequent Army General Orders of 1879, specifically War Department General Orders 36, March 27, 1879.2(p162) In these orders, the Army finally listed qualifications in the veterinarian hiring process, stipulating that veterinary sergeants were required to be graduates of reputable veterinary colleges.2(p162) However, the previously appointed “veterinary surgeons” who were originally blacksmiths, farriers, or self-declared veterinarians were allowed to stay in their positions; it took another 32 years before all positions were filled with veterinary college graduates.2(p194)

By 1881, six cavalry regiments were authorized one veterinarian, and four cavalry regiments were authorized two veterinarians.2(p195) In addition, the Quartermaster Department had one inspecting veterinary surgeon (for government animal purchases).2(p195) These veterinary positions totaled 15; nine positions were filled by veterinary college graduates, four positions were filled by nongraduates, and two positions were authorized but unfilled.2(p195)

It took time to leverage the potential usefulness of US veterinarians on the civilian side, too. Even though the US government started recognizing the importance of animal diseases in 1843 (eg, contagious pleuropneumonia and Texas fever in cattle, glanders in horses, and hog cholera in swine), the government did not take action until 1884, when it finally founded the Bureau of Animal Industry, which was to be directed by a veterinarian, under the Department of Agriculture.2(p135)

Numerous attempts were made in the 1880s and 1890s to get bills passed in Congress to establish a Veterinary Corps or Service, many supported by the AVMA. For example, General Philip Sheridan (Commanding General of the Army of the United States) wanted to improve veterinary service in the US Army and was working on a proposal for creating a Veterinary Corps in 1887 to 1888, but he died before introducing his bill to Congress.2(pp221-222) General Orders 19, February 20, 1889, spelled out the veterinary surgeon’s responsibilities to improve veterinary service by giving them a larger role to provide veterinary treatment and practice preventive veterinary medicine, as well as set conditions for providing a veterinary hospital building.[13] All of these roles were strictly equine-related, however, and generally, veterinarians weren’t utilized by purchasing boards or consulted about nutrition. MJ Treacy, a veterinarian of the 8th Cavalry, wrote about this subject in 1898, and he was the first recorded to propose that Army veterinarians should perform food inspection. Unfortunately, he died of yellow fever in Cuba July 14, 1899, and his visionary efforts were delayed.2(pp232-233)

Spanish-American War to Pre-World War I

At the start of the Spanish American War in 1898, a veterinary sergeant was authorized for each field artillery battery, and 14 veterinary surgeons were authorized for 10 cavalry regiments.1(p3) Although the Army veterinary surgeons’ skills were generally improved at the beginning of the Spanish-American War, the veterinary services they initially provided were not substantially better overall than what were provided during the Civil War. The potential roles of veterinary services at that time were hindered by actions of the Quartermaster Department, which purchased many horses unfit for military service at twice their market value. These costly purchases resulted in appalling animal losses that captured the national press’ attention.2(p253) After the Quartermaster Department’s procurement problems, some leaders recognized the need for qualified veterinarians to be involved in the purchase process; however, not everyone agreed. Even as late as 1900, during a senate debate concerning improving Army veterinarian benefits, a senator argued that the cavalry captain of the troop had more experience and ability to determine a horse’s condition than young veterinarians coming out of college.2(p240)

When veterinarians were finally utilized in greater numbers on purchasing tours in the western United States, the quality of the animals procured greatly improved. Many of the horses staged at Tampa, Florida, for the Spanish-American War were deemed unfit by the veterinarians and were not shipped to the battle sites. Unlike the situation at the end of the Civil War, the Bureau of Animal Industry quarantined the animals at the Tampa camps, preventing the spread of disease to other parts of the United States. Also, the Florida courts banned the horses from being shipped out of the staging camps.2(p253) Veterinarians, federal agencies, and states were beginning to understand the importance of herd health and enforcing zoonotic disease control.

Other advances and progress in the United States brought more changes to the Army, many of which affected military veterinarians. The Army Reorganization Act of 1901 provided that all veterinarians in cavalry and artillery regiments received the pay and allowances of a second lieutenant with a salary of $1,500 per year.2(p342) The number of these positions was 42.2(p238) Although still viewed as civilian employees, Army veterinarians were now given quasi-commissioned officer status2(p342) (Figure 1-4). In addition to better pay, Army veterinarians now wore a uniform and were entitled a salute from enlisted personnel.2(p342) Even though other Army officers had a better impression of these uniformed veterinarians, Army veterinarians were still handicapped by not falling under the medical department and not having authority, which was only granted by their immediate commanding officer.2(p341)

With somewhat of an increase in status, veterinary officers’ responsibilities expanded. For example, they now were usually able to oversee the work of their horseshoer and farrier. Veterinarians also were appointed as instructors at the Army training school for farriers and blacksmiths at Ft Riley; one was an assistant instructor in hippology at the Infantry and Cavalry School at Ft Leavenworth.2(p341) In garrison, veterinarians assisted with hippology instruction to junior officers. They were also selected to provide age determination and soundness exams for horses being procured by the purchase boards. In the field, they accompanied their commands to care for disabled horses.2(pp341-342)

Figure 1-4. Early veterinarian insignia denoting the branch of assignment, crossed sabers (cavalry) or crossed cannons (artillery), number of the regiment at the peak, and the winged horseshoe. The horseshoe provides not only the symbol and shape of the horse hoof, but also a stylized “V” for veterinarian.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

To supplement Army veterinary officers, the Quartermaster’s Department continued to hire contract veterinarians as civilians for $100 per month.2(p248) There were over 60 civilian veterinarians in the Philippines during the Spanish-American War (1898) and the Philippine-American War (1899 to 1902).1(p3),2(pp345-346) These veterinarians had no promotion potential, retirement, or disability benefits.2(p345) Beginning in 1904, these veterinarians had to pass an entrance examination before being appointed, and eventually, these veterinarians and those of the mounted services (Cavalry and Artillery) would all be commissioned.2 (p346)

As the 20th century approached, the military’s veterinary service mission expanded to include food inspection. This new mission was in part connected to the “Progressive Era” of thinking in America. Because of discoveries and the recent acceptance of the germ theory of disease, scientific approaches to problems were recognized more. A congressional act approved in 1884 established the Bureau of Animal Industry (BAI), a new department under the Department of Agriculture, and required a veterinary surgeon to be the department chief. The BAI was to determine the causes of costly livestock diseases such as bovine pleuropneumonia and tuberculosis, establish quarantine procedures for infected animals, develop prevention strategies and cures, and suppress export of diseased animals.

With a thriving agriculture industry, the US wanted to be able to export livestock and meat products. In 1890, another act of Congress required the Secretary of Agriculture, via the BAI, to inspect meats for exportation and to prevent adulterated foods and beverages from being imported into the United States. A year later, acts were passed to provide for the safe and humane export of cattle to foreign countries and inspection of live cattle, hogs, and carcasses for interstate commerce. However, it was not until 1896 that adequate funds were appropriated for the BAI to properly accomplish all these missions.[14] Although the federal laws’ and BAI’s focus was to reduce diseased animals and prevent their products from entering the market, at this time, little legislation was written to properly enforce sanitation requirements, grade, condition, and quality of meats.

Just a few years later, at the end of the 19th century, the Spanish-American War’s “Embalmed Beef Scandal” played another important part in the establishment of the Army’s veterinary food inspection service. Soldiers in Army camps in the southern United States, Cuba, and Puerto Rico alleged their beef rations were preserved with harmful chemicals, rendering the meat unpalatable and making them sick. The US press ran numerous scurrilous stories featuring the claims (Figure 1-5).

President William McKinley appointed a commission, chaired by General Grenville Dodge, to investigate the War Department’s conduct during the war with Spain, partially based on various Spanish-American War veterans’ allegations, to include embalmed beef used for subsistence. The Dodge Commission Report determined the refrigerated and canned beef was generally wholesome and met the quality standards of the day. The commission found no evidence of chemically tainted beef but indicated that the beef occasionally may not have been optimally stored, issued, and prepared. The commission also noted that, over time, refrigerated beef can have surface mold growth, but with trimming, the meat underneath is still satisfactory.[15] Although these findings may have been scientifically accurate, witnesses seeing the mold-covered refrigerated beef concluded the food was aesthetically unacceptable and unfit for consumption.

Figure 1-5. Public opinion remained inflamed over the quality of food and its production in the years after the embalmed beef scandal during the Spanish-American War and the subsequent publication of The Jungle by Upton Sinclair, as this image of the 1906 cover of Puck illustrates.
Reproduced from the Library of Congress. http://hdl.loc.gov/loc.pnp/ppmsca.26067/. Accessed October 23, 2017.

In the early days of military food inspection, Army training was lacking. Subsistence department personnel often relied on the beef suppliers’ quality inspectors for contract compliance.[16] In 1901, the Army’s food inspection gap was initially filled by hiring a US Department of Agriculture (USDA) veterinarian, who was appointed as meat inspector, Subsistence Department, US Army, to perform receipt meat inspection.1(p3) By 1906, the Army had six veterinary food inspectors. Based on War Department orders, veterinarians were to conduct locally procured beef inspections for post commanders.1(p3)

In 1906, Upton Sinclair’s book The Jungle graphically described horrid sanitary conditions in the Chicago meatpacking houses. This novel enraged the public and, along with the Embalmed Beef Scandal’s negative press, compelled Congress to pass the Federal Meat Inspection Act of 1906. By 1907, the Federal Meat Inspection Act empowered the BAI to hire over 2,200 inspectors to apply explicit sanitary standards and enforce 100 percent mandatory ante mortem and postmortem inspections at approximately 700 slaughter and processing establishments.[17] (For more information about the evolution of food inspection in the US military and current evolving missions, see Chapter 9, Food Safety and Defense.)

After several years of lobbying by the AVMA and Army veterinarians, a congressional act established retirement benefits for military veterinarians in 1910.2(p350) Conversely, in 1913, Congress questioned why military veterinarians should be part of Army medical service. The Surgeon General, in discussions with the Secretary of War on June 12, 1913, made a strong case that veterinary service personnel should be formed into a new corps in the Medical Department.2(p356) Despite the discussions, veterinary personnel were not included in the Medical Department until 5 years later.

The first reference to establish a veterinary reserve corps was made in February 1916 at the semiannual meeting of the Missouri Valley Veterinary Association.2 (p474) Europe was already embroiled in World War I, and many saw American involvement as imminent. Dr Robert Vans Agnew, a veterinary officer in the 5th Cavalry, Ft Leavenworth, wished to compile a list of those willing to serve in case of war.2(p474) At this and later meetings, a list said to contain 700 names was accumulated.2(p474) This list was given to the Quartermaster General but was never mentioned again.2(p474)

In March 1917, the president of the AVMA, Dr Chas E. Cotton, appointed a special commission on Army veterinary service. At the same time, he issued an appeal to the veterinary profession, “If our country is drawn into this war … it will be necessary to have a large reserve corps.”2(p503) He asked all eligible men to volunteer their services and noted a reserve corps would have numerous duties, to include the inspection of meat and feed, care of horses and mules, and the usual veterinary work at hospitals and depots near the battle lines.2(p503)

As noted in this chapter thus far, military veterinary medicine—from the Revolutionary War until 1916—progressed as the civilian veterinarian gained stature; however, problems remained. Veterinarians in the cavalry and artillery regiments were paid differently than the veterinarians working for the Quartermaster General. Veterinarians still were not considered Army officers, and standardization of training and authority was lacking. The US Army lagged decades, if not a century, behind some of the European armies in establishing a veterinary corps, which became more apparent in the years before World War I. Many of these problems were rectified by the National Defense Act of 1916.

VETERINARY SUPPORT OF THE US MILITARY JUNE 3, 1916, TO PRESENT

World War I to Pre-World War II

Expansion of the US Veterinary Corps and Veterinary Service

On June 3, 1916, the National Defense Act established the US Army Veterinary Corps and expanded entrance requirements. Veterinarians could now be officially commissioned officers within an Army Corps if they were citizens of the United States, 21 to 27 years of age, and a graduate of a recognized veterinary college who could pass professional and physical examinations. After a proscribed term of service, they could achieve the rank of major.1(p5) Although this National Defense Act stated the US Army Veterinary Service was supposed to fall under the Medical Department, veterinary officers were still aligned with artillery and cavalry regiments and the Quartermaster Corps when the United States entered the war on April 6, 1917.2(p471) The National Defense Act also provided for the establishment of the Veterinary Section, Officers’ Reserve Corps, but, as will be noted later in this section, nothing was done to establish this component until after war was declared.2(p507) When the National Defense Act was approved, the Veterinary Corps had no organization above regiments or station sites (camps or depots).

In early 1917, the Surgeon General, Major General William C. Gorgas worked with various military and civilian veterinarians, veterinary college deans, and the AVMA to better organize the American Veterinary Service, which was based on the British Army’s Veterinary Service. Later, he established a veterinary advisory board to further develop the organization and plans for the US Veterinary Service. This led to the publication of Special Regulation 70, which spelled out technical and administrative direction to the Veterinary Service until 1921.1(p7) Also, General Gorgas established the Veterinary Division in the Surgeon General’s office in October 1917.18(p52) Since almost all veterinary officers were in combat divisions or Quartermaster Corps remount depots, Gorgas had five senior veterinary officer general inspectors visit and advise the largely young and inexperienced veterinary officers and report back to him on their findings and recommendations.1(pp8-9)

The Overman Act of May 18, 1917, allowed President Woodrow Wilson to further expand the Veterinary Corps. At the beginning of World War I, the Veterinary Service was made up of 58 officers; this number rapidly increased as the war progressed.1(p10) To meet the demand, many veterinary officers were appointed via the National Defense Act of 1916’s Veterinary Section, Officers’ Reserve Corps.1(p11) Major Gerald E. Griffin, the senior veterinary officer detailed to the Office of The Surgeon General (OTSG), started to organize the Veterinary Reserve during the summer of 1917.2(p476) The reserve officers would be commissioned in the rank of second lieutenant, were subject to call to duty only in time of actual or threatened hostilities, were only entitled to pay or allowances when in active service, and would receive no retirement or retired pay.2(p509) However, they were entitled to a pension for disability in the line of duty and while in active service.2(p509)

Reserve officers were commissioned, quickly brought on to active duty, and given various duties, often with no military experience or training. Some of these officers were sent to France with no supplies, equipment, plans, or regulations.2(p524) These officers initially fell under combat or infantry divisions and the Quartermaster during World War I, instead of the Medical Department because there was no Medical Department plan for veterinarians until January 1918.2(p479) During World War I, 74 National Guard and 1,596 Reserve commissioned veterinary officers served on active duty.1(p11)

At the time the United States entered the war, the entire meat inspection force of the Army consisted of just three regular Army veterinary officers, three civilian veterinarians, and one retired enlisted man.[19] Under the authority of the Overman Act, the War Department General Orders 130 on October 4, 1917, called for the first use of enlisted men in veterinary service and established regulations for their utilization (one Veterinary Corps officer [VCO] for 16 enlisted soldiers per 400 animals).1(p12) Enlisted personnel were authorized as sergeants first class, sergeants, corporals, farriers, horseshoers, saddlers, cooks, privates first class, and privates.1(p7) Interestingly, the farriers, horseshoers, saddlers, and cooks were known by their titles and not by a rank recognized today.

To briefly summarize the progression of the Veterinary Corps thus far, legislation established the Corps in the National Army; a larger force formed during World War I and was augmented by conscription, volunteers, and the National Guard. General Orders 130 provided for officers and enlisted men in the proportions that the Surgeon General had recommended, although, as noted earlier in this chapter, no veterinary officers were to serve in rank above the grade of major.1(p5)

Later, authorizations were expanded to provide two colonels and six lieutenant colonels.20(p199) The peak wartime strength of VCOs was 2,234 on November 20, 1918; the peak strength of veterinary enlisted personnel was over 18,000 men by October 31, 1918.1(p12) The size of the US Army in the American Expeditionary Forces (AEF) was approximately 1.2 million soldiers.21(p630)

There was also another soldier component in the expanded Army: a very small number of African-American veterinarians received commissions during World War I. Although these veterinarians served in segregated units such as the 92nd and 93rd divisions, their duties remained the same as other Army veterinarians. African-American veterinarians were responsible for maintaining equine health, food inspection, and camp sanitation.

Evolution of Improved US Veterinary Training and Expanded Veterinary Missions

As the US Veterinary Service rapidly expanded, almost all officers and enlisted soldiers lacked military experience and needed individual, as well as unit training. Many had to rely on on-the-job training wherever possible, but this training suffered because of a shortage of trained instructors.

Five Medical Department training facilities and schools opened from the summer of 1917 through February 1918. This formal training included a veterinary laboratory course in Philadelphia, Pennsylvania, and courses from Medical Department schools located at Camp Lee in Virginia, Camp Greenleaf in Georgia, Fort Riley in Kansas, and Meat and Dairy Hygiene and Forage Supply Inspection courses in Chicago, Illinois.1(p13) In general, veterinary personnel at the camps were provided training in subject matter areas such as meat and dairy hygiene, veterinary laboratory, and veterinary hospital operations overseas. However, only half of the enlisted soldiers and veterinary officers received any formal training from these schools during World War I.1(p13) Lieutenant Colonel Everett Miller, Veterinary Corps, and principal author of the United States Army Veterinary Service in World War II, observed that “the most discouraging situation in the beginning wartime expansion of the Army Veterinary Service [in World War I] was its inadequate training.”1(p12) (More specific information about schools and specific training courses is found in the expanded missions subsections of this chapter.)

In addition to experiencing training problems at the beginning of World War I, the Medical Department had practically no veterinary equipment or supplies, and adequate stocks were not available in the medical supply system until late 1917.1(pp14-15) A few specific items, especially veterinary supplies and instruments, were exceptionally difficult to obtain, possibly because of the enormously increased demand; the difficulties involved in predicting what might be needed and in drawing adequate attention to these needs; and the newness of the Veterinary Corps itself.

The Army Medical School supplied veterinary vaccines, and later, a veterinary laboratory, established in Philadelphia, began making some of the drugs needed for animal treatment. In some instances, the Medical Department paid veterinary officers for their instruments when these doctors joined the Veterinary Corps. However, particular difficulty was encountered in providing horse ambulances because the Army had never purchased such an item before.18(p58)

Despite training and logistical issues, the Veterinary Corps’ missions expanded during World War I. During this time, zoonotic disease prevention and control was added to the list of veterinary services provided to the military. Food inspections were initiated at food establishments, conserving Army stockpiles by surveillance inspections and included nonanimal origin food. The term “Army animals” grew to include not only horses and mules, but also (unofficially) Army dogs, signal pigeons, and laboratory animals.

Zoonotic Disease Protection and Control Mission. The Veterinary Corps started establishing its laboratory service in December 1917.2(p599) Three laboratories produced mallein for glanders testing and performed bacteriological and pathological work, as well as dairy and meat product testing.2(pp599-600) A laboratory was set up in Philadelphia on January 19, 1918. Laboratory rooms were provided by the University of Pennsylvania, with the Army Medical Department responsible for furnishing supplies. Important work was initiated to include the study of influenza, pneumonia, and strangles (equine distemper). The veterinary officers trained in laboratory work at this facility were invaluable and served to promote the “efficiency of the service.”20(p204) In 1920, the veterinary laboratory course was transferred to Washington, DC, and eventually served as part of the Army Veterinary School.1(p14)

Food Inspection Mission. The National Defense Act (1916) and Special Regulations 70 (1916) charged the Army Veterinary Service with duties involving food supplies of animal origin.1(p5) The mission included the inspection of meat-producing animals before and after slaughter, dressed carcasses, and milk herds and dairies. Expertise in this area actually began at the General Supply Depot in Chicago, which was the central purchasing point during the war. A small number of veterinarians had engaged in these inspection duties for years, and their inspections were expanded to other purchasing points and to the field.1(p15) In the early months of the war, inspections varied from none at all to other agencies such as the BAI conducting the inspections.

In an effort to improve these unsatisfactory inspection procedures, the Secretary of War directed that meat and dairy inspections would be the responsibility of the Veterinary Corps.20(p205) Thus, the Veterinary Service’s food inspection mission assured that food supplies of animal origin, purchased by the Army, were wholesome, produced in establishments with acceptable standards of sanitation, and met quality standards. In addition, efforts were made to ensure proper food storage at Army stockpiles to minimize loss.

The Meat and Dairy Hygiene and Forage Inspection Course opened at the General Supply Depot in Chicago in August 1917.1(p13) The course originally served to train veterinary officers, but soon enlisted men were accepted as students.20(p204) The increased food inspection roles of the Veterinary Service and the essential need for this type of technical training led to the permanent establishment of the school.20(p204) The course was designated as the Veterinary School of Meat and Dairy Hygiene and Forage Inspection in 1920.1(p14) After reorganization in 1922, the school was renamed the Army Veterinary School, transferred to Washington, DC, and finally integrated into the formation of the Army Medical Center.1(p14)

Animal Care Mission. As the Veterinary Corps’ animal care mission expanded during World War I, the need for military and specialized veterinary training also increased. The principal training school for commissioned officers was at the veterinary section of the Medical Officer’s Training Camp at Camp Greenleaf, Georgia. If suitable, graduates were then assigned to the Veterinary Training School at Camp Lee for inclusion in the overseas veterinary units.20(p203) Graduate veterinarians would receive both training in the basic duties of a soldier and specialized training as a future officer.20(p203) An enlisted section was also trained at Camp Greenleaf. In addition, the camp received all of the veterinary graduates of the Medical Enlisted Reserve Corps called to active duty.

A training school was also established at the Medical Officers’ Training Camp at Fort Riley, Kansas. The veterinary section of the school focused only on training enlisted men for duties related to the Veterinary Service and in specialized skills such as cooking and horseshoeing. Graduates were then assigned to organizations for overseas duty. This school was eventually transferred in September 1918 to the Veterinary Training School at Camp Lee, Virginia.20(p203)

The Veterinary Training School at Camp Lee, Virginia, focused on the organization and training of veterinary field hospital units for the American Expeditionary Forces in France.1(p13) The Camp Lee school sent almost 6,500 of its students overseas to maintain the veterinary hospitals and to work with other veterinary organizations.1(p13) At the outbreak of the war, veterinary hospitals were constructed at some of the older posts having mounted troops, and remount depots were built at each divisional cantonment. The official capacity at three of these depots was 10,000 animals, eight depots of 7,500 animals, and 23 depots of 5,000 animals.20(p205) The remount depots were responsible for the reception, processing, and issue of newly purchased animals to the divisions. However, because of an accumulation of horses and the overcrowding of sick animals housed with healthy animals, the efficiency of the Veterinary Service and the management of communicable disease was affected. Thus, the veterinary hospitals at the remount depots became the center of veterinary activities at the camps. The largest depots had veterinary detachments of 12 officers and 150 enlisted men; nine officers, and 100 enlisted men for those of intermediate size; and six officers and 75 enlisted men for the smallest depots.20(p205)

In December 1917, the territory of the United States was divided into five zones, with five experienced officers assigned as general inspectors, whose purpose would be to develop appropriate sanitary standards while increasing the efficiency of veterinary personnel.20(pp205-206) Serving as both inspectors and instructors, they identified deficiencies and corrected the defects, providing essential instruction to improve veterinary efficiency. Their work greatly benefited the US animal industry to include the inspection of stockyards and their supply of animals for the public.20(p206) This emphasis on veterinary preventive medicine was also used to preserve the health status of animals maintained at remount depots. Preventable conditions and communicable diseases were appreciably decreased by recognizing the need for shelter with proper sanitation and by providing less overcrowding in corrals.20(p206)

Progress was also seen on animal transports proceeding overseas. Veterinary personnel cared for the sick, supervised sanitation for the animals on the outward voyage, and cleaned and disinfected the ships upon return. Temporary details using veterinarians and casual officers changed to permanent assignments of one veterinary officer and 25 enlisted men to each transport. Of the 66,071 horses and mules shipped overseas, there were only 660 lost or 1%.20(p207)

The Tables of Organization for the Veterinary Service (later renamed the Tables of Organization and Equipment or TO&E) were promulgated around January 1, 1918.20(p208) An evacuation unit was authorized for each infantry division. This unit was known as the Mobile Veterinary Section and was allocated one officer and 21 enlisted men. Veterinary personnel for each division totaled 12 officers and 51 enlisted men, with a division veterinarian and division meat inspector assigned.20(p208) With some exceptions, the division veterinary personnel were organized, trained, and equipped at the divisional camps and were sent overseas with their unit.20(p208)

The authorized veterinary hospital units for field service included a corps mobile veterinary hospital (evacuation) with two officers and 35 enlisted personnel.20(p209) There was also an Army mobile veterinary hospital (evacuation) with four officers and 144 enlisted personnel. This hospital had half the equipment of a veterinary hospital and could handle 500 patients.20(p209) The base veterinary hospital (stationary) had the same personnel numbers and equipment as the mobile veterinary hospital. Finally, the typical hospital for service in the rear was the veterinary hospital (stationary) with eight officers, 311 enlisted soldiers, and a patient capacity of 1,00020(p209) (Figure 1-6).

The first complete veterinary hospital unit arrived in France in April 1918. At this time, the US Army had procured over 60,000 animals. Prior to the new unit’s arrival, care was being provided by a squadron of Cavalry assisted by “veterinary advisors.”2(p519) In June 1918, a complete veterinary hospital, with a capacity for 500 patients, opened.

Figure 1-6. Reproduction brassard with green cross representing veterinarians. The red cross represented noncombatants on the battlefield. The green cross signified veterinary officers who (carrying sidearms, ostensibly to dispatch wounded horses) were not guaranteed unarmed Geneva Convention protection.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

All overseas veterinary hospitals were used only for treating mounts. The American Army officially did not have dogs in military service during World War I or any of the preceding wars.21(p949) The major reason for equine admissions in the overseas veterinary hospitals was mange, although there were many other causes of equine injury2(p523) (Figure 1-7) (Figure 1-8).

Figure 1-7. While there were many equine health issues in Europe during World War I, sarcoptic mange was a widespread (and largely curable) problem. Shown here are horses receiving sulfur gas treatment. US Army Signal Corps photo 17880.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Figure 1-8. In World War I, there were plans for mobile sulfur gas treatments for incapacitated animals or those in remote areas.
Reproduced from Lepinay, Vigel, Chollet. Sulfur gas in the treatment of mange. Am J Vet Med. 1918;13(5-6):263. Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Overview of the US Veterinary Service at the Great War’s End

On August 24, 1918, veterinary service in Europe was transferred from the Quartermaster Corps to the Medical Department as spelled out in General Orders 139.21(p717) (This transfer had been detailed in Special Regulations 70 in 1917 but was never implemented.) During the Great War, the Veterinary Service had personnel at five components: the Headquarters of the Veterinary Corps; the Veterinary Division in veterinary hospitals and remount depots; the separate schools for the Veterinary Corps, meat inspectors, and farriers; the food inspection branches for military forces; and the Army Veterinary Laboratory Service.21(pp912-937)

World War I was a bloody conflict, and the newly formed Veterinary Corps was not immune from losses. An issue of The Veterinary Bulletin from February 1920 states that during World War I “104 [veterinary] officers and [veterinary enlisted] men” were “fatal casualties.”22(p1) Of that number, 94 died as a result of disease.22(p1) One of the Veterinary Corps personnel killed in action was Second Lieutenant James C. Cox, who was attached to the ammunition train for the Third Infantry Division.23(p312) The “train” or rolling convoy of supplies consisted of motorized trucks and wagons pulled by horses and mules. It made sense for a veterinarian to be on hand for any equine emergencies. During the Meuse-Argonne offensive, the ammunition train came under sustained artillery fire from the enemy, and on October 23, 1918, Cox was killed, and his assistant, seriously wounded23(p308) (Figure 1-9).

Several important programs seen during World War I would shape the future work of the Army Veterinary Service. Major George A. Lytle, initially assigned as a subsistence inspector at the Chicago depot, has been referred to as the “father of Army veterinary food inspection.”16(p20) Having obtained the support of the Surgeon General and the Quartermaster Corps, the Chicago school for meat inspectors was established in June 1917. Lytle supervised and trained an inspection force in meat and dairy products, established the basic principles for today’s military food inspection system, and developed the nine classes of food inspection.16(p20) At purchasing points alone, the inspection service inspected a total of 1.26 billion pounds of meat and dairy products from 1917 to 1919. Overall, an estimated 11 million pounds of food were condemned, thus protecting the health of troops and their combat effectiveness.16(p21) In 1922, for the first time, the administrative, technical, and professional duties of the Veterinary Service were set out in Army regulations.16(p23)

Figure 1-9. The roads were indeed dangerous for all types of traffic during World War I. Second Lieutenant James C. Cox, Veterinary Corps, was attached to the ammunition train for the Third Infantry Division in order to provide care to animals used for transport. During the Meuse-Argonne offensive, Cox was killed when the ammunition train came under artillery fire. US Army Signal Corps photo.
Reproduced from US Army American Expeditionary Forces 3d Div. History of the Third Division, United States Army in the World War for the Period December 1, 1917, to January 1, 1919. Andernach-on-the-Rhine, Cologne, Germany: M. Dumont Schauberg; February 1, 1919: 307.

Another key program to evolve and lead to the growth of the Veterinary Corps’ food mission was the Civilian Conservation Corps (CCC). Established in 1933, the CCC’s expansion prepared the Veterinary Corps for better food inspection programs in later years. Under the Act of Congress entitled “An Act for the relief of unemployment through performance of useful public works, and for other purposes,” the CCC was placed under the War Department and became a force of 2.5 million.16(p23) Upon activation of the CCC, the USDA was initially responsible for conducting food inspection duties, but the USDA was overwhelmed by the new emergency military role of the CCC. Therefore, the Army Veterinary Service, which previously had only covered military posts and depots, was given responsibility for the CCC’s entire inspection service, which doubled the size of the active duty Veterinary Corps.16(p23) In addition to more active duty VCOs, over 100 Reserve Corps veterinary officers were utilized.1(p11) These officers’ overall success eventually led to having the Veterinary Corps conduct the inspections of other foods such as fruits, vegetables, and bread, which, in turn, provided a more experienced and versatile Veterinary Service for early World War II.16(pp23-24)

Toward the end of the post-World War I period and perhaps because of the Depression Era programs (eg, Works Progress Administration, Civilian Conservation Corps, and other mobilizations of government jobs), US Army Reserve numbers were increasing. The VCO Reserve Corps numbered 626 on the active list on June 1, 1935. 21(p915) The number of enlisted personnel was about 600.21(p938) Even so, on the eve of World War II in 1939, the number of VCO authorizations in the Regular Army had decreased to 126 VCOs, and the National Guard had roughly 150 VCOs.1(p10)

During the drawdown at the close of World War I’s hostilities, the Army was able to sell excess horses (100,000 within the United States) at good prices, in part because of the excellent disease control procedures being implemented by the US Army veterinarians.2(pp562-563) This was an economic bonus that did not occur after the Civil War and the Spanish American War. After those wars, entire lots of horses had contagious diseases and were either sold, spreading disease all over the country, or were in such bad condition they could not be sold.

In addition to the aforementioned benefits of stricter disease control, the Army Veterinary Corps secured another victory by pushing to have Bulletin No. 33 published on April 19, 1919, to stop public animals belonging to military forces in Europe from being imported to the United States. This blockage was achieved after coordinating with the US Department of Agriculture, which implemented quarantine regulations for privately owned mounts that were returning to the United States. This forethought prevented several diseases such as mange, foot and mouth disease, and glanders from being brought back from Europe in horses that would have been shipped all over the country.21(p843) Despite these effective policies, exceptions were made; General John J. Pershing brought his horse back from service in France.24(p149)

With the exception of the course of instruction at the Chicago General Supply Depot and the Veterinary Laboratory Course, the end of World War I brought the closure of all of the wartime veterinary training schools.1(p13) Then, in 1920, the Medical Field Service School for the field training of Medical Department personnel was established at Carlisle Barracks, Pennsylvania. Veterinary Corps officers first began attending in 1923, and a total of 113 veterinary officers graduated before 1941.1(p14)

Training in veterinary units of the Reserve Officers’ Training Corps (ROTC) proved to be some of the most important peacetime training. Conducted at four veterinary colleges (Iowa State College, Kansas State College, the Ohio State University, and New York State Veterinary College at Cornell University) between 1920 and 1935, nearly 500 veterinary ROTC graduates were commissioned as second lieutenants.1(p14)

After the terrible pandemic of influenza killed millions worldwide (including many US Army veterinarians), training in hygiene was given more consideration and was one of the many concerns studied by veterinary personnel. Similarly, tropical diseases and rabies were scourges that veterinary scientists looked to defeat. One VCO in particular, Raymond A. Kelser, devoted much of his career during the postwar period to discovery and prevention of these diseases.

Kelser had an interesting background, with foundations in science and hard work. Securing a position that allowed him to work through college and night school courses, Kelser became a “messenger” for the Bureau of Animal Industry under the Department of Agriculture at age 17.25(p201) The position led to subsequent promotions to secretary and then laboratory assistant. Advancing in his studies as well, Kelser earned his doctorate of veterinary medicine at George Washington University’s School of Veterinary Medicine through his continual night school course schedule.25(p202)

Kelser joined the Army in 1918 during World War I. He did not see service overseas at that point but would later serve in the Philippines and Panama. For the next 20 years, Kelser performed numerous studies and made significant observations. In 1928, while in the Philippines, he developed a vaccine for rinderpest in cattle.25(p207) His pioneering laboratory work led to a test for detecting botulism in canned foods, the first “killed virus” vaccine that utilized chloroform as an inactivating chemical, important observations in equine encephalomyelitis, and an improved rabies vaccine25(p207) (Figure 1-10).

From the Spanish American War to World War I, military veterinary requirements, missions, and official acceptance expanded. During World War I, the importance of food and meat inspection for an Army in the millions became apparent. Similarly, animal care and the important discoveries made by veterinarians in laboratories greatly assisted war efforts. At the close of 1918, the “Great War” was over, but US Army veterinarians were still on duty to support the military through animal care, food inspection, and discoveries in the laboratory. Some veterinarians remained as part of the occupation forces in Europe, ultimately leaving in 1922, while others were sent to administer animal care as part of the Siberian and North Russia Expeditions (1918 to 1920).[26] The Veterinary Corps was now established as an official corps of the Medical Department, and despite the post-World War I drawdown, the Veterinary Corps was poised for service in the next war.

World War II to Pre-Korean War

Important Changes in US Army Veterinary Service During World War II

Mission Changes. During the World War II to pre-Korean War timeframe, VCOs and enlisted soldiers became more specialized, as veterinary medicine in general expanded. By the time World War II began, the Army Veterinary Service had already defined and tested its missions and responsibilities, which led to a much more orderly expansion to meet World War II wartime requirements than had previously occurred with the onset of World War I.1(p17) The Veterinary Corps’ missions were essentially the same as they were during World War I—animal health and food inspection—but World War II missions were much more defined. Tasks were spelled out (ie, zoonotic disease control responsibilities, as well as food procurement, safety, and quality responsibilities, throughout the supply chain).1(pp17-19)

The Veterinary Corps’ missions also underwent a shift in emphasis during World War II; animal health expanded from horses and mules in World War I to horses, mules, pigeons, Army dogs, and laboratory animals during World War II.1(p22) As an example, the total equine strength for the Army in Europe during World War I was 191,631; the average equine strength in the US Army during the peak year of 1943 was only 56,287.1(pp 520,552) Also, the food inspection mission increased in magnitude as the animal health mission decreased.1(p23) In 1944, the food procurement inspections alone peaked at approximately 500+ million pounds.1(p675)

Figure 1-10. Lieutenant Colonel Raymond A. Kelser (standing, on the far right) in the bacteriological laboratory at the US Army Veterinary School, US Army Medical Center, Washington, DC. Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

In other words, the Army Veterinary Service conducted three main activities during World War II: veterinary animal service, military meat and dairy hygiene service, and veterinary laboratory service and research. The second activity was the most extensive, and together with the third activity, they were the most important veterinary activities performed during World War II. By 1943, the animal mission steadily decreased in volume.1(p520) Initially, Army veterinarians were responsible for inspecting meat and dairy products, but later they became more involved in inspecting all subsistence, including fruits and vegetables, as well as other nonanimal-origin foods.1(pp681-682) Approximately 20 percent of veterinary personnel were involved with inspecting the Army’s subsistence during World War I. During World War II, this increased to about 90 to 95 percent of veterinary personnel; they inspected 142 billion pounds of meat and dairy products from 1940 to 19451(p675) in support of a massive Army with 8 million plus troops.

The veterinary subsistence inspection mission was considered an extension of the Medical Department’s troop health programs.1(p676) Veterinary personnel worked closely with the Quartermaster Corps and Transportation Corps to optimize subsistence quality, sanitation, and wholesomeness throughout the procurement, storage, and distribution processes.1(p676) In the two world wars, the Army Veterinary Service and the subsistence supply chain minimized unwholesome food, resulting in the “best and healthiest fed” Army of modern times; no foods issued under veterinary supervision caused food-borne disease as a result of the food being unsound, unwholesome, or contaminated at the time of issue.1(p727) One wartime survey indicated at least 190 outbreaks involving over 22,000 cases of illness, but the causes were determined to be improper mess hall practices, poor sanitation, or uninspected foods.1(p726)

In addition to helping the Medical Department with subsistence inspections, VCOs were often requested by medical officers to participate in many of the epidemiological investigations.1(p727) Although no full-time veterinary officers were assigned for pet care, the Veterinary Service also provided limited care to privately owned pets, established immunization programs, and worked with local provost marshals on mitigating stray animals.1(p668)

Colonel (later Brigadier General) Raymond Kelser, mentioned previously in this chapter for his veterinary laboratory contributions, advanced to the position of Chief of the Veterinary Corps at the beginning of World War II. Kelser was promoted to help facilitate his management of veterinary support of the exponentially expanding military. He stayed in position until the end of the war and was the second veterinarian recognized with the Distinguished Service Medal (Figure 1-11).

During World War II, Veterinary Service personnel strength peaked at 2,116 veterinary officers and 6,370 enlisted soldiers, as well as a small group of civilians.1(p33) During this time, about 15 percent of the nation’s total veterinarians were in the Army.1(p33) The VCOs were comprised of Regular Army (not more than 126 at any time during World War II), National Guard, Officer Reserve Corps, and a few retired Regular Army officers brought back to active duty. The Veterinary Corps Reserve was the major source for officers in the active Army Veterinary Service during this expansion.1(p36)

Training Changes. Unlike World War I, in which there wasn’t time to establish training programs for the newly created Veterinary Corps and needed military veterinary positions were filled by basically placing uniforms on untrained civilian veterinarians with unsatisfactory results, the Army Veterinary Service had time to mature between wars and advance its training programs. Many remaining officers completed various military training courses and worked on postgraduate professional education, in addition to receiving training from the ROTC, reserve officer experiences, and National Guard unit training.1(p83)

Also, many existing Regular Army training courses were modified and often shortened to get new recruits special training for needed skills before being sent to duty sites; even after relocation, training still continued, sometimes as on-the-job training.1(p85) The Refresher Course in Forage Inspection, Special Graduate Course in Clinical Pathology (later changed to Refresher Laboratory Course), Refresher Officers’ Course, and the Meat and Dairy Hygiene Course aided in getting officers up to speed for their missions.1(pp86-87)

Figure 1-11. Brigadier General Raymond A. Kelser, eighth chief of the Veterinary Corps (1938–1946). His tenure of leadership was tested by World War II, but he managed the corps during great expansion and worldwide service. Prior to serving as chief, Kelser made significant discoveries in the laboratory. His pioneering lab work led to a test for detecting botulism in canned foods, the first “killed virus” vaccine that utilized chloroform as an inactivating chemical, important observations in equine encephalomyelitis, and an improved rabies vaccine. Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Despite the time for training programs to advance between wars, after World War I, the Army demobilized, and tactical unit training almost disappeared. At the onset of World War II, just a few veterinary units remained. When the United States entered combat, the need for immediate veterinary support was again great, and the number of veterinary units that had to quickly be trained grew to more than 200.1(p107) In many cases, these units’ training had to continue overseas as, unlike more tenured veterinary personnel, incoming personnel were only trained in animal origin food inspection. Overseas, however, the Army Veterinary Services inspected all of the Army’s foods.1(p108) As the war in the Pacific matured, the veterinary animal service units’ mission decreased, but the food procurement and surveillance mission increased, requiring large numbers of personnel be locally retrained to support the more diversified overseas food inspection mission1(p109) (Figure 1-12).

Figure 1-12. Two enlisted members of the US Army Veterinary Services conduct an inspection of subsistence supplies in the European theater of operations during World War II. While World War I may have been the high point for animal transportation care, World War II served as the standard for food inspection on a massive scale.
Reproduced from Miller EB. United States Army Veterinary Service in World War II. Washington, DC: Office of The Surgeon General; 1961: 682.

Army veterinarians also provided horse and mule health and care instruction to more than 4,400 Cavalry officers and 1,041 enlisted personnel; to Field Artillery School personnel on almost as an extensive scope; and to almost 1,500 enlisted horseshoers. Army veterinarians provided Army dog and Army signal pigeon health, emergency first aid, and care instruction to more than 4,800 dog handlers, as well as to many of the Signal Corps enlisted pigeoneers personnel.1(p111) Army veterinary officers also provided instruction in pack animal care and horseshoeing to Allied-sponsored military forces and to over 2,000 Chinese personnel, including veterinary officers1(p114) (Figure 1-13).

Assignment Changes. Veterinary military occupational specialties (MOSs) in 1943 were as follows:

- veterinary officer;

- veterinary officer, large animal;

- veterinary officer, small animal;

- veterinary officer, staff;

- veterinary officer, remount;

- veterinary unit commander;

- meat and dairy products inspector;

- meat products inspector;

- dairy products inspector;

- food chemist; and

- veterinary laboratory officer.1(p68)

Figure 1-13. A mule bogged down in mud receives medical care. Veterinary personnel treated government owned animals and animals captured from enemy forces; they also assisted with civilian animal concerns when possible. US Army Signal Corps photo N86439A.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Enlisted MOSs were revised in 1944 and reduced from seven to three to include meat or dairy inspectors, veterinary technician, and veterinary ambulance orderly.1(p79)

The World War II War Department TO&E veterinary units numbered 24 initially and grew to 65; at least 550 activated units had veterinary officers and enlisted personnel assigned to them.1(p206) Veterinary personnel were assigned to Army Corps and Division headquarters; Infantry, Armored, Airborne, Mountain, and Cavalry divisions; Cavalry brigades and regiments; Field Artillery battalions and regiments; Division Artillery; Medical Department units, including veterinary field units; Quartermaster units; Signal Corps units; Transportation Corps units; and Army Air Force units.1(pp207-208)

Veterinary personnel were also assigned to the Chemical Warfare Service (later known as the Chemical Corps) with a diversified mission of operating laboratory animal colonies and conducting scientific research on the effects of chemical and biological agents and weapons and developing protective measures, equipment, and tests for personnel, animals, and foods.1(pp92-93)

Significant Impact of Army Veterinarians During World War II

Collective Efforts. The Veterinary Corps attained prominence during World War II in pathology, radiology, epidemiology, and biomedical research. Military veterinary medicine achieved a distinguished record of research firsts to include developing a vaccine for rinderpest; discovering sleeping sickness vectors between animals and people; making advances in laboratory animal medicine through the creation of a disease-free large-scale colony at Walter Reed Army Hospital; demonstrating the value of tetanus toxoid in preventing lockjaw in animals prior to its use for humans; and conducting high-altitude studies. The World War II-generated high-altitude studies also contributed to the definition of aerospace medicine (then centered at Brooks Air Force Base in San Antonio, Texas).[27]

The Army Veterinary School Laboratory personnel perfected and produced equine encephalomyelitis vaccine, improved biologic preparation for typhus vaccine production, and produced Japanese B encephalitis vaccine. In addition, the laboratory staff isolated and identified various types of equine encephalomyelitis infections in man and animals.1(p391) The Army Medical Museum (redesignated in 1946 as the Army Institute of Pathology) utilized Army veterinarians, along with an AVMA sponsorship, to build the Registry of Veterinary Pathology and contributed to wartime research on animal disease of military importance, such as equine influenza, equine periodic ophthalmia, and canine leptospirosis.1(pp430-431)

Veterinarians also developed a list of sanitarily approved commercial food establishments from which Army contractors could procure subsistence, which was the beginning of the Veterinary Service Approved Sources list that is utilized today. As testimony to the large number of inspections of all types being performed in 1944, about 4,000 commercial food establishments were being regularly inspected every month.1(p679) From 1941 to December 1945, the Veterinary Service inspected almost 13.5 billion pounds of meat and dairy products procured, while minimizing perishable subsistence losses.1(p700)

Veterinarians and their detachments worked closely with the Quartermaster Corps to provide professional and technical services to at least seven animal purchasing boards, seven remount areas, four remount depots, six dog centers, 18 depots, and 34 market centers to inspect, supply, and care for the armed forces’ horses, mules, and dogs, as well as perform subsistence procurement, testing, and surveillance inspections. About 50 VCOs who fell under the control of the Surgeon General’s Office were involved with the professional and technical supervision of procurement and processing of remount animals for the Army Remount Service, who fell under the control of the Quartermaster General. Approximately 60,000 animals were procured in the Zone of Interior, with 6,000 procured in Australia, and thousands captured or procured in various theaters such as the China-Burma-India, Mediterranean, and European theaters.1(p489)

About 18,000 dogs were brought into the military, with about 10,000 dogs being issued to various K-9 units.1(pp615-616) Officially new to the inventory, Army dogs were classified for various types of work, including attack (police), cart, messenger, pack, sentry, scout, sled, trail, and specialty (mine detection, chemical warfare agent detection, and casualty) work.1(p619) Dog platoons were made up of various combinations of these responsibilities and were authorized one veterinary sergeant to provide first aid (Figure 1-14).

The new weapon in the Army arsenal, the dog, faced various health challenges, including a food supply that was variable and often questionable. Commercial dog food couldn’t maintain an Army dog in good working condition without supplementation; dogs fed raw rabbit meat experienced an outbreak of tapeworms; other dogs were fed meats rejected for human use because of tuberculosis. Subsequently, the Army Veterinary Service initiated the requirement to cook all meats fed to military canines.1(p621) Veterinary officers also conducted trial feeding of the various Type C ration meat components and found them to be acceptable supplements.1(p621)

Although no laws or regulatory agency existed concerning health requirements for importing or exporting dogs in the Zone of Interior, the Army Veterinary Service took the initiative and implemented quarantines and other controls to prevent the spread or introduction of diseases from Army dogs in the United States and overseas. Fifteen dog platoons deployed to the overseas theaters; however, because of quarantine restrictions, none of these dogs were sent to Great Britain.1(p628) The US Army and Army Air Corps received and utilized about 300 British-trained dogs for use in the country. After the Normandy invasion, US war dogs could be shipped directly from the United States to Europe to support the troops,1(p631) but few dogs were allowed to be brought back to the United States from their overseas service sites.1(p624)

Figure 1-14. Sergeant William C. Dutton, a veterinary technician, bandages the paw of “Thundeis,” a scout dog with the 38th War Dog Platoon, 85th Division, near Villa Di Sassonero, Italy; February 27, 1945. US Army Signal Corps photo 202050-8.
Courtesy of the National Archives and Records Administration.

A local dog procurement program was also more feasible in Hawaii because of the 120-day quarantine on imported dogs implemented there. Modeled after the program in the United States, the Army Veterinary Service in Hawaii conducted physical examinations on over 3,250 dogs, and 344 dogs were successfully trained.1(pp632-633)

US Army VCOs also implemented zoonotic disease control regarding dogs and other pets that included import quarantine operations in cooperation with local authorities in the Panama Canal area. There was also a fatal case of human rabies in an Army officer in Guatemala in which a dog was implicated; the animal was quarantined for 2 months in the local Army veterinary hospital and was destroyed but tested negative for rabies. This led to civil action to extend the animal import quarantine period to 6 months.1(p221) Furthermore, in January 1945, at a rest camp in Egypt, two recreational riding horses borrowed from the British forces developed rabies. A rabies control program was instituted with the vaccination of 17 personnel, quarantine of the stable area, destruction of stray animals, and reiteration of a year-long order against having animal pets in the camp area.1(p244)

In addition to its World War II procurement and disease prevention duties, the Army Veterinary Service was responsible for the overall veterinary care and transport of “Army animals,” which by then had grown to include not only military working horses and mules (strength averaged 44,000 during the war years), but also 10,000 dogs, 54,000 signal pigeons, hundreds of livestock and poultry (maintained by the Quartermaster Corps and Army Exchange System food-producing farms or by other departments at rehabilitation and rest centers), all the laboratory animals (eg, mice and rabbits), and captured military animals.

During World War II, the Army Veterinary Service provided over 2 million hospital treatment days for Army horses and mules and implemented evacuation plans in overseas theaters with 72 veterinary detachments, companies, hospitals, and provisional organizations. The Zone of Interior alone had a stall capacity of 2,500 for disabled animals.1(p563)

World War II was also the first time aircraft were used to move horses and war dogs in a tactical setting. Over 20,000 mules and horses, about 1,900 Army dogs, several thousand pigeons, and Medical Department research animals were shipped overseas.1(pp543,615, 649-651) The Army Veterinary Service played an important role in minimizing animal losses during transport by air, ship, rail, or truck by conducting examinations for condition prior to movement and accompanying animals to monitor their health while en route.1(p539) The Veterinary Service also supervised the loading and shipping of these animals at the ports of embarkation.

At least 17 VCOs provided veterinary services to the birds used by Signal Corps pigeon centers and units.1(p643) The VCOs’ main objectives were to protect the pigeons’ health and prevent zoonotic disease transmission from pigeons to other animals and humans.1(pp644-645) For deployment overseas, 12 Signal Pigeon companies consisting of three platoons of 1,500 pigeons were activated, with an authorized veterinary detachment consisting of one VCO and one enlisted technician.1(p649)

The Veterinary Service also cared for officers’ private mounts, troop mascots, and privately owned pets of military personnel, as well as various animals involved with Civil Affairs in liberated and occupied areas, Marine Corps scout dogs, Coast Guard horses and sentry dogs, and livestock on Navy-administered island bases.1(p519)

Shortly after the attack on Pearl Harbor on December 7, 1941, Army veterinarians initiated an antibiological warfare program (now called a food defense program) in Hawaii. The program instituted a plan to safeguard fresh milk from deliberate bacterial contamination and extended the program to soft drink beverage plants, ice cream manufacturers, and other commercial food industries throughout the Hawaiian Islands.1(p433,728-729)

Figure 1-15. Captain Clayton H. Mickelsen, Veterinary Corps. Mickelsen earned the Distinguished Service Cross for heroism in the Philippines when he stopped the Japanese advance by destroying a bridge and rescuing fellow soldiers in the process.
Courtesy of Washington State University, College of Veterinary Medicine, Pullman, Washington.

In 1941, the Army Veterinary Service also established the first of its kind civil affairs assistance program in Iceland. This program received praise from Iceland’s prime minister for initiating regulatory controls against diseases affecting the country’s animal industry, modernizing its dairy industry, developing hog raising, and conducting research and investigational studies on sheep diseases.1(p228) Similar programs were later undertaken by veterinary personnel in developing countries and are now common.

Individual Losses and Gains. Veterinarians in the Philippines were surrounded almost from the beginning of the war because Japan invaded the island soon after attacking Pearl Harbor. Serving in very difficult circumstances, these VCOs were vital to the local procurement and field slaughter of carabao (local water buffalo) for over three months, as food supplies diminished. The veterinarians’ skills were also needed to provide medical care during the long imprisonment.

One VCO who served in the Philippines, Captain Clayton H. Mickelsen, received the Distinguished Service Cross for acts of heroism carried out when he was a first lieutenant on the Philippine front lines. The Distinguished Service Cross citation mentions his great achievement in delaying the enemy advance as well as his concern for fellow soldiers:

For extraordinary heroism in action at Rosario, La Union, Philippine Islands, on December 22, 1941. During a concentrated fire from enemy tanks and infantry at close range against the rear guard of the 26th Cavalry [Philippine Scouts], Lieutenant Mickelsen, with one other officer, with total disregard of his personal safety, remained between the hostile troops and his own force, set fire to a truck placed on a bridge, and remained at the bridge exposed to enemy fire until satisfied that the bridge was in flames. Subsequently, Lieutenant Mickelsen, with the other officer, in a scout car, moved slowly with the rear most elements of the 26th Cavalry, picking up the wounded and collecting and giving orders to stragglers. By his heroic actions, Lieutenant Mickelsen prevented unhindered pursuit by the hostile tanks, saved the lives of a number of wounded, collected many stragglers, and set an inspiring example of courage for the entire regiment.1(p74-75)

Sadly, Mickelsen later succumbed to illness as a prisoner of war (Figure 1-15).

As with previous conflicts, there were other losses of veterinary personnel. A total of 17 VCOs died or were killed during World War II.1(p75) Of that number, four VCOs were killed in action.1(p75) Some of the personnel were recognized for their valiant efforts during the war. Five VCOs and approximately 31 veterinary enlisted men were awarded the Combat Medical Badge in the China-Burma-India Theater of Operations.1(p75) At least one VCO was awarded the Combat Infantryman Badge.1(p75)

Significant Transformations During and After World War II

World War II was significant for the Veterinary Corps in numerous other regards. Early in World War II, VCOs could be found in the ranks of first lieutenant through colonel. The first brigadier general was appointed during World War II, Brigadier General Raymond Kelser, but the authorization was dropped in 1946 after he retired.1(pp68-69) Later, The Officer Personnel Act of 1947 restored the grade of brigadier general to the Veterinary Corps.1(p69) The first female VCOs, First Lieutenant Thais de Tienne and First Lieutenant Helen M. Robertson, were appointed at the close of World War II1(pp76-77) (Figure 1-16). Another change occurred some years after the war. In the summer of 1949, Air Force General Orders 35 established an Air Force medical service and included an Air Force Veterinary Corps.

Figure 1-16. Helen M. Robertson, a veterinarian with the Women’s Army Auxiliary Corps. Robertson is shown inspecting beef, but also performed animal care tasks. Thais de Tienne and Robertson were the first female US Army Veterinary Corps officers. US Army photo.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Army Veterinary Service personnel continued working in occupied countries such as Japan after World War II ended. Although the animal health and zoonotic disease control (eg, rabies control) duties were still important parts of their overall mission, the emphasis was on food inspection and enforcing sanitary standards throughout storage and distribution.28(pp1-3) Most of the food being consumed by US forces was shipped from the Zone of Interior. Some ice cream was locally procured; eight ice cream plants in Yokohama were inspected, and samples were tested biweekly for standard plate count and coliforms.28(p6)

Postwar conditions in Japan were quite dismal—as illustrated by the plight of stray dogs caught without tags after the war ended. For a short time, the US Provost Marshal impounded these strays, and after a period of time passed without the dogs being claimed, he had the dogs donated to Japanese farmers. However, when the complaint of the farmers butchering the dogs for food and using the hides for clothing was verified, this practice was halted, and veterinary personnel were tasked to euthanize these dogs.28(p3)

In an effort to rebuild war-torn Japan, various US military actions were taken. Several shipments of milk cows and milk goats were imported to Japan as breeding stock and as a supplement to the Japanese milk supply. Army Veterinary Service personnel inspected these imported animals to prevent foreign animal disease introduction into Japan.

The Eighth Army established military government teams, with one veterinary officer authorized and working with the Public Health section. The teams had a similar role as current agriculture development teams and nation-building activities. The military government teams’ duties consisted of animal disease control, veterinary education, and surveillance of the inspections made by the Japanese Veterinary Service. Each team’s goal was to build a safe food supply in Japan and establish a self-sufficient Japanese Veterinary Service.1(pp480-481)

Veterinary research was also conducted in Japan. Major Kenneth F. Burns was assigned to the Eighth Army to study Japanese B encephalitis (mentioned earlier in this chapter) and proved the causative organism in humans was the same virus causing equine encephalomyelitis. He also developed an effective vaccine for horses.28(pp9-10)

As with the close of the previous wars, the US Army proceeded to shrink from its enormous World War II size. However, continual conflicts and the start of the Cold War increased the need for a worldwide American military presence. For the US Army Veterinary Corps, support missions continued. Although equine care was greatly minimized, canine use in government service was now established, and canine numbers would increase in coming years. Food safety inspection and laboratory work remained essential tasks, as interaction and cooperation with other government agencies saved countless jobs and lives by curtailing various disease outbreaks.

Korean War and the Early Years of the Cold War

Korean War

The United States was once again caught off-guard when the Korean War erupted. The US military presence was still global in nature but was greatly diminished from its peak during World War II. Within 2 weeks of North Korea’s invasion of South Korea on June 25, 1950, Veterinary Service units arrived with US and UN forces in Korea, with the 95th Veterinary Food Inspection Detachment (VFID) arriving on July 8, 1950, and the 476th VFID arriving on July 15, 1950.29(pp1-2) At the end of 1950, one port veterinarian and four VFIDs were in Korea. The 150th VFID participated in the Inchon landing on September 24, 1950. Two veterinary personnel supervised the loading of 80 tons of fresh frozen turkeys and accompanied the military vanguard for 7 days, moving north over bad roads to ensure the soldiers were fed a turkey in good condition, which was appreciated.29(pp1-2)

Similar to the previously mentioned detachments, the 66th VFID was subordinate to the 2d Logistical Command. The Eighth Army had veterinary consultants: the 106th VFID and the 477th VFID.29(pp2-3) Although the Army Veterinary Service’s mission was to support only the Army, one enlisted inspector was detailed out to the 1st Marine Division upon request, when the division was experiencing large losses of perishable items. Attachment to a larger organization, especially near the ever-changing front lines, and recognition of their inspection mission was often overlooked in the first months of the war. Additionally, refrigeration issues, improper storage, and theft were continual problems.29(p11-12)

Veterinary resources were largely shared or transferred between Japan and Korea inside the Far East Command. This arrangement made sense for both proximity and needs; the country of Korea was still recovering from Japanese occupation and didn’t yet have dairy or large food production facilities. At the beginning of 1951, there were 13 VFID units within the command, and at the close of the year, 30 VCOs were assigned to the Far East Command.30(p43) Throughout the war, veterinary laboratory service for the Far East Command was largely provided by the 406th Medical Laboratory in Tokyo and the 1st Medical Field Laboratory attached to the 121st Evacuation Hospital or by other nearby medical units willing to share resources.29(p16),30

Although food inspection was the primary mission, some veterinary units were involved with animal care (Figure 1-17). The 26th Infantry Scout Dog platoon arrived in Korea in June 1951.[31] Initially, the unit had several “journeymen” dog handlers acting as veterinary technicians in the field.32(p83) When the dog platoon was attached to the 3d Infantry Division, the port veterinarian for the 21st Transportation Medium Port served as the attending veterinarian.[31] Later, when the dog platoon was transferred to the 24th Infantry Division, the veterinarian performing food inspection for the 548th Quartermaster depot at Chunchon (477th VFID) was to provide medical care for the unit’s canines.31,33(p10) Of the “journeymen” dog handlers and veterinary technicians (their specialty remained Infantry), Sergeant Robert Goodwin received the Silver Star award for rescuing two wounded soldiers trapped in a minefield while under enemy fire32(p83),34 (Figure 1-18).

Figure 1-17. Major William L. Abbot receives the Bronze Star for his service in the Korean War. Abbot commanded the 477th Veterinary Food Inspection Detachment and later served as the attending veterinarian for the 26th Infantry Scout Dog Platoon. During his travels in Korea, Abbot’s jeep came under fire, with two bullets reaching the windshield. Fortunately, Abbot was unharmed. US Army photo.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Figure 1-18. Sergeant Robert D. Goodwin, “journeyman” (and unofficial) veterinarian technician and dog handler for the 26th Infantry Scout Dog Platoon, receives the Silver Star medal for rescuing fellow soldiers trapped in a minefield while under fire. US Army photo 20-51-4 FEC-53-1397.
Courtesy of the National Archives and Records Administration.

In June 1952, the 7th Cavalry Regiment of the 1st Cavalry Division trained nine dogs purchased from local Koreans for use as scout and guard dogs.[31] Similar to other dog teams in Korea, nutrition was a continuous and sometimes contentious issue since beef was a premium and hard-to-procure source of protein. The 1st Cavalry Division dogs suffered combat losses—one killed in action, one wounded in action, and one declared missing with its handler—but the dogs had some success before the division redeployed to Japan.[31]

The 26th Infantry Scout Dog platoon received more visibility, with stories appearing in newspapers, and ultimately, the unit received a Meritorious Unit Citation for service in Korea.32(p160) In 1952, when one of the unit’s dogs was severely wounded by shrapnel (approximately 50 fragments), the dog received care at the 121st Evacuation Hospital and survived to return to the continental United States (CONUS).29(p15) While use of the human treatment facility was very much appreciated, the incident identified a need for a separate veterinary medical facility, a request that was approved in late 1953 and was made possible via a veterinary detachment transfer.

The 150th Veterinary Detachment was freed from its duties of food inspection at the massive Enemy Prisoner of War (EPW) holding area at Koje-Do Island south of the Korean Peninsula and was sent to Munsan-Ni north of Seoul. At Munsan-Ni, the unit was attached to the 43rd Surgical Hospital, Mobile Army (8055th MASH). Establishing operations in a Quonset hut with the sign “1st Veterinary Hospital in Korea,” the unit provided animal care as well as food inspection for the Munsan-Ni to Ui-Jong-Bu areas.29(p15)

The utilization of helicopters for moving wounded canines during the war had been very positive and expanded to include dog transport experiments.[35] At the close of the war, ad hoc “kennels” consisting of frames and chicken wire were mounted on H-13 helicopters. These experimental kennels allowed dogs from scout teams to either be deployed to the reconnaissance area or evacuated if wounded.32(p137) The innovation was short-lived, but the idea received consideration for future conflicts (Figure 1-19).

While there were no “official” large US government-owned animals for which US Veterinary Service were responsible during the Korean War, there were captured enemy equines. After a brief inspection at capture, they were transferred to Republic of Korea forces.[31] The animals were largely, and ironically, from the Chinese Army, which had greatly benefited from American veterinarians and the US supply system during World War II.1(p352) One captured mule was brought to the 26th Scout Dog platoon, presumably because of the platoon’s veterinary connection.[36]

Figure 1-19. H-13 Helicopter with chicken wire kennel pods to transport dogs.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Public health concerns were also an issue in Korea. In the years after Japanese occupation of the Korean Peninsula and before the outbreak of war (1945–1949), cholera, smallpox, and tuberculosis were frequent problems. Later, during the war (1951), veterinary supplies were quickly transferred from Japan to prevent further expansion of an outbreak of hog cholera and swine erysipelas.30(p228) Rabies was a problem for servicemen, civilians, and even South Korea’s president.

Veterinarians vaccinated President Syngman Rhee’s dog for rabies and treated the dog when it became ill. Several months later, the dog started acting strangely and exhibited signs of rabies. The dog was isolated, died, and tested positive for rabies at the 1st Medical Laboratory. The Eighth Army Surgeon made arrangements to have the entire Rhee household receive the antirabies treatment.

Mascots for units and pets for Army generals serving in Korea fell under the small but varied category of animal care. Dogs, cats, and monkeys were in this group but so were bears. The 187th Regimental Combat Team’s Anti-Aircraft Artillery Battery kept a male bear named “Rocky” as a mascot.[37] The bear, outfitted with a special harness, made a few parachute jumps and was wounded when an enemy mortar round hit the 187th Regimental Combat Team’s area in Korea in 1953.[37] It is presumed his care and vaccinations were provided by an Army veterinarian. Army veterinarians also vaccinated a bear that was imported to the United States, a gift from South Korea’s President Rhee to President Dwight Eisenhower.29(p16)

Veterinary efforts and those of the US Army, in general, stabilized as hostilities ceased with the Korean Armistice Agreement on July 27, 1953. The military footprint within the country remained as the uneasy truce held. Veterinary services continued to ensure food safety and provide animal care as designated for the next 50 years. The Veterinary Service now has fewer personnel in Korea, due to the shifting of troops to the wars in Afghanistan and Iraq, but still performs its missions.

The Early Years of the Cold War

Europe. Although the war in Korea was the “hot” embodiment of the Cold War, the American military maintained a global presence after the 1953 ceasefire that impacted various Veterinary Service missions. The massive number of US troops as well as military dependents in Europe provided an urgent need for food inspection. The inspection mission followed troop concentrations and local production facilities. Veterinarians and veterinary technicians served in a variety of European countries and were instrumental in preventing food-related sickness over the course of five decades.

To ensure food safety for the large Army of the Cold War, veterinary personnel were serving roles similar to the USDA and the Food and Drug Administration (FDA) in overseas locations. As an example, the veterinary food inspection specialists in Romania and Yugoslavia performed antemortem and postmortem carcass beef and pork inspections destined for all services (most meats were locally procured). Dairy plants were inspected using the FDA’s Pasteurized Milk Ordinance and had to meet equivalent standards.

The US Army Veterinary Detachment, Europe, performed food inspection missions across an extensive geographic area. The countries that inspectors surveyed commercial food plants included Denmark, Norway, Sweden, Finland, Scotland, Iceland, Greenland, The Netherlands, Luxembourg, Belgium, France, Spain, Austria, Yugoslavia, England, Wales, Northern Ireland, Germany, and the Azores.[38] Inspections of local perishable products eliminated the need for expensive air transportation modes to deliver American-produced perishable items to overseas locations with any shelf-life remaining. Since these local inspections involved large contracts, the DoD not only saved millions of dollars in overseas shipping charges, but also reduced the amount of money lost due to US-procured perishable products spoiling during shipments (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author).

Similar to the mission in Europe, food inspection missions were conducted in Africa from the 1950s to 1970s. Working in locations such as Eritrea and Ethiopia, local sources of food were inspected, and health standards were improved for service members. These new sanitary improvements brought about a pasteurized milk plant that greatly assisted the local economy as well (conversation between Sergeant Major [Retired] Robert Kilburn, US Army Veterinary Service, and Nolan A. Watson, chapter author, May 18, 2015).

Although the first mission in post-World War II Europe for veterinarians was food safety, veterinary treatment facilities (VTFs) were established for government-owned animals and, later, for the pets of military service members and their families. Unlike previous conflicts, the American Army did not dismantle after the Korean ceasefire, and as the military continued to build, it became the chosen profession for many more people. These volunteers were augmented by millions of drafted servicemen. The larger force and the unprecedented “Baby Boom” changed the US Army’s global outlook about medical care needs for humans and animals. An increasing number of military families needed medical care, and privately owned animals and military working dogs (MWDs) were growing in numbers as well. European animal quarantine requirements and veterinary treatment, in general—coupled with the continuous movement of service families—kept the US Veterinary Service busy.

In Europe, veterinarians also monitored the procurement of dogs for the military. A European Command Dog Training Center was established in 1950 at Lenggries, Germany. (See Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Services, for more information about the evolution of military canine procurement, training, and healthcare at home and abroad.) The unit would later change its name to the US Army Dog Training Detachment, Europe, and was directly supported by the 51st Medical Detachment (Veterinary Animal Hospital).

The 51st would remain in Europe and go through some name changes and moves in the coming decades; it was later designated as the 51st Medical Detachment (Veterinary Medicine). In 2008, the detachment left its station on Pulaski Barracks in Kaiserslauten, Germany.[39] A veterinary activity remained in place, however, and was renamed Dog Center Europe.[39] (Dog Center Europe served as the first stop for in-depth [Role 3] treatment and evaluation for seriously wounded MWDs evacuated from Operation Enduring Freedom [renamed Operation Freedom’s Sentinel in 2014] and Operation Iraqi Freedom; further discussion of these operations is found in subsequent sections of this chapter.)

Early comprehensive food testing and other diagnostic and laboratory support for veterinary activities in Europe was provided through the US Army Europe Medical Laboratory located at Landstuhl, Germany.[40] The laboratory was established in 1954 and had a veterinary element, the Department of Veterinary Medicine, staffed by personnel assigned to the 10th and 4th medical laboratories.[40] The work load was considerable: in the mid-1960s, the laboratories performed approximately 60,000 separate food analysis determinations per year.[41]

Stateside research and laboratory work also continued and took into consideration the possibility of a nuclear battlefield. Veterinary testing increased understanding of safety and treatment for the new threat. Similarly, biological and new chemical agents were also examined. Building upon efforts during World War II, specifically the veterinary pathology registry organized in 1944 at the Army Medical Museum (renamed the Armed Forces Institute of Pathology, 1948–2011), Army veterinarians were able to expand and document laboratory work, seeking to improve human health through experimentation, observation of zoonotic diseases, and other research.[42] In the early days of space travel, veterinary pathologists were also tasked with observing the health of animal test subjects and the correlation of human physiology. By 1961, the Veterinary Pathology Division at the Armed Forces Institute of Pathology had three branches: (1) General Veterinary Pathology, (2) Animal Care, and (3) Surgery and X-ray.[42]

Stateside Successes and Struggles. These ongoing studies had positive results. In 1952, Major (later Colonel) William S. Gochenour, Jr, Veterinary Corps, demonstrated that “Ft Bragg Fever,” thought to be caused by a virus, was actually due to infection with a Leptospira bacterium.[43] An internationally known veterinary scientist, Gochenour had served previously during World War II and was held in captivity by the Japanese in the Philippines until his liberation in 1945.[44] Clayton Mickelsen (previously mentioned Distinguished Service Cross recipient) and Gochenour served together in the 26th Cavalry Philippine Scouts[45] (Figure 1-20).

Figure 1-20. Colonel William S. Gochenour, Jr, (right) at retirement in 1971 wearing an abbreviated version of his uniform. Gochenour spent numerous years performing research as veterinary scientist at the Walter Reed Institute of Research. Previously he served in World War II and was held in captivity by the Japanese. During the war he earned the Combat Infantryman Badge. Later, during the establishment of the Vietnamese National Institute of Bacteriology in Saigon (1967–1968), Gochenour donated 120 bound volumes and 775 scientific journals from his personal library to the facility.
Courtesy of the Walter Reed Institute of Research Archives, Washington, DC.

Despite successes and the growing peacetime force, there was some opposition to retaining the military Veterinary Corps. Charles Erwin Wilson, Secretary of Defense (1953–1957), sought to rein in military spending after the Korean War. In his efforts, he decided that veterinarians of the Army and Air Force needed to leave the military or find nonveterinary-related positions.[46] Wilson reasoned that contracted animal care was more efficient, echoing statements that he had made publicly that there were more veterinarians in the military than animals.[47] His analysis totally disregarded the Veterinary Corps’ food safety and inspection missions and laboratory work.

As part of his plan to cut the Veterinary Corps, Wilson wrote a memorandum on May 15, 1956, barring the commissioning and enlisting of veterinary personnel. However, because the Veterinary Corps was established by Congress in 1916, Congress alone had power to disestablish the Corps, and despite his testimony before Congress, this legislative body rescinded Wilson’s order.[47] Unfortunately, the elimination of veterinary services would again be revisited after the Vietnam War (Figure 1-21).

In 1946, the Medical Field Service School at Carlisle Barracks, Pennsylvania, closed for its upcoming move to Ft Sam Houston, Texas. After closing and moving, the school was renamed the “Army Medical Department Schools,” operating under the then-named Brooke Army Medical Center, but this school was not to last.48(p2) On January 15, 1947, Brooke Army Medical Center General Orders 3 reorganized the school components and consolidated them back into the newly incorporated “Medical Field Service School.”48(p2) Included in the school was the Department of Veterinary Service, which had the early responsibilities of not only instruction, but also oversight for a veterinary and pharmacy Reserve Officers Training Corps summer camp in the early 1950s.48(p41) In the 1950s, departmental courses were comprised of, but were not limited to, the following subject matter: food inspection, veterinary laboratory service, veterinary service with military animals, veterinary preventive medicine, and veterinary public health.

Figure 1-21. European Stars and Stripes newspaper from May 22, 1956. The headline describes the problem faced by military veterinarians when Secretary of Defense Charles Erwin Wilson issued a memorandum barring the commissioning and enlisting of veterinary personnel and also sought to replace veterinarians in uniform with contract veterinarians.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Even before the Medical Field Service School move, Ft Sam Houston had several Veterinary Service connections. Serving as the headquarters of the Army’s Southern Department for operations along the US and Mexico border (1912–1918), Remount Station #2 (now located on the grounds of Dodd Army Airfield) was used as a depot to provide equine care support for cavalry and other troops.[49] Similar operations would continue as post operations expanded during World War I. One horse began his Army career in 1912 at Ft Sam Houston, and “Pat” remained at the post, ultimately passing away at age 45 in 1953.[50] The post also maintained an aviary as part of the World War II Signal Corps pigeon breeding program. (For more information about the uses of various government-owned working animals throughout US military history, see Chapter 2, Military Working Dog History; Chapter 6, Human-Animal Bond Programs; Chapter 7, Marine Mammal Program; and Chapter 8, Military Equine Programs.)

As the Medical Field Service School became more ingrained at Ft Sam Houston, there were other changes. On January 14, 1955, dedications took place in Building 2792. Several halls were memorialized in memory of great leaders and pioneers in different fields of Army medicine. The eastern bay of the building was dedicated to Brigadier General Raymond A. Kelser, US Army Veterinary Corps, who passed away in 1952.[51] Later, in 1972, when the two current Army Medical Department (AMEDD) Center and School (C&S) buildings were dedicated (Aabel Hall, Building 2840, for Colonel Bernard Aabel, US Army Medical Service Corps; and Willis Hall, Building 2841, for Major General John M. Willis, US Army Medical Corps), the eastern plaza of Willis Hall was designated as Kelser Plaza (Figure 1-22). The total campus of the AMEDDC&S is now referred to as the AMEDDC&S, Health Readiness Center of Excellence (HRCoE).

Elsewhere, other Army veterinary training was also undergoing changes. There was not an official Meat and Dairy Hygiene School for Army veterinarians until after World War II. During the war, the Chicago Quartermaster Depot maintained the facility, allowing veterinarians to provide instruction and courses. In 1952, War Department General Orders 80 moved control of the activity from the Quartermaster General to the Surgeon General and changed the name of the facility to the “Army Medical Service Meat and Dairy Hygiene School.”

Figure 1-22. Photograph of current (2017) plaque for Kelser Plaza at the Army Medical Department Center and School, Health Readiness Center of Excellence, Joint Base-San Antonio, Ft Sam Houston, Texas.
Courtesy of Nolan A. Watson, chapter author.

Vietnam War

Establishing a US Veterinary Presence

Early Army efforts in Vietnam began with the Military Assistance Advisory Group, later to be called the Military Assistance Advisory Group Vietnam. Up until 1965 (when American involvement increased), the United States only sent advisors and support personnel, considered as “noncombat” troops. In an effort to bolster the capabilities of the Army of the Republic of Vietnam (ARVN) (Figure 1-23), the Military Assistance Group Vietnam worked towards enhancing the ARVN MWD program already in place (canine numbers increased from 56 to over 1,000 MWDs).24(p1) The ARVN Veterinary Corps didn’t have any graduate veterinarians, and the MWDs were experiencing extensive medical problems.24(p22)

The first US Veterinary Corps officer to serve in Vietnam, First Lieutenant Roger N. Wiggins, arrived in early 1962.24(p3) His mission was to help establish a veterinary care system for the ARVN MWD program.24(p23) Although this was a huge task for a first lieutenant with less than a year of service, his plan was quickly implemented, with only a few modifications as the war progressed.24(p4)

Since the ARVN Veterinary Service was poorly equipped and poorly trained, and only one college in South Vietnam offered a 4-year Bachelor of Science degree called Veterinary Engineer, US Army VCO advisors had to start from the beginning to build the ARVN Veterinary Service. They provided on-the-job training to the ARVN Veterinary Engineer warrant officers, developed a 6-week course for ARVN enlisted veterinary technicians, and set up policies and procedures for medical supply channels, records and reports, dog rations, parasite control, immunizations, kennel sanitation, and evacuation.24(p23) ARVN veterinary personnel also were sent to the United States to attend the basic food inspection course. As the need (and the war) expanded, more US Army veterinary personnel, including numbered units, were brought in to provide veterinary care for the expanding ARVN MWD program.24(p25)

In 1967, to rectify the shortage of graduate Vietnamese veterinarians in the military and civilian community, Veterinary Corps advisors arranged to train Vietnamese students at the veterinary school in Thailand with the US Agency for International Development funding.24(pp36-38) Unfortunately, the first group of students didn’t start training in Thailand until 1970,24(p38) but 50 students were trained in Thailand and returned to Vietnam by 1974.24(p38)

A major problem with the ARVN MWDs was malnutrition, as it was hard to build an acceptable ration from local sources. Dog food that contained enough protein to maintain the dogs’ health cost more than the AVRN handlers’ ration and wasn’t approved by the ARVN leadership.24(p14) When the supplementation ration finally arrived, the handler and his family often ate a portion of the dog food, and the MWD still ended up being malnourished.24(p14) The appearance and nutritional health of the dogs began to improve in 1966, when an Army VCO went through the Military Assistance Program to obtain US-produced dog food.24(p15)

Figure 1-23. Map of veterinary units (circa 1967–1968) in Vietnam.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Another major problem with the ARVN MWDs was heat exhaustion, especially when dogs purchased from CONUS were initially brought into Vietnam. Eventually, several factors limited MWD heat casualties: helping animals acclimate, limiting MWD training hours and work, and educating handlers on heat exhaustion dangers.24(p31)

Several diseases also were crippling the ARVN MWD program including distemper and leptospirosis. US Veterinary Corps advisors were able to bring distemper under control by exceeding the original recommended doses of serum and vaccine usually given to canines with distemper.24(p30) The advisors suspected rat infestations throughout the MWD compounds, including the food storage areas, were causing the leptospirosis problem and concluded the dogs were suffering from strains of Leptospira resistant to most existing vaccines. The MWDs were finally successfully treated using high doses of penicillin.

US Veterinary Corps personnel were also involved in many ARVN civic action (CA) activities with very limited long-term success, to include working in dog clinics, human clinics, animal husbandry programs (for swine, poultry, and cattle), and rabies control programs.24(pp41-44) One of the more successful US Veterinary Corps efforts was the establishment of the ARVN food inspection program; at first, the ARVN personnel were trained in the United States and later established the Vietnamese Army’s food inspection program, patterning it after the US Army Veterinary Corps program, which included origin and surveillance inspections and laboratory testing.24(p45) In 1966, US veterinary personnel established a 3-month food inspection course to train future ARVN enlisted personnel in Vietnam.24(pp45-46) Eventually, locally trained ARVN program personnel became even more self-sufficient, not only developing combat rations for their own ARVN soldiers, but also inspecting these rations using their own food inspectors.24(p46)

The road to this self-efficiency was a bit bumpy. Many of these first Military Assistance Advisory Group Vietnam advisors reported having diarrhea. First Lieutenant Wiggins, who earlier had helped establish the ARVN MWD program, was asked to develop a food inspection program for the ARVN.24(p88) Wiggins recommended more VCOs be brought in to assist with the new task, and more VCOs and enlisted personnel were sent to Vietnam, starting in May 1962.24(p88)

Concerned about the deteriorating political climate in Vietnam in 1962, President John F. Kennedy decided to increase the numbers of US personnel from 3,000 to over 11,000. The larger numbers of troops did not ease the cases of diarrhea; cases of hepatitis also increased.24(p88) The causes for these problems were not mysterious: large amounts of perishable foods were spoiling during the shipment from the United States to Vietnam, and locally procured food was suspected of causing food-borne illness. A food inspection program was needed to improve the safety and wholesomeness of locally procured food, as well as the food arriving from the United States. The first veterinary food inspector in Vietnam, First Lieutenant Gerald D. Kugel arrived in May 1962 and was soon followed by more Army and Air Force Veterinary Service personnel. They would have the unenviable task of developing and implementing the food inspection program in Vietnam, including an approved local food source directory.

Many problems needed to be addressed, including substandard warehousing and storage facilities at the port and a shortage of refrigeration and freezer space. Staggering food losses occurred until late 1967, when ships arrived with food in self-refrigerated Sea-Land vans that could continue refrigerating the items during transport to the various bases in Vietnam.24(p93) Since ships took 45 to 50 days to reach Vietnam from the United States, Veterinary Service personnel were deeply involved with local procurement inspections of foods, to include dairy, ice, bread, fresh fruits and vegetables, and eggs; each egg had to be candled to check for potential defects24(p94) (Figure 1-24).

Filled milk plants had to be established and inspected as Vietnam had practically no dairy industry. Filled milk, or milk reconstituted from skim milk powder with vegetable fat (coconut oil), was often used in the Pacific and was of high quality, wholesome, and greatly appreciated by service members (electronic personal communication from Colonel [Retired] William Kerr, US Army Veterinary Corps, to Colonel Leslie G. Huck, chapter author, January 18, 2015). Ice plants had to be closely inspected to monitor proper chlorination and sanitation to prevent numerous diseases.[52] Sanitation was so bad in the local bakeries that none was on the approved list; instead, inspectors were kept at the bakeries on a full-time basis.

One study on bacterial flora from fresh fruits and vegetables received showed 30 percent of the samples were positive for Shigella, so veterinary personnel provided chlorination instructions and focused inspection efforts on mess halls to ensure produce was washed, chlorinated, and rinsed in three separate tanks.24(p100) Surveillance food inspection was always in demand to mitigate losses due to dispersed Class I operations: poor storage facilities, heat, humidity, limited refrigeration capabilities, rodent problems, insect infestations, and excess food supplies in storage. The 9th Medical Laboratory arrived in Vietnam in May 1966. The unit’s arrival helped support the field inspectors’ decisions.24(p105) Through constant monitoring and inspection, food-borne illness was never reported as a significant problem, despite all of the other problems encountered with the food (electronic personal communication from Colonel [Retired] William Kerr, US Army Veterinary Corps, to Colonel Leslie G. Huck, chapter author, January 18, 2015).

Figure 1-24. Specialist 4 Ronald G. Lopez and Staff Sergeant John R. Weeks, both of the 245th Medical Detachment (Veterinary Services), inspect a shipment of orange juice at Long Binh, Vietnam, December 1968. US Army Signal Corps photo 54132.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Initiating a Veterinary Animal Care System

In 1965, military police brought in the first US military dogs to support American forces. By November 1965, the 180 sentry dogs in country were spread out at 10 locations.24(p117) Marines also brought in sentry dogs. The first scout dog platoon arrived July 14, 1966, and by the end of 1966, the total number of dogs rose to 673.24(p117) Since dog food and fixed kennels were not readily available locally, veterinary personnel were kept busy trying to mitigate these supply system problems.

The veterinary care system, patterned after the human medical care system, started at the primary level with the Military Occupational Specialty 91T (now 68T Animal Care Specialists) organic to each scout and sentry dog platoon at the dispensary level; the veterinary hospital level provided long-term care.24(p117) The improved care also included an evacuation system for each level.24(p117) Because of the wide dispersion of dog platoons and the increased number of dogs (1,200 dogs by 1967), veterinary food inspection (JA and JB) detachments had to pick up the dispensary level care. (JA and JB refer to TO&E listings. JA units are small or expansion Veterinary Service teams. JB units are larger Veterinary Service teams.) Military Occupational Specialty 91R (today’s 68R Veterinary Food Inspection Specialists) were cross-trained by VCOs to provide animal care. The JA and JB teams’ TO&Es were eventually changed to include veterinary medicine sets and 91T personnel.24(p118) Later when the numbers of military dogs in Vietnam grew, the organization of veterinary units altered and small animal dispensaries (IE units) and small animal hospitals (ID units) increased.24(pp118-119)

By January 1966, the veterinary units in Vietnam included the 4th Medical Detachment (Veterinary Service, VS), 75th Medical Detachment (JA), 68th Medical Detachment (JA), and the 936th Medical Detachment (ID).24(pp119-120) Initially, veterinary hospital care fell to the 936th Medical Detachment Infantry Division, which maintained a small animal hospital located at Tan Son Nhut in early 196624(p120) (Figure 1-25). The 504th Veterinary small animal dispensary arrived in Vietnam in October 1966.24(p121) Adequate veterinary assets were now able to focus on improving preventive medicine and kennel facilities.

The initial evacuation system for working dogs in Vietnam did not include helicopters, and Air Force plane evacuation procedures were not very dependable. In 1969, helicopter evacuation became available for dogs and handlers, and an evacuation policy was established for dogs requiring more than 7 days of treatment; however, no dogs were medically evacuated outside of Vietnam.24(p123)

Complaints concerning dog food being shipped to Vietnam go back to 1959. Because of rancidity, mold, and insect infestation, large quantities had to be condemned, which led to the development of a special stress diet developed by Hill’s Packing Company. Mitigating other problems such as shelf life, the “diet” included preventatives for heartworms and hookworms.24(p125) Since the dog force build-up was rapid, many kennels were initially constructed without veterinary consultation, which led to an increased incidence of hookworms and sanitation problems. In addition to using the new dog food for MWDs, veterinary personnel worked closely with kennel staff to improve MWD kennel conditions.24(p127)

The US military looked at improving dog capabilities and expanding their mission (eg, to include mine and booby-trap dogs, drug detection dogs, and explosive detection dogs). For German shepherds, the military started to research genetic improvements to reduce inherited problems such as hip dysplasia and improve intelligence and trainability. Three VCOs, a geneticist, 27 enlisted personnel, and two clerks worked on these traits in the Biosensor Research Program starting in fiscal year 1969.24(p129) After 8 years, they succeeded in reducing hip dysplasia from 50 percent to 18.7 percent, while improving intelligence and trainability.24(p133) Termed the “Super Dog” Program, the project was supposed to switch from research to production, but since the war was over by the time of the results, the entire program was eventually halted.24(pp128,133) (See Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Services, for more information about historic and current canine research and training programs.)

Figure 1-25. (Left to right) Specialist 4 Richard S. Shanks, dog handler, holds down his injured scout dog “Gunn” as Captain Rodney F. Taylor, Veterinary Corps, and Captain William T. Watson, Veterinary Corps, administer treatment. Image taken at the 936th Veterinary Detachment’s “War Dog Hospital” at Tan San Nhut Air Base, November 30, 1968. US Army Signal Corps photo 54174.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Supporting Special Forces and Laboratories

In the early 1960s, as the Army began officially recognizing Special Forces units, veterinary support was also considered for these units. In Vietnam, some of the first VCOs serving in Special Forces had the mission of food inspection. Isolated from supply systems, local livestock was often the food source for these soldiers and their teams. VCOs also assisted the Special Forces teams by controlling animal diseases and improving livestock and crop production in local areas. These tasks were efforts to help villages and the imbedded teams become self-sufficient. Veterinary personnel performed animal care in support of other missions such as animal transport to include elephants. The Special Forces veterinary personnel would also assist in aspects of medical CA programs (Figures 1-26 and 1-27).

Figure 1-26. “These assignments should be most interesting….” An early notice seeking Army veterinarians for Special Forces from the April 1963 Army Veterinary Corps Memorandum (newsletter).
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Figure 1-27. A Special Forces veterinarian providing instruction for the 97th Civil Affairs Group, Okinawa. Special Forces veterinarians were involved in a variety of tasks in Vietnam, including one instance of elephant transport.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Laboratory support for the veterinary personnel and their operations was essential, and similar to the other activities, it took time to coalesce. Testing for diseases and food nutrition or studying other occurrences, military personnel performed the laboratory work at larger facilities until the veterinary detachments and their substations were solidified and properly equipped. The Veterinary Division of the 9th Medical Laboratory started providing comprehensive veterinary laboratory service in Saigon on August 1, 1966. When the 9th was inactivated and left Vietnam, the 406th Medical Laboratory in Japan assumed its duties.

The South East Asia Treaty Organization Medical Laboratory in Bangkok, Thailand, was another source for comprehensive research. Items encountered in the field were also collected. Some of the histopathology specimens were sent to the Armed Forces Institute of Pathology in Washington, DC, for further study.24(p127)

Another major veterinary laboratory was located in Vietnam. VCOs worked closely with the US Agency for International Development to control livestock diseases and develop a vaccine production facility in Vietnam (Figures 1-28 and 1-29). Vaccine production was achieved through the establishment of the Vietnamese National Institute of Bacteriology, which had to be created virtually from scratch. US Army veterinary personnel worked together with the South Vietnamese to maintain production, research, and testing. The first objectives were to build laboratory infrastructure in Vietnam, which required improved administration, facilities, equipment, supplies, testing capability, vaccine and bacterin production, and training programs for Vietnamese personnel to eventually run the programs. Through hard work, these VCOs were instrumental in producing vaccines for hog cholera, Newcastle disease, fowl pox, and rinderpest, as well as several bacterins.24(pp167-168)

Figure 1-28. The Vietnamese National Institute of Bacteriology, exterior view. Formed in cooperation with the US Agency for International Development, the institute performed research and produced vaccines for livestock diseases within Vietnam. Daily operations were overseen by Army Veterinary Corps officers.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Studying and Preventing Zoonotic Disease

Combining the previously mentioned Special Forces’ capability and the need to study and collect samples from Vietnam, veterinary personnel served on the field epidemiology survey teams (FEST) from the Walter Reed Army Institute of Research (WRAIR).24(p140) These teams, which were attached to the 5th Special Forces Group in Vietnam, were Special Forces-qualified in order to ensure their personnel’s abilities to work autonomously within the country. Originally, the mission of FEST was to collect and study diseases found in Vietnam that were affecting US troops. In late 1966, FEST was expanded to include veterinary and laboratory officers, not just Special Forces personnel.

Figure 1-29. Graphic for the Vietnamese National Institute of Bacteriology and US Agency for International Development.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Figure 1-30. Major James A. Ferguson, Veterinary Corps, inspects a Vietnamese villager’s cow. Ferguson served as a member of the Walter Reed Army Institute of Research’s field epidemiology survey teams in Vietnam in 1967 to 1968. These teams were attached to the 5th Special Forces Group in Vietnam. The personnel were Special Forces-qualified in order ensure their ability to work autonomously within the country. US Army photo.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Zoonotic diseases were of primary importance of study and collection by the veterinary contingent. Additionally, the added veterinary presence allowed for animal health surveys that were not tied to one region. Although successful in gathering information and samples, the FEST program was disestablished in October of 1968 (Figure 1-30).

In addition to Veterinary Services personnel in laboratories, preventive medicine units, and Special Forces, there were six types of TO&E veterinary units assigned in Vietnam. The 522nd Medical Detachment located in Long Binh was the TO&E units’ command and control unit. Subordinate units included three JB teams (4th Medical Detachment responsible for III and IV Corps, the 176th Medical Detachment supporting II Corps, and the 175th Medical Detachment supporting I Corps); two JB (reduced) units in II and III Corps; one JA team in III Corps; and one ID Veterinary hospital at Long Binh, and several IE small animal dispensary units in III and II Corps (electronic personal communication from Colonel [Retired] William Kerr, US Army Veterinary Corps, to Colonel Leslie G. Huck, chapter author, January 18, 2015).

Transmissible Canine Pancytopenia. During the summer of 1967, Army veterinarians in Vietnam began noticing fevers of unknown origin in their MWDs. One year later, these veterinarians realized they were dealing with an epidemic; of the 1,200 US MWDs in the region, 89 had died.24(p139) In addition, the MWDs that had served in Vietnam and then were sent back to Okinawa were becoming ill and several died. Epistaxis was usually the first clinical sign, with death usually occurring a few days afterward. Some other symptoms noticed included weight loss, anemia, leukopenia, thrombocytopenia, edema, lethargy, dyspnea, and anorexia.24(p139)

US veterinarians instituted a quarantine (Vietnam and Okinawa MWDs were not allowed to be shipped to other countries).24(pp140,144) After consulting with the WRAIR and 406th Medical Laboratory in Japan, they tested MWD blood samples for known viral and bacterial agents, including known rickettsial diseases—all were negative.24(p140) Despite the results, the Army veterinarians suspected the illness was caused by a rickettsial organism and was being spread to the MWDs by ticks. In addition to the quarantine of suspect MWDs, veterinarians implemented a strict tick-control program and euthanasia of clinical cases. In 1969, several Army veterinarians at the WRAIR found the tick-borne culprit, Ehrlichia canis, which had been identified earlier in other parts of the world but wasn’t known to cause hemorrhagic disease.24(p143) The disease, canine ehrlichiosis or tropical canine pancytopenia (TCP), was thought to have been brought into Vietnam when US forces bought tracker dogs from the British military in Malaysia.24(pp143-144) Researchers at the WRAIR worked out the pathogenesis, diagnostic test, and treatment, and demonstrated tetracycline was effective to prevent and treat the disease.24(p145)

By 1970, the high MWD losses to TCP were mitigated. However, the US and ARVN estimated losing 300 and 100 MWDs, respectively, to this disease before bringing it under control.24(pp144-145) In addition to TCP, Army veterinarians kept busy treating more common illnesses and nonbattle-related injuries. In fact, though there were some combat injuries, the majority of animal treatment cases were not related to actual combat24(p415) (Figure 1-31).

As the Vietnam War drawdown began, troop numbers including veterinary units decreased; however, the numbers of MWDs being supported did not decrease. By May 1970, the Army and Air Force had approximately 1,600 MWDs in Vietnam.24(p149) Initially, DoD policy did not allow these dogs to be brought back to the United States because the TCP epidemiology was still being researched.24(p149) However, after public outcry and congressional involvement, healthy dogs could be returned after screening. Army veterinarians ran 21-day quarantine programs to exclude suspect MWDs,24(p150) and 191, deemed healthy, returned to the United States by the end of 1972. Of the remaining dogs, some were euthanized or died, but the majority (971) were transferred to the ARVN.24(p151) (For more information about the service and care of canines during the Vietnam War, see Chapter 2, Military Working Dog History; information about more current MWD procurement and disposition policies can be found in Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Services.)

Common Diseases. Some of the more common zoonotic diseases in Vietnam were brucellosis, anthrax, salmonellosis, shigellosis, cysticercosis, meliodosis, leptospirosis, and rabies.24(p155) Military veterinarians were involved in controlling leptospirosis, both in humans and MWDs, first, through their food inspection duties and animal care and, later, via their laboratory capabilities. For example, in 1962, one airman died of leptospirosis, and 16 others became ill.24(p155) Since inspectors suspected that a local bread source’s cooling racks were being contaminated by rats (rodents transmit leptospirosis), the military stopped buying from local sources. Rats were also suspected of contaminating MWD food supplies.24(p156) After the 9th Medical Laboratory started testing in August 1967, the laboratory found 42 human cases of leptospirosis within 5 months.24(p156)

Rabies, a widespread problem in Vietnam both before and after American military involvement, was briefly brought under control. While US forces were in the country, the disease was somewhat corralled, especially in light of the number of servicemen involved and considering the disease is endemic in Vietnam. Outbreaks and sources were studied early on. Although animal mascots boosted the troops’ morale, they were considered a constant rabies threat. Through testing, VCOs determined rabies was not a problem in wildlife; the disease was primarily found in stray dogs.24(p158) Over 25 percent of positive cases were in pups less than 16 weeks old; they were usually asymptomatic when they died.24(p158)

Figure 1-31. While most of the health problems faced by military working dogs in Vietnam were related to malnutrition, heat, and disease, combat injuries were also seen by Veterinary Corps officers. Information found in the January 1969 report of scout dog operations, 39th Infantry Scout Dog Platoon, 173rd Airborne Brigade.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

In the beginning, however, rabies testing and confirmation processes had logistical issues (eg, when the laboratories servicing the veterinarians were unable to communicate or transfer samples). Lieutenant Colonel Thomas G. Murnane, VC (later Brigadier General and Chief of the Veterinary Corps, 1976–1980), added rabies testing capability to the 9th Medical Laboratory in 1966.24(p159) His arrival as an onsite VCO resolved some of the communication issues between laboratories that were testing for rabies. During that year, 64 out of 296 animal heads tested positive for rabies.24(p159)

After a later exposure incident involving a dog mascot and a large number of Marines, rabies control received command emphasis to include mascot registration and vaccination and stray animal control. Rabies suspect animals were quarantined, and the collection and evaluation of statistics for the disease were strictly maintained. Despite the major achievements made by US Army veterinary units, five Americans died from rabies (two military and three contractor employees) in Vietnam.24(p165) (For more comprehensive information about rabies and other military zoonotic disease control concerns for service members and civilians, see Chapters 11, 12, and 13 in this textbook’s Section 4, Preventive Medicine and Public Health Services.)

Conducting Civic Action

Veterinary personnel expanded their mission in Vietnam to include what was later called “nation-building” or “stability operations.” One area with potential to build positive partner capacity with was the project to help the Vietnamese produce adequate amounts of animal protein, which was in short supply. Livestock production was hampered by disease: almost half of the swine died of hog cholera (Figure 1-32); death rates in chickens often approached 100% due to Newcastle disease, fowl pox, and fowl cholera; and cattle and buffalo were stricken with serious diseases such as rinderpest, anthrax, and foot and mouth disease (FMD).24(p167) Additionally, most of these animals suffered from parasites and malnutrition.24(p167)

In July 1966, for the first time in Vietnam, US veterinary personnel supported a large-scale CA program. Working with the 1st Infantry Division, the veterinary personnel assisted a resettled local population in fortified villages by deworming pigs and vaccinating them using a Saigon-produced hog cholera product. They also developed an edible garbage feeding program,24(p170) provided antibiotic treatment to treat secondary infections of cattle and buffalo stricken with FMD, and helped construct livestock pens.24(p170)

Figure 1-32. The 4th Medical Detachment (Veterinary Services) civic action team members treat pigs in the Vietnamese village of Co Vap. US Army photo.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

In March 1967, veterinary personnel were attached to the 4th Infantry Division to assist with this division’s CA programs. Veterinary unit-level CA projects, which saved some livestock and had a positive effect on the Vietnamese people, included animal vaccinations, treatments, and surgeries. One enlisted Veterinary Service soldier actually lived in a village in order to help the residents construct a church, hog pens, wells, and toilets.24(p174) The medical and dental units developed CA programs known as Medical Civil Action Program or MEDCAP and Dental Civil Action Program or DENCAP; later, veterinary units formalized CA programs known as the Veterinary Civil Action Program (VETCAP), which included a purebred swine import program, mobile vaccination teams, and a veterinary training program for Vietnamese students in Thailand.24(p176)

Remembering Veterinary Service Losses in Vietnam

During the Vietnam War, the US Army Veterinary Service lost two soldiers, who seemingly had a lot in common. On December 20, 1968, Specialist 4 Douglas O. Duke (animal care specialist) was driving a jeep with VCO Captain Jack P. Blake in the Binh Duong Province. Their jeep hit an enemy mine or similar device, with the resultant explosion killing both soldiers.[53] Both men served with the 4th Medical Detachment (VS). Captain Blake was from Beaumont, Texas, and a graduate of Texas A&M University (class of 1966). Specialist Duke was from Oklahoma, a graduate of Oklahoma State University, and had also lived in Texas. Blake and Duke were also very close in age (24 and 23 years of age, respectively) (Duke was 8 days from turning 24)[54] (Figure 1-33).

Figure 1-33. On December 20, 1968, Specialist 4 Douglas O. Duke, animal care specialist, was driving a jeep with Veterinary Corps officer Captain Jack P. Blake in the Binh Duong Province. Their jeep hit an enemy mine or similar device, and the resultant explosion killed both soldiers. They served with the 4th Medical Detachment (Veterinary Services). (The image was not taken during the time of the incident.) Blake is behind the steering wheel; Duke is the passenger seated diagonal from Blake.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Ensuing Problems After the Vietnam War

Mirroring the withdrawal of forces in Vietnam, veterinary services were proportionally reduced. Food inspection, laboratory testing, and animal care in Vietnam diminished as the American military presence departed. Despite the exit from Vietnam, laboratory services and research continued in Thailand and Japan. The Veterinary Corps also continued to safeguard the military by providing food inspections, assist civil authorities curb animal disease epidemics, and conduct continuous laboratory and research elsewhere. Despite these actions, there were again governmental calls to eliminate veterinary services for the military.

Veterinary Service Scrutiny. During the 1970s, a series of studies and reviews targeted the US Army Veterinary Corps, ranging from total elimination, merging with other corps, and large personnel cuts. In 1970, a US Government Accountability Office (GAO) Report to Congress indicated a need to reassess the food inspection roles of the various federal organizations, including the DoD.55(p6) The report noted that there was considerable federal inspection overlap on many foods, which caused dissatisfaction in the food industry. The report also included the viewpoint that various federal food inspection organizations could be streamlined to be more effective and less costly.55(pp6-7),56

After the 1970 GAO report was released, the US Army’s veterinary missions were scrutinized almost yearly, and the fate of the US Army Veterinary Corps and how the US Army Veterinary Service should operate hung in the balance for a decade:

- In 1971, a Senate bill was drafted with the following goals: to conduct a review and use its results to more practically meet the military’s medical needs, while reducing military medical personnel in administrative and research roles. The bill further proposed medical personnel should be used only in their specialty in a clinical role. DoD officials included the Army Veterinary Corps in this review. The review concluded that food inspection didn’t necessarily have to be performed by licensed veterinarians; they could potentially be replaced by trained sanitarians and food technologists with lower salaries.

- In 1972, a Department of the Army (DA) study was conducted to examine all the Veterinary Corps’ functions and determine which corps’ authorizations could be filled with civilian veterinarians or nonveterinary military personnel. That same year, the DA established a team to analyze the entire Veterinary Corps with the objective of providing veterinary service at the lowest cost to the DoD.

- In 1974, the GAO investigated military veterinary activities, again looking for ways to reduce military veterinarians to the minimum number necessary to accomplish their responsibilities. The GAO found Veterinary Service (includes enlisted personnel) was providing cost-effective, essential duties that could not be outsourced more economically. That same year, the Army Audit Agency examined the Veterinary Corps (includes VCOs only), per the request of the Secretary of Defense.

- Also in 1974, the Office of the Secretary of Defense (OSD) requested the GAO audit both the Army and Air Force Veterinary Corps to look for possible ways to reduce VCO numbers (eg, by replacing VCOs with nonveterinarian personnel in various food inspection activities, with civilian veterinarians for privately owned pet care, and with contractors for government-owned animals in the United States). However, rebuttals by the Army Surgeon General and a Deputy Assistant Secretary of Defense involved with supply and services stopped this audit.

- The Army Surgeon General (Health Affairs) submitted budget guidance for fiscal year 1975 that reduced US-based VCO end strength by 29% over a 2-year period. It took the efforts of the Army Chief of Staff to convince the DoD not to reduce the current VCO end-strength numbers.

- There was also a study to determine if it were feasible to combine the Army Medical Service Corps with the Veterinary Corps. The DA tasked the OTSG to study the feasibility of combining the Army Medical Service Corps and the Veterinary Corps. The intent was to reduce total authorizations, but the 1976 study results convinced the DA to keep them separate.55(pp44-45)

In 1977, private veterinarians complained to the OTSG about low-cost vaccinations being provided by the Army Veterinary Service, which should not be permitted because this Army provision was punishing the civilian veterinarians. When the complaints reached the attention of congressmen on the House Appropriations Committee (HAC), the OTSG responded that the Army Veterinary Service was only implementing a preventive medicine program on a reimbursable basis, and this program was endorsed by the AVMA.55(pp63-66)

The “Boston Massacre.” The aforementioned studies and legislative action from the 1970s shaped the structure of current US military veterinary services. There were a series of events that took place prior to the 1977 vaccination complaint, however, which revolved around the Veterinary Corps meat procurement inspections in Boston. Meat procurement brought about further studies and inquiries that would greatly impact other changes in the Veterinary Corps. In 1974, a Florida meat packer had two lots of boneless beef rejected by Army Veterinary Service personnel. He thought his product better met the specifications than a competitor’s product processed in Boston that was being accepted.

In 1975, the disgruntled meat packer met with his senator, who was on the Senate Subcommittee for Federal Spending Practices, Efficiency, and Open Government. Samples of ground and diced beef from the Boston packing company, which passed Army Veterinary Service origin inspection and in the military supply chain, were collected and inspected; however, the diced beef was found to be nonconforming and did not meet specification. This led to further inspections and finding more nonconforming beef products from additional packing companies. An audit of six military supply points showed that over half of the beef samples were nonconforming. Also, pork loins from a packing company were found to be grossly nonconforming.

A veterinary technical team from the Academy of Health Sciences went to the Boston beef packer to overview the packing and inspection process and found major problems with the meat processing company and the military veterinary inspectors. For example, the inspectors were not familiar with the specifications, were not well trained, and were poorly supervised. The Defense Investigative Service found that other vendors in the United States, in addition to the Boston packing companies, also had major problems.

Several military inspectors were found to be taking various types of bribes to accept nonconforming products. Several of the meat packer companies’ owners and managers pled guilty or were convicted of bribery, fraud, and conspiracy to upgrade meat. In September 1975, an experienced VCO and noncommissioned officer were sent to Boston, a training program was implemented, and soon conforming product was being produced. However, by then, the Army Veterinary Service had received negative media attention, which quickly led to other major changes.

A US GAO team found the inspection system did not insure meat being procured for the DoD would meet requirements. At about the same time, Air Force Veterinary personnel were investigated by the Office of Special Investigations in Ireland for accepting unauthorized gratuities and allowing similar nonconforming meat products to be distributed in Europe.55(p55) Although eventually resolved, the problems caused by the actions of these few inspectors damaged the reputation of the Veterinary Service.

Other changes added to the turmoil of Army restructuring in the post-Vietnam era. Responsibility for the US Army Veterinary School was transferred from the OTSG to the Academy of Health Sciences in February of 1973.[57] With this change, the school was moved to Ft Sam Houston from Ft Sheridan, Illinois. In November 1974, the functions of the AMEDD Veterinary School were transferred from Ft Sheridan to Ft Sam Houston.[58] This action also closed the US Army Meat and Dairy Hygiene School in Chicago in 1975.[58]

Proposed Congressional Phase-Out of the Veterinary Corps. Based on the meat investigation, the HAC asked the DoD for more information. Committee members wanted to know why the meat inspection could not be done by the USDA, at least in CONUS. Some of their questions included the following: Why does it take military officers—ie, can’t civilians do this job? Why does the DoD have to be involved in food inspection, and what are the DoD inspection costs for 1977 to 1978?

The HAC also wanted change. A Special Investigation of Veterinary Food Inspection Activities report by the US Army lnspector General & Auditor General, dated January 10, 1977, summarized that little had been done since the Boston incident to correct the military’s food inspection problems.55(p74) The lingering shadow of these systemic failures not only led to the handing over of CONUS in-plant responsibilities to the USDA, but also would lead to renewed threats to cut the Veterinary Corps completely and, eventually, to reduced military specifications and cuts in military veterinary personnel.55(p74)

Starting in 1977, the HAC and OSD debated several options: reduce or civilianize VCOs or eliminate the Veterinary Corps entirely, perhaps by using a phase-out process. After reviewing numerous studies and investigations, the HAC recommended origin meat inspections in the US be transferred from the Army and Air Force veterinary services to the USDA. Thus, in August 1977, the responsibility for CONUS in-plant inspection of meat and food products, conducted by Army and Air Force veterinary personnel, was transferred to the US Department of Agriculture and US Department of Commerce. During the planning and transfer stages, the military veterinary services continued to provide those food inspection services to the DoD, and although HAC had recommended the transfer be finished by 1978, it was not officially completed until September 30, 1979.[59]

In 1978, the HAC wanted to further reduce and eventually phase out the Veterinary Corps; however, the Senate contested the language of the HAC’s proposed appropriations bill for fiscal year 1979. The HAC recommended a cut of 520 enlisted and 100 veterinarian positions and almost 9 million dollars in funding from the Army and Air Force. The Senate Armed Services Committee recommended much lower personnel and funding cuts. A Joint Committee finally agreed on cutting Army VCOs by 20 authorizations.

The aforementioned budget and personnel discrepancies generated another audit of the Army and Air Force Veterinary Corps in 1978. After evaluating the two corps, the Defense Audit Service identified that the US Veterinary Corps could be consolidated under an executive agency, which would increase the time VCOs utilized their professional skills and minimize their administrative time, so the numbers of VCOs could be decreased.

During the writing of the Fiscal Year 1979 Program Decision Memorandum, the OSD also wanted to eliminate the Veterinary Corps. The DA contested this option from the OSD, and the Secretary of Defense finally agreed not to phase out the Veterinary Corps but would be willing to restrict the Health Professions Scholarship Program (HPSP) to physicians. Veterinarians would no longer receive military pay for attending military-approved universities to earn their veterinary degrees.

In October 1978, OSD contracted with MAXIMUS, a consulting firm, to further study options for the Veterinary Corps. The five recommendations of this study were as follows: (1) reduce the size of the Veterinary Corps; (2) replace 30 percent of VCOs with other specialties; (3) stop HPSP scholarships for veterinarians (as stipulated by the Secretary of Defense); (4) stop the $100-per-month special pay; and (5) make a Tri-Service approach to veterinary services.

A copy of the MAXIMUS report was sent to the HAC in early 1979 with the additional comment that a majority of research VCOs could be civilianized with a cost savings. The HAC released their report in September 1979, which stipulated the following six actions: (1) the Air Force Veterinary Corps was to be disestablished by March 31, 1980; (2) the Army would be the executive agent for all DoD veterinary functions; (3) VCOs would be reduced by 10 percent; (4) another 30 percent of VCOs would be replaced with other less-costly personnel; (5) HPSP would be stopped for VCOs; and (6) special pay would be stopped.55(pp144-145)

The House and OSD supported the MAXIMUS findings, but the Senate deferred. In September 1979, the Veterinary Corps received the support of Senator Strom Thurmond. In his letter to Senator Warren G. Magnuson, Thurmond stated, “It is difficult to understand why the Secretary of Defense has renewed such an ill-advised proposal, overriding the strong objections of the Surgeons General of the military departments.”55(p163) In December 1979, a House and Senate Joint conference finally decided to reduce military veterinary services by almost $4 million and realign military veterinary structure as proposed by the House (ie, the Army was to be the DoD Executive Agent).[60]

Consolidation. The Fiscal Year 1980 DoD Appropriation Bill became law December 1979, which directed the disestablishment of the Air Force Veterinary Service not later than March 31, 1980. At that time, the Army would become the executive agent for all DoD veterinary functions.[61] Also, using many of the MAXIMUS’ and HAC’s earlier recommendations, 10 percent of VCO were eliminated, and 30 percent of VCOs were to be substituted; furthermore, there was to be a civilianization of research VCO positions and a phase-out of the HPSP program for veterinarians. The process was to be completed in fiscal year 1985.

In April 1981, the Army Surgeon General informed the OSD that their civilianization hiring attempts to replace VCOs in Research and Development (R&D) positions had failed and recommended to restore the 102 VCO positions that were to be civilianized back to the Army inventory. In May 1981, a HAC report acknowledged the difficulties in civilianization and did not note the perceived cost savings. The report recommended restoring these positions back to the Army and Air Force VCO end-strengths. The House Armed Services Committee’s report essentially recommended the same as the HAC.

The Army’s Surgeon General, Veterinary Corps chiefs and staff, AVMA, various agencies supported by veterinary services, and individuals who contacted key legislative officials in Congress worked extremely hard to save the Army Veterinary Corps from multiple attempts to eliminate the military Veterinary Corps. Through compromise, only the Air Force Veterinary Corps was disestablished. In addition, there was a strong push to remove VCOs from all food inspection duties and civilianize R&D VCO positions. However, while the Army had to give up some VCO positions relating to food inspection, the Army was able to establish a veterinary warrant officer program, retain VCOs in the food inspection field, and keep VCOs in R&D positions.55(pp170-172)

Highlighting the Positives

Congressional directives specifically stipulated that the Air Force Veterinary Service be disestablished not later than March 31, 1980, and that the Army became the Executive Agency for all DoD veterinary functions, April 1, 1980.[61] The Army started its veterinary warrant officer program in 1981. Despite these successes, the road to securing branch existence was arduous. With the backdrop of possible elimination of military veterinary services in the 1970s, positive deeds were sometimes minimized or forgotten, and missteps were sometimes magnified.

Venezuelan Equine Encephalitis. Previously found only in Colombia and Ecuador, a Venezuelan equine encephalitis (VEE) epizootic spread north through Central America and reached southern Texas in June 1971. Army Veterinary Corps personnel were involved in studies and human vaccine development for VEE and eastern equine encephalitis decades before this epizootic reached Texas. Although the experimental human vaccine they developed was for laboratory personnel working with the virus, the human vaccine proved to be effective in equines.

Figure 1-34. Threatened by equine encephalitis strains, which were migrating from Central and South America in the late 1960s and early 1970s, a massive (and successful) vaccination program was enacted. In 4 months starting July 1971, almost 3 million horses were vaccinated in 19 states in America.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

The US Army provided the vaccine, and VCOs provided technical assistance for emergency vaccination of horses during a VEE outbreak in Colombia in 1957, followed by Guatemala and El Salvador in 1969. Through 1970, almost 2 million doses of VEE vaccine were provided to five Central American countries and Mexico. In 4 months starting July 1971, almost 3 million horses were vaccinated in 19 states in America, which, along with other preventive measures such as aerial insecticide spraying, contained the outbreak to southern Texas. No VEE cases originating in the United States were reported by 1972[62] (Figure 1-34).

Newcastle Eradication Campaign. Late in 1971, exotic Newcastle disease was diagnosed in California’s poultry. California regulatory officials soon were overwhelmed and ran out of money fighting what eventually turned out to be one of the most extensive animal disease eradication campaigns in history. The USDA realized this could jeopardize the US’ $6 billion poultry industry, and in March 1972 requested military assistance. Initially, 20 Army and 20 Air Force veterinarians were requested. Eventually, over 400 Army, Air Force, Navy, and Marine officer and enlisted personnel participated in the operation that grew to a task force numbering 1,300. The outbreak was declared a national emergency; southern counties in California and western counties in Arizona were put under quarantine. About 12 million infected and exposed birds, valued at 56 million dollars, were destroyed. In addition, the task force implemented an extensive vaccination program for birds in the quarantine area. Military assistance ended on September 30, 1972.55(p13)

Standardizing Veterinary Pay

In the years after World War II, the DoD was having problems recruiting VCOs, which led Congress to pass Public Law 83-84 in 1953, entitling VCOs to special pay ($100 per month). Years later, this action would be revoked. With the Vietnam War concluding and Congress contemplating an all-volunteer Army in 1972, increasing special pay and constructive credits were again brought up as a way to maintain VCO end-strength with no draft, or decline in ROTC numbers, or cuts in scholarships; however, none of these incentives became law until years later. Those entering active duty on or after June 30, 1975, were no longer receiving the $100 per month special pay; thus, the first-year VCO retention rate dropped to 8 percent in 1975.

Public Law 95-114 in 1977 reinstated the VCO special pay beginning on October 1, 1977.[63] There were other changes as well. Effective October 1, 1999, based on the National Defense Authorization Act for Fiscal Year 2000, VCOs would receive board certification pay at the same rate as psychologists and nonphysician health care providers (the scale increased from $1,000 to $5,000 dollars, depending on the number of years of service).[64] Incentive pay, retention bonus pay, and an increase in board certification pay were incorporated and became effective on October 1, 2009; board certification pay was set at $6,000 per year regardless of years of service. However, since VCOs did not get the chance to apply for the extra payments until the summer of 2010, once the payments started, back pay from the original effective date was required to catch up.

Shifting Personnel Changes

After World War II there was only one female veterinarian, Doreen H. Lewis, who served in both an enlisted and then commissioned capacity from 1947 to 1948.[65] After Lewis’s service, there was a considerable absence of women veterinarians in the Army; the next female commissioned veterinarian was Jean E. Hooks (later Sessions), who was commissioned in 1970[66] (Figure 1-35). By 1975, there were eight commissioned female veterinarians on active duty and in the reserves.[67] Female VCO numbers in 1983 totaled 29, with another four females serving as veterinary warrant officers.[68] However, by 2014, the number of active duty female VCOs represented over half of the force, with 285 female officers serving in the Veterinary Corps (electronic personal communication from Colonel Noreen Murphy, Assistant Corps Chief, Veterinary Corps, to Nolan A. Watson, chapter author, January 9, 2014).

As noted earlier in this chapter, one of the results of the Army becoming the Executive Agency for DoD Veterinary Service was the development of a veterinary warrant officer program. Initially, the program consisted of senior NCOs, trained in food inspection, who would then transition to warrant status after further training and selection.[69] The concept was approved by Congress in September 1980, and in 1981, the Army began training warrant officers in the field of food inspection.[69] Initially, there were 10 candidates for the Military Food Inspection Technician Program who graduated in November of 1981. The program met its goals of producing 53 warrant officers within 2 years.[68]

Figure 1-35. Staged image of Captain Joanne Marie Rick, Veterinary Corps, at the Ft Sam Houston stables, 1972. Rick was one of the early female veterinarians joining the Army in the early 1970s. Jean E. Hooks (later Sessions) was the first female commissioned Army veterinarian since 1948 and was commissioned in 1970. US Army photo 41-133-6145-2/AK-72.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Despite its establishment, the warrant officer food inspection program was soon in danger. Many of its personnel were almost eliminated because of an Army-wide reduction of warrant officers. To avoid this mishap, the Chief of the Veterinary Corps at the time, Brigadier General Robert R. Jorgensen was able to intervene directly to the Army Vice-Chief of Staff and relay the vital importance of the food inspection mission (electronic personal communication from Brigadier General [Retired] Robert Jorgensen, former Chief, US Army Veterinary Corps, to Nolan A. Watson, chapter author, June 2, 2013). Jorgensen’s message was successful. In 2015, there were 67 warrant officers serving in veterinary services (electronic personal communication from Colonel Kathleen Miller, Veterinary Corps Personnel Proponent Officer, to Nolan A. Watson, chapter author, February 19, 2015).

Pre-Persian Gulf War

In the early 1980s, as the aftereffects of post-Vietnam Army reorganization subsided or were reinforced by positive doctrinal changes, the Army was bolstered with budgetary increases, which led to better troop morale and overall effectiveness. These improvements were part of a strategic plan for victory in the Cold War. Soldiers entering the Army during this time would be well-poised for continuous challenges during the next three decades. For the Army Veterinary Service, not only were there more changes on the horizon, but also continuing emphases on health concerns, humanitarian actions, and global VETCAP support. Food inspection evolved from examining preparation facilities for sanitation to food safety, in which causes for preventing food-borne illnesses were more closely studied (electronic personal communication from Brigadier General [Retired] Michael Cates, former Chief, US Army Veterinary Corps, to Nolan A. Watson, chapter author, May 13, 2013). Usage of military working dogs also expanded.

During this time, the Veterinary Service also faced numerous challenges. The new standard Army ration, the Meal Ready to Eat (MRE) had gone through research and just as it was being fielded, problems with packaging and concerns for the food surfaced. To manage the issue, then-Brigadier General Robert R. Jorgensen supervised the Veterinary Corps and answered concerns at the OTSG, while former Veterinary Corps Chief Brigadier General (Retired) Frank A. Ramsey was brought out of retirement to examine the problem at storage and distribution areas. Concerns were abated, and the MRE was fielded without further incident.[70]

Operation Urgent Fury

On October 25, 1983, combined US forces with Caribbean contingents deployed to the small island country of Grenada. The troops were sent in response to Grenada’s leader, Maurice Bishop, being deposed and murdered while the threat of Cuban Communist forces increased on the island. Despite some setbacks, the operation was successful and provided numerous examples for improved procedures and cooperation between military branches and services for future operations.

Initial operational planning minimized medical assets and postponed support and involvement with combat units. In addition to ship-borne medical support and elements of the 307th Medical Battalion, a collection of medical support units from the 44th Medical Brigade was gathered for deployment and built around the 5th Surgical Hospital and designated Medical Task Force 5 (MTF 5).[71] As part of MTF 5, personnel of the 248th Medical Detachment (VS) arrived in Grenada on November 2, 1983, after spending a few days in a staging area on the island of Barbados.72(p1) (The two initial soldiers who came from the 248th were Major Thomas J. Callahan, VCO, and Sergeant Steve Lancaster, a veterinary technician and food inspector.72(p1))

During their deployment to Barbados and Grenada, 248th Medical Detachment (VS) personnel treated military working dogs afflicted with gastroenteritis and lacerations.72(p1) A food safety mission of inspecting newly arrived “C” rations was also performed without incident. Another food inspection task, however, was more significant. Elements of the 248th were tasked by XVIII Airborne Corps’ G-5 (CA) to inspect captured Cuban military rations that were to be distributed to local Grenadians in need.72(p2) Fortunately, the team was able to eliminate 90 percent of the material that was found to be hazardous and prevented countless food-borne illness cases.72(p2)

Rabies was once again a threat to US forces, as the disease is endemic in Grenada, found largely among the mongoose population on the island. Recognizing the threat, the 248th team worked with the Grenadian Ministry of Agriculture to develop a rabies vaccination program,72(p2) but one critical element was missing: the rabies vaccine. The 248th team contacted the US Office of Foreign Assistance and was able to procure $2,000 in order to purchase enough of the vaccine to implement a vaccination program.72(p2)

On November 18, 1983, the 36th Medical Clearing Company assumed the medical mission from MTF 5, as MTF 5 began redeployment to Ft Bragg.[73] The deployed portion of the 248th remained in Grenada under the 36th. By mid-December, all American forces, except a training element, departed the island.

Years later, in 1996, during the veterinary-specific Operation Green Cross, the 73d Medical Detachment (Veterinary Service) under the command of Major John L. Poppe (later Brigadier General Poppe, 25th Veterinary Corps Chief, 2011–2015), and augmented by Major (later Colonel) Neal E. Woollen (Veterinary Corps), re-established the Grenadian Ministry of Health’s rabies diagnostic laboratory. With an improved capability, the laboratory confirmed the first case of rabies on the island since 1977 and initiated a tuberculosis and brucellosis control program for the Ministry of Agriculture’s large animal population (electronic personal communication from Brigadier General John L. Poppe, Chief, US Army Veterinary Corps, to Nolan A. Watson, chapter author, March 4, 2015).

Hormone Testing of Beef

In the late 1980s to early 1990s, US Army veterinary personnel initiated testing for illegal hormones in beef being offered for procurement in Europe, possibly based on the European Commission (EC) plan to ban US beef imports into EC countries because of legal hormone use in cattle in the United States. The EC ban became effective for imported beef on January 1, 1989, and applied to US beef in which hormones were used as a growth promoter. The ban didn’t apply to foods for US troops, which were covered under the Status of Forces Agreement or to commissary foods, which had received such protection by precedent.

During the same time that the EC was banning US beef imports, new Defense Supply Region-Europe contracts for beef procurement in Europe prohibited the use of illegal hormones in EC cattle procured for US forces. The 7th Medical Command (MEDCOM) began a survey in May 1988 to determine if illegal hormones were present in European beef procured for US forces. A small percentage of urine samples collected were found to be positive.[74]

The 7th MEDCOM program involved cattle urine testing and monitoring based on the USDA program used in the United States. Urine samples were taken in slaughter houses where US beef was procured in Europe. Approximately 25 samples per month were analyzed by Dr G Maghuin-Rogister of the veterinary faculty, University of Liege, Brussels, Belgium. Of 210 samples tested through December 1988, only six were positive, three in Germany and three in Belgium.[75] Issues concerning European beef would resurface in the mid-1990s, with bovine spongiform encephalopathy (BSE) receiving greater media attention.

Bovine Spongiform Encephalopathy (BSE)

A developing issue, beginning in the 1980s (prior to the Persian Gulf War) and continuing into the following decades, was the protection of military service members and their dependents from BSE, commonly known as “mad cow disease.” This public health problem took a while to unfold as geographic regions of concern faced the disease threat at different points in time. Several of the Veterinary Service disciplines were cooperatively involved in the study of this public health issue, including animal health professionals, food safety inspectors, and laboratory specialists.

In 1986, the first case of BSE was reported in dairy cattle in the United Kingdom (UK).76(p1) BSE is a fatal, chronic degenerative disease affecting the central nervous system of cattle and has also been called mad cow disease because of the neurologic symptoms.76(p1) The disease was thought to be nonzoonotic and isolated within the region. However, in the following years, BSE spread to other countries, and in 1989, the USDA banned the importation of beef and cattle from countries with confirmed cases of BSE.76(p3) This action was taken in order to protect the American livestock industry, but not public health, as a zoonotic link was not yet known.77(pp61-62)

Ten years after the first reporting of BSE, a new variant of a human disease, Creuztfeldt-Jakob Disease (CJD), appeared.76(p1) CJD is a rare, degenerative, fatal brain disorder, with 90% of patients dying within one year.76(p1) The variant form of CJD (vCJD) differed from the classic CJD in that a younger population developed signs of disease (average age of 29 years versus 60 years, respectively) with a longer time period from development of clinical signs to death (average of 13 months versus 4–6 months, respectively);76(p1) as the illness progresses, mental deterioration becomes pronounced and involuntary muscle movements, blindness, weakness of the extremities, and coma may occur.76(p1) BSE and the vCJD are classified in the transmissible spongiform encephalopathy group of diseases.76(p1)

As information from the CJD report was released in March 1996, the European Union imposed a worldwide ban on beef exports from Britain.76(p2) In March 1996, the DoD Veterinary Service Activity (DODVSA) recommended cessation of the purchase and sale of beef from BSE-endemic areas based upon a potential relationship between BSE, CJD, and the consumption of BSE-infected beef.76(p3) At this time, this cessation only applied to beef purchased from the UK. Beef from other European countries would continue to be purchased for AAFES operations and Moral, Welfare, and Recreation (MWR) activities.76(p3) Beef for commissary use and military dining facilities was obtained from the United States.

The issue of beef procurement and its possible contamination with BSE continued to percolate within Europe. In 1998, the USDA enacted further prohibitions, placing bans on the importation of ruminant meat (primarily cattle, sheep, goats, and deer) and ruminant meat products and by-products from Europe into the United States.78(p6) The new ban encompassed all of Europe—versus just the UK—and caused some new complications.

Although DODVSA enforced the ban, there was a delay due to miscommunication with the USDA.78(pp6-7) Other mixed messages also caused difficulties. On July14, 1999, the European Union lifted the worldwide ban on British beef exports to be in effect by August 1, 1999.76(p3) During the time of contrary regulations, AAFES was buying beef from Italian and German sources for their concession operations in Europe.78(p6) Italy and Germany were still deemed free of BSE and considered “safe” sources for procurement.78(p6)

Scientific papers released on December 21, 1999, in the Proceedings of the National Academy of Science established a probable link between BSE and vCJD. A few months later in March 2000, based upon this evidence and in response to the emergence of BSE in additional European countries, and changes in US import laws (Title 9, US Code of Federal Regulations, 9CFR94.18), the Army Surgeon General (under the advisement of DODVSA) banned the procurement of all ruminant meat and meat products of European origin.79(p3) This action caused a considerable amount of anxiety among AAFES concessionaires, and because it was an immediate ban, there was an immediate cancellation of contracts and lost revenue.78(p6) The ban not only affected AAFES, but also affected other MWR activities throughout Europe that were still purchasing local beef.78(p6)

Despite protestations that German and Italian meat products were safe for consumption, the ban continued. Within 1 week to 10 days, AAFES had hamburgers flown in from the United States; AAFES concessionaires were up and running again, serving more than just chicken and fish.78(p6) Complaints continued until 9 months later when Italy and Germany were both diagnosed with BSE in their cattle population, and the DODVSA-recommended ban proved to be timely.78(p6)

Although bans were in place limiting the consumption and transference of possible infected beef, there was also a considerable effort in trying to advise consumers of potential risk.80(p3) The US Army Center for Health Promotion and Preventive Medicine-Europe (CHPPM) engaged in an information awareness program that was designed to lessen the concerns of service members and their dependents.80(p3-4) While stopping procurement from sources in the UK in 1996 and the rest of Europe in 2000 was achievable, there was no ban on American personnel consuming ruminant meats and meat products in European restaurants. The decision to consume these items from local and host nation food service facilities was an individual’s choice.[81]

There were additional complications as well. Because of concerns that blood from an individual with vCJD may be infectious to another individual, the FDA, DoD, and other blood collection agencies implemented blood donor deferral policies.80(p5) The most restrictive policy, that of the American Red Cross, deferred anyone who had accumulated 6 months of time in Europe from 1980 to present.[82] This requirement limits a significant portion of blood donors because it is estimated that, during the period of 1980 to 1996, approximately 4.5 million service members and their families served in Europe and may have consumed beef from the UK.80(p2)

While the disease remains a danger to animal and human health, risk mediation procedures have been implemented. The USDA has conducted risk assessments sufficient to identify the historical and existing BSE risk factors and has developed a list of regions classified by their controlled risk for BSE. As of the final editing of this chapter (2017), the ban on procurement of all ruminant meat and meat products of European origin is still in force.

Operation Just Cause (Panama 1989–1990)

Background for Invasion. As tensions between the United States and the Noriega-run government in Panama escalated, armed confrontations between the countries became more frequent and violent. While the country’s dictator, General Manuel Noriega, crushed political opposition in Panama and was under federal indictments for drug trafficking, his Panamanian Defense Forces (PDF) ran amuck. Events coalesced on December 16, 1989, when Noriega declared Panama to be in a “state of war” with the United States.

After the declaration, a PDF roadblock turned deadly when Robert Paz, a Marine Corps lieutenant, was killed. A Navy lieutenant and his wife witnessed the event and were detained, assaulted, and threatened by the PDF. These events were the immediate precursors for the American military intervention in Panama, Operation Just Cause.

In the years prior to the conflict, veterinary personnel frequently worked within Panama and surrounding countries (telephone conversation with Colonel [Retired] Paul Schmidt, US Army Veterinary Corps, and Nolan A. Watson, chapter author, July 29, 2014). The veterinary assets within Panama at that time were the 216th Medical Detachment (VS) and Veterinary Service for USA MEDDAC-Panama, which operated two VTFs and maintained a laboratory and personnel for food inspection. With a large military population and geographic area to support, veterinary services were in great demand for a variety of tasks.

Supporting US Army South, the 216th Medical Detachment (VS) was subordinate to the 193rd Infantry Brigade and was assigned to the 142nd Medical Battalion. The unit based at Ft Clayton would also provide support to the 3rd Battalion of the 7th Special Forces Group (electronic personal communication from Colonel [Retired] John Taber, US Army Veterinary Corps, to Nolan A. Watson, chapter author, July 23, 2014). The 216th provided both animal treatment and food inspection duties and participated in missions that spanned several countries.

Veterinary Service for USA MEDDAC-Panama was headquartered in the Gorgas Army Community Hospital. In Panama, Veterinary Service’s laboratory facilities were primarily concerned with food safety, so food inspectors were distributed at various installations. Additionally, there were two VTFs subordinate to Veterinary Service for USA MEDDAC-Panama: (1) the Mindi VTF, on the Atlantic side of the country near Ft Davis; and (2) the Corozal VTF, on the Pacific side of the country (telephone conversation with Colonel [Retired] Paul Schmidt, US Army Veterinary Corps, and Nolan A. Watson, chapter author, July 29, 2014). Both VTFs focused on animal care and military working dog health.

The larger VTF at Corozal provided animal care for MWDs and animals owned by military service members and government employees, including Panama Canal Commission workers and embassy personnel. Because of the number of clients, the facility operated with a high volume and was staffed with three military personnel, two US civil service veterinarians, one nonappropriated-fund veterinarian, and approximately 12 local national employees (telephone conversation with Colonel [Retired] Paul Schmidt, US Army Veterinary Corps, and Nolan A. Watson, chapter author, July 29, 2014).

One reason for the large size was that newly relocated animals to Panama needed to be quarantined for 40 days. Also, the VTF routinely supported MWDs from Howard Air Force Base and Rodman Naval Base. During the 1989 through 1990 timeframe, the Air Force deployed 18 MWD teams to Panama in 90-day increments to provide additional security. One of the deployed MWDs expired from heat stroke in November 1989. The dog was one of several brought from CONUS amid bomb scares in Panama. The MWD had been transported from New Jersey and was unable to acclimate in the short transit time from winter in CONUS to the tropical climate of Panama (telephone conversation with Colonel [Retired] Paul Schmidt, US Army Veterinary Corps, and Nolan A. Watson, chapter author, July 29, 2014). Prior to combat operations, the 549th Military Police Company, a local unit, would sometimes assist with the care of the animals at the facility. This unit had kennels on both the Pacific (Ft Clayton) and Atlantic (Ft Davis) sides of Panama and had a close relationship with the MWD care providers.

Food Safety, Preoperations. In addition to the deteriorating political climate in Panama, service personnel and their dependents were also affected by problems in the food supply chain. While food inspections and examinations are not unusual veterinary-provided services, local food procurement for the American military installations within the country came under even closer scrutiny during 1989 to 1990 for political and food safety concerns.

For example, because of connections to Noriega, the Blue Star Milk Company (Estrella Azul) was suspended from supplying local commissaries with milk and juice products in early December 1989.83(p128) To overcome this deficit, a first, and then second, shipment of milk (totaling 135,000 pounds) was airlifted to Panama from CONUS on December 7, 1989.83(p128) From then on, two shipments were received each week and were then distributed among 58 locations within the country.

Monitoring of commissary operations revealed thawing problems during transport and led to the elimination of highly perishable items such as ice cream.83(p128) Adding to the strain in the days before the invasion, AAFES shoppette privileges were granted to employees of the Panama Canal Commission, presumably to provide these employees safer shopping areas.83(p149)

Operational Support from Veterinary Service. Invasion operations began in the early hours of December 19, 1989. Veterinary personnel were not part of the invasion force but were drawn from previously mentioned assets already in the country. USA MEDDAC-Panama was placed under the control of the 44th Medical Brigade as medical personnel provided treatment and support during the operation[84] (telephone conversation with Colonel [Retired] Paul Schmidt, US Army Veterinary Corps, and Nolan A. Watson, chapter author, July 29, 2014).

On December 20, 1989, elements of the 988th Military Police Company (deployed from Ft Benning, Georgia) moved to secure a PDF kennel facility at Curundu, Panama. A brief firefight ensued, which ended with the capture of PDF soldiers. After the exchange, veterinary personnel from the 216th Medical Detachment (VS) and Corozal VTF were sent to the area to treat the surviving animals and the badly injured PDF MWDs wounded in the shootout. The staff also disposed of the remains of many other PDF MWDs that were shot within their kennels by incinerating the dead animals (electronic personal communication from Colonel [Retired] John Taber, US Army Veterinary Corps, to Nolan A. Watson, chapter author, July 23, 2014). The surviving PDF MWDs (approximately 25) were moved to the Corozal VTF to receive treatment and allow for recovery time until they were returned to the post-Noriega Panamanian Army.

As the operation progressed, other animal care missions surfaced. The 216th Medical Detachment (VS) euthanized a horse wounded during the assault on the Cerro Tigre PDF logistics base. The unit would also treat horses at the Military School of Equitation in Panama City, provide animal care at the Balboa Refugee Center, and continuously support the animals of the 3rd Battalion, 7th Special Forces Group (electronic personal communication from Colonel [Retired] John Taber, US Army Veterinary Corps, to Nolan A. Watson, chapter author, July 23, 2014).

Food inspection missions in support of the operation emerged from both ordinary and unusual circumstances. Inspection of items possibly damaged from lack of power or a transport delay based on wartime contingencies were to be expected. Less common were the inspections of food extracted from Noriega’s personal bunker at Ft Amador or the inspection of confiscated Christmas propaganda packages for Noriega’s troops. Working at the request of the 82nd Airborne Division, the food items were inspected by the 216th Medical Detachment (VS), pro-Noriega items were removed, and the packages were then distributed as a humanitarian gesture to local residents in need (electronic personal communication from Colonel [Retired] John Taber, US Army Veterinary Corps, to Nolan A. Watson, chapter author, July 23, 2014).

After the invasion transitioned from Operation Just Cause to Operation Promote Liberty, US Army Veterinary Service activities continued food inspection and animal care support within Panama and Central and South America. These VETCAP missions included vaccinations of pets for rabies and deworming of livestock. Paul Schmidt, then a captain with the Corozal VTF, served on a mission to Coiba Island (where Noriega exiled many of his political prisoners) to vaccinate the freed prisoners’ animals for rabies and evaluate their livestock (telephone conversation with Colonel [Retired] Paul Schmidt, US Army Veterinary Corps, and Nolan A. Watson, chapter author, July 29, 2015). During these VETCAP missions, John Taber, then a captain and commander of the 216th Medical Detachment (VS), observed that local children were hesitant to bring in their pets for vaccination until the children were permitted to mark their animals with a colorful cattle-marking pen (electronic personal communication from Colonel [Retired] John Taber, US Army Veterinary Corps, to Nolan A. Watson, chapter author, July 23, 2014).

Veterinary Corps Chief

The Officer Personnel Act of 1947 raised the rank of Chief of the Army Veterinary Corps to Brigadier General; however, in 1990, because of Army structural changes, the Chief of the Veterinary Corps would no longer hold the grade or rank of 07 or Brigadier General. Despite this change, the abundant challenges of near-continuous military involvement from 1990 to 2004 were met by the 06s or colonels who served in the capacity of Veterinary Corps Chief: Colonel Clifford I. Johnson (1991–1995), Colonel Paul L. Barrows (1995–1999), and Colonel John S. Fournier (1999–2004). In 2002, bills were introduced to bring back the star to the Veterinary Corps, and in 2004, Congress restored the rank of Brigadier General to the Veterinary Corps Chief position.

Persian Gulf War

Hastened Troop Deployment and Veterinary Support

Less than a year after Operation Just Cause in Panama, the US military would be tested again. Iraqi military forces under the direction of Saddam Hussein invaded Kuwait in August of 1990, and a coalition of countries quickly formed to stop Iraqi aggression before it reached the Kingdom of Saudi Arabia (KSA) and then to free Kuwait. The initial phase of planning and gathering forces while maintaining security for the KSA was named Operation Desert Shield. Collectively, Operation Desert Shield (1990) and Operation Desert Storm (1991) are called the Persian Gulf War.

US forces began rapidly deploying to Southwest Asia (SWA) in August 1990, the fastest buildup of the AMEDD up to that time. Over 23,000 AMEDD personnel (55% were Reserve Component) (over 18,000 were enlisted soldiers) deployed to SWA.85(pp3-4) Veterinary personnel were on the ground in the KSA within a few weeks of the start of the operation (two enlisted food inspectors of the 248th Veterinary Service Detachment), along with preventive medicine and forward surgical teams.85(p4)

Army Veterinary personnel quickly went to work, ensuring local food being procured was safe, as well as inspecting all the operational rations. Veterinary personnel played a key role in minimizing food-borne illness rates for more than half a million military personnel; no documented food-borne illness cases were reported from the consumption of any type of operational ration during the entire operation.85(p5) Veterinary personnel also inspected the food at enemy prisoner of war camps and ensured safe food and water for Kuwaiti citizens after the ground war ended in Kuwait.85(p5)

Approximately 50 VCOs, both active component and reserve component, and 113 Veterinary Service enlisted personnel were deployed to the Persian Gulf War area of operations.86(pp70-71) Additionally, reserve component veterinarians backfilled positions in CONUS and Europe. Seventeen separate veterinary TO&E units, both active and reserve, contributed personnel to the Persian Gulf War.86(pp73-74) (As a reference point, in 1991 there were 445 active VCOs serving worldwide.[87])

Organization and Units. Unlike the gradual buildup during the Vietnam War, US forces moved quickly, assembling a large force for the Persian Gulf War. Medical and, more specifically, veterinary assets were initially largely marshaled out of Europe (Germany) and sent to the KSA. The 483rd Medical Detachment (VS) (based at Augsburg) of the 7th MEDCOM was notified of deployment to the Persian Gulf War on August 12, 1990.88(p1) Serving as an ALO 1 (Authorized Level of Organization) JB team, the unit would soon be augmented with other units and personnel.88(p1) This included the 100th Medical Detachment (VS) and the 168th Medical Detachment (VS) both serving as JA teams.88(p1)

Additional personnel and equipment added to the 483rd from 7th MEDCOM units included the following veterinary detachments: 72nd, 110th, 167th, 24th, 655th, 769th, and Veterinary Detachment Europe.88(p1) Additional personnel and resources came from the 196th Hospital, 2nd General Hospital, and 10th Medical Laboratory.88(p1) The 248th Veterinary Detachment, which had arrived in the KSA as a part of the 44th Medical Brigade, was also assigned to the 483rd. The 73rd Medical Detachment (JA) from Ft Lewis arrived in September and was attached to the 483rd for operational control.

While the 483rd had numerous personnel, there were issues of command and control, with the 483rd answering to both the theater veterinarian and the 44th Medical Brigade.88(p3) Changes occurred in December as veterinary operations were transferred from XVIII Airborne Corps control to VII Corps.86(p72) The 483rd was transferred to a provisional medical group and the command and control of the 320th Medical Detachment Veterinary Headquarters (EAC, Echelon Above Corps), an Army Reserve unit.88(p3)

Other reserve component veterinary units in theater included both veterinary services detachments (the 356th, 358th, 422nd, and 423rd) and VCO detachments for small animal care (the 449th and the 888th).86(p71) VCOs also served in Preventive Medicine, CA, and Special Forces units and at medical headquarters.

Because the American military had never been stationed in the KSA, other than as an advisory capacity, there were no approved sources for food supplies in the Persian Gulf countries. Thus, initial sanitary inspections had to be conducted in five countries to create a list of approved sources for host nation contractors to procure food supplies. Over the first 4 months, the Veterinary Service worked with approximately 300 food vendors in these five countries.86(p72) Quality assurance inspections of CONUS origin subsistence, as well as local food sources involved in the host nation feeding program, were a major area of mission accomplishment (Figures 1-36 and 1-37). The Veterinary Service approved 286 local sources in the area of operations, to include bakery, dairy, shell egg, meat processing, and catering establishments, thereby contributing to very low rates of food-borne or water-borne disease in military personnel (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author).

Significant Animal Care Needs. Veterinary Service personnel cared for approximately 120 MWDs in theater and provided much needed support for starving dairy cattle and horses in Kuwait City that had suffered under the Iraqi invasion.89(p1) In addition, veterinary personnel including a Special Forces veterinarian rescued and treated starving, dehydrated, and mistreated animals that remained in the Kuwait Zoo.89(p4),90 Few of the zoo animals survived, however, and the 483rd Medical Detachment veterinary personnel provided much of the removal of animal remains and general cleanup of the zoo.88(p20)

Figure 1-36. Held together by tape, stacks of canned food await inspection during Operation Desert Storm.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Figure 1-37. Photograph taken pending inspection of a local poultry processing facility in Saudi Arabia during the Persian Gulf War.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Veterinary clinical activities included examinations and treatment of all MWDs in the theater. They also were responsible for policies related to injuries involving indigenous animals due to military action. In the lead-up to the Persian Gulf War’s Operation Desert Storm’s tactical activities, four locally owned animals (three camels and a horse) were injured by American forces in a training exercise.86(p73) The animals were treated without incident.

Consultation regarding zoonotic diseases such as rabies and the establishment of US Army Central (ARCENT) and US Central Command (CENTCOM) policies regarding animals also fell under the Veterinary Service’s umbrella. The 423rd Veterinary Laboratory augmentation team located at Eskan Village, Riyadh, KSA, tested numerous samples and also sent animal heads for rabies testing to the veterinary medical laboratory in Germany.86(p73) (See Chapter 12, Rabies and Continued Military Concerns for more information about animal policies during deployments and military rabies control programs.)

There was significant veterinary involvement in the development of biological and chemical agent prevention and treatment modalities, as well as in the provision of training for military personnel in biological and chemical defense procedures. A veterinary toxicologist was the commander-in-chief’s US CENTCOM advisor on chemical defense. Veterinarians served as commanders and deputy commanders of institutes and directors of research programs responsible for vaccine and drug development and chemical and biological defense medical research programs to protect the soldiers. Veterinary specialists in laboratory animal medicine, pathology, physiology, pharmacology, microbiology, and toxicology served as primary investigators and conducted research support for a broad array of biomedical research in support of the Persian Gulf War.

A veterinarian also was assigned with the Multinational Peacekeeping Force, and the CENTCOM veterinarian and one 68R (food inspector) were assigned in Kuwait. Navy Forces Central Command requested veterinary support, and a staff study determined a nine-person TDA veterinary unit was required for the current CENTCOM missions. Staff actions progressed to accomplish this requirement, and as the US military presence continues in SWA, Veterinary Service remains an important military medical asset.

Veterinary Operations Highlights. From the period January 17, 1991, (the Persian Gulf War’s Operation Desert Storm and air-war phase begins) to February 1, 1991, Veterinary Corps assets increased dramatically. The 888th Medical Detachment (VS) (JA) arrived in theater with five additional personnel, and the 356th Medical Detachment (VS) (JB) arrived about 1 week later with 26 additional personnel.89(p1) Both of these units were deployed with no modified table of equipment supplies (eg, vehicles and tents), which required considerable improvisation with respect to mission accomplishment.89(p1) Three reserve component VCOs and ten 91R food inspection specialists from Health Services Command arrived in theater in mid-January as individual augmentees, and all were assigned to the 483rd Medical Detachment (VS) (JB).89(p1) The overall strength for veterinary support increased to 95 assigned personnel.89(p1) In addition to surveillance of operational rations, initial and routine sanitary inspections continued to ensure the wholesomeness of Class A rations for over 365 establishments. The care of MWDs also continued for the approximately 120 government-owned canines in theater.89(p1)

The 422nd Medical Detachment (VS) (JB) and the 888th Medical Detachment supported the host nation warehouses in the King Khalid Military City area in the KSA, and the other units remained in the Dammam and Al Khobar area.89(p1) Veterinary personnel also provided support at temporary duty locations in Jeddah (KSA), the United Arab Emirates, and Oman, mainly in support of Air Force and Navy installations.89(pp1-2) Here, they discovered large amounts of nonapproved and disapproved food sources being procured. In fact, disapproved shell eggs (poultry eggs in their shells as opposed to dried or powdered eggs) caused the most severe food-borne illness outbreaks, and host nation caterers resulted in the second highest number of cases.89(p2) Later on, veterinary personnel located on airbases learned that many of the Air Force environmental health officers had redeployed early with their hospitals; therefore, surveillance of food was none to minimal.89(p2) The result was large warehouses of rations that were outdated and needed extensions of shelf-life or condemnation and destruction.89(p2)

Difficulties Encountered and the Solutions. Issues were encountered when providing support for enemy prisoner of war (EPW) camps. In addition to the poor field sanitation habits of the EPWs, disinfectants, food preparation surfaces that could be disinfected, and sanitary food-handling utensils were lacking. These problems required extensive coordination with Saudi government officials, Coalition Forces, and US Army preventive medicine and military police personnel.89(p2) The quality and quantity of rations being fed to EPWs were also significant sources of debate for two main reasons: (1) the amount of unacceptable cultural foods (ie, large portions of NATO rations contained pork, which Muslim EPWs could not eat), and (2) political concerns (ie, the “equalness” of rations being fed to Coalition Forces and EPWs).89(p2)

In addition, transportation issues increased during the Persian Gulf War. The problem of deployment of two modified table of equipment units without organic vehicles was never resolved. Contracting civilian cars was a partial solution, but the decreased mobility of these units was a definite constraint in planning their missions.89(p2) If the Persian Gulf War had lasted longer, additional teams that needed to move north following the food supplies would have resulted in failed missions, due to the lack of tactical vehicles, tents, and generators.89(p2)

One of the most difficult problems was that of unit morale. Once the Persian Gulf War combat objectives were achieved and redeployment began, units were supposed to follow President George H. W. Bush’s announced policy of First In-First Out or FIFO for their return home.89(p3) However, ARCENT MEDCOM would not authorize the transfer of equipment from the 422nd Medical Detachment, thus allowing them to redeploy first.89(p2) Therefore, this detachment continued to support the mission at the King Khalid Military City area until the majority of the VII Corps troops were redeployed, at which time the detachment troops would be released.89(p2) The 483rd was to serve as a stay-behind unit to provide ongoing veterinary support.89(p2)

In addition to the equipment transfer complication, the Health Care Operations, the OTSG, and Total Army Personnel Command failed to quickly establish a rotation and replacement policy and rotate replacements in for soldiers already in the war zone for 7 months.89(p4) With neither US ARCENT nor MEDCOM embracing the First In-First Out redeployment plan and the apparent indecision by both the Health Care Operations and Total Army Personnel Command, serious morale problems resulted for the veterinary unit designated to remain behind. The result was discipline problems, in addition to health and mental health issues.89(p4)

Once the redeployment phase began, support to temporary duty locations became very difficult. Travel by C-130, Eastern Star Flights (from the countries of Qatar, the United Arab Emirates, and Oman) and Western Star Flights (from the KSA cities of Tabuk, Taif, and Jeddah), began to be cancelled and not fly on a daily basis.89(p3) The eventual concern was that no flights would travel to these areas, and expensive ticketing for temporary duty personnel to conduct sanitary inspections would be required. Air Force C-12 flights were used temporarily to fill in the gaps; however, as those planes and pilots belonged to the US Military Training Mission, this air transportation support could be cancelled at any time.89(p3)

Airport access and travel in more rural areas also caused several unforeseen issues. A set of TDY orders and a US Forces identification card had been enough to gain access and travel anywhere in the United Arab Emirates, the KSA, Bahrain, Oman, Kuwait, and Qatar.89(p3) However, when non-English speaking host nation military personnel began guarding those sites, these personnel demanded passports, visas, and access badges.89(p3) The command realized that in the future, VCOs and noncommissioned officers (Staff Sergeant E-6 and above) might be necessary to conduct the extensive civilian sanitary inspections for the veterinary service mission in Third World host nations.89(pp3-4)

The 483rd Medical Detachment (Veterinary Service) (JB). For the 483rd Medical Detachment (VS) (JB), the period encompassing the Persian Gulf War from January to April 1991 saw rapid changes in both the mission and the living conditions. Even if the THREATCON level was ALPHA, BRAVO, or CHARLIE, (the first three incremental threat conditions, ALPHA being the least critical), all of their routine duties had to be performed under THREATCON DELTA (threat condition critical, the highest of the four threat conditions). Veterinary personnel carried weapons and live ammunition; chemical, biological, radiological, nuclear, and explosives protection masks; personal arms systems for ground troops’ vests; and Kevlar helmets.88(p14) In addition, co-drivers were required in each vehicle.88(p14) The almost nightly SCUD (a type of long-range surface-to-surface guided air missile) alerts exhausted the soldiers, and a good portion of each night was spent in MOPP 4 (the highest level toxic environment protective gear) and operating M8 alarms (automatic field alarm systems developed for detecting chemical agents present in the surrounding air).88(p14)

With the possibility that the supply system might stop, every site was required to stockpile a 10 days’ supply of MREs and bottled water in living areas.88(p14) An increase in the THREATCON level and the number of guard positions had unit personnel pulling 12-hour guard shifts almost every other day, thus leaving little available time to perform their mission.88(p14) Conducting commercial sanitary inspections had to be severely reduced because of terrorist threats and the closure of many small establishments as the owners fled the country. Although VCOs performing inspections wore civilian clothes, they were still required to carry a weapon and protective gear wherever they traveled.88(p14)

A unit decontamination site was selected southwest of Dhahran, and intensive nuclear, biological, and chemical training was conducted to ensure each soldier could survive in such an environment. After one of the initial SCUD attacks, all unit personnel were directed to start PB (pyridostigmine bromide) tablets as an antinerve agent, and everyone was given a total of two anthrax immunizations against a possible biological threat.88(p14) The vaccine caused considerable swelling, erythema, and pruritus that lasted up to 7 days in about 20 percent of the soldiers.88(p14)

Because adequate quantities of the anthrax vaccine were not available, the normal time period between injections was increased to more than 1 month for the majority of soldiers.88(p14) In addition, everyone had a blister pack of ten 750 mg ciprofloxacin tablets as prophylaxis in the event of a potential biological threat.88(p14) Upon notification or suspicion that biological agents were being used, they were to take one tablet every 12 hours.88(p14) This antibiotic was also excellent for the treatment of resistant strains of salmonella and shigella, and, thus, quickly became the drug of choice for bacterial infections.88(p14) An inadequate number of CANA (Convulsive Antidote, Nerve Agent) auto injectors of valium, 19 for 45 people, were issued to the unit.88(p14) Because of the shortage of injectors overall, the unit dispensed what it had to the forward-based teams with the Marines and in Kuwait.88(pp14-15)

At the beginning of Operation Desert Storm, the 483rd had a rapidly reducing mission except in the MARCENT (US Marine Corps Forces Central Command) area of operations.88(p15) The majority of rations were being delivered directly from the port to forward bases in anticipation of the onset of the ground war. In fact, during the initial buildup, rations were not a priority shipment and were replaced instead by equipment and weapons.88(p15) The 888th Medical Detachment (VS) (JA), a Veterinary Reserve unit from Lexington, Kentucky, arrived on January 20, 1991, in the middle of a SCUD attack at Al Khobar Towers, KSA.88(p15) Another Veterinary Reserve unit, the 356th Medical Detachment (VS) (JB) from the Bronx, arrived on January 26, 1991.88(p15) Both of these units arrived without equipment or vehicles. As a result of the reduced mission and a gross overload of personnel, the 888th was moved to King Khalid Military City to support the 422nd Medical Detachment (VS).88(p15)

Upon retrograde in the middle of March, units and subsistence moved back to Dhahran, and the workload then increased drastically. Units were supposed to turn in their excess operational rations into the unit they drew them from; however, that policy didn’t last long as the units who were to accept the rations were also getting ready to redeploy.88(p16) The theater-wide excess of MREs and B-rations could not be consumed by the units in place. In addition, there was confusion as to the ownership since the Saudi government had paid for all operational rations entering the theater.88(p16) This question, plus a lack of guidance on the disposition of returning rations and an inadequate number of personnel to complete the inspections, led to great difficulty in performing the mission. Eventually, the excess MREs were permitted to be used for humanitarian aid and were flown by a C-5 to Turkey and air-dropped to feed starving Kurdish refugees.88(p16) Additional rations were flown to Kuwait and southern Iraq, also to support refugees.88(p16)

The two EPW camps south of Forward Operating Base Bastogne became partially operational in early February 1991.88(p17) At the time of the initial visit by veterinary personnel, there were only nine EPWs present; by early March, the EPW population was approximately 20,000; the American population was 4,000.88(p17)

For these camps, the veterinary food inspection expertise was vital in bridging the gap between US food service and preventive medicine personnel. Preventive medicine service members were occupied full-time with waste, water, and pest control issues, and food service staff were responsible only for food produced for US personnel, not for EPWs. The EPWs themselves prepared their food, but lacked the proper training and understanding of food service sanitation. Thus, Veterinary Service personnel provided guidance to the camp military police, camp surgeon, and actual EPW cooks. Still, numerous problems ensued.88(pp17-18)

With no hot water, a central hot water system had to be installed to allow the EPWs to heat their operational rations.88(p18) For food preferences, NATO rations were desired, and then Saudi canned products, and finally MREs (listed in order of EPW preference).88(pp18-19) Because adequate dry and refrigerated food storage facilities were lacking, the semi-perishable rations were stacked directly on the ground and in the sunlight. Perishable products were stacked haphazardly in refrigerated units with commingling of different meats, fresh fruit, and vegetables.88(p18)

The food preparation equipment and utensils also were inadequate; for example, EPW cooks were using entrenching tools to cut meat on pieces of cardboard placed on the ground, and nails and knives were used to open cans.88(p18) There was also an inadequate supply of potable water. Initially, the camp tried to install a central-piped water supply, but it never functioned properly.88(p18) The camp also brought in 250-gallon onionskin bladders of potable water, but the water bladders didn’t have hoses to properly dispense the water.88(p18) EPWs would instead dip 5-gallon cans and buckets into the water bladder to obtain water.88(p18) In order to prevent disease from contamination, the water was hyper-chlorinated to 10 parts per million.88(p18)

There was also a lack of proper waste collection facilities to include dumpsters and grease pits, no sanitizing compounds or cleaning supplies, and no clean clothing for the EPW cooks.88(p18) All these issues were tackled by the veterinary personnel, and most were resolved by obtaining the proper equipment and supplies and providing the appropriate training in food sanitation.88(p19)

Post-Persian Gulf War to Present

When the Persian Gulf War ended quickly, millions of pounds of food packaged for the war were stranded en route, and the Army Veterinary Service was faced with the inspection of these rations during the summer of 1991. These items included MREs (packaged field rations); T-rations (ready-to-cook meals in a tray); unitized B-rations (100-meal modules of canned goods); MOREs (off-the-shelf purchases); bulk B-rations (semi-perishable dry goods); and bread, cereal, and sundries. All required inspection.[91]

Food items that passed inspection were then distributed to more than 30 nations, all 50 states, Puerto Rico, American Samoa, and the Mariana Islands.[91] The Second Harvest network of food banks, as the largest distributor in the United States, received about 120 million pounds of food.[91] The rations were sent out to the network’s food banks, which would then distribute them to approximately 43,000 charitable organizations to include soup kitchens, day-care centers, and homeless shelters.[91]

The Army Veterinary Service inspected about 4,500 containers of food between the summer of 1991 and March 1992, with each shipping container about the size of an 18-wheeler truck and holding about 40,000 pounds of food.[91] Shelf-life was the main concern; not bringing in any pests that required quarantine of the product was another.

Returning rations arrived in various ports, with the largest operation at Oakland, California. After being inspected at the port, the vans would receive a condition code ranging from “good for a 6-month shelf life” to “condemned.”[91] The containers of rations were then moved to government agencies, hospitals, schools, disaster relief services, homeless shelters, or food banks; about 1,500 containers were directed to relief projects in Latin America.[91] In addition, some of the food was used to assist victims of disasters, including floods in Texas and fires in California.[91] Even more rations were sent to Eastern Europe, Africa, and Asia, but the Army did retain some of the containers of MREs for its use.[91] Historically, the US had not performed a retrograde operation of any size since World War II; in Vietnam, most items were left behind.[91]

The talents of Veterinary Service personnel were readily demonstrated during the crisis in SWA. Broadly trained, innovative, and experienced military veterinary personnel were able to quickly adapt from the supposed European battlefield to one in the desert. Despite initial organizational challenges and expansive working distances, Army veterinary personnel inspected approximately 700,000,000 pounds of food.86(p72)

Operation Provide Comfort, 1991 to 1996

Although the Persian Gulf War’s Operation Desert Storm tactically concluded very quickly, with 5 weeks of aerial bombardment, followed by roughly 100 hours of punishing ground attack, there were lingering effects. Saddam Hussein and his forces made several attacks on the Kurdish people who had opposed him during the war. Hundreds of Kurds sought refuge in the mountains of northern Iraq along the border with Turkey. By April 16, 1991, US forces were assisting the Kurds and trying to prevent massive starvation in what became known as Operation Provide Comfort.[92]

The coalition effort was a multinational military and civilian force that merged into an international relief effort, and US Army medical personnel were involved from the beginning. Operation Provide Comfort provided aid to a Kurdish refugee population that was estimated between 360,000 to 760,000 civilians.93(p32) Having fled their homes to escape Iraqi aggression, the refugees were trying to survive in the mountain cliffs, enduring harsh weather and a critical lack of potable water, food, shelter, and medical care.93(p32)

Elements throughout 7th Medical Command were deployed to numerous locations in Turkey and Iraq to aid in preserving the lives of Kurdish refugees and assist in relocating the people.93(p31) A vast food inspection effort by the Veterinary Service resulted in the delivery of more than 30 million pounds of subsistence for the operation.[94] A nine-person team from the 99th Medical Detachment (VS) was deployed from Europe to the region to oversee the veterinary mission, and they were assisted by inspectors from the 34th Medical Detachment based at Incirlik, Turkey.95(p162)

Veterinary Service personnel stationed in Turkey (the 34th Medical Detachment, [VS]) led by then-Major John L. Poppe) continued to support northern Iraq refugee relief operations in the coming months and provided animal health support and food protection support for the Combined Task Force compound in Zahku, Iraq. The 34th was part of Joint Task Force Proven Force, of the Combined Task Force for Operation Provide Comfort (electronic personal communication from Brigadier General John L. Poppe, Chief, US Army Veterinary Corps, to Nolan A. Watson, chapter author, March 4, 2015). At the time, it was considered the largest humanitarian relief effort ever undertaken.93(p35)

Operations Restore Hope and Continue Hope, 1992 to 1994

Facing famine and civil war, the people of Somalia were in dire peril. Desperately needed food supplies were withheld from the starving populace by feuding Somali warlords. United Nations Peace Keepers participating in UNOSOM I (United Nations Operation in Somalia) were similarly deterred and often brutally attacked. In order to provide assistance, President George H.W. Bush ordered US troops to support humanitarian relief efforts and quell the violence. Hence, Operation Restore Hope began on December 8, 1992, and lasted until most American troops were withdrawn by March 25, 1994, ending the follow-on mission, Operation Continue Hope.[96]

Veterinary Service operations from January 2, 1993, to March 22, 1994, in Somalia for Operations Restore Hope and Continue Hope included support food inspection, MWD care, and zoonotic disease control.97(p2) During that timeframe, personnel from the 248th Veterinary Service Support Squad and 73rd Medical Detachment (VS) provided this vital mission support with the personnel strength of one VCO and nine enlisted in January 1993, which decreased to one VCO and one enlisted soldier after January 1994.97(p3)

These personnel provided inspection of MREs, operational rations, fresh fruits, and vegetables.97(p4) Military sanitary inspections were performed, and commercial sanitary inspections were conducted in both Kenya and Somalia.97(p4) The monthly food inspection workload varied from as low as approximately 0.25 million to a high of 3.5 million pounds per month.97(p5) Retrograde food inspections were conducted on semiperishable subsistence for a total of 293 MILVANs (military-owned demountable containers) equaling 2,542,662 pounds that included MREs, rations, shelf-stable bread and rolls, cereal, and ultra-high temperature processing or UHT milk97(p9) (Figure 1-38). Veterinary Service personnel also provided preventive and emergency health care to four MWDs and consultation on zoonotic disease threats.97(p4)

Lessons learned for the food inspection mission included the need for coordination with the United Nations on approved food sources for dining facilities and concessions, identifying subsistence as early as possible for retrograde movement and proper disposition, and recognizing that mobility may be limited in visiting food sources and Class I points (food, ration, and water supplies).97(p10) For the animal care mission, the need to coordinate MWD health care support and evacuation was noted, as well as screening MWDs prior to deployment.97(p16) Other issues noted were the limited expertise available for Third World livestock and the importance for support of an official mascot program, if current general orders allowed mascots.97(p16)

In addition to the aforementioned, another important lesson learned was that the level of hostile threat limited the performance of the food inspection mission and the ability to provide support for the MWD, local animal missions, and higher headquarters. Overall, the other branches of the military and the United Nations needed to be educated on the potential roles for Veterinary Service.97(p28) In fact, when questions arose concerning local food procurement, the Army Surgeon General sent then-Chief of the Veterinary Corps Colonel Clifford I. Johnson to assess the situation first-hand and make recommendations to the Commanding General in Somalia. After viewing local sanitation and food facilities, Colonel Johnson recommended that food not be procured locally for consumption by troops in Somalia. When the colonel was leaving Somalia, the military aircraft he was traveling in came under attack by hostile gunfire (electronic personal communication from Colonel [Retired] Clifford Johnson, former Chief, US Army Veterinary Corps, to Nolan A. Watson, chapter author, March 22, 2013).

Figure 1-38. Subsistence supplies are unloaded and await inspection in Somalia during Operation Restore Hope.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Veterinary Command, Activation and Inactivation, 1994 to 2011

The Veterinary Command (VETCOM) was created in 1994 as part of the larger US Army Medical Command (MEDCOM) establishment (Figure 1-39). The MEDCOM organizational changes were made to consolidate the management and oversight of medical treatment facilities and replaced the Health Services Command or HSC, which had been established in April 1973. VETCOM had Veterinary Service Support Areas (VSSAs) that mirrored Health and Dental Service Support Areas for the rest of MEDCOM, which were known as HSSAs and DSSAs, respectively.

Figure 1-39. Distinctive unit insignia for US Army Veterinary Command, created in 1994. The insignia drew from symbols and imagery originally used by the Chicago-based Army Medical Service Meat and Dairy Hygiene School.
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

VSSAs differed in that they also supported Navy and Air Force activities, because the Army maintained Executive Agency status for Veterinary Service. Local veterinary activities, which were a part of Medical Department Activities (MEDDACs) at the time, were reorganized into 20 veterinary districts under the VSSAs. In 1996, the HSSAs were renamed Regional Medical Commands or RMCs, and the VSSAs were renamed Regional Veterinary Commands or RVCs.[98] Regional Veterinary Commands were subordinate commands under VETCOM and were established to align with the larger Regional Medical Commands. Also, the DoD Veterinary Food Analysis and Diagnostic Laboratory at Ft Sam Houston and the DoD Military Working Dog Center at Lackland Air Force Base, San Antonio, Texas, were directorates under VETCOM (written communication, Colonel Leslie G. Huck, chapter author, March 2015).

On July 22, 2011, VETCOM was inactivated. The former command combined with the US Army Center for Health Promotion and Preventive Medicine or CHPPM to create the new US Army Public Health Command or USAPHC. These changes were short-lived as MEDCOM again reorganized in 2014, and its reorganization is still ongoing (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author).

Operation Uphold Democracy, Haiti, 1994 to 1995

Initially begun in 1994 to reinstate Jean-Bertrand Aristide as the properly elected President of Haiti, Operation Uphold Democracy altered to provide humanitarian assistance and order. Veterinary and preventive medicine services were urgently needed in a country that struggled with numerous health issues. The US-led multinational forces’ veterinarian coordinated efforts with the Haitian Ministry of Agriculture and provided technical advice to the Ministry of Agriculture and Ministry of Health.99(pp21,24) The multinational forces’ veterinarian also played a vital role in controlling illnesses associated with food by coordinating with other veterinarian assets in theater to inspect local sources of meats and water from the Haitian economy.99(p24)

As a part of the larger US military Operation Uphold Democracy, the veterinary-specific Operation MAD DOG was a humanitarian CA project with the goal of protecting civilians and United Nations soldiers in Haiti by immunizing dogs and cats against rabies (Figure 1-40). Rabies is endemic in Haiti and numerous other Caribbean countries, and every year several deaths are attributed to the disease.100(p17)

Figure 1-40. Rabies poster for distribution during Operation Uphold Democracy in Haiti, 1994 to 1995.
Roughly translated as, “If you see/had contact with a rabid dog from 10 to 17 January 1995, you should find an American/Marine for treatment.”
Courtesy of the Army Medical Department Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

In July and August 1995, teams of Haitian and American veterinarians and technicians executed Operation MAD DOG.100(p17) Operation MAD DOG achieved a measure of success because of the mutual cooperation of numerous governmental, nongovernmental, private volunteer, military, and nonmilitary organizations that participated in the operation. Army veterinarians—working closely with the Christian Veterinary Mission, the Pan American Health Organization, and the revitalized Haitian Ministry of Agriculture and Ministry of Health—conceived a plan to conduct a massive rabies vaccination campaign using donated vaccine.100(p17) The 94th Medical Detachment (VS) from Ft Sam Houston contributed the majority of the veterinary staff for US forces.100(p17) Additional medical units and the 248th Medical Detachment (VS) also assisted in the operation.

Divided into two phases, the operation resulted in a grand total of 47,768 animals being immunized against rabies.100(p19) The Haitian public responded enthusiastically to the program, so much so that crowd control was a constant problem, as the spectacle of Haitian veterinary agents and American soldiers vaccinating dogs and cats was a source of entertainment for the local people.100(pp19-20)

Other issues encountered included the heat, the language barrier, traffic conditions, and the unpredictability of the animals. From the perspective of the military forces involved, this operation was an invaluable training experience in a real-world setting and provided the veterinary units an opportunity to train in tasks related to deployment, humanitarian assistance, convoy procedures, and animal disease suppression.100(p20)

The Kingdom of Saudi Arabia

Other Veterinary Service missions would serve as precursors for larger operations. The 46th Medical Detachment (VS) was forward deployed from Ft Stewart, Georgia, to SWA near Dhahran, KSA, on July 4, 1996, under the command of then-Major Leslie G. Huck. The unit was deployed to assume the garrison support veterinary services mission in SWA. About 10 days prior to their arrival, on June 25, 1996, the Khobar Towers area (quarters for non-Saudi Arabian military personnel) was bombed (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author).

Not long after arrival, Major Huck, along with finance and other out-processing personnel, visited various sites in KSA to prepare military dependent family members for a noncombatant evacuation operation (NEO). Colloquially known within the 46th as “Operation Noah’s Ark,” this NEO began with veterinary personnel administering necessary vaccines to pets. The health certificates also needed for privately owned animal travel were given to their owners after the travel health checks and vaccinations were finished (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author).

Pets were evacuated separately from military dependent family members; over 100 dogs and cats were transported to Riyadh and flown via an Air Force C141 to Charleston, South Carolina. To make sure pets were properly cared for before and during their flight to Charleston, two VCOs (Captain [later Colonel] Thomas E. Honadel and Major [later Colonel] Robert L. Vogelsang, III) and two 91Ts (now 68Ts) were sent from CONUS to Riyadh to accompany the pets. Other veterinary personnel were awaiting the arrival of the pets in Charleston; these personnel set up temporary living quarters and cared for the pets until all animals were reunited with their owners (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author). Operation Noah’s Ark, which proved successful, paved the way for similar Veterinary Service NEO endeavors that are mentioned later in this chapter.

Food Safety, Food Security, and Food Defense

As a follow-on mission in the KSA, the 46th Medical Detachment increased its food surveillance activities and a new terminology arose: food defense. Although protecting food from intentional attack already took place to some extent after Pearl Harbor was attacked during World War II, it was not part of the veterinary service mission in the 1980s and would alter during the 1990s (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author).

As a part of post-Khobar bombing assessments for security in 1997, an Air Force public health officer was conducting water vulnerability assessments and shared his findings with Major Huck, who added food to the items to be studied. The 46th personnel started conducting Food and Water Risk Assessments (FWRAs) to determine vulnerability at US facilities in Bahrain, the KSA, and Kuwait and shared the findings with installation command teams, so mitigation measures could be instituted to prevent possible intentional attacks on the food and water supplies. At that time, these measures were called “food security,” which was later changed to “food defense”(personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author).

After the American Embassy bombings occurred in 1998 in Africa, force protection measures increased throughout the United States European Command. Veterinary services personnel started conducting FWRAs at many US facilities in Europe. Faced with continuous threats to military and dependent personnel, the concept of using FWRAs spread throughout Veterinary Services. After the attacks of September 11, 2001, the Veterinary Corps Chief, Colonel John S. Fournier, wanted to formalize the inspection process and gathered a team consisting of Thomas J. McNeil, Chief Warrant Officer 3 Robert D. Ralyea, Lieutenant Colonel Robert D. Weir, and then-Lieutenant Colonel Leslie G. Huck to write the first edition of the US Army Center for Health Promotion and Preventive Medicine Technical Guide 188, US Army Food and Water Vulnerability Assessment (personal knowledge, Colonel [Retired] Leslie G. Huck, chapter author). Food defense remains an integral and formal part of the US Army Veterinary Service’s food protection mission for the DoD.

Bosnia: Operation Joint Endeavor, Operation Joint Guard, and Operation Joint Forge, 1995 to 2004

In order to provide stability in the former Yugoslavia and to enact provisions of the Dayton Peace Plan, America and other European countries (Figure 1-41) provided military resources known as the Implementation Force (IFOR) to end ethnic clashes. The early phase of the deployment of US military in support of IFOR was known as Operation Joint Endeavor and began in December 1995.101(p1) With over 20,000 American soldiers deployed into the Bosnian Theater, medical and veterinary support was understandably needed.

After extensive predeployment training, personnel from the 72nd Medical Detachment (VS) arrived in the former Yugoslavia as part of the 30th Medical Brigade’s medical support for Task Force Eagle on December 27, 1995.101(p3) The unit performed food safety missions and provided care for MWDs within Hungary, Croatia, and Bosnia-Herzegovina.101(p2-3)

Figure 1-41. Swiss dog handler Corporal Hans Loetscher (left) comforts his patrol dog “Kirro” as Specialist Thomas D. Lombardi, veterinary technician, checks its vital signs. US Army photo published in The Talon, November 8, 1996, page 9.
Reproduced from http://www.dtic.mil/bosnia/talon/tal19961108.pdf. Accessed October 23, 2017.

Figure 1-42. Warrant Officer Roman I. Chyla, a food inspection technician, conducts an inspection of a Bosnian bakery. US Army photo published in The Talon, March 14, 1997, page 4.
Reproduced from http://www.dtic.mil/bosnia/talon/tal19970314.pdf. Accessed October 23, 2017.

For example, local bakeries were often examined by the 72nd as baked goods were often a staple food source for IFOR or Stabilization Force (SFOR) troops[102] (Figure 1-42). Larger food production facilities, those owned by corporations, were excluded in favor of small, local-based producers. This action was enacted in hopes of gaining goodwill with the local populace.101(p7) Trichinosis in locally procured pork products presented a problem as there were outbreaks in the country that affected hundreds of Bosnians.[103] The problem did not affect American pork consumption, however, and veterinary inspectors ensured that locally purchased pigs used in morale building cookouts were fit for consumption.101(p7)

The 72nd provided treatment for MWDs and public health monitoring of stray animals that were pervasive in the country. Although mascots were officially not permitted, soldiers eagerly sought pets. The numbers of stray dogs increased alarmingly around troop concentrations, and the Veterinary Detachment, in an effort to provide better public health, had the unpopular task of euthanizing many of the animals. MWDs in the area were also faced with a tick-borne disease, babesiosis. Once diagnosed by Captain (later Lieutenant Colonel) Martin M. LaGodna, the 72nd’s executive officer, and after receiving medication (Imidocarb) provided by a local veterinarian, the MWDs recovered, and veterinary personnel were ready for future cases of the rickettsial disease. Despite the many veterinary medical issues and challenges encountered during IFOR, there were no MWD casualties, nor did it ever become necessary to medically evacuate an MWD to Dog Center Europe, Germany, for Level III definitive medical care.101(p9)

There were rumors that foot and mouth disease (FMD) or biological weapon storage were used to the advantage of Bosnian Serb forces.101(p12) These incidents were quickly dispelled by military veterinarians. On August 14, 1996, the German Bundeswehr (Army) veterinarians hosted an IFOR veterinary FMD summit in Trogir, Croatia. Major (later Colonel) Robert E. Walters, the 72nd commander, and then-Captain LaGodna attended as the US Army IFOR representatives.101(p13) With Major Walters taking the lead, the group put together an IFOR FMD contingency plan in the event of an FMD outbreak in Bosnia-Herzegovina or Croatia.101(p13) On October 16, 1996, after a week of transition, Major Walters and Captain LaGodna redeployed from the former Yugoslavia and were the last members to leave of the original Veterinary Detachment.101(p14) They were replaced by the incoming 72nd Commander, Major (later Lieutenant Colonel) Daniel E. Holland and his Executive Officer, Captain (later Colonel) Robin K. King.101(p14)

American and the partnering countries’ involvement in Bosnia changed in December 1996 when the tasks of IFOR were transitioned to the SFOR.104(p33) SFOR took active steps to prevent and arrest war criminals within Bosnia. American forces were reduced to approximately 5,000 troops, and the operation was renamed Operation Joint Guard,104(p33) which was followed by Operation Joint Forge on June 20, 1998.104(p37) Operation Joint Forge resulted in a further decline in US troop numbers and the units that were formerly drawn from USAEUR. Replacement troops were sought from the National Guard and the Army’s Reserve component.104(p37)

US forces continued to dwindle in the area as there was a shift to operations in Kosovo and, then, Afghanistan and Iraq. For the most part, American involvement ended in Bosnia when European forces took command of the mission, altering SFOR to European Force or EUFOR in 2004.104(p37) As activities in Bosnia stabilized, there were other portions of the former Yugoslavia that were in need of assistance.

Kosovo: Operation Joint Guardian, 1999 to Present

Moving into the area of Kosovo within the former country of Yugoslavia in June of 1999, NATO and American forces worked to maintain peace and end thousands of attacks and murders related to ethnic divisions.105(p5) This group was known as Kosovo Protection Forces (KFOR), with the American portion termed Operation Joint Guardian.105(pp5,17) Task Force Medical Falcon, based at Camp Bondsteel, Kosovo, had a critical mission to save lives and provide medical support to US military personnel, Kosovar soldiers, and local national Kosovars.[106] The Task Force Medical Falcon was supported by many of 30th Medical Brigade’s units, including the 100th Veterinary Detachment.[106]

The mission of the 100th was to provide food safety, veterinary public health, level II+ veterinary medical care to government-owned animals, and limited civil military operations in Kosovo, the Former Yugoslavia Republic of Macedonia (FYROM), Greece, and Bulgaria.[107] Military communities supported included Camp Bondsteel, Kosovo; Camp Monteith, Kosovo; and Camp Able Sentry, the FYROM.[107] Civil military operations included inspection of humanitarian rations for World Health Organization’s World Food Program and VETCAPs.[107] The food safety mission involved prime vendor surveillance inspection of Class I facilities (subsistence), conducting 11 commercial sanitary food plant inspections in Kosovo, the FYROM, and Greece; managing the hazardous food recall program; and supplementing preventive medicine missions when necessary.[107]

For veterinary public health, the 100th provided consultation to the military treatment facility commander, clinicians, Task Force Falcon (TFF) staff, and nongovernment organizations on zoonotic diseases; developed mascot and stray animal policies; and served as a member of Rabies Advisory Board.[107] The Level II+ veterinary medical care involved support for approximately 50 government-owned animals, with outpatient services, minor surgery, and stabilization for evacuation.[107] Major surgical stabilization, which would require the use of the hospital operating room, laboratory, radiology, and pharmacy support, was limited because of in-house facilities.[107]

For civil military operations, the VETCAP missions were directed by TFF and provided limited assistance to local populations in the form of veterinary care. In later years (eg, 2009) tasks were received from the command element, which was the 40th Infantry Division for that year (written communication from Major Laura K. Lester, Centers for Disease Control [CDC] Epidemic Intelligence Service Officer, Arkansas Department of Health, US Army Veterinary Corps, January 11, 2015). The primary focus of VETCAPs was to improve the level of public health via examination, vaccination, and deworming of animals. Animal husbandry training was also provided. The teams would also assist in diagnosis of animal disease outbreaks or endemic animal diseases, provide recommendations on control measures, and train local public health and agriculture officials.[107]

Beginning in 2010 and concluding in 2015, the KFOR Strategic Health Engagement partnership with the European Union and the Kosovo Food and Veterinary Agency worked with US Army personnel to eliminate rabies in Kosovo.[108] This task was undertaken first through the dispersal of oral rabies vaccine at Camp Bondsteel and then further distribution at strategic locations and bait sites.[108] Vaccines were aerially distributed with vaccines put into food material and dropped, as well as delivered by NATO and KFOR military compounds.[108] The overall mission in Kosovo, although diminished in numbers, continues at the time of this 2017 chapter writing.

Operation Enduring Freedom and Operation Iraqi Freedom

On the morning of September 11, 2001, Al Qaeda terrorists working under the direction of Osama Bin Laden conducted suicide attacks utilizing hijacked aircrafts that were crashed into the World Trade Center buildings in New York and the Pentagon. An additional plane attack on Washington, DC, was prevented by the passengers of United Airlines Flight 93; all passengers aboard the United Airlines plane perished during this foiled Al Qaeda mission. The immediate consequence of the multiple attacks was a deployment of US forces into Afghanistan.

The Army Veterinary Service supported the war against terrorism during Operation Enduring Freedom in several regions to include Afghanistan (Figure 1-43), the Philippines, and Africa. The Veterinary Service has also performed crucial duties during Operation Iraqi Freedom and its closing piece, Operation New Dawn. Despite the long years of conflict, the Army Veterinary Service—encompassing active duty and reserve veterinarians, warrant officers, enlisted soldiers, and civilians—continues to serve in SWA and Africa providing world-class veterinary medical and food inspection support to US and coalition forces.[109]

Figure 1-43. “T-Wall” signage for the 64th Veterinary Detachment. The signage was located on the exterior concrete wall of the Craig Joint Theater Hospital in Bagram, Afghanistan. The center crest on the eagle demonstrates medicine and military working dog care; the box cutter and test tube show the importance of opening samples and testing of food items.
Courtesy of Nolan A. Watson, chapter author.

Operation Enduring Freedom. The first VCO to deploy in support of Operation Enduring Freedom was Lieutenant Colonel Paul Dakin, who teamed with Special Forces in 2001. Although veterinary personnel served as part of Special Forces teams or with CA detachments, one of the first veterinary units deployed in support of the military efforts against terrorism (later named Operation Enduring Freedom) was the 248th Medical Detachment (VS).110(p19) Eight members of the unit arrived at an Uzbekistan staging area on December 3, 2001.110(p19) Three personnel from the unit established veterinary services operations at Kandahar Air Field in February 2002.110(p19) Portions of the unit redeployed in May 2002, leaving three personnel in Uzbekistan until July 2002.110(p19) Of special note is that the team leader from the 248th (Major, later Colonel, David Fletcher) was the first VCO in Afghanistan in 2002 when US forces were seizing Bagram Airfield to render aid to an MWD.

Another unit, the 994th Medical Detachment (VS), US Army Reserve (USAR), was also deployed early in the conflict and followed the 248th. The 994th was a subordinate unit of the 807th Medical Brigade, and assisted the 248th in Uzbekistan and relieved the 248th in Kandahar.110(pp2,8) Detachment 1 of the unit arrived in theater on November 29, 2001, and Detachment 2 arrived on February 9, 2002.110(p4) With a larger capability (25 soldiers), the 994th maintained veterinary service for Afghanistan, Qatar, Kuwait, Oman, Bahrain, Djibouti, and Kyrgyzstan.110(pp6-7)

TDY missions to many other surrounding countries were also part of the 994th’s mission. Its personnel provided MWD support and DoD food safety missions for Operations Anaconda, Mountain Lion, and Condor in Afghanistan and elsewhere in the SWA Theater.110(p8) The unit was also tasked by the Coalition Forces Land Component Command Surgeon to lead an epidemiological investigation of a British outbreak of a meningitis-like illness in May 2002.110(p9) Additionally, the 994th conducted a serological survey of leishmaniosis in a large group of Afghan mine detection dogs in Kabul during June 2002.110(p9) When the 994th redeployed in 2002, the 109th Medical Detachment (VS), USAR, assumed the outgoing unit’s roles and responsibilities.110(pp13, 22)

Operation Iraqi Freedom. After numerous stalled attempts to allow United Nations weapons inspectors into Iraq, Iraqi leader Saddam Hussein’s support for terrorism, and fearing another attack on Americans utilizing weapons of mass destruction, a coalition of US-led forces invaded Iraq on March 20, 2003. The new military phase in the continuing war against terrorism was named Operation Iraqi Freedom. Initial stages of the operation saw mechanized and armored forces break through and advance quickly into the country.

The 248th Medical Detachment (VS) was originally assigned to the 62nd Medical Brigade from Ft Lewis, Washington, and aligned with the 4th Infantry Division to take the northern land route through Turkey into northern Iraq. Turkey denied access for the planned northern route, and US forces were diverted to Kuwait. The 248th was part of this new movement and reassigned to the 30th Medical Brigade under V Corps. The unit was located at Camp Virginia and conducted veterinary missions in Kuwait and southern Iraq (personal electronic communication from Brigadier General John L. Poppe, Chief, US Army Veterinary Corps, to Nolan A. Watson, chapter author, March 4, 2015).

Displaced from the northern Iraq mission, the 248th assumed the animal health and food protection mission from the 109th Medical Detachment (VS) in Kuwait and southern Iraq. After arriving in Kuwait and being reassigned, it was originally planned for the 248th to split the veterinary mission in Iraq, with the 248th responsible for veterinary services in northern Iraq and the 72d Medical Detachment (VS) (organic to the 30th Medical Brigade) having responsibility for southern Iraq. The day before the 30th Medical Brigade and 72d pushed north into Iraq, the 248th received redeployment orders. The 109th (USAR) had been in the CENTCOM Theater an extended time and were being extended further. To relieve the 109th, the 248th assumed their mission to give them relief in place. The 248th was redeployed in June 2003 (personal electronic communication from Brigadier General John L. Poppe, to Nolan A. Watson, US Army Medical Department, chapter author, March 4, 2015).

Many veterinary units for the invasion force (V Corps) were subordinate to the 30th Medical Brigade and the 93rd Medical Battalion (Dental Service).[111] The 93rd Medical Battalion was organized to provide command and control to subordinate units with functions other than dental tasks.[111] Included under the 93rd were the following units: the 21st Medical Detachment (VS), 43rd Medical Detachment (VS) (Operational Control [OPCON]), 72nd Medical Detachment (VS), and 218th Medical Detachment (VS) (Attached).[111]

Continued Support and Global Concerns

The operational tempo and length of veterinary support against terrorism would see multiple deployments of veterinary units and personnel over the years to both Iraq and Afghanistan. Additionally, other areas such as Djibouti, other countries in Africa, CENTCOM sites, and the Philippines were frequent duty stations for Army Veterinary Service members. As previously mentioned, veterinary personnel were also assigned to Special Forces units, CA units, and Agribusiness Development teams. Other veterinary detachments and medical detachments (VS) not previously mentioned that were deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom include the 51st, 64th, 463rd, 438th, and 463rd. Reserve Component units included the 109th, 358th, 422nd, 445th, 719th, 949th, and 993rd (personal electronic communication from Colonel Tami Zalewski, FORSCOM Chief, Medical Operations and Command Veterinarian, to Colonel Leslie G. Huck, chapter author, November 6, 2014).

There have been both military and humanitarian benefits of veterinary personnel’s work. One example of the benefit of food inspection support by the Army Veterinary Service has been the inspection and approval of locally owned bottled water plants in Afghanistan. The resulting savings have been more than 38 million dollars per year and the elimination of over 4,000 water-hauling truck trips from supply routes, thus decreasing drivers’ hazard to improvised explosive devices.112(p5) These water plants are now part of the approved source audit program, protecting deployed service members and contributing to overall food safety.112(p5) Veterinary Service personnel, working directly with the governments of Afghanistan and Iraq, have also assisted in the development and improvement of food safety programs for those nations.109,112(p5)

Figure 1-44. Lieutenant Colonel Neil Ahle, Multinational Division-Baghdad veterinary officer, gives a lamb a dose of wormer at a veterinary operation in Al-Taraq, Iraq. The operation, conducted by Ahle and soldiers of Company C, 4th Battalion, 31st Infantry Regiment, 2nd Brigade Combat Team, 10th Mountain Division (Light Infantry), treated about 100 animals for worms and provided vaccinations and vitamin injections for the livestock that forms a critical part of the local economy.
Reproduced from the Defense Video and Imagery Distribution System. https://www.dvidshub.net/image/34693/yusufiyah-animals-benefit-visit#.VJRMC1KDA. Accessed October 23, 2017.

Supplying veterinary care to the hundreds of working dogs supporting operations has been another major function of the Army Veterinary Service. Another invaluable Veterinary Service mission more readily visible in recent years is animal care for host nation countries, usually referred to as CA or humanitarian assistance missions. During these deployments, veterinary personnel provide clinical and preventive veterinary care to livestock (Figure 1-44) and other animals of the native people of countries such as Afghanistan, Iraq, Nicaragua, Africa, and the Philippines112(p5) (Figure 1-45). The military not only improves the health of the animals, but also directly impacts the quality of life for the families and often the economies of these countries.112(p5) The Veterinary Service has also served as coordinators and facilitators for nongovernmental and private volunteer organizations.

Figure 1-45. A sedated lion at the Baghdad Zoo has blood drawn March 24, 2010, by Iraqi zoo workers as Major Matt Takara, commander of the 51st Medical Detachment Veterinary Medicine, 248th Medical Detachment Veterinary Services, observes the procedure. Takara was part of a US forces team organized by 1st Armored Division, US Division-Center, continuing a relationship started early in the Iraq campaign.
Reproduced from the Defense Video and Imagery Distribution System. http://www.dvidshub.net/image/263914/iraqi-us-veterinarians-partner-help-baghdad-zoo-animals#.VK_4yclMGos. Accessed October 23, 2017.

A significant accomplishment was seen in Afghanistan during the emergence of H5N1 Highly Pathogenic Avian Influenza (HPAI) and concerns over its possible role in precipitating a pandemic; the first H5N1 outbreak in Afghanistan occurred in March 2006.113(p41) The US Naval Medical Research Unit No. 3 (NAMRU-3) deployed one of its Army veterinarians with a mobile polymerase chain reaction or PCR laboratory, which was able to diagnose the cause of the outbreak as H5 avian influenza.113(p41) However, government systems were not in place to respond, resulting in a delay of over a week while the outbreak continued to spread.113(p41)

Several thousand birds in the infected villages had to be culled, impacting livelihoods and also confidence in the Afghan government. The virus spread to more than six provinces in Afghanistan.113(p41) 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.113(p42) From observation and data collection, the laboratory diagnosed a H5N1 reintroduction into Afghanistan in February 2007.113(p42) This time, the Afghan government responded immediately once the positive results were obtained, and the H5N1 outbreaks were limited to three provinces, and only a few hundred birds had to be culled.113(p42) Thus, the country had achieved both a laboratory capacity and an improved responsiveness for future outbreaks through the efforts of NAMRU-3.113(p42)

Some other interesting observations in the Iraq and Afghanistan theaters have been documented since 2010. US installations in both Iraq and Afghanistan have authorized the opening of small restaurants, coffee shops, grocery stores, and convenience stores on the installations. The garrison command’s purpose was to endorse local vendors as a means of economic stimulation for the community and to generate goodwill in the local area.114(p1) However, the local food establishments had problems such as the sale of unapproved food sources.114(p1)

Unfortunately, these sources lacked traceability; thus, if a food-borne illness were to develop, the military would be unable to work with the local government to pull the food from the market.114(p1) In addition, the food defense and transportation methods of the food producer were unknown; such breaches in food defense are a real threat to the military’s subsistence.114(p1) Also, the medical screening of food vendor employees was uncertain.114(p1) These vendors may have received a certificate of health through a local physician; however, the quality of screening was unknown.114(p1) The recommendations, to decrease at least the risk of some food-borne illnesses, were to limit the products to be sold to hot tea, hot coffee, and unfilled pastries and breads.114(p3)

Concerning livestock and veterinary programs for Iraq in 2010, the reviews were mixed. Although there were 11,000 veterinarians in the country, most were not doing veterinary work and had little or no technical skills.115(p11) With 16 veterinary schools in the country, and 400 graduates per year, a surplus of veterinarians existed, yet the services they provided were minimal.115(p11) The Iraqi Veterinary Syndicate, similar to the American Veterinary Medical Association, was present; there were also several national associations that were operating then to include the Iraqi Red Meats Association for cattle and sheep producers and the Iraqi Poultry Producers Association.115(pp10-11)

Most interestingly, developing national animal health plans was no longer considered a priority for the postwar government of Iraq.115(p11) Before the war, the country of Iraq had large farms and was equipped with modernized capability. However, since then that capability has greatly diminished. Though many tractors have been introduced, fuel has been a problem and is expensive.115(p17) Iraq needs a long-range plan that focuses on water supply, electricity, and land reclamation (one similar to the United States’ reclamation plan in 1936–1944 during the Dust Bowl).115(p17) With the right agricultural approach, the country could have very productive areas.115(p17)

Finally, the threat of rabies appeared again, this time in Afghanistan in 2011. While service personnel were warned of the dangers of feral dogs within the country and many had been treated after coming into contact with the animals, one US soldier was bitten and later died from the disease.[116] The tragic death would cause increased efforts by veterinary services to educate commanders and local nationals on the dangers of stray animals and their contact with humans (Figure 1-46). (See also Chapter 12 of this textbook for more information about military veterinary efforts to educate commanders, service members, and local nationals about rabies control.)

Forward Operating Base Salerno, Afghanistan. On June 1, 2012, personnel from the 72nd Veterinary Detachment experienced an attack first-hand while stationed on Forward Operating Base Salerno in Afghanistan.117(p1) During lunchtime in the dining facility, insurgents detonated a vehicle-borne improvised explosive device at a nearby gate, with the shock wave causing the roof of the dining facility to collapse on those inside.117(p1) Veterinary personnel were inside the facility, and although they sustained minor physical injuries, they assisted others to get to safety. As they left the dining facility, they were then met by small-arms fire by insurgents wearing suicide vests; the insurgents breached the base perimeter after the initial blast.117(p1)

While running for cover, they assisted and treated other injured personnel. They also pulled a contract worker from a mound of rubble and administered first aid.117(p1) Allowing others to seek cover, one of the veterinary personnel provided suppressive fire against two of the insurgents.117(p2) An attacker positioned under a Humvee eventually blew himself up, ending the assault.117(p2) Numerous insurgents were killed during this attack, along with one US soldier and a civilian contractor.[118] Recognized for their actions during the attack were the following soldiers: Sergeant Sandra M. Castle (later Staff Sergeant) and Sergeant (later Staff Sergeant) Robert W. Blackmore III received the Army Commendation Medal with “V” (Valor) device, and Sergeant (later Staff Sergeant) Raffique Khan and Captain (now Major) Bethany A. Everett received the Bronze Star Medal with “V” device.119,120

Another veterinary unit serving in Afghanistan, the 64th MDVSS, had the task of conducting FWRAs, including one for a high-profile Independence Day celebration at the US Embassy in Kabul. Initially, the 64th enforced and supervised food defense and sanitation standards for events that involved the US ambassador, State Department employees, US and Afghan military dignitaries, and 1,200 Afghan citizens. On July 17, 2014, a Transition of Authority ceremony was held on Bagram Air Field, transferring the mission from the 64th MDVSS to the 72nd MDVSS.[121]

Figure 1-46. A US Army Public Health Command-produced rabies poster that relays to local nationals the dangers of not reporting unsafe contact with animals. This poster is printed in Dari, one of the predominate languages in Afghanistan.
Reproduced from https://usaphcapps.amedd.army.mil/HIOShoppingCart/viewItem.aspx?id=442 and https://usaphcapps.amedd.army.mil/HIOShoppingCart/viewItem.aspx?id=510. Accessed October 23, 2017.

Role in Nation-Building. Stability and reconstruction operations in failed or failing states, like Afghanistan, are crucial to US security interests.122(p71) Military veterinarians have been planning and conducting animal and public health activities in support of stability operations since World War II.[123] In Afghanistan, agriculture accounts for 45 percent of the gross domestic product and serves as the main source of income for the Afghan economy; over 80 percent of the population is involved in farming, herding, or both.[124] However, the decades of war, drought, and security challenges have devastated the country’s agricultural sector, and revitalization is critical to building confidence in the government and stabilizing the country.122(p71-79) Early engagement by veterinary teams stimulates agricultural productivity, improves animal and human health, and contributes to stabilization operations.122(p71) As noted before in this chapter, Army Veterinary Service personnel are frequently engaged in these operations as members of Special Operations Forces, CA units, and civil-military operations task forces.122(pp76-77) They work closely with the host state’s military counterparts and government ministries and agencies.122(pp76-77)

Coalition Joint Civil-Military Operations Task Force-Kabul VCOs have worked with several of the Afghan ministries to include the Ministries of Agriculture and Animal Husbandry, Higher Education, Public Health, and Defense.122(p77) VCOs have coordinated with international and nongovernmental organizations on a variety of projects to improve the health of both the animal and human populations.122(p77) The programs included reinvigoration of the Afghan Ministry of Agriculture and Animal Husbandry’s veterinary infrastructure; rebuilding the national veterinary diagnostic laboratory and the national vaccine laboratory; and working with nongovernmental organizations to build veterinary clinics to improve access and serve as veterinary training facilities.122(pp77-78) Other projects included rebuilding greenhouses and national animal and crop production research facilities; rebuilding the national poultry industry infrastructure; and providing supplies to regional veterinary clinics to service local populations.122(p78) Improvement in the state’s agricultural sector hopefully can reduce the possibility of a humanitarian crisis or continuance of insurgency.122(pp71,79)

Veterinary personnel also frequently conduct domestic animal vaccination programs to reduce the prevalence of disease in support of host state governments. These VETCAPS, conducted in areas such as Afghanistan, Iraq, and the Horn of Africa region, have improved animal health and provided training to local livestock producers, veterinarians, and veterinary technicians.122(p78) Interestingly, when combined with medical and dental services in villages, often it was the veterinarian who had the most patients and the longest lines; the families cannot survive without their livestock.122(p78) The early deployment of veterinary assets can improve self-sufficiency for the local population, and the promotion and initiation of sustainable agricultural programs leads to overall host nation economic and social growth.122(p79) (Chapter 17, Veterinary Support in the Irregular Warfare Environment, highlights many other veterinary nation-building activities.)

Although significant work has been completed during global nation-building missions, there have been losses. Lieutenant Colonel Daniel E. Holland, US Army veterinarian, was killed on May 18, 2006, while serving on a CA mission in Iraq. Holland was serving with the 352nd Civil Affairs Command at the time. Holland, three other soldiers, and a civilian interpreter died when an improvised explosive device detonated near their Humvee during combat operations in Baghdad. The Lieutenant Colonel Daniel Holland Leadership Award and Lieutenant Colonel Daniel E. Holland MWD Hospital at Joint Base San Antonio-Lackland preserve his name and honor his service.

Joint Task Force Katrina, 2005. When Hurricane Katrina devastated New Orleans and much of the surrounding Gulf Coast area in the latter part of August 2005, state and federal agencies mobilized and provided assistance. The Department of Defense response was organized as Joint Task Force Katrina, and this task force was able to greatly assist and stabilize the region through logistical, medical, and organizational assistance. Because of concerns for animal care, public health, and food-related issues, the Army Veterinary Service was included in the task force.

The veterinarian serving on the task force commander’s staff was Colonel Timothy K. Adams (future Brigadier General and 24th Veterinary Corps Chief, 2008–2011); the task force commander was Lieutenant General Russell Honore. After initial planning and coordination, the 248th Medical Detachment (VS) under the command of Lieutenant Colonel (later Colonel) Tami Zalewski was deployed to Louisiana as a part of the joint task force.[125] The unit would arrive with 20 members on September 27, 2005.[125] The 248th soon divided, with half of the team going to Belle Chasse Naval Air Station in New Orleans to inspect dining facilities and Class I storage locations.[125] The inspection mission would encompass more than 700,000 pounds of rations and 275,000 pounds of water.[125]

The second section of the team was stationed at Gonzales, Louisiana, where it coordinated the evacuation of all animals held at the area to other locations.[125] The animals had been staged at the 4-H Expo Center by the Humane Society and volunteers. The team at Gonzales registered and prepared more than 1,500 animals for shipment and examined and treated over 1,100 animals.[125] Because of the team’s efforts, the evacuation mission ended earlier than expected, on October 10, 2005.[125]

Camp Shelby, Mississippi, served as the forward command post for the joint task force. Because of its proximity to the affected area and infrastructure, Camp Shelby was also the staging area for numerous units and smaller task forces. The camp had thousands of personnel moving through it and received countless shipments of rations and food relief items of many types. These items included donated food from the California Growers’ Association, donations from food-producing corporations, MREs from overseas storage areas or rerouted from Defense Logistics Agency depots, items from Federal Emergency Management Agency vendors, and donated German military rations.126(p4) All rations needed to be inspected after arrival at the installation.

Inspections of items at Camp Shelby were performed by Mobilization Center Shelby (VS). The Mobilization Center Shelby VS team consisted of four personnel with one officer, two 91R NCOs, and one contract civilian.126(p5) In addition to the food safety mission at the camp, additional inspection of items and facilities expanded to other parts of Mississippi affected by the hurricane and flooding.126(pp5-6)

Keesler Air Force Base located on the gulf at Biloxi, Mississippi, received veterinary support from several activities. In order to enact the privately owned animal NEO from the base, the Gulf Coast District Veterinary Command at Ft Rucker (Maxwell Air Force Base section) coordinated with Ft Benning’s Veterinary Service branch and the Redstone Arsenal section to provide transportation, medical support, and emergency shelter.127(p1) Gathering the animals in convoy, the 101 animals were then treated and sorted in a triage method.127(p2)

As the region stabilized and floodwaters subsided, veterinary liaisons focused on long-term recovery and public health. Veterinary activities were generally successful during the operation of the joint task force, with positive interaction and coordination between the USDA, the US Public Health Service, the Humane Society, and state governments.[125]

Operation Tomodachi, Triple disaster in Japan 2011. On Friday, March 11, 2011, the largest in a series of earthquakes struck Japan near the city of Sendai. During the first event and the early hours of recovery, Japan District Veterinary Command (JDVC) located at Camp Zama and led by Lieutenant Colonel (later Colonel) Margery Hanfelt and First Sergeant Bradley Reynolds, shifted to emergency operations. Power outages and potential structural damage posed immediate food safety concerns. JDVC food inspectors called, drove, or walked (as needed, sometimes for miles) to reach all affected facility managers and to conduct refrigeration failure procedures and note potential physical damage impact to food safety.128(p20)

Within 24 hours of the earthquake, after initial food and animal facility assessments at Camp Zama and other American military installations at Yokosuka and Misawa were conducted, Veterinary Service branches started preparing command channel messages at their installations. The messages were for food safety during power outages and to provide continued refrigeration failure support to government food facilities.128(p20)

MWD kennels, stray facilities, and MWR kennels were contacted to determine physical status and address any animal injury and care issues. An increased food surveillance laboratory testing program was initiated because of increased food sanitation-related concerns. The Misawa Veterinary Service Branch and its VTF in the northern part of the island of Honshu at Misawa Air Force Base lost power, heat, and telecommunications.128(p20) Its personnel struggled to continue operations and remain warm for the next couple of weeks.128(p20)

As the tremors and aftershocks from the large earthquake decreased in magnitude but continued, another threat appeared. The earthquake had caused a vast tsunami along the east coast of Japan, which was particularly damaging to the Sendai area. Personnel from the Yokosuka Veterinary Service Branch (animal care, JDVC food inspectors, and a Navy Food Management Team noncommissioned officer) stationed on Yokosuka Naval Base had to withdraw for a short time because of fears of the tsunami, which crested 6 feet near Yokosuka versus the height of 30 feet near Sendai, approximately 100 miles to the north.128(p20) Breaking through a lowered coastline due to the earthquake, the waters crushed countless walls and buildings and damaged the Fukushima Daiichi nuclear power plant.

To aid in recovery efforts, search and rescue dogs from the United States, United Kingdom, and Australia needed veterinary support to be imported.128(p20) The strict animal import requirements of the Japanese government were met largely through the JDVC’s efforts. Once in Japan, the dogs required veterinary support while completing their search and rescue missions (Figure 1-47).

The tsunami also directly and indirectly impacted Japanese commercial food plants normally audited by the JDVC.128(p22) Still reeling from earthquake concerns, JDVC’s immediate post-tsunami actions included communicating with these plants and determining their physical damage, power supply, proximity to affected areas, and state of operations.

Figure 1-47. Misawa, Japan (March 13, 2011). Staff Sergeant Travis Lausier, right, and Specialist Jason Hayes, both assigned to the Japan District Veterinary Command, Misawa Branch, draw blood from “Lago” while his handler, Tim Dinges, comforts him. Dinges and Lago are with Virginia Task Force 1 of the Fairfax County Fire and Rescue Department and arrived at Misawa Air Base to take part in search and rescue efforts in Sendai, Japan.
Reproduced from the Defense Video and Imagery Distribution System. http://www.dvidshub.net/image/376868/us-navy-provides-tsunami-relief#.VJRaX1KDA. Accessed October 23, 2017.

The start of the new work week on Monday, March 14, brought more challenges when the containment building for nuclear reactor Unit #3 at the Fukushima power plant exploded.128(p21) JDVC identified a concern in providing support to MWDs that might need preventative radiologic protection through the administration of potassium iodine or KI tablets.128(p21) JDVC addressed the US Forces Japan (USFJ) surgeon and worked through the US Army Public Health Command (VS) with the Department of Defense Military Working Dog Veterinary Service to determine a dosage and dosing scheme, then coordinated with the US Army Medical Department Activity, Japan, Commander to obtain the tablets and finalize the plan, in case tablets were needed.128(p21) Dosage and methods of dispersal were quickly discovered and relayed but not administered.128(p21)

VTFs at Camp Zama, Yokosuka, Yokota, and Misawa began seeing increased visitation by military dependents—steadily, then very dramatically. Dependents and DoD civilians had concerns for their safety and were voluntarily leaving after receiving health certifications for their pets. The increasing stream of people often nearly overwhelmed the staff of the VTFs. This was particularly true when official notification allowed for voluntary evacuation for dependents and their pets, and “Operation Pacific Passage” began on March 22nd.128(p21) This operation would involve the examination and certification of health for over 2,700 privately owned animals.128(p21)

Although the VTFs were faced with completing countless pet certifications and vaccinations, they succeeded through dedication and shifting personnel.128(p21) Supplemental personnel were primarily available food inspectors from the Yokosuka and the Camp Zama VS branches.128(p21) There were also volunteers standing in line, MWD handlers, and a newly arrived JDVC Animal Health Technician destined for the Sasebo VTF who had not in-processed yet.128(pp21-22) A surgeon in the Misawa VTF line, also wishing to help, was given a stethoscope and a crash course on animal physical exam basics and was put to work in an exam room.128(p22)

Although plans had previously been made for a NEO from Korea in the event of the outbreak of hostilities on the Korean Peninsula, Operation Pacific Passage from Japan served as the first real test, even though there were no hostilities. The number of spouses, dependents, nonlocal civilian employees, and their animals presented a formidable hurdle for the US military during the Japan NEO.

As military personnel and family members decided what course of action to take, a town hall meeting was called at Camp Zama. USFJ and garrison command leadership fielded questions and concerns. One issue that came up was the care of personally owned animals. Noting the extreme concern, USFJ Commander, Major General Michael T. Harrison agreed (along with fellow service commanders in Japan) that personally owned animals could be a part of the voluntary departure.128(p23)

This command action would ease many military personnel and dependents’ minds, but also significantly increase the workload for VTFs and their staffs. Though most of the dependents and civilians opted to stay in Japan, a fair number decided to leave. Volunteers helped to bridge the gap for animal care in the manner of feeding and walking. Also, some government exchanges provided complimentary water and pet carriers. Navy personnel also assisted in movement of the pets to Narita airport near Tokyo.128(p23) Navy Seabees even constructed a very large pet carrier for a bull mastiff.

After 4 to 8 weeks, many of the dependents returned to Japan. Operation Pacific Homecoming, the reverse of Operation Pacific Passage, went smoothly.128(p24) The ease of the transition in connection to the movement of personally owned animals was largely due to JDVC’s interactions with the Government of Japan. The JDVC was able to maintain the documentation and field a variety of questions that satisfied the Government of Japan’s requirements.128(p24)

Approximately 2 weeks after the March 11th earthquake, concerns of food procurement continued to surface. Radiologic contamination was the most notable concern, but of equal importance were refrigeration and other storage and transportation issues related to the earthquake and its aftermath.128(p24) Veterinary food inspection teams, previously assisting in the animal care mission, “re-tooled” to their original function (food safety) and began another phase of recovery.128(p24) Although the food safety inspection was a task previously assigned, it expanded greatly because of the new challenges developed by the unfolding disasters.128(p24)

JDVC developed and initiated a novel program for radiological surveillance. Supplemented with additional radiation meters received from the AMEDDC&S, US Army Veterinary Command, and the US Army Public Health Command, the program provided daily radiological surveillance monitoring of up to 68 different animal and food related facilities and conveyances on 14 different installations for all service branches within USFJ, with over 7,000 readings by July 2011.128(p22) The monitoring provided command and public assurances of no health threat to the installation level food supply from radiation.

JDVC worked with the Government of Japan to receive all testing results and with Defense Logistics Agency and the Defense Commissary Agency colleagues regarding normally exempted product origins. JDVC’s food inspectors also began surveying at the installation level.128(p22) The result was the immediate response to USFJ and up the JDVC chain of command to provide assurances that the contaminated products had not reached USFJ installations.128(p22)

VETERINARY SERVICE’S RECENT AND SIGNIFICANT MILITARY AND PUBLIC CONTRIBUTIONS

A Broad Review of Current Veterinary Service’s Military Missions and Research Efforts

The US Army veterinary clinical medicine officers provide veterinary care for contract working dogs, marine mammals, horses and mules, beneficiaries’ pets, live tissue training animals, and laboratory animals during regular animal care missions, as well as livestock care during stability operations and irregular missions. Veterinary comparative medicine officers, laboratory animal medicine officers, veterinary pathologists, and enlisted soldiers (animal care specialists) are vital to research and development (R&D). Examples of their contributions include depleted uranium (DU) studies. (Soldiers hit by “friendly fire” have depleted uranium fragments in their bodies that cannot be safely removed; veterinary pathologists have studied laboratory animals’ tissues after DU exposure to better understand the damage DU does to affected humans.[129]) (More information about DU and other studies can be found in Chapter 16, Veterinary Biomedical Science.)

Veterinary officers are also critical in researching defense strategies against chemical, biological, and nuclear attacks. Related to the Cold War, a Soviet biological weapons scientist defected to the United States and admitted Soviet offensive biological weapons programs involved weaponized anthrax and small pox. This scientist was interviewed by a team, including a VCO, Colonel (Retired) Gerald Parker, who also commanded the US Army Medical Research Institute of Infectious Diseases (USAMRIID), the military’s largest infectious disease research facility.[130] (Several other VCOs were selected to command USAMRIID: Colonel David Huxsoll, Colonel David Franz, and Colonel Skvorack.)

The public has traditionally associated the military veterinarian with the mounted forces and most recently with food inspection. Few people realize that approximately 24 percent of the 526 Army veterinarians on active duty are engaged in research and development (R&D) for the military. There are 125 VCOs with AOCs 64C, 64D, and 64E assigned to R&D work (personal electronic communication from Colonel Kathleen Miller, Human Resource Command, to Colonel Leslie G. Huck, chapter author, July 17, 2014).

Recent public health threats have helped US Army veterinary personnel gain recognition, however. The Hot Zone, a well-known novel, highlights US military research efforts and features the individuals who used biosafety level 4 (BSL4) “space suits” to depopulate a colony of research monkeys in a civilian facility close to Washington, DC. At the time, these individuals thought the monkeys were infected with an Ebola virus that could infect humans.[131] (Another section of this chapter tells a more complete story of the military veterinarian’s connection with the Ebola virus and subsequent disease research.) Ft Detrick also became a more-recognized name after it assisted the CDC with anthrax testing of suspect samples during anthrax mailing threats.[132] Veterinarians within the Biological Defense Research Program at MRMC also have been directly involved in the development of medical countermeasures against threat toxins such as ricin. As noted earlier in this chapter, VCOs have served in lead roles in the development of a new vaccine for VEE and also Staphylococcal Enterotoxin B or SEB at the WRAIR.

Veterinary officers are assigned not only to the laboratories of the US Army Medical Research and Materiel Command (MRMC), which was formerly the US Army Medical Research and Development Command and the Materiel Development & Readiness Command, but also to several Navy locations to including Headquarters, Research & Development (Bureau of Medicine & Surgery or BUMED), Naval Medical Research Unit (NAMRU) 3 in Cairo, NAMRU in Peru, Navy Regional Medical Center (NMRC) at Forest Glen, Navy Dental Laboratory/Tri-Service Research Laboratory, and Navy Medical Center in San Diego. In addition, VCOs are assigned to the Joint Pathology Center (JPC), formerly known as the Armed Forces Institute of Pathology, United States Army Research Institute of Environmental Medicine (USARIEM), Uniformed Services University of Health Sciences (USUHS), and Armed Forces Radiobiology Research Institute (AFRRI) at Bethesda. (AFRRI, which now falls under USUHS, formerly fell under the Defense Atomic Support Agency.[133]) Finally, Army veterinarians hold a variety of positions in biomedical research, serving as assistant or principal scientific investigators or directors of research.[133]

At USAMRIID, VCOs within the Pathology Division have brought about immunocytochemical and molecular diagnostic capabilities to identify emerging viruses in tissues. Using these methods, a team assisted in the definitive diagnosis of a case of Korean hemorrhagic fever in a soldier serving in Korea. In addition, the chief of the Applied Research Division at USAMRIID served as an expert consultant on a World Health Organization (WHO) team sent to Egypt to look into a Rift Valley fever epidemic and was responsible for the development and fielding of a new modified live vaccine for humans and livestock (personal electronic communication from Colonel [Retired] David Franz, former Deputy Chief, USAMRIID, to Lieutenant Colonel [Retired] William Inskeep II, Office of The Surgeon General, November 16, 1994).

Army VCOs have also supported biological nonproliferation efforts. Colonel (Retired) David Franz, Deputy Commander, USAMRIID served as chief inspector on three United Nations Special Commission biological warfare inspection missions to Iraq and as technical advisor on long-term monitoring. He was also a member of the first two US/UK teams visiting Russia in support of the Trilateral Joint Statement on Biological Weapons for Ukraine.[134] In addition, Colonel (Retired) Gerald Parker served in the Senior Executive Service, as the Deputy Assistant Secretary of Defense for Chemical and Biological Defense.[135] And finally, a Veterinary Corps officer, Colonel John V. Wade, served as medical chemical and biological warfare adviser to Army General Norman Schwarzkopf, Desert Storm commander during the Gulf War.136,137

A More Specific Review of Veterinary Service’s Recent Research Efforts

Involvement in Ebolavirus Outbreaks and Contributions to the Advancement of Military Medical Ebola Virus Research

The USAMRIID at Ft Detrick, Maryland, is known for its high-hazard infectious disease research, including America’s most extensive biocontainment capabilities (ie, Biosecurity Level-3 and Biosecurity Level-4, the two highest levels of biocontainment). In executing its mission to provide medical defense countermeasures against potential biowarfare agents, USAMRIID has conducted various biodefense research projects involving many high-consequence pathogens thought to pose a threat on the battlefield, including Marburg and Ebola viruses.[138] (See Chapter 15, Veterinary Pathology, for more information about USAMRIID efforts.)

In 1967, African green monkeys imported from Uganda transmitted a mysterious fatal hemorrhagic fever (25% mortality) to polio vaccine laboratory workers in Marburg, Germany, and in Yugoslavia. Eventually, the causative agent was identified as a deadly new virus, classified in the family Filoviridae, genus Marburg, but shortly after this discovery, the lethal virus disappeared as quickly as it had emerged.[139]

In 1976 and 1979, another filovirus called Ebolavirus emerged, causing several highly fatal outbreaks of hemorrhagic fever in humans in Zaire and Sudan, with exceedingly high mortality (60–90% mortality).[140] Unlike the 1967 Marburg outbreaks, the Ebola Zaire and Ebola Sudan strains had no known zoonotic connection. In the wake of an additional human Marburg case in South Africa in 1975 and concerned by the very real risk of introducing Marburg or other possible zoonotic diseases into the United States, the US Public Health Service instituted a mandatory 30-day quarantine for all nonhuman primate imports in 1975.141,142

The filoviruses disappeared back into the African bush, but the reservoir remained elusive. What follows is an account of the Ebola Reston emergence based on the personal recollections of doctors Nancy and Jerry Jaax, two retired VCOs who, along with countless other federal and military personnel, dealt with the 1989 Ebola Reston outbreak firsthand while on active duty.

Ebola Reston Outbreak, 1989. In the late fall of 1989, a shipment of cynomolgus (crab-eating) macaques imported from the Philippines arrived at a nonhuman primate quarantine facility in Reston, Virginia, that housed up to 500 monkeys. Dr Daniel Dalgaard, the consulting veterinarian, was concerned that the shipment contained an abnormally high number of dead monkeys and more that were sick and dying. Dalgaard concluded that the cause was Simian hemorrhagic fever virus, an arterivirus that is a dangerous to macaques but is not considered to be zoonotic, and sent diagnostic specimens to USAMRIID for further testing.

When the samples arrived at USAMRIID, US Army Veterinary Pathologist and Chief of the Pathology Division, Colonel Nancy Jaax, concurred that the samples were likely infected with the Simian hemorrhagic fever virus. However, in accordance with protocol, the diagnostic specimens were then sent to USAMRIID’s Disease Assessment Division for virus isolation; the Pathology Division used histopathology and electron microscopy to evaluate the tissues. Surprisingly, the samples tested positive for a filovirus. Since Marburg was the only filovirus known to be associated with monkeys in natural outbreaks in 1989, Marburg was initially assumed to be the causative agent.

Subsequent electron microscopy revealed that the monkeys were co-infected with Simian hemorrhagic fever virus and a distinctive thread-like microbe pathognomonic for a filovirus. Immunogold electron microdiagnostics quickly identified the virus as positive for the Zaire strain of Ebola, not the relatively less pathogenic Marburg.

At this point, the stakes escalated considerably. The confirmation that a deadly hemorrhagic viral disease was spreading through a monkey quarantine facility in Reston, a community contiguous with Washington, DC, stunned USAMRIID and the world’s infectious disease research community. In an emergency meeting, Colonel David Huxsoll, DVM, USAMRIID Commander (and the first Veterinary Corps Commander of USAMRIID); Colonel CJ Peters, MD, Chief, Disease Assessment Division; Dr Peter Jahrling, PhD, Disease Assessment Division; Colonel Nancy Jaax; and Dr Tom Geisbert, microbiologist and electron microscopist, presented the startling diagnostic evidence to Major General Phillip Russell, MD, Commander of the US Army’s Medical Research and Development Command. Russell, a highly respected tropical medicine researcher, immediately consulted with other infectious and tropical disease experts, including those from the DoD, Centers for Disease Control and Prevention (CDC), WHO, and public health departments of Maryland and Virginia. Prominent filovirus experts Fred Murphy, DVM, PhD; Joe McCormick, MD; and Carl Johnson, MD, were at the CDC at the time. All of the experts concluded that a dangerous public health emergency existed and that an extraordinary and unprecedented response effort was needed.

In the chaotic hours and days that followed, there were more questions than answers:

- Ebola was an African virus, so why were monkeys from Asia affected?

- Ebola had never been reported in wild monkeys, so why was it was killing previously wild macaques shipped to Reston?

- How many humans might have been infected as the monkeys were imported?

- How quickly could it spread to the surrounding community?

- What should be done to respond and contain the outbreak, and who would and could do it?

Finding answers to these questions, especially those involving response capabilities, took teamwork. In late 1989, there was no established national plan or infrastructure to respond to a dangerous emerging disease outbreak like Ebola, and no single organization had the designated mission or specialized training and equipment needed to handle this unanticipated outbreak. However, since the CDC typically handled public health concerns, the CDC was tasked to take the lead for the complex public health response to the outbreak. USAMRIID’s Veterinary Medicine Division (VMD) was tasked with mounting an emergency response to the contaminated quarantine facility in Reston and the Ebola-infected animals. Even though USAMRIID had no deployment or field mission or equipment, the VMD had a contingent of experienced laboratory animal medicine veterinarians and animal care personnel.

Once preliminary planning was complete, Colonel Jerry Jaax, DVM, chief of the VMD, led a USAMRIID emergency response team (consisting of US Army veterinarians and animal care technicians with training and experience working with monkeys in biocontainment) to the Reston facility. VMD veterinarians (Major Mark Haines, Major Steve Denny, and Major Nate Powell); Army Veterinary Service animal technicians (led by Sergeant First Class Tom Amen and Sergeant Curtis Klages); and VMD animal caretakers (led by Bill Gibson and Merle Gibson) implemented the emergency operational plans and safety protocols devised for the Ebola-infected animals and premises.

As with any complex undertaking, the various military and federal agencies faced many challenges during the collaborated response:

- The USAMRIID emergency response team’s daily travel between USAMRIID in Frederick, Maryland, and the outbreak site in Reston, Virginia, was problematic because a growing number of civilians traveling or residing in this metropolitan area believed the response team members might transmit disease from the biocontainment site to the general public. Controlling mounting fears in this highly populated area with extreme traffic congestion required coordinated and constant communication among public health officials from DoD, CDC, and local health departments.

- At this time, Ebola field management was completely unknown, except to a few infectious disease experts in Africa, Europe, the USAMRIID, the Soviet Union, and the CDC.

- Many of the VMD team had limited to no experience in “space suit” work (one nickname used to describe the protective gear worn when handling deadly pathogens). Facility operations had to be carefully monitored and personnel duly prepared to ensure that the safety of the VMD team was not compromised, especially given the scope and emergency nature of the team’s work.

- The Reston quarantine facility’s heating, ventilation, and air conditioning unit malfunctioned early in the operation. This malfunction caused ambient temperatures to rise to 90 degrees and above, creating extremely harsh working conditions for VMD personnel who had to wear full-body personal protective equipment (ie, the “space suits”) while performing high-risk activities in contaminated premises.

- Infected animals were removed from the Reston quarantine facility for eventual necropsy at USAMRIID. However, about 40 percent of the monkeys were not housed in squeeze cages. (A squeeze cage is equipped with a mechanism that allows a caretaker to move the back of the cage to the front thereby “squeezing” the cage-housed animal [eg, monkey] for safe restraint and manipulation [eg, moving or administering an intramuscular vaccination] without causing harm to the animal or human.) The absence of squeeze cages eliminated the best and safest options for catching monkeys in cages, necessitating the innovative use of u-shaped padded poles and 3-foot long pole syringes to anesthetize the monkeys. Predictably, a monkey escaped in one of the animal rooms. Although there was never any concern that the animal could get out of the room or the biocontainment facility, catching an unrestrained monkey in a contaminated room, with limited capture options, in restrictive personal protective equipment, was an arduous task and posed serious safety concerns to the animals and the humans in the room.

- VMD veterinarians performed postmortem examinations and target tissue collection on all of the euthanized monkeys. Handling of sharps equipment, necessary to conduct the necropsies, was particularly risky because Ebola is primarily transmitted through contact with infected blood and bodily fluids. Infected sharps could easily cut through most protective gear as well as wound any unprotected or exposed body parts.

Once the building was depopulated, decontamination of the infected premises commenced. VMD and safety teams systematically used paraformaldehyde gas and other disinfectants throughout the whole facility, so there was no chance that the Ebola virus could escape. The Reston quarantine facility was successfully depopulated and decontaminated in just over 1 week.

Eventually, USAMRIID scientists discovered that a completely new Ebola virus species, Ebola Reston, had emerged—not the Ebola Zaire species (the causative agent for the 2013 West Africa Ebola outbreak). Fortunately, Ebola Reston virus was found to be nonpathogenic to humans; although this virus infected several quarantine facilities animal workers, its infection resulted in seroconversion (ie, development of anti-Ebola virus antibodies) but no clinical disease. Despite the prolonged and intensive activities by dozens of USAMRIID personnel in the Reston quarantine facility, not one USAMRIID-associated person seroconverted secondary to Ebola exposure. These clinical data strongly validated the success and effectiveness of the emergency procedures and operations carried out by the USAMRIID response teams.

In the end, the first Ebola virus outbreak in the United States was successfully eradicated. The USAMRIID emergency response to the 1989 Ebola Reston outbreak, spearheaded by a team of Army Veterinary Service personnel, remains a historical case template for emerging or intentional infectious disease threats and has been an important lessons learned application for DoD’s medical and logistical response to the virulent Ebola Zaire epidemic that began ravaging portions of West Africa in late 2013. (The Acknowledgments section at the chapter’s end further explains the way a contemporary author recognized the work of the US Army Veterinary Service during the Ebola Reston outbreak.)

In the interim between the 1989 Ebola Reston outbreak and devastating 2013 Ebola Zaire virus outbreak, there were multiple smaller Ebola (and Marburg) outbreaks in Africa.[143] International research teams, coordinated by the WHO, have historically been involved with efforts to identify the elusive reservoir of Ebola. Supporting such efforts and lending Ebola-subject matter expertise, Army Veterinary Corps personnel deployed to the Ivory Coast (Major Neal Woollen, DVM, PhD, and Major Keith Steele, DVM, PhD) and Kikwit, Democratic Republic of the Congo (Major Woollen only) as part of the WHO-led international teams.

Ebola Zaire Virus Outbreak in West Africa and Operation United Assistance, 2013. In December 2013, an Ebola virus disease (EVD) epidemic began in the West African country of Guinea. On March 23, 2014, the rapidly evolving EVD outbreak was officially reported to the WHO.[144] On August 8, 2014, with rapid spread to four other countries in West Africa (Liberia, Nigeria, Senegal, and Sierra Leone), the WHO declared the epidemic to be a “public health emergency of international concern” because in terms of morbidity and mortality, it was larger than all previous EVD outbreaks combined.145(p1481) Despite multinational and international efforts to the control the spread of infection, reported EVD cases and deaths continued to grow from week to week.

Because EVD was becoming a threat to both national and global security, on September 16, 2014, President Barack Obama announced two major expansions of US efforts to halt spread of the deadly disease: (1) he mandated a regional joint forces command and control center be established in Liberia’s capital, Monrovia, and (2) he deployed 3,000 US troops to West Africa.[146] Aptly named Operation United Assistance (OUA), US Africa Command, through US Army Africa, provided coordination of logistics, training, and engineering to the US Agency for International Development to assist in the overall US government foreign humanitarian assistance and disaster relief efforts to contain the spread of the EVD outbreak, as part of the international assistance effort supporting the governments of Liberia, Sierra Leone, and Guinea.147,148

US Army Veterinary Service personnel were highly concerned regarding the deployment of US service members (and potentially MWDs) into Ebola outbreak areas, their redeployment, and subsequent integration with family members and privately owned animals (ie, pets). Despite first being identified in 1976, Ebola virus remains an elusive and dynamic disease in humans, and more so in animals, both domestic and wildlife. Therefore, US Army Veterinary Services personnel were involved in tactical, operational, and strategic medical planning, coordination, and implementation across the full spectrum of veterinary operations (including, but not limited to, food protection and defense, veterinary public health, medical research and development, and global health engagement) not only in West Africa, but also in the United States, in the event the fatal disease made it to the homeland.

US Army veterinarians with advanced postdoctoral training in comparative medicine, pathology, and laboratory medicine have historically applied their disciplines as primary researchers or in direct support of the development of medical countermeasures and therapeutics against diseases of significant military medical relevance such as Ebola and Marburg viruses. In support of Operation United Assistance and the humanitarian assistance efforts in West Africa, US Army veterinarians within military medical research and development not only continued to provide such support, but also accelerated their efforts during the EVD outbreak in West Africa.

Similarly trained Army veterinarians in positions outside of “traditional” military medical research also actively contributed to efforts in West Africa and the military health and national public health response. Specifically, the interagency relationships (eg, the USDA, Department of Health and Human Services, and Department of State) developed and fostered through Defense Health Agency (DHA) Veterinary Service’s active participation in the Foreign Animal Disease Threat Interagency Working Group (supporting the Committee on Homeland and National Security, in the White House’s Office of Science and Technology Policy) were instrumental in the early response to the Ebola epidemic. Such early and sustained communication and coordination between DHA Veterinary Service and interagency partners ensured that the Army Veterinary Service stayed abreast of national and international efforts to control the epidemic.

Additionally, shortly following President Obama’s expansion of US efforts to curb EVD expansion, the AVMA and CDC established the AVMA Ebola Companion Animal Response Plan Working Group, in which DHA Veterinary Service became a lead participant, mainly because of concerns about deploying MWDs into Ebola outbreak areas and their subsequent redeployment.

Equally concerning was the idea that a redeployed service member infected with Ebola virus while supporting efforts in Ebola outbreak areas could potentially transmit the virus to the family pet following redeployment. Such a scenario—although deemed highly unlikely because of the strict protocols and procedures in place following the redeployment of service members (including a mandatory 21-day enhanced medical monitoring period on designated military installations)—might not be impossible.[149] The paucity of scientific literature on Ebola virus in companion animals (specifically dogs and cats), relative to virus shedding, length of virus shedding (if shedding does occur), or potential for carrier status to develop in asymptomatic companion animals, fueled such doubts.

As part of the AVMA interagency working group, subject matter experts representing multiple agencies and organizations, including DHA Veterinary Service, co-authored landmark EVD documents establishing baseline guidance for federal and state animal and human health officials who are confronted with an animal exposed to a human with confirmed EVD.150,151 In concert with the guidance, DHA Veterinary Service also developed multiple information papers and implementation guidelines providing veterinary-specific recommendations and guidance to the Joint Staff Surgeon’s office and US Africa Command, which were also widely disseminated to installation-level veterinary, preventive medicine, and public health personnel.152,153,154

A Confirmed Human Ebola Case in Texas and Army Veterinary Service Involvement. As a recognized force health protection asset, MWDs deploy in support of most military operations. The possibility of MWDs deploying in support of Operation United Assistance was no exception. Prior to the EVD outbreak in West Africa, there was no recognized diagnostic screening test for Ebola in dogs, a known circumstance that would create an operational gap in the event MWDs were deployed. (Previously, USAMRIID had developed a polymerase chain reaction assay for the detection of Ebola virus ribonucleic acid or RNA in humans. Although this assay was used by the DoD for Ebola virus detection in humans [under the Department of Health and Human Services-FDA’s Emergency Use Authorization protocol], whether or not such a test could be used in dogs or if the limit of virus detection in dogs was the same [or similar] as in humans remained unknown[155]).

Through collection of blood samples from naïve MWDs at Ft Belvoir, Virginia, and coordinated efforts between DHA Veterinary Service and USAMRIID, USAMRIID’s Special Pathogens Laboratory determined, for the first time, that the assay used for detection of Ebola virus RNA in human blood samples could detect Ebola virus RNA in canine blood samples at equivalent levels of detection. Similar results were produced via evaluation of canine urine and stool samples (personal written communication, then-Lieutenant Colonel Derron A. Alves, DHA Veterinary Service, Falls Church, Virginia, October 1, 2014, chapter author).

During this testing and evaluation process, Nina Pham, a 26-year-old nurse in Dallas, Texas, was diagnosed with EVD, after taking care of the first Ebola patient diagnosed on US soil.[156] Though Pham was transferred to the National Institutes of Health in Bethesda, Maryland, for treatment, her pet Cavalier King Charles spaniel dog “Bentley” remained in a quarantine at a Dallas decommissioned naval air base; the pet’s future was uncertain. The CDC in Atlanta, Georgia, aware of the confirmation diagnostic testing in MWDs conducted at USAMRIID, contacted Lieutenant Colonel Derron A. Alves, an Army veterinary pathologist, to determine USAMRIID’s interest in screening blood, urine, and feces that would be collected from Bentley for the Ebola virus.

USAMRIID’s concurrence led to a collaborative effort among DHA Veterinary Service, USAMRIID, the CDC, and Texas local and state veterinary and public health authorities for the collection, submission, and testing of samples at two different time points while Bentley was quarantined. At both time points, blood, feces, and urine were negative for Ebola virus, and the dog was released to be reunited with the recovered owner, Pham, after completing the 21-day quarantine. This case clearly shows how the Army Veterinary Service, through its established and continued working relationships within military medical research not only advanced operational military veterinary medicine, but also contributed greatly to the larger veterinary and public health community. Without such collaboration, a healthy animal might have been unnecessarily euthanized, and a dutiful healthcare worker might be needlessly grieving the loss of a beloved companion animal.

The Veterinary Service’s Impact Beyond Department of Defense Missions

US Army VCOs also impact the DoD and global populations in many other significant ways. VCOs are involved in food protection (food safety and defense) services, disease surveillance, epidemiology, zoonotic disease control, Special Forces, CA, stability operations, nation-building, and Veterinary Laboratory Services (such as rabies testing). In fact, recent national and global events have both refined the Veterinary Service’s older missions and expanded its role into new avenues.138(p8) The Army Veterinary Service provides animal care to the Secret Service, Transportation Security Administration (TSA), and Border Patrol. In addition, it provides food inspection support to the Antarctica missions of the National Science Foundation.

Army veterinarians have also served as liaisons to numerous activities in support of Homeland Defense.138(p9) These include a public health veterinarian assigned to the Northern Command Surgeon’s Staff; DoD Liaison to the USDA; support to the US Joint Forces Commands Joint Task Force-Civil Support; participation in the White House working groups on agroterrorism; and work with the Government Coordinating Council, comprised of federal, state, tribal, and local governmental agencies responsible for many types of activities, including agricultural, food, veterinary, public health, laboratory, and law enforcement programs.138(p9)

Finally, veterinary teams have served at events such as the 2002 Olympic Games in Salt Lake City, the opening of the United Nations General Assembly, Republican and Democratic national conventions, the G-8 Summit, presidential inaugurals and funerals, and other activities as part of the Veterinary Service’s defense support to civil authorities.138(p9)

SUMMARY

US Army Veterinary Service has a rich history of accomplishment that officially dates back to 1916 and unofficially starts with the dawn of the American Army. It is interesting to note how the Veterinary Service began and how it has changed over time. The Army recognized the need for and utilized veterinary medicine long before most other US government agencies. Through the publication of this chapter, it is hoped that by understanding the past, Americans can better understand where they are today and have a better appreciation for what the Veterinary Service does, not only for the Army, but for the Department of Defense and beyond. Brigadier General Raymond Kelser perhaps stated it best:

The field of the medical sciences covers a broad expanse. Many of the problems and difficulties of one branch are likewise those of another branch. The accomplishments of one often shed light on questions of the other. Thus, as research in the realm of human medicine has contributed to the welfare of our lower animals, so has research in the field of veterinary science contributed to the welfare of mankind. This is as it should be, and I am certain that the closer the alliance the greater will be the benefits to both.157(p330)

Acknowledgments

In 1994, author Richard Preston made a powerful contribution to the cause of public health and infectious disease awareness when he published his number one New York Times bestseller The Hot Zone, which detailed the Ebola Reston outbreak. The Army Medical Department and the Veterinary Corps owe Preston a special debt for the way he showcased the significant roles and contributions of USAMRIID, Army biomedical research, and uniformed veterinarians in public and human health. Preston went on to write other successful books focused on infectious disease and biowarfare topics, but this chapter’s authors feel none captured the public’s imagination like The Hot Zone.

While not directly quoted, Brigadier General (Retired) Charles V. L. Elia and Brigadier General (Retired) Thomas G. Murnane, 15th and 16th chiefs, respectively, of the US Army Veterinary Corps, were instrumental in preserving and presenting much of the history of the Veterinary Corps. Their first-hand knowledge and experiences were of great benefit in the writing of this chapter. The AMEDD Center of History and Heritage’s Archives and record collection maintained by Ms. Mary Hope and Mr. Carlos Alvarado were also of great assistance in historical research.

Special thanks should also be given to Brigadier General (Retired) John L. Poppe for envisioning this Textbook of Military Veterinary Services and to both Poppe and the current Veterinary Corps Chief, Brigadier General Eric H. Torring III, for helping to keep this vision alive until its final publication.

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Section II: Military and Family-Owned Animal Services

This statue featuring veterinary personnel working to medically evacuate a US military working dog represents one of the major missions for Army military veterinary services: the care and treatment of military working dogs—at home and abroad, in peace and in combat. Other US Army veterinary statues, representing other key veterinary service missions, are located side by side outside the US Army Medical Department Museum at Joint Base San Antonio-Ft Sam Houston, Texas.

Photograph: Courtesy of Nolan A. Watson.

Chapter 2

MILITARY WORKING DOG HISTORY

NOLAN A. WATSON, MLA*

INTRODUCTION

COLONIAL AMERICA AND THE CIVIL WAR

WORLD WAR I

WORLD WAR II

KOREAN WAR AND THE EARLY COLD WAR

VIETNAM WAR

THE MILITARY WORKING DOG

CONCLUSION

*Army Medical Department (AMEDD) Regimental Historian; AMEDD Center of History and Heritage, Medical Command, 2748 Worth Road, Suite 28, Joint Base San Antonio-Fort Sam Houston, Texas 78234; formerly, Branch Historian, Military Police Corps, US Army Military Police School, Fort Leonard Wood, Missouri

INTRODUCTION

History books recount stories of dogs accompanying ancient armies, serving as sources of companionship and performing valuable sentry duties. Dogs also fought in battle alongside their owners. Over time, however, the role of canines as war dogs diminished, especially after firearms became part of commanders’ arsenals. By the 1800s and up until the early 1900s, the horse rose to prominence as the most important military animal; at this time, barring some guard duties, dogs were relegated mostly to the role of mascots. It was not until World War II that the US Army adopted broader roles for its canine service members—uses which grew and changed with subsequent US wars. Currently, US forces utilize military working dogs (MWDs) in a variety of professions such as security, law enforcement, combat tracking, and detection (ie, for explosives and narcotics). Considered an essential team member, an MWD was even included in the successful raid against Osama Bin Laden in 2011.[1] (See also Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Services for more information about the historic transformation of the MWD program and the military services available for canines.)

COLONIAL AMERICA AND THE CIVIL WAR

Early American Army dogs were privately owned at first; there was neither a procurement system to secure canines for the military, nor a great desire to increase their numbers. Even though George Washington adored dogs, he did not see a need to use them in battle.[2] Still, dogs infrequently followed their owners to war during the American Revolution and other frontier conflicts.[3] On the rare occasions when dogs accompanied their owners’ units, these animals sometimes performed sentry duty; however, standardization for training, care, or use in performing military-related tasks did not exist. Instead, these dogs were mostly kept as personal pets or unit mascots. (The practice of soldiers and units maintaining mascots or keeping animals on the battlefields extended throughout America’s early conflicts [Figure 2-1] and, to a small degree, continues today; see also Chapter 12, Rabies and Continued Military Concerns.)

The minor role of canines working in the US military continued throughout the next century and into the American Civil War. With the advent of field (mobile) artillery and these weapons’ transportation requirements, horses far exceeded dogs in terms of military importance. In fact, because of their significance to the 19th century premechanized Army, horses and mules were the only US government-owned animals. Horse and mule procurement programs also were developed, and new soldier specialties and tasks were created to provide care and maintenance for military working horses and mules (eg, cavalry duties). (None of these newly developed soldier tasks were conducted by licensed animal doctors, however. At this time, there were no accredited veterinary colleges in America. See Chapter 1, Military Veterinary Support Before and After 1916, for more information about the development of the US Veterinary Corps and the growth of its groups of specially trained animal care providers.)

WORLD WAR I

When the United States entered World War I in April 1917, the American army still had no official military dog program, even though other armies had organized canine programs in place before the war began in 1914. Germany, in particular, devoted a fair amount of resources to its canine war efforts, initially bringing 6,000 dogs with its army as it advanced on the Western Front. Britain, France, and Italy followed suit, gathering thousands of dogs for their armies, looking for similar advantages on the battlefield.4(p949)

As years of war in Europe depleted the continent’s horses, dogs also were used to move small wagons, carts, and supplies. Belgium, its horse population particularly ravaged by the war, used dogs in many sectors of civilian life as well. At this time, dogs were deemed of such importance that canine gas masks and chemical protective suits were developed by both the Allies and Central Powers (Figure 2-2).4(p950)

Studying the British and French army models, leaders of the American Expeditionary Forces (AEF; the name given to the US armed forces sent to Europe to aid the Allies in World War I) also saw some potential for using canines, but recommended plans, including placing these animals under the control of the Army Medical Department, were not employed.5(pp22–24) Unofficially, local commanders and soldiers procured a few dogs from local French sources for limited service.[6] While some breeds were better suited for their appointed duties than others, at this time, breed was not as an important a criterion for selection as intelligence and loyalty.[7]

Figure 2-1. American soldiers attempt to put one of their gas masks on Taps, their pet terrier (1918).
Photo courtesy of the US Army Chemical Corps Museum, Ft Leonard Wood, Missouri.

Some of the selected canines served as sentries to detect nighttime incursions in the trenches and as couriers for transporting messages. Though not officially in the Army’s inventory, Red Cross dogs or “mercy dogs” assisted in locating the wounded.[6] But the majority of AEF dogs still served mainly as mascots and pets; in fact, despite many stories of canine heroics (eg, fighting the enemy or delivering vital messages), overall dog use by the AEF was minimal and always unofficial.4(p949)

At the close of the Great War, the state of animal use by armies was in flux. As previously mentioned, horses were scarce in Europe; mule populations also were decimated. Although remount stations of the US Veterinary Corps kept significant numbers of these animals in service during the last year of the war, their decline was inevitable and coincided with the growing production of motorized transport. While pigeons remained in military inventories and would be used as messengers in the next war, these birds were being outpaced by technology too.

Figure 2-2. German-produced canine gas protection suit and mask (1941).
Photo courtesy of the US Army Chemical Corps Museum, Ft Leonard Wood, Missouri.

Despite their small role during World War I, canines received significant praise and attention after the war, garnering news releases on multiple occasions.[8] Some dogs—such as Sergeant Stubby and, most notably, Rin Tin Tin—also appeared in books and movies and on radio programs and were considered war heroes.5 (pp24–27),9 However, this increased public popularity did not lead to heightened US military interest in dogs or development of an organized canine program. The US Army of the 1920s and 1930s was still too small to explore this option.10(p615)

WORLD WAR II

World War II marked the beginning of real change in the use of US military dogs. Since America was committed to total war on many fronts during this time, dogs gradually were viewed as more than just mascots or pets; they began to be seen as another means to save vital manpower. In the current Army lexicon, they became “force multipliers.”

In the late 1930s, the Army increased its dog numbers only slightly by expanding a sled dog program. However, as the United States became more involved in World War II, interest in military dogs accelerated. Overseas participation in the war and security concerns within America’s borders precipitated the need for several rapid-succession dog program overhauls: (a) on March 13,1942, the secretary of war approved the acceptance of 200 trained guard dogs offered by the American Theater Wing Incorporated program, a civilian project consisting of volunteer dog owners and trainers; (b) this program was soon replaced by the War Dog Program; (c) under this program, Dogs for Defense was named as the agency in charge of the procurement of non-sled dogs; and (d) finally, in July 1942, the US Army Quartermaster Corps became the sole agency providing trained dogs for the military and other federal agencies.10(p616)

Americans were enthusiastic about the growing need for military canines. An estimated 40,000 dogs were voluntarily donated to the Dogs for Defense program (Figure 2-3). However, because this number was so large, uniform standards to screen war dog candidates for the newly formed (and colloquially named) K-9 Corps had to be quickly implemented. The need for standardized curriculum and guidelines for veterinary caretakers also required immediate attention. In response, the US Army Veterinary Corps conducted thorough examinations and culled unhealthy animals or those with limited potential, while the Quartermaster Corps established training schools and published a formal technical manual about war dog care.[11]

Figure 2-3. Clyde Porter gives his dog, Junior, to the Texas recruiting station for Dogs for Defense, August 1942. Accepting the dog for the Army is dog trainer First Sergeant Bill Bryant. Although standardization of use, training, and care began during World War II, origins of the dog program had volunteer roots.
Photo courtesy of the National Archives (A-19043), cover picture from On Point: The Journal of Army History, issue 17.1, Summer 2011.

Unlike previous military dog guidance, the new standards contained strict breed and size requirements. At this time, only the following breeds of dog were generally accepted into military service: German shepherd, Belgian sheep dog, Doberman pinscher, farm collie, Siberian husky, Malamute, Eskimo, and crosses of those breeds. Ideally, all dogs selected for military service were to weigh between 40 and 80 pounds and be between 14 and 24 months old. Although some exceptions might be made for breed and size–usually dependent on the dog’s projected tasks–good health and dependability were continual requirements.10(pp618–619)

Trainers and dog handlers also had to conform to new standards and received standardized training via a specialized program. The Quartermaster Corps paired the dogs and their prospective handlers, training them in different specialties at one of several stateside “dog centers.” During World War II, these centers were located at Front Royal, Virginia; Fort Robinson, Nebraska; Cat Island, Gulfport, Mississippi; Camp Rimini, Helena, Montana; San Carlos, California; and Beltsville, Maryland. Camp Rimini was designed primarily for sled and pack dogs. The Cat Island facility trained many Pacific theater-bound dogs.10(p617)

Because invasion and sabotage were major concerns during the early years of World War II, the trained dogs and their handlers were first tasked with providing security at US depots, transportation hubs, and factories. During this time, the Coast Guard received 3,174 trained dogs to patrol US beaches and ports.10(p619)

As war efforts moved overseas, US military planners studied feedback from use of the American-trained canines on various foreign battlefields. Early results from North African operations were not favorable: the war dogs were bewildered by artillery fire and other battle noises that exceeded their stateside training around firearms and were unable to perform their duties. Canine mine detection missions also were tried in various foreign locations during World War II but were similarly deemed unsuccessful.[12]

However, there were certain jobs that dogs seemed “made” to perform. For example, the dogs’ heightened senses enabled these animals to detect enemy activity, even across the nonexistent battle lines of World War II. (This finding later shaped the effective use of canines during the Vietnam War.)

War dog detachments and platoons also were successful in other direct combat roles, including serving as scouts, guards, and messengers. These special dog and handler teams were attached to Army and Marine units and acted both as scouts searching for the enemy and as early warning detectors against snipers or ambushes. The majority of these teams served in the Pacific and enjoyed a fairly good reputation, receiving requests for further support (Figure 2-4).5(p131)

In Europe, dogs guarded airfields and assisted with medical evacuations in snow-covered areas.10(pp630–631) Until American dogs arrived in France in mid-1944, most of the dogs used in Europe came from and were trained in Great Britain. Although lesser known, messenger dogs also provided beneficial service in several World War II theaters.[13]

After World War II ended, many people hoped that the dogs originally donated for service in war could be returned to their previous owners. Although it was not possible to return all of the animals, some canines—including the most famous war dog of World War II, Chips—were returned home. (Chips received the Silver Star and Purple Heart medals for charging and capturing a machine gun nest during the invasion of Sicily. The medals were later rescinded because Army policies do not permit service animals to officially receive war decorations designed exclusively for human service members. Chips would also infamously [and harmlessly] bite General Eisenhower upon meeting him, although the dog continued to receive accolades even after the incident.)5(pp74–77)

The dogs that did not return home to owners after their World War II service ushered in another era in canine military history. A corner was finally turned: serving as sentries and scouts, guarding prisoners and America’s shores, this generation of service dogs had impressed the military enough to remain authorized even after the massive post-World War II disbandment.

Figure 2-4. A well-known image: A Marine with the 7th War Dog Platoon, 25th Marine Regiment, takes a nap while Butch, his war dog, stands guard, Iwo Jima, February 1945. Dobermans were favored in some jungle environments. Sentry and scout dogs were sought out after it was determined that they could find snipers and would-be attackers before ambushes.
Photo courtesy of the National Archives website. http://www.archives.gov/publications/prologue/1996/fall/buddies.html. Accessed July 10, 2012.

KOREAN WAR AND THE EARLY COLD WAR

In the years following World War II, the military continued to use canines, even though most dog training centers closed, and the soldiers needed to maintain these facilities were largely demobilized. The sole remaining dog center, Front Royal, was relocated to Ft Riley, Kansas, in 1948.[12]

As the Korean War unfolded, the need for military dog facilities and trained scout dog teams grew. In 1951, proponency of the Army dog program shifted from the Quartermaster Corps to the Military Police Corps, and the new proponent moved the dog training facility from Ft Riley to Ft Carson, Colorado. On July 11, 1951, a war dog receiving and holding station was also activated at Cameron Station in Alexandria, Virginia. Newly purchased dogs were processed and conditioned here before they were shipped to the Army Dog Training Center in Ft Carson.[12]

Scout dog teams operated during the Korean War but on a much smaller scale than in World War II (Figure 2-5). The 26th Infantry Scout Dog Platoon is the most notable of these Korean War canine-soldier teams. Reports indicate this platoon performed admirably, receiving a meritorious unit commendation.[14]

Despite such successes, the dog program was not expanded after the Korean War, and scout dogs were not trained again until the United States became involved in Vietnam. Prior to the Vietnam War, in the early stages of the Cold War, the dog program underwent several more changes in addition to the aforementioned shift in proponency in 1951: (a) the German shepherd was chosen as the standard breed for military dogs; (b) the Army continued sentry dog training at Ft Carson until closing this dog school in 1957; and (c) the US Air Force saw value in continuing a school and began training all Department of Defense sentry dogs at Lackland Air Base, Texas, in October 1958.[15]

By the sixties and seventies, reasons for keeping dogs in the military arsenal diversified. The Army military police and Air Force and Navy security forces maintained dogs for sentry service but also started to train dogs for law enforcement activities. Taking the lead from canine utilization in the civilian world, the various branches of the US military also began training dogs for narcotics detection.5 (p244)

VIETNAM WAR

Major growth and more recognition for military working dogs occurred during the Vietnam War. A school for combat tracking teams was established at Ft Gordon, Georgia (the location of the Military Police School), in 1967 and was modeled after the British Jungle Warfare School in Malaysia.5(p212) (The school in Malaysia also hosted training for the teams during the formative years of the program.) Another scout dog school was established at Ft Benning, Georgia.[16]

While the German shepherd was still the standard breed for the majority of tasks, the revisited function of combat tracker allowed for the inclusion of another dog breed in military service during the Vietnam War: the Labrador retriever. Early combat tracker teams trained for use in Vietnam were built around the dogs and focused on visual clues as well the dogs’ abilities to follow scent trails. Although the tracker dogs were trained to be protective of their teams, this dog’s mission was only to detect enemies, not attack them (Figure 2-6). During Vietnam, canines also served as mine and tunnel detection dogs and contraband (ie, drug) detector dogs.

Figure 2-5. Locally produced and misspelled pin (“SOHOOL” for “SCHOOL”) made for the 820th Military Police Platoon in Korea, late 1960s. Labeled “Four Footed Radar,” the dogs from this platoon monitored the demilitarized zone, and the pin honors their small sentry training center in Kimpo, Korea.
Photo courtesy of the US Army Military Police Museum, Ft Leonard Wood, Missouri.

The dogs used by the military in Vietnam were also employed for psychological reasons. Many US troops felt a familiar connection to the trained canines in the units, bonds similar to the ones felt for the pets they owned before entering military service. Also, the large sentry dogs, which were trained attack dogs, were used to intimidate enemies. A case illustrating the advantageous use of this tactic occurred at a battle on the American Embassy grounds during the Tet Offensive.

Figure 2-6. Handler and dog of the 49th Scout Dog Platoon, 199th Infantry Brigade searching for the enemy in Vietnam.
Reproduced from the Army Digest, February 1969.

On the morning of January 31, 1968, a Viet Cong “sapper” (a term used to describe Vietnamese saboteurs and explosive carriers) was unaware that an American sentry dog was guarding the area between the US Embassy in Saigon and the wall surrounding the building. When the sapper climbed over the wall, he was attacked by the dog. US military police then cordoned the area, followed the wounded sapper’s blood trail, located his dropped weapon, and captured him.[17] An enlisted Army photographer took an iconic picture of the captured Viet Cong sapper and his US military police escorts (Figure 2-7) after the US sentry dog initially deterred him.[18]

THE MILITARY WORKING DOG

When the Vietnam War ended, the military repeated its previous patterns of demobilization and reorganization. The scout and combat tracker programs for dogs were largely abandoned; however, canine use for law enforcement applications expanded. While sentry dogs used in Vietnam were trained to alert their handlers and attack the enemy, the growing numbers of the military’s newly trained “police dogs” were tasked with stopping criminals through intimidation and nonlethal bites. The growing professionalism provided by this new training led to two new labels for military service dogs; each term added to perceptions of canine usefulness. In 1977, canines were referred to in Field Manual 19-35 as “military police working dogs.”[19] In ensuing years, the name was shortened to the now familiar “military working dog” (this term appears in Field Manual 19-35, Law and Order Operations, from 1987).[20]

Although dogs continued to serve as drug detectors in both civilian and military policing agencies, as terrorism concerns surfaced in the 1980s, breeds that had previously been excluded from military service (eg, beagles) also were tasked with searching for explosives. Military and civilian dog handlers became very familiar to the public as they patrolled areas with their canine partners.

By the time of the September 11, 2001, terrorist attacks, MWDs were considered vital members of the US military forces. Although the German shepherd had long been the standard breed for most MWD tasks, the Belgium Malinois rose to prominence during this timeframe as another multitalented breed capable of performing a number of military tasks.

With the onset of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq, the US military further expanded its dog programs. For example, scout and combat tracker dog training was revisited and again reinstituted. Because of the growing threat of improvised explosive devices in Afghanistan and Iraq, mine detection training also resumed (Figure 2-8). Dogs became members of forward deployed teams, served with airborne units, and were transported by helicopters when needed.[21] (See also Chapter 4, Medical Evaluation of the Military Working Dog, for more information about the duties, transportation, and combat care of today’s MWDs.)

CONCLUSION

Whether they are remembered historically as the “K-9 Corps” or “War Dogs”—or by their more modern vernacular, the MWDs—it appears that canines will continue to serve in the military. Humans are continually rediscovering that technology cannot match many canine senses and other inherent abilities, and they also realize that dogs continue to remain loyal even as equipment and conflicts evolve around them.

Figure 2-7. US Army military policemen escort a Viet Cong sapper away from the US Embassy in Saigon after a military working dog helped make this enemy capture possible.
Photo courtesy of former Army photographer Specialist 5 Donald A. Hirst.

Figure 2-8. A military police officer and her military working dog conduct a security assessment of the customs yard being built near the Afghanistan-Pakistan border in the Spin Boldak district at Kandahar province, Afghanistan, April 8, 2013.
Photo by Staff Sergeant Shane Hamann and courtesy of the US Army Defense Video and Imagery Distribution System.

REFERENCES

1.   Gardiner H. A Bin Laden hunter on four legs. The New York Times. May 6, 2011.

2.   Washington G. The Diaries of George Washington. In: Jackson D, Twohig D, eds. The Papers of George Washington. Vol 5. Charlottesville, VA: University Press of Virginia; 1979. Written February 1789.

3.   Alden JR. General Charles Lee, Traitor or Patriot? Baton Rouge, LA: Louisiana State University Press; 1951:73, 82, 83, 169.

4.   Merillat LA, Campbell DM. Veterinary Military History of the United States. Vol II. Chicago, IL: Veterinary Magazine Corp.; 1935.

5.   Lemish MG. War Dogs: A History of Loyalty and Heroism. 1st paperback ed. Washington, DC: Brassey’s; 1999.

6.   Going CG. Dogs at War. New York, NY: The Macmillan Company; 1944:2.

7.   Baldridge CLR, Baukhage HR. “I Was There” With the Yanks on the Western Front, 1917-1919. New York, NY; London, UK: G. P. Putnam’s Sons; 1919:97.

8.   Givenson IM. Man’s loyal friend the dog in time of war. The Red Cross Courier. 1925; February 16:18.

9.   Orr G. Dog Stars of Hollywood. Akron, OH: The Saalfiled Publishing Company; 1936.

10.   Miller EB. United States Army Veterinary Service in World War II. Washington, DC: Department of the Army - Office of the Surgeon General; 1961.

11.   US War Department. Technical Manual 10-396: War Dogs. Washington, DC: July 1, 1943.

12.   Waller AM. Dogs and National Defense. Washington, DC: Department of the Army - Office of the Quartermaster General; 1958:51.

13.   Behan JM. Dogs of War. New York, NY: C. Scribner’s Sons; 1946:19.

14.   Department of the Army. General Order 21-53: Meritorious Unit Commendation - 26th Infantry Scout Platoon. Washington, DC: 1953.

15.   US Army Quartermaster Foundation. Quartermaster War Dog Program. http://www.qmfound.com/K-9.htm. Accessed July 10, 2012.

16.   Olsen K. Vietnam’s combat trackers. The American Legion Magazine. 2013. http://www.legion.org/magazine/214896/vietnams-combat-trackers. Accessed July 24, 2014.

17.   Johnson TL, Himes MR. Assault on the American Embassy TET-1968. Fort McClennan, AL: Department of the Army - US Army Military Police and Chemical Schools Training Center; 1983:33.

18.   Hirst D. Capturing the Embassy Sapper. Published online November 21, 2011; In: HistoryNet.com. http://www.historynet.com/capturing-the-embassy-sapper.htm. Accessed August 1, 2014.

19.   Department of the Army. Field Manual 19-35: Military Police Working Dogs. Washington, DC: February 18, 1977.

20.   Department of the Army. Field Manual 19-10: Military Police Law and Order Operations. Washington, DC: September 1987.

21.   Bearl D. Hero Dog. 2007. http://www.army.mil/article/1733/Hero_Dog/. Accessed July 24, 2014.

Chapter 3

MILITARY WORKING DOG PROCUREMENT, VETERINARY CARE, AND BEHAVIORAL SERVICES

JENNIFER BECK, DVM*; NOLAN A. WATSON, MLA†; AND WALTER BURGHARDT, DVM, PhD‡

INTRODUCTION

HISTORICAL OVERVIEW OF MILITARY DOG PROCUREMENT AND VETERINARY CARE

World War II Procurement

World War II Veterinary Care

Korean War and European Theater Procurement

Korean War and European Theater Veterinary Care

Vietnam War Procurement

Vietnam War Veterinary Care

Vietnam-Era Research, Breeding, and Training Programs

Pre-Persian Gulf War Procurement

Persian Gulf War Veterinary Care

Military Working Dog Procurement, 1990–2015

Operations Enduring Freedom and Iraqi Freedom Veterinary Care

EVOLVING SPECIALTY TRAINING AND SUPPORT ACTIVITIES

Long-Term Health Education and 64F Training

Military Veterinary Behaviorist Programs

Behavioral Medicine Applied Research and Development Activities and Challenges

First-Year Graduate Veterinary Education

RECENT MILITARY WORKING DOG VETERINARY SUPPORT EFFORTS

Army Public Health Command

Army Public Health Command Regional Consultants

Foxtrot (64F) Research Support

SUMMARY

*Lieutenant Colonel, Veterinary Corps, US Army; Clinical Instructor, Fort Belvoir First-Year Graduate Veterinary Education Program; Fort Belvoir Veterinary Medical Center, 10015 Theote Road, Building 610, Fort Belvoir, Virginia 22060

†Army Medical Department (AMEDD) Regimental Historian; AMEDD Center of History and Heritage, Medical Command, 2748 Worth Road, Suite 28, Joint Base San Antonio-Fort Sam Houston, Texas 78234; formerly, Branch Historian, Military Police Corps, US Army Military Police School, Fort Leonard Wood, Missouri

‡Chief, Department of Defense Military Working Dog Veterinary Service, Behavioral Medicine and Military Working Dog Studies; Lieutenant Colonel Daniel E. Holland Military Working Dog Hospital, 1219 Knight Street, Joint Base San Antonio-Lackland Air Force Base, Texas 78236

“War dog procurement is partly a matter of selecting breeds for combat and then drawing a steady supply, but it’s also a matter of demilitarization and repatriation.”1(p18)

—Maria Goodavage, author of Soldier Dogs: The Untold Story of America’s Canine Heroes

INTRODUCTION

The US Army Veterinary Corps’ first primary patients were horses and mules; Army veterinary personnel did not formally begin caring for canines until the establishment of the “War Dog” program in 1942. (See also Chapter 2, Military Working Dog History.) Since World War II, support for military dogs has grown. The Department of Defense (DoD) Military Working Dog (MWD) program now procures its own MWDs and provides many relatively new services in various canine care arenas: applied behavioral and biomedical research and development; behavioral care and employment; consultation to the DoD MWD executive agent and the MWD Training Center regarding procurement, assessment, and employment of MWDs; clinical veterinary medicine for MWDs with behavioral and training problems; and training for veterinary and other personnel. This chapter gives an overview of the historic procurement and veterinary care programs for MWDs; describes new specialty training for veterinary personnel who care for MWDs; and explores research, contingency, and breeding programs that support MWD operations as well as the challenges faced by current and incoming MWD veterinary service providers.

HISTORICAL OVERVIEW OF MILITARY DOG PROCUREMENT AND VETERINARY CARE

World War II Procurement

As noted above, World War II was the first conflict in which the US military used canines in a significant capacity, thus requiring new provisions for professional veterinary care for dogs. At the start of the war, the US military did not have its own dog procurement program. Conversely, equine use and procurement was already well established; 140,000 equines were utilized during the war, and over 66,000 horses and mules were procured during the war, numbers that far surpassed the number of dogs acquired for military service.[2] Discounting mascots and a couple of pre-World War II dog procurement program initiatives (an assortment of sled dogs and a coastal artillery dog project at Ft MacArthur, California), the first major step towards large-scale canine procurement was taken in 1942.[2]

On March 13, 1942, the undersecretary of war granted approval to the Quartermaster Corps to accept 200 trained guard dogs offered by the American Theater Wing, Inc., a voluntary organization that received donated canines from dog owners and presented them to the military.[2] When this organization was unable to continue its “Gift of Dogs” program, it was replaced by the “War Dog” program.2(pp616,638) Under the new program, Dogs for Defense, Inc., a private civilian organization, took the lead in canine procurement. However, in March 1945, Dogs for Defense, Inc., ceased procurements, and the military—through the Quartermaster Corps—began to directly acquire dogs, generally from private pet owners.[2]

World War II Veterinary Care

Once the dogs were accepted and transported to various “dog centers,” US Army veterinary staff provided full care for dogs as well as training in husbandry and dog care to handler personnel. (See also Chapter 2, Military Working Dog History, for more information about dog centers.) Trained dogs shipped to fixed military installations were cared for by installation veterinarians or the closest military veterinarian if the site did not have its own veterinarian. Coast Guard dogs were similarly cared for by the closest military animal doctor. Many dogs were utilized by the Quartermaster Corps to guard important civilian facilities such as manufacturing plants. These dogs also received care by Army veterinary assets when possible, but local civilian veterinarians were utilized by commanders when Army animal doctors were not readily available.[2]

Care for dogs deployed overseas was divided between trained veterinary sergeants and military animal doctors. During World War II, 15 Army infantry scout dog platoons were deployed overseas; each was authorized one veterinary sergeant who provided routine care and first aid. Medical needs outside the sergeant’s ability were provided by the closest veterinarian in the area. US Marine Corps dog units in the Pacific were also given veterinary assistance by nearby Army veterinary personnel.[2]

At this time, veterinary field units that focused on animal care existed as separate detachments and hospitals; each covered specified geographic areas usually located at some distance from the battlefields. Ill or injured dogs were evacuated to the nearest facility. Dogs serving in remote jungle units in the China Burma India Theater were sometimes flown to rear areas for veterinary care[2] (Figure 3-1).

At the end of the war, some dogs acquired from private owners were returned to civilian life after receiving training by Quartermaster personnel to “demilitarize” the animals.2(p636) A veterinary examination was performed prior to release to ensure only healthy animals were returned.2(p637)

Korean War and European Theater Procurement

After World War II, another method of procurement was needed; purchasing dogs for military service was deemed preferable to public donation to the military since there was no need to return dogs to their original owners after a war’s end. The Army Dog Association, Inc., formed with the goal of providing German shepherds for government use (Figure 3-2), and a noted canine expert, Sergeant William Hankinson, was sent to Germany, where he procured eight German shepherds. The association accepted the breeding stock from the government, then transferred the animals to individuals and dog breeders, who increased the stock’s numbers for military service. A few years later, the military dog program was greatly reduced. Since increased numbers of German shepherds were no longer needed, the Army Dog Association, Inc., eventually ceased operations.[3]

In the early 1950s, at a crucial time in the formative years of the Cold War and the Korean War, the proponency, locations, and number of dog training centers changed. Although there were canines in service in the continental United States, Europe, and Japan, more dogs were sought for duty in Korea, and the Quartermaster Corps turned over management and proponency of these dogs to the Military Police Corps.[3]

On July 11, 1951, a war dog receiving and holding station was activated at Cameron Station in Alexandria, Virginia. Newly purchased dogs were processed and conditioned onsite before they were shipped to the Army Dog Training Center at Camp Carson (later named Ft Carson), Colorado.[3] There were also a few instances of American units in Korea purchasing local animals for improvised sentry or scout duty. The 7th Cavalry Regiment of the 1st Cavalry Division purchased nine dogs from local inhabitants and trained the dogs onsite.[4] When possible, the dogs utilized in the Korean War remained in service after the war’s end, continuing to patrol the demilitarized zone, performing security in Japan, or, in some cases, returning to the continental United States. The lack of records makes it difficult to estimate the number of dogs in the Korean War, but a rough estimate is that this number was under 300 dogs (William H. Clark, Retired Colonel, US Army Veterinary Corps, unpublished data collected during service at the Office of the Surgeon General, 1989, and unpublished manuscript produced from this information, 2009, Ringgold, Georgia).[5]

Figure 3-1. “Skipper,” an Army dog, receives treatment for a gunshot wound in the lower jaw at a (human) field hospital on Luzon in the Philippines, April 8, 1945. His wounded handler, Animal Technician 5 Frank Oliver (left) assists in bandaging his dog. The enlisted medical person is unknown and whether he is wearing a green cross armband (Veterinary Corps medical symbol identification for its field personnel similar to the Red Cross symbol for human medical personnel) is not discernable. “Skipper” served as a scout and sentry dog and was presented to the Army through the Dogs for Defense program.
Photograph courtesy of the National Archives and Records Administration. SF 756129 WP.

Figure 3-2. This figure notes a publicized change in the dog procurement method and mentions the favored breed for the Army directly after World War II.
Reproduced from the Bulletin of the U.S. Army Medical Department, Volume 6, Number 2, August 1946, page 117. http://stimson.contentdm.oclc.org/cdm/singleitem/collection/
p15290coll6/id/3023/rec/1. Accessed May 15, 2015.

Dogs were also needed to support the large American military presence in post-World War II Europe. By 1950, a European Command Dog Training Center was located at Lenggries, Germany, to initiate and direct the purchase of military dogs. Although its mission remained the same, the center later changed its name to the US Army Dog Training Detachment, Europe, and received direct support from the 51st Medical Detachment (Veterinary Animal Hospital). Under the direction of the European Zone of Communication (1952–1966) quartermaster and personnel of the 51st Medical Detachment, the dog training detachment would inspect animals to be purchased through the West German Schaeferhund Association. Following a passing veterinary health inspection and purchase, the animals were placed in a 5-week quarantine and given appropriate vaccinations before initiating training.[6]

Korean War and European Theater Veterinary Care

Historical records regarding use and care of US Army dogs in the Korean War are limited because the dogs were not used as frequently in the Korean War as they were in World War II. While there were several infantry scout dog teams and other dogs serving in different capacities during the conflict, some of the most complete records are from the 26th Infantry Scout Dog Platoon. The first squad of this platoon was deployed to Korea from May to June 1951, with the remainder of the unit arriving in January 1952.[5]

Animal care for these units varied, but, similar to World War II care conditions, an enlisted animal technician was generally available, either organic to the unit or within the area. Veterinary Corps officer (VCO) care was provided geographically, with locally available VCOs providing treatment when not performing their primary mission of food inspection (William H. Clark, Retired Colonel, US Army Veterinary Corps, unpublished data collected during service at the Office of the Surgeon General, 1989, and unpublished manuscript produced from this information, 2009, Ringgold, Georgia). Technicians—either formally trained or serving in a “journeyman” (other-than-medical-branch) capacity—provided treatment at the point of injury or during convalescence. (See also Chapter 1, Military Veterinary Support Before and After 1916.) For example, Private First Class Farnia Rose, who served as both a veterinary technician and a dog handler for the 3rd Reconnaissance Company, had previously worked at the veterinary hospital at Ft Riley, Kansas. (The 3rd Reconnaissance Company arrived on June 12, 1951, and was the first unit to officially utilize scout dogs in Korea.[7]) Sergeant Robert Goodman was a dog handler with the 26th Infantry Scout Dog Platoon but also served as the unit’s veterinary technician.8,9 (Goodman would earn a Silver Star for rescuing fellow soldiers trapped in a minefield.5,9)

When combat casualties occurred, some injured canines required more extensive care than could be provided by the facilities and equipment available to the food inspection detachments. One anecdote from June 1952 describes a dog with multiple shrapnel injuries that had to be cared for at a human evacuation hospital (ie, the 121st Medical Evacuation Hospital). Although this experience signaled the need for a veterinary hospital in Korea, plans for this construction were not approved and implemented until the summer of 1953, at the close of the war. A food inspection detachment (ie, the 150th Veterinary Detachment) that had previously supported enemy prisoner of war operations was relocated after its original mission concluded and was re-established as the veterinary hospital (William H. Clark, Retired Colonel, US Army Veterinary Corps, unpublished data collected during service at the Office of The Surgeon General, 1989, and unpublished manuscript produced from this information, 2009, Ringgold, Georgia).

Veterinary treatment of military dogs in the European theater was similar to the care received by canines stationed in Korea before and after the war: treatment was dependent upon VCO availability or proximity to the 51st Medical Detachment. Former Brigadier General Frank A. Ramsey, Veterinary Corps Chief from 1980 to 1985, described the scope of available dog care while serving in France in the late 1950s as follows: “Although food inspection and food establishment sanitary inspection was our major duty, we had several hundred military working dogs in our western district and also provided limited care to pets of US personnel, including an immunization clinic.”10(p10)

Records also indicate a steady growth of military dog care in Europe. In 1956, the 51st Medical Detachment’s hospital staff administered 11,958 military dog treatments (in- and outpatient).[11] By 1961, the American military used 1,470 sentry dogs in Europe.[12]

Vietnam War Procurement

By the 1960s, American military dog procurement was somewhat stabilized, and the previously mentioned US Army Dog Training Detachment in Germany received a DoD request for 300 German shepherds for shipment to Vietnam in late 1961. The first dogs brought to Vietnam through American efforts were sent there in 1961 to bolster South Vietnamese security. By October 1962, all of the canines were delivered to Saigon. These first military dogs were to be part of Army Republic of Vietnam forces, but extensive training, care, nutrition, and treatment programs had to be developed. Replacement animals were subsequently purchased from the Military Dog Center at Lackland Air Force Base (AFB), San Antonio, Texas.[13]

In 1964, the procurement of military dogs changed from a US Army to a US Air Force (USAF) responsibility. Replacement animals were subsequently received from the Military Dog Center at Lackland AFB.13,14 Harkening back to World War II, the USAF sought dogs from US citizens, who were encouraged by an advertising campaign to bring their animals to temporary mobile buying team sites where the animals could be donated or purchased.[14] Later, in an effort to centralize procurement with dog training, the USAF formed Detachment 37 at Lackland AFB.[14] Detachment 37, under the control of Air Force Logistics, handled nearly all aspects of dog procurement including recruiting, training, and veterinary care.14,15 Detachment 37’s facilities came to be known as the Military Working Dog Center; in 1971, it was renamed the DoD Dog Center (DODDC).14,16

In the Vietnam War’s earliest phases, US military dogs sent to Vietnam were research and development dogs brought by the USAF personnel. Later, in 1965, the animals were US Army military police dogs. As the war continued, the role of the military dogs expanded from sentry to scout missions. All the dogs used by the US military were assumed to have been received through the Military Dog Center at Lackland AFB and completed training at one of the following specialty schools: Sentry Dog School at Lackland AFB; the British Jungle Warfare School in Malaysia; Scout Dog School in Ft Benning, Georgia; combat tracker training at Ft Gordon, Georgia; or the military dog training facility at Okinawa, Japan. Army, Air Force, and Marine dog usage increased after 1965; by mid-1966, over 500 military dogs were estimated to be in Vietnam.[17] At the end of 1970, approximately 5,000 dogs were utilized worldwide by the DoD, according to information presented at a 1970 MWD conference at Lackland AFB.[16]

Vietnam War Veterinary Care

Although the rate of establishing American and South Vietnamese care systems for military dogs serving in Vietnam paralleled the rate the Vietnam War escalated, establishing an independent military dog program was very problematic for South Vietnamese forces. A lack of resident veterinarians was the one of the largest hurdles. A program to educate doctors of veterinary medicine, which began early in the war, took years to reach fruition, sometime near the war’s end.[17]

The US Army’s veterinary care system in Vietnam—patterned after the human medical care system—started at the primary level and included an evacuation plan at each of three levels. First- or primary-level care was given by military occupational specialty 91T personnel (now called 68T animal care specialists) who were organic to each scout and sentry dog platoon. The next care level was the dispensary level (care requiring short-term treatment and medication but generally not requiring surgery). Because the dog platoons were widely dispersed and used an increasing number of dogs (1,200 dogs by 1967), veterinary food inspection teams provided dispensary care. The last level of care (ie, long-term care) was provided at veterinary hospitals[17] (Figure 3-3).

By January 1966, three veterinary detachments were in Vietnam: (1) the 4th Medical Detachment (Veterinary Service), (2) the 75th Medical Detachment (Veterinary Service-JA), and (3) the 936th Veterinary Detachment. At first, veterinary care was the responsibility of the 936th, which maintained a small animal hospital located at Tan Son Nhut. The 504th Veterinary Detachment, a small animal dispensary, arrived in October 1966 to supplement the hospital’s resources. With adequate veterinary assets available, preventive medicine and improved kennel facilities became priorities for long-term dog health (Figure 3-4).[17]

Figure 3-3. Kennel area (complete with green cross) for the 175th Veterinary Detachment at Da Nang, South Vietnam. As referenced in the sign, the detachment provided care for military dogs for all military branches.
Photograph courtesy of Colonel (Retired) William Kent Kerr, US Army Veterinary Corps, Corpus Christi, Texas.

Despite improved care plans, military animal evacuation systems did not initially include animal transport via helicopters. From 1968 through part of 1969, Brigadier General Hal B. Jennings (then commander of the 44th Medical Brigade in Vietnam) (later Lieutenant General and US Army Surgeon General, 1969–1973) would not allow dogs to be evacuated on unit helicopters. In 1969, after the 44th Medical Brigade’s change of command, helicopter evacuation became available for dogs and handlers, and an evacuation policy was established for dogs that required more than 7 days’ treatment. However, dogs were not evacuated outside of Vietnam.[17]

By May 1970, approximately 1,600 American military dogs were serving in Vietnam.[17] In ensuing years, as American forces withdrew from Vietnam, fewer dogs were needed for service, and fewer veterinarians were deployed there to provide canine treatment. How to withdraw the remaining canine forces in Vietnam became an issue.

At first, because of health and animal behavioral concerns, the majority of requests for handlers to adopt service canines were denied (this decision was later restudied). Transmissible canine pancytopenia, a disease that had killed 300 military dogs by 1969, played a major role in these initial denials. It was later determined that if the canines passed medical examinations by veterinary personnel and if other commands needed the animals, the dogs could be transferred out of Vietnam.[17]

Over the next two years, military dog numbers dropped from the May 1970 figure of 1,600. From 1970 to 1972, 148 military dogs died from wounds, disease, or other mishaps; 371 were euthanized for various reasons; and 191 were returned to the continental United States. The vast majority of the animals (ie, 971) were transferred to service with the South Vietnamese army and quarantined to the Southeast Asia Theater to prevent the spread of canine pancytopenia.[17]

Vietnam-Era Research, Breeding, and Training Programs

In the latter years of the Vietnam War, the US military researched increasing dog capabilities not only in the tasks assigned, but also for physical improvements in dog breeds. Although discussion of the proposed program had occurred for years, 1967 was the first year of a formalized plan of study. The US Army Training and Doctrine Command authorized the program, the US Army Combined Arms Combat Development Command was designated as the proponent, and the US Army Medical Research and Development Command was designated as the developing agency. The project was further delegated to the Walter Reed Institute of Research, Ft Meade, Maryland. Program facilities were initially based at the Walter Reed’s Animal Farm at Ft Meade but later moved to Edgewood Arsenal at Aberdeen Proving Grounds, Maryland.[17]

Figure 3-4. A veterinarian captain from the 175th Medical Detachment (Veterinary Medicine) uses a stethoscope to listen to the heart of a K-9 sentry dog during the dog’s monthly examination.
US Army photo by Specialist 5 Ronald Delaurier, December 16, 1968, courtesy of the AMEDD Center of History and Heritage Archival Collection, Joint Base San Antonio-Ft Sam Houston, Texas.

After examining the applicability of several dog breeds, the program focused on improving the genetics of German shepherds.[14] In fiscal year 1969, three VCOs, two clerks, a Medical Service Corps geneticist, and 27 enlisted personnel conducted research on various traits, including reducing inherited problems such as hip dysplasia and improving intelligence and training capacities, in what became known as the Biosensor Research Program. Numerous consultants from the military, academia, entertainment, and civilian police agencies also contributed to the program.[17]

Research from the program provided not only breeding information, but also some canine behavioral data that was compiled for later use, which included socialization in outdoor environments and with humans as well as litter behavior dynamics and future training aptitudes. To better understand the effects of certain stressors on military dogs, program puppies also were tested using extremely minor temperature and motion changes. While these changes were not harmful to the animals, public outcry caused the Humane Society of the United States to conduct an investigation that later affirmed that the minimal “stressing” of these puppies during program testing was not detrimental.[17]

Finally, a small portion of the program was diverted to conduct trials that proved canines could detect marijuana and other illegal substances. The results of the testing were reported to the Office of the Provost Marshal and disseminated to the US Army Military Police School at Ft Gordon so that handlers and dogs stationed there could begin training on their new detection mission.[17]

Through four generations of dogs, the Biosensor Research Program succeeded in reducing hip dysplasia from 50 percent (as found in a civilian population of dogs of the same breed) to 18.7 percent, and projections for follow-on years were positive.[17] Similarly, the quality of the dogs, in respect to their intelligence, was improved. However, despite successes, budgetary limitations for the post-Vietnam US Army loomed. Termed the “Super Dog” Program by some, the project was supposed to switch from research to a larger production of working dogs, but since the war was over by the time of the results, the program was halted in the mid-1970s.[17]

Other dog programs that supported combat operations (ie, scout, combat tracker, and mine detection schools) were eliminated in 1976. This left only sentry dog tasks and the emerging law enforcement field, which were largely under the control of the US Army military police and USAF security forces. After the Biosensor Research Program closed, program animals considered “fit for duty” were shipped to Lackland AFB. Seeing Eye Inc., of Morristown, New Jersey, received some of the Biosensor Research Project dogs as well. Other animals were retained for proposed breeding programs with the US Bureau of Customs and the USAF. Both agencies maintained minimal breeding programs for study, but, by 1979, these programs were discontinued.[17]

Pre-Persian Gulf War Procurement

After Vietnam, the Army reduced its numbers and restructured. Without a current conflict, the need for MWDs was greatly reduced, and, as noted earlier in this chapter, the Army‘s combat tracker and scout dog schools closed. However, years later, new threats from terrorism and a proliferation of the drug trade led to an increased need for dogs used in law enforcement and detection roles. Many of these dogs were trained at Lackland AFB for use by non-DoD federal agencies for detection roles. Still maintaining a public US advertising campaign and operating mobile buying teams, the DODDC accepted dogs to the Lackland AFB center if the privately owned animals presented for program consideration were approved by a military or civilian veterinarian and the mobile buying teams evaluating them for overall health and general aptitudes[14] (Figure 3-5).

This program of accepting dogs from private US citizens worked for a while, but, by the early 1980s, problems emerged. The increased demand for working dogs (an estimated 2,200 were in use by the DoD in 1982) was not met by the animals volunteered by the public or American breeders, and an animal deficit occurred.14,18 The USAF was still the proponent for acquiring the dogs and overseeing their training, but with veterinary service changes throughout the DoD, the US Army maintained animal health. This arrangement was formalized by DoD Directive 5200.31 from September 7, 1983.[19] (Near the close of 1990, DoD document, AFJI-23-224 [December 1, 1990], reinforced the USAF’s responsibility of procuring and training MWDs.[20])

In 1984, the DODDC sent mobile buying teams to Europe to procure more dogs. At first these teams gathered enough animals to reduce the deficit; however, the gap gradually reappeared as rejection rates eliminated 25 to 50% of the animals. By 1990, there was a backlog of 485 MWD requisitions.[14]

Figure 3-5. “Air Force needs dogs….” In addition to running in the McKinney, Texas, newspaper, similar articles appeared in newspapers across America as part of the Air Force campaign to maintain the military working dog force. Also of note, the dogs being requested for potential military service are smaller breeds suited for narcotics detection.
Reproduced from the McKinney Courier-Gazette, November 11, 1975, archived excerpt provided courtesy of Susan Kusterbeck, genealogy librarian, Roy and Helen Hall Memorial Library, McKinney Public Library System, McKinney, Texas.

Persian Gulf War Veterinary Care

With the onset of the Persian Gulf War (Operations Desert Shield and Desert Storm, 1990-1991), MWDs were deployed, but their roles were generally limited to that of base security, performing functions such as explosives detection, and monitoring entry control points. At their peak numbers of utilization, approximately 110 to 140 MWDs were in the Southwest Asia Theater at numerous locations within Saudi Arabia and other Gulf States (electronic personal communication from Colonel [Retired] Robert Vogelsang, former US Army Consultant, to Lieutenant Colonel Ronald Burke, US Army Veterinary Corps, May 31, 2013). Despite the massive build-up of American and coalition armies, the fighting did not last long.

Veterinary care for these dogs was provided by the closest veterinary unit available. At this period of time, only one type of detachment was designed specifically for animal medical care, and only one such unit existed: the 51st Medical Detachment (Veterinary Medicine). Although this unit was an active component detachment, it was not deployed in support of MWDs during the Persian Gulf War. Instead, veterinary care was provided by other units, which—similar to the ones in Korea and Vietnam—had a food inspection focus but could also provide basic MWD care (electronic personal communication from Colonel [Retired] Robert Vogelsang, former US Army Consultant, to Lieutenant Colonel Ronald Burke, US Army Veterinary Corps, May 31, 2013).

No MWDs perished from enemy activity during the Persian Gulf War. Of the known MWD treatment cases during Operation Desert Storm, one 13-year-old MWD was euthanized due to chronic renal disease, two MWDs were identified as unfit for duty and returned to CONUS, and one MWD was treated for urinary tract infection. Other minor medical conditions such as cracked nares, eye irritations, and minor cuts were treated without incident.[21]

Military Working Dog Procurement, 1990-2015

As American forces expanded military operations in the 1990s through early 2000s—first, with lower-intensity operations in Somalia (Figure 3-6), Haiti, and the Balkans and, later, with more intense operations in Afghanistan and Iraq—there was a continuing need for MWDs. Because previous procurement methods were inadequate for the demand, the feasibility of maintaining an “in-house” breeding program was studied.

While MWD procurement is generally under the control of the USAF, the US Army also conducted a MWD breeding program feasibility project from 1994 to 2005. The project built on earlier efforts and included collaboration with academic partners and other breeding programs to develop an evidence-based assessment of the use of quantitative genetics and selective pressure to demonstrate the feasibility of producing between 10 to 30 percent of the military’s requirements for MWDs while providing a contingency program to supplement adult-purchase of candidate MWDs (Dr Walter Burghardt, chapter author, unpublished data, January 2015).

In April 1998, after again making purchases of breeding stock animals in Europe, the USAF’s 341st Training Squadron, located at Lackland AFB, began breeding operations.[22] The program focused on two dog breeds: the (1) Belgian shepherd (Malinois) and (2) Dutch shepherd.[23]

In 2002, a new breeding, whelping, and rearing facility opened on the grounds of Lackland AFB’s training-school kennel. The facility has 2,016 square feet of building space with four sheltered whelping rooms and another 5,000 square feet of running yard space. The facility accommodates up to four litters of puppies and their mothers from 1 week prior to birth to the fostering age, approximately 9 to 12 weeks. The working dogs are then “fostered” to families as puppies to provide a solid human connection before their military or law enforcement training.[24]

Operations Enduring Freedom and Iraqi Freedom Veterinary Care

In 1999, the DoD had 1,326 MWDs serving worldwide.[22] However, when military operations expanded after the 9/11 terrorist attacks, the need for MWDs increased. By 2004, there were an estimated 2,300 dogs serving in the DoD.[25] More dogs meant an increased potential for canine injuries and, hence, a growing need for more veterinary support.

During Operations Enduring Freedom and Iraqi Freedom, some mine detection dog units were deployed with an organic veterinary technician, but the vast majority of dog units relied on the closest veterinary unit for care. Such in-theater care was provided by medical detachments, veterinary service (MDVS) and later, medical detachments, veterinary service support (MDVSS). MDVSs usually focused on food inspection but had some animal care capability. Medical detachments, veterinary medicine (MDVMs), which had specific animal care missions, did exist, but none were deployed to Iraq; instead, personnel from two of the MDVMs were utilized in Iraq from 2007 to 2010 under an MDVS unit. No MDVM units or personnel were deployed to Afghanistan (electronic personal communication from Colonel [Retired] Robert Vogelsang, former US Army 64F Consultant, to Lieutenant Colonel Ronald Burke, US Army Veterinary Corps, May 31, 2013). Although units specifically deployed for MWD veterinary care, all units had the capability to provide veterinary care at various levels, or roles of care. These roles of care mirrored the human medical system.[26] (See also Chapter 4, Medical Evacuation of the Military Working Dog.)

Figure 3-6. A military working dog and its military police handler inspect vehicles in Somalia during Operation Restore Hope.
Reproduced from the briefing, Veterinary Operations in Somalia, January 2, 1993, to March 1994, Veterinary Corps Photograph Collection, Box 2, Army Medical Department Center of History and Heritage Archives, Joint Base San Antonio-Fort Sam Houston, Texas.

Role 1 care generally included first aid by the handler or a medic assigned to the unit, as well as basic stabilization and first aid by a veterinary team. Role 2 care generally consisted of more advanced veterinary services, including emergency surgery and stabilization as well as management of more advanced disease processes. Most Role 2 veterinary sites generally had basic diagnostic capability such as running blood work, fecal exams, and urinalysis, but other capabilities often varied considerably, depending on location and facilities. For example, a Role 2+ facility might provide more advanced surgical and medical care, as well as some imaging capability and other diagnostics, and advanced dental care, while other Role 2 teams only had the ability to perform stabilization surgery and evacuate to the next level of care, Role 3.

Role 3 facilities were usually manned by teams consisting of one VCO, multiple food inspection specialists, and one or two animal care specialists. Veterinary clinical specialists (64F military occupational specialty) were also part of these teams. (See the section on long-term health education training later in this chapter for more information on the 64F specialty.)

Role 3 facilities had the capability to provide advanced medical and surgical care, as well as diagnostics and advanced imaging. They were most often co-located or closely located to a human hospital and often acquired services from it. For example, the mobile magnetic resonance imager at Bagram Air Field (BAF) in Afghanistan was utilized for MWDs when needed. The radiology facility at BAF regularly supported the veterinary team by performing radiographs, computed tomography, and other imaging whenever necessary. In these instances, MWD care was never allowed to impact human care (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

The veterinary clinical specialist, or 64F, was critical to providing advanced care of MWDs at Role 3 facilities, and, historically, the 64F was the MDVM commander. However, with the deactivation of the last MDVM in 2011 from Korea, the soldiers in the MDVMs were reassigned to the MDVSSs, minus some administrative and logistics soldiers (electronic personal communication from Lieutenant Colonel Douglas Owens, Commander, 129th MDVM, to Colonel Thomas Honadel, US Army Veterinary Corps, February 2, 2015). The 64F was then utilized as the MDVSS chief of clinical operations and served as consultant for the rest of the dispersed teams throughout the area of operations.

Units typically operated in a dispersed fashion through food procurement and laboratory teams, veterinary service support teams, and veterinary medicine and surgical teams. The food procurement and laboratory team was generally staffed with field veterinary service veterinary officers (64As) (usually one per team) and enlisted veterinary food inspection specialists (68Rs) while the veterinary service support teams were staffed with 64As, 68Rs, and 68Ts (animal care specialists). The unit’s 64F was generally assigned to the veterinary medicine and surgical team along with supporting 68T soldiers.[27] During the transition process to the MDVSS, many MDVSs did not have an assigned 64F veterinary medicine and surgical team. During deployment to OIF and OEF, 64Fs were often deployed as a Professional Filler System (PROFIS) officer,[28] pulled from various veterinary units across the globe.

Because of the critical roles MWDs played (and, in some areas, still play) in making Afghanistan and Iraq safer for military personnel and civilians (Exhibit 3-1), MWD care during these wars became more like human care. During the early stages of these conflicts, veterinary units (ie, MDVSs and later MDVSSs) were dispersed to locations where MWD populations were concentrated. Some locations with kenneled dogs had a veterinarian and a technician; some had either a veterinarian or a technician. Other locations had no veterinary assets on the installation where the dogs were kenneled. These dogs either traveled with their handlers to the nearest veterinary staff, or veterinary personnel went to the dog kennels. Routine care and minor illness and injury were handled locally by the closest veterinary personnel. MWDs that had nonbattle injuries or illnesses beyond the capability of the local veterinary asset were evacuated to the veterinary detachment’s medical or surgical team by either ground or air, generally via helicopter (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

Dogs sustaining battlefield injuries were often evacuated straight to the nearest installation with an appropriate medical facility—even if it did not have a co-located veterinary asset—especially when both the handler and MWD were injured. In a number of instances when veterinary assets were not available, human doctors and other medical staff performed life-saving procedures on the dogs while waiting for veterinary personnel to arrive, or in consultation with veterinary assets. Because of such cases, veterinary staff developed clinical practice guidelines (CPGs) for use by human medical providers treating MWDs.[29] (See Chapter 4, Medical Evacuation of the Military Working Dog, for additional information on the veterinary CPGs and MWD evacuations briefly described in this chapter.)

The CPGs enabled human care providers to appropriately stabilize and perform life, limb, and eye-saving procedures in the absence of veterinary support. Veterinary teams provided sundry training to their medical counterparts on anything from taking the vitals of an MWD, treating shock, and wound management, to major surgery. If advanced procedures had to be performed by a human care provider on an MWD, the human provider who administered the care to the animal had to be certified or trained to perform that procedure in a human patient.

Even when an MWD was evacuated to a veterinary medical or surgical team, sometimes the animal’s injury required more advanced care than the veterinary unit’s limited equipment or manpower could provide. For example, veterinarians often worked with their medical counterparts within hospitals to obtain necessary advanced imagining studies such as magnetic resonance or computed tomography. They also collaborated with medical (ie, nonveterinary) orthopedic surgeons, other medical surgeons and specialists, and nursing and technical staff to perform labor-intensive or highly complex procedures on MWDs.

EXHIBIT 3-1.

“…[M]ilitary working dog teams in Afghanistan were credited with finding more than 12,500 pounds of explosives in 2010. The number is probably slightly higher, officials say, since dogs are not always given credit for finds. Still, when you think of the damage even [10] pounds of explosives in an IED can do, you get a sense of the importance of these dogs to our military capability.”

____________

Source: Goodavage M. Soldier Dogs: The Untold Story of America’s Canine Heroes. New York: Dutton; 2012:11.

In one case, an MWD was presented to a forward surgical team (FST) for various injuries and complications after receiving multiple close-range gunshot wounds: (a) The dog’s right front leg was injured so badly that it was essentially amputated and had very little remaining soft tissue; (b) its humerus was fractured into many small pieces and was nonreconstructable, and the blood supply to the rest of the front leg was destroyed; (c) the other front leg was also injured; and (d) a bullet had severed the MWD’s triceps muscles and caused a large, contaminated wound. A junior VCO was co-located at the same forward operating base as the FST and was prepared to receive the dog. However, the veterinary team could only offer Role 2 care at best and was not trained in advanced surgery (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

FST and veterinary personnel worked together, in consultation with the 64F at BAF, to perform amputation of the unsalvageable front limb and began limb-saving treatment of the other front limb. The other injuries were fairly minor and were also managed. The dog was then evacuated to the BAF Level 3 facility to receive further care directly from the 64F, who was a veterinary surgeon with advanced surgical skills. The MWD received advanced wound management care and stabilization at BAF before being further strategically evacuated for further advanced care at a Role 4 hospital (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015). Despite best efforts by all health care providers, dog team casualties occurred, but canine deaths were only recently tracked[1] (Exhibit 3-2).

Once MWDs were stabilized and resuscitated (if necessary) at either the medical or veterinary deployment facility, most were quickly evacuated to Germany, especially when the medical or veterinary staff determined that the dog could not reliably return to duty within approximately 10 to 14 days.30,31 Injured MWDs traveled on the same aircraft as human casualties flying to the Army hospital at Landstuhl, Germany. Dogs were then transported from Landstuhl to the nearby Dog Center Europe (DCE) facility at Pulaski Barracks in Vogelweh, Germany. The DCE is a Role 3 facility and has the capability to perform definitive surgery and hospitalization.

During the Afghanistan and Iraqi operations, the DCE was manned with two clinical specialists, at least one being a surgeon, as well as a robust technical staff.[32] The DCE received evacuated MWDs and provided necessary definitive care (eg, orthopedic implant application and skin wound reconstruction). Once an MWD recovered enough to travel, it was further evacuated to its home kennel, where the local garrison veterinarian took over required follow-up care.

Some MWD patients, particularly those needing long-term physical therapy, went from the DCE to the only facility in the DoD with the staff and equipment to provide this service: the Lieutenant Colonel Daniel E. Holland MWD Hospital (Holland MWD Hospital) at Lackland AFB. Similar to human physical therapy, the procedures used at the Holland MWD Hospital helped dogs injured in Afghanistan and Iraq to regain full range of motion, mobility, and muscle strength, enabling them to work again. (For more information about the Holland MWD Hospital, see the Public Health Command section and the section on Foxtrot Support to Operations Enduring and Iraqi Freedom in this chapter.) Dogs that could not return to work even after treatment were generally made available for adoption.

Changes in technology, legislation, and public opinion have all guided veterinary care and treatment for the MWD. As noted, it is not uncommon for injured dogs to receive high-quality care equivalent to human soldiers while being evacuated from around the world. Veterinary assets are now dedicated to not only maintaining the force of MWDs and their procurement, but also their continued health after tactical service. Physical therapy and behavioral training (which will be discussed further later in this chapter) had humble beginnings but are now receiving greater attention. MWDs also have a better chance for fuller lives after retirement; the “Robby Law” (H.R.5314, amendment to Title 10- Public Law 106 - 446) was ratified by Congress on January 24, 2000, and allows for the adoption of former MWDs at retirement or when the dog is otherwise excess to DoD needs.[33]

EXHIBIT 3-2.

“Even as troops start to draw down in Afghanistan, the dog teams don’t show any signs of staying home for long. Because of their vital role there, many in the military dog world think the dog teams could keep deploying steadily to the end of [US] involvement. This could put them at higher risk. Already, [17] handlers have been killed in action since 2001, and [44 MWDs] have died in war zones since 2005, the first year for which figures are available. (The number of dog deaths includes dogs killed in action and dogs [that] have died from heat injuries and other causes. The [DoD] does not yet have a full report of causes of death.)”

____________

Source: Goodavage M. Soldier Dogs: The Untold Story of America’s Canine Heroes. New York: Dutton; 2012:11.

The MWD adoption program is managed by the USAF 341st Training Squadron.[34] (See also Chapter 4, Medical Evacuation of the Military Working Dog, which features the adoption of an injured MWD by an injured Marine Corps sergeant and his family.)

EVOLVING SPECIALTY TRAINING AND SUPPORT ACTIVITIES

Long-Term Health Education and 64F Training

In the past, military veterinarians with more advanced clinical skills generally trained to support the research community rather than the MWD mission. Only a small number of VCOs received post-professional training to acquire skills in specialties such as surgery, medicine, radiology, and ophthalmology, and no standardized method existed to acquire such training. However, after a significant number of MWDs were lost to service due to problems that were potentially preventable or treatable, it became apparent that if MWDs were to be provided the best care possible, more clinical specialists were needed within the Army Veterinary Corps (electronic personal communication from Colonel [Retired] Robert Vogelsang, former Army 64F Consultant, to Lieutenant Colonel Ronald Burke, US Army Veterinary Corps, May 31, 2013).

Most Army Medical Corps officers who receive specialty training do so within a large military medical center. However, VCOs selected for clinical residency training—other than in the field of pathology—must study at civilian veterinary institutions because these clinical residencies are not available in military settings.

In the 1980s, the Veterinary Corps began sending VCOs who desired to become clinical specialists to civilian residency programs to meet this need. The first residents were confined to a 2-year residency, culminating in a master’s degree, although clinical residency programs were traditionally 3 years long. The first Army veterinary radiology resident was required to complete the program in only 2 years, and the first surgery resident was initially authorized a 2-year program, which was later extended to a 3-year program (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

VCOs who complete residency training and subsequent board-certification are classified as area of concentration 64Fs; these 64Fs are also dubbed “Foxtrots” within the Veterinary Corps. Initially, these clinical specialists were assigned to the MWD hospital at Lackland AFB, DODMWDVS, and to research facilities, where their skills gave them the expertise to evaluate shock, trauma, and other animal models that were used to improve human trauma care and resuscitation. They also began to participate in the training of junior VCOs and cared for all MWDs in training at the 341st Training Squadron. Later, the 64F personnel were assigned as regional veterinary clinical specialists to provide consulting services for MWDs, other government-owned animals, and privately owned pets at a number of locations around the world. As time went on, the numbers of 64Fs grew to the current number of 38 authorized positions (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

Military Veterinary Behaviorist Programs

One of the Army’s more recently recognized 64F subspecialties is the veterinary behaviorist. A veterinary behaviorist is a veterinarian who has completed formal residency training, passed the board examination of the American College of Veterinary Behaviorists, and is qualified to provide advanced evaluation and veterinary behavioral treatment of animals displaying problem behaviors.

The scope and depth of available behavioral care used in the treatment of US MWDs often varies from location to location, depending on disparate service missions and philosophical and physical distances among various personnel responsible for MWD care. For example, procurement, training, certification, and operational assessment of MWDs, provided by the USAF’s 341st Training Squadron and operational units in all branches of the military, are not considered veterinary functions, which often results in an artificial division between training and behavior personnel. Since military trainers and handlers have virtually no instruction in the identification and management of behavioral problems, they often use a training model of management to “treat” MWD behavioral problems (ie, they deal with a behavior problem as a training issue), instead of referring the animal to military behavioral specialists for diagnosis and treatment. Access to adequate veterinary behavioral services also depends on whether the Army veterinarian overseeing a particular MWD kennel is willing to rely on the remote diagnosis and treatment recommendations of a behavioral specialist who may never see the patient on site (Dr Walter Burghardt, chapter author, unpublished data, January 2015).

Historically, military behavioral services have been limited because of the small number of personnel initially available and capable of providing such care for MWDs. As mentioned previously, prior to 1983, the USAF and US Army provided separate veterinary care for their MWDs. Although the Army Veterinary Corps provided a number of research psychologists to support such MWD programs as the Biosensor MWD, the Army Veterinary Corps did not specifically provide behavioral medicine service or support to its operational MWDs.[35]

Until 1983, the USAF Veterinary Corps allocated only one behavioral position to serve its MWD school at Lackland AFB: a veterinary research psychologist (Air Force Specialty Code 993XD). This psychologist’s behavioral support included assistance with handler and MWD training program design, MWD team assessment, identification and treatment of MWD behavior problems, and support for MWD task-related research and development activities. The Navy and Marine Corps MWD programs did not possess organic veterinary support and received all of their veterinary services from either the USAF or Army (Dr Walter Burghardt, chapter author, unpublished data, January 2015).

In 1980, all veterinary services for all military branches began being provided by Army personnel; training and inventory management transitioned to the USAF personnel. However, between 1983 and 1994, the Army still offered no behavioral support while the USAF continued to engage the services of a veterinarian with advanced training in behavior via either a contract or government employee position in support of the MWD Training Squadron. One USAF behaviorist during this period was Colonel Dan Craig, who provided similar support in his civilian position as he did while on active duty working with the USAF MWD program (ie, similar training designs, MWD procurement and team assessment, and applied research projects in explosives and drug detection) (Dr Walter Burghardt, chapter author, unpublished data, January 2015).

In 1993, US Army Colonel Gary Stamp served as the director of the DODMWDVS, the Army Veterinary Corps unit supporting the DoD MWD Training School at Lackland AFB. Stamp spearheaded an effort to acquire the services of a board-certified veterinary behaviorist to support the training school through the Army Veterinary Corps. A civilian position, created by the Army at the DODMWDVS in 1995, was filled by Dr Walter Burghardt. From 1995 to the present, the entire DoD veterinary behavioral program has been supported by this single Army position (Dr Walter Burghardt, chapter author, unpublished data, January 2015).

In 2010, in order to meet a perceived need to expand specialty veterinary behavioral services, Colonel David Rolfe, then commander of the Army Veterinary Command (VETCOM), laid the groundwork for a Long-Term Health Education Training (LTHET) residency in behavioral medicine. In 2009, the DODMWDVS Behavioral Medicine Section was tasked with creating a specific local residency training program for veterinarians focusing on MWD behavior. Ultimately, this program became a 4-year joint residency in behavior and veterinary practice, culminating with a master’s thesis in neurobiology from the University of Texas at San Antonio. The behavioral residency program is recognized as conforming by the American College of Veterinary Behaviorists (the only conforming program not affiliated with a veterinary college). Ideally, this program trains one new resident every 3 to 4 years (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

Behavioral Medicine Applied Research and Development Activities and Challenges

One of the most significant products of the DODMWDVS and its program of applied research and development in selective breeding at Lackland AFB has been the formation of the International Working Dog Breeding Association (IWDBA), a professional organization representing a broad spectrum of the working dog community from 26 countries around the world. In 1999, as US DoD personnel prepared for proof-of-concept breeding programs for the military and the Transportation Security Administration, they planned a conference for approximately 50 attendees at Lackland AFB. The nine invited presenters were selected on the basis of their expertise and publications in the management of large-scale breeding programs and the science related to successful selection, breeding, whelping, and rearing. During the 1999 meeting, participants felt that a conference of this sort was not only unique but could also be of value to a larger working dog audience than just the US military. The eventual formation of the IWDBA stemmed from these sentiments and an unexpected event.[36]

In 2001, the conference was repeated at Lackland AFB but was also expanded to attract a wider audience and presenter selection. As fate would have it, the 2001 meeting, attended by 50 international guests from 12 countries, was scheduled for three days: September 10, 11, and 12.[36] The terrorist events of September 11, 2001, could have ended the meeting early, particularly with the virtual lock-down of the conference site for security reasons. Instead, 9/11 galvanized the participants to form the IWDBA to represent the interests of working dog programs and support future meetings (Dr Walter Burghardt, chapter author, unpublished data, January 2015). Since 2001, IWDBA has held conferences every other year on a rotating basis (Figure 3-7).

By the 2011 meeting, the conference size grew to over 200 participants from 25 countries, and the scope of the meeting included program management, applied theriogenology, selection, quantitative and molecular genetics, nutrition, husbandry and veterinary care, and canine sports medicine. Participants represented major military, government, public, and private canine programs involving military and police work, substance detection, canine assistance and therapy programs, academic and research community projects, the working dog-related industry, and smaller canine programs for individual canine handlers and end-users.[36]

Challenges for the Behavioral Medicine Section have included those common to virtually every private or public veterinary practice: funding, facilities, and manpower. The DODMWDVS has never had a dedicated line of funding in support of applied research and development activities. All applied research and development has been performed using extramural or operational funds, which is fraught with the challenge of maintaining year-to-year continuity in ongoing programs. The other significant financial challenge has been access to sufficient travel funding to allow for optimal patient care and veterinary support for a worldwide patient base.

The Behavioral Medicine Section also has no dedicated clinical or research facilities. Therefore, attempting to support advanced behavioral assessments and applied research and development projects that require instrumentation, recording equipment, climate control, or other environmental controls is a continuing challenge. Over the years, the program temporarily used a variety of facilities (from research laboratories to abandoned buildings) and was able to construct a whelping kennel to support the MWD breeding assessment project from 1999 to 2005 (subsequently granted to the USAF 341st Training Squadron for use in their operational MWD breeding program). A 5,000-square-foot behavior evaluation, treatment, and research building was planned in 1995 but never constructed (Dr Walter Burghardt, chapter author, unpublished data, January 2015).

Figure 3-7. Attendees of the 3rd International Working Dog Conference, October 5 to 8, 2003, at Lackland Air Force Base, Texas. Almost 100 representatives from 12 countries on 5 continents met to address global working-dog issues.
Photograph courtesy of Dr Walter Burghardt, Department of Defense Military Working Dog Veterinary Services; Joint Base San Antonio-Lackland Air Force Base, Texas.

The final significant challenge is a long-standing one: manpower. Although the Behavioral Medicine Section has had a staff of up to 15 term contract employees, there has only been one permanent employee in the department since inception.[33] All additional staffing was hired in support of specific training and research programs using contract labor. Although this source provided sufficient personnel to accomplish a number of successful projects, as noted earlier in this chapter, the clinical staff was still left with only one board-certified veterinary behaviorist serving the entire DoD.

As early as 1995, the need for a dedicated behavior technician and several trainers was identified to support the clinical portion of the service. In 2010, the Army Veterinary Corps also recognized the need for additional uniformed veterinary behaviorists in geographical and operational areas that are difficult to serve by a single behaviorist based in San Antonio (eg, Europe, the Far East, Asia, and Africa) and, as previously noted, funded the first residency for uniformed veterinarians. Given time, more specialists can offer better behavioral support worldwide, starting with the graduation of the program’s first resident in 2016, but these newly trained specialists will also need adequate facilities and staffing (Retired Colonels Gary Stamp and David Rolfe, US Army Veterinary Corps, personal communications, July 1995, and January 2010, respectively).

Future opportunities include meeting the various challenges just enumerated: (a) securing an ongoing line of basic funding for research and development; (b) acquiring a permanent facility to support applied behavioral research and development and clinical activities; (c) hiring a veterinary behavior technician and one or more trainers to work with each veterinary behavior specialist; and (d) maintaining a sufficient number of uniformed veterinary behavior specialists to support worldwide requirements. Several other opportunities also exist for the Behavioral Medicine Section, namely in training. Although all uniformed veterinary interns (VCOs) receive 22 hours of behavioral training at the seven First-Year Graduate Veterinary Education (FYGVE) sites (see the next section of this chapter), uniformed veterinary technicians (68T enlisted soldiers) currently receive no formal behavioral training. Accordingly, there is a need to create and insert training into the 68Ts’ technical school training and produce a series of technician training tracks that could be used as continuing education.

The other significant opportunity to improve MWD behavioral care would be through the training of MWD handlers, trainers, and kennel masters. Like veterinary technicians, operational MWD handlers, trainers, and kennel masters are not formally trained to identify behavioral problems in MWDs or to implement the various methods used to treat these problems. Opportunities for and implications of such training are currently being explored because, as an aggregate, behavioral problems may represent the single largest cause of lost service in MWDs (Captain Desiree Broach, DODMWDVS intern, unpublished data, 2015).[37] Early identification and effective intervention may be more likely if such training is actively implemented and may result in better outcomes for MWDs with behavioral problems.

First-Year Graduate Veterinary Education

Since the primary animal mission conducted by the Veterinary Service is comprehensive care of MWDs, VCOs must have competency in basic animal medicine and surgery skills to resuscitate, stabilize, and evacuate wounded dogs to the next higher level of care. However, sustaining such skills within a garrison environment is often difficult because most MWDs rarely present with medical issues. These dogs are seen regularly by Army veterinarians for scheduled wellness checks, usually need only routine surgeries (eg, spays and neuters), and typically present few complex medical conditions for VCOs to treat. To maintain the skills needed to make more difficult diagnoses and perform other surgeries in contingency operations, VCOs and their animal technicians draw from a larger available pool of “patients”: pets of service members and retirees. When veterinary clinics are not being used for MWD care (the first priority), veterinary personnel hone a wider variety of critical skills by taking care of family-owned animals on a space-available basis. (See also Chapter 5, Family-Owned Animal Health Services.)

Gaining necessary veterinary expertise from MWDs and the larger patient population of beneficiary pets was only one challenge faced by VCOs before the creation of the FYGVE program. Although other Army Medical Department officers just out of professional school (eg, physicians, dentists, and nurses) are assigned to locations where they work under other officers to gain experience in both their medical area and serving as an Army officer, many new VCOs are first assigned to locations where they are not only the sole veterinarian, but also the officer-in-charge of a section. Because the Army provides veterinary support for all services, new VCOs can also be located at non-Army installations, where they may be the only Army officer.

Given this set of unique challenges, new VCOs, especially those who were the lone veterinarian at a small base with minimal facilities or equipment, used to be at particular disadvantage as they tried to establish and maintain needed animal medical and surgical skills. To provide beginning VCOs better preparation, the FYGVE program was created in 2010 and is similar to programs established for other new Army medical officers.[38]

The FYGVE program began training at one location, and, by the summer of 2014, was fully established at seven locations including Ft Benning, Georgia; Ft Bragg, North Carolina; Ft Campbell, Kentucky; Ft Carson, Colorado; Ft Hood, Texas; and Joint Base Lewis-McChord, Washington. As of 2015, all new VCOs now receive an initial 1-year assignment to one of the FYGVE sites. Each site has a cadre of two VCOs, each offering a different area of concentration: one is a 64B (veterinary preventive medicine specialist), and the other is a 64F (veterinary clinical specialist). The 64F clinical cadre is responsible for training new VCOs in basic surgical and medical procedures, helping them understand the MWD program and diverse responsibilities of MWD care and handler training, and providing guidance about veterinary treatment facility management. The FYGVE program’s overall goal is that new VCOs leave the program feeling confident and competent to perform the clinical tasks expected of a junior VCO; advanced specialty training may be pursued later (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

RECENT MILITARY WORKING DOG VETERINARY SUPPORT EFFORTS

Army Public Health Command

The Army Public Health Command (PHC) was created on October 1, 2010, when the former Army Center for Health Promotion and Preventive Medicine (CHPMM) and VETCOM merged.[39] Prior to PHC’s formation, CHPMM was responsible for disease control and prevention, environmental health, and health surveillance activities within the Army while VETCOM was responsible for providing veterinary care to almost all MWDs (dogs in Korea and Bahrain were the exceptions), performing food protection (ie, safety and defense), and quality assurance programs. VETCOM also accounted for the majority of Veterinary Corps personnel within the Army. With the establishment of PHC, these missions were integrated within a single unit. As of 2014, veterinary personnel provided installation and area veterinary support for approximately 2,250 MWDs at their home stations and to over 150 Army, Navy, Air Force, and Marine Corps installations located throughout the world.[40] (As of publication, it remains unclear how all the proposed US Army medical transformation will affect the organization of veterinary medical assets.)

Generally, current local installation veterinary facilities are small in size and have limited staffs who provide routine preventive and minor medical and surgical care for their MWDs. Dogs requiring facilities, expertise, and equipment beyond that of home station veterinary teams are referred to facilities with more capabilities, generally regional veterinary sites, if they are capable of being transported. MWDs with cases that are emergent or cannot be transported are referred to local civilian veterinary facilities.[41]

If regional facilities cannot support needed care, transportable MWDs are usually referred to PHC’s Holland MWD Hospital. This facility is a state-of-the-art veterinary hospital staffed with 11 veterinarians (8 of the 11 are specialists); over 20 animal technicians; and logistical, medical records, resource management, and information technology staff.[32] The hospital’s approximate 38,000 square feet is divided into surgery, dental, medicine, intensive care, imaging, behavior, canine reproduction, and physical therapy sections. The hospital is capable of providing care to an average population of over 800 MWDs from a patient population that includes dogs being trained at Lackland AFB for subsequent assignment worldwide or used as permanent party training aids at the dog school, puppies from the breeding program, and operational dogs from other kennels referred for veterinary care (electronic personal communication from Colonel Cheryl Sofaly, Director, DODMWDVS, to Lieutenant Colonel Ronald Burke, US Army Veterinary Corps, March 16, 2015).

Army Public Health Command Regional Consultants

Within PHC, each of its five regions is authorized one 64F who acts as the regional clinical consultant, providing the region’s commander with advice and guidance regarding any animal health-related matters. Each regional 64F also performs several other key consulting duties: (a) acts as the primary clinical consultant to individual units and veterinarians within their region when assistance is required to manage MWD and other animal medicine cases; (b) ensures regional animal medicine staff are trained to, and maintain, an acceptable level of clinical proficiency; (c) assists veterinarians with the disposition of MWDs no longer able to perform military duties (generally this assistance results in transfer to civilian law enforcement agencies or adoption as pets); and (d) interacts with other nations’ agricultural or quarantine services to ensure animal importation requirements are clear and disseminated to other veterinary units, enabling pet owners to understand pretravel requirements.[32] (As noted previously, it remains to be seen how the US Army Medical Command transformation will affect this organization.)

Foxtrot (64F) Research Support

Currently, there are two authorizations for 64Fs within military research institutions: the Army Institute of Surgical Research in San Antonio, Texas, and the Walter Reed Army Institute of Research. Clinical specialists supporting these organizations assist investigators and laboratory animal veterinarians to ensure analgesia, anesthesia, and general veterinary medical care methods and processes are well planned and executed. The presence of both laboratory animal and clinical specialist veterinarians within these institutions provides two synergistic assurances: (1) any research performed is in strict accordance with regulatory guidance and requirements; and (2) animal medical care is provided by an individual with veterinary clinical training beyond that of a general veterinary practitioner or laboratory animal medicine veterinarian (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

In addition, the clinical specialists provide expertise in their field when evaluating research protocols, ensuring that proposed animal models meet the intent of the research. Because clinical specialists possess advanced knowledge of trauma, resuscitation, cardiovascular pathophysiology, critical care, and other important research subject matter, they can provide input to improve study models using animals. Research in the field of tactical combat casualty care has led to significant advances in trauma care and care of the battlefield wounded soldiers in Iraq and Afghanistan. For example, innovations such as the tactical tourniquet and combat gauze have revolutionized initial management of hemorrhage on the battlefield, allowing more soldiers to survive and reach definitive care (Lieutenant Colonel Jennifer Beck, chapter author, unpublished data, March 2015).

SUMMARY

Although canines have always been valued by civilians and militaries across the globe, the American military’s use of war dogs is relatively recent and has waxed and waned over a period of many conflicts. However, even with today’s advanced technology, the dog still reigns supreme for overall utility in battle. The dog is mobile, requires little maintenance, and provides the intangible benefit of companionship to its handler and unit. The US Army now has its own procurement program as well as strong ties to the modern dog facilities at Lackland AFB (ie, the dog training center and the Holland MWD hospital, which offers advanced rehabilitation opportunities for wounded dogs). Although legal and moral changes since the Vietnam era now make MWD adoption to an owner the preferred means to discharge a dog from service, wounded MWDs must continue to have adequate veterinary care available in a timely fashion to prevent such disposition. New training programs for all junior Veterinary Corps officers and the addition of a growing number of Army behavioral care specialists to the senior ranks has steadily improved the efficiency and standard of MWD care both on and off the battlefield. Quality veterinary care for these canines remains the highest priority of the US Army Veterinary Corps’ modern animal mission.

Acknowledgment

The authors would like to acknowledge Colonel (Retired) Robert Vogelsang for his help in initiating the preparation of this chapter.

REFERENCES

1.   Goodavage M. Soldier Dogs: The Untold Story of America’s Canine Heroes. New York: Dutton; 2012.

2.   Miller EB. United States Army Veterinary Service in World War II. Washington, DC: Department of the Army - Office of the Surgeon General; 1961.

3.   Waller AM. Dogs and National Defense. Washington, DC: Department of the Army - Office of the Quartermaster General; 1958.

4.   Department of the Army. Eight Army Surgeon Report of Activities. Section VI, Veterinary Service. Washington, DC: DA; 1951.

5.   Fickbohm R and Granger SF. Cold Noses, Brave Hearts: Dogs and Men of the 26th Infantry Scout Dog Platoon. Bloomington, IN: Xlibris Corp.; 2011.

6.   Manus A. Veterinary Mission - War Dogs. Medical Bulletin of the US Army, Europe. June 1964; 21.

7.   Brown D. Squad of War Dogs New on Recon Duty. Pacific Stars and Stripes. September 4, 1951.

8.   Wounded-Baron. Pacific Stars and Stripes. May 13, 1953.

9.   Department of the Army, Eighth Army. General Order No. 118. Award of the Silver Star. Camp Zama, Japan: DA; January 19, 1953.

10.   Oral history interview of General Frank A Ramsey conducted on 15 April 1999 by Dr. Barry W. Fowle, US Army Medical Department, Office of Medical History. http://history.amedd.army.mil/memoirs/Ramsey/Faramoh.pdf. Accessed January 8, 2015.

11.   Morris J. The Army Dog and the US Army Veterinary Corps. Medical Bulletin of the US Army, Europe. August 1958; 15.

12.   USAREUR Veterinary Service Wide Spread and Varied. Medical Bulletin of the US Army, Europe. June 1961; 18.

13.   Murray MK. The Contributions of the American Military Working Dog in Vietnam. Ft Leavenworth, KS: US Army Command and General Staff College; 1998.

14.   Frost DF. A Centralized Source of Information for the Military Working Dog Program. Ft Leavenworth, KS: US Army Command and General Staff College; 1990.

15.   Seedle DC, Concepts Division Combat Developments Directorate, Academy of Health Sciences. Veterinary Doctrine in Support of Mobilization. Ft Sam Houston, TX: DA; 1984.

16.   Olson RC. Veterinary Aspects of Military Working Dogs. In: Conference on Research to Expand the Usefulness of the Military Working Dog. Lackland AFB, TX, 1970.

17.   Clark WHH. The History of the United States Army Veterinary Corps in Vietnam, 1962-1973. Roswell, GA: W.H. Wolfe Associates; 1991.

18.   Office of the Comptroller of the Army. Exemption of Health Care Function from Commercial Activities (CA) Program Requirements. Memorandum for Assistant Secretary of the Army (Installations, Logistics, and Financial Management). Washington, DC: DA; December 3, 1982.

19.   US Department of Defense. Department of Defense Directive 5200.31.Single Manager for DoD Military Working Dog Program. Washington, DC: DoD; September 7, 1983.

20.   Departments of the Army, the Navy, the Air Force, and the Marine Corps. AR 700-81/OPNAVIST 5585.3/AFJI 23-224/MCO 10570.1A DoD Military Working Dog (MWD) Program. Washington, DC: DoD; December 1, 1990.

21.   DoD Veterinary Service Activity, Office of the Surgeon General. Zoonotic Diseases from the Persian Gulf War. Memorandum for the Assistant Secretary of Defense (Health Affairs). Falls Church, VA: DA; April 25, 1995.

22.   Office of the Inspector General. Audit Report, Military Working Dog Procurements, Report No. D-2000-102. Arlington, VA: DoD; March 14, 2000.

23.   Lindsey JJ. Sailors Foster Future Military Working Dogs. http://www.navy.mil/submit/display.asp?story_id=83189. Accessed February 25, 2015.

24.   San Antonio Business Journal. Military dog program at Lackland adds whelping kennel. http://www.bizjournals.com/sanantonio/stories/2002/05/20/daily1.html. Accessed February 5, 2015.

25.   Miles D. Military Working Dogs Protect Forces, Bases During Terror War. http://www.defense.gov/news/newsarticle.aspx?id=25393. Accessed February 25, 2015.

26.   Headquarters, Department of the Army. FM 4-02 Army Health System. Washington, DC: DA; August 26, 2013.

27.   US Forces Command. Medical Detachment, Veterinary Services – MTOE [unit manning authorization]. Fort Bragg, NC: DA; July 15, 2004.

28.   Department of the Army. AR 601-142: Army Medical Department Professional Filler System. Washington, DC: DA; April 9, 2007.

29.   Joint Trauma System - US Army Institute of Surgical Research. Joint Theater Trauma System Clinical Practice Guideline, Clinical Management of Military Working Dogs. Fort Sam Houston, TX: DA; 2012.

30.   72nd Medical Detachment (Veterinary Service Support). TFMED-72-SOP 202: Standard Operating Procedures - MEDEVAC and STRATEVAC of Military Working Dogs. Bagram, Afghanistan: DA; July 18, 2014.

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32.   Department of the Army, US Army Medical Command. US Army Public Health Command Table of Distribution and Allowances [unit manning authorization]. San Antonio, TX: DA; October 2, 2014.

33.   US Congress. Title 10 US Code 2583 - Robby Law. Washington, DC: 2000.

34.   US Air Force. Official Adoption Website of the DoD Military Working Dog. http://www.37trw.af.mil/units/37traininggroup/341sttrainingsquadron/. Accessed March 3, 2015.

35.   Colonel Robert JT Joy, Director, Walter Reed Army Institute of Research. Staff Study. Silver Spring, MD: DA; January 2, 1976.

36.   The International Working Dog Breeding Association. Resources. http://iwdba.org/. Accessed February 8, 2015.

37.   Burghardt WF. Behavior Problems in Working Dogs. In: 9th International Working Dog Conference. La Grande-Motte, France, 2015.

38.   US Army Medical Command. Operation Order 09-38 (Veterinary Corps First-Year Graduate Medical Education [FYGME] Program). Fort Sam Houston, TX: DA; April 10, 2009.

39.   Ugalde RM and Resta JJ. The US Army Public Health Command initiative: transforming public health services for the army. US Army Med Dep J. 2010; 4-10.

40.   US Army Public Health Command. Veterinary Service Application Portal (restricted access). https://vet1.amedd.army.mil/. Accessed February 8, 2015.

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Chapter 4

MEDICAL EVACUATION OF THE MILITARY WORKING DOG

JAMES T. GILES III, DVM, MS*

INTRODUCTION

MILITARY WORKING DOG CASUALTY CONTINUUM OF CARE

Delineating Initial Battlefield Treatment Providers

Reaching In-Theater Veterinary Providers

Moving Patients through the Continuum of Care

SUMMARY

ATTACHMENT: HUMAN AND MILITARY WORKING DOG REHABILITATION, A PHOTOGRAPHIC VIGNETTE

*Lieutenant Colonel, Veterinary Corps, US Army; Chief of Surgery, Department of Defense Military Working Dog Center Service, 1219 Knight Street, Building 7602, Joint Base San Antonio-Lackland Air Force Base, Texas 78236; formerly, Advanced Animal Health Branch, Joint Base San Antonio-Fort Sam Houston, Texas

INTRODUCTION

Military working dogs (MWDs) are employed in unprecedented numbers on the modern battlefield and in the military medical system. Contract working dogs (CWDs), which are owned by a private company and perform a Department of Defense mission, are also utilized in large numbers in the current operating environment. Both MWDs and CWDs are susceptible to combat- and noncombat-related injuries in the deployed environment and may require medical evacuation (MEDEVAC) in or out of the combat theater.

MEDEVAC is the movement of casualties (MWD and human service members) from the battlefield and other locations (eg, medical treatment facilities or MTFs) within a designated theater aboard dedicated, standardized vehicles or aircraft with medical attendants to provide en route medical care.[1] The MWD and handler may also be transported by casualty evacuation [CASEVAC], which is by any means necessary [eg, being carried or using tactical or logistical aircraft and vehicles] when a dedicated medical transport with en route medical provider is not available.[2]

Currently, no separate MEDEVAC system is in place for MWDs, so they are transported using existing evacuation modalities emplaced for humans (eg, MEDEVAC flights). CWDs are also eligible for MEDEVAC flights and veterinary care within the combat theater. Medically evacuating CWDs and MWDs presents unique challenges to consider and account for such as the air crew’s safety and attending medical personnel’s ability to provide appropriate veterinary care.

Aeromedical evacuation (AE) is a US Air Force function of moving patients under medical supervision and treatment on fixed-wing aircraft between MTFs.[3] Patients may be moved within or out of the combat theater via AE. MWDs are eligible for AE out of the combat theater as well as intertheater (eg, to the continental United States) for medical care and travel along with human patients. However, AE of CWDs out of the combat theater is the owner’s responsibility and is not performed by the US Air Force.[1]

This chapter defines the four roles of care for MWDs that become ill or are injured while serving in combat areas, often necessitating MEDEVAC to receive the highest level of care available to recover to the fullest amount possible. Each level of care is populated with health care providers with varying skill levels and areas of expertise who are equipped with different resources that are dependent on the environment in which they serve, but all work toward one common goal: providing excellent veterinary care to the MWDs that serve alongside military members.

MILITARY WORKING DOG CASUALTY CONTINUUM OF CARE

Figure 4-1 illustrates the continuum of MWD care from the point of injury or illness through the various roles of veterinary care available in the Central Command, African Command, and European Command area of operations. (A similar scheme applies to the Pacific Command. Within the Northern Command and Southern Command, emergent MWD care may involve military or civilian veterinary facilities and civilian or military transport. MWDs in garrison will have local veterinary support; however, those on specific operations will have veterinary care and medical evacuation considered in their operational plans.)

In the Figure 4-1 flowchart, the MWD team is featured as the starting point in the referral network because the MWD handler is trained to be a first responder, the one who recognizes and initiates first aid to the ill or injured MWD. After initial assessment, the MWD and handler may be transported to MTFs by CASEVAC or, if available, by MEDEVAC on dedicated medical transport (eg, ground ambulance or helicopter) with one or more dedicated medical providers aboard for en route medical care.

The MWD is evacuated to Role 1, Role 2, or Role 3 veterinary care based upon the severity of its illness or injury, proximity to veterinary facilities, or mission constraints. (Definitions for Role 1–4 veterinary care are provided in Figure 4-1; these roles also appear amidst broken-arrowed continuum of care routes on the flowchart.) En route to a veterinary hospital, ill or injured MWDs often receive aid from health care providers who are not veterinary health care providers. In Figure 4-1, these individuals are denoted as “medics,” “handlers,” and “HCPs” (eg, a nurse onboard a MEDVAC flight). The HCP treating the transported MWD may also be the same HCP who provided initial first aid.

The Medical Detachment Veterinary Service Support (MDVSS) forms the basis for many of the roles of in-theater veterinary care featured in Figure 4-1. Role 1 veterinary care is provided by an independent animal care specialist (68T) who is part of MDVSS or an MWD-owning unit. Role 1 and Role 2 veterinary care are provided by five veterinary service support teams (VSSTs) within the MDVSS. Roles 1, 2, and 3 are provided by the veterinary medical and surgical team (VMST) at a theater veterinary hospital. (See Exhibit 4-1 for more information about MDVSS structure in a theater.)

Figure 4-1. Military Working Dog Care and Referral Network: A Continuum of Care.
This flowchart illustrates the total spectrum of military working dog (MWD) care after battlefield injury or illness in the Central Command, African Command, and European Command area of operations. As the MWD passes through this medical and veterinary referral network, each role provider at respective levels 1, 2, 3, or 4 (see Roles 1–4 below) performs prescribed duties and, if necessary, refers the MWD to the next role provider until treatment is completed. Treatment assessment usually begins on the battlefield.
Role 1 is nonsurgical care provided by a 68T or veterinarian with assistance from the military working dog (MWD) handler to provide care for minor wounds, injuries or illnesses, preventive medicine, emergency intervention for airway, hemorrhage, fracture, and immobilization.
Role 2 care includes veterinarian-directed resuscitation and stabilization and may include advanced trauma management, emergency medical procedures, and forward emergency resuscitative surgery.
Role 3 care includes referral for advanced veterinary diagnostic, therapeutic, and surgical procedures. This level of care requires a veterinary clinical specialist with advanced specialty training in surgery, internal medicine, or critical care. In the combat theater, the facility is typically co-located with a Role 3 medical treatment facility (human hospital).
Role 4 care is given at the Department of Defense MWD Veterinary Service at Joint Base San Antonio-Lackland Air Force Base, Texas. This level of veterinary care not only provides Role 1 through 3-level services, but also affords additional surgical, medical, rehabilitative therapy, behavior, and convalescence capabilities.
Source: Headquarters, Department of the Army. Army Health System. Washington, DC: DA; August 2013. US Army Field Manual 4-02.
CASEVAC: casualty evacuation
CONUS: continental United States
DODMWDVS: Department of Defense Military Working Dog Veterinary Service
HCPs: health care providers
MEDEVAC: medical evacuation
MWD: military working dog
OCONUS: outside the continental United States
68T: animal care specialist or 68 “Tango”
VETACs: veterinary activity centers
VETCENs: veterinary centers
VMST: veterinary medical surgical team
VSST: veterinary service support team
Flowchart courtesy of chapter author.

EXHIBIT 4-1.

MEDICAL DETACHMENT VETERINARY SERVICE SUPPORT STRUCTURE, ROLE 1, ROLE 2, AND ROLE 3

The Medical Detachment Veterinary Service Support (MDVSS) provides comprehensive veterinary services in an area of operations. The animal care portion is provided by five veterinary service support teams (VSST; Roles 1–2 veterinary care) and the veterinary medical and surgical team (VMST; Roles 1–3 veterinary care). (See Figure 4-1 for the definitions of each role.)

- Each VSST is comprised of one veterinary officer (64A, general practitioner), one animal care specialist (68T) and five veterinary food inspection specialists (68R). The VSSTs are typically geographically dispersed and co-located with a Role 2 medical facility.

- The VMST consists of a veterinary clinical specialist (64F), one veterinary officer, and three animal care specialists. The VMST is usually co-located with a Role 3 medical facility.

____________

Data source: chapter author.

MWDs that are fit to return to duty after receiving in-theater care from Role 1, 2, or 3 providers do so by standard logistical means. MWDs that require further treatment leave the Role 3 theater veterinary hospital via US Air Force fixed-wing AE, which is also referred to as “strategic aeromedical evacuation” or “intertheater evacuation.”[4]

While humans and dogs travel on the same AE flights, human casualties are transported to an MTF in Landstuhl, Germany. MWDs that require AE travel are transported to Kaiserslautern, Germany, where Dog Center Europe, a robust Role 3 veterinary activity (VETAC) that often provides definitive care, is located. (Note the route by the words, “Aeromedical Evacuation” in Figure 4-1.) (See Exhibit 4-2.)

After treatment at Dog Center Europe, MWDs that do not require intense rehabilitation will return to their normal duty station and receive follow-up at a regional Role 3 VETAC or veterinary center (VETCEN). Those MWDs that require definitive care not available at a Role 3 facility or need long-term rehabilitation go by AE to the Role 4 Department of Defense MWD Veterinary Service (DODMWDVS) at Joint Base San Antonio-Lackland Air Force Base (Lackland AFB). (Note the route from Role 3 to Role 4 in Figure 4-1.) (See other sections of this chapter and Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Services, for more information about behavioral and other treatment options as well as the Level 4 capabilities available at the Lieutenant Colonel Daniel E. Holland MWD Hospital at Lackland AFB.)

EXHIBIT 4-2.

TYPES OF MILITARY WORKING DOG REFERRAL CENTERS, ROLE 3 AND ROLE 4

The 11 stateside and overseas military working dog (MWD) referral centers that provide Role 3 or 4 services are either US Army veterinary activity centers (VETACs) or US Army veterinary centers (VETCENs) or the Department of Defense MWD Veterinary Service (DODMWDVS). (See Figure 4-1 for the definitions of each role.)

- The Role 3 VETACs include Dog Center Europe, Kaiserslautern, Germany; Dog Center Japan, Kadena Air Base, Okinawa, Japan; Ft Shafter, Hawaii; and the 106th Medical Detachment Veterinary Service Support, Yongsan, Korea.

- The Role 3 VETCENs include Joint Base Lewis-McChord, Washington; Ft Carson, Colorado; Ft Hood, Texas; Ft Campbell, Kentucky; Ft Benning, Georgia; and Ft Belvoir, Virginia.

- The Role 4 DODMWDVS is located at Joint Base San Antonio-Lackland Air Base, Texas.

____________

Data source: chapter author.

Delineating Initial Battlefield Treatment Providers

As previously mentioned, the handler or a nonveterinary HCP (or both) usually provide initial treatment for an injured MWD. MWD handlers are extensively trained in first-aid procedures for their dogs and follow the combat medic’s principles of Tactical Combat Casualty Care or TC3 (ie, medical intervention is directed at life-saving procedures, and the degree of intervention is dictated by the tactical situation).[5] Additionally, a combat medic, trained in human trauma management, is often available at the point of injury, and, in some instances, an Animal Care Specialist (68T) may be present to provide Role 1 urgent care to the MWD (See Figure 4-1). Initial medical care is limited to analgesia (eg, morphine), wound management, hemorrhage control, fluid therapy, and basic life-saving measures.

Reaching In-Theater Veterinary Providers

After initial treatment on the battlefield, injured or ill MWDs are transported to a veterinary provider as soon as possible. Based on the situation, the MWD team may first evacuate by CASEVAC, which is initiated when MEDEVAC assets are not readily available. In this scenario, MWDs are physically carried or mechanically transported to medical care or casualty collection points either in tactical or logistical vehicles or in aircraft with no dedicated medical personnel. In other instances, the MWD team may receive a MEDEVAC from the point of injury to the next role of medical care. MEDEVAC is the preferred means of patient evacuation because, in this scenario, the casualty is more likely to receive timely and appropriate medical care en route to an MTF.

Initiating a MEDEVAC for an MWD is done the same way one is secured for injured service members (ie, using a 9-Line MEDEVAC Request). Requests are prioritized based on the nature of injury or illness. As noted earlier in this chapter, MEDEVACs are conducted via dedicated medical vehicles such as ambulances or helicopters, and en route emergency medical care is usually administered by a nonveterinary HCP such as a combat medic. Although canine and human patients often travel together during MEDEVACs, humans have priority over MWDs in both medical treatment and MEDVAC availability. In other words, MWDs may be treated concurrently and evacuated alongside human casualties as long as human patient care is not hindered. MEDVAC crews determine whether it is safe or detrimental to human patient care to permit concurrent MWD and human patient MEDEVAC. If concurrent travel is deemed detrimental, the MWD must await additional MEDEVAC.

Whether the MWD team is evacuated to the next role of medical or veterinary care by MEDEVAC, casualty evacuation, or AE is dictated by the nature and severity of injury, proximity to facilities, and tactical situation. Ideally, the MWD is immediately evacuated to a Role 2 or 3 veterinary facility after initial treatment and stabilization. Sometimes, however, environmental conditions and tactical situations delay needed veterinary care by hours or days. To mitigate these potential treatment delays and in recognition of the HCPs’ critical role in MWD combat emergencies, specific deployed providers are trained in and have access to the Joint Theater Trauma System’s clinical practice guideline (CPG).[6] This comprehensive manual helps nonveterinary HCPs successfully recognize and manage MWD medical emergencies in the absence of veterinary personnel. The MWD CPG, authored by subject matter experts and published within the CPGs for human health care, is readily available to all HCPs.

HCPs receive training in MWD CPGs via numerous venues. Many deploying hospital units receive MWD training in predeployment training such as the Joint Forces Combat Trauma Management Course. In deployed settings, available detachment veterinarians provide training. Recently, the occupational specialty Critical Care Flight Paramedic officially incorporated a number of MWD emergency management critical tasks into their medical required training.

With the publication and implementation of the MWD CPG and subsequent training, the HCP role in deployed MWD emergency care has become much more structured in recent years. Given the limited number of veterinary providers in theater, such targeted HCP intervention is pivotal to delivering timely health care to MWDs. However, even though HCPs have an important and newly defined role in managing MWD emergencies in the absence of veterinary personnel, they are not permitted to provide routine veterinary care without specific veterinary consultation and authorization.

Moving Patients through the Continuum of Care

The first veterinarian contact with an MWD is generally at a Role 2 or 3 facility in the combat zone. Here, ill or injured MWDs are assessed, stabilized, and managed according to their condition. For example, MWDs treated initially at a Role 2 veterinary facility might remain there until they are able to return to duty or transfer to a Role 3 veterinary facility if conditions worsen.

Seriously injured MWDs may require immediate surgical stabilization at a Role 2 or Role 3 veterinary facility. In the combat zone, an animal hospital is typically co-located with a corresponding human MTF. The MTF provides the veterinary facility with diagnostic, medical, and surgical support (eg, equipment and clinical expertise).

Veterinarians determine if MWDs are treated and returned to duty in theater via usual logistical means or if they must leave the theater via AE on Air Force fixed-wing aircraft for further treatment and recovery. The United States and most coalition MWDs in the Central Command and African Command are evacuated to Dog Center Europe for further care and stabilization.

When stable to travel, MWDs transfer to the next appropriate role of care or to their home duty station (or to their home nation, if a coalition-partner animal). Although Dog Center Europe is able to perform advanced medical and surgical care for MWDs, it is not staffed to provide intermediate or long-term recovery and rehabilitation. The DODMWDVS, Joint Base San Antonio-Lackland Air Force Base, is the only Role 4 veterinary facility within the US Department of Defense.

MWDs that must leave theater on fixed-wing Air Force aircraft for further treatment, rehabilitation, or recovery must have en route medical care and access to certain medical treatment devices during transport. In fact, all medical equipment and supplies used on MWDs during AE flights must be specifically approved by Air Force Instruction 10-2909, to ensure airworthiness, reliability, and patient and aircraft safety.[7]

AE patient movement also is regulated and validated before any patient and medical attendants are manifested on a flight. (“Regulated” refers to the coordination of the patient’s flight and its receiving hospital to ensure the receiving hospital and staff are prepared to accept and treat the patient upon known arrival. “Validated” refers to the flight surgeon’s process of clinical review of the patient prior to approving the patient transport in order to verify that pertinent clinical and flight-related issues that must be resolved prior to going to altitude are addressed.[3]) The attending veterinarian initiates the mandated process of transporting an MWD via AE with patient movement requests (PMRs), forms providing a comprehensive medical review of an MWD’s injuries, illnesses, and clinical status, ensuring the patient is safe to travel and that all pertinent medical issues are addressed.

A veterinarian must determine the appropriate time to transport an MWD, based upon its medical status, urgency for the next role of veterinary care, and the dog’s chances of surviving the flight. MWDs that are not expected to survive an AE flight are generally not transported unless the clinical condition improves. In some instances, an MWD may have a nonsurvivable injury or illness that warrants humane euthanasia in theater. This is a usually a veterinary function, but provisions in the MWD CPG authorize an HCP to perform MWD euthanasia in extreme circumstances.[5]

The veterinarian also determines which attendants should accompany the patient, based on the clinical condition and other extenuating circumstances. Typically, an MWD handler is present; however, when the assigned handler is also a casualty, another handler assists in the evacuation. For seriously injured MWDs, a 68T or veterinarian is usually assigned as a medical attendant to provide veterinary care during the AE flight. However, if a 68T or veterinarian serves as a medical attendant, they are pulled out of the in-theater veterinary detachment to accompany the MWD to the next role of veterinary care and return to their veterinary detachment duty afterwards. No dedicated veterinary providers are assigned on AE flights for MWDs; AEs only provide dedicated medical staff for their human patients.

PMRs are validated by the MTF flight surgeon and submitted to a patient movement requirement center (PMRC) via the Transportation Command Regulating and Command and Control Evacuation System, also known as TRAC2ES.[3] The requirement center provides final regulation and validation to manifest the MWD patient and any medical or nonmedical attendants out of the combat theater. The coordinating PMRC may be a joint patient movement requirements center (JPMRC), which is a deployable asset that communicates movement requirements to a theater patient movement requirement center (TPMRC).

In the absence of a JPMRC, all patient movement within a theater is coordinated with the TPMRC. The TPMRCs are permanent facilities located at two sites: one in Europe (TPMRC-E at Ramstein Air Force Base, Germany) and one in the Pacific (TPMRC-P at Hickam Air Force Base, Hawaii). A global patient movement requirements center, located at Scott Air Force Base, Illinois, handles intertheater patient movement as well as patient movement within the US Northern and Southern commands.[3]

As previously mentioned, US and most coalition-partner MWDs in the Central, European, and African commands that require significant care from battlefield injuries or illnesses are evacuated to Dog Center Europe. This center’s AE resources parallel the human AE resources available at the Landstuhl Regional Medical Center in nearby Landstuhl, Germany. The MWDs arrive at Ramstein Air Force Base and are transported to nearby Dog Center Europe in military police or security forces vehicles. (An equivalent veterinary facility, Dog Center Pacific, is located in Okinawa, Japan, for MWDs that suffer noncombat injuries or illnesses while stationed in the Pacific Command area of operations.)

Figure 4-2. An Australian military working dog being unloaded from an ambulance after traveling via medical evacuation helicopter to Kandahar Airfield, Afghanistan. He was shot in the forelimb during combat and suffered a near amputation. The handler and a combat medic provided initial care at the point of injury. The dog traveled to a Role 2 veterinary hospital via medical evacuation and received treatment from a veterinarian and physician before transfer to the Kandahar Role 3 veterinary treatment facility.
Photo courtesy of chapter author.

Figure 4-3. The Australian military working dog from Figure 4-2 being transported on an aeromedical evacuation flight from Kandahar Airfield, Afghanistan, to Bagram Airfield, Afghanistan, en route to Dog Center Europe in Kaiserslautern, Germany. He traveled on a stretcher alongside wounded service members and was accompanied by a 68T and military working dog handler. The dog underwent multiple surgeries at Kandahar Airfield in both the Role 3 medical treatment facility and Role 3 veterinary treatment facility to save his forelimb from amputation. He received definitive surgical care at Dog Center Europe, retired from military service, and became a mascot for the owning unit.
Photo courtesy of chapter author.

Figure 4-4. A British military working dog (MWD) being loaded onto an aeromedical evacuation flight from Kandahar Airfield, Afghanistan, to Bagram Airfield, Afghanistan, en route to Dog Center Europe in Germany. The male MWD was shot through the pelvis in combat operations. The handler and a physician provided initial care near the point of injury. The MWD then was treated briefly at a coalition-partner Role 2 veterinary treatment facility and transferred to the Kandahar Airfield Role 3 veterinary treatment facility. He underwent multiple surgeries on his gunshot wound and had abdominal surgery and blood transfusions at the Kandahar Airfield Role 3 medical treatment facility.
Photo courtesy of chapter author.

Figure 4-5. The British military working dog (MWD) from Figure 4-4 on an aeromedical evacuation flight from Bagram Airfield, Afghanistan, to Dog Center Europe in Germany. A veterinarian accompanied the MWD to this center due to the dog’s critical condition. This MWD had a full recovery and returned to duty.
Photo courtesy of chapter author.

Figure 4-6. United States Marine Corps female military working dog Lucca undergoing surgical forelimb amputation at the Kandahar Airfield Role 3 medical treatment facility in Afghanistan. (She suffered a traumatic amputation of the lower portion of her forelimb from an improvised explosive device detonation.) Lucca received initial medical care from the handler and a combat medic at the point of injury and traveled via medical evacuation to Camp Leatherneck, Afghanistan, for initial veterinary treatment. She was later transferred on a nonmedical fixed-wing aircraft flight to Kandahar Airfield, accompanied by a veterinarian and handler. Veterinary and human surgeons operated on Lucca upon her arrival at the Kandahar Airfield Role 3 medical treatment facility.
Photo courtesy of chapter author.

Depending on the severity of the injury or illness, several outcomes are possible for the MWDs evacuated from the combat theater and treated at Dog Center Europe. They may be (a) returned to duty in the combat theater; (b) transferred to their home duty station with local veterinary support; (c) transferred to one of the Role 3 VETACs or VETCENs located outside or within the continental United States (whichever is in closest proximity to the home duty station); or (d) transferred to the Role 4 DODMWDVS at Lackland AFB for definitive care and long-term rehabilitation.

The DODMWDVS is staffed with multiple veterinary specialties, including advanced surgery, internal medicine, critical care, diagnostic imaging, behavior medicine, and physical rehabilitation. The AE process to transfer the MWD to one of the above locations is the same as to leave the combat theater: a PMR is submitted through an MTF to a PMRC, and the request must be validated and regulated before the patient and attendants are manifested on a medical flight. However, as mentioned earlier, coalition-partner MWDs will usually return to their home nation from Dog Center Europe.

Figure 4-7. Military working dog Lucca from Figure 4-6 awaiting aeromedical transport to Bagram Airfield, Afghanistan, en route to Dog Center Europe in Germany, accompanied by a 68T and her handler. Lucca then transferred from Dog Center Europe to a Role 3 veterinary center at Camp Pendleton, California, and returned to her kennels. She eventually retired from military service and was adopted by her previous handler.
Photo courtesy of chapter author.

MWDs that regain full function generally return to duty. Those with some impairment to function are assessed to determine if they could serve in another capacity within the Department of Defense or a law enforcement agency. Those that cannot return to duty are evaluated for retirement and adoption. Figures 4-2 through 4-7 illustrate MWD evacuations of coalition and American dogs, their passage through divergent treatment roles, and varying outcomes. A photographic vignette at the end of this chapter illustrates how one US service member and his MWD, both injured in Afghanistan, moved through a similar continuum of care, with the MWD eventually being adopted by the service member and his family.

SUMMARY

MWDs are extensively involved in military operations and are ever-present on the modern battlefield. Their critical role in combat operations and saving human lives with their unique skills is well known. Since they are at risk for injury and illness when on duty, MWDs are incorporated into the existing medical evacuation system emplaced for human service members. However, unique challenges face those coordinating the evacuation of injured MWDs such as the safety of air crew members; mandated transportation and medical plans for the animal and all designated accompanying medical providers; and providing standardized veterinary treatment of injured animals, prior to their arrival at veterinary-staffed facilities. In the current operating environment, critically injured MWDs are routinely evacuated from the point of injury on the battlefield, receive life-saving intervention from various human and veterinary health care providers, and are evacuated across multiple continents to receive whatever long-term physical rehabilitation is appropriate and possible.

REFERENCES

1.   Headquarters, Department of the Army. Medical Evacuation. Washington, DC: DA; May 2007. US Army Field Manual 4-02.2.

2.   Joint Publication 4-02, Health Service Support. http://www.dtic.mil/doctrine/new_pubs/jp4_02.pdf. Published July 26, 2012. Accessed August 1, 2012.

3.   Department of the Air Force. Air Force Instruction 11-2AE, Vol. 3, Aeromedical Evacuation (AE) Operations Procedures. Published May 18, 2010. http://static.e-publishing.af.mil/production/1/440aw/publication/
afi11-2aev3_440awsup_i/afi11-2aev3_440awsup_i.pdf. Accessed August 1, 2012.

4.   Headquarters, Department of the Army. Army Health System. Washington, DC: DA; August 2013.

5.   Department of Defense Military Working Dog Veterinary Service (DODMWDVS). Medical Care of Military Working Dogs by Handlers. San Antonio, TX: Director, DODMWDVS; June 2014. Military Working Dog Handlers Training Manual.

6.   United States Army Institute of Surgical Research Clinical Practice Guidelines. Published March 19, 2012. http://www.usaisr.amedd.army.mil/clinical_practice_guidelines.html. Accessed August 1, 2012.

7.   Department of the Air Force, Headquarters, Air Mobility Command. Aeromedical Evacuation Equipment Standard. Scott Air Force Base, IL; June 2013. Air Force Instruction 10-2909.

Figure 4-8. US Marine Corps (USMC) military working dog (MWD) Drak and his then-active-duty handler USMC Sergeant Kenneth Fischer, on a combat mission in Afghanistan.
Photo courtesy of Sergeant (Retired) Kenneth Fischer.

Figure 4-9. Drak receives initial triage at Kandahar Airfield, Afghanistan.
Photo courtesy of chapter author.

ATTACHMENT: HUMAN AND MILITARY WORKING DOG REHABILITATION, A PHOTOGRAPHIC VIGNETTE

US Marine Corps (USMC) military working dog (MWD) Drak and his handler, USMC Sergeant Kenneth Fischer, were both severely injured by a vehicle-borne improvised explosive device in Afghanistan, September 2011. They were evacuated separately to Camp Bastion, Afghanistan.

Drak received initial pain management and wound care at nearby Camp Leatherneck and was then evacuated to Kandahar Air Field (KAF), Afghanistan, for surgical care. Fischer was then evacuated to Landstuhl Regional Medical Center, Germany, via Bagram Air Field (BAF), Afghanistan, and eventually arrived at Joint Base San Antonio-Brooke Army Medical Center, Texas, for definitive care.

Drak underwent blood transfusions and two surgeries at KAF prior to aeromedical evacuation to Dog Center Europe (DCE) via BAF. Drak received definitive surgical care at DCE and was eventually evacuated to the Department of Defense Military Working Dog Veterinary Service (DODMWDVS) at Joint Base San Antonio-Lackland Air Force Base for rehabilitative care. (Drak and Fischer were reunited at DODMWDVS as they both underwent rehabilitative care for their wounds at Joint Base San Antonio.) (See figures 4-8 through 4-15 for this story in photos.)

Figure 4-10. Scout view computed tomography image showing large metal object in Drak’s lower back.
Photo courtesy of chapter author.

Figure 4-11. Drak being prepared for his first surgery at the Role 3 hospital at Kandahar Airfield, Afghanistan.
Photo courtesy of chapter author.

Figure 4-12. Drak being prepared for his second surgery at Kandahar Airfield, Afghanistan. The substantial wound over his right hip is apparent, in addition to wounds on his face and all four extremities.
Photo courtesy of chapter author.

Figure 4-13. Drak with a negative pressure wound therapy dressing in place for aeromedical evacuation to Dog Center Europe. US Marine Corps Sergeant Kenneth Fischer was treated with the same device for his wounds.
Photo courtesy of chapter author.

Figure 4-14. US Marine Corps Sergeant Kenneth Fischer and Drak are reunited at the Department of Defense Military Working Dog Veterinary Service at Joint Base San Antonio-Lackland Air Force Base, Texas.
Photo courtesy of Sergeant (Retired) Kenneth Fischer.

Figure 4-15. Lieutenant Colonel James T. Giles III, an Army veterinarian specializing in military working dog care, with Drak and the Fischer family at Joint Base San Antonio-Ft Sam Houston, Texas, in November 2012.
Photo courtesy of chapter author and with permission of the Fischer family.

Later, Drak was medically retired and adopted to Fischer and his family. (Fischer was also eventually medically retired due to his combat injuries.) Drak lived with the Fischer family for 3 years until he died of lymphoma in April 2015.

Data source: chapter author.

Chapter 5

FAMILY-OWNED ANIMAL HEALTH SERVICES

NANCY A. VINCENT-JOHNSON, DVM, MS*

INTRODUCTION

EVOLUTION OF MILITARY-PROVIDED PET CARE SERVICES

FINANCING OF VETERINARY CARE FOR PRIVATELY OWNED PETS

MAINTENANCE OF PRIVATELY OWNED ANIMAL HEALTH RECORDS

TRAINING FOR MILITARY PET CARE PROVIDERS

Army Enlisted Animal Care Specialists

New Army Veterinary Corps Officers

Specialized Army Veterinary Corps Officers

STANDARDIZATION OF MILITARY PET CARE

Clinical Credentialing Program

Veterinary Medical Standardization Board

REORGANIZATION OF VETERINARY TREATMENT FACILITIES

SPECIAL TYPES OF MILITARY ANIMAL CARE SERVICES AND PROGRAMS

Horse Stables

Stray Animal Facilities

Animal Bite and Rabies Control Program

“Above and Beyond” Program

SUMMARY

*Lieutenant Colonel (Retired); formerly, US Army Veterinary Corps; currently, General Schedule Veterinary Medical Officer, 10015 Theote Road, Building 610, Fort Belvoir Veterinary Center, Fort Belvoir, Virginia 22060

INTRODUCTION

Family-owned animal health services have changed immensely since their beginnings in the early 20th century, not only in what care is provided but also how that care is financed and documented. This chapter covers the history of privately owned animal care in the US Army Veterinary Corps, various opportunities for US Army Veterinary Services personnel, the reorganization of Army veterinary treatment facilities, two standardization programs for military pet care, and several special services and programs that have been provided by Veterinary Services personnel.

EVOLUTION OF MILITARY-PROVIDED PET CARE SERVICES

Preventing transmission of zoonotic diseases to service members and their families has been of utmost importance throughout the history of the Army Veterinary Corps and is a main emphasis of its public health mission. Although military veterinarians have long provided some general veterinary care to service members’ dogs, cats, and other pets, the Veterinary Corps’ original and primary motivation to treat privately owned pets was to prevent disease transmission such as rabies to humans, military animals, and communities, particularly during animal movement.

As far back as 1928, Army veterinarians vaccinated pets against rabies, a disease that can be fatal to humans and animals. On Army installations, the provost marshal initially had two mandates for animals that resided in government housing: (1) all dogs and cats had to be registered annually, and (2) they needed annual rabies vaccinations to renew the registrations each year. Unregistered animals and strays were subject to impoundment and disposal. In addition to providing vaccination services, Army veterinarians also conducted physical examinations and issued veterinary health certificates to pets prior to their transportation. Upon arrival at their destination, these animals were kept under quarantine or veterinary observation until declared free of contagious diseases.[1]

Later, the military initiated vaccination programs for diseases that could be transmitted to military working dogs (MWDs), including distemper, adenovirus (hepatitis), parainfluenza, leptospirosis, and parvovirus. Military veterinarians also began vaccinating cats for common feline viruses.

Military programs for other personally owned animals have also changed over the years. For example, before World War II, military officers’ privately owned horses were given the same veterinary care as that provided for Army-owned horses and mules.[2] Today, most installation horse stables have either disappeared or are run by private clubs. Veterinarians stationed on installations with equine boarding facilities offer only limited testing and vaccination services in addition to providing mandatory sanitary inspections of installation stables on a quarterly or monthly basis. (See also the section on horses in this chapter and Chapter 8 in this textbook, Military Equine Programs.)

After establishment of the US Air Force Veterinary Corps in 1949, the Air Force Veterinary Corps serviced Air Force installations. The Army Veterinary Corps provided veterinary services to Army installations and shared provision of veterinary services to Navy and Marine Corps installations with the Air Force. However, upon dissolution of the Air Force Veterinary Corps in 1980, the Department of the Army expanded Army services to provide animal health care to all military installations.[3] (Although the executive agency has shifted in recent years, the Army still provides veterinary support for all military service branches; see also Chapter 1, Military Veterinary Support Before and After 1916.)

In 1969, an agreement between the US Army Veterinary Corps and the American Veterinary Medical Association (AVMA) limited the practice of military veterinary medicine in pets within the United States (Brigadier General Frank A. Ramsey, Chief, US Army Veterinary Corps, written correspondence to Dr Richard B. Williams, May 20, 1983). Shortly after this time, military veterinary facilities were referred to as ADPACs, an acronym for Animal Disease Prevention and Control, which emphasized the ADPACs’ preventive medicine services and downplayed their limited veterinary services for privately owned animals.[4]

Essentially the only services allowed for pets by Army regulation and the initial AVMA military animal disease prevention and control policy were health certificates, vaccinations, deworming, and diagnosis and treatment of potentially zoonotic conditions. Pet surgery was restricted to those emergency procedures necessary to prevent undue suffering or to save the life or limb of animals before transporting to a civilian veterinarian for further care[5] (Brigadier General Frank A. Ramsey, Chief, US Army Veterinary Corps, written correspondence to Dr Richard B. Williams, May 20, 1983). All other medical and surgical conditions had to be referred off the installation to local civilian veterinarians for further workup and treatment. The impetus behind the AVMA policy was to limit competition with the civilian veterinarians in communities surrounding military installations. It also focused Army veterinarians on their primary missions. Privately owned pet care was, and remains today, a mission that ranks in priority behind three other veterinary missions: (1) care for MWDs and other government-owned animals, (2) food safety, and (3) public health.6,7

Some geographic exceptions were made to the AVMA policy regarding Army-provided pet care. In military terms, the 48 contiguous United States are called the “continental US,” commonly referred to by the acronym, CONUS; the two noncontiguous US states (Alaska and Hawaii) and overseas locations are considered “outside the continental United States” or by the common reference, OCONUS. Because of language barriers and a lack of equitable veterinary standards in several countries where US service members and their families are stationed, full-service military veterinary clinics were established at many OCONUS locations. These clinics provided a wider array of veterinary services for pets of authorized personnel than ADPAC facilities could, including surgery and treatment for conditions other than zoonoses. At some OCONUS locations, military veterinarians even provided 24-hour emergency care. These extra services were not against policy because the AVMA agreement applied only within the United States.[5]

However, in some remote locations, an exception to policy allowed full-service veterinary clinics to operate even in the United States because no civilian veterinary clinics were located nearby (eg, Ft Irwin, California, and White Sands Missile Range, New Mexico, both situated in the desert a long distance from a city or large town). At OCONUS locations and some remote locations, DoD civilians were also authorized veterinary care for their pets because these civilians could receive DoD medical care when living in these areas.[5]

By the early 1990s, key Veterinary Corps leaders realized that the policy prohibiting Veterinary Corps officers (VCOs) from practicing surgery and services beyond preventive medicine in pets caused various second- and third-order effects: without more animal practice, officers lost needed veterinary skills; MWD quality of care gradually declined; officers began to lose interest in staying in the Veterinary Corps; and retention became a problem.

The 1994 version of the triservice veterinary regulation (ie, Army Regulation 40-905, Secretary of the Navy Instruction 6401.1B, and Air Force Regulation 48-131) corrected some of these detrimental effects by permitting the military to authorize population control and other animal surgical programs within the United States and its territories. Under this regulation’s provisions, VCOs established spay and neuter programs for unclaimed, adoptable stray dogs and cats found on installations after receiving prior approval from commanders.[8]

As these new programs for pets developed, ADPAC facilities were named “veterinary treatment facilities” or, more commonly, VTFs. Not only did the term VTFs align with the new acronym used for human care facilities of the time (ie, “medical treatment facilities” or MTFs), but use of the term VTFs also strengthened the animal mission by adding the word “veterinary” to the names of treatment facilities operated by the Veterinary Corps.[8]

As part of the Army Medical Department’s reorganization, the US Army Veterinary Command (VETCOM) was established on October 2, 1994, to unite broadening veterinary activities scattered across the United States and institute new common goals and policies.[9] To maintain and develop VCOs’ clinical skills, the second VETCOM commander, Colonel Gary Stamp, started a clinical proficiency initiative that required each VCO to perform a small number of cases each quarter in three categories: (1) surgeries, (2) medical workups, and (3) emergency medicine. Eventually, the required number of cases within each category expanded to seven, and 7-7-7 became the minimum standard, with no limits set on the maximum (Figure 5-1) (Colonel [Retired] Gary Stamp, written communication, February 2015). (See also Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Services.)

Figure 5-1. An Army Veterinary Corps officer counsels a client about surgical options after diagnosing her pet Scottish terrier with a cranial cruciate ligament rupture.
Photo courtesy of Dr Nancy Vincent-Johnson, chapter author.

MILITARY VETERINARY TREATMENT FACILITIES (VTF) POLICY

Army veterinarians provide health care for government-owned animals and for animals of individuals authorized military privileges, with an emphasis on wellness, preventive medicine, and outpatient services. Veterinary services will be provided across the full spectrum of veterinary medicine. These services are an important benefit for service members and their families. These clinical platforms also provide a critical training and proficiency base for Army veterinarians. Authorized veterinary services, for both active duty and retired personnel, are the same for personnel living on or off post. The military veterinary treatment facility is operated by the veterinary officer or designated civilian veterinarian in charge, and all assistants are under their direct supervision. A valid Veterinarian-Client-Patient relationship (VCPR) will be established prior to initiating treatment. Veterinary services will not be provided in support of any commercial operations raising animals (pet or livestock) for sale or profit.

Cooperation and referral between civilian and military veterinary personnel is strongly encouraged. Participation of military veterinary service personnel in local and state veterinary activities such as associations, immunization campaigns, fairs, epizootic control programs, public relations functions, etc. in a professionally complementary manner is authorized and encouraged. The vital “One Medicine” human and animal health effort may require government and civilian veterinarians to partner in an overwhelming event such as natural or man-made disasters or disease outbreaks. Army veterinarians may be authorized to assist the local veterinary association or other appropriate civilian authority in these situations, upon request and, with the approval of their chain of command.

The AVMA recognizes and supports Department of Defense animal and public health programs. In the event clarification is needed on the activities of a particular military treatment facility, the president of the local veterinary association should first contact the veterinary officer in charge, and if further clarification is needed, the American Veterinary Medical Association.

Exhibit 5-1. American Veterinary Medical Association (AVMA) Military Treatment Facilities (VTF) Policy (current as of April 2015 and under review).

Reproduced with permission of the AVMA.

Source: AVMA website. https://www.avma.org/KB/Policies/Pages/Military-Veterinary-Treatment-Facilities-Policy.aspx. Accessed February 17, 2015. (Updates to current policy, if any, will be provided at the AVMA website after April 2015.)

The original AVMA agreement that set limits on military pet care in the United States was later revised to the current* version, which reads in part as follows: “Veterinary services will be provided across the full spectrum of veterinary medicine. These services are an important benefit for service members and their families. These clinical platforms also provide a critical training and proficiency base for the Army veterinarians.”[10] (*Exhibit 5-1 is a reproduction of the entire AVMA policy for military VTFs as of April 2015. This policy is currently under review; any changes to the existing policy will be available in the future at the AVMA website.)

FINANCING OF VETERINARY CARE FOR PRIVATELY OWNED PETS

Although funds are appropriated by Congress to provide veterinary care to government-owned animals, privately owned animal veterinary care operations are financed through nonappropriated funds (NAFs), which are self-supporting. NAFs are generated through the sale of goods and services to support or provide authorized programs; in other words, the money raised from an individual program’s sales is used for the collective benefit of the program that generated them. A few examples of other entities that operate using NAFs include morale, welfare, and recreation facilities such as bowling alleys, child development centers, and military exchange and lodging programs.

However, the Veterinary Services NAF is quite different from other NAFs. Because veterinary facilities are not considered morale, welfare, or recreation facilities, the Veterinary Service NAF was established as a separate, supplemental mission fund under the NAFs system.5,8,11 Operational control of the veterinary facility, including fiscal decisions, is handled by the installation veterinarian.

Rather than aiming to make large profits, the goal of the Veterinary Service NAF is to be a nonprofit activity that generates enough funds to cover expenses including NAF salaries. (If any profits are made, they are to be put back into the veterinary facility [eg, buying new equipment and increasing services].) Although the salaries of Army VCOs and Army animal care specialists are paid through appropriated funds because these personnel are in the military, civilian receptionists who work at the veterinary facility are paid through NAFs funds generated by the fees collected from pet owners who utilize the facility.

The NAFs collected also must be sufficient to purchase and restock the large inventory of medications and supplies that are used to provide care for privately owned animals. In addition to the NAF fees that cover the actual costs of the products and services rendered, a $2.00 user fee is charged with each transaction. The mandated user fee goes to the US Treasury to offset the use of appropriated fund resources that support the NAF activity, namely military personnel.[12]

Demand for pet appointments at military clinics usually outnumbers the supply available. In order to better meet clientele needs, many veterinary facilities started hiring civilian veterinary technicians using NAFs. NAFstechnicians allowed for continued availability of pet appointments during shortages of Army animal care specialists and increased the number of appointments overall. However, NAF technicians could only work when a VCO was in the building to supervise appointments. Because of this restriction, it became common practice to add civilian NAF veterinarians to VTF staffs (Sergeant First Class [Retired] Tracey L. Draper, Deputy Director for Veterinary Treatment Facility Operations, Assistant Fund Manager, US Army Public Health Command, Veterinary Services Central Fund, written communication, May 2015). This addition provided for an increased number of available appointments even when the VCO was out of the facility and in other situations where continuity of care might be affected (eg, when the supervising VCO moved, attended a lengthy military school, or had to focus on the more primary missions of food inspection, MWD care, and public health).

Unfortunately, as the number of NAF employees increases, the fees charged to clients also have to increase to cover the cost of additional wages. Recently, due to manning changes necessary to provide deployed veterinary support for combat operations during the Iraq and Afghanistan conflicts, some VCO and noncommissioned officer-in-charge authorizations were converted to general schedule positions. General schedule personnel retain the same spectrum of responsibilities as were held by VCOs or noncommissioned officers-in-charge and because these positions are paid for with appropriated funds, they do not contribute to increased NAF costs.

Historically, large variations existed in the scope of services provided and the amount of fees charged to clients for pet services among various military veterinary facilities. Although assigned VCOs were responsible for the clinical operations of their respective veterinary facilities, local installation NAFs councils, which managed individual NAFs, reviewed and often influenced these operations. In 2008, VETCOM began an initiative to consolidate all veterinary facilities under one central NAF fund (ie, the Veterinary Service Central Fund) (Sergeant First Class [Retired] Tracey L. Draper, Deputy Director for Veterinary Treatment Facility Operations, Assistant Fund Manager, US Army Public Health Command, Veterinary Services Central Fund, written communication, May 2015). The goals of this consolidation were to standardize fees, expand services, and increase continuity of care by being able to hire additional NAF veterinarians and technicians where needed. In addition, by consolidating under a single umbrella account, military clinics received price breaks on bulk drug and supply purchases, producing cost savings that could be passed on to clientele.

Veterinary facilities from Army, Navy, and Marine Corps installations converted from their individual NAF to the one central NAF fund in May 2012. Operations on Air Force installations converted in October 2012 (Sergeant First Class [Retired] Tracey L. Draper, Deputy Director for Veterinary Treatment Facility Operations, Assistant Fund Manager, US Army Public Health Command, Veterinary Services Central Fund, written communication, May 2015).

MAINTENANCE OF PRIVATELY OWNED ANIMAL HEALTH RECORDS

Veterinary medical records are initiated on privately owned animals at the time of animal registration or at the first visit to the veterinary facility. Traditional hard-copy medical records consisted of the green record jacket, Defense Department Form 2344, and inside, on the left, a Defense Department Form 2343, Veterinary Health Record, which was used as a cover sheet to display pertinent items such as owner information, animal data, immunization data, a master problem list, and a record of laboratory test procedures. The right-hand side of the record held the Standard Form 600 forms documenting the doctor’s and technician’s medical notes. Many other DoD forms and standard forms also were filed within the pet health record, including the rabies vaccination certificate and health certificates.[12]

With the advent of computerization came the transition to electronic medical records. At first, veterinary facilities transitioned at will to software programs of their choice. Even though most facilities opted to use software for invoicing and inventory control only, not for taking medical notes, many different programs were in use. Transitioning from one facility to another often was difficult because personnel had to learn a new system with each change of station. The large variety of programs also generated very different-looking reports, making data comparison difficult from one facility to the next. Because of these issues, VETCOM encouraged all VTFs to standardize to one commonly used veterinary medical record software program called AVImark (McAllister Software Systems, Piedmont, Missouri). By September 2009, all facilities had made this transition, which allowed for implementation of standardized wellness packages (Sergeant First Class [Retired] Tracey L. Draper, Deputy Director for Veterinary Treatment Facility Operations, Assistant Fund Manager, US Army Public Health Command, Veterinary Services Central Fund, written communication, May 2015).

Veterinary personnel also began to use AVImark’s medical recordkeeping feature to document their medical notes directly into the computer. The use of one system drastically improved note-keeping efficiency because veterinarians and technicians no longer had to learn new programs when they moved from one location to the next. However, because each AVImark program resided only on the computer hard drives or local server within the building, the individual AVImark programs could not communicate with each other. All animal data had to be completely reentered when clients changed veterinary facilities. Veterinarians and staff also could not retrieve records from another facility, which was problematic when proof of a previous vaccination was required but could not be accessed.

In 2005, strategic planners recognized that a web-based system of electronic veterinary medical records similar to CHCS and AHLTA would allow global access of records across all VTFs and make data mining possible for epidemiologic investigations. In 2007, a source selection board chose a vendor to build a web-based system to be used by all Veterinary Services personnel. Ultimately, the planned Veterinary Electronic Medical Record system was replaced by a similar system called the Remote Online Veterinary Record (ROVR), which was fielded worldwide to all VTFs in 2013 to 2014. ROVR can be accessed only by credentialed personnel via any common access card-enabled computer. With the mandated ROVR system, client and animal data no longer has to be reentered with each client move, and permissions can be granted to access data from other facilities when the need exists (Lieutenant Colonel Kay D. Burkman, VSSM Subject Matter Expert, oral communication, February 2015).

TRAINING FOR MILITARY PET CARE PROVIDERS

Army Enlisted Animal Care Specialists

The trained Army animal care specialist plays an extremely important role in the provision of military veterinary care to pets. Previously classified as the military occupational specialty (MOS) of 91T, the animal care specialist’s designator was changed to 68T or “Tango” in September 2006 because of reclassification of the medical MOS series.[13] Individuals with the 68T MOS must possess the skills of medics, laboratory technicians, X-ray technicians, nurse anesthetists, operating room technicians, pharmacy technicians, patient administration specialists, and dental hygienists, all rolled into one. At all duty locations, Tangos perform multiple tasks, including administering anesthesia, placing intravenous catheters, prepping animals for surgery, assisting the veterinarian in surgery, testing blood and urine, performing dental cleanings, taking X-rays, and managing the animal bite and rabies control program (Figure 5-2).

Tangos learn many of these skills on the job because the advanced individual training (AIT) school for 68Ts is shorter than the training for personnel at any other medical AIT school. The training received at the AIT school for Tangos is also much shorter than that of their civilian counterparts: veterinary technicians.

Because of the length and scope of their education, only graduates of civilian programs can sit for individual state veterinary technician licensing examinations. Even though the brevity of their AIT makes Tangos ineligible for state licensing, once assigned to their permanent duty station, they undergo credentialing based on the tasks listed in the Soldier’s Manual and Trainer’s Guide MOS 91T Animal Care Specialist, becoming critical force multipliers by enabling the military to provide more services to many more pets than could be seen by the base veterinarian alone.[14]

Figure 5-2. An Army animal care specialist (68T) assists a Veterinary Corps officer in changing a bandage on a pet dog belonging to a military family.
Photo courtesy of Dr Nancy Vincent-Johnson, chapter author.

Tangos assist veterinarians with military family animals’ sick call appointments just like licensed veterinary technicians do with pets in civilian practices, but unlike veterinary technicians in civilian practices, credentialed Tangos also can handle military family animals’ wellness appointments independent of veterinarians. During these wellness appointments, Tangos perform vital sign checks, obtain brief health histories, perform screening physical exams, obtain blood for heartworm and feline leukemia tests, perform other laboratory procedures, administer vaccines, insert microchips, and dispense preventive heartworm and flea and tick products. Tangos also answer client questions regarding health and training and alert the veterinarian when health problems are identified. Because there are relatively few Army veterinarians to cover all branches of the Armed Forces worldwide, the Tangos’ ability to provide diverse pet care assistance is imperative to the success of the Veterinary Corps’ animal care mission.

When a veterinarian is not physically present in the military clinic, Tangos are normally limited to performing noninvasive animal care procedures such as fecal examinations. However, an exception to policy has occasionally been granted in some remote OCONUS locations (eg, the Azores), allowing Tangos to perform vaccinations, heartworm testing, and minor treatment for parasites and ear infections in the absence of a veterinarian. The Tangos who singularly perform these services not only make increased veterinary care possible for military pets that have no permanently assigned veterinarians, but also allow these veterinarians to concentrate on more serious health issues (eg, performing surgical procedures) during their limited remote-site visits (Sergeant First Class [Retired] William L. Wade, Licensed Veterinary Technician, Registered Licensed Animal Technologist, Certified Professional Institutional Animal Care and Use Committee Administrator, written communication, March 2015).

New Army Veterinary Corps Officers

Most veterinarians enter the Army Veterinary Corps shortly after graduation and are typically assigned to duty sites where they are the only veterinarian; these assignments can be somewhat overwhelming to the new graduate who usually has had limited hands-on experience. (See also Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Sciences.) Unlike most of their civilian counterparts who enter internships or go into private practice under the direct supervision of a seasoned clinician or practice owner, new VCOs may not have mentors nearby when performing surgery, seeking advice on medical cases, or managing a business.

Although the problems faced by junior VCOs were recognized for quite some time, a solution for them was not simple. After much work and several briefings to the staff of the Army Surgeon General, a First-Year Graduate Veterinary Education (FYGVE) program was eventually approved. The first FYGVE class started in fall 2010 with five new graduate veterinarians who reported to the Ft Belvoir Veterinary Center (VETCEN) for the first iteration of the 10-month program. Since inception, participating VCOs have alternated between clinical and nonclinical rotations (eg, public health and food protection) every 2 to 3 weeks. During clinical rotations, VCOs typically spend a week conducting MWD appointments, another week conducting privately owned pet appointments, and throughout the rotation block, the VCOs also perform surgery and other procedures. During the week of MWD appointments, VCOs are also on call for MWD emergencies. (Lieutenant Colonel [Retired] Nancy Vincent-Johnson, chapter author, unpublished data, fall 2010).

Clinical rotations are supervised by a 64F clinical specialist at each participating veterinary center (Figure 5-3). Learning is supplemented by various activities, including daily group case discussions, critical review of journal articles, pathology rounds, topic presentations, and lectures by outside speakers. Participants are also allowed 1 to 2 weeks to perform off-site elective rotations such as spending time with a veterinary ophthalmologist, a veterinary neurologist, a veterinary emergency practice, or an equine veterinarian at Joint Base Myer-Henderson Hall, Virginia (Lieutenant Colonel [Retired] Nancy Vincent-Johnson, chapter author, unpublished data, 2014).

Figure 5-3. A 64F instructor for the First-Year Graduate Veterinary Education program demonstrates the use of a vessel-sealing device during an emergency splenectomy procedure on a dog.
Photo courtesy of Dr Nancy Vincent-Johnson, chapter author.

In 2011, additional FYGVE programs were established at Ft Bragg, North Carolina, and Joint Base Lewis-McChord, Washington, allowing for approximately 15 participants in all. From 2012 to 2013, four more sites opened at Ft Benning, Georgia; Ft Campbell, Kentucky; Ft Hood, Texas; and Ft Carson, Colorado, allowing virtually almost all new Veterinary Corps accessions to participate in the FYGVE program. As the other FYGVE sites opened on various military installations, rotation schedules have varied from the Ft Belvoir initial design. Each site runs the details of its own program within a set of standard guidelines; specifics are often based on the numbers of participants, which changes slightly from year to year (Lieutenant Colonel Jennifer Beck, 64F FYGVE instructor, oral communication, April 2015).

Specialized Army Veterinary Corps Officers

VCOs who stay in the Army after their initial two tours are encouraged to apply for long-term health education training, including clinical medicine programs. Officers have completed residencies in veterinary internal medicine, surgery, emergency medicine and critical care, radiology, and sports medicine. Veterinarians who successfully complete their clinical residency and become board-certified in their specialty are given the MOS designator 64F, nicknamed “Foxtrots,” and are assigned to work in various clinical positions. The FYGVE program enables participants to get a solid clinical experience that is extremely beneficial to those who decide to pursue one of the clinical specialties and become Foxtrots. (See also Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Sciences for more information about Foxtrots, FYGVE, and long-term health education for VCOs.)

STANDARDIZATION OF MILITARY PET CARE

Clinical Credentialing Program

In 2005, the VETCOM commander, the late Colonel Clifford Walker, proposed that a clinical credentialing program be developed, assuring all VCOs assigned within VETCOM met a set standard of clinical skills. A credentialing program conducted only in the Southeast Regional Veterinary Command was used as a model for the new VETCOM credentialing program (see also Chapter 3, Military Working Dog Procurement, Veterinary Care, and Behavioral Services). However, the North Atlantic Regional Veterinary Command was chosen to develop, test, and refine the VETCOM clinical credentialing program because this command had just created a new position for a regional 64F clinical consultant.[15]

Clinical credentialing is designed to test the newly graduated VCOs’ abilities to apply their knowledge and skills in a clinical setting, focusing on the critical skills necessary to provide the best veterinary care to MWDs and privately owned pets. The Clinical Credentialing Checklist used during testing is separated into four critical skill sets—(1) general medicine, (2) anesthesia, (3) radiology, and (4) surgery—and tasks are categorized into those requiring mastery, proficiency, or familiarization (Exhibit 5-2).

Using this checklist, supervisors test groups of two to five junior VCOs over a period of 1 week, ensuring that each VCO knows how to conduct comprehensive physical, neurologic, orthopedic, and ocular examinations; interpret electrocardiograms and radiographs; and perform anesthesia and two different types of surgery. Evaluations normally take place in the junior officer’s everyday work environment, in familiar facilities and with the usual equipment and clinical staff.

Tasks are graded as a “Go” or “No Go.” Those that are “No Go’s” are trained and retested during the same credentialing period when possible. If the junior officers’ first retesting attempts are still not successful, VCO commanders can order additional extensive training in identified weak areas and set clinical limitations until success is achieved.

Because the initial VETCOM program design was highly successful, clinical credentialing became a US Army Institute of Public Health policy that now is applied to all Army VCOs, GS, and NAF veterinarians. Credentialing of surgical and anesthesia tasks must be done within 90 days of assignment or employment, with the remainder of the tasks being credentialed within 180 days.[16]

The benefits of clinical credentialing include ensuring a minimal level of clinical competency in military veterinary practitioners, instilling confidence levels in new officers, giving new Army veterinarians an opportunity to ask questions and gain additional training in weak areas, and developing rapport between junior officers and their region’s 64F clinical consultant. These benefits also facilitate consultations and referrals, which result in improved veterinary care for both government-owned and privately owned animals.

Exhibit 5-2. Veterinary Command (VETCOM) Veterinary Corps Officer Clinical Checklists for Mastery, Proficiency, and Familiarization.

Source: VETCOM Clinical Operations Handbook, VETCOM Headquarters, Ft Sam Houston, Texas, website. https://vet1amedd.army.mil/862574E500672F73. Accessed April 27, 2015.

Veterinary Medical Standardization Board

In 2007, Colonel David Rolfe became the VETCOM commander. As a board-certified small animal internal medicine specialist, he sought to improve the level of clinical veterinary medicine in 150-plus VETCOM veterinary facilities. He selected a small number of VCOs to develop the Clinical Operations Handbook, a guide that standardizes the way each veterinary facility operates in order to give clients a consistently good experience at every facility.[17] Simultaneously, he directed the establishment of the VETCOM Veterinary Medical Standardization Board (VMSB) to create norms modeled after the human clinical practice guidelines of some of the most successful health maintenance organizations and medical institutes in the United States (eg, using standard formularies and equipment). The VCOs selected to be VMSB members represented various ranks and specialties in the Veterinary Corps; these officers worked in committees to create a set of high but practical standards and create consistency regarding equipment and pharmaceuticals. Three groups were organized: (1) the Formulary Committee, (2) the Equipment Committee, and (3) the Protocol Committee.18,19

The Formulary Committee

The Formulary Committee created a standardized formulary similar to the ones found in military medical treatment facilities. Items not used frequently enough to remain on the formulary are prescribed to an individual patient for purchase at an outside pharmacy. Such standardization is necessary because VCOs generally change duty stations every 2 to 3 years.[19]

Before formulary standardization, transitioning VCOs often found their new clinic’s shelves stocked with medications different from the ones they typically prescribed at their previous duty site. Rather than using up the existing but unfamiliar stocks before they expired, the incoming veterinarian ordered new prescription pharmaceuticals, resulting in shelves filled with slightly different versions of similar medications, many of which were wasted.

Formulary standardization resulted in several benefits: (a) enabling military veterinarians to transition more easily from one facility to another because the inventories are now almost the same at each clinic; (b) saving money by combining purchasing power among facilities and changing inventories less frequently; and (c) helping consolidate various individual NAFs into one centralized NAF account.

The Equipment Committee

The Equipment Committee researched numerous manufacturers and models before recommending the initial selections for the Veterinary Corps’ standardized equipment list. In order to choose only one brand and model of each equipment item that they felt would best serve all veterinary facilities, the committee analyzed feedback and requests from the field and adjusted the list of standardized equipment accordingly. Final selection was based on a number of factors, including functionality, compatibility, reliability, ease of use by the end user, maintenance requirements, upfront and ongoing costs, and availability of expendable supplies or parts (Lieutenant Colonel [Retired] Nancy Vincent-Johnson, chapter author, unpublished data, September 2008).

VETCOM and the subordinate regions or districts then evaluated each clinic’s need for new equipment. Rather than automatically replacing functional equipment items with a standardized item, the Equipment Committee mandated that existing equipment be kept in place until its life expectancy ran out to avoid waste and excessive expenditures.

Besides helping cut costs, equipment standardization solved several other common problems among clinics. Prior to equipment standardization, there was great disparity among veterinary facilities’ equipment inventories. When VCOs and Tangos transitioned from one veterinary facility to another, they often found either a lack of essential equipment or the presence of equipment that they did not know how to use. Learning how to use a different piece of equipment sometimes proved difficult, especially when a veterinarian or Tango was only filling in temporarily. Other times, purchased equipment turned out to be incompatible with existing systems or expendable supplies, and replacement parts were hard to come by, which led to disuse of the item.

Standardization ensured that all new equipment came with the same options rather than having different configurations. Purchasing numerous identical items also allowed for large price breaks from the manufacturer, which saved the government substantial costs. Additionally, by standardizing equipment, all veterinary facilities have the same capabilities to perform needed procedures such as administering anesthesia, taking X-rays, and providing laboratory testing. Also, training needs to be done only once on standardized equipment; VCOs and Tangos carry their universal training from one facility to the next.

The Protocol Committee

The Protocol Committee, the third of the original VMSB committees, established standards of care predicated on evidence-based medicine whenever possible. Rather than forcing veterinarians to practice an algorithm style of medicine (ie, one in which a decision tree of symptoms or clinical signs leads the clinician to specific laboratory testing, a diagnosis, and a step-by-step protocol for managing a health care problem), this committee set a minimum bar—with parameters on the right and left—and no ceiling, leaving a large box in which to practice. These guidelines ensured that patients received high-quality care, although the specifics of that care could vary depending on the individual veterinarian.

The first product that emerged from the Protocol Committee was the Anesthesia/Pain Management Standards. Because many new veterinarians lack confidence using anesthesia, providing guidelines about safe methods for administration of an anesthetic drug and how to critically monitor the patient while under its effects is extremely important. The comprehensive handbook not only sets minimal standards in such areas as preanesthetic workup and anesthetic through postanesthetic monitoring, but it also provides numerous tips and advice on what to do if one encounters abnormal findings on preanesthetic bloodwork or during anesthetic monitoring.[20]

The handbook establishes several protocols for using anesthesia with specific groups of animals being treated: (a) “normal” patients; (b) patients suffering from various conditions, including heart disease, kidney disease, and liver disease; (c) patients requiring emergency procedures; and (d) critically ill patients. Additionally, it lists recommendations for controlling pain before, during, and after surgery using various methods of pain management.[20]

The Small Animal Vaccination Guidelines is another handbook that the Protocol Committee produced. This guide standardizes vaccination protocols and vaccine products so that when clients move, they do not encounter drastic differences in their pets’ vaccination schedules or vaccine types from one installation clinic to another. This handbook also takes into account the risk factors for specific diseases that vary among geographical areas. For example, Lyme disease vaccine is highly recommended for dogs in the northeastern and Midwestern states but is not advocated as much for dogs living in the southeastern United States or the West.[21]

Current Committee Activities

Currently, VMSB committee chairpersons discuss issues with committee members by conference call on an annual, a semiannual, or a quarterly basis to consider additions and changes to their specific areas. Requests for additions or changes to the formulary, equipment items, and protocols can be made by any military, NAF, or GS veterinarian via standard request forms. These forms are forwarded to the appropriate committee for review and are used to refine and improve their products. For example, a number of new pharmaceuticals were added to the formulary as a result of field input. Business practices are largely developed and implemented by the Veterinary Service Central Fund, which also accepts feedback from veterinary staff.

REORGANIZATION OF VETERINARY TREATMENT FACILITIES

Around the time the VMSB was established, VETCOM leaders acknowledged that for various reasons, including size or inadequacy of physical facilities and lack of a permanently assigned veterinarian, some VTFs could never be set up to offer the full spectrum of veterinary services. In the past, VTFs were classified by tiers into three different levels: tier one VTFs were those that had a full-time staff consisting of a minimum of one VCO and one animal care specialist with full-time responsibility for the VTF; tier two VTFs offered limited services (although there was an assigned VCO and animal care specialist, these personnel had other major responsibilities that kept them from working full-time in the VTF); and tier three VTFs were considered attending sites because they lacked an assigned VCO (their services were provided by a VCO assigned to a tier two VTF). Mobile clinics were also set up on a recurring basis at installations lacking a dedicated VTF. These clinics were often held in recreational center rooms or other facilities and used minimal equipment and supplies because everything had to be transported in from a fixed facility and set up by the visiting veterinarian and animal care specialist (Lieutenant Colonel [Retired] Nancy Vincent-Johnson, chapter author, unpublished data, September 2000).

Because this terminology was confusing, new terminology was developed, along with standards defining what staffing, equipment, and procedures would be present at each level of the four reorganized facilities: (1) veterinary centers (VETCENs); (2) veterinary activity (VETACs); (3) veterinary treatment facility (VTFs); and (4) veterinary clinics (vet clinics). Tiering of each veterinary medical facility is based on the MWD and government-owned animal population and mission, privately owned animal catchment area, and the geographic location of the facility.[22]

The majority of veterinary facilities retained the name VTF. Wellness and sick call appointments continue to be available at these VTFs, in addition to appointments for routine surgeries (eg, spay, neuter, and small mass removal) and any unscheduled basic emergency care.[22]

Smaller VTFs were renamed “vet” clinics. Vet clinics do not have a full-time, assigned Army veterinarian but are staffed either as an attending site or with a NAF veterinarian and primarily offer wellness appointments and basic sick call with no surgery capability. After basic stabilization, emergent patients are transported from vet clinics to appropriate civilian or military facilities.[22]

The other two reorganized facilities—the VETCEN and the VETAC—are designated as the highest military veterinary tiers because they offer the most comprehensive clinical services. The primary difference between the two facilities is that the VETCENs have a training mission whereas the VETACs do not. The seven VETCENs support the seven FYGVE sites as well as the training of visiting VCOs, Army animal care specialists, and, occasionally, veterinary students. As teaching hospitals, VETCENs are staffed with more than one veterinarian, including a clinical specialist with expertise in surgery, internal medicine, or critical care. Not only do VETCENs have the same capabilities for appointments and basic routine surgery as are offered at VTFs, VETCENs also handle some advanced procedures and surgeries, depending on the equipment, staffing, and capabilities of the assigned specialist. VETCENs also accept referrals from other VTFs on a space available basis[22] (Figure 5-4).

VETACs are located on installations that have high numbers of MWDs, government-owned animals, or a very high privately owned animal catchment area. The VETACs’ organization resembles the structure of the VETCEN, minus the training mission. All VETACs have an assigned clinical specialist and increased technical staff and equipment to manage more involved cases. The facilities in Okinawa, Japan, and Vogelweh, Germany, are current examples of VETACs.[22]

Figure 5-4. At the Ft Belvoir Veterinary Center, a clinical specialist veterinary medical officer instructs a junior Veterinary Corps officer about performing an abdominal exploratory surgery. The case was referred from another veterinary treatment facility.
Photo courtesy of Marla Grewelle, General Service Veterinary Technician, Ft Belvoir, Virginia.

SPECIAL TYPES OF MILITARY ANIMAL CARE SERVICES AND PROGRAMS

Horse Stables

As mentioned at the beginning of this chapter, the vast majority of installation stables have disappeared, and military-provided care of privately owned horses is very limited. Although the Army still owns some horses and mules (primarily for ceremonial events), many graduate veterinarians focused their training on small animals and do not feel comfortable working on or around equines. Sanitary inspections of military stables and occasional end-of-quarantine examinations of incoming horses may be the only contact some VCOs have with these large animals.

However, for VCOs who have a strong interest in equine medicine, installations that stable government-owned horses (eg, Joint Base Myer-Henderson Hall; Ft Hood; Joint Base San Antonio-Ft Sam Houston, Texas; Ft Huachuca, Arizona; and West Point, New York) are highly requested duty stations. VCOs with an interest in horses also often provide some services to privately owned horses stabled on military installations such as vaccinations and annual Coggins (equine infectious anemia) testing. Additional services generally are not offered because of limitations in time and resources.

Stray Animal Facilities

Although collection of stray animals on military grounds is a responsibility of the installation commander, the US Army Veterinary Corps has traditionally played important roles in stray animal control. On many installations (mainly Army posts), the Army Veterinary Service was responsible for the confinement of strays and, by default, maintenance of the stray animal facility. At these locations, animals in the stray facility were cared for by veterinary staff—before and after clinical hours—and during weekend and holiday hours. This extra-duty workload not only took a toll on unit morale, it also detracted from the other veterinary missions.

Because of these problems, VETCOM began an initiative to turn over responsibility for stray animal confinement to individual installations. By 2012, most installation Veterinary Service activities no longer had direct responsibility for a stray animal facility. At those military installations with stray animal facilities, Army veterinarians are still responsible for performing sanitary inspections of the facility at least quarterly (but preferably on a monthly basis) to ensure the facilities meet minimum standards of safety and cleanliness. Army veterinarians also examine injured or ill strays, which are considered government-owned animals for the first 3 working days to provide owners sufficient time to reclaim their animals. After that waiting period, animals with good dispositions are typically put up for adoption. Feral animals, as well as those with bad temperaments or severe medical problems, might need to be euthanized.[12]

In addition to providing veterinary care to ill or injured animals, the installation’s Army veterinarian may manage a population control program, which involves neutering stray animals prior to their adoption. Expenses for neutering and vaccinating the adoptable strays are recouped through an adoption fee paid by the new owner.

Animal Bite and Rabies Control Program

Of all the missions performed by the Army Veterinary Corps, one of the most important is that of preventing rabies in humans. VCOs and their staff are considered the subject matter experts in rabies for all branches of the Armed Forces. Knowing which species of animals possess a risk of rabies and which do not, how to manage military pets that may have been exposed to a rabid animal, and when and how to test rabies suspects are just a few examples of essential knowledge for the Army veterinarian. (See also Chapter 12, Rabies and Continued Military Concerns.)

When a human patient presents to a military treatment facility with any animal bite, a Defense Department Form 2341, or animal bite report, is generated to record all the details about the bite, including a description of the biting animal and, if it is a pet, the name and address of its owner, when available. The report is then forwarded to the veterinary facility responsible for following up on the biting animal to help determine risk of exposure to rabies for the patient; this, in turn, assists the attending physician in deciding whether or not to vaccinate the patient against rabies. Rabies postexposure treatment is generally successful as long as it is initiated in a timely manner but is never undertaken lightly because it is expensive, painful, and not without risk of adverse effects.12,23

Attempts are made by Veterinary Services staff to locate the biting animal either indirectly, by contacting the military police, health departments, and animal control officers; or directly, by contacting the animal owner. If the owner lives on an installation, the owner must bring the biting pet to the military veterinary facility. Here, the veterinarian will review the animal’s medical record and perform an exam to determine whether the animal is current on its rabies vaccination and if it is exhibiting any clinical signs suspicious of rabies. Depending on the findings, the pet may be allowed to undergo a home quarantine at the owner’s house or, in some cases, the pet may be required to undergo quarantine in a veterinary facility under the observation of a veterinarian. (Although some military veterinary facilities have the isolation kennels necessary to perform rabies quarantine, some do not. In the latter case, a civilian veterinary clinic would be used to conduct the quarantine.12,23)

If the pet exhibits neurological signs consistent with rabies at either the prequarantine examination, the end-of-quarantine examination, or at any time during the quarantine, the animal must be euthanized and tested for rabies. Feral (unowned) dogs and cats or wild animal rabies suspects (eg, raccoons, foxes, and skunks) that are captured after biting a person must immediately be euthanized and tested. On military installations, VCOs are responsible for euthanizing and submitting animals for rabies testing and for ensuring that all results are communicated to owners and patients’ physicians as soon as they become available.12,23

“Above and Beyond” Program

Each year Public Health Command reviews nominations from numerous veterinary facilities, selecting one to receive the annual “Above and Beyond” Award, an honor started under VETCOM that is still given to units that go out of their way to do more than just their expected duties. Following is a list of some previously recognized accomplishment categories with brief explanations of their exceptional support:

Figure 5-5. A veterinary staff member and her dog perform an agility demonstration during a pet fair organized and hosted by the Ft Belvoir Veterinary Center.
Photo courtesy of Marge Brandel, civilian client of the Ft Belvoir Veterinary Center, Virginia.

Pet fairs: Pet fairs are community events that feature activities such as pet and owner health walks; pet shows; demonstrations by military working dog teams, dog agility clubs, and dog obedience clubs; distribution of free samples; information booths; and tours of veterinary facilities. Military communities have often hosted such fairs, with installation veterinarians and staff members serving as organizers and sponsors (Figure 5-5).

Pet visitations to hospitals: After undergoing screening for health and temperament, certain animals have been certified by the American Red Cross and other agencies to perform pet visitation to patients in military and civilian hospitals. Several military veterinarians and technicians have participated in this program with their own pets and provided support to others who want to attain certifications for their pets.

Vaccination clinics: Some veterinary facilities took their services to military housing areas so that families unable to transport their animals could still get care for their pets. Other VTFs hosted Saturday or evening clinics for those clients whose schedules would not allow them to bring their animals in for treatment during the week.

Visits to schools and daycare centers: Veterinarians and technicians have visited elementary and preschool classes to give talks and demonstrations on various Veterinary Services’ missions such as prevention of animal bites. Frequently, these children got to see various animals accompanying the staff and received educational coloring books featuring animal care themes.

SUMMARY

Even though privately owned pet care is a lower priority mission than government-owned animal care, food inspection, and the public health mission, military veterinary care providers feel that treating pets is a very important and rewarding task. Not only have the pet care services provided by the Army Veterinary Corps expanded over the years because of revised AVMA limitations, but the standard of care provided by Veterinary Services has also improved because of newly established officer and enlisted educational, training, and credentialing programs. The Army Veterinary Services continues to provide care to the pets of service members, retirees, and family members of the Army, Air Force, Navy, Marine Corps, and Coast Guard. All these services are funded by the NAF system and guided by formulary, equipment, and protocol committee standards. Transferring pet records from duty station to duty station also has become easier and more efficient because installation veterinarians now use a universal electronic recordkeeping program. As veterinary personnel strive to provide consistently good services at every veterinary facility, innovative veterinary programs, which enrich the communities being served, continue to be recognized by higher commands.

REFERENCES

1.   Animal farms, captured animals, and privately owned animals. US Army Medical Department, Medical History website. http://history.amedd.army.mil/booksdocs/wwii/
vetservicewwii/chapter19.htm: 668. Accessed February 5, 2015.

2.   Miller EB. United States Army Veterinary Service in World War II. Washington, DC: Office of The Surgeon General, Department of the Army; 1961.

3.   US Army Medical Department Veterinary Corps history. US Army Medical Department, Veterinary Corps website. http://veterinarycorps.amedd.army.mil/history.htm. Accessed December 8, 2014.

4.   US Department of the Army. Veterinary Animal Services. Washington, DC: HQDA; 1975. Army Regulation 40-905, Change No. 2.

5.   US Departments of the Army, Navy, and Air Force. Veterinary Health Services. Washington, DC: DA, DN, and DAF; 1985. Army Regulation 40-905, Secretary of Navy Instruction 6401, and 1/Air Force Regulation 163-5.

6.   US Department of the Army. Composition, Mission, and Functions of the Army Medical Department. Washington, DC: HQDA; 1983. Army Regulation 40-1. July 1, 1983.

7.   Department of the Army, Veterinary Command Headquarters. US Army Veterinary Command (VETCOM) Policy on Mission Priorities. Ft Sam Houston, TX: VETCOM HQ; 2011. Command Policy No. A-11.

8.   US Departments of the Army, the Navy, and the Air Force. Veterinary Health Services. Washington, DC: DA, DN, and DAF; 1994. Army Regulation 40-905, SECNAVINST 6401, and 1A/ARI 48-131.

9.   Department of the Army, Headquarters, US Army Medical Command. Permanent Orders 109-3 [Orders establishing the Veterinary Command]. Ft Sam Houston, TX: DA; September 21, 1994.

10.   American Veterinary Medical Association website. Policy. https://www.avma.org/KB/Policies/Pages/Military-Veterinary-Treatment-Facilities-Policy.aspx. Accessed February 17, 2015.

11.   Department of the Army. Veterinary Medical Standardization Board (VMSB) and Veterinary Service Central Fund (VSCF) Guidelines. Aberdeen Proving Ground, MD: US Army Institute of Public Health. AIPH (VET) MEMO A12-15, October 10, 2012.

12.   US Departments of the Army, the Navy, and the Air Force. Veterinary Health Services. Washington, DC: DA, DN, and DAF; 2006. Army Regulation 40-905, SECNAVINST 6401, and 1B/AFI 48-131.

13.   AHRC-PLC-C. FY07 Enlisted Military Occupational Classification and Structure (MOCS) Personnel Reclassification Actions. MILPER Message Number: 06-118. August 25, 2006.

14.   Department of the Army, Headquarters. Soldier’s Manual and Trainer’s Guide MOS 91T Animal Care Specialist Skill Levels 1/2/3/4. STP-8-91T14-SM-TG. Washington, DC: DA; August 2002.

15.   Department of the Army, Veterinary Command Headquarters. USA Veterinary Command TDA (Table of Distribution and Allowances). Ft Sam Houston, TX: VETCOM; 2005 (Effective date October 1, 2007).

16.   Department of the Army. Credentialing of Veterinary Staff. Aberdeen Proving Ground, MD: US Army Institute of Public Health. AIPH (VET) MEMO A13-02, June 13, 2013.

17.   VETCOM clinical operations handbook. US Army Veterinary Service Application Portal. https://vet1.amedd.army.mil/862574E500672F73. Accessed April 27, 2015.

18.   VMSB charter. US Army Veterinary Service Application Portal. https://vet1.amedd.army.mil/862574E500672F73. Accessed April 27, 2015.

19.   Small animal drug formulary. US Army Veterinary Service Application Portal. https://vet1.amedd.army.mil/862574E500672F73. Accessed April 27, 2015.

20.   Veterinary medical standardization board anesthesia/pain management standards. US Army Veterinary Service Application Portal. https://vet1.amedd.army.mil/862574E500672F73. Accessed April 27, 2015.

21.   Small animal vaccination guidelines. US Army Veterinary Service Application Portal. https://vet1.amedd.army.mil/862574E500672F73. Accessed April 27, 2015.

22.   Department of the Army. Policy on Veterinary Medical Tiering and Tiering Standards. Aberdeen Proving Ground, MD: US Army Institute of Public Health. AIPH (VET) MEMO A12-13, October 11, 2012.

23.   National Association of State Public Health Veterinarians, Inc. (NASPHV). Compendium of Animal Rabies Prevention and Control, 2011. Atlanta, GA: Centers for Disease Control and Prevention. http://www.nasphv.org/documentsCompendia.html. Accessed March 21, 2015.

Chapter 6

HUMAN-ANIMAL BOND PROGRAMS

PERRY CHUMLEY, DVM, MPH*; JAMES T. MILLS, MS, PT†; ARTHUR F. YEAGER, MSOT‡; MICHELLE NORDSTROM, MS, OTR/L§; MATTHEW G. ST LAURENT, MS, OTR/L¥; RICK A. YOUNT, MS, LSW¶; MOLLY A. MORELLI**; MEG D. OLMERT††; SARA M. HOOK, OTR/L‡‡; PATRICIA B. KENNEDY§§; WINIFRED M. CAREY, MS, OTR/L¥¥; NOAH L. BRISCOE, MA, OTR/L¶¶; CYNTHIA E. RHODES, CTRS***; CECILIA NAJERA, MS, OTR/L†††; TERRY M. MARTINEZ, MSW, LCSW‡‡‡; MYRNA CALLISON, PhD, OTR/L§§§; MARY JO BECKMAN¥¥¥; and LARRY PENCE¶¶¶

INTRODUCTION

Animals and the Military

Animals and Military Healthcare

DEFINITIONS OF ANIMALS USED IN HEALTHCARE SETTINGS

Assistance or Service Animals

Therapy and Activity Animals

ANIMAL-ASSISTED ACTIVTY AND ANIMAL-ASSISTED THERAPY PROGRAMS

Tripler Army Medical Center Animal-Assistance Programs

Complementary Intervention for Post-Traumatic Stress Disorder

Other Specialized Wounded Warrior Service Dog Training Programs

Dwight D. Eisenhower Army Medical Center Animal-Assistance Programs

COMBAT AND OPERATIONAL STRESS CONTROL DOGS PROGRAM

Background of Combat and Operational Stress Dogs Program

Justification for Animal-Assisted Therapy Programs in Theater

Animal-Assisted Therapy Program Strategies in Theater

Considerations for Deployment with Therapy Teams

Post-Deployment Considerations

The Way Forward

EQUINE-ASSISTED THERAPY PROGRAMS

Overview of Equine-Assisted Therapy

History of the Caisson Platoon Equine-Assisted Programs

Caisson Platoon Equine-Assisted Programs’ Benefits and Success Stories

The Way Forward

CONCLUSION

*Colonel, Veterinary Corps, US Army; Chief of Human Animal Bond Programs, Department of Defense Veterinary Service Activity, 7700 Arlington Boulevard, Falls Church, Virginia 22042

†Lieutenant Colonel, Medical Specialist Corps, US Army; Physical Therapy Clinical Staff Officer, Rehabilitation and Reintegration Division, 7700 Arlington Boulevard, Suite 112 Defense Health Headquarters (DHHQ), Falls Church, Virginia 22042

‡Lieutenant Colonel, Medical Specialist Corps, US Army; Chief of Occupational Therapy, Rehabilitative Services, Reynolds Army Community Hospital, 4301 Wilson Street, Fort Sill, Oklahoma 73503

§Research Occupational Therapist, Henry M. Jackson Foundation and the Center for Rehabilitation Sciences Research, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889

¥Lieutenant Colonel, Medical Service Corps, US Army; Assistant Chief of Occupational Therapy, Department of Orthopedics and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, Maryland 20889

¶Executive Director, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

**Director of Dog Program, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

††Director of Research and Development, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

‡‡Rehabilitation Manager, Warrior Transition Brigade, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 62, Bethesda, Maryland 20889

§§Director of Communications and Government Relations, Warrior Canine Connection, 14934 Schaeffer Road, Boyds, Maryland 20841

¥¥Occupational Therapist, Warrior Transition Brigade, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 62, Bethesda, Maryland 20889

¶¶Occupational Therapist, Warrior Transition Brigade, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 62, Bethesda, Maryland 20889

***Recreational Therapist, Inpatient Behavioral Health, Dwight D. Eisenhower Army Medical Center, Fort Gordon, 300 East Hospital Road, Augusta, Georgia 30905

†††Major, Medical Specialist Corps, US Army; Occupational Therapist, US Army 1st Medical Recruiting Battalion, 4550 Parade Field Lane, Suite 5502, Fort George G. Meade, Maryland 20755

‡‡‡Lieutenant Colonel, US Army (Retired); formerly, Medical Specialist Corps, Social Worker, Evans Army Community Hospital, 1650 Cochrane Circle, Fort Carson, Colorado 80913

§§§Colonel, Medical Specialist Corps, US Army, Executive Officer, Occupational Health Sciences, Army Institute of Public Health, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

¥¥¥Commander, US Navy (Retired); formerly, Communications Officer, Naval Telecommunications Command, Washington, DC; currently, Co-founder and Volunteer, Therapeutic Riding Instructor, Caisson Platoon Equine-Assisted Program, 268 Old Cropps Mill Road, Fredericksburg, Virginia 22406

¶¶¶Command Sergeant Major, US Army (Retired); formerly, 5th Command Sergeant Major of the Army National Guard, Washington, DC; currently, Co-founder, Caisson Platoon Equine-Assisted Program, 268 Old Cropps Mill Road, Fredericksburg, Virginia 22406

“If all the beasts were gone, men would die from a great loneliness of spirit, for whatever happens to the beasts soon happens to the man. All things are connected.”

— Chief Seattle of the Suquamish Tribe[1]

INTRODUCTION

Animals and the Military

Ever since mankind went to war, animals have played significant roles in military operations. Such roles have been either in official capacities such as cavalry horses, sentry dogs, carrier pigeons, and unit mascots or unofficially as a soldier’s battle companion. Prior to a battle, the Roman army performed a ritual that involved offering food to sacred chickens: if the chickens ate the food, it was an omen that the gods would join them; if the chickens refused to eat, defeat was imminent.[2] Lieutenant Colonel George A. Custer, who commanded the 7th Cavalry at the Battle of the Little Big Horn, was known to have his dogs around him during the American Indian campaigns. He affectionately mentions being surrounded by his dogs in several letters to his wife, such as the one written on June 12, 1876: “Tuck regularly comes when I am writing and lays her head on the desk, rooting up my hand with her long nose until I consent to stop and notice her. She and Swift, Lady, and Kaiser sleep in my tent.”[3]

During World War II, highly trained carrier pigeons provided a means of communication. Also during World War II, General Eisenhower once remarked that his Scottish terrier mascots were especially appreciated, “because they are the only ‘people’ I can turn to without the conversation returning to the subject of war.”[4] Today, most utilitarian uses of animals in the military are not well known, except for the military working dogs that are trained for various uses, including attacking the enemy and detecting explosives or narcotics. However, the US military inventory of animals is actually quite diverse and includes Navy dolphins and beluga whales, Special Operations horses, Marine Corps mules, and even peacocks that act as security alarms at key government installations.

Animal mascots have long been associated with unit esprit de corps. For example, in the spirit of interservice rivalry, service members have boasted the Air Force falcon versus the Army mule or the Navy goat versus the Marine Corps bulldog. Animal mascots have been placed on official unit orders and even given rank by the adoring units that proudly parade them around the military posts. There are many stories of animal mascots being integral parts of combat units, offering pride and stress relief, during challenging periods.

Finally, animals are bona fide members of many military families, with these strong bonds perhaps even assisting with military family transfers or service member deployments. A 1985 book about pets and families notes that pets are a stabilizing factor for children of military families.[5] A more recent study showed a direct correlation with pet attachment levels and the military pet owner’s decision to take the pet with them during transfers, despite the obstacles faced with moving to a new duty location.[6] Other research shows that for a married couple without children, the attachment level to the pet can be very high, implicating a “surrogate” child relationship with animals (Perry Chumley, chapter author, unpublished study data, 1992).

Animals and Military Healthcare

As more US military personnel commit suicide,[7] the military seeks to use every possible treatment modality to assist service members. “Of the 750,000 veterans of wars in Afghanistan and Iraq, more than 100,000 have sought mental health treatment from the government, and about half of those have been diagnosed with PTSD [post-traumatic stress disorder].”[8] In the healthcare field, popularity of the bond that is enjoyed between humans and animals is increasing. Multiple healthcare professions have recognized potential health benefits associated with the interactions that humans experience with animals. For example, it is well-documented that the presence of dogs has been associated with reductions in blood pressure, mean arterial pressure, heart rate, and distress. Furthermore, Friedmann et al demonstrated a decreased mortality rate in pet owners a year after discharge from a coronary care unit.[9] These examples illustrate the beginning of many potential treatment benefits offered by companion animals in a clinical treatment setting.

Animals have a place in assisting the human healthcare professionals work with patients to meet specific goals through a practice known as animal-assisted therapy (AAT). One of the first documented AAT sessions in the US military was in 1919 at St Elizabeth’s Hospital (Washington, DC) when the hospital promoted the use of dogs as a therapeutic intervention with psychiatric patients.[10] Another early documented human-animal bond program involved the Department of Defense (DoD) at Pawling Army Air Force Convalescent Center (Pawling, New York) during the 1940s.[11] The center’s farm animals were integrated into the treatment milieu for emotionally traumatized veterans and provided a purposeful interaction during their convalescence. Following World War II, Dr Boris Levinson, a psychologist, used his own dog as a co-therapist during counseling sessions and published his findings in the 1960s.[4] Interest in this field grew rapidly with the formation of the Delta Society in 1981 (now called Pet Partners), along with international membership and influence, leading to recognized benefits of human-animal bond interactions being accepted by the healthcare professions.

In 1983, Lieutenant Colonel Thomas Catanzaro, US Army Veterinary Corps, wrote of the interdependent relationships of animals, humans, and the health professions and also described many considerations for establishing an AAT program in An Administrator’s Guide for Animal Facilitated Therapy Programs in Federal Healthcare Facilities.[12] In 1985, the US Army Veterinary Corps took the lead in developing a better understanding of human-animal relationships and actively pursued ways for this knowledge to contribute to the military community.

To this end, a Veterinary Corps officer, Major Lynn Anderson, was designated as the Human-Animal Bond Advisor to The Surgeon General of the Army in 1986. The Veterinary Corps also established a 2-year Masters of Public Health program with an emphasis in the human-animal bond and community health specialties at the University of Tennessee in Knoxville. Upon graduating from this program in 1992, Major Perry Chumley became the Veterinary Corps subject matter expert. He established the US Army Service Dog Training Center (SDTC) in 1995 and directed it until 2004 (Colonel Perry Chumley, chapter author, personal knowledge).

A pilot program was initiated to assist physically disabled veterans and exceptional family members at the SDTC. Through the SDTC, stray dogs were trained to become the indispensable helpers for these veterans and family members. The SDTC staff consisted of two civil service animal trainers who trained not only the animals, but also select inmates from the Ft Knox Military Law Enforcement Command’s prison. The inmates who assisted with this animal training program could also experience rehabilitation as they transformed the unwanted stray dogs into invaluable helpers for persons in need (Colonel Perry Chumley, chapter author, personal knowledge).

The SDTC graduated its first-trained human recipient and animal teams on Veterans Day 1997. Throughout its 7-year history, the SDTC successfully graduated over 60 human-animal teams, represented by all of the DoD Services. This program closed in October 2004 because of funding constraints within the Army Medical Department (Colonel Perry Chumley, chapter author, personal knowledge).

Today, various military medical centers support animal-assisted activity (AAA) programs, which are frequently run by the Red Cross. AAA programs occur in both inpatient and outpatient settings and do not require specific patient and animal goals or a therapist. AAA programs typically include animal visitation with volunteers and operate at a number of Army medical centers, most notably at Tripler Army Medical Center (AMC) (Honolulu, Hawaii), Walter Reed National Military Medical Center (WRNMMC) (Bethesda, Maryland), and Brooke AMC (Joint Base San Antonio-Ft Sam Houston, Texas), as well as the Munson Army Health Center (Ft Leavenworth, Kansas). The main purpose of these programs is therapeutic, bringing smiles to the patients, family members, and hospital staff. In doing so, patients focus on the animals, which may help alleviate their fear, anxiety, and pain. Often, the hospital staff reports an increased patient-provider interaction after patients participated in the AAA programs.

An example of the DoD AAA program’s continued success is the Tripler AMC animal visitation program, which has existed for over 20 years and has been endorsed by the Annual Hawaii State Red Cross Heroes Award on multiple occasions. Also, before it was deactivated, the US Army Veterinary Command spearheaded a competition each year, recognizing among other best practices the best human-animal bond program among its subordinate branches. (For more information about the Above and Beyond recognition program, see Chapter 5, Family-Owned Animal Health Services.)

As an adjunct to traditional treatment modalities, WRNMMC is currently involved with a service dog training program. This program is run by Occupational Therapy and uses the human-animal bond and mission-based trauma recovery, allowing soldiers with PTSD, depression, and anxiety to train mobility service dogs. Each dog is trained by 60-plus service members over a 2-year timeframe. If the dog passes all requirements, the dog is permanently assigned to a veteran with mobility impairments. The Dwight D. Eisenhower Army Medical Center (Eisenhower AMC) (Ft Gordon, Georgia) also has a dog program that uses one therapy dog to help soldiers recovering from post-PTSD to work with dogs. Both programs are distinctly different but work toward the same purpose: facilitating the patient’s goal-oriented therapeutic regimens.

Another human-animal bond program is Task Force Phoenix (Joint Base Lewis-McChord, Washington). This therapeutic program began in 2008 and trains dogs to become service dogs for physically disabled individuals. The wounded warriors must train their dogs in weekly classes as part of their transitioning process. Contributing to the success of this program are the monthly board meetings with the commands and social work department that access new applications for dogs and help address issues that may arise.

In the military operational environment, pairs of certified therapy dogs have been specially trained and deployed to Iraq and Afghanistan with several combat and operational stress control units. Using therapy dogs has been shown to affect patient attitudes, mood state, job satisfaction, stress levels, and resilience level.[13] Command teams are also more willing to request briefs that focused on life skills and stress management, and service members were more likely to share their concerns, fears, and goals when therapy dogs are used.

Several aforementioned programs are described in more detail later in this chapter. For clinical staff interested in learning more about animal-assisted therapy programs, the DoD technical bulletin DoD Human-Animal Bond Principles and Guidelines is an excellent initial source for information and guidance.[4]

DEFINITIONS OF ANIMALS USED IN HEALTHCARE SETTINGS

With few exceptions (eg, medicinal leech therapy), medical interventions using a live animal are defined by the human-animal bond. Encounters center on the dynamic and interactive relationship between humans and animals to provide a psychological or physical benefit.14,15 This bond is the core of several therapeutic approaches using various species. The most common are assistance or service animals; therapy and activity animals; and emotional support, companion, or social animals. The efficacy of the human-animal bond as a healthcare treatment modality greatly depends on how the animal’s roles are used by a group or an individual. Unlike medical equipment, defining specific functions of a living treatment modality is essential to the maintenance and common logistical factors that affect the health and welfare of the animal. From a legal perspective, definitions are necessary for establishing eligibility, benefits, and even liability when considering whether the standard of care is met. As the military medical community increases its use of animals, specifically canines, clarification of utility is needed to develop policy and ensure good practice.

Assistance or Service Animals

Throughout much of the world, assistance animals are categorized into guide dogs, hearing dogs, or service dogs.16,17 However, the term “service animal” is often used in the United States and may mean any type of assistance animal.[17] In 2010, the Americans with Disabilities Act (ADA) 42 United States Code (USC) §12101-12213 and 47 USC §§225, 611 was revised with regard to the definition and use of service animals.[18] For purposes of US law, Title III of the ADA (Title 28 Code of Federal Regulations) (CFR), Part 36 (revised as of July 1, 2013) defines a service animal as “any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.”18(p704) Further, Title III stipulates that “individuals with disabilities shall be permitted to be accompanied by their service animals in all areas of a place of public accommodation where members of the public, program participants, clients, customers, patrons, or invitees, as relevant, are allowed to go.”18(p709)

The ADA definition of disability is a “physical or mental impairment that substantially limits one or more major life activities of such individual.”18(p702) To be considered a service animal, a direct link must exist between the animal’s work or tasks and the handler’s disability. However, the animal’s work must be a trained behavior and not a response that is natural to the animal.

The current ADA definition of service animal work or tasks includes, but is not limited to, the following work:

… assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing nonviolent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors.18(p704)

However, the ADA definition does not include violent protection (whether trained or untrained), crime deterrence due to an animal’s presence, emotional support, well-being, comfort, or companionship as acceptable work or tasks.

Moreover, although animals such as primates, horses, birds, cats, pigs, and even bovines have all been trained to help humans perform daily tasks, 28 CFR §36.104 limits the definition of a service animal to canines only and does not include any other species of animals, regardless of whether those other species are wild or domesticated, trained or untrained.[18] A trained miniature horse as an alternative to an assistance dog is the one exception to permitting the use of a noncanine species in the role of a service animal in a public space.[18] However, a miniature horse is not defined as a service animal by 28 CFR §36.104 and its use is subject to certain limitations, as outlined in 28 CFR.18,19

The ADA further delineates conditions and rules regarding service animals. A service animal must be housebroken and under the control of the handler at all times; must remain harnessed or leashed at all times (unless that restraint would interfere with the performance of the animal’s work); and is not subject to size, weight, or breed limitations.[20] A public entity cannot inquire about the nature of an individual’s disability; however, an entity may ask the handler whether the animal is required because of a disability and what work or task the animal performs for the disabled person to determine whether an animal qualifies as an assistance animal. The public entity cannot ask for proof of documentation that the animal is a qualified or trained assistance animal or require payment of a surcharge for access to a public space or facility, even if that entity requires payment for pet access.[18]

Given legal constraints, canines are the most common species of assistance animals, working well as guide dogs, hearing dogs, or service dogs. Guide dogs assist the visually impaired (blind or low vision) with navigation such as avoiding obstacles, stopping at curbs and steps, and negotiating traffic.[21] Hearing dogs are trained to alert those with hearing impairment (deaf or hard of hearing) to the presence of people or household and community sounds by making physical contact and, if appropriate, leading their handlers to the source of the sound.[22]

Service dogs are also trained to perform a wide variety of common and customized tasks for individuals with impairments other than auditory or vision dysfunction. Assistance with physical, cognitive, or psychiatric disabilities can promote functional independence and increased quality of life. Specially trained service dogs can perform a variety of tasks including, but not limited to, providing balance and counterbalance; alerting the handler to pending medical disorders such as seizures or hypoglycemia or assisting during episodes of those disorders; assisting to pull a wheelchair; retrieving a variety of large or small items; alerting to the presence of an allergen; turning lights on and off or pushing elevator and automatic door buttons; assisting with functional transfers; and providing nonviolent protection or rescue work.[23] Specific skills that address a particular disability may be included in a service dog’s title, such as “balance dog” or “psychiatric service dog.” The latter may assist individuals “with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors,” or mitigating behavioral health disabilities in other ways, per 28 CFR §36.104.18(p704) All of the above examples of assistance dog tasks are consistent with the ADA definition of a service animal.

Therapy and Activity Animals

While federal law does not define therapy and activity animals, some states do have laws defining such animals. Regardless of a therapy or activity animal’s legal definition, they are not service animals and do not have the public access privileges afforded to service animals. The main distinction between therapy or activity animals and service animals is that the former, through the use of the human-animal bond, provide services to other people (with or without disabilities) under the direction of their handlers, whereas, the latter are trained to do work or tasks for a single disabled handler. In other words, service animals usually work exclusively for one person at a time, but therapy and activity animals are expected to work reliably and safely with different people, often with many distractions and in group settings.

Recognizing that the therapeutic effects of the human-animal bond are not exclusive to people with disabilities,15,24,25 several professional and animal advocacy organizations also have made distinctions among various types of therapeutic animal work. Two such organizations, Pet Partners (formerly known as Delta Society) and the American Veterinary Medical Association, provide definitions for both AAT and AAA.25,26

AAT is part of a goal-directed, individualized healthcare treatment plan for individuals with physical, social, emotional, or cognitive dysfunction, whereas the AAT intervention is documented in the patient’s health record. AAT is conducted in scheduled visits, on regular intervals, and directed or delivered by a professional within the practice scope of a healthcare provider. AAT animals may or may not have previous formal assistance or service dog training. Examples of an AAT may be a patient with balance dysfunction using a trained dog wearing a rigid-handled harness to assist with gait training or the use of trained dogs in military combat stress control units for behavioral health interventions.

TABLE 6-1.

CHARACTERISTICS OF TYPES OF ANIMALS USED IN HEALTHCARE SETTINGS

AAT: animal-assisted therapy

AAA: animal-assisted activities

Adapted with permission from Mills JT, Yeager AF. Definitions of animals used in healthcare settings. US Army Med Dep J. 2102; Apr-Jun:12-7.

Comparatively, AAAs are untailored “meet-and-greet” activities without specific treatment goals. AAA can be conducted in group settings with many people, and no documentation is necessary. Unlike a therapy program, the AAA visits and activities can be spontaneous, of any length or frequency, and conducted by any handler. Examples of an AAA might include a volunteer handler with a dog visiting a hospital pediatric oncology ward to raise the spirits of children or a dog training organization bringing their animals to an outpatient facility to positively interact with wounded warriors.

Animals used in AAT and AAA are often dogs, but also frequently include equines, such as hippotherapy programs, which use horses as part of an integrated rehabilitation treatment program supervised by a healthcare therapist.[27] Resident or facility animals can be AAT or AAA animals and are similar in that each works with a volunteer or professional whose training falls under the auspices of a formal program.[25] The work of a facility animal can include visitations or professional therapy in one or more locations.

Resident animals can live or work in a facility full time. They are often owned by the organization or a facility staff member and can be handled and cared for by the staff, volunteers, or residents. After appropriate training and screening, resident animals that are deemed capable of facility work may formally participate in appropriate planned or spontaneous activities and therapies.[25]

Resident animals may also function in the role of emotional support, companion, social, or mascot animals. Although the scientific medical evidence for the health benefits of the human-animal bond is not definitive,[28] empirical evidence suggests that pets can promote health and well-being in disabled and able persons alike.24,29

Skills that are inherent to a canine do not necessarily assist an individual in completing a task but instead can provide emotional support to an individual. For example, emotional support animals provide comfort to persons with psychiatric disability but do not perform trained tasks to assist the individuals. Because the comfort offered by the mere presence of an animal is not a trained skill, emotional support animals are not covered under US laws that apply specifically to service animals.[18] However, some persons with psychiatric disability served by emotional support animals may be afforded certain housing rights as a “reasonable accommodation” under Section 504 of the Rehabilitation Act of 1973 (29 USC §701) and the Federal Fair Housing Amendments Act of 1988 (42 USC §3601-3619).30,31

Unit mascots are similarly not considered service animals. According to the governing Tri-Service regulation to qualify as a mascot, the animal must be on orders signed by an officer in the grade of 0-5 or higher.[32] Such mascots are owned by the DoD and are eligible for veterinary medical and surgical care and support services. However, animal mascot or pet adoption is also subject to the policies and limitations of animal adoptions imposed by theater commands in their respective areas of responsibility such as the US Central Command’s prohibition of animal adoption in the deployed environment.[33] (For information about other relevant command restrictions regarding nonservice animal interactions with deployed military members, see Chapter 12, Rabies and Continued Military Concerns.)

Legal definitions notwithstanding, the overwhelming success of using animals in a therapeutic setting relies more on America’s cultural familiarity with canines and family pets than it does on the legal type of animal used. More specifically, patients respond well to animal interactions regardless of whether the animal is a service dog with public access, an emotional support dog’s efficacy can be proven, or a therapy dog fosters rehabilitative care. For many, a dog’s all-accepting disposition and wide range of intangible health-promoting factors is a welcome oasis in a setting where anxiety, pain, or decreased function is often prevalent.

Some of the defining characteristics of the different types of animals involved in healthcare are presented in Table 6-1. Understanding the legal, professional, and common definitions of these types of animals will help providers deliver the best care and develop appropriate policy to maximize the tangible and intangible benefits of the human-animal bond.

ANIMAL-ASSISTED ACTIVITY AND ANIMAL-ASSISTED THERAPY PROGRAMS

Tripler Army Medical Center Animal-Assistance Programs

At Tripler AMC, there are three distinct, yet similar, animal programs. One program is based on informal pet visits (AAA) by the volunteer teams to promote social interaction between patients, their visiting families, and medical staff. Touted as one of the first large AAA programs within the DoD, this program was approved and implemented in 1989 to aid in the convalescence of patients by using animals and their volunteer handlers as “co-therapists.” The AAA program places immense value on the animal-patient-staff-family interactions that occur during animal visits. During each session, animals facilitate socialization, providing unconditional affection for all people involved. This, in turn, promotes an environment with less stress, as evidenced by studies that indicate a lowering of heart rate and blood pressure while petting an animal.[34]

Another Tripler program involves a therapist who requests the use of an animal in a goal-oriented and documented treatment plan (AAT). Patients who participate in this program (especially younger patients) may experience a decrease in isolation, a temporary escape from pain, a calming of anxiety, and even enhanced self-worth.

The third Tripler program, which offers many of the same therapeutic benefits offered by the other programs, involves patients who are visited by only their own pet animals.

Complementary Intervention for Post-Traumatic Stress Disorder

AAT is utilized in a variety of hospital settings for many patient-related needs to include pain reduction, emotional support, comfort, and specific therapeutic applications in rehabilitation settings.[35] Because AAT also has been shown to reduce anxiety ratings in psychiatric patients,[36] Rick Yount, a social worker, professional service dog trainer, and chapter author, introduced the use of AAT as a complementary behavioral health intervention to help wounded warriors suffering from traumatic brain injury (TBI) and PTSD symptoms as a result of deployments to Iraq and Afghanistan.

Yount’s nonprofit organization, Warrior Canine Connection, harnesses the healing power of the human-animal bond by introducing and teaching wounded warriors with TBI and PTSD symptoms to train mobility service dogs. The program’s primary goal and design is reducing the symptoms of TBI and PTSD in wounded warriors who train the dogs.[37] These warrior-trained service dogs are then partnered with physically disabled veterans. Warrior participants benefit from reduced symptoms and the development of new communication skills and interests that can be used in everyday life.

A secondary goal is to harness the warrior ethos of taking care of battle buddies. The opportunity to help fellow veterans offers a powerful motivation for warriors to participate in the program. It also permits warriors to shift their mindset from consumers of mental health treatments to contributors who are meeting the critical needs of other wounded warriors.[38] Disabled veterans, in turn, benefit as recipients of highly trained service dogs to assist them with functional independence and public access challenges.

Other Specialized Wounded Warrior Service Dog Training Programs

Problems Being Addressed by Military Treatment Center Programs and Supporting Programs

Defense and Veterans Brain Injury Center reported 357,048 total diagnosable cases of TBI from 2000 to 2016.[39] PTSD affects 11 to 20% of Operation Iraqi Freedom and Operation Enduring Freedom veterans, 12% of Gulf War veterans, and 15% of Vietnam veterans.[40]

TBI and PTSD are widespread problems in veterans. Close to 40% of the veterans treated at health centers from 2002 through 2008 were diagnosed with PTSD, depression, or other mental health issues.[41] Extended deployments, physical and psychological combat injuries, and unemployment put a severe stress on military families. Being separated, divorced, or widowed can also pose a serious post-deployment risk for mental health problems.

Effective treatments to mitigate TBI and PTSD symptoms are necessary. Both TBI and PTSD may lead to drug and alcohol abuse and other maladaptive behaviors that stress families, relationships, functional independence, and occupational performance. Complementary and alternative medicine approaches can be used as adjunct treatments and may prove to be an effective treatment option. Service dog training programs offer another safe treatment approach to mitigate these symptoms.

To meet the diverse needs of the wounded warriors, the occupational therapy programs at the WRNMMC, Ft Belvoir Community Hospital, and National Intrepid Center of Excellence operate service dog training programs in the National Capital Region. These programs, facilitated by professional service dog trainers, teach warriors service dog training skills through positive verbal and nonverbal communication while also challenging their memory and concentration. Wounded warriors undergoing outpatient rehabilitation in these facilities are eligible to participate in the service dog training programs based on their interest and clinical staff recommendations. The programs’ target populations are wounded warriors diagnosed with PTSD, TBI, or both.

Unlike many other AAT programs, the service dog training programs are considered occupationally based behavioral health interventions that are complementary to traditional forms of behavior health treatments. Those involved in the programs are offered the opportunity to address their PTSD symptoms (eg, negative cognition and mood, avoidance, arousal and the re-experiencing of traumatic events) through the process of training a future mobility service dog. Participation in this program offers the warriors structure. It also facilitates the development of social interaction and other skills needed to successfully train a service dog and reintegrate into the community.

Purpose-Breeding of Dogs Used in the Programs

The dogs are purpose-bred specifically for their health and temperament: social responsiveness, soft temper, and low arousal. The dogs are then loaned specifically for the training from the Warrior Canine Connection (WCC) service dog nonprofit organizations (NPO). The WCC directs the selection and training of the service dog trainers and are ultimately responsible for the health, welfare, and management of the dogs in training.

Throughout the training, typically 18 to 24 months (Figure 6-1), the WCC maintains responsibility for the health and well-being of the service dog in training and maintains the skill sets of the dog trainers, ensuring everyone is using the same standard and the warrior trainers are receiving the best and most consistent information and practice. Once fully trained as a mobility service dog, determined by a rigorous evaluation completed by the WCC, the dog is then placed with a qualifying veteran, based on their needs and the dog’s skill sets. Dogs participating in the program are required to consistently demonstrate behaviors that include low arousal, control, and obedience around other dogs, patients, family members, and visitors.

Breeding the right type of dog for this program is critical since many complex tasks may be required of a service dog on a daily basis. Service dogs must have stable and reliable temperaments, ensuring the recipient, a disabled veteran, can consistently depend upon the dog’s service. Each dog must also be mentally and physically healthy, as well as intelligent and eager to please. These traits make certain breeds more desirable as service dogs. Labradors and Golden retrievers often have the specific set of desirable traits required of service dogs; their controlled friendliness and eagerness to please makes training them to be well behaved in public easier than most other breeds.

Figure 6-1. Young pup service dog in training on a community trip to the Pentagon.
Photo courtesy of Erin A. Krik-Cuomo, US Department of Defense.

At the conclusion of training, a certified service dog must perform up to 90 different tasks that assist the physically disabled with functional and mobility limitations. These tasks include retrieving items such as the following: medications, keys, phones, small objects dropped on the ground, clothing out of a drawer, or money from a purse or backpack. They are also used for pulling wheelchairs, opening a door, and balancing someone along a busy sidewalk. According to Assistance Dogs International, a dog’s presence can be a natural deterrent to a perpetrator, but, again, service dogs should not be protective. In other words, a service dog’s job is to make individuals with disabilities more able—it is not to protect them. Because many disabled people are unable to physically restrain their dogs, the service dog must be under verbal control to ensure public safety.[42]

Early Socialization and Training of Puppies

Purpose-bred puppies begin their training process from birth. During this time, the puppies are continuously handled to build trust and socialization with humans. Around 12 weeks, the puppies are transitioned to the training site where they continue to develop during training with the warrior trainers and the official service dog instructors to foster socialization (Figure 6-2). Learning basic commands such as sit, down, and stay begins soon after their eyes are open and they respond to sounds. Puppies-in-training require exposure to as diverse a population as possible and are introduced to persons of all races, sizes, smells, ages, and abilities so that they are comfortable with any person.

Fostering of Puppies

“Puppy parents” (foster parents) are volunteers who shelter and care for dogs in training at the foster parent homes during nonduty hours. Puppy parents attend training sessions provided by WCC to learn handling and proper dog care before taking a puppy or dog home. They are expected to reinforce learned commands while the dogs are in their care. Puppy parents also are expected to work out reasonable schedules with the service dog instructors to deliver and retrieve the dogs to and from training throughout the workweek.

Figure 6-2. Early puppy petting and socialization, Brookville, Maryland.
Photo by Cynthia Del Conte, Cynthia Del Conte Photography, Rhiebeck, New York, provided courtesy of Colonel Perry Chumley, chapter author.

Warrior trainers may assist with puppy parent training, which facilitates social interactions, competence, sense of mastery, and pride in their accomplishments as highly skilled participants within a meaningful occupational program. Trainers and foster parents may meet in a public location to work on public access issues with the service dog. The WCC also evaluates the dogs to make sure learned commands are reinforced, and the dogs are not learning bad habits.

Government Relationships with Nonprofit Organizations Supporting the Programs

One of the most critical and important factors in developing a wounded warrior service dog training program is the relationship between the government and the NPO, in this case it is the WCC. Most professional service dog organizations are federally recognized nonprofit organizations and rely solely on donations, which can complicate their ability to operate and function with wounded warriors (ie, government employees are bound by ethics to prevent any quid-pro-quo, monetary, or other gift exchange for services or access provided when collaborating and relating with NPOs). It is also imperative that the formal service dog training facility is near the installation where the training takes place.

To maintain the highest professional standards and render the most effective and ethical program, program planners and participants are highly recommended to work closely with the military installation’s public affairs office for guidance on public relations activities or events involving the government and NPOs. The real or perceived exploitation in caring for wounded warriors for marketing purposes poses a major concern. Although nonprofit organizations rely on donor funding, clear boundaries must be set that allow the NPO to operate while maintaining the utmost respect for the wounded warriors.

The service dog training program at the WRNMMC, National Intrepid Center of Excellence, and Ft Belvoir collaborate with a single NPO because of the specific training requirements for the patient population and the dogs in training. Additional organizations would have to demonstrate similar interests and objectives in providing service dog training programs that serve the best interests of the wounded warriors’ individual medical needs and the military installation providing access. The dogs and their food, equipment, medical care, and other animal-related resources are not donated to the government. These are all provided by the NPO as a loan agreement for the sole purpose of operating the program.

Government employees participating in this program manage the training schedule processes. Both the government and NPO collaborate to manage the puppy parent foster program. Once dogs are fully trained, the NPO certifies and determines placement for the dog with a disabled veteran, military family, or, on occasion, an active duty wounded warrior.

Costs of the Programs

Service Dog Training program costs vary depending on facility needs or arrangements. Once a command endorses a program for warrior care, budgets can be determined based on employee and facility space availability. A program cannot be started without NPO volunteer interest. Much of the work required for this type of program involves significant volunteer efforts from all parties involved.

Staff Roles and Responsibilities in the Programs

Service Dog Instructors. Service dog training refers to the training of purpose-bred dogs to be certified mobility service dogs. Since service dog instructors facilitate and instruct participating warriors in service dog training, instructors and volunteers are required to be fully qualified and certified with expertise in training service dogs. Identification of the training standard must be identified by the NPO and accepted by the military instillation as well as the clinical support system for the program.

Service dog instructors give direction and guidance and maintain control of the training environment. They ensure that successful training progresses safely and assists individual warrior trainers as needed. Instructors are present during every training activity until the warrior trainer has progressed to an advanced level of training. At this time, he or she may request to assist as a volunteer in order to help care for the dogs independently. Additional instructors may be necessary, acting as eyes and ears for controlling the training environment, depending on the number of participants and dogs.

Clinicians, Social Workers, Occupational Therapists, and Recreational Therapists. Healthcare providers are responsible for implementation and management of the service dog training program. Supervising healthcare providers informally evaluate staff performance through weekly and daily interactions, collaborations, and coordination through annual reports. The healthcare providers are responsible for oversight of the training instructors who, in turn, ensure the well-being of the participating dog. Supervising healthcare providers also ensure that all required documents (eg, instructor certification credentials and canine health records) are maintained, current, and complete.

Healthcare providers manage several different groups of program personnel, including all warrior volunteers participating in the program. The supervising healthcare providers maintain weekly communications between the service dog instructors and the warrior’s referring healthcare provider. Specific patient goals and objectives are identified and updated as the patient progresses through the program. Supervising healthcare providers also ensure that the service dog instructors accompany and monitor warriors at all times when with the dogs in training. In rare cases, the supervising healthcare providers, service dog instructors, and the referring healthcare provider may want the warrior trainer to work on independent activities with the dog. Independent work is a possibility only after the trainer has successfully advanced through the program, demonstrating confidence and competence with the service dog in training, and an emergency plan has been agreed upon prior to the independent activities. In some cases, the trainer may be authorized to have the dog overnight.

Figure 6-3. Warrior trainers work together during a training session, Walter Reed National Military Medical Center, Bethesda, Maryland.
Photo courtesy of Helen Hocknell, Naval Support Activities Bethesda Public Affairs staff writer, Walter Reed National Military Medical Center.

Warrior Trainers. Service members are considered “warrior trainers.” They are participating in a “train the trainer” program and follow all direction from the certified training instructors and clinical staff responsible for managing the program in which the service members are enrolled. There are three types of warrior trainers: (1) Novice, (2) Advanced, and (3) Senior, which can be characterized as follows:

- Novice trainers: Novice trainers focus on learning service dog training work tasks and policies.

- Advanced trainers: Warrior trainers are considered advanced when they demonstrate a solid working knowledge of the program and are comfortable with the dogs.

- Senior trainers: Senior trainers are encouraged by instructors to take a leadership role in the training environment and to possibly mentor both novice and advanced trainers when appropriate (Figure 6-3).

Instructor Teaching and Instruction Guidelines

Each program’s curriculum consists of service dog tasks intended to assist a disabled veteran in mitigating functional limitations and enhancing public access. Oftentimes, the training methods and curriculum must be adapted to meet the needs of the trainers. For example, instruction of these tasks may avoid the use of certain cues that the disabled veteran may not be able to use (eg, snapping fingers, clapping hands, or manipulating the dog’s position using the leash).

Timeline for Instruction. Warrior trainer comprehension and retention is accomplished through repetition; however, the trainer and the dog are often learning at the same time. As a result, the timeline of learning a task progresses slower than traditional service dog training involving only a professional trainer.

Continuity of Instruction. Dogs will work with multiple trainers throughout their training. With each change, the dog must learn to adjust and bond with the new trainer. This creates an opportunity for the warrior trainer to learn patience through practice and witness the powerful effects that a meaningful bond has on a relationship. During the first sessions that a dog has with a novice trainer, the warrior may feel much like a substitute teacher working with a classroom of unfamiliar students. He or she is likely to feel overwhelmed and unsure how to motivate the dog. However, with time, the trainer will gain familiarity with the new dog, establish appropriate boundaries, and identify the best ways to instruct the dog.

Training of Low-Arousal Dogs. As the warrior trainer progresses and gains competence, skill, timing, and precision are developed and refined (Figure 6-4). Some trainers have previous dog training experience working with breeds that have much higher arousal levels. For example, warrior trainers with prior military working dog handler experience (eg, with high-arousal Belgian Malinois military working dogs) may expect their program dogs to also immediately respond to a command. Initially, working with program purpose-bred, low-arousal dogs can be challenging to these warriors. However, with patience, such instructional challenges can result in benefits. Teaching the warriors to slow down and connect with the purpose-bred, low-arousal dogs is helpful in reducing the warrior trainers’ symptoms of hyperarousal.

Figure 6-4. A senior animal-assisted therapy trainer exhibiting competence, Brookville, Maryland.
Photo courtesy of Rick Yount, chapter author.

Training Session Instruction Overview

Ongoing professional instruction (one-on-one, group, or team training) is provided throughout the dog’s training to master essential concepts such as self-control. Professional instruction should not interfere with a warrior trainer’s opportunity to teach and engage a dog unless there is an immediate concern for safety. Safety is paramount for the success of the warrior trainers and the program as a whole. Instructors are responsible for ensuring that the dog behaves at all times and never presents as a safety risk to others. Instructors are also responsible for supplemental dog training to mitigate the risk and potential safety hazards.

One-on-One Training. Training sessions at the one-on-one level are typically conducted once per week and last about an hour, but both the length of time and number of days may fluctuate, depending on the warrior trainer’s needs and goals. Each training session has a predetermined training plan set by the instructor and clinical staff. This plan is based upon the expected training goals of the warrior trainers at that session as well as the skills and abilities of the dogs participating. Instructors match each warrior trainer with a dog prior to each training session to maximize benefits and success for both trainer and dog (Figure 6-5); however, instructors must be willing and able to change or adapt their training plan both before and during a training session ensuring trainer participation and success.

The initial training session begins with an explanation of the reward and reinforcement system and a review of the warrior trainer and provider goals. The next step is a demonstration and the opportunity for hands-on practice while completing the same task. At conclusion of the initial session, expectations regarding timelines, dress code, and attendance are set, and any questions or concerns are answered. If available, a visual reference such as a white board should display each dog’s name and the task being trained or validated during the exercise. At each additional session, the instructors should conduct a short verbal question-and-answer session with the participating trainers evaluating retention and comprehension before starting the session. Each new session will follow a similar pattern as the first with new commands and possibly new environments (eg, bringing the dog outside or around the facility). Every training session concludes with a summarization of events. Trainers and instructors discuss their observations, review tasks trained, set goals for the next session, and allow time for additional questions. Instructors also confirm the time and date of the next scheduled session.

Group Training. A circle group requires all instructors and trainers to work together using one dog at a time. The lead instructor gives verbal instruction to the group and, if possible, asks the support instructor or a senior trainer to demonstrate for the group. During the group session, it is important that the lead instructor maintain control of the training session to ensure all trainers have equal opportunity to participate regardless of their skill and ability.

Benefits of training in the circle group include giving the trainers the ability to observe and learn from each other. Instructors can use circle groups to incorporate novice trainers and challenge senior trainers while fostering an atmosphere of camaraderie and encouragement for all participants. Earlier in this chapter, it was mentioned that senior trainers are encouraged to mentor novice trainers. Since all trainers must participate for effective dog training, circle group training can facilitate socialization between instructors and warrior trainers and is recommended when there is a larger number of trainers available than dogs.

Team Training. Team training involves one senior trainer and one novice trainer per dog. Service dog training instruction is geared toward tasks that require at least two people for teaching. Team training provides senior trainers with an opportunity to teach the skills they have learned. Teaching and mentoring solidifies learning, builds confidence, and helps the senior trainer to see the progress and accomplishments they have made thus far. The novice trainer benefits by learning from a peer who is able to correlate commands with many of the service dog training tasks. Team training is also valuable for a warrior trainer whose treatment goals include improving communication skills (Figure 6-5).

General Benefits of the Training Programs

The wounded warrior service dog training programs have far-reaching benefits. Military medicine benefits from a low-cost, nonpharmaceutical, complementary treatment method that is safe and effective. Military installations implementing these programs offer warrior trainers friendly social contact with countless other patients, family, staff, and visitors every day. Service dogs are required to be well socialized to public settings, allowing service members to take the dogs-in-training out into the community (Figure 6-6). The purpose-bred Labrador and Golden retrievers provided to the program serve as social lubricants and facilitate interactions between warriors and civilians. Participants commonly report that the interactions inspired by the dogs are less stressful, since the dog becomes the topic of conversation rather than war-related stories.

Additionally, the presence of dogs helps to reduce the institutional appearance of the medical facility and the stigma that medical treatment can sometimes trigger. As noted earlier in this chapter, the treatment method of training service dogs appears to be effective, including producing the psychosocial and biological effects that can modulate the warrior’s TBI and PTSD symptom clusters of re-experiencing, avoidance and numbing, and hyperarousal.[43] Finally, service dogs provide a means for the disabled individual to regain functional independence and public access.

Controlling Re-experiencing. Wounded warriors must reintegrate into civilian life while leading the dogs they are training. Many aspects of civilian life (eg, crowds and loud noises) that may trigger PTSD symptoms may also upset young dogs being trained. By participating in a Warrior Transition Battalion (WTB) program, wounded warrior trainers accomplish a symbiotic goal: they learn to control their anxiety and take a confident lead in order to calm their dogs in these challenging situations.

Figure 6-5. Warrior training session, Walter Reed National Military Medical Center, Bethesda, Maryland.
Photo courtesy of Heidi Bonorato, service dog instructor, Walter Reed National Military Medical Center.

Figure 6-6. Community reintegration trip to the Warrior Café, Walter Reed National Military Medical Center, Bethesda, Maryland.
Photo courtesy of Heidi Bonorato, service dog instructor, Walter Reed National Military Medical Center.

Learning to train a service dog requires a focus on the needs of the dog in the here and now. Each dog needs to develop positive associations with all of the environments and situations encountered on a daily basis. Warriors are taught and encouraged with positive responses to shape the dog’s perceptions of new experiences in a light-hearted and fun manner, thus shaping the dog’s attitudes to be confident and comfortable in all situations.

This shaping not only teaches the dog a positive way to internalize these events, but also provides warriors with a way to challenge their own automatic thoughts that can transform safe environments into threatening ones. The presence of their dog in training can also help to lower anxiety and make PTSD-impacted service members more successful in challenging their intrusive or distorted thinking.

Overcoming Avoidance and Numbing. A trainer must use effective communication skills when interacting with the dog to optimize service dog training. The trainer must use an assertive command voice to instruct the dog and then follow up with a happy, emotional praise voice to reinforce the desired behaviors offered by the dog. Trainers are taught to use the positive affect (praise voice) to reinforce service dog behaviors such as retrieving, rope tugging, wheelchair pulling, and turning on lights. The need to sound happy when praising the dog even when the warrior may not feel happy or may want to avoid doing or feeling anything creates many opportunities for the warriors to “fake it” until they “make it.”

Although initially challenging, the sense of duty to a fellow veteran can be a compelling reason for an emotionally numb warrior to emote positive affect. Warrior trainers learn how intensity of experience determines speed of learning for the dogs. In this case, positive, intense emotions quickly result in associations between commands and learned behaviors. The dogs provide immediate and honest feedback when the warrior trainers “get it right.” Participating in the “no-fail mission” of training a service dog for a brother or sister-in-arms provides the reason to “fake it” in this program. “Making it” describes the end goal of patterning of warrior’s behaviors, much like the patterning of learned service dog’s behaviors, which happens simultaneously.

Managing Increased Arousal. The dogs used in this program are purpose-bred to have a low-arousal temperament, an inhibited prey drive, a friendly and affectionate personality, and a desire to focus more on their trainer than on stimuli around them. Training enhances these traits, making the dog more manageable for a veteran recipient with severe mobility limitations.

However, training a low-arousal dog requires warriors to lower their hyperarousal state to successfully connect with the dog. As noted earlier, warriors who are used to having a command obeyed in a split second have to readjust to the low-arousal dog’s timing and processing speed. This opportunity to practice patience and emotional regulation through the training process is experientially provided through a meaningful and purposeful activity.

Focusing on the dog’s training needs also helps divert the warrior from focusing on their own survival. Learning to synchronize with the “laid-back” dogs in the program has been shown to have very calming effects on trainers. Periodically, warrior trainers are authorized to complete an overnight with the dogs-in-training. After the overnight experience the trainers frequently have reported improvement to their quality of sleep by having their dog-in-training sleep with them. Participants also report a dog’s presence as being very helpful in disrupting nightmares, and they fall back asleep after awaking from the nightmare. Participants have also reported it is easier to fall asleep initially with their dog by their side.[44]

Final Thoughts About the Benefits of Service Dog Training Programs

The process of training a service dog for a fellow veteran is a form of AAT and can help address symptoms and daily functional activities associated with PTSD.[38] Mitigation of PTSD symptoms in warriors can improve their functional recovery and reengagement of life roles (eg, participants may see improved emotional regulation as training service dogs requires patience).

When wounded warriors are involved as trainers, they also benefit from other improved social, emotional, cognitive, and physical symptoms through human-animal bond experiences and purposeful participation in a therapeutic occupation. Multiple clinical staff observations and wounded warrior participant testimonials report improvement in PTSD-related symptoms to include improved impulse control, sleep, parenting skills and family dynamics, startle response, and pain perception, as well as lowered stress levels and noticeable improvements in social interactions.[45] As one wounded warrior in the program stated in an ABC World News webpage story about dogs helping veterans, “It [the program] helped me a lot more than it’s helped the dog for sure. It’s nice just to get out and about again. Because, you know, after I was wounded, I was kind of stationary for a bit. So it’s nice to actually do something productive and meaningful, instead of just healing. It’s nice to contribute back.”[46]

AAT also has been documented as helpful for individuals with mental health disorders and may decrease depression.[36] Reports of reduction of sleep and pain medications and decreased social isolation, irritability, and anxiety have occurred as well.[44] Service dog training and the associated benefits of human-animal bonding also can provide a safer and more cost effective means for treating mental health injuries.

As previously mentioned, the program may also provide a sense of purpose to warriors by helping fellow veterans. Training service dogs provides an opportunity to participate in training and produce professionally certified service dogs that will be placed with physically and or psychiatrically disabled veterans. Through volunteerism and experiential learning, learning by doing, the warrior trainers are working toward their individual recovery and overcoming the symptoms of TBI and PTSD.

Dwight D. Eisenhower Army Medical Center Animal-Assisted Programs

Program Session Overviews

Dogs are routinely used for animal-assisted interventions. Both AAA (nonstructured, non-goal-oriented session) and AAT (treatment session with a specific clinical goal focusing on the human and the animal) programs are held at the Eisenhower AMC. During AAA sessions, a therapy dog like “First Sergeant” Maverick (Figure 6-7) enters a group setting and is let off leash to freely interact with the patients. When a patient initiates interaction, the dog responds by stopping and returning the interest and interaction. If the patient ignores the dog, it continues to the next patient. Once the dog and patients have interacted for a few minutes, the therapist begins the session. The therapy dog will continue to sit quietly as long as someone is petting it and then will go and lie down quietly until the group has ended. Normally, at the conclusion of a group session, patients will again initiate interaction.

Clinical experiences at the Eisenhower AMC with the therapy dog Maverick demonstrated the need to limit the number of patients in a group. Inpatient groups no larger than 12 patients created the optimal environment for the dog to co-facilitate patient interaction and communication. During inpatient group psychiatry sessions, where getting the patients to beneficially interact with one another is normally difficult, Maverick was found to be the icebreaker that put patients at ease. They laughed together with the dog, played with him, and spontaneously began talking about their own dogs and other pets (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, personal observations, 2012).

Another benefit of AAA is that no specific treatment goal setting is required. Although special or extended interactions between the patient and the dog may be documented, casual contacts do not require detailed notes. Each visit is unique because the patient population frequently changes because of various factors including appointments, testing, and discharges from the hospital. Visits with the dog also create spontaneous interaction, whether in a group or in the hall. Although the amount of time Maverick interacted with patients was frequently controlled by the patients and the confines of the healthcare provider’s schedule, the relaxed atmosphere of the visits encouraged patients to let down their “protective” or “self-constructed” walls of isolation and focus on the love and attention being offered by a cute, playful, nonthreatening dog (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, personal observations, 2012).

Figure 6-7. Maverick, an animal-assisted activity and animal-assisted therapy dog at Dwight D. Eisenhower Army Medical Center, Ft Gordon, Georgia.
Photo courtesy of Jerry P. Coule, Retired medical photographer, Dwight D. Eisenhower Army Medical Center.

Individual AAT sessions are normally scheduled for 20 to 30 minutes and involve the handler, patient, and the dog. Although AAT is usually a referral from one of the psychiatrists, anyone on the interdisciplinary treatment team can make the recommendation. During therapy sessions with Maverick, the therapy dog, patients often communicated, established rapport, and trusted the therapist quicker when Maverick was present, possibly from patients following his lead in trusting the therapist (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, personal observations, 2012).

A frequently utilized AAT method is using the dogs in community reintegration. Many of the soldiers returning from Iraq or Afghanistan who suffer with PTSD experience typical symptoms that include hypervigilance, anxiousness, social phobias, and inability to sit in a room unless their backs are to the wall. They also experience feeling unsafe, anger and irritability, increased startle responses to sudden noises or movements, panic attacks, depression, social withdrawal and self-isolation, and trouble sleeping. Some dogs are trained to help alleviate these symptoms; canines learn to block people from getting too close, help remove the handler from a crowded area during a panic attack, or search a room and turn on the lights. Some patients request that their dog lie next to them in bed to help them feel at ease and rest while other patients lead their dog through crowded areas in the hospital and facilitate interactive therapy.

Unlike AAA, AAT needs to be carefully documented with attention to certain details in a patient’s notes. For example, specific times need to be allotted and may vary depending on the anticipated length of the individual treatment.

Each AAT session should also have identified goals, which are determined individually according to patient needs. Typical goals may include the following:

- Increased willingness to interact with healthcare providers and be more involved in treatment

- Improved involvement in group activities and verbal interactions with group members

- Increased attention skills and time a person stays on task

- Reduced hyper-vigilance, anxiety, stress, loneliness, anger, and irritability

- Increased exercise

- Increased self-esteem

- Increased ability to accept and give unconditional love

The Assessment, Planning, Implementation, and Evaluation (APIE) system of documentation is common for most recreation therapists (Exhibit 6-1).

Program Results and Findings

Animals have found a permanent place in assisting human healthcare professionals treat wounded warriors. As reiterated throughout this chapter, the use of animals to serve as “co-therapists” is becoming an accepted treatment modality with multiple benefits for several reasons. Dependent, dependable, domesticated animals present perpetually juvenile attributes that stimulate innate nurturing responses and provide people with unconditional love and acceptance. In addition to serving as catalysts for social interaction and as bridges to interpersonal communication and attachment, animals that provide unconditional regard can also assist in the stress relief of hospitalized patients and hospital personnel (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, personal observations, 2012).

Finally, animal interaction provides a medium for communication and relaxation that promotes and supports emotional well-being, and tactile, auditory, and visual stimulation can be provided through animal contact.[47] By using a therapy dog in the recreational therapy programming within the Behavioral Health Department at Eisenhower AMC, the healthcare team seeks to improve patient health outcomes by promoting recovery, increasing the speed of service members returning to function and mission readiness, and promoting healthy behaviors and wellness.

After 42 months of utilizing Maverick, the inpatient behavioral health unit documented 1,862 separate encounters with patients. Of these documented appointments, 1,537 were with male service members and 325 with females. Patient diagnosis was not a limiting factor in exposure to AAT as Maverick appeared to work well with a wide variety of behavioral health concerns.

Patient satisfaction surveys have gained a great deal of acceptance within the healthcare industry. They are used to measure patient outcomes and are useful when looking for ways to improve programs. Two surveys were used to assess patient satisfaction, one for the Eisenhower AMC recreational therapy programs and one for the Eisenhower AMC animal-assisted programs.

EXHIBIT 6-1.

PATIENT ASSESSMENT, PLANNING, IMPLEMENTATION, AND EVALUATION

Assessment

Demographic information

Sergeant John Doe is a 25-year-old 11B (infantryman) who presented to the unit with complaints of severe anxiety, depression, and hypervigilance. He has served in the active duty Army for 6 years and has been deployed twice to Iraq and was in the seventh month of a 12-month scheduled deployment to Afghanistan.

History

This is the patient’s first encounter with behavioral health since enlisting in the Army. He states he is having trouble concentrating and remaining focused on a singular task. He states he is more isolative and avoids contact with his friends. He is able to speak with his wife; however, he feels more distance from her since his last deployment. Patient states he is no longer interested in activities he enjoyed prior to deployment. Patient states he has no physical concerns and is not on a physical profile. Patient was active in his church prior to his deployment and has requested to see the chaplain.

Present behavior

Psychiatrist has ordered diagnostic testing to determine a more finite diagnosis. Patient has indicated that he has difficulty walking in crowded areas and cannot eat in the cafeteria because of the crowds. Patient stated that he loves dogs and has expressed an interest in working with our therapy dog. Doctor has placed a referral for animal-assisted therapy to help reduce patient’s anxiety in crowds. Patient’s wife is very supportive.

Planning

Long-term goal

Reduce Sergeant Doe’s anxiety in crowded situations.

Short-term goals

The two short-term goals are to be able to walk through the crowded pharmacy area of the hospital without experiencing a panic attack and to be able to sit in the cafeteria for meals.

Content

Sergeant Doe will be enrolled in Recreational Therapy, Occupational Therapy, and Spiritual Wellness courses during his admission. Patient will be provided with anger management training, coping skills, self-esteem building, leisure awareness, and relaxation therapy. Patient will participate in individual animal-assisted therapy sessions with the recreational therapist.

Process

During each of the individual animal-assisted therapy sessions, therapist will discuss with the patient possible coping techniques to help the patient relax in crowded situations. The patient will be educated about possible treatment programs for service members suffering with post-traumatic stress disorder. The patient will be provided with information about how he may benefit from his own service dog.

Implementation

Sergeant Doe will walk with Maverick, the therapy dog, and the recreational therapist through the lobby of the pharmacy area three times each day and stay in the area for increasing amounts of time each day. Patient will initiate one conversation with a stranger who shows an interest in the dog during each outing.

Patient will go to the cafeteria with Maverick and the recreational therapist and observe mealtime routines for 2 days. The next day, the patient will sit at a table close to the door with Maverick for 15 minutes during each meal. Patient will consume breakfast and supper in the cafeteria with Maverick and the recreational therapist for the fourth and fifth day. Beginning the second week, the patient will consume all meals in the cafeteria with Maverick and the recreational therapist for 3 days. Patient is to eat all meals in the cafeteria without Maverick being present beginning the fourth day of week two of his admission.

Evaluation

The interdisciplinary team reevaluates each patient’s progress and treatment plan on a weekly basis. The recreational therapist has charted Sergeant Doe’s progress during each week to determine the effectiveness of the animal-assisted therapy program.

TABLE 6-2.

RECREATIONAL THERAPY WITH AND WITHOUT DOG

Without a Dog

Recreational Therapy helped me to cope with my hospitalization.

76%

I understood the role of Recreation Therapy services I received.

80%

I did not receive enough Recreational Therapy.

38%

Recreational Therapy has helped to prepare me for discharge.

74%

I enjoyed the Recreational Therapy sessions.

74%

Which recreational therapy groups do you feel helped you the most :

Worksheets

3

Exercise

14

Games

15

Community Outings

19

Leisure Awareness

4

With a Dog

Recreational Therapy helped me to cope with my hospitalization.

80%

I understood the role of Recreation Therapy services I received.

84%

I did not receive enough Recreational Therapy.

34%

Recreational Therapy has helped to prepare me for discharge.

80%

I enjoyed the Recreational Therapy sessions.

84%

Which recreational therapy groups do you feel helped you the most :

Worksheets

7

Exercise

12

Games

21

Community Outings

16

Leisure Awareness

7

Animal-Assisted Therapy

14

*Patient surveys were handed out at the Dwight D. Eisenhower Army Medical Center to patients who had a dog involved in their treatment and those who did not. Results were based on completed surveys.

Data courtesy of Cynthia Rhodes, chapter author.

The surveys were voluntary and were handed out by the nursing staff at discharge to every psychiatric inpatient at the Eisenhower facility. A total of 100 patients completed the surveys, 50 by each group; however, of the 50 in one of the two groups, 18 were incomplete. Therefore, 32 completed surveys were randomly selected from each group to include the 100 general Recreational Therapy satisfaction surveys collected. Results from Recreational Therapy without a dog and Recreational Therapy with a dog (Table 6-2) were used to represent the experiences of 64 patients who self-randomized into the using and not using animal-assisted intervention (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, 2012).

The collected questionnaire information (Table 6-3) (expressed in a mean score from the Likert scale used) (1=strongly disagree/dislike and 5=strongly agree/like) is a starting to point to see if and what the patients viewed as beneficial regarding having a dog in the unit. The two top answers (expressed in percentages) were as follows: 90% of the patients (29 out of the 32 useable surveys) felt the dog created a calming presence, and 85% of the patients (27 out of the 32 useable surveys) felt their mood improved when the dog was present. These data show a relatively strong positive correlation with having a dog involved and satisfaction with the AAA or AAT activities, despite the fact that about 10% of the patients (3 out of the 32 useable surveys) chose not to actively participate with a dog (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, 2012).

TABLE 6-3.

RESULTS FROM A POST-ANIMAL-ASSISTANCE-THERAPY PROGRAM SATISFACTION QUESTIONNAIRE*

Mean Score

The dog provided me with companionship

4.07

The dog created a calming presence within me

4.54

The dog made me feel safer

4.07

I did not find the dog comforting

2.25

The dog provided me with emotional support

3.82

My mood improved when the dog was present

4.25

The dog did not lessen my frustration/irritability

2.00

The dog made it easier to communicate with others

3.39

The dog reduced my frustration/irritability

3.96

I was more relaxed when the dog was present

3.93

I would prefer that there was not a dog that visits the unit

1.50

I would have liked to have spent more time with the dog

4.14

*Results based on questionnaires that were handed out to patients specifically receiving treatments with a dog at the Dwight D. Eisenhower Army Medical Center and used a 5-point Likert scale where “1” was “strong disagreement” and “5” was strong agreement.

Data courtesy of Cynthia Rhodes, chapter author.

One of the more difficult parts of gathering information was that survey and questionnaire completion was optional; probably the last thing a patient who is finally being discharged from an inpatient psychiatric facility wants to do is complete additional paperwork. Despite this challenge, 32 useable questionnaires were collected during the 3-month period without the dog, and 32 additional questionnaires were collected during a separate 3-month period with a different group of patients who had the benefit of Maverick’s company (see also Table 6-2) (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, 2012).

Two conclusions were made from the survey data in Table 6-2. Scheduled treatment methods were relatively consistent with or without Maverick, and they included game activities, community reintegration, worksheets, leisure education, and physical fitness. Almost every category improved, at least slightly, with the therapy dog present (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, 2012).

The total number of activities indicated as beneficial by the service members, regardless of demographics, sometimes more than doubled when they were exposed to Maverick (see also Table 6-2). This suggests an overall improvement in the patients’ willingness or motivation to participate in treatment, which is often a key battle when dealing with behavioral health patients. There are some limitations and confounders that must be noted. Most notably, the patient socio-demographics and diagnosis, which may have impacted the responses, could not be adjusted for as the surveys were anonymous and voluntary, and, given patient-schedule constraints, the two groups being measured in Table 6-2 at check-out were not composed of the same people (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, 2012).

Below are real-life examples of how AAT played significant roles in the gradual treatment of two patients in military therapy programs. These two examples come from the personal communications and observations of therapists and chapter authors and are representative of the progress other patients with similar issues experienced:

Example (1) Patient with Post-Traumatic Stress Disorder. Some of the most memorable AAT experiences present sometime after the AAT sessions when patients contacted the staff in thanks. One such example is from a female who loved working with Maverick. She didn’t say much and startled very easily because of PTSD. However, she was adamant about later saying thank you for the following reasons:

After returning from Afghanistan I saw Maverick and started petting him, tears started flowing. When I’m around people, my defenses are up and emotions are numbed, so I am able to function in any situation; but with Maverick, that defense was not needed. I would not have known about this possible form of therapy for my situation if I hadn’t met Maverick.

Example (2) Patient with Paranoid Schizophrenia. The following is an example of how Maverick benefited a patient with paranoid schizophrenia who had been at the inpatient psychiatric unit for several days. The treatment team consisted of a psychiatrist, physician assistants, social worker, chaplain, occupational therapist, and a recreational therapist. The patient was angry, confused, paranoid, and not talking to anyone, and had been pacing circles around the nurse’s station. At one point, he stopped pacing briefly, petted Maverick for a few minutes, and then resumed pacing. Later that day, he again petted the dog, a little longer this time, but still would not speak to the recreational therapist and continued pacing.

On day 3, the patient was asked if he would like to walk the dog. He walked Maverick halfway down one hall, but returned the dog after that brief encounter. The recreational therapist brought a tennis ball onto the unit and asked the patient if he would please work with Maverick and try to teach the dog to fetch, explaining that the dog would go get, but not return, the ball. The only condition was that the patient would have to come into the classroom to work with Maverick so that the patient was kept in sight.

The patient was hesitant at first because his paranoia made it difficult for him to believe someone was being truthful with him. He “negotiated” that he must be allowed to sit by the door and allowed to leave whenever he wanted. The first classroom session lasted less than 5 minutes, but within 2 days, the patient was participating in groups from his chair by the door as he “worked” to teach Maverick to fetch.

Follow-up Care Programs

As patients discharged from the inpatient psychiatry unit, they were oftentimes assigned to the WTB. Significant challenges encountered in the WTB include the lack of consistent involvement in activities; the need for patients to isolate themselves; and the tendency for patients to become noncompliant: not taking their medication, taking an incorrect dosage, or using the wrong frequency, which causes them to end up back in the hospital. Occupational Therapy at the WTB also reported difficulty encouraging behavioral health patients to become involved in programs possibly because a relationship wasn’t established prior to discharge.

To help address these problems, the Eisenhower AMC behavioral health staff formed the group “Transitioning to Success,” a patient-centered and patient-directed program that encouraged social interaction and included AAT. Based on patients’ feedback, the interaction with the dogs is something the wounded warriors love and feel good about, which adds to their everyday happiness.

Every animal program at Eisenhower AMC illustrated how service members can become more tolerant and accepting of one another, kind and considerate of each other’s limitations, and willing to put another’s needs ahead of their own. The Eisenhower healthcare team also has found the dogs to be a beneficial addition to the staff; they have witnessed some very touching moments only the dogs could have evoked. For example, when participants in one of the previous AAT programs were asked how many sessions they felt would be adequate to receive maximum benefit from the group (dogs and people), they were all quiet. One member finally spoke up and asked, “You mean it has to end?” (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, personal observation, 2012).

COMBAT AND OPERATIONAL STRESS CONTROL DOGS PROGRAM

Background of Combat and Operational Stress Control Dogs Program

Deployed service members experience a multitude of stressors during the course of their tour in theater. In addition to the rigorous combat environment, service members are deprived of the simple comforts of home, including pet interactions. Prolonged periods of deprivation from these familiar comforts may ultimately affect performance and hinder the unit mission. It is imperative to maximize the functional capabilities and mission effectiveness of service members within theater and restore the mission capabilities of those affected by combat and operational stress reactions or other bio-psycho-social conditions.

The presence of AAA and AAT dogs elicit the human-animal bond and opens doors to behavioral healthcare interventions. Therapy dogs are an effective means to assist service members affected by crisis or challenges, especially in a prolonged war environment as part of deployed and combat operational stress teams. Combat and Operational Stress Control (COSC) personnel used therapy dogs in pilot programs from 2007 through 2013 to facilitate human-animal interaction when treating combat and operational stress reactions in deployed service members (Figure 6-8).

Justification for Animal-Assisted Therapy Programs in Theater

Following a traumatic event, most service members require compassion, in addition to basic needs of food, shelter, and medical care for physical injuries; thus, a tenet of combat stress and disaster management is therapy presence and face-to-face interaction.[48] One of the common AAT methods used to manage combat stress occurs during walk-abouts, when therapists make contact with service members to build rapport and trust. These walk-abouts are informal and typically done in the service member’s living or working environment in deployed settings. The service members who interact with therapy dogs often receive needed friendly and affectionate companion-like contact from the canines. When accompanying occupational therapists in theater, therapy dogs positively impact these therapists’ interactions with units and help alleviate some of the common types of combat and operational stress service members experience during deployment.

In addition to walk-abouts, the therapy dogs were used primarily by the prevention team for unit briefings and classes, traumatic event management, and by fitness teams during their classes and therapeutic sessions. Prevention teams visit units and conduct general COSC-related classes or briefings in the unit’s environment while fitness team meetings are conducted in the COSC clinic and are typically designed for service members who have been identified by their unit or a provider to have specific COSC-related needs.

Figure 6-8. Therapy dog “Sergeant First Class” Boe poses with occupational therapists then-Major Arthur Yeager and then-Captain Cecilia Najera (chapter author) in Tikrit, Iraq.
Photo courtesy of Lieutenant Colonel Arthur Yeager, chapter author.

Deployed service members often remark that a primary stressor is the lack of a close relationship and social support. During stress management sessions, the AAT dogs are used to improve social interaction in groups and facilitate discussion concerning healthy coping strategies. The AAT dogs also assist in improving the morale of service members attending restoration programs. For example, having the dog perform a trick or rest his or her head on a service member’s lap will typically lead to some laughter, smiles, and conversation with other service members. For a moment, an uncomfortable situation becomes more light-hearted with the dog’s presence.

In the COSC setting, the presence of an AAT dog during therapist-lead, psychosocial evaluations, and treatment sessions is often viewed as nonthreatening, providing reassurance with nonverbal and tactile comforts that may help break a cycle of social withdrawal. After a relationship is built with units and their leadership, the prevention team is often requested for traumatic event debriefings after incidents leading to serious injury or death have affected the unit and, consequently, its morale. The AAT dog becomes a safe outlet for expression of emotions and receiving comfort in these difficult times.

In one particular case in which a unit was affected by the death of five of its members, several support providers were summoned the night following the event. An NCO respectfully turned all away, stating the team requested to be alone, “except for you,” turning to the therapist and her dog. “You and the dog can stay.” That evening, not another word was spoken, but the dog made her rounds past the service members who lovingly petted or hugged her (Cynthia Rhodes, Eisenhower AMC ambulatory therapist and chapter author, personal knowledge).

Animal-Assisted Therapy Program Strategies in Theater

There are seven therapeutic goals of AAT that could be used in theater, all aimed at service member well-being:

- Improve socialization and communication

- Reduce isolation, boredom, and loneliness

- Brighten affect and mood

- Lessen depression

- Provide affection

- Address grief and loss issues

- Reduce stigma for behavioral healthcare[49]

The COSC doctrine incorporates occupational therapy with these goals. Occupational therapists assess client progression through graded levels of performance, culminating in the client’s functional independence. The AAT Program may likewise be graded to match service members’ ability levels to help build skills, self-confidence, and motivation to move beyond the physical and psychological barriers the wounded warriors may be experiencing. For instance, the actions of walking, grooming, and feeding a dog are potential activities that can be incorporated into the occupational therapy intervention.

Considerations for Deployments with Therapy Teams

Determining Resources and Establishing Relationships

Advanced planning and careful considerations are required prior to deploying with a therapy dog team, to include selecting the appropriate dogs to deploy. Not all therapy dogs should deploy with COSC units, despite passing the typical behavioral requirements for therapy dogs. The dogs should have the ability to work for long hours, be accustomed to traveling in rotary and fixed-wing vehicles, and be able to acclimate to environmental factors (eg, weather, surrounding wildlife, war zones, and overstimulation).

Units must obtain approval from the command structure, utilizing the established standard operating procedures detailed in the next section. Primary and secondary handlers must be identified, and all members of the unit need to be trained on AAT. Units must provide the necessary equipment (eg, kennels, muzzles, and ear protection) and arrange travel with the flight crews to ensure the dogs are safe and secure. Most importantly, units must have a detailed program description of how the dogs will be implemented into an AAT program within theater.

The AAT program should include targeted therapeutic goals and objectives for incorporating the dogs into therapy and describe whether the interventions will be AAA versus AAT. Since the utilization of AAT in deployed environments was a pilot program from 2007 through 2013 that is no longer in continuation, it is recommended that a program evaluation or research study be conducted to assess its effectiveness and value for future considerations.

It is imperative that representatives from the COSC, Occupational Therapy, Veterinary Services, and Behavioral Health Division interface to develop awareness and maintain support for any in-theater AAT program. Approvals must also be obtained from the US Medical Command, US Forces Command, and US Central Command for the dogs’ entry into theater. Veterinary Services at home station and in theater must be aware of the dog teams’ status and final destination as Veterinary Services will be responsible for conducting medical and temperament evaluations; providing health certificates, immunizations, and medications; and providing monthly follow-up care in theater.

Planners must also ensure funding is available for instructor travel to train primary and secondary handlers, transport the dogs to the unit, and provide additional familiarization with dog handling, care, and commands to the entire COSC unit. Funding to purchase the pilot program AAT dogs was not necessary as all dogs were donated from nongovernmental organizations to the US Army for use in the COSC.

Standardized Procedures

Because of the complexity of theater AAT programs, all team members need to follow a set of standardized procedures. The core principle behind these procedures is that therapy dogs are trained professional animals. All dog handlers must be trained and familiarized with proper handling procedures for these trained professionals to include verbal and nonverbal commands, rewards, and discipline. It is also important to incorporate the COSC unit in familiarization training as all service members need to understand the proper methods of responding to and rewarding the dogs. Service members who are afraid of dogs, do not like these animals, or have allergies to them can elect not to participate in the AAT program.

The therapy dog’s husbandry must be coordinated and authorized by the handler, including all nutritional intake (ie, food and water), grooming, hygiene, and healthcare. The therapy dog should only receive the type and amount of food prescribed by the supporting veterinarian. A specific diet is recommended for the dogs, and handlers are provided with the national stock number to order their supply. The dogs must be weighed monthly, and this information is reported to the supporting veterinarian, who will provide required mandatory health examinations every 6 months and additional care as needed.

The handler is also responsible for the therapy dog’s work-rest cycle, kennel arrangements, and other scheduling or logistical concerns. Therapy dogs need to reside with their handlers and should not be kenneled with other military working dogs to eliminate the potential of being injured or acquiring aggressive traits. When alone, the dogs should be kept in a quiet area. When the dogs are out of their kennels, they must be kept on-leash. Finally, all theater travel arrangements for AAT teams are coordinated with the handlers.

Evaluating Benefits

Modeled after civilian programs, the utilization of therapy dogs in unit briefings and classes served to build a sense of companionship with the dog as well as to assist with participant self-regulation of emotions, behaviors, and social interactions.[50] However, other people in theater may benefit from encounters with the dogs, including other military members, civilian contractors, and third-country or local nationals (Figure 6-9). Depending on safety and availability, dogs were authorized to travel to other forward operating bases and prevention teams when requested by the unit representative.

An overwhelming amount of literature depicts anecdotal evidence on the benefits of incorporating AAA and AAT into therapy sessions.[51]-[54] In contrast, very few articles demonstrate statistically significant evidence supporting AAA and AAT, probably because the benefits provided by animal therapy are temporal and subjective, and therefore, more challenging to determine whether results are real (and measurable) or happen by chance. For example, after a 30-minute visit with a therapy dog in a COSC unit, a service member being treated may report a feeling of decreased anxiety. However, whether this service member’s improved work performance after the 30-minute visit is directly related to the dog interaction (or how much it might be related) is more difficult to ascertain via scientific evaluation methods. Deployed environments provide even more challenges to conducting clinical evaluation studies of AAT benefits (eg, because of the deployed environment’s frequent unit and personnel turnover).

Figure 6-9. Therapy dog “Sergeant First Class” Boe entertains handler, then-Captain Cecilia Najera, and fellow soldiers during a conference at the Al-Faw Palace, Baghdad, Iraq.
Photo courtesy of Major Cecilia Najera, chapter author.

Figure 6-10. Captain Theresa Schillreff, an occupational therapist and therapy dog handler, prepares “Sergeant First Class” Timmy for flight in Afghanistan.
Photo courtesy of Captain Theresa Schillreff, US Army.

Furthermore, the individual personalities of each dog play a part in how the dogs will be utilized Figures 6-10, 6-11, and 6-12). For example, during one deployment tour, it was found that one therapy dog did well with travel but disliked engaging in large group settings; in contrast, the unit’s other therapy dog thrived on being the center of attention but became very anxious with travel. This unit had to adjust and accommodate to these differences in personalities to maximize performance when engaging these animals with service members. Unfortunately, it takes time for unit personnel to understand their dogs’ individual traits and acclimate the dogs to the deployed environment, making it difficult to submit a research protocol in time to get it approved, start the program, and collect sufficient data prior to redeployment.

Figure 6-11. Staff Sergeant Blas Guigni and therapy dog “Sergeant First Class” Boe at a combat support hospital in Tikrit, Iraq.
Photo courtesy of Major Cecilia Najera, chapter author.

Figure 6-12. “Sergeant First Class” Budge plays ball in Mosul, Iraq.
Photo courtesy of Lieutenant Colonel Arthur Yeager, chapter author.

Although a research study is preferred, the deployed environment lends itself to program evaluations to show the effects of AAA and AAT on deployed troops. Examples of possible program evaluations for COSC units include surveys requesting anecdotal information from service members, identifying the number of COSC visits attributed to using the therapy dog, or providing service members with Likert scales that rate the effects of AAA and AAT during their COSC experience.

Post-Deployment Considerations

COSC units were generally deployed 9 to 15 months in support of Operations Iraqi Freedom and Enduring Freedom. The nature of the environment combined with being away from loved ones and experiencing stressful events led many units to bond as a family—this bonding effect was especially common between handlers and their therapy dogs, leading to separation issues for the redeploying handlers, other unit members, and the therapy dogs that remained in theater.

Oftentimes, the unit that deployed with the dog did not get to return home with the dog, making unit members feel as if they were leaving a “battle buddy” behind, especially since many individuals desired to adopt or continue working with the therapy dog back at the home station. Since the deployment of therapy dogs with COSC units in 2007, most dogs have typically served two consecutive tours, requiring them to transition to new handlers. During unit transitions, it takes time for the dog to acclimate to its “new family” and build a trusting relationship with its new handler. It is possible that lengthy deployments may also be stressful for the animal, and his or her behavior and health should also be documented.

To make the transition process smoother, it is advisable to have a set plan for the dog’s tour prior to deployment. All members of the unit need to understand how the dog will be used during and after deployment. Clarifying these roles helps minimize the disenchantment unit members may develop about keeping the dog with their unit.

The Way Forward

For decades, the human-animal bond has anecdotally demonstrated powerful positive effects on individuals’ emotional and physiological state. The US Army’s AAT pilot program in COSC units indicates similar effects in deployed environments; however, more research and program evaluations would be beneficial to justify permanently incorporating such programs in the military. In addition, it is important to consider the safety of the dogs in such programs, the consequences of handler-animal and unit bonding and separation, and placement of the dogs post-deployment and after retirement.

EQUINE-ASSISTED THERAPY PROGRAMS

Overview of Equine-Assisted Therapy

Therapeutic horseback riding is another example of successfully using animals for the treatment of individuals with emotional and or physical disabilities.[55] Therapeutic riding has as its primary objective, the alleviation, in so far as possible, of the rider’s handicap or disability through a prescribed riding program.[56] This objective is accomplished by selecting a particular mount and equipment specific to the assigned rider in combination with a qualified instructor who has a thorough understanding of the teaching methods pertaining to physical, cognitive, and emotional disabilities.

The rider requires the proper horse based on the rider’s size, strength, physical limitations, and experience. New riders would benefit from a docile horse, but they may not be able to get their legs around the girth of a wider horse, or they may require a thinner horse because of range of motion restrictions. They also require proper equipment, and the hands-on support provided by side-walkers. When the rider has achieved a stable, secure base of support, he or she can learn better torso control.

Guernsey describes the ideal therapy horse as one that will stand quietly, especially when the students mount and dismount, and be tolerant of off-balanced riders, wheelchairs, ramps, leg braces, and unusual noises that riders may make. She indicates that when a qualified horse is available, the rider can realize numerous and extensive benefits, including learning riding skills and developing physical strength, flexibility, coordination, improved motor skills, balance, and body awareness.[57] All of these benefits contribute to the rider’s increased self-esteem.

Some of the more well-known equine-assisted treatment using high-quality equines for therapy work was the product of the now-legacy organization Caisson Platoon Equine-Assisted Programs (CPEAP). Formed as an all-volunteer organization in May 2006 in Ft Myer, Virginia, CPEAP was founded to provide equine-assisted therapy to service members and veterans at the Walter Reed AMC, later renamed the WRNMMC. During its years of operation, soldiers helping fellow soldiers was a key strength of CPEAP. Powerful Percheron draft and draft cross horses from the Caisson Platoon were partnered with their handlers, active duty soldiers of the platoon. During the CPEAP lessons, the soldiers served as horse leaders and side-walkers for fellow military members and veterans who were riding the horses (Figure 6-13). CPEAP activity was terminated by the Army in January 2015. (The Caisson Platoon belongs to the US Army’s famed 3rd US Infantry Regiment [The Old Guard], whose duties include guarding The Tomb of the Unknowns and conducting military ceremonial honors during funerals at Arlington National Cemetery.) (For more information about the Caisson Platoon, see Chapter 8, Military Equine Programs.) (More information about CPEAP is found in the History and subsequent sections of this chapter.)

Some of the more well-known reasons for using horse riding as a therapeutic treatment modality for disabled individuals was found in a pamphlet at the National Institutes of Health Library, Bethesda, Maryland (pamphlet located by Mary Jo Beckman, chapter author, spring 2017). The pamphlet quotes a section of the forward written by Dr R.E. Renaud in the book Riding for Rehabilitation; A Guide for Handicapped Riders and Their Instructors:

Horse riding for the disabled has indeed been an enriching experience. Day by day we are finding features which point even more forcefully to the advantages of this modality of treatment. For example: The need to stay mounted provides a major motivating factor; the isometric type of exercises are admirable for treatment; the length of therapy time is at the discretion of the patient’s fatigue tolerance; the unconscious stimuli of contact between horse and rider tend to induce reflex muscle activity and tone. Many of these stimuli and responses can be regarded as physiological and this spontaneity of performance gives this recreational pastime its greatest therapeutic value.[58]

Figure 6-13. An animal-assisted therapy patient escorted by soldiers from the Caisson Platoon, illustrating the use of the “soldier helping solider” concept in hippotherapy.
Photo courtesy of Mary Jo Beckman, chapter author.

Both physical and psychosocial benefits occur from therapeutic riding. The rhythmic, swinging movement of the horse promotes coordination and motor development, and the position of a rider astride a horse promotes correct postural alignment and evenly activates and strengthens trunk musculature for the dynamic balance required when sitting.59,60

More specifically, patients who are affected both orthopedically and neurologically must develop balance to compensate for movement of the horse. The balancing skills required in horsemanship improve postural alignment and facilitate equilibrium reactions. Patients who ride horses also experience improvements in sitting balance (and, in some cases, standing balance) and walking and decreases in lower extremity adductor spasticity.[61]

Other physical benefits include facilitation of normal movement, integration of sensory stimulation with motor-planning skills, and low-level cardiovascular conditioning. Riding has also been shown to improve self-esteem and increase strength, flexibility, and range of motion.[62]

History of the Caisson Platoon Equine-Assisted Programs

In 1997, Dr Paul W. Brown (Colonel, US Army, Retired) was the keynote speaker at the Ninth International Therapeutic Riding Congress (Denver, Colorado). Brown wrote an article, “Rehabilitation of Bilateral Lower-Extremity Amputees,” in which he describes some of the over 500 patients with major amputations who were treated from May 1966 to May 1969.[63] Brown was instrumental in developing unique rehabilitation methods such as skiing, golfing, scuba diving, and equestrian therapy with Vietnam War amputees. With the help of Mary Woolverton, a horsewoman and social worker at Fitzsimmons Army Hospital, Aurora, Colorado, he developed and implemented an ancillary riding rehabilitation program for amputees.

In December 2005, Mary Jo Beckman (chapter author) was introduced to Larry Pence (chapter author), who became the spokesperson for the CPEAP, described earlier in this chapter. The first meeting with the Caisson Platoon occurred on April 11, 2006, after receiving official permission from 1st Battalion, 3d US Infantry Regiment Caisson Platoon and Ft Myer. Discussions during this meeting included horse selection and training, mounting ramp construction, equipment requirements, and training soldiers to serve as leaders and side-walkers for the riders with disabilities. Patient riders were also concurrently recruited from the Walter Reed AMC Physical Therapy Department.

After the meeting, Caisson Platoon soldiers built a ramp complex; the Caisson horses Mickey, Minnie, Aribie, and Wiley were trained; and 14 soldiers were trained as horse leaders and side-walkers. The four-lesson pilot program was sponsored by the Walter Reed AMC Occupational Therapy Department, and a therapist accompanied the patients each week.

Program participants were given balance tests before and after they rode, and the results demonstrated increased core stability. Riders also reported how much they enjoyed the riding experience and wanted to return after the pilot program.

Caisson Platoon Equine-Assisted Programs’ Benefits and Success Stories

Improving Confidence

One of the earliest success stories for the CPEAP involved a 23-year-old female enlisted soldier. In June 2005, she was deployed to Iraq, and in October of the same year, the vehicle she was driving was hit by an explosive device. Her injuries included amputation of her left leg below the knee. During her recovery, she suffered a fracture of her left tibia, which delayed the fitting of an artificial limb. In early 2006, she suffered from phantom pain and constipation and had some psychological factors that affected her physical condition. She was seriously challenged by the loss of her leg and, as a result, had chosen to have limited interaction with others.

At the first riding lesson, the female soldier arrived at the stables using crutches. Although she came in a van with other participants, she kept herself apart from the other riders and soldiers. She wore a cap and walked with her head down. She positioned herself apart from the other riders and their family members at the initial briefing.

The first lesson was a group lesson, during which the female soldier was very tense and hesitant. The instructor was told she had been on a horse before, but the extent of her riding experience was unknown. Once mounted, the soldier gripped the horse’s mane, and her body position was crouched. She was instructed to do deep breathing and relax into her horse’s movement. After the horses walked around for a while and the riders got used to the respective movements of the horses, the horses were halted, and the students were instructed on how to turn sideways on their horses, facing toward the inside of the arena.

Once in position and appropriately supported by the side-walkers, the riders requested their horses to “walk-on.” In the new position, the female soldier was extremely dependent on her side-walkers for stability, and she had difficulty allowing her body to face sideways. After one time around the arena, the horses were stopped, and all riders were asked to sit facing backwards. This rider found riding backwards was better because of a wider base of support; however, facing sideways to the other side was just as challenging as the first position. All riders were challenged by the instructor to move into a forward position with the horses walking, which they did with maximum assistance of the side-walkers.

The next activity was the ball toss. Extra people were brought into the arena, including the female soldier’s mother, who served as her catching buddy. Initially, the ball tossing was done at the halt and then at the walk in both directions. This exercise was selected to challenge balance, encourage upper extremity independence, and provide the soldiers with an activity that they could accomplish prior to their injuries. This soldier was positively engaged in throwing and catching the ball and seemed to enjoy the activity.

Following the first riding lesson, all soldiers were asked to complete a questionnaire. In response to the first question, “Was the riding session what you expected?” the female soldier marked “no” and added that she enjoyed riding and learning about the “beautiful” horses and had expected to ride around in circles, but “the difference in positions [brought] a positive feel overall”(Mary Jo Beckman, chapter author and therapeutic riding instructor, personal review of the Ft Myer questionnaire, 2006).

During subsequent lessons, the female soldier learned to steer her horse through poles while practicing lateral weight shifting through her hips. The trotting sequences provided her with increased motion, which required more balance. As the rider established more control with her horse, she was allowed more independence. Her horse, Minnie, was receptive most of the time to the physical cues (pressing the knee into the side of the horse cueing a change in direction), otherwise known as body-aids. However, Minnie frequently challenged her rider by not listening to her physical cues, which meant the rider had to increase her aids to accomplish the task. This final understanding between horse and rider resulted in an increase in the rider’s sense of accomplishment.

As the lessons progressed, the rider’s position became more stable because her body was relaxed and followed the horse’s motion. Eventually, she developed the confidence and skills to ride independently. Because of her increased riding skills and abilities on the horse, the rider gained self-confidence, self-esteem, and determination. The change in her attitude and demeanor were observed by the Caisson Platoon soldiers and the instructor. Additionally, the hospital staff noted that because of her increased physical ability and association with the horses, she was more determined to proceed with her rehabilitation.

Additional Benefits and Rider Goals and Achievements

Because of the centralization of expensive high technology and specialty providers at tertiary care medical centers, families often have to leave their homes so that injured service members can receive required treatment. This separation causes significant stress for the patients and their families.[64] For example, the parent from the riding lesson story recounted earlier (the one who threw the ball to her daughter) did not live in the same city or state where the daughter received treatment. The parent had been with this soldier for most of the hospitalization and rehabilitation at the Walter Reed AMC, which was a major stressor and hardship. The parent also attended all of the riding sessions at Ft Myers. However, while here and talking with the Caisson Platoon leader at the first lesson, the parent noted a positive change in the daughter. The parent reported, “That’s the first time since she got back from Iraq that I’ve seen a smile on her face.”[65] With the daughter being more engaged and happier,[66] the parent’s stress and concern decreased.

In addition to stress relief for themselves and their families, goals for all riders participating in the pilot program are improved balance, development of core muscle strength and control, independent riding, and increased exercise. The end goal for therapy was for each of the students to be able to ride independently while the horse is walking and execute a drill team maneuver with three other riders.

In order to measure the physical progress of the riders in the pilot program, an occupational therapist administered the Timed Get Up and Go Test before and after each riding session. The Timed Get Up and Go Test measures mobility and includes a number of tasks such as standing from a seating position, walking, turning, stopping, and sitting down.[67]

More specifically, the test requires individuals to stand up from a standard chair and walk a distance of approximately 10 feet, turn around and walk back to the chair, and sit down again using their usual footwear and any assistive walking device they normally use. Individuals sit with their back to the chair and arms on the arm rests, holding any walking aid they use in their hands. Timing, using either a wristwatch with a second hand or a stop watch, begins when individuals start to rise from the chair and ends when they are once again seated in the chair. The normal time required to finish the test is between 7 to 10 seconds.[67]

Continuing with the example of the same female soldier used previously, this female soldier’s timing improved more than 42 percent over the course of 2 weeks: from 13.8 seconds to 7.9 seconds. (Table 6-4 details more of this soldier’s test results.) The female soldier also worked with the Ft Myer military veterinarian. A horse in the Caisson Platoon injured her hoof the evening before the first therapeutic riding class. The female soldier saw the horse when she was in the barn and asked the veterinarian about the injury. The veterinarian informed her about the wound and told her she could help change the dressing after her second ride.

Between the first and second lessons, the female soldier drew a picture of a horse’s hoof with all parts labeled to show the veterinarian and was able to assist in changing the wounded horse’s dressing. After the third ride, she worked with the veterinarian’s technician to review equine radiographs.

While the female soldier benefited physically from the therapeutic riding classes, her attitude and friendliness also changed as she realized her goal of becoming a veterinarian was still obtainable. Because of her increased physical ability, she developed more self-confidence and increased self-esteem. Once a shy and noncommunicative wounded individual, this soldier blossomed into a confident young lady. She rode in the weekly lessons at the Caisson Platoon until her medical discharge from the Army. She was also featured in some of the national television news segments representing the CPEAP, including The NewsHour.[68]

The riding program made a major difference in her outlook concerning her skills, abilities, and her life after the Army. After her medical discharge, she enrolled in a preveterinary and veterinary technician college program in North Carolina. In October 2009, this retired soldier returned from North Carolina to be one of two riders at the Washington International Horse Show during the CPEAP demonstration. She rode her favorite horse, Minnie.

TABLE 6-4.

ONE SOLDIER’S PRE- AND POST-RIDING THERAPY TEST RESULTS* USING TIMED GET UP AND GO TEST

19 May

Timed Up and Go Test* pre-riding

13.8 seconds

Timed Up and Go Test post-riding

10.6 seconds

Improved time

3.2 seconds

Single Leg Stance (right leg) pre-riding

43 seconds

Single Leg Stance (right leg) post-riding

137 seconds

Improved time

94 seconds

26 May

Timed Up and Go Test pre-riding

9.0 seconds

Timed Up and Go Test post-riding

7.9 seconds

Improved time

1.1 seconds

Single Leg Stance (right leg) pre-riding

119 seconds

Single Leg Stance (right leg) post-riding

134 seconds

Improved time

15 seconds

*Results from a 23-year-old female soldier who suffered amputation of her left leg from injuries she received in Iraq. Joe Butkus, an occupational therapist at the Walter Reed National Medical Center, administered the Timed Get Up and Go tests for the Caisson Platoon equine pilot program in 2006. A more detailed description of the Timed Get Up and Go Test used by this soldier and other patients during the duration of the pilot program can be found at http://www.fallprevention.ri.gov/Module3/sld006.htm.

Data courtesy of Mary Jo Beckman, chapter author.

CPEAP has also benefited numerous other patients, based on author and therapists’ recollections. Representative examples of the diverse kinds of patient improvements witnessed after hippotherapy appear below:

- A male soldier, with his right leg amputated above the knee, was having difficulty learning to use his prosthetic. After riding on a hard-surface road, his body equalized, instead of relying solely on his intact (dominate) left side. After the riding lesson, he returned to the clinic and went from using the parallel bars to walk—to using two canes—to only using one cane—all in a single week, a notable improvement.

- A female officer with the diagnosis of PTSD rode numerous times in 2011. She had never been on a horse before joining the CPEAP. During four of her lessons, she suffered flashback episodes due to unexpected noises at Ft Myer. After each episode, she praised her horse for “being there” for her and allowing her to return to the present very quickly.

- In July 2009, an adaptive horse-drawn carriage ordered from Europe arrived with a built-in wheelchair ramp. In 2010 and 2011, Caisson Platoon soldiers, certified by the Carriage Association of America Driver Proficiency Program, assisted a veteran with a TBI learn to drive again using this carriage. The veteran could perform the correct automobile driving reactions when using a computer; however, this simulation did not translate to being behind the wheel. By driving a horse carriage around Ft Myer, the veteran was put in a more realistic environment, which made it easier for him to transfer his “horse-driving” skills to appropriate and proper decisions on real highways.

As of December 2011, the CPEAP at Ft Myer had provided equine experiences to almost 80 wounded service members and others undergoing rehabilitative services at WRNMMC and the local Veterans Administration Medical Center, Washington, DC. In April 2012, the Army moved the CPEAP to a section of land on Ft Belvoir, Virginia, which had previously been used by the Caisson Platoon for training and resting the horses. Service members diagnosed with TBIs and receiving care at Ft Belvoir Community Hospital were referred to the program. Of this population, the most common subjective reports to the physical therapists included reduced pain levels, better coordination, improved memory, and peace of mind. A June 2012 report from the Old Guard Public Affairs Office updated the numbers treated by the therapeutic riding program to approximately 175 service members.[69]

The Way Forward

CPEAP was highly successful, partly because of the lessons that have benefited the participants, but also because of the commitment of all who supported the program (Figure 6-14). The camaraderie before, during, and after the CPEAP lessons proved to be immensely positive for active duty and veteran soldiers, and CPEAP’s “soldier helping soldier” concept is one of the cornerstones of many military and civilian therapy programs. The international publicity generated by CPEAP activities also brought increased awareness of the value and benefits of the equines.

Figure 6-14. Ryan Kules, who works for the Wounded Warrior Project and supports the hippotherapy program, sits atop his horse awaiting riding lessons to begin. Warriors like Kules appreciate the chance to visit with other soldiers and veterans during the equine-assisted therapy sessions.
Photo courtesy of Larry Pence, chapter author.

In fact, the results of the publicity allowed existing Professional Association of Therapeutic Horsemanship (PATH) International centers to establish Equine Services for Heroes (formerly North American Riding for the Handicapped Association Horses for Heroes) programs. One program in Illinois is servicing five veterans’ centers and has over 50 veterans participating weekly. In 2012, the Wounded Warrior Project partnered with PATH International to provide grant money for veterans injured after 9/11 to benefit from equines. PATH International is now able to help more than 5,500 veterans and active-duty military personnel with physical, cognitive, and emotional challenges find strength and independence through the power of the horse each year.[70]

The legacy of the CPEAP (Soldiers and Horses—Helping Soldiers, Now and in the Future) has been very positive and rewarding. Looking forward, more research must be accomplished to document the equine-assisted benefits for the wounded military members and veterans. Testimonials from participants are powerful and heart-warming; however, senior military and Department of Veterans Affairs leaders need data, statistics, and empirical objective evidence in order to promote this alternative therapy model. (For more information about other ways the military used and continues to use horses and other equines to benefit military and civilian populations, see Chapter 8, Military Equine Programs.)

CONCLUSION

There has been a huge increase in interest and programs designed to help wounded warriors throughout the DoD. Numerous nongovernment organizations have developed as well to help assist America’s wounded personnel. When the assistance is physical, the results are usually quite obvious in how the animals (usually dogs) help individuals cope with their physical disability. However, when the assistance stems from a mental or psychiatric disability, the results may be more challenging to document.

Often, substantial amounts of “anecdotal” evidence associated with such programs exist, but little hard, clinical data can be documented. For example, there are a multitude of benefits associated with human and companion animal interaction. A 2008 literature review by Barker and Wolen reported that humans will generally benefit across the whole spectrum of interaction from simple ownership to participation in defined AAA and AAT programs.[71] While most of the published studies in this review were descriptive and conducted with convenience samples, a promising number of controlled studies also supported the health benefits of the human-animal interaction.

Still, there is a tremendous need for more objective research in the animal-assisted therapies. Additionally, there may be more subtle benefits that may be objectively measured via lower drug dosages or blood cortisol levels, which could be investigated as possible adjuncts to conventional therapies in pain management. For example, recent findings show that blood oxytocin levels rise in both animals and people as the animals and humans interact with each other.[72] Oxytocin is thought to be associated with pair bonding and a reduction in fear or anxiety.

Another area of investigation with possible far-reaching implications is the human-animal bond effect as a broad alternative to conventional direct pain relief. Using a multidisciplinary approach, the human-animal bond programs associated with animal-assisted therapy may offer significant help for select patients to minimize pain. For example, the activity of caring for animals, both small and large, assists people with arthritis by providing activities that requires them to move about (eg, walk a dog or feed a horse). Some patients may have a greater pain tolerance while in the company of live animals.

Finally, there is a definite role for companion animals in the treatment of US military personnel in multiple treatment venues. Involving the animals as an adjunct to traditional treatment modalities has been shown to have positive psychological and physical benefits for some patients during the healing process. However, as the Barker and Wolen article points out, there are still many knowledge gaps and challenges within the human-animal bond field regarding specific therapeutic benefits.[71] Although much of the evidence that supports the use of animals is anecdotal, the limited empirical data collected thus far has yielded promising results. Future research employing more rigorous designs and systematically building upon a clearly defined line of inquiry is needed to advance knowledge of the benefits of human-companion animal interaction.

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56.   Strandquist J. Stabilizing the rider-handling techniques to improve the base of support in sitting. In: BT Engel, ed. Therapeutic Riding II Strategies for Rehabilitation. Durango, CO: Barbara Engel Therapy Services; 1997: 171-179.

57.   Guernsey K. The therapy horse: an integral player. The Horse. March 1, 2006. http://www.thehorse.com/articles/15989/the-therapy-horse-an-integral-player [limited access site]. Accessed July 19, 2013.

58.   Bauer JJ. Riding for Rehabilitation: A Guide for Handicapped Riders and Their Instructors. Toronto, Canada: Canadian Stage and Arts Publication Limited; 1972.

59.   Mayberry R. The mystique of the horse is strong medicine: riding as therapeutic recreation. Rehabil Lit. 1978;39:192-196.

60.   Tuttle JI. The horse as member of the therapeutic team. Rehabil Nurs. 1987;12:334-5.

61.   Freeman G. Hippotherapy/therapeutic horseback riding. Phys Ther. 1984;8:30-32.

62.   Wingate L. Feasibility of horseback riding as a therapeutic and integrative program for handicapped children. Phys Ther. 1982;62:184-6.

63.   Brown PW. Rehabilitation of bilateral lower-extremity amputees. J Bone Joint Surg Am. 1970;52:687-700.

64.   Agazio JB, Ephraim P, Flaherty NJ, et al. Effects of nonlocal geographically separated hospitalizations upon families. Mil Med. 2003;168:778-83.

65.   Burgess L. Been through the desert, now on a horse. Stars and Stripes. June 5, 2006. http://www.stripes.com/news/wounded-veterans-get-back-in-the-saddle-1.49936. Accessed May 3, 2016.

66.   Shapiro TR. Riding toward recovery: caisson horses help injured vets get on with life. Washington Post. In: Stars and Stripes. January 11, 2010. https://www.stripes.com/. Accessed June 21, 2017.

67.   Rhode Island Government Fall Prevention. Fall prevention “train the trainer” manual, module 3: developing a fall prevention program, 2004. http://www.fallprevention.ri.gov/Module3/index.htm. Accessed September 2, 2013.

68.   Lehrer J. Ski therapy helps healing process for war veterans. The NewsHour. Washington, DC: PBS; January 9, 2007. http://www.pbs.org/newshour/bb/health-jan-june07-ski_01-09/. Accessed May 4, 2016.

69.   Brooks L. Caisson therapeutic riding program moves to Belvoir. The Old Guard Public Affairs Office online press release. June 19, 2012. https://www.army.mil. Accessed June 21, 2017.

70.   PATH International. Professional Association of Therapeutic Horsemanship International. http://www.pathintl.org/. Accessed June 9, 2017.

71.   Barker SB, Wolen AR. Historical perspective: the benefits of human-companion animal interaction: a review. J Vet Med Educ. 2008;35:487-95.

72.   Olmert MD. Made for Each Other: The Biology of the Human-Animal Bond. Cambridge, MA: Lifelong Books/Da Capo Press; 2009.

Chapter 7

MARINE MAMMAL PROGRAM

KAMALA J. RAPP-SANTOS, DVM, MPH, DACVPM*

INTRODUCTION

HISTORY AND BACKGROUND OF THE MILITARY MARINE MAMMAL PROGRAM

The Evolving Marine Mammal Program

The Evolving Roles of Marine Mammals in the Program

The Evolving Roles of Military Veterinarians in the Program

CURRENT MILITARY OBJECTIVES AND MISSIONS IN THE MARINE MAMMAL PROGRAM

Marine Mammal Systems Using Bottlenose Dolphins

Marine Mammal Systems Using California Sea Lions

Healthcare Research Furthering Marine Mammal Understanding

PREVENTIVE MEDICINE FOCUS FOR MILITARY MARINE MAMMAL HEALTH

Physical Examinations and Health Monitoring

Sanitation and Nutrition Oversight

Data and Tissue Collection and Management

Deployment Support

Development of Advanced Clinical Technology

Environmental Health Monitoring

Emphasis on Education

CURRENT RELEVANT MARINE MAMMAL DISEASES

Respiratory Disease in Dolphins

Ocular Disease in Sea Lions

Metabolic Conditions in Dolphins

Gastritis in Dolphins and Sea Lions

SUMMARY

*Major, Veterinary Corps, United States Army; currently, Laboratory animal medicine resident at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland 21702; formerly, Captain, Veterinary Corps, US Army, Clinical Veterinarian, US Navy Marine Mammal Program, San Diego, California

INTRODUCTION

The US Navy Marine Mammal Program (MMP), located in San Diego, California, maintains a large population of military working bottlenose dolphins (Tursiops truncatus) and California sea lions (Zalophus californianus). This unique group of animals provides rapidly deployable support for mine warfare countermeasures, swimmer defense, and object recovery in support of expeditionary amphibious warfare training missions.[1] Many of the tasks marine mammals perform resemble what military working dogs (MWDs) are trained to do. However, rather than using sense of smell to carry out their missions as canines often do, marine mammals rely on their other senses and unique physiological adaptations (eg, sonar, for dolphins; underwater directional hearing and low-light vision, for both dolphins and sea lions). Trained and certified marine mammals are assigned to a Marine Mammals System (MMS) that includes four to six highly trained animals with a specific set of behaviors, hardware, and personnel.[1]

The MMP veterinary medicine program provides the best possible veterinary care through continued application of advanced knowledge, methods, and equipment, despite the challenges of marine mammal medicine. For example, dolphins and sea lions rely on an evolutionary survival strategy to avoid predation by masking illness or injury. As such, routine physical examinations by skilled veterinarians and daily observations by practiced animal trainers must be employed to rapidly detect subclinical conditions. Additionally, important and routine aspects of terrestrial veterinary medicine such as indwelling catheters, splinting, and casting, along with surgery, are made difficult, if not impossible, because of the animals’ aquatic lifestyle. To help advance marine mammal medicine and overcome such challenges, the program continues to perform cutting-edge research of global significance.

This chapter reviews the history of the MMP and highlights different roles that marine mammals fill in the US Navy. It also briefly explains the current use of US Navy marine mammals, including their role in enabling research; outlines the different components of a comprehensive seven-part preventive medicine program; and covers selected marine mammal diseases currently relevant to the population.

HISTORY AND BACKGROUND OF THE MILITARY MARINE MAMMAL PROGRAM

The US military has recognized the value of working animals ever since the 18th century when General Washington directed that a “regiment of horses with a farrier” be raised.[2] War dogs were widely used by the Egyptians, Greeks, Persians, Romans, and other ancient civilizations and are still widely used today by the military for patrol and detection work.[3] Marine mammals represent a unique population of working animals with highly specialized skills that have contributed to US Navy programs for over 50 years.[4] (See Chapter 8, Military Equine Programs, and Chapter 2, Military Working Dog History, for more information about equine and canine military service missions, respectively, throughout US history. See Chapter 1, Military Veterinary Support Before and After 1916, for more historical background on all US military working animals.)

Veterinarians have partnered with the US Navy since the program’s inception in 1959. Dr Sam Ridgway, then a veterinary officer in the US Air Force, became involved in marine mammal medicine when Navy scientists approached him about their interest in using dolphins for Navy science. In the mid-1900s, veterinarians occasionally worked on marine mammals in zoos and aquariums, but when he accepted a position in 1962 with the Naval Missile Center at Point Mugu, California, Dr Ridgway became the first person to begin a full-time career in marine mammal medicine (Figure 7-1).[5]

The program has grown significantly since 1962 and has become a world leader in military applications of marine mammals as well as marine mammal health and welfare. These following three sections provide an overview of the history of the program, detail the different roles that marine mammals have filled throughout the years, and explain how US Air Force and Army veterinary personnel have provided support.

The Evolving Marine Mammal Program

Today, the MMP is attached to the Space and Naval Warfare Systems Center Pacific. Over the past 50 years, the Space and Naval Warfare Systems Center Pacific has had several name changes, including the Naval Undersea Center, Naval Ocean Systems Center, and Space and Naval Warfare Systems Center San Diego. However, most of the early marine mammal investigations took place at the facility in Point Mugu, California. In 1960, the US Navy acquired a Pacific white-sided dolphin named Notty to conduct hydrodynamic studies. Navy scientists were primarily interested in studying the special characteristics that contributed to dolphins’ hydrodynamic efficiency, with the goal of applying these characteristics to design US Navy vessels.4,5

Figure 7-1. Dr Sam Ridgway, now the senior scientist with oversight of the veterinary and research program at the US Navy Marine Mammal Program, gives a visual cue to a beluga whale.
Photo courtesy of the US Navy.

These earliest studies proved to be of limited value but soon evolved to include study of the marine mammals’ specially developed senses and capabilities (eg, sonar and deep-diving physiology) and how marine mammals might be employed to perform useful underwater tasks. A major accomplishment was the demonstration that trained dolphins and sea lions could work untethered in the open sea with great reliability. In 1965, a Navy dolphin named Tuffy participated in the Sealab II project off La Jolla, California, carrying tools and messages between the surface and aquanauts operating out of the habitat 200 feet below (Figure 7-2).[5]

In l968, some of the animals and personnel were transferred from Point Mugu to a new laboratory in Hawaii at the Marine Corps Air Station on Kaneohe Bay. The research in Hawaii focused on the following topics: (a) behavioral studies; (b) reproductive physiology; (c) further study of the dolphin echolocation system; and (d) investigation of the potential of marine mammals for performing underwater tasks more efficiently, safely, and cost effectively than is possible using human divers or submersibles.[4]

The rest of the operation later moved to a new facility on Point Loma. Here, the research and development program continued and included further studies of the following topics: (a) capabilities of marine mammals; (b) development of improved techniques for diagnosis and treatment of diseases; (c) neurophysiologic studies using behavioral and other noninvasive techniques to gain a better understanding of how the large dolphin brain functions; (d) development of instrumentation for determining by brain wave activity the hearing range of a cetacean; and (e) investigation of how dolphins produce the sounds they make.4,5

The Evolving Roles of Marine Mammals in the Program

At Kaneohe Bay, Hawaii, under the Advanced Marine Biological Systems Program, the initial four MMSs were developed.[4] These included the Mark (MK) 4, MK 5, MK 6, and MK 7 systems. Because of the unique capabilities of marine mammals, dolphins and sea lions were trained to perform a variety of tasks, including underwater surveillance for object detection, swimmer defense, and mine countermeasures. The MK 6 swimmer defense system was deployed to Vietnam in 1970 to 1971 and successfully protected the US Army ammunition pier at Cam Rahn Bay from all underwater attacks.1,4 This defense system was again called to duty in Bahrain during Operation Earnest Will in 1987 to 1988 and in San Diego during the 1996 Republican National Convention.[4]

Figure 7-2. Tuffy the dolphin participating in the project Sealab II, in which he repeated dives to 200 feet to deliver mail and tools to the divers below. Tuffy was also trained to guide lost divers to safety.
Photo courtesy of the US Navy.

In 1993, because of a Base Closure and Realignment Commission action, the Hawaii laboratory was closed, and the majority of the animals and personnel moved to San Diego (Figure 7-3). The consolidation of support activities was paralleled by a reduction and consolidation of Fleet MMS to San Diego during the same period. The program was also declassified in the early 1990s. The MMP was first accredited by the Association for Assessment and Accreditation of Laboratory Animal Care (now the AAALAC International) in 1995.[4]

In 1996, the MMP was directed to cease further downsizing and pursue the development of new MMSs and enhancements. As a result, the program developed new shipboard forward deployment capabilities and added a fifth type of MMS—MK 8—in October 2001.1,4

The terrorist attacks on the USS Cole in 2000 and against the US homeland in September 2001 brought dramatic change to the United States and the US Navy, and the MMP responded. The successful and continuous employment of the MK 6 MMS at home during Operation Noble Eagle in 2001 to 2003 was followed immediately by simultaneous deployments of multiple MMSs to Iraq, Kuwait, and Bahrain during Operations Enduring Freedom and Iraqi Freedom.1,4

Figure 7-3. The US Navy Marine Mammal Program, located in San Diego Bay, houses marine mammals in open-water netted enclosures. This arrangement provides easy access to the work sites and also offers the animals enrichment and the ability to communicate with each other.
Photo courtesy of the US Navy.

MMP military and civilian personnel, dolphins, and sea lions traveled to the northern Arabian Gulf and served on the front lines of the war on global terrorism. MMSs played a key role in ensuring that the Iraqi ports of Umm Qasr and Az Zubayr were clear of sea mines and other potential hazards, allowing much needed food and medical aid to reach the Iraqi people early in the conflict. MMS dolphins and sea lions also helped to protect coalition forces from the threat of underwater attack and remained in theater and on duty from 2003 to 2005.[4]

These missions were highly successful because of the outstanding performance of MMP dolphins and sea lions and the efforts of many individuals, from those few who themselves ventured into harm’s way, to the hundreds of others who supported them. Current tasking for MMSs to provide continuous underwater security at naval installations in Kings Bay, Georgia, and Naval Base Kitsap-Bangor in Washington State suggest that the MMP will be called on to continue a period of unprecedented activity through the Future Years Defense Plan.[4]

Figure 7-4. A photograph taken earlier than Figure 7-1, featuring Dr Sam Ridgway, who served as the first marine mammal veterinarian for the US Navy Marine Mammal Program. Since he started full-time work in marine mammal medicine in 1962, Ridgway has conducted numerous studies on physiology and neurology, including a study in which he demonstrated right-eye preference in dolphins.
Photo courtesy of the US Navy.

Figure 7-5. Brigadier General Michael Cates (now retired), previously assigned as an Army captain to support the marine mammal facility in Hawaii, visits with one of the US Navy Marine Mammal Program sea lions.
Photo courtesy of the US Navy.

The Evolving Roles of Military Veterinarians in the Program

In addition to Dr Sam Ridgway, who holds the distinction of being one of the pioneers of marine mammal physiology and medicine (Figure 7-4), many other US military veterinarians have played key roles throughout MMP’s history.[5] One of the earliest Air Force veterinarians, Major Donald Van Dyke, contributed significantly to the study of diet formulations and rations for marine mammals.[6] Many other Air Force veterinarians continued to assist the MMP mission, contributing to the understanding of marine mammal nutrition, physiology, and medicine and supporting deployments and exercises. For example, Air Force veterinarians supported Operation Earnest Will in the Persian Gulf from 1986 to 1988, deploying with several dolphins on mine-hunting and swimmer defense missions.[4]

In 1980, when the Air Force Veterinary Corps was disestablished, the US Army became the service branch that provided all DoD veterinary services.[2] In the late 1980s, the MMP program began receiving support from the Army Veterinary Corps. Captain Michael Cates, who was assigned to the Hawaii laboratory in the 1980s, contributed to understanding blastomycoses in bottlenose dolphins.[7] Cates would later be promoted to Brigadier General and serve as Chief of the US Army Veterinary Corps from 2005 to 2008 (Figure 7-5).[8]

Army Captain Richard Linnehan was assigned to the program in 1989, contributing to research in the areas of cetacean and pinniped anesthesia, orthopedics, drug pharmacokinetics, and reproduction.9,10 Toward the end of his tour, he was selected by NASA to attend astronaut candidate training and went on to participate in four space flights, including a mission to the Hubble Space Telescope.[11]

When the Hawaii laboratory closed in 1993, the mission of the US Army veterinarians shifted back to San Diego. Army veterinarians again supported marine mammals deployed to Bahrain in Operations Enduring Freedom and Iraqi Freedom. With the establishment of two satellite facilities, Army veterinarians played a critical role in providing veterinary support at remote sites.[4]

Because of its broad mission, the MMP also has benefited from the wide range of experience and knowledge that other US Army veterinarians have contributed over the years. Alumni include experts in virology, pathology, laboratory animal medicine, public health, nutrition, physiology, and many fields. These Army veterinarians contributed to research, publishing articles that cover a wide range of topics from nutrition, infectious disease, anesthesia, pharmacology, physiology, internal medicine, and radiology. They participated in numerous deployments and exercises, forged relationships with other military medical personnel, and established policies and standard operating procedures. US Army veterinarians also manage the fish procurement program and maintain regulatory requirements needed for the MMP research program. The value that Army Veterinary Service personnel add to the MMP is substantial and will continue for as long as the need is present (Figure 7-6).

Figure 7-6. Group photograph of a unit of US Army veterinary personnel, typical of the Army personnel that provide daily, round-the-clock support to the US Navy Marine Mammal Program.
Photo courtesy of the US Navy.

CURRENT MILITARY OBJECTIVES AND MISSIONS OF THE MARINE MAMMAL PROGRAM

The primary objective of the MMP is to operate and maintain in-service MMS readiness. In support of this mission, the Biosciences Division of the Space and Naval Warfare Systems Center Pacific is designated as the lead laboratory for all US Navy-sponsored programs that involve the acquisition, transport, care, and maintenance of marine mammals.[12] This laboratory is charged with the duty to “ensure that all naval marine mammals receive the highest quality of humane care and maintenance per all applicable laws and regulations.”12(p3) As a supporting objective, the laboratory also participates in a variety of research focus areas that contribute to the understanding of marine mammals.[13]

Currently, the unique capabilities of marine mammals that contribute to the US Navy mine and undersea warfare missions cannot be matched by existing technology, despite significant efforts and upgrades. Often, the varied underwater terrain present in harbors, rivers, and shallow water provides significant challenges to the marine mammals’ technological counterparts. Until technology advances further, marine mammals will continue to perform required operational capabilities.[13]

Marine Mammal Systems Using Bottlenose Dolphins

Each MMS consists of animals that have been trained and certified to performance specifications for that particular task, dedicated personnel, and equipment needed to perform the mission and operate forward deployed from shore or aboard ship. Three MMSs are currently operational to perform tasks that cannot be accomplished by hardware or human divers, including two systems that operate at satellite facilities. All but one system includes bottlenose dolphins.

Bottlenose Dolphin Physiology

The common bottlenose dolphin (Tursiops truncatus) is classified in the infraorder Cetacea (carnivorous, finned, aquatic marine mammals) and belongs to the family Delphinidae, which includes over 30 species of toothed whales.14(p298) They are characterized by a medium-sized, robust body, moderately falcate dorsal fin, and dark coloration, with sharp demarcation between the melon and short rostrum.14(p250) They are typically colored light gray to black, dorsally and laterally, with a light belly. Many scientists recognize several subspecies, including the Atlantic bottlenose dolphin (Tursiops truncatus) and the Pacific bottlenose dolphin (Tursiops truncatus gilli), which tend to be slightly larger and with darker pigment.14(p250) Most dolphins from the MMP are Atlantic bottlenose dolphins, but the program does maintain some T. gilli hybrids.

One of the most unique and well-known adaptations of dolphins involves their sophisticated echolocation abilities. Dolphins have evolved the ability to produce focused high-frequency clicks and listen for echoes that bounce off small objects to locate obstacles and prey. A 1980 study demonstrated that dolphins can detect a 2.5 cm metal target about 72 m away.[15] The dolphin brain has subsequently evolved for rapid auditory processing and can integrate this high-frequency energy over an interval of about 0.25 ms.[16]

Dolphins are also especially adapted for exceptional aquatic locomotion and diving. They have replaced long limbs and small feet characteristic of terrestrial mammals with a markedly reduced appendicular skeleton, streamlined bodies, and enlarged propulsive appendages.17(pp73-76) In addition, they have evolved the ability for prolonged breath holding and thus submerged swimming, where drag forces have least impact. They routinely swim at 2 to 4 meters per second, with sprint speeds reaching 10 meters per second.14(p1143)

In order to dive, marine mammals have also developed some unique methods for dealing with lack of oxygen and increased pressure underwater. Total oxygen stores of marine mammals often exceed two to three times that of terrestrial mammals.14(p328),18 Dolphins and other deep diving marine mammals use skeletal muscles and blood, rather than lungs, as the primary oxygen storage site to support aerobic metabolism during diving.14(p328) They also have increased myoglobin concentrations in the muscles, in addition to changes in blood volume, hemoglobin concentration, and respiratory volumes.14(pp328-329),17(pp79-86) Their unique “dive response” includes breath-holding, bradycardia, and peripheral vasoconstriction in order to decrease oxygen demand to peripheral tissues.17(p83) During the dive, the lungs and airways collapse in response to the hydrostatic pressure, enabling them to avoid buildup of nitrogen and subsequent decompression sickness when resurfacing.[18]

Bottlenose Dolphin Operational Systems

US Navy dolphins participate in two out of three operational systems, focusing on two main areas of interest: mine countermeasures and force protection operations. All systems can be ready to deploy within 72 hours of notice, at any time, to virtually any location in the world. Teams of animals and personnel, including all their equipment and supplies, must be rapidly transported by aircraft, helicopter, land vehicles, or ships to the work site, get set up, and get to work quickly. MMSs have the ability to deploy to extreme environments, from areas as warm as Bahrain in the summer and as cold as Alaska in the winter. Once they arrive to their destination, dolphins are housed at shore facilities in floating enclosures or aboard amphibious assault ships or other ships of opportunity in specially designed inflatable shipboard dolphin pools.

Mine Countermeasures Operations. One operational system, MK 7, employs dolphins to search for, detect, mark, and neutralize mines. Using their sensitive biosonar, they operate in water depths up to 1,000 feet. The dolphins are particularly suited for precision mine hunting in difficult, highly cluttered acoustic environments of the near shore zone. They play an important role in securing ports and harbors for the US Navy and currently provide the Navy’s only capability for detecting, marking, and neutralizing buried mines (Figure 7-7).[4]

MK 7 utilizes dolphins to detect and neutralize proud and buried bottom mines in shallow water. This system has been enhanced to include moored mine capabilities and minefield mapping, and to expand its operational area into very shallow water.

Force Protection Operations. Both dolphins and sea lions are trained in force protection operations and operate as the “patrol dogs of the sea.” They have helped to mitigate threats of underwater attack for 40 years, beginning with the defense of the ammunition pier at Cam Rahn Bay, Vietnam, in the early 1970s.[4] US Navy dolphins and sea lions also play an essential role as an operational underwater security component at US submarine bases in Georgia and the state of Washington.

Figure 7-7. A US Navy dolphin, trained to detect sea mines and other submerged, unexploded munitions, leaps into the air in Montenegro’s Strait of Verige during Operation Dolphin 2012. Photo courtesy of the US Navy.

Force protection operations are carried out day or night and in all environmental conditions. Using its superior biological sonar, the dolphin can search off the bow of the patrol craft for intruders. Once detected, the dolphin reports the presence of a swimmer or diver and localizes the position of the threat. Dolphins also can detect and localize intruders in and around piers, ships, and pilings and on various diving modes such as re-breather, scuba, or breath hold.

Bottlenose Dolphin Fleet Support

Animals not assigned to a MMS Service Unit or designated as a certified replenishment animal are given the designation of fleet support. These animals include breeding female dolphins; dependent and weaned dolphin calves; young animals working toward MMS certification (Figure 7-8); and animals involved in enabling research related to deployment, clinical research, biosonar, and environmental compliance. The MMP acquires new dolphins from the in-house breeding program as well as from loans with other institutions or participants in the National Oceanic and Atmospheric Association Marine Mammal Stranding Network, a nationwide network consisting of members that respond to marine mammal strandings.

Figure 7-8. A female bottlenose dolphin guides her new calf. The US Navy Marine Mammal Program manages a successful breeding program to provide replacement dolphins for the Navy’s Marine Mammal Systems.
Photo courtesy of the US Navy.

Marine Mammal Systems Using California Sea Lions

California Sea Lion Physiology

The California sea lion (Zalophorus californianus) belongs to the family Otariidae, which includes fur seals and sea lions.14(pp861-862) Otariids are distinguished from other pinnipeds (seals and walrus) by their external ear flaps, large hind flippers that can be rotated under their body to support weight, and long, sparsely haired foreflippers with vestigial nails.17(p14) Their flipper structure allows them more mobility on land. California sea lions, like other otariids, are sexually dimorphic. The males are longer and up to three times heavier than females and develop a raised forehead with prominent sagittal crest on the skull.14(p170),17(pp14-15) Like other marine mammals, sea lions are adapted for exceptional aquatic locomotion. Their body and appendages are streamlined to reduce drag forces during swimming. They have also adapted a dive response and have been shown to hold their breath for up to 16 minutes.[13]

Unlike dolphins, sea lions do not use a sonar system to locate objects. Instead, they rely on their exceptional ability to see underwater in low-light situations. They also use directional hearing, though their ability to determine the sound source is not as sensitive as that of dolphins. Finally, as an adaptation to cold temperatures in aquatic environments, sea lions rely on a combination of an external fur layer and an underlying blubber layer to keep warm.17(p84)

Sea lions have a good disposition and are very trainable for tasks such as object detection, location, marking, and recovery. The MMP currently uses male castrated sea lions. Castration may improve health with regard to certain disease conditions, reduces aggressive behaviors, and reduces development of secondary sexual characteristics. Sea lions are highly food-motivated, and fish serve as the primary positive reinforcement for most behaviors.

California Sea Lion Operational Systems

US Navy sea lions participate in tasks involving both force protection and hardware recovery. Just like the dolphin systems, sea lion systems must be ready to deploy within 72 hours. During deployments and exercises, they may be housed at shore facilities, in land-based enclosures, or aboard ships in specially designed sea lion pens.

Force Protection Operations. Like their dolphin counterparts, US Navy sea lions provide port security operations. Sea lions naturally inhabit open water; areas under wharfs and piers; and along shorelines, rock walls, and quarry walls, and other places that limit the use of hardware systems. They have excellent low-light vision, passive acoustic detection, and agile mobility that allow them to detect and mark an intruder in total darkness. Sea lions may work autonomously, searching specified areas for intruders, or may be directed to specific locations to pinpoint and classify targets acquired with other assets such as anti-swimmer sonar systems.

Object Recovery Operations. Sea lions also participate in the MK 5 system to locate and attach recovery hardware to underwater objects (eg, practice mines or instrumented hardware) that the US Navy has fired or dropped into the ocean.[19] Although human divers may recover these items, they are limited by depth; poor visibility; currents; and the requirements for medical personnel, a recompression chamber, and other surface support. In contrast, the sea lion recovery system consists of a small rubber boat, a sea lion, and two or three handlers.

When the boat arrives at the approximate position of the object, the sea lion begins searching the area. If the sea lion searches and then reports the presence of an object, it is given a bite plate to which an attachment device is mounted (Figure 7-9). A strong line tied to this device is payed out from the boat as the sea lion swims down and attaches the device to the object. To be sure the connection is good, the sea lion tests it by pulling back on the line a few times. The sea lion then returns to the boat, and a crane is used to pull the object off the bottom. The sea lions can also carry a tethered underwater video camera down to the object, providing surface personnel a real-time view of unknown targets reported by the mammals.

Figure 7-9. A California sea lion assigned to the MK 5 system attaches recovery hardware to an underwater target. Once the hardware is attached, the sea lion returns to the boat and a crane is used to pull the object to the surface.
Photo courtesy of the US Navy.

MK 5 became operational in 1975 and has been in use since that time. It boasts a recovery success rate in excess of 95% for objects in water depths up to and exceeding 1,000 feet.[4]

California Sea Lion Fleet Support

Similar to the dolphins, sea lions that are not assigned to a MMS Service Unit or designated as a certified replenishment animal are given the designation of fleet support. This category includes sea lion pups, young animals working toward certification, and animals involved in enabling research.[20]

The US Navy is committed to providing care to all of its marine mammals for the duration of their natural lives. Similar to MWDs or military police dogs and the dolphins in the MMP, US Navy sea lions are cared for by a professional staff, including at least one veterinarian and veterinary technician who are on call at all times. When not deployed, US Navy sea lions live in social groups of four to five animals, and are housed in floating enclosures that provide natural bay water and a combination of shade and sunshine. When not on patrol or recovery operations with their trainers or handlers, their days are filled with training and enrichment activities, as well as ample opportunity to rest. They swim and dive in the open ocean every day.

US Navy sea lions typically live into their late 20s, three times as long as their wild counterparts. Very few animals retire from service in the MMP. As expeditionary animals grow older, and the rigors of deployment become more difficult for them, the US Navy considers assigning them to duty at submarine bases where they can continue to serve without traveling. The oldest sea lions live out their last years in familiar surroundings at the MMP’s facility in San Diego and spend time socializing with the programs’ youngest pups. US Navy animals are only euthanized in the face of debilitating terminal illness when, in the judgment of the attending veterinarian, the animal’s quality of life can no longer be maintained. The MMP uses only castrated male sea lions that are acquired from zoos and stranding network participants or collection from the wild in accordance with 10 US Code 7524.1,20,21

Healthcare Research Furthering Marine Mammal Understanding

The MMP has pioneered much of the research responsible for the current knowledge about marine mammals and their healthcare, and the program’s spirit of commitment to advancing marine mammal wellness continues today. With over 1,000 publications, the MMP is the single largest contributor to open scientific literature on marine mammals.[4] The MMP, which is accredited by the AAALAC International in accordance with DoD regulations, was the first DoD nonbiomedical animal use program to be accredited and continues to receive exemplary evaluations from AAALAC International and DoD program reviews and facility inspections.[22]

Clinical research is essential for maintaining the readiness of the MMP’s various marine mammal systems. Clinicians are continuously seeking to improve the ability to detect, diagnose, treat, and prevent marine mammal illnesses. Most recently, the MMP’s research program has focused on several topics of high priority, including improved geriatric care, common infectious and metabolic diseases, advanced medical technologies, protection against disease, and applying the One Health concept to benefit both animals and humans.[19]

Aging Research

Dolphins and sea lions at the MMP benefit from a lifespan that, on average, exceeds that of their wild counterparts by more than 10 years.[23] Thus, the goal of research on aging is to increase the quality and duration of life for working geriatric animals. Aging research with US Navy dolphins has demonstrated that dolphins are more likely to have hypercholesterolemia and chronic inflammation as they aged past 30 years, which resembles changes that are seen in aging humans.[24] By comparing with research in human aging, the US Navy hopes to understand the cause of chronic inflammation and dyslipidemia in older animals and develop means to prevent and treat these conditions.

Pneumonia

In general, dolphins are especially susceptible to pneumonia.[25] For Navy dolphins, advanced age is a significant risk factor for pneumonia.[26] Thanks to routinely implemented molecular diagnostics and use of ultrasound-guided sampling of lesions, rapid and accurate detection methods for viral, bacterial, and fungal infections in marine mammals are rapidly improving.

Figure 7-10. To better understand pulmonary function, this dolphin is participating in a noninvasive pulmonary function evaluation. The elastic resistance bands are loosely placed around the dolphin’s chest to measure the expansion of the ribs and diaphragm during respiration.
Photo courtesy of the US Navy.

Limitations of pathogen detection that are present in traditional domestic animal and human medicine, however, also exist for marine mammals. Current methods being investigated to improve disease diagnosis include advancements in digital imaging, characterization of noninvasive breath condensate metabolites, and predictive models for disease onset and outcomes.[13] Some dolphins and sea lions have participated in pulmonary function tests, with the goal of improving understanding of pulmonary diseases and anesthesia (Figure 7-10).

Metabolic Conditions

Health data from US Navy dolphins has demonstrated that dolphins can develop a subclinical condition similar to metabolic syndrome in humans, including elevated insulin, glucose, and triglycerides and associated iron overload and fatty liver disease.[27]-[30] In addition, dolphins can develop ammonium acid urate kidney stones, a condition present in an estimated quarter of the US Navy’s dolphin population.[31] Current research, including genomics, proteomics, and metabolomics, is focusing on potential dietary, genetic, and environmental factors that may influence these metabolic conditions in dolphins.[28]

Advanced Medical Technologies

The most significant challenge associated with providing clinical care to marine mammals concerns their unique in-water environment and the specialized anatomy and physiology developed by these animals to cope with living in the ocean. For example, major surgery such as exploratory laparotomy has been limited due to challenges the marine environment creates for postoperative care and proper wound healing. Currently, several institutions are working with the MMP to evaluate the use of minimally invasive surgery in marine mammals. Advanced medical technologies that are currently being incorporated into clinical care include computed tomography scans or CT, magnetic resonance imaging or MRI, renal scintigraphies, interventional radiology, and laparoscopy. Safe and successful use of general anesthesia, including techniques for invasive and noninvasive blood pressure monitoring and blood gas monitoring, are also high clinical priorities. The program has performed successful anesthesia for several dolphin cases and has developed the expertise to place arterial catheters in both dolphins and sea lions to monitor blood pressure and other parameters.

Disease Prevention Research

Since US Navy marine mammals deploy worldwide, generalized protection against the various diseases they may encounter is critical. In collaboration with Stanford University and Baylor College of Medicine, a dolphin probiotic candidate has been identified that may protect the dolphin gastrointestinal system against infections.[13] Additionally, adipose stem cells successfully isolated from the nuchal fat pad in dolphins have been shown to effectively speed up wound healing (Figure 7-11).[32] In sea lions, stem cells have been isolated from adipose tissue and used to treat ocular disease and for joint care. Stem cell therapy shows promise in treating or preventing many other disorders.

Other Research

Aside from research that directly supports MMS requirements, operation and maintenance, and care, the MMP also provides a unique opportunity for scientists to conduct research in support of other US Navy and government activities. The federal government does not maintain marine mammal inventories to support research and development efforts outside the MMP; rather, Navy mammals may be used opportunistically when requested by other activities in support of efforts for which the Navy and research sponsors see the potential for enhanced scientific knowledge. Many of these efforts offer direct and indirect benefits to the MMSs, and no efforts are undertaken that might adversely affect any aspect of supporting MMSs. Sponsors for these efforts generally fund costs associated with the research, along with any unique maintenance and support costs that emerge as a result of these efforts.[13]

Figure 7-11. An Army Veterinary Corps officer assigned to the Marine Mammal Program injects a topical anesthetic in preparation for a procedure to measure the effects of stem cells on wound healing.
Photo courtesy of the US Navy.

Since the late 1960s, behavioral conditioning techniques have been used at the MMP to evaluate hearing sensitivity and auditory function in a variety of marine mammal species (Figure 7-12).[33]-[41] More recently, electrophysiological techniques have been developed to allow audiometric assessment in animals not specifically trained for behavioral hearing tests or to whom access is limited, including stranded and rehabilitating marine mammals. Electrophysiological methods rely on the measurement of auditory evoked potentials (AEPs), which are small changes in the electrical activity in the brain produced when an animal hears a sound.[40]-[42] A rugged, portable system for AEP measurements, developed by the MMP, is used for hearing assessment in a variety of marine mammals. The unique capabilities of the MMP to conduct both behavioral and AEP tests with the same animal allow the AEP results to be validated with more universally accepted behavioral data.

Procedures have also been developed to conduct periodic auditory screening of MMS dolphins and sea lions via AEP measurements. Many US Navy dolphins and sea lions have been tested, revealing potential effects of age, gender, and certain health conditions on their hearing abilities. These data form an important complement to clinical physical examinations and provide key information for MMP animal management decisions.

Figure 7-12. A California sea lion participates in a hearing study.
Photo courtesy of the US Navy.

Over the last decade, concerns that high-intensity Navy underwater sound sources may adversely affect the health and behavior of marine mammals in the wild have steadily increased. To address these concerns, MMP scientists have applied both behavioral and AEP methods to directly measure the effects of intense sound on marine mammal hearing.35,36 These studies compare marine mammal hearing thresholds measured before and after exposure to intense sound to determine the amount, if any, of temporary hearing loss, called temporary threshold shift.34,37 The resulting data have been used to predict and mitigate the effects of underwater noise on wild marine mammals and develop deconfliction guidelines for US Navy dolphins and sea lions operating near active acoustic sources. At present, the data collected by MMP scientists form the cornerstone of the Navy’s criteria to assess the effects of midfrequency sonar and explosives on marine mammals.

MMP scientists are also combining psychophysical approaches, acoustic measurements, AEP measurements, and functional medical imaging modalities to learn how dolphins detect and use various echo features to identify targets and to improve the performance of man-made sonars.33,43,44 Although some progress has been made in understanding the characteristics of dolphin biosonar emissions, the operation of the biosonar receiving system, particularly the signal processing stage, is still not well understood, and dolphin biosonar capabilities currently exceed those of man-made sonars, particularly in shallow, cluttered environments.

Finally, the MMP recognizes the unique adaptations of marine mammals that make them especially well suited for military purposes. They can dive deeper, longer, and safer than any human diver and have demonstrated the ability to locate targets with exceptional accuracy. For several years, the US Navy has been developing unmanned underwater vehicles that also use sonar to locate objects, with the goal of replacing the marine mammal. However, until technology can accurately replace the natural skills and trainable tasks that make the marine mammal systems successful, the MMP will continue to provide an invaluable service to the US Navy.

PREVENTIVE MEDICINE FOCUS FOR MILITARY MARINE MAMMAL HEALTH

The cornerstone of the MMP healthcare practice is the extensive preventive medicine program established by veterinary personnel within the MMP. This program, which is essential to protecting, promoting, and maintaining optimal health as well as preventing disease, disability, and death, consists of seven components: (1) physical examinations and health monitoring, (2) sanitation and nutrition oversight, (3) data and tissue collection and management, (4) deployment support, (5) development of advanced clinical technology, (6) environmental health monitoring, and (7) education. Historically, US Army personnel have contributed significantly to the preventive medicine program and continue to provide support in areas vital to maintaining good health.[45]

Physical Examinations and Health Monitoring

Similar to the standards set for the MWDs, US Navy marine mammals receive a comprehensive physical examination at least once a year. These examinations include a thorough history and observation; visual examination; palpation; auscultation; blowhole and stool sample collection to screen for parasites and inflammation; gastric fluid analysis; and blood sample collection for complete blood count and serum chemistry. Because of their unique anatomy and housing requirements, ultrasound examination is extremely valuable for dolphins and is often included as part of the physical examination. Additional imaging may include radiology, CT, and MRI as needed. In some animals, endoscopic procedures are indicated to monitor health. The veterinarian performing the physical examination may add any additional diagnostics depending on the animal and its current health status. From these results, veterinarians can often detect the early stages of illness and prescribe effective treatment.

Deployability guidelines for military marine mammals differ from that of MWDs. Although there are four categories that determine MWD deployability, marine mammals assigned to a fleet system or certified as a spare animal are designated as either (1) “fit” or (2) “unfit” for duty. The US Navy deploys only healthy animals that are fit for duty.

Animal trainers teach husbandry and medical behaviors so that dolphins and sea lions will allow voluntary examinations. Dolphins start this training as soon as they are born, interacting with trainers and learning to accept fish. By the time they are 6 to 8 months old, dolphins learn to follow the trainer’s hand as a guide and lay out for medical body checks. Young dolphins are also taught to present their flukes and keep them raised for up to 3 minutes for venipuncture.

New sea lions are taught to line up, leave the water when called, and climb onto a dressing stand for examination. Many will voluntarily present their hind end for venipuncture. Sea lions also learn to open their mouths on command, hold up their flippers when asked, and hold still for auscultation and palpation (Figure 7-13).

Figure 7-13. With the help of a marine mammal trainer, a US Army Veterinary Corps officer performs a voluntary physical exam on a California sea lion.
Photo courtesy of the US Navy.

Training for additional medical procedures, such as ultrasound examination and radiographs, is accomplished by the training staff when the need arises (Figure 7-14 and Figure 7-15). The emphasis on training solid medical behaviors—essential for ensuring good health—is critical when illness arises and animals need medical treatment.

Figure 7-14. Ultrasound examination of animals such as this California sea lion provides valuable information to ensure marine mammal health.
Photo courtesy of the US Navy.

Given that animals are maintained in close proximity to the veterinary hospital, veterinary personnel are in close communication with the training staff and can observe the animals on a daily basis. In addition to the annual examination, animals are examined frequently for other reasons, including illness or a change in health status, pre- or post-deployments, pregnancy, neonatal care, and geriatric care. For example, since all nondeployed animals are housed in open-ocean enclosures with access to wild fish and other wildlife, a parasite control plan is essential to ensure good health. Dolphins and sea lions are dewormed every 6 months and as needed. Sea lions are susceptible to canine heartworm, so they also receive monthly prophylactic parasiticide (eg, ivermectin). Currently, vaccinations are not considered part of the MMPs preventive medicine plan and are rarely administered because of the potential for side effects and limited research demonstrating efficacy (Dr Eric Jenson, Attending Veterinarian, Navy Marine Mammal Program, personal communication, February 2013).

Sanitation and Nutrition Oversight

Each year, the US Navy purchases over 800,000 pounds of fish to feed its marine mammals (Dr Mark Xitco, Head of Navy Marine Mammal Program Biosciences Division, personal communication, February 2013). US Army personnel are largely responsible for overseeing the sanitation and nutritional aspects of marine mammal care, and this oversight is the second key component of the MMP’s preventive medicine program.

Figure 7-15. A bottlenose dolphin presents her ventrum so that a veterinarian can place a urinary catheter to collect a urine sample. Marine mammal trainers shape behaviors that allow animals to voluntarily participate in medical procedures.
Photo courtesy of the US Navy.

Figure 7-16. Veterinary Corps personnel inspect the fish production facilities that supply all fish fed to the US Navy marine mammals.
Photo courtesy of the US Navy.

All fish fed to the Navy’s animals are purchased from production facilities that are individually inspected by US Army veterinary personnel (Figure 7-16). These personnel reference military sanitation requirements for food establishments, including the Military Standard 3006C[46] and Military Handbook 3006C.[47]

In addition to general sanitation guidelines, Army veterinary personnel rely on more specialized references for fish and fisheries products.[48] A variety of fish may be fed, including capelin (Mallotus villosus), herring (Culpidae spp), mackerel (Scromber spp), croaker (Micropogonias spp), pin fish (Lagodon rhomboids), and mullet (Mugilidae spp). Additionally, squid (Loligo spp) is frequently fed. All fish are caught, packaged, shipped, and stored using the same standards as for human food. Each new lot of fish is subject to organoleptic sensory evaluation, chemical proximate analysis, heavy metals, and pathogenic bacteria screening upon procurement.[48]

Food service sanitation principles are also applied to all aspects of the ration preparation and feeding. The US Army maintains a hazard analysis critical control point plan with critical control points and potential significant hazards associated with fish transport, storage, and handling on-site. The San Diego facility is equipped with two fish preparation areas designed to meet or exceed the standards set forth in MIL STD 3006C, Sanitation Requirements for Food Establishments. Frozen fish are stored at 0° F at a large off-site facility and delivered to on-site freezers and fleet support freezers at satellite facilities. US Army Veterinary personnel inspect the fish preparation facilities and freezers monthly. Microbiological testing is routinely conducted on food-contact surfaces and includes frequent use of an adenosine triphosphatase (ATPase) system to detect biological contamination.46,49,50

All animals are weighed monthly, and their body condition is evaluated regularly to ensure maintenance within individually established guidelines. Each individual goal weight is based on historical morphometrics, individual animal health needs, statistical analyses of free-ranging animals, and US Navy animal’s morphometrics. A customized ration is formulated for each animal based on the caloric and nutritional content of the fish being fed and the animals’ requirements.

Data and Tissue Collection and Management

The third key component of the preventive medicine program includes data management and tissue collection and archiving. In addition to maintaining hard copy healthcare records, the MMP maintains an extensive electronic medical records database that was specifically designed for the program. All data, including observations; diagnostic sample submissions and test results; treatment records; medication history; body weight and length measurements; daily diet rations; and transport history are entered into the database by a dedicated staff, which includes a veterinary epidemiologist. The database is capable of gathering the input information and performing sophisticated statistical analyses on this information to guide future clinical decisions. Using the database, epidemiologists also can analyze past and current trends in order to track an epizootic event and predict the future course and impacts of that event.

In addition to the database, the records department manages an extensive collection of archived tissue samples (Figure 7-17). Just like MWDs, every deceased marine mammal undergoes a comprehensive and complete necropsy procedure not only to characterize disease and determine cause of death, but also to collect and archive as much tissue as possible. These tissue samples may be used for future research purposes such as characterizing fatty liver disease in dolphins, a recently discovered disease state. Other biological samples archived include serum, plasma, buffy coats, feces, milk, urine, and fluid aspirates. These samples also support future retrospective studies.

To ensure MMP animals are ready to deploy, the records department researches requirements for animal transports and prepares all required documentation and permits for imports and exports. The regulations governing transport of marine mammals are extensive and vary based upon the destination. The records department maintains relationships with host nation, state, and federal regulatory agencies such as the National Oceanic and Atmospheric Administration, US Fish and Wildlife Service, and US Customs and Border Protection.[51]-[53]

Figure 7-17. The US Navy Marine Mammal Program manages an extensive collection of archived tissue samples dating back to the origins of the program in the 1960s. These tissue samples can provide valuable insight into pathology that may not have been recognized in the past due to recent advances in technology.
Photo courtesy of the US Navy.

Deployment Support

The fourth component of the preventive medicine program is deployment support. The MMP supports, on average, 12 deployments per year, ranging from local exercises lasting a week to full-scale overseas deployments lasting several months (Dr Mark Xitco, Head, Navy Marine Mammal Program Biosciences Division, personal communication, February 2013). The US Army veterinary element participates heavily in supporting these deployments. Prior to deployment to a new location, an extensive site survey is conducted to gather information on the location and support available. A veterinarian usually accompanies the team to identify local medical and veterinary resources and perform an environmental assessment.

Animals scheduled for deployment undergo a pretransport health assessment using risk assessment-based principles. The goal of these health assessments are to identify any emerging health problems or reasons the animal should not be transported or participate in an exercise. A veterinarian or veterinary technician accompanies all animals while on deployment. Usually local exercises require a veterinary technician, but larger exercises involving aircraft, long-distance travel, longer duration, or deployment to more remote areas require at least one veterinarian to be present.

A mobile marine mammal clinic, fully stocked with appropriate diagnostic and treatment supplies, is also available for large-scale deployments. During transport, veterinary personnel are responsible for monitoring animal health, establishing health parameters, and diagnosing and treating any medical issues that arise. Once the animals arrive at the destination, the veterinary personnel monitor animal health and provide treatments if necessary, liaise with local medical support when needed, and perform water quality assessments (Figure 7-18).

Upon return, animals are usually quarantined to protect the population. Each animal receives a full post-transport physical examination, and depending on location, diagnostic testing specific to infectious risks associated with the deployment location.

Figure 7-18. A Navy dolphin slides into a beaching mat in preparation for work. Dolphins are housed in special inflatable shipboard pools when transporting and working off ships.
Photo courtesy of the US Navy.

Development of Advanced Clinical Technology

The MMP prides itself in striving to be the best marine mammal facility in the world, and the fifth component of the preventive medicine program emphasizes the goal to continually improve knowledge, equipment, and methodology. Clinical research includes kidney disease pathophysiology, hormonal stress markers, intestinal microbiota, breath analysis, stem cell therapy, and metabolic syndrome. The program has published over 1,000 papers in peer-reviewed scientific journals.[4]

The concept of “One Medicine,” which is often credited to the veterinarian Calvin W. Schwabe, is thoroughly embraced by the MMP veterinary team.54,55 (See Chapter 13, Global Zoonotic Disease Surveillance and Control, for more information about the One Medicine concept and its proponents, including Rudolf Virchow and Sir William Osler.)

The MMP has developed and expanded collaborations between veterinarians, physicians, public health officials, and environmental scientists, with the goal of providing the finest care to the marine mammals and obtaining a better understanding of the link between multiple disciplines. For example, specialists in human medicine fields have recently assisted veterinarians with CT, MRI, and positron emission tomography scans (Figure 7-19); CT-guided biopsies (Figure 7-20); advanced wound management; and laparoscopic procedures, and these specialists also have helped develop and refine the technique for ultrasound-guided hepatic vein catheterization in dolphins.

Figure 7-19. Army Veterinary Corps personnel assist in performing a positron emission tomography scan on a bottlenose dolphin.
Photo courtesy of the US Navy.

Figure 7-20. A bottlenose dolphin undergoes a computerized tomography scan in preparation for a guided bone marrow biopsy. US Navy and other military healthcare facilities provide valuable medical support.
Photo courtesy of the US Navy.

Since the MMP values the care and welfare of each animal, the program provides resources for procuring and testing new, high-quality equipment that will benefit marine mammal health. Researchers and clinicians have recently developed a breath condensate collection technique that measures certain compounds in breath, which may be useful in detecting early indicators of inflammation or infection. The program also opened a 2,500-square-foot, newly renovated, state-of-the-art marine mammal hospital in 2012. This facility included creation of a surgery suite, laboratory, pharmacy, and pathology room. Mechanical, electrical, and information technology improvements support new diagnostic-imaging and patient-monitoring capabilities.[53]

A final area of technological development focuses on the marine mammal’s special medical needs. Because of the unique physiology and housing requirements of marine mammals, standard veterinary procedures are not always possible or practical. For example, even though exploratory laparotomy may be indicated, it may not be possible because large surgical incisions may not heal well in a marine environment. The MMP veterinary team is currently working on developing an abdominal laparoscopy technique and refining anesthesia in cetaceans. Development of these techniques will allow clinicians to greatly improve the level of care available to marine mammals and increase cetacean lifespan.

Figure 7-21. An Army animal care specialist collects plankton for domoic acid testing. Environmental testing is critical to preventing marine mammal disease.
Photo courtesy of the US Navy.

Environmental Health Monitoring

The effect environmental health likely contributes to animal disease processes is not a new concept for marine mammal medicine or the MMP. Recently the program increased its efforts to better understand the area of marine biotoxins and how they may affect US Navy marine mammals.

At the MMP, all nondeployed animals are housed in open ocean enclosures and frequently train untethered in open water. The MMP meets and often exceeds policies and procedures consistent with the Animal Welfare Act and Regulations in regard to animal housing and water quality monitoring.[56] Marine mammal enclosures and work sites are tested weekly for total coliforms. The program also has expanded on the recommended guidance to better understand the potential presence of other environmental contaminants. Environmental monitoring includes testing fish, mussels, and plankton for domoic acid (Figure 7-21); testing water for heavy metals and toxins; and testing native wildlife and excrement for various infectious agents.

Emphasis on Education

The final concept of the preventive medicine program, the education of MMP personnel, is arguably the most important for two reasons. First, because the Army element of the US Navy staff is constantly rotating, the requirements of marine mammal care are new to most incoming soldiers. All veterinary staff—civilian, contractor, and Army—must embrace the challenge of training new animal care staff on the state-of-art medicine practiced by the MMP.

Second, a good preventive medicine program is essential in any field of medicine but is especially critical for marine mammals because of their tendency to mask disease. To meet this challenge, the MMP strives to provide the most complete educational training possible, focusing, as aforementioned, on the preventive medicine components of marine mammal care: physical examinations and health monitoring, sanitation and nutrition, data and tissue collection and management, development of advanced clinical technology, deployment support, and environmental health monitoring.

CURRENT RELEVANT MARINE MAMMAL DISEASES

Marine mammals are susceptible to a variety of diseases, including infectious diseases and metabolic conditions. The following section on current relevant marine mammal diseases briefly covers a few disease processes that are of particular interest to the US Navy MMP, namely respiratory disease, ocular disease, metabolic conditions, and gastritis.

Respiratory Disease in Dolphins

Just like terrestrial mammals, marine mammals are susceptible to respiratory disease. However, as mentioned previously in this chapter, because of the unique anatomy and behavior of cetaceans in particular, they are vulnerable to developing both primary and secondary pneumonia. In order to dive, bottlenose dolphins rely on long periods of breath-holding with periods of brief surfacing to take breaths, and, therefore, have developed specialized respiratory anatomy that enables rapid exchange of large volumes of air.[57] The nasal passage, located on the dorsal aspect of the head, lacks the intricate nasal turbinates and sinuses of other mammals that perform the important function of warming and filtering air. While humans exchange about 20% of their lung capacity with each breath, dolphins take short and deep breaths, with an exchange of 75% to 90% of air in one-third of a second.[58]-[60] These breathing adaptations put them at increased risk of respiratory infections by enabling deep lung exposure to airborne threats at the marine surface.

A retrospective study conducted at the MMP indicated that Staphylococcus aureus was the most common confirmed pathogen in US Navy dolphins with pneumonia, it being present in 19% of cases.[25] Other pathogens confirmed in this study include Cryptococcus neoformans, Erysipelothrix rhusiopathiae, Histoplasma capsulatum, parainfluenza virus, Proteus spp, Pseudomonas aeruginosa, and Streptococcus zooepidemic.[25] Other known infectious causes of pneumonia in dolphins include Aeromonas hydrophilia, Aspergillus fumigatus, Coccidioides immitus, Halocercus sp. (lung-worm), morbillivirus, Streptococcus Group D, and Toxoplasma gondii.[25]

Histiocytic pneumonia is also reported as common in dolphins. Potential causes of histiocytic pneumonia may include eosinophilic pneumonia, drug reactions, chronic infections, and metabolic or iron storage diseases.[25]

Clinical Signs

Pneumonia in cetaceans often presents with subtle clinical signs, if any signs at all. Clinicians must remember that cetaceans are extremely good at masking signs of illness. Declining appetite or anorexia may be the only clinical sign; therefore, clinicians should not dismiss this important finding nor hesitate to obtain additional diagnostics.

While bacterial respiratory disease often makes other animals cough, cetacean coughing occurs mainly with upper respiratory disease; however, frequently, tachypnea is not observed until a significant portion of the lung field is damaged. Unilateral pneumonia or large abscesses in the lungs can sometimes cause animals to list to the side of the damaged lung.61(p326)

The animal care staff is the most significant source of information regarding history and early clinical signs. At the MMP, clinical signs that have preceded pneumonia include reluctance to perform trained behaviors, blepharospasm, abnormal odor from the blowhole, increased discharge from blowhole, lethargy, and partial to complete anorexia. Progressive clinical signs can include abnormal respiratory character, tachypnea, shallow breaths, dull eyes, anorexia, skin desquamation, lethargy, halitosis, disorientation, abortion, difficulty maintaining buoyancy, and dyspnea.[61]

Diagnosis

As previously mentioned in this chapter, history and visual examinations often give little indication that cetaceans have pneumonia. Auscultation is rarely useful because of the cetacean’s thick blubber layer, rapid expiratory-inspiratory cycle, and ability to emit loud transmitted sounds that can obliterate subtle rales.61(p901) When faced with equivocal clinical signs, veterinarians turn next to hematology and serum chemistry. Blood results may show signs of inflammation (described subsequently in the clinical pathology section) in varying degrees. It is helpful if the clinician has access to previous blood values in order to appreciate subtle changes or deviations from normal.

Ultrasound examination is another valuable tool in diagnosing and assessing progression of pneumonia (Figure 7-22, a–d). Findings can include pleural effusion detected between parietal and visceral pleura (see Figure 7-22b). If a pulmonary mass is present on the periphery of lungs, it can sometimes be visualized, allowing for fine needle aspiration or biopsy (see Figure 7-22d). Rockets or ring-down artifacts (B-lines) can indicate alveolar interstitial syndrome (AIS), especially if clustered or seen with higher frequency than expected (see Figure 7-22c).[62]

AIS is an increase of fluid or cellular infiltrate in the interstitium and reduced air in the alveolar spaces, with or without interlobular septal thickening.[62] Visual observation of AIS is a nonspecific finding that indicates acute disease (ie, pulmonary edema, respiratory distress, or interstitial pneumonia) or chronic disease (ie, pulmonary fibrosis or interstitial lung disease). If pulmonary consolidation is present, the lung may have an appearance similar to liver. Lymphadenopathy may be noted if the marginal lymph node is visualized.

Figure 7-22 a–d. A. Normal sonogram of thorax of a bottlenose dolphin, including blubber (B) layer, ribs (curved arrows) with acoustic shadowing (white arrowheads), visceral pleura (white arrows), and reverberation pattern (black arrows). B. Example of pleural effusion (*) between the visceral (black arrows) and parietal pleura (white arrows). Comet-tail and ring-down artifacts are present (arrowheads). C. Example of a pleural lesion creating a ring-down artifact (black arrows). D. Pulmonary abscess with hypoechoic center (*) and concentric echogenic outer layer (arrowheads).
Photo courtesy of the US Navy.

Radiography is also a valuable tool in evaluating cetacean lungs for pneumonia; this tool often allows more complete visualizations of lesions, especially deep lesions that are not noted on ultrasound. Fine needle aspirates and bronchiolar lavage, currently the most successful means of isolating sole bacterial pathogens antemortem, are invasive techniques and can be technically difficult. Additional diagnostics can include cytology of nasal or blowhole swabs, in addition to culture and sensitivity and molecular diagnostics if organisms are present.[25]

Clinical Pathology

Complete blood cell count and serum chemistry often yield important indicators of inflammation. These indicators are not specific for pneumonia, but in the absence of clinical signs that suggest otherwise, the clinician should assume and treat for pneumonia. The tests that are most useful for indicating inflammation include white blood cell count, differential count, erythrocyte sedimentation rate, plasma fibrinogen, serum albumin, alkaline phosphatase, and serum iron.[63]

Fibrinogen is a very reliable indicator of inflammatory disease in cetaceans and should be measured with the photo-optical test, as the heat precipitation test is prone to inaccuracy. Fibrinogen elevation of 20% or more above the animal’s normal value is significant, but it can “be elevated by 50% or more with significant inflammation.”61(p902)

Erythrocyte sedimentation rate (ESR) is a traditional tool for inflammation that measures the distance erythrocytes fall through a vertical suspension of anticoagulant over time. The magnitude of inflammation is directly related to the rate with which erythrocytes fall in a standard vertically positioned tube. ESR is associated with increases in plasma fibrinogen, and although it is prone to fluctuations, ESR is commonly used in cetacean medicine because it is easily run with inexpensive equipment.

Alkaline phosphatase (ALP) will typically decrease dramatically during illness. ALP may function in endotoxin detoxification, as observed in rats and humans, causing depletion of serum ALP that returns to normal with resolution.[64] Although the level of ALP is considered a very reliable prognostic indicator, it is a poor prognostic indicator if serum levels remain low, despite clinical therapy. ALP will also normally decline with age and decrease in food uptake61(p409) and can indicate other things such as hemolysis, certain drugs, and anticoagulants.61(p902)

Total white blood cell count (WBC) is a reliable indicator of an inflammatory response and is interpreted similarly as in terrestrial animals. However, life-threatening pneumonia can be associated with unremarkable total WBCs. Cetacean differential counts are also interpreted the same way as terrestrial animal differential counts. WBCs and the differential may fluctuate unpredictably over a very short interval, which may affect interpretation.[63]

Serum iron decreases acutely in animals with bacterial infection or acute inflammation. The body sequesters iron in the liver in a form that is not available to pathogenic bacteria, which can readily use transferrin-bound iron in the serum.[65] The change can be profound, decreasing to levels 20% of normal or less in 24 hours.61(p902) A low serum iron indicates infection or inflammation but not necessarily the severity; thus, clinicians should not automatically begin supplementing with iron in cases of potential inflammation. Serum iron, along with WBC and ALP, are often the most sensitive parameters to monitor when assessing treatment and response to therapy. Fibrinogen and ESR are also useful, but improvements tend to occur later in the time course of therapy.

Therapy

Treatment of pneumonia in dolphins usually consists of antibiotic therapy, with selection that follows routine culture and sensitivity. Since treatment often begins before diagnostic results are available, broad-spectrum antibiotics are a good choice.61(p326) At the MMP, daily intravenous antibiotics, along with supportive care, have produced good results, especially if an animal presents with anorexia. Supportive care often consists of fluid support, gastrointestinal protectants, pain medications, and appetite stimulants. Antifungal therapy is often considered because of the likelihood of fungal overgrowth during antibiotic treatment.

Since pneumonia is common in cetaceans, clinicians must be knowledgeable of the subtle clinical signs and be prepared to consider diagnostics and treatment, even when the animal does not appear to be sick. Although this condition can be rapidly fatal, it can be treated very successfully if diagnosed early.

Ocular Disease in Sea Lions

While ocular disease affects many marine mammals, diseases affecting the cornea and lens are especially common in sea lions. This section focuses on five topics: (1) background information concerning the sea lion’s innate proclivity to ocular disease; (2) the challenges of conducting sea lion ocular examinations; (3) the potential causes and risk factors of sea lion ocular disease; (4) specific information concerning certain diseases common to sea lions (ie, otariid keratitis, cataracts, and lens luxation); and (5) the treatment and prevention methods for these typical diseases.

Anatomy and Physiology

Pinnipeds, such as sea lions, have evolved some unique characteristics that allow them to achieve visual function both above and below water. The cornea and aqueous humor have roughly the same refractive index as sea water, essentially making them optically inefficient when underwater.[66] The refractive power of the submerged eye depends on the function of the lens, which is large and spherical, with a high refractive power.17(pp128-132),66,67 This spherical lens would tend to cause severe myopia on land, but sea lions have adapted to overcome this obstacle as well.

The surface of the cornea contains an obvious round, flattened area approximately 6.5 mm in diameter at the midnasal region, which helps achieve a negative refractive power that counteracts myopia in air.17(p131),66 Additionally, sea lions have a teardrop-shaped pupil and possess the ability to constrict this pupil to a pinpoint shape that aligns with the flat surface. This provides a window that allows refraction to remain almost constant in both air and water (Figure 7-23).61(pp920-921)66,67

Figure 7-23. The normal appearance of a sea lion’s globe.
Photo courtesy of the US Navy.

Several adaptations have evolved that allow for great vision in low light, including a highly developed tapetum lucidum that encompasses almost the entire fundus, large ganglion cells, and a predominance of rods in the retina.61(pp921),66,67

Eye Examination

Performing an ophthalmologic examination in sea lions can be challenging, especially if the clinician suspects ocular disease that may be interfering with normal vision. Visually impaired animals accommodate rapidly to their surroundings using tactile and visual cues; therefore, it is not always obvious from observation that the animal is having difficulties seeing. The menace response (the reflex blinking that occurs in response to the rapid approach of an object) is difficult to evaluate because sea lions have sensitive vibrissae (whiskers), which can cause a blinking response even if the animal cannot see the object.

Further complicating the examination, sea lions have a prominent nictitating membrane, strong eyelids, and ability to retract the globe into the ocular cavity.61(p921) The narrow pupils can limit visualization of the internal eye structures such as lens and retina. Pharmacologic dilation is not generally used as topical parasympatholytic agents do not adequately dilate pinniped pupils.[66] Thus, voluntary ocular examination is best performed in low-light settings. Visually impaired sea lions tend to thrust their vibrissae forward for prolonged periods to investigate new surroundings and may have short or broken vibrissae.61(p921) This may provide an addition clue that the animal is visually impaired.

Pathogenesis

Both wild and managed sea lions appear to be susceptible to numerous corneal lesions; however, the epidemiology and pathogenesis varies significantly between the two groups.61(pp920),67-[70] Among the most common lesions found in captivity are keratitis, cataracts, and lens luxations.[66] A 6-year study of managed pinnipeds showed keratitis or keratopathy present in 62.8% of sea lion eyes examined.[68] In a separate study, 42.4% of California sea lion eyes were found to have cataracts, lens luxations, or both. While populations of wild sea lions appear to be affected by keratopathy and cataracts, the incidence appears greatly reduced compared to the managed populations studied. Several theories have emerged as to why managed sea lions seem more susceptible to these ocular lesions, and the cause appears to be multifactoral. Risk factors that have been identified in development of cataracts include age, history of eye problems, and history of fighting.[66]

Increased ultraviolet (UV) exposure has been suggested as another likely contributing factor to developing ocular lesions.66,71 Pinnipeds with no access to shade may be 10 times more likely to develop cataracts or lens luxations.[66] Spatial characteristics of the animal enclosures that may contribute to UV exposure include the orientation of the sun on wet and dry areas, depth of enclosures, and surface color.[66] Also, hand-feeding of fish causes the captive sea lions to look upward toward the sky much more often than they would in the wild.

Water quality issues have also been implicated, including the effects of disinfectants such as chlorine, bromine, and ozone, as well as total coliform levels.66,71 Additionally, freshwater or environments with low salinity are thought to increase the frequency of eye lesions and have been directly linked to development of corneal edema.61(p920),69 Further studies are needed to enhance understanding of the causes and specific risk factors in order to further improve prevention and husbandry practices.

Otariid Keratitis. Corneal disease, common in both managed and wild sea lions, can cause impaired vision and significant pain. Otariid keratitis (ie, inflammation of a sea lion’s cornea) has been described and characterized, including progression and risk factors. Subadults and adults may be affected by mild to moderate ulcerative corneal disease, and it has been theorized that keratitis can cause uveitis and, therefore, contribute to cataract formation. More specifically, the disease has been categorized into three stages, ranging from mild focal corneal opacities with superficial ulcers to severe diffuse corneal lesions with recurrent ulcers and secondary infection.[66]

In a study involving captive otariids, predominantly California sea lions, most presented with bilateral disease, and animals over 5 years of age were found to have a 50% chance of presenting with keratitis lesions. Animals typically presented with signs of eye pain such as epiphora, periocular brown debris caked on the eyelid fur, and blepharospasm. Other clinical findings present in varying degrees include perilimbal or diffuse edema, pigmentation that crosses the limbus, vascularization, and conjunctival hyperemia (Figure 7-24). In severe cases, the epithelium sloughs easily, and some cases present with stromal abscess formation.[66]

Potential causes identified include viral infections, underlying uveitis, trauma, excessive sunlight, and changes in water quality. For example, severe cases are characterized by chronic recurrence, typically two to four flare-ups per year that seem to coincide with increased daylight duration and more intense UV exposure (eg, flare-ups occur in colder climates on days that coincide with snow on the ground and sunny skies).[66] At the MMP, sea lions are housed in shaded structures. Although they could be exposed to increased sunlight during work sessions, water quality seems to play an important role. Flare-ups are often associated with increase in total coliforms, which can occur in the winter because of increased rainfall and runoff.

When keratitis presents with superficial ulcers, it should be treated aggressively to prevent secondary infection. If infection is suspected, aggressive use of antibiotic and anti-inflammatory therapy is recommended to avoid progression. While waiting for culture and sensitivity results, an antibiotic should be selected that targets pathogens present in the water (eg, coliforms, Pseudomonas spp, and Aspergillus). Oral doxycycline has been suggested for its role in stabilizing the corneal stroma and speeding epithelialization and for general anti-inflammatory effects.[66]

Topical nonsteroidal anti-inflammatory drugs such as nepafenac may reduce eye pain; however, oral nonsteroidal anti-inflammatory drugs should be considered for more severe pain and secondary uveitis. Cyclosporine (2%) or tacrolimus (0.03%) can be helpful to reduce recurrence of active disease.[66] Hypertonic saline applied several times per day is useful in reducing corneal edema.61(p921) In addition to drug therapy, animals should have access to shade in order to accelerate resolution.

Figure 7-24. Severe keratitis in a sea lion’s eye, characterized by diffuse corneal edema, fibrosis, and vascularization.
Photo courtesy of the US Navy.

Figure 7-25. A mature cataract in a sea lion’s eye.
Photo courtesy of the US Navy.

Cataracts and Lens Luxations. Cataracts, commonly defined as opacity of the lens or capsule, have been documented as a common cause of visual impairment in both wild and managed pinnipeds (Figure 7-25). However, cataract formation appears to be much more prevalent in managed populations, which could be attributed principally to the increased lifespan of managed sea lions.[68] Suspected causes of cataracts in the wild population include congenital anomalies, nutrition, trauma, and age.[72]

Cataracts should be distinguished from nuclear or lenticular sclerosis, an aging change in which the nucleus of the lens becomes compressed over time and is seen as a bluish haze that typically does not affect vision.[68] The pathogenesis of age-related cataract formation may be similar to that of human cataracts, which are thought to develop as a result of long-term exposure to solar radiation and subsequent oxidation, protein cross-linking, and denaturation of soluble lens proteins.68,73 However, cataract changes were detected in all age groups over 5 years old, suggesting that other factors besides age may play a role in development of cataracts, including, as previously mentioned, history of fighting, history of ocular disease, and no access to shade.[66]

The clinical appearance of cataracts in sea lions is similar to that of other species and is often initially detected as increase in light refraction with punctuate to linear opacification in the adult nucleus of the lens. A unique component of this disease in pinnipeds is the tendency for them to develop lens instability and luxations, often in association with cataract formation (Figure 7-26). It has been suggested that chronic or prolonged exposure to UV radiation could cause degradation of zonular-like, fibrillin-rich structures that adhere the ciliary processes to the lens, resulting in lens instability and luxation. The onset for lens luxation is variable but typically involves anterior luxation, causing uveitis with blepharospasm and epiphora. Lens luxation can progress to secondary glaucoma and severe keratitis and bullous keratopathy.[68]

Sea lions at the MMP that present with lens luxations are usually treated with intracapsular lens extraction, a procedure which has been shown to dramatically decrease pain and improve vision but requires intensive perioperative and postoperative medical management. Such management typically consists of frequent application of topical antibiotics, antifungals, anti-inflammatories, and analgesics.

Until the pathogenesis of sea lion cataract formation is fully understood, prevention is currently targeted at reducing some of the risk factors that have been identified. Lutein, a carotenoid that protects ocular tissue against photooxidative stress, may be useful in improving ocular health.[68] Pinnipeds have been shown capable of absorbing orally ingested lutein, and, therefore, may be capable of accumulating this antioxidant in their lenses.[74]

Figure 7-26. Acute lens luxation in a sea lion’s eye.
Photo courtesy of the US Navy.

Early detection and treatment of sea lion ocular disease is essential for preventing future disease or progression. However, because diseases such as otariid keratitis, cataracts, and lens luxations are highly prevalent in pinnipeds, and these diseases appear to be related at least in part to management and husbandry, further study is needed to determine the best methods of prevention. Current recommendations to reduce UV radiation exposure include providing shade structure, avoiding activities that encourage animals to look at the sun, and reducing the amount of reflection from the environment. Marine mammal facilities should also undergo frequent water quality evaluations to mitigate factors such as high chemical levels or coliform counts.

Metabolic Conditions in Dolphins

Metabolic Syndrome

Dolphins can develop metabolic syndrome, a subclinical condition similar to that seen in humans.28,30 Metabolic syndrome in dolphins includes a combination of the following blood abnormalities: elevated ferritin, iron, insulin, glucose, or triglycerides as well as lower adiponectin (an insulin-sensitizing protein).[29] Dolphins with metabolic syndrome may also have hepatic iron deposition or fatty liver disease.[27] The MMP has been on the forefront of research investigating metabolic syndrome and exploring the parallels between humans and dolphins.

Cetaceans and primates share some unique traits that support a shared drive for common glucose metabolism. Compared to other terrestrial animals, primates have high encephalization quotients (a measurement of actual brain size compared to expected brain size given body mass); cetaceans possess similar high quotients.[75] Primates and cetaceans also share the trait of having red blood cells that are extremely permeable to glucose, theoretically for the purpose of supplying the high amounts of glucose a larger brain requires.[76] Because cetaceans consume a high-protein, low-carbohydrate diet, an insulin-resistant state may be evolutionarily advantageous to ensuring that glucose is always available for the brain. Humans may have also benefited from this evolutionary trait during the ice age, when they consumed a high-protein diet.[77] With the return to high-carbohydrate diets, insulin resistance became pathologic, leading to type 2 diabetes.[28] In the past few years, clinicians and researchers have begun to link together several metabolic diseases seen in dolphins, potentially associating them with this common metabolic trait shared by large-brained mammals.

Two components of a metabolic syndrome seen in Navy and other dolphins—namely, (1) iron overload and (2) fatty liver disease—and nephrolithiasis, a different condition, are briefly highlighted in subsequent sections. All of these conditions are common problems found in cetaceans in managed populations and to lesser degrees in wild populations.

Iron Overload. Hemochromatosis or iron overload is characterized by high serum iron (>300 ug/dl), high transferrin saturation (83%–85%), high serum aminotransferases, hyperglobulinemia, hypercholesterolemia, hypertriglyceridemia, and hyperferritinemia.31,78,79 Hemosiderosis refers to a form of iron overload resulting in the accumulation of hemosiderin, which is often observed in the liver of affected dolphins. Like dolphins, increased levels of iron in the serum and liver of humans also has been associated with hyperinsulinemia and insulin resistance.80,81

In dolphins, hemochromatosis can be initially treated using phlebotomy. Three dolphins diagnosed with hepatopathy and hemosiderosis at the MMP were treated with phlebotomy and monitored for changes in their blood values. In all three cases, phlebotomy treatment successfully resolved the clinicopathologic abnormalities, supporting the diagnosis of iron overload in these dolphins.[78] Treatment involved weekly removal of 7% to 17% of estimated blood volume (1–3L) for 22 to 30 weeks (Figure 7-27).[78] During treatment, red blood cell indices were closely monitored, including hematocrit and hemoglobin, and no adverse effects were noted in the three dolphins.

A trace dietary saturated fatty acid, called heptadecanoic acid or C17:0, recently discovered in fish, may help prevent or treat high ferritin and associated metabolic syndrome.[81] Studies with MMP and free-ranging dolphins demonstrated that higher C17:0 blood levels independently predicted lower ferritin and insulin. When six dolphins were fed a diet of fish higher in C17:0, ferritin decreased within 3 weeks, and metabolic syndrome improved within 24 weeks. While encouraging, this nutrition research is still in its early stages, and recommendations for dolphin diets are pending.

The exact cause of hemochromatosis in dolphins remains unknown, but it has been suggested to be multifactoral, including genetic, nutritional, and infectious disease processes.[82] While dolphins from managed populations have demonstrated significantly higher serum iron, ferritin, and transferrin saturation than free-ranging animals, hepatic hemosiderosis was also present in approximately 25% of the wild dolphins studied after being stranded along US coastlines.79,83

Fatty Liver Disease. A study involving histological examination of postmortem liver samples from US Navy bottlenose dolphins showed that 39% had morphological change suggestive of fatty liver disease, similar to nonalcoholic fatty liver disease in humans.[27] The fatty liver disease observed in humans and dolphins should be differentiated from hepatic lipidosis seen in cattle and cats, which is associated with obesity, negative energy balance, and hypoglycemia.84,85

Figure 7-27. A US Army Veterinary Corps captain performs a phlebotomy procedure to correct hemochromatosis in a bottlenose dolphin.
Photo courtesy of the US Navy.

Evidence of fatty liver disease was observed in 18% of wild, stranded dolphins along US coastlines.[83] These dolphins were more likely to have postprandial hyperglycemia than dolphins that did not demonstrate fatty liver disease. They also were more likely to have leukocytosis and hyperglobulinemia throughout the last year of life, suggesting that chronic inflammation was also present in dolphins with fatty liver disease.[27]

Fatty liver disease is seen in humans as a component of metabolic syndrome, which is associated with fasting hyperglycemia and insulin resistance.[85] The evidence from wild dolphins suggests that the potential link between insulin resistance, type 2 diabetes, chronic inflammation, and fatty liver disease seen in humans may also apply to dolphin metabolism.[27]

The US Navy is actively conducting research to better understand the link between the insulin-resistant-like syndrome in dolphins and other metabolic diseases such as iron overload, fatty liver disease, and chronic inflammation. The goal is to learn how to better detect, treat, and prevent these changes. Another value of the current research is the potential to apply what is learned to human metabolic diseases, including metabolic syndrome and type 2 diabetes.

Nephrolithiasis

Nephrolithiasis (the process of forming renal calculi or kidney stones) has been identified in bottlenose dolphins from the MMP population and has been reported in other managed dolphin populations.27,86 Archived nephroliths from the MMP were determined to be composed of 100% ammonium acid urate (Figure 7-28).[27] The analysis of archived samples and record review of cases at the MMP revealed that 50% of mild nephrolithiasis cases and 100% of advanced cases involved both kidneys. Advanced cases also demonstrated increased likelihood of visible collecting ducts and hydronephrosis, diagnosed on ultrasound. One case presented with ureteral obstruction, confirmed by CT.[27] If large enough, nephroliths can be visualized on ultrasound examination as a hyperechoic structure with acoustic shadowing.[27]

Figure 7-28. Ammonium acid urate nephroliths (kidney stones) recovered during necropsy of a bottlenose dolphin.
Photo courtesy of the US Navy.

Like iron overload disease, urate nephrolithiasis appears to be a disease of managed populations.[86] The direct cause is under investigation but is thought to be linked to the finding that dolphins from the MMP and other managed collections demonstrated significantly lower levels of urine citrate compared to free-ranging wild dolphins. Potential therapy being investigated include lower protein diets (more squid, less mackerel) and use of potassium citrate.[86] Researchers are also investigating the potential benefit of altered feeding schedules that more closely mimic what wild dolphins experience.[27]

At the MMP, dolphins that are diagnosed with kidney stones are closely monitored to assess progression of the disease. Ultrasound examination of kidneys can be used to subjectively assess the extent and progression of disease. Signs of ureteral obstruction visible on ultrasound include visibly enlarged collecting ducts and hydronephrosis. Routine blood is collected and monitored for increasing renal values that could indicate obstruction. CT scan is valuable for quantitative assessment of stone burden and documenting the location of ureteral obstruction. In cases of acute bilateral ureteral obstruction, anesthesia and surgery may be necessary to relieve obstruction. The MMP is working towards developing a laparoscopic technique to remove stones in life-threatening cases.

Gastritis in Dolphins and Sea Lions

Etiology

In wild and managed populations of marine mammals, gastroenteritis has been attributed to parasites, bacterial infection, stress, or foreign bodies.61(p533),87 As in other mammals, severe lesions can progress to perforations and peritonitis. Gastritis in US Navy marine mammals and other managed populations can develop secondary to pica,[87] a craving for unnatural articles such as food, which can include organic material (eg, sea grass and kelp) or inorganic material (eg, plastics). While the cause for this unusual craving is unknown, several theories exist, including motivation by hunger; response to gastrointestinal pain or discomfort; behavioral problems; vitamin and mineral deficiencies; and other reasons.[87] A complete and thorough management plan is required to treat this complex and multifactorial problem.

Since animals at the MMP are housed in free-floating enclosures in the San Diego Bay, US Navy marine mammals may have access to naturally occurring marine animals and vegetation that grows on the ocean floor and the nets. Specifically, this includes kelp (Macrocystis spp), eel grass (Zoster marina), and surf grass (Phyllospadix spp).[87] Most animals consume little to no plant material, but some animals are known to consume substantial amounts of plant material. Since this material is poorly digested, it can remain in the forestomach of dolphins or stomach of sea lions, potentially causing local irritation and gastric ulceration.

Clinical Signs and Diagnosis

Animals with pica and secondary gastritis typically present with subtle signs such as inappetence and behavioral changes such as reluctance to participate in daily routines. If the condition progresses, animal care personnel may observe the animal vomiting plant material or note the presence of vomited material in the enclosure. They may also directly observe the animal eating vegetation that is present in the enclosures or open water.

Signs of gastric ulceration may be present on routine complete blood count and serum chemistry, especially if the animal has a progressive anemia. A gastric sample can be a valuable diagnostic tool when suspecting gastritis in dolphins. Normal gastric samples from a fasting dolphin should appear clear to light pink in color, produce a pH of 1.5 to 2.0, and emit a light fishy odor.61(p444) Abnormal samples can show evidence of hemorrhagic ulceration, including a dark pink-red coloration and the presence of coffee-ground appearing material and a foul coppery smell.

Gastroscopy is the diagnostic tool of choice to confirm the presence of a phytobezoar (a trapped mass made up of indigestible plant matter) and evidence of secondary gastric ulceration and hemorrhage. Often, ultrasound evaluation will also reveal a distended forestomach (in dolphins) or stomach (in sea lions). Use of an endoscope is often helpful, and dolphins and sea lions can be trained to voluntarily accept an endoscope for examination (Figure 7-29a and Figure 7-29b).

Cetaceans have a three-chambered stomach, consisting of the forestomach, fundic chamber, and pyloric region.61(p632) Few foreign bodies pass beyond the forestomach because of the small opening leading into the fundic chamber. The normal forestomach has peristaltic contractions that occur at a rate of 3 to 4 cycles per minute; reduced peristalsis can indicate a digestive disturbance such as delayed gastric emptying.61(p632)

Figure 7-29 a. A US Army Veterinary Corps captain performs a voluntary gastroscope exam on a bottlenose dolphin with the help of an animal trainer and a veterinary technician.
Photo courtesy of the US Navy.

Typically, only the cetacean’s forestomach is visualized during gastroscopy. A small amount of cloudy gray fluid is usually present and considered normal. In dolphins with pica and gastritis, the large mass of plant material is easily visualized. If gastritis is present, the clinician may observe gastric lesions on the mucosal surface of the forestomach. However, gastric lesions can easily be missed as much of the mucosa can be obstructed by plant material or fluid.

Sea lions have a simple stomach, similar to dogs. Sea lions can also be trained to voluntarily accept an endoscope for examination of the esophagus and stomach mucosa. If the voluntary behavior is not yet trained, sea lions are typically anesthetized (using procedures similar to other small animals) in order to perform the evaluation.

Treatment and Prevention

Treatment consists of removing the source of mucosal irritation. Dolphins with plant material in their forestomach will often spontaneously vomit this material over several days, especially when they are placed in an enclosure that limits further access to vegetation such as an open- or closed-system pool. This placement not only prevents further ingestion of material, but also allows for evaluation of the animal and visualization or collection of the vomited material.

Figure 7-29b. Endoscopic image obtained from an animal that consumed a significant amount of vegetation.
Photo courtesy of the US Navy.

Other treatment methods for dolphins include oral administration of hydrogen peroxide, which may result in vomiting of the material. As with other animals, care should be taken when attempting this treatment because of the risk for entrapment in the esophagus and asphyxiation. Foreign material can also be extracted either manually or with an instrument.[87]

Treatment of sea lions consists of removal of the plant material with gastroscopic instruments, as hydrogen peroxide administration has not been very effective in this species. Once the source of irritation is removed, animals may be treated symptomatically with gastric protectants, proton-pump inhibitors, or H2-receptor antagonists, and healing progresses quickly.

Prevention involves development of a long-term management plan to reduce or eliminate the behavior. The management plan should be tailored to each case, taking into consideration the potential causes for the behavior. For example, nets on the enclosures should be kept relatively clean and free of vegetation. Feeding schedules and types of fish given can be modified in an attempt to limit the behavior, and animals may be provided with additional items to provide enrichment.

SUMMARY

Marine mammals represent a vital asset to the US Navy because they currently possess the ability to complete underwater detection tasks easier, safer, and with better accuracy than any other technology or human team. Maintaining the health of the US Navy’s marine mammals is a vital part of the MMP’s mission and focus. The marine mammals at the MMP are susceptible to a variety of disease processes, many of which are found in other managed populations. Some diseases, such as pneumonia in dolphins, have been well documented in both managed and wild populations. Others, such as metabolic syndrome, are still being actively researched in order to obtain a better understanding of the pathophysiology in order to develop effective treatment plans. The MMP continues to be at the forefront of marine mammal medicine and research, with the goal of better understanding the issues that affect the US Navy animals as well as other managed and wild populations.

The veterinary care team provides health care to keep all MMP animals well and fit for duty, incorporating cutting-edge techniques and technologies and supporting research programs focused on constantly improving animal health. The continued success of the veterinary care program depends on several key MMP elements: a strong preventive medicine program, continued support of US Army veterinary personnel, employment of expert civilian veterinary staff, and positive relationships with the training and husbandry staff. With so many people and endeavors invested in the health of the US Navy marine mammals, the program will continue to thrive and provide a valuable service for years to come.

Acknowledgments

The author would like to thank all those from the US Navy MMP who contributed to this chapter. Special thanks to the following individuals: Dr Sam Ridgway, for personal communications regarding the history of the program and, specifically, the history and contributions of military veterinarians; Dr Mark Xitco, for information on the operational systems and research and his insight and help with editing; all the clinical veterinarians who kindly reviewed and edited certain sections of the chapter, including Drs Eric Jensen, Stephanie Venn-Watson, and Cynthia Smith; and, especially, Dr Lara Cotte, who helped organize and edit the chapter as a whole. Finally, this author is grateful for all the military marine mammals that enthusiastically complete their daily missions and for all the sailors and soldiers who diligently provide their service day after day, for without them and their enduring partnership, the US Navy MMP would not be successful.

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48.   US Food and Drug Administration. Fish and Fisheries Products Hazards and Controls Guidance. 4th ed. Rockville, MD: Department of Health and Human Services; 2011: 29-180.

49.   National Seafood HACCP Alliance for Training and Education. Hazard Analysis and Critical Control Point Training Curriculum. 5th ed. Gainesville, FL: National Seafood HACCP Alliance; 2011: 105-113.

50.   US Navy Marine Mammal Program. Navy Marine Mammal Program HACCP Plan. San Diego, CA: US Navy Marine Mammal Program; 2012.

51.   National Oceanic and Atmospheric Administration. http://www.noaa.gov. Accessed May 6, 2013.

52.   US Fish and Wildlife Service. http://www.fws.gov. Accessed February 13, 2013.

53.   US Customs and Border Patrol. http://www.cbp.gov. Accessed May 6, 2013.

54.   Potter P. “One medicine” for animal and human health. Emerg Inf Dis. 2004; 10:2269.

55.   Schwabe CW. Veterinary Medicine and Human Health. 3rd ed. Baltimore, MD: Williams & Wilkins Company; 1984: 1-680.

56.   Specifications for the Humane Handling, Care, Treatment, and Transportation of Marine Mammals, 9 USC, §3.100-3.118. 2008.

57.   Ridgway SH. Mammals of the Sea: Biology and Medicine. Springfield, IL: Thomas; 1972: 1-812.

58.   Irving L, Scholander PF, Grinnell SW. The respiration of the porpoise, Tursiops truncatus. J Cell Comp Physiol. 1941; 17:137-149.

59.   Olsen CR, Hale FC, Elsner R. Mechanics of ventilation in the pilot whale. Respir Physiol. 1969; 7:137-149.

60.   Ridgway SH, Scronce BL, Kanwisher J. Respiration and deep diving in the bottlenose porpoise. Science. 1969; 166:1651-1654.

61.   Dierauf LA, Gulland MD (Eds). CRC Handbook of Marine Mammal Medicine. 2nd ed. CRC Press LLC; Boca Raton, FL; 2001.

62.   Smith CR, Solano M, Lutmerding BA, et al. Pulmonary ultrasound findings in a bottlenose dolphin Tursiops truncatus population. Dis Aquat Organ. 2012; 101:243-255.

63.   McBain J. Clinical pathology interpretation in Delphinidae with emphasis on inflammation. In: 28th Annual Conference American Association of Zoo Veterinarians. Puerto Vallarta, Mexico; 1996.

64.   Poelstra K, Bakker WW, Klok PA, Hardonk MJ, Meijer DK. A physiologic function for alkaline phosphatase: endotoxin detoxification. Lab Invest. 1997; 76:319-327.

65.   Lowenstine LJ. Iron overload in the animal kingdom. In: Fowler ME, Miller RE, eds. Zoo and Wild Animal Medicine. Current Therapy. 4th ed. St Louis, MO: Saunders; 1999:260-268.

66.   Colitz CM, Renner MS, Manire CA, et al. Characterization of progressive keratitis in otariids. Vet Ophthalmol. 2010; 13 Suppl:47-53.

67.   Gage LJ. Ocular disease and suspected causes in captive pinnipeds. In: Fowler ME, Miller RE, eds. Zoo and Wild Animal Medicine: Current Therapy. 7th ed. St. Louis, MO: Elsevier; 2011:490-494.

68.   Colitz CM, Saville WJ, Renner MS, et al. Risk factors associated with cataracts and lens luxations in captive pinnipeds in the United States and the Bahamas. J Am Vet Med Assoc. 2010; 237:429-436.

69.   Dunn JL. An epidemiologic survey to determine factors associated with corneal and lenticular lesions in captive harbor seals and California sea lions. In: 27th Annual Meeting of the International Association of Aquatic Animal Medicine. Chattanooga, TN; 1996.

70.   Latson E. Byproducts of disinfection of water and potential mechanisms of ocular injury in marine mammals. What you can’t see might hurt them. In: 40th Annual Meeting International Associations Aquatic Animal Medicine. San Antonio, TX; 2009.

71.   Gage LJ. Captive pinniped eye problems, we can do better! Journal of Marine Animals and Their Ecology. 2011; 4:2011.

72.   Truscott RJ. Age-related nuclear cataract-oxidation is the key. Exp Eye Res. 2005; 80:709-725.

73.   Gerber JA, Roletto J, Morgan LE, Smith DM, Gage LJ. Findings in pinnipeds stranded along the central and northern California coast, 1984-1990. J Wildl Dis. 1993; 29:423-433.

74.   Kuotsos EA, Schmitt T, Colitz CM. Appearance of lutein in plasma of marine mammals is source and species specific. In: 40th Annual Meeting of the International Association of Aquatic Animal Medicine. San Antonio, TX; 2009.

75.   Marino L, McShea DW, Uhen MD. Origin and evolution of large brains in toothed whales. The Anatomical Record Part A: Discoveries in Molecular, Cellular, and Evolutionary Biology. 2004; 281(2): 1247-1255.

76.   Craik JD, Young JD, Cheeseman CI. GLUT-1 mediation of rapid glucose transport in dolphin (Tursiops truncatus) red blood cells. Am J Physiol. 1998; 274(1 Pt 2):R112-119.

77.   Miller JC, Colagiuri S. The carnivore connection: dietary carbohydrate in the evolution of NIDDM. Diabetologia. 1994; 37:1280-1286.

78.   Johnson SP, Venn-Watson SK, Cassle SE, Smith CR, Jensen ED, Ridgway SH. Use of phlebotomy treatment in Atlantic bottlenose dolphins with iron overload. J Am Vet Med Assoc. 2009; 235:194-200.

79.   Mazzaro LM, Johnson SP, Fair PA, et al. Iron indices in bottlenose dolphins (Tursiops truncatus). Comp Med. 2012; 62:508-515.

80.   Mendler MH, Turlin B, Moirand R, et al. Insulin resistance-associated hepatic iron overload. Gastroenterology. 1999; 117:1155-1163.

81.   Venn-Watson SK, Parry C, Baird M, et al. Increased dietary intake of saturated fatty acid heptadecanoic acid (C17:0) associated with decreasing ferritin and alleviated metabolic syndrome in dolphins. PLoS One. 2015; 10:e0132117. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132117. Accessed March 3, 2017.

82.   Venn-Watson S, Smith CR, Jensen ED. Assessment of increased serum aminotransferases in a managed Atlantic bottlenose dolphin (Tursiops truncatus) population. J Wildl Dis. 2008; 44:318-330.

83.   Venn-Watson S, Colegrove KM, Litz J, et al. Adrenal gland and lung lesions in Gulf of Mexico common bottlenose dolphins (Tursiops truncatus) found dead following the Deepwater Horizon oil spill. PLoS One. 2015; 10:e0126538. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126538. Accessed March 3, 2017.

84.   Herdt TH. Fatty liver in dairy cows. Vet Clin North Am Food Anim Pract. 1988; 4:269-287.

85.   Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med. 1993; 44:121-131.

86.   Venn-Watson SK, Townsend FI, Daniels RL, et al. Hypocitraturia in common bottlenose dolphins (Tursiops truncatus): assessing a potential risk factor for urate nephrolithiasis. Comp Med. 2010; 60:149-153.

87.   Meck S, Jensen E, Van Bonn W. Health risks associated with pica: A craving for and possible ingestion of unnatural articles. In: 23rd Annual International Marine Animal Trainers’ Association Conference. East Lansing, MI; 1995.

Chapter 8

MILITARY EQUINE PROGRAMS

CHERYL D. SOFALY, DVM, MS*; DALE R. BEEBE, DVM, MS+; JASON R. CRAWFORD, DVM, MPH‡; AND NOLAN A. WATSON, MLA¥

INTRODUCTION

HISTORICAL USE OF EQUINES IN WARFARE

Equine Procurement and Care in the American Military in the 18th and 19th Centuries

Equine Procurement and Care in the American Military of the 20th and 21st Centuries

CURRENT MILITARY USE OF EQUINES

Equine Units Maintained for Training

Equine Units Reformed to Preserve History and Dignity

Equine Units Reformed to Support Human Well-Being

ROLE OF VETERINARY OFFICERS IN MILITARY EQUINE HEALTH

SUMMARY

*Colonel, Veterinary Corps, US Army; Director, Department of Defense Military Working Dog Veterinary Service, 1219 Knight Street, Joint Base San Antonio-Lackland Air Force Base, Texas 78236

+Lieutenant Colonel, Veterinary Corps, US Army; Command Veterinarian, US Army Special Operations Command, 2929 Desert Storm Drive, Building E-3525, Fort Bragg, North Carolina 28310

‡Major, Veterinary Corps, US Army; Resident, Veterinary Pathology, Joint Pathology Center, 606 Stephen Sitter Avenue, Silver Spring, Maryland 20910

¥Army Medical Department Regimental Historian, Army Medical Department Center of History and Heritage, Medical Command, 2748 Worth Road, Suite 28, Joint Base San Antonio-Fort Sam Houston, Texas 78234; formerly, Branch Historian, Military Police Corps, US Army Military Police School, Fort Leonard Wood, Missouri 65473

“Look back on our struggle for freedom, Trace our present day’s strength to its source; And you’ll find that man’s pathway to glory Is strewn with the bones of a horse.”

— Author unknown

INTRODUCTION

No other animal has proven itself more meritoriously in battle, nor borne the high cost of war throughout the ages than the horse. The stories of horses’ valor and sacrifice have largely gone unheralded through time. Yet these loyal, stoic, and gentle creatures capture our imagination like none other can. In this modern age, horses are primarily used for more leisurely pursuits; however, the qualities that are highly prized by competitive equestrians today—speed, endurance, intelligence, and courage—owe their origins to ancestors bred for the battlefield.

To this day, horses and mules continue to serve humbly and gracefully in many capacities. They lend dignity to time-honored ceremonies, serve soldiers’ needs on the battlefield, and help train the next generation of warriors. Thus, it is fitting that the US Army equine’s contributions to military service are honored in this chapter, which focuses on the history of the mule and horse in recent military conflicts, outlines the contributions that equines make to US service members, and describes the role that military personnel and veterinarians play in the long-term care of this valuable resource.

HISTORICAL USE OF EQUINES IN WARFARE

The use of horses in conquest and warfare stretches back through the centuries. In all likelihood, horses were employed in military actions shortly after their domestication, generally agreed by scholars to have been between 4000 and 3500 BCE.1,2,3 A horse’s agility, speed, and ability to move great distances in less time than conventional foot soldiers vastly changed the battlefield tactics of military commanders throughout the world. In battle, a horse’s very presence projected fear into an opposing force while simultaneously bolstering confidence within its rider’s ranks (ie, the horse is one of the earliest methods of effective psychological warfare). Cavalry tactics were developed as early as 1250 BCE by the Assyrians and continued well into the 20th century, when advances in modern technology, specifically mobile armor and light machine guns, rendered the horse’s service largely impractical for large-scale, direct engagement with enemy armies.[4] In addition to using horses in cavalry force campaigns, draft horses, mules, and donkeys contributed to ancient war efforts by carrying the supplies, baggage, and implements needed to lay siege to enemy fortifications.

Napoleon and Frederick the Great are credited with the adage, “An army marches on its stomach.” Draft animal power gave their armies advantages during movements: an extension to the geographical range of a well-supplied army and an extended sustainment of a military campaign. These “baggage trains” required incredible coordination of movement to route supplies to the correct area at the critical moment of battle. Draft animals were not typically regarded in the same romantic sense as classic mounts for battlefield maneuver. Nevertheless, they frequently engaged in battle and were often specifically targeted by enemy forces to disrupt supply routes, win materiel that was in a critical shortage, deny resupply to friendly forces, and plunder for personal gain.

Equine Procurement and Care in the American Military in the 18th and 19th Centuries

American Revolution to the Mexican War

As the fledgling American Army formed to secure freedom for the colonists, there was definitely a need for horses. Developing a system of acquiring and maintaining the animals’ health was more complicated. Many Revolutionary War officers and members of dragoon units entered service with their own mounts. Although there were allotments for these personal animals used in service, the increasing demand for equines to support artillery and supply efforts required additional horses to be brought into service. These larger draft horses needed for military service were usually not selected or removed from a family farm. As the war progressed, they were purchased for Army use at various auctions or through designated suppliers.[5] Once either privately owned or purchased animals started their service, their owners and units received allowances for their animal’s forage from newly appointed quartermasters.[6]

Not very much is known about the examination of animals purchased for early Army use, nor about those that were brought into service by their owners. Horses were a part of everyday life in the colonies and were fairly plentiful; mules were not common. Horses were often cared for by their owners, although some animals were specially attended to by farriers. During this time, farriers did not simply shoe horses, they spent the majority of their time with these animals and were also often charged with providing care and advice for horse ailments and injuries. Horse maintenance was their vocation.

Similar to human health of the 18th century, animal medicine was rudimentary and still developing; hence, knowledge of disease causes and formal education about equine health was unknown in America. (For more information about the evolution of veterinary education, veterinary services in the military, and historic military equine missions, see also Chapter 1, Military Veterinary Support Before and After 1916.) Dr Everett B. Miller, author of the journal article “Veterinary-Farriery Services in the Continental Army April 1775–May 1777,” describes the farriers of the American Revolution as “uneducated [due to the lack of a veterinary university in America], but not necessarily unskilled,” as there was usually an apprenticeship system in place.7(p106)

As far as can be determined, the position of US Army farrier is first mentioned in a letter from General George Washington to Elisha Sheldon, the newly designated commander of a “Regiment of Horse” (ie, cavalry).[8] The letter, dated December 16, 1776, outlines the composition of the unit and its requirement for farriers.[8] Subsequent dragoon and cavalry units would follow the letter’s instruction and maintain the requirement for farriers.[8] Later, on January 16, 1777, General Washington wrote a similar letter of instruction providing for farriers in support of artillery units.[9]

The requirement for Continental Army farriers mirrored that of the British Army, which used farriers in uniformed service. American Army farriers could be in uniform or contracted employees often directly hired by the local commander. Considering the need for equine care in the standing armies of Europe, other countries adopted similar arrangements. For example, reports indicate that Baron Von Steuben, the well-known Prussian advisor to the early American Army, was accompanied by a farrier from Germany.[10]

Not much is known about the treatments for military animals serving in the Continental Army, but equines were injured with contemporary war wounds such as saber strikes, gunshots, and artillery fragments. Wounded and ill horses may have been bled or blistered (as with human treatments of the 1700s), bound to immobilize battered limbs, or given experimental concoctions of “medicinal material.”10(p37) Vinegar and purgatives were popular remedies. Continual troop movement also caused problems, and an official notification was ordered to end the use of horses being worn down “very cruelly, by riding them extremely hard on all occasions.”7(p112) Limited and improper forage led to starvation in some cases.

At the end of the Revolutionary War, horses remained an important component in Americans’ transportation, commerce, and investments. In the early 1800s, Congress was still receiving requests for compensation for personal horses injured or lost during the American Revolution.[11] Farriers also were included in future plans for the small American Army, but very few were needed.

By the 1830s, the job titles used for and education of farriers began changing, including references to farriers as “veterinary surgeons.”12(p1) At the same time, animal care publications began to receive more attention within the United States. These journals and booklets were slightly more scientific than previous manuals of the 1700s and tended to blend the traditional trade duties of farriers (eg, shoeing and grooming) with more in-depth and learned veterinary skills (eg, disease prevention and animal health functions and remedies). Even so, there was still no formal veterinary education system in place in America, and the titles “farrier” and “veterinary surgeon” were often wrongly confused or used interchangeably as synoymns[12] (Figure 8-1).

The reinstatement of dragoon units in the 1830s expanded military farrier use. Because the units depended on the health of their mounts, commands increased the scrutiny of their animal caretakers. As described in the 1835 General Regulations for the Army, Inspector General reports were to record the competency of veterinary surgeons (the term “farrier” was also used) to determine if “horses were shod in the proper manner…,” and if the farriers were able to observe disease, “…especially the glanders….”13(p135)

Six months after the War with Mexico ended in August of 1848, Congress approved the “hire of veterinary surgeons” and the purchase of “medicine for horses and mules.”14 (p117) This contractor-type appointment lasted through the following year, and payments were made through the Quartermaster Department.14(p117) As far as can be determined, this economic arrangement continued until the Civil War.

The American Civil War

In 1855, Captain George B. McClellan was sent to observe the Crimean War. After viewing the European struggle, he recommended several improvements for the American Army. One suggestion was for the Army to create a veterinary school and adopt the veterinary systems he observed at the Berlin and Vienna veterinary schools.14(p123) Ultimately, the report did not receive enough attention to warrant action.

Figure 8-1. Title page of a veterinary medical book from 1830. Note how “Veterinary Surgeon” and “Farrier” are used as almost the same term.
Courtesy of the AMEDD Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

When the American Civil War began in 1861, horse procurement was similar to previous practices, with the Quartermaster Department purchasing government equines through auctions or designated suppliers. Once again, some service members brought their own animals into the Army. After veterinarians became a slightly more permanent part of the Union force in 1863, they inspected animals purchased by the Quartermaster Department and helped enforce a better health standard. One potential reason for veterinary inclusion in the Union Army was the large expense the US government incurred replacing unhealthy animals.

Estimates for the number of horses and mules lost during the war range from 1 million to over 1.5 million.[15] As with previous conflicts, battle wounds were a hazard, but the horses and mules that died in service were predominately lost from exhaustion, insufficient forage (an army with horses needs a large, continuous supply of food), and disease. Glanders was the preeminent disease spread across America by Civil War horses during and after the conflict.14(p164) Because the war bogged down to attrition in some areas, even healthy horses died; some units were forced to slaughter hundreds of horses in an effort to deny the enemy their animals before they were captured (Figure 8-2).

Despite the tremendous animal losses during the Civil War, veterinarians were treated somewhat better than in previous wars. Not only were they perceived to be of some assistance, they were gaining acceptance in the Army, and War Department General Orders 195 and 137, dated May 12, 1864, provided for the purchase of “horse medicines.”14(p152) Items included in the purchases resemble contemporary substances used for human patients and were certainly an improvement over the bloodletting treatments of only a few decades before.

Figure 8-2. Although the majority of equine losses during the Civil War were not battle-related, they occurred with some regularity. This image demonstrates some of the aftermath of the Battle of Gettysburg. The 9th Massachusetts Artillery Battery (Bigelow’s) went into battle with 110 horses; after the battle, the unit had only 22 horses.
Reproduced from the Library of Congress online. http://www.loc.gov/pictures/item/2013645105/. Accessed January 5, 2016.

George F. Parry, a graduate of the Boston Veterinary Institute, was one the earliest formally educated veterinarians to serve with the Army. Contemporary accounts from his Civil War diary of his service with the 7th Pennsylvania Cavalry Regiment highlight his duties as well as some equine treatment and healthcare challenges. In addition to writing about inspecting and classifying the horses into four classes according to War Department orders, Parry mentions pressing charges against two soldiers who abused their horses, perhaps by running them too hard. (Parry requested these men be transferred to the infantry.) Earlier in the war, he addressed potential public health concerns after animals died during combat in inclement weather. One journal entry written near Murfreesboro, Tennessee, on July 3, 1863, describes the sight of dead horses and mules floating by in the nearby, flooded Stone River.[16]

Parry also notes the number of horses that were starving to death as the war progressed. In 1864, reportedly hundreds suffered this fate. Equally as distressing to this veterinarian was the fate of those horses that did have enough forage. According to his journal entry from March 10, 1865, the forage issued to the regiment since March 1, 1865, may have been spoiled; recounted testimony from the forage master and veterinary surgeons suggests that previously healthy horses suffered from diarrhea after eating the bad food and, consequently, many died.[16] The fact that a veterinarian was there to care for the sickened animals and, perhaps save some, could be viewed as a sign of progress.

Post-Civil War to the Spanish-American War

After the Civil War, equines were relied upon to maneuver through the vast expanses of the American West and Great Plains in pursuit of Native Americans and to patrol border areas. Although the Army’s size decreased, new cavalry units formed, and veterinary personnel were attached to keep these units’ animals healthy.

Equines that were not of use to the government, either because of age, ill health, or the shrinking size of the military, were put up for auction. Unfortunately, the scrutiny the animals underwent during their initial purchase was not observed when the animals left service. This lack of attention further contributed to the spread of glanders to areas that were formerly disease-free, and it took many years to stabilize the disease and prevent further equine fatalities.

Veterinary professional recognition and equine care both progressed and suffered setbacks in the period following the Civil War. Because the horse population significantly decreased after the war due to various factors including glanders, a new importance was placed on the remaining animals’ well-being. The increase in horse value beneficially coincided with increasing post-Civil War educational opportunities for veterinarians. The founding of more American universities in the 19th century fostered more formal veterinary education, and education and experience requirements were codified by Army regulations and General Orders in 1877 and 1879.

Unfortunately, increasing the number of academic veterinary medicine institutions and mandating elevated knowledge and skill sets didn’t equate to immediate universal acceptance of the veterinarian as a recognized professional with specialized animal medicine training. For example, instead of hiring a veterinarian, in 1868, Congress hired a farmer and paid him $10,000 to treat lameness in the Army’s horses by trimming their hooves in a special way. Similarly, equine medicines were often distributed to untrained unit commanders or quartermasters instead of skilled, university-educated veterinary personnel.[14]

Despite the setbacks, equine health prospects improved further as the years passed, thanks to the innovative knowledge gleaned from postwar research. A case in point of veterinary medicine’s continuous evolution forward via lessons learned is the story of “Traveller,” one of General Robert E. Lee’s horses.

Traveller was noted by many to be Lee’s primary horse during battles, and this animal survived the Civil War without incident, only to step on a rusty nail postwar and contract tetanus. Traveller died a few months after Lee in 1871. Two decades later, in 1893, Olaf Schwarzkopf, an Army veterinarian who was between service periods and conducting veterinary research, published his successful findings concerning “The Horse as a producer of Antitoxins,” and explained the new process of tetanus antitoxin production.[17]

Although post-Civil War veterinarians continued to struggle for recognition, they also continued to provide steadfast patient care on the front lines, even while sustaining their own causalities. One famous patient was Comanche, the horse ridden by Captain Myles Keogh who was killed in the Battle of Little Big Horn on June 25, 1876. Comanche received at least seven gunshot wounds but was saved by Army veterinary surgeon Dr Charles A. Stein.[18]

As campaigns against Native Americans subsided in the 1890s, the Army again decreased in size. However, when war was declared against Spain in April 1898, this trend was quickly reversed. An overwhelming number of volunteers, largely from state militias, clambered to join the conflict and swelled the ranks of the military. The large troop numbers, in turn, increased requirements for equines and fueled a frenzied rush to purchase more government animals. Costly problems ensued.

Figure 8-3. A rare and retouched image of a US Army veterinarian performing surgery on a horse circa 1909. The veterinarian (second from the left operating on the horse) is Dr Alexander Plummer, one of the earliest veterinary instructors at the Army’s Mounted Service School at Ft Riley, Kansas. The image is found in an early Army manual, The Army Horse in Accident and Disease: Edition 1909.
Image courtesy of the AMEDD Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

With a limited number of veterinarians to assist with purchasing oversight, the Quartermaster Department bought many horses without veterinary input. Records indicate that 38,000 horses were purchased at a cost of approximately $4 million in preparation for the Spanish-American War. Most of these animals were not immediately sent to Cuba but were kept in marshaling areas in Florida; meanwhile, glanders spread.14(p253)

When veterinarians examined the war horses staged at Tampa, Florida, many of the Quartermaster Department’s procured animals were deemed to be unfit and could not be shipped to battle sites. Worried about the spread of disease to nonmilitary equine populations, a Florida court issued an injunction against selling the horses, and other states protested receiving the animals.14(p253) The large number of unfit equine and military monetary losses gained the national press’s attention and resulted in further inquiry.

After this debacle, veterinary officers’ recognition and responsibilities expanded. By the early 1900s, veterinarians were able to oversee horseshoers and farriers. Veterinarians were also appointed as instructors at the Army training school for farriers and blacksmiths at Ft Riley, Kansas. Another veterinarian served as an assistant instructor in hippology at the infantry and cavalry school at Ft Leavenworth, Kansas.14(pp200–202) In garrison, veterinarians instructed junior officers in hippology. They were also selected to provide age determination and soundness examinations for horses being procured by the purchase boards. In the field, veterinarians accompanied their commands to care for disabled horses (Figure 8-3).

Equine Procurement and Care in the American Military of the 20th and 21st Centuries

World War I

All the military powers engaged in conflict during World War I fielded and employed cavalry units. An estimated 2 million horses were used by cavalry units between 1914 and 1918.[4] However, World War I was the first war in which large-scale cavalry forces and tactics were not key to securing a decisive military victory. Horses’ tactical advantages of speed, maneuverability, and psychological fear were mitigated by technological advances such as improved ammunition ballistics, accuracy of modern battle rifles, and the use of chemical warfare.

An implement as simple as barbed or concertina wire strewn about the ground between opposing trenches effectively removed the threat of a cavalry charge. Wire arranged in this manner caused debilitating injuries to the horses, slowed their progress across the field, and left mounted soldiers exposed to small-arms and artillery fire. These experiences on the Western Front led commanders to hold their cavalry in reserve, using them only in engagements where there was a clear advantage. The Eastern Front presented a better opportunity for cavalry forces to engage with enemy units, but cavalry use was primarily limited to flank security and reconnaissance maneuvers.[4]

The Allied cavalry’s greatest success came in the Middle Eastern Theater, where the joint forces of Great Britain, Australia, New Zealand, and India faced the army of the Ottoman Empire.[4] British Army General Sir Edmund Allenby effectively utilized the Desert Mounted Corps, composed of Australian and New Zealand cavalry (specifically the Australian 4th Light Horse Brigade), to attack the Ottoman defenses in the Battle of Beersheba in modern-day Israel. The horses’ mobility and the Australians’ aggressive tactics swept the Turks from the field of battle in a mere 38 days.[4] When all was said and done, the cavalry had traveled 500 miles and captured 80,000 prisoners.[4]

Though the battlefield was changing toward mechanization and away from cavalry charges, the European armies of World War I still relied significantly on horses and mules. However, after years of battle, Europe’s horse populations were largely decimated. In countries such as Belgium and in some areas of France, both military and civilian horses were virtually eliminated, and dogs had to be used as “draft” animals to pull smaller carts.[19] (See Chapter 2, Military Working Dog History, for more information about how canines supported military efforts before and after World War I.) The United States was largely unaffected by the war, remaining neutral until April 1917. To many Americans, the country’s neutrality did not affect its ability to sell goods to the Allied countries. With ample land and farms, horse stock was plentiful, and equines were sold to the Allies in large numbers for use in the war.

The infusion of horses was further assisted by the United States’ entrance into World War I and its newly formed Army Veterinary Corps (established June 3, 1916). With over 2,300 veterinarians and 18,000 enlisted personnel serving during the war, the US Army Veterinary Services expanded to care for an army still quite dependent on horse power.[12] It is worth noting that, at the time, horses and mules (and, to a lesser degree, carrier pigeons) were the only official US government animals, and almost all US veterinary animal care was focused on the well-being of these animals.[19] Although cavalry charges were largely outdated by machine-gun fire, equine power moved artillery pieces and could still pull supply wagons through areas without improved roads. Logistics relied on horse power in many cases. Single mounts were also used by soldiers performing reconnaissance or patrol duty.

Animals purchased for government service (by the Quartermaster Corps) within the United States were taken to remount depots, which also served as quarantine areas.20(p16) Serving under the Quartermaster Corps, personnel assigned to the depots furnished new or refreshed horses for divisions before deployment, and veterinarians were assigned to the depots to ensure equine health before the animals were issued to units.

During American involvement in the war, the US Army shipped 68,694 horses and mules to Europe for military use.[21] Losses during shipment due to disease or mishap were low, 660 or around 1% percent.[22] Once overseas, the US Army acquired more equines from the Allies and from other countries. The total number of equines in use by the American Expeditionary Forces (AEF) is estimated to range between approximately 170,000 to 190,000.14(p552) Still, there were many shortages: many of the animals may have been recovering from service or were simply unavailable to some units. US Army veterinarians worked to “conserve the fighting strength” of horses and the animals’ availability.

As in previous wars, common major health problems for horses serving in World War I continued to be poor nutrition, exhaustion, and disease; however, there are some notable differences between World War I animal healthcare trends and those from previous conflicts. Significant improvements in animal medicine and disease cause and prevention were made since the last major war involving Americans. For example, many of the US veterinary hospitals used during World War I had laboratories that made pathology work possible, animal surgery was practicable at some veterinary hospitals, and the discovery of a mallein reaction test that made glanders detectable potentially saved thousands of horses from being unnecessarily culled.

Unfortunately, new problems were discovered as well. Miserable field and weather conditions intensified parasite infestation, resulting in humans being plagued with lice and equines suffering from sarcoptic mange. Equines also sustained numerous foot ailments and skin problems as a result of the muddy conditions. Poison gas attacks (chemical warfare), artillery bombardments, and rifle fire rounded out the sources of equine injury.

Faced with these numerous dangers, veterinary members of the AEF served at remount stations (depots) and at veterinary hospitals for more in-depth medical care. At the remount stations, horses were given time to recuperate and were examined and separated for possible diseases. If determined to be diseased, the animals were treated or culled as necessary. Animals that were infested with parasitic mange or other skin infections were shorn, thoroughly scrubbed and cleaned, and then walked through a large trench full of a cleansing solution (Figure 8-4).

Figure 8-4. Soldiers of the American Expeditionary Force bathe and scrub a horse at a remount station in France. The cleanings were needed to rid thousands of horses of mange and other skin ailments during World War I.
Photograph courtesy of the AMEDD Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Lieutenant John J. Riordan, a veterinarian with the 4th Corps Veterinary Hospital, provides more details about the cleansing or dipping procedures used to treat mange during World War I:

To combat this disease [mange] a large “dipping vat” deep enough to completely immerse the horses and mules was filled with a lime and Sulphur [sic] mixture in the water. The solution was brought to a boil…. We “dipped” the horses and mules when the solution was warm, lining up the animals to be treated and driving them through the vat. If the disease was caught early, the treatment was very effective, and the animals recovered.20(p59)

Other World War I mange treatments included the use of sulfur gas. (see Chapter 1, Military Veterinary Support Before and After 1916, for more in-depth information about animal treatments throughout military veterinary medical history).

Although the remount stations and veterinary hospitals saved many horses, losses sustained during the war were substantial. By December 1918, AEF equine deaths totaled 42,311, and although records are nearly impossible to verify, total equine losses from 1914 to 1918 are thought to be approximately 8 to 9 million animals.14(p552),23

At the close of the war, military equines faced various fates. Thousands of AEF horses were given or sold to continental Europeans devastated by the 4 years of war. Many animals found unfit for service were butchered for food. Other horses were set to be imported to the United States. To stop publicly and privately owned animas belonging to military forces in Europe from being indiscriminately imported to the United States, the Army Veterinary Corps pushed to have Bulletin No. 33 published on April 19, 1919.19(p902) The Army Veterinary Corps also coordinated with the US Department of Agriculture, the agency responsible for implementing the quarantine regulations for privately owned mounts returning to the United States, which made the veterinary-championed import restrictions possible. The Army Veterinary Corps’ forethought prevented diseases such as mange, foot and mouth disease, and glanders from being brought back from Europe in horses that would have been shipped all over the country (Figure 8-5).

World War II

World War II featured equine support to combat operations in the European and Pacific theaters, but on a much smaller scale than in World War I. Tanks, armored personnel carriers, and mechanized heavy weapons platforms such as half-tracks and tank destroyers were among the technological advancements that greatly improved armies’ mobility and lethality and reduced dependence on horses. Armored corps’ battlefield employment, infantry support, tactics, and techniques doctrine were built on lessons learned from World War I and the Spanish Civil War, among other engagements.[24]

Figure 8-5. Medical personnel of the 137th Ambulance Company put an equine gas mask on a mule. The mule is harnessed and may be pulling a supply wagon or an ambulance. Although there were mechanized vehicles in use during World War I, horse and mule power was consistently used.
Photograph courtesy of the AMEDD Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Surprisingly, despite these advancements, many European nations maintained a modest number of equine cavalry units, including the French, Austrians, Bulgarians, Poles, Lithuanians, Romanians, and Czechs.25,26,27 The famed German “blitzkrieg,” or “lightning war,” still depended on horses in some cases to pull artillery and to move supplies. However, the British almost entirely replaced their cavalry units by 1939.25,28

Major changes to US Army horse use occurred in the 1930s. Although there were 15 active horse cavalry regiments in the Army after World War I, by 1937, two of the regiments were converted to mechanized units.29(p79) The pattern continued in the following years, and for the first time in American military history, horses were not a significant part of the force. The Louisiana Maneuvers, an enormous series of war exercises in 1940 and 1941 used to evaluate US Army tactical doctrine and the mobility of forces, relied partially on horses, as well.29(p354) After the maneuvers, the horse-borne units were converted primarily to mechanized units.

Despite these technological conversions, there was still a need to ensure military equine health. Army veterinarians provided horse and mule health and care instruction to more than 4,400 cavalry officers and 1,041 enlisted personnel, as well as to field artillery school personnel on a similarly extensive scope, and supplied training to almost 1,500 enlisted horseshoers.12(p111) During World War II, the Army Veterinary Service provided over 2 million hospital treatment days for Army horses and mules and implemented evacuation plans in overseas theaters with 72 veterinary detachments, companies, hospitals, and provisional organizations. The Zone of the Interior alone had a stall capacity of 2,500 for disabled animals.

The average yearly equine strength during the war was over 44,000 animals.12(p519) The peak year of equine strength for the US Army was 1943, with 56,287 animals.12(p519) An estimated 60,000 horses and mules were purchased in the Zone of the Interior, and another 6,000 horses were purchased from Australia.12(p489) The numbers of equines purchased for military service in other theaters of the war (as remote as Tibet) are not known but likely added several thousand to the total (Figure 8-6).

As was the case during World War I, there was a substantial need to maintain a supply of horses and mules to Allied countries, and thousands of US animals were shipped overseas. These animals had to pass inspection by US Army veterinary personnel working alongside transportation and Quartermaster Corps personnel at depots.

Initially, the US Army operated four remount facilities in the United States and a number more in the Pacific and European theaters. However, the total number of horses produced or procured dwindled as the war went on. The last US Army remount station was transferred to the US Department of Agriculture in 1948.30,31 Approximately 50 Veterinary Corps officers who fell under the control of The Surgeon General’s Office were involved with the professional and technical supervision of procuring and processing remount animals for the Army Remount Service, which fell under the control of the Quartermaster General.

Figure 8-6. Veterinarians were very much a part of the inspection and procurement process during World War II. In this image, veterinarians are inspecting ponies in Tibet to be purchased for use in the China-Burma-India Theater.
Reproduced from an unnamed slide collection courtesy of the AMEDD Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

China-Burma-India. Although equines were used to a smaller degree overall in many areas during World War II, the largest numbers attached to American forces were found in the Mediterranean Theater (see the next section) and the China-Burma-India (CBI) Theater. The terrain in these locations—mountains and jungles without improved roads—prevented the passage of even jeeps, making mule or horse use necessary. In addition to other tasks, US Veterinary Services inspected, cared for, and supervised animal loading and shipping at the ports of embarkation, as well as cared for the animals while in transit.

An early test in New Guinea in May of 1943 explored mass air transportation of equines.12(pp553–554) Army veterinarians were available to assist with possible animal health issues and securing the animals. After the tests were considered successful, pack animals were transported by air to move them more quickly further into Burma and then over the Himalayan Mountains into China. Three major US airlifts transported a total of over 7,000 horses and mules in the CBI theater of operations.12(p553) The animals were largely used by Chinese forces. US Army veterinary personnel oversaw the loading of the animals as well as of their required food and equipment.

In August 1943, the War Department created a volunteer force designated as the 5307th Composite Unit (Provisional) for the specific purpose of engaging Japanese forces deep within CBI’s jungles and rugged terrains. Nearly 3,000 men were committed to the unit, later known as “Merrill’s Marauders,” and were supported by an animal transport company that consisted of nearly 300 pack mules brought from the United States by transport ships.[32] The pack company was supplemented with replacement horses from New Caledonia. The mules and horses were used to haul light and heavy equipment alike, including ammunition, rations, artillery, and mortars, through dense jungle and inhospitable terrain.

The animals suffered equally as the men but played a vital role in moving supplies and materiel, enabling the infantry to reserve their strength to engage and fight large Japanese elements. For nearly 750 miles, the mules marched with the unit, fighting all along the way in a multitude of engagements. Ultimately, combat operations lasted for nearly half a year and culminated in the capture of the town of Myitkyina and its strategically located airfield. Because of massive casualties from combat and disease, the few remaining officers and enlisted soldiers were reassigned to the 475th Infantry Regiment, and the 5307th was disbanded roughly a year after its creation. The mules that survived were left with Chinese, Burmese, and Indian allies for further use (Figure 8-7).[32]

Figure 8-7. Mules and soldiers of Merrill’s Marauders travel on the Ledo road in Burma.
Reproduced from a Department of the Army photograph found in “India-Burma: The US Army Campaigns of World War II,” Center of Military History Publication 72-5.

A follow-on unit was created to continue the war in the CBI Theater. The new unit was larger and sought to provide not only more troops, but also a better capability for caring for human and animal casualties. The MARS Task Force, or 5332d Brigade (Provisional), consisted of the 475th Infantry Regiment, the 124th Cavalry Regiment, two field artillery battalions, three portable surgical hospital units, six Quartermaster Pack Troops, and the 18th Veterinary Evacuation Hospital.[33] Each of the infantry, cavalry, and artillery units in the task force had 280 to 330 mules.[33] The animals were also needed in a support role because horses and mules moved the 42nd, 44th, and 49th portable surgical hospitals attached to the task force.[33] The total for all equines in the provisional brigade, including animals under Chinese Army control, was 2,960.[33]

Because of the workload and their importance in logistics and maneuvers, these military equines received veterinary medical care that mirrored human evacuation and treatment plans. The 18th Veterinary Evacuation Hospital was commanded by Lieutenant Colonel Elmer W. Young (later, Brigadier General Young, 11th Chief of the Veterinary Corps, 1954–1959). Paralleling a military medical collecting company of the time, which transported ill or wounded service members to human hospitals to receive necessary care, the 7th Veterinary Company (Separate), attached to the 18th, moved ill or wounded animals from the front lines to the veterinary evacuation hospital for more in-depth treatment.[33] While air-dropped medical supplies were (and still are) marked with red crosses for human use, veterinary supplies were (and still are) marked with green crosses (see Chapter 1, Military Veterinary Support Before and After 1916, for more information about the use of the green cross.).[33] Given the improved animal care and the availability of trained equine personnel, losses due to exhaustion and disease were considerably fewer than with the previous provisional unit.

Europe. Although many people are familiar with the frequent use of equines in World War II in the CBI Theater, horses and mules were used on a much larger scale, albeit less well known, in the European Theater. Just as the pack animals supported soldiers in the CBI Theater, mules were relied upon to carry artillery and supplies up mountain trails in the many inaccessible areas of the Italian Campaign.

However, equine use began slowly. The 3d Infantry Division used burros in a portion of the North African Campaign and in the invasion of Sicily in 1943.12(p575) During the invasion month of July, the animals did not fare well, suffering not only from battle casualties, but also from heat and exhaustion. All the unit’s 60 animals died by the month’s end.12(p575) To continue operations in Sicily, horses and mules were procured locally, but again, losses were high. Of the 487 mules and 219 horses acquired, 43% were killed in action.12(p575)

After landing on the Italian Peninsula, Allied forces’ use of animals accelerated; in late 1943 and early 1944, the Fifth Army’s animal strength was considerable and growing. The 3d, 34th, 36th, and 45th Infantry Divisions used 1,078 mules and horses for artillery battalions and pack trains.12(pp575,582) Another 1,835 animals were acquired from Italian Army mule pack trains.12(p582) A part of the Fifth Army included the French Expeditionary Corps, which comprised 4,300 animals, later growing to 9,000 for the southern invasion of France.12(p582) The mean animal strength of the Fifth Army from December 1943 through June 1945 averaged 5,150 mules and horses.12(p582)

After Italian forces separated from their German allies in September 1943, Italian Army mule trains were allotted for American Fifth Army and British Eighth Army use as well as by Italian veterinary units.12(p582) Italian Army veterinarians assisted in the collection, treatment, and operation of remount stations for the American and British troops within the area.12(p582) With the large number of animals, care and evacuation became issues and, in addition to veterinarians assigned to the previously mentioned divisions, more veterinary personnel were needed.

An evacuation plan for the Fifth Army’s animals was developed that included two separate veterinary companies, a veterinary company from the 10th Mountain Division, two evacuation detachments, and at least nine veterinary hospital organizations, and a complete remount operation.12(p582) Italian veterinarians were to be part of the plan, with supervision provided by Allied veterinary personnel. The plan was massive and was pared down and altered based on available veterinary assets (Figure 8-8).

Two Italian veterinary evacuation hospitals, the 110th and 130th, were established at Treponti and Nocelleto, respectively.12(p584) A third hospital unit, the 17th US Army Veterinary Evacuation Hospital, was deployed from the Zone of the Interior to Teano, Italy.12(p584) Remount stations were established at Persano, Santa Maria, and Bagnoli.12(p584) As the Allied forces advanced, the stations continued to provide dispensary care. The French Army briefly provided support to the remount stations with the 541st Ambulance Company, as did a provisionally formed US Army veterinary hospital, but, later, both units were shifted in preparation for the invasion of southern France.12(p584)

As the fighting progressed past mountainous areas, equine use was again largely discontinued. Many of the animals reverted back to Italian control; consequently, veterinary support was in less demand. Some equines were used for the initial push into German-held northern Europe, but they were not a significant portion of the force. Veterinary support to these units was largely attached to the 601st and 602nd Field Artillery Battalions.12(pp590–591)

The number of official US Army horses and mules that died from all causes, including destruction (euthanasia) due to disease or age, during the war (1941–1945) totaled 12,916.12(p533) The number is a large reduction from previous conflicts and demonstrates a lower reliance on animal power in general during World War II, but the number of losses may not include the many locally procured animals.

Special operation’s connections during World War II foreshadowed future equine use in unconventional warfare. The current 75th Ranger Regiment traces portions of its origins to the 5307th Composite Unit and its 475th Infantry Regiment.[34] Similarly, the 6th Ranger Battalion, which freed hundreds of prisoners behind enemy lines in a raid on a Cabanatuan prisoner of war camp in the Philippines, was formerly a mule-borne artillery unit. Originally designated as the 98th Field Artillery Pack Battalion, the unit participated in the 1943 test to transport mules by airplane (ie, the test mentioned earlier in this chapter).12(p533)

Figure 8-8. Mules are unloaded from their “ambulance” to further veterinary care by soldiers of the 45th Infantry Division in Italy. The reliance upon horses and mules necessitated a large veterinary care system.
Photograph courtesy of the AMEDD Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Equines were also used in unconventional warfare that occurred directly after World War II, when civil war erupted in Greece. Although the conflict officially lasted from 1946 to 1949, guerrilla raids continued for some time afterward. Greece’s forces and communist groups vied for control in the turmoil left after German occupation. US support for the anticommunist forces included 4,000 mules and their pack equipment, purchased in the United States and transported to Greece.[35] While some of the American advisors were experienced in pack techniques, further support and animal treatment was provided by US Army veterinarians.

Serving as a part of the Joint US Military Aid Group, Greece, American veterinarians served from 1947 through 1955. One of these veterinarians was Lieutenant Colonel Charles V.L. Elia (later, Brigadier General Elia and future Chief of the Veterinary Corps, 1972–1976).[36] When US forces stationed in Greece were placed under Air Force control, the Army veterinarians were replaced by Air Force veterinarians.[37] The use of mules in the counterinsurgency, versus motorized transport, furthered the military’s debate over continued equine use in later years.

Korean War. Large-scale fielding and use of equines for battle had concluded by 1945, with western major military powers principally committing themselves to motorized heavy weapons platforms and transportation. Improvements in helicopters and their ability to reach previously inaccessible areas also curbed animal transportation. With the outbreak of the Korean War in 1950, “military animal” seemed to be an antiquated term.

The 1st Cavalry Division acquired a few local horses in Korea, but they were not used for long or for large-scale operations.38(p51) Horses were also purchased, borrowed, or adopted by other American units in Korea, though not much is known about the use or terms of service of these animals. However, the story of one horse that saw considerable combat was extensively recorded.

This horse came to be known as “Reckless,” and her story is now a Marine legend. After a rifle platoon belonging to the 5th Marine Division discovered that the Korean terrain and requirements unique to their unit were suited for a horse, the rifle platoon commander purchased a diminutive sorrel mare at a racetrack in Seoul for $250 in 1952. This platoon used the mare for draft power, moving heavy, recoilless rifles and ammunition between the ammunition supply point and their frontline fighting position. First named “Flame of the Morning,” the horse was renamed “Reckless.”39(p84) The Marines throughout the company, battalion, and soon the division quickly became fond of the mare and selflessly shared their bunks, beans, and beer with her. Because she was so well liked and had proved herself valuable to their mission, the Marines bestowed her with the rank of sergeant.

Sergeant Reckless’ position as unofficial mascot came second to her primary role as a draft animal. The Marines of her platoon patiently worked with the mare, teaching her to lie down or find adequate cover from both direct and indirect fire. She learned these tasks quite well, first without and then carrying the 115-pound, 7-foot rifle and the six to ten accompanying 24-pound rounds.[40] Once the platoon commander felt she was adequately trained and prepared, Reckless was pressed into service.

The platoon relied on her in several large-scale engagements. She was reported to have remained calm but alert while under fire, reliably delivering supplies and ammunition. The mare frequently traversed unaccompanied between the ammunition supply point and the front line. She remained steadfastly loyal to her fellow Marines and never broke from battle. She was injured twice, receiving shrapnel wounds to her flank and the skin above her left eye.

When the war ended in 1953, Reckless’ fate was in question. Through the efforts of her fellow Marines and private citizens, Reckless was brought to the United States in 1954. The stories of her battlefield valor were widely reported in popular media of the time. Reckless was stabled at Camp Pendleton, California, later promoted to staff sergeant (SSGT), and awarded two Purple Hearts and a Presidential Unit Citation prior to retirement in 1960. She was the guest of honor at several Marine Corps birthday functions and ate her share of birthday cake every November 10th. The courageous sorrel mare passed from life on May 13, 1968, and was buried with full military honors at Camp Pendleton.[40]

Vietnam War. By the mid-1950s, the US Army had extremely few equine units. The majority were ceremonial units, and a few were quartermaster pack units. One of the last refuges for actual working horse and mule units was at Ft Carson, Colorado, until the 4th Field Artillery Battalion (Pack) and 35th Quartermaster (Pack) Company were inactivated, and the animals were sold at public auction in February 1957.39(p85),41

Veterinary support for equines had continually declined since the end of World War II, but these specialized veterinary skills were not totally discarded. As the US military adjusted to counter smaller conflicts that were part of the larger Cold War and US involvement in Vietnam, military planners suggested increased equine use, and during the early to mid-1960s, there was considerable debate over this issue. Studies from the equine debate had listed horse use in Thailand and by North Vietnamese forces as possible reasons for US equine procurement in Vietnam.38(p26) (Ultimately, US equine use during the Vietnam War did occur but was extremely limited.)

Finally, it was decided that there would not be an active horse procurement program within the continental United States as there had been in America’s recent past. Horses and mules, and other draft-type animals needed by the US Army (eg, camels and elephants) would be locally procured when the need arose. However, instruction to utilize and care for these animals would still be needed. In the Army, Special Forces soldiers would receive equine pack training because they were the soldiers most likely to work with indigenous forces in developing countries (they were already being deployed to Southeast Asia).

A few soldiers in the Army still possessed the necessary skills to correctly load pack animals and also to purchase the right animal for the job, but these individuals were mostly attached to ceremonial horse units, with a few exceptions. Most did not have a related military occupational specialty such as the veterinary specialist (MOS 084), which indicated an ability to shoe horses and mules, so it was hard to identify those soldiers who had this skill set.42(p64)

The United States Marine Corps (USMC), with recollections of SSGT Reckless’s deeds still fresh, as well as some historic studies from their use of local mounts during the occupations of Haiti and Nicaragua in the early 1930s, incorporated “The Employment of Pack Animals” into USMC Basic School.39(p84) The courses’ lesson plan dates to at least 1961.42(p66) Special Forces veterinary personnel attended the course and returned to Ft Bragg to incorporate it into “pre-mission” training.43(p76) Interestingly, the instructors for the USMC course consisted of an Army detachment with “one veterinarian, one lieutenant, and one instructor-horseshoer (E-7).”42(p66) Although the Marines had the only official equine packing school, the animal care instructors were from the Army (Figure 8-9).

Figure 8-9. An Army veterinarian demonstrates basic horse care and treatments to a group of Special Forces soldiers.
Reproduced from an unnamed slide collection courtesy of the AMEDD Center of History and Heritage Archival Collection, Ft Sam Houston, Texas.

Arrangements for training and using equine forces changed in the decades following the 1960s, but there were some relative constants. Use remained low, and other than animals in ceremonial units, equines were likely connected to a Marine or Special Forces operator.

Operation Enduring Freedom. One of America’s darkest hours occurred on September 11, 2001. The country’s citizens and service members alike watched helplessly as more than 3,000 noncombatants died in coordinated terrorist strikes in New York, Virginia, and Pennsylvania. In the days and weeks that followed, military planners worked around the clock to draft a definitive response to Al Qaeda terrorists and their Taliban sponsors. However, Afghanistan was largely underdeveloped in terms of intelligence assets and allies, and there was a paucity of information regarding the leaders of both organizations.

Moreover, what industrial and military infrastructure that remained intact following the Soviet invasion and occupation of the 1980s did not present a target-rich environment wherein an aerial bombing campaign would effectively pave the way for a ground invasion. Throughout history, Afghanistan’s advantages against invaders were its rugged, unforgiving terrain and indigenous fighters’ familiarity with and use of that terrain. America had few prudent options available to project forces into Afghanistan. The most immediate and best option available was to turn to the specialists in unconventional warfare. A handful of US Army Special Forces operators could assess the situation on the ground, develop military alliances with friendly indigenous forces, gather and prioritize useful intelligence, and direct attacks against the Taliban and Al Qaeda.

Several operational detachments alpha (ODAs) from the 5th Special Forces Group were surreptitiously inserted into Afghanistan beginning in October 2001.[44] Each ODA consisted of 12 men and was given specific Afghan counterparts with whom they imbedded themselves. Several of the ODAs were met at their drop sites by their assigned Afghan partners and cavalry detachments. Many of the Afghan horses were small and thin, appearing more like ponies than true horses; however, they were tough and sure-footed, which served them well on the harsh steppes and in the unforgiving mountains. Local donkeys were similarly used as pack animals. Together, the Americans, the Afghans, and their mounts maneuvered through hostile territory. Many of the operators lacked experience of any kind in a saddle: despite this, they quickly adapted and performed well.

The ODAs used the horses to quietly move into positions whereby they could direct airstrikes onto Taliban fighting positions. The Afghans of the Northern Alliance began to grow confident with each bomb delivered against the enemy. Together, the ODAs and Afghans developed a successful strategy of coordinated airstrikes followed by a cavalry charge and infantry assault. The Afghan cavalry charge was much like that from World War I in which the cavalry would race ahead to the enemy line, dismount, and deliver effective small-arms fire to enemy lines. The well-coordinated attacks produced a psychological fear in the enemy, causing many of the Taliban to retreat or surrender to the Northern Alliance.[44]

CURRENT MILITARY USE OF EQUINES

In today’s military, horses play several important ongoing roles. They prepare soldiers for combat operations, support public relations and recruiting efforts, preserve cavalry traditions and tactics, and help protect and restore human health. Today’s military equine units are not legacy units but have been created or reformed for one of two basic missions: (1) they have been created to serve a vital training purpose or (2) they have been reformed because of a desire to preserve the history and dignity that horses share with the US military or to provide support to human well-being.

Equine Units Maintained for Training

The USMC’s Mountain Warfare Training Center, located in in the mountains of northern California, is home to about 50 horses and mules. Training center personnel prepare military forces to use equines in current operational settings and develop service members’ proficiency in employing horses and mules to transport personnel and supplies in rugged terrain. US Army veterinarians participate in the instruction at the center, providing training for safe animal handling, evaluation and selection of animals for purchase, and basic equine first aid and emergency management.

Equine Units Reformed to Preserve History and Dignity

Nationwide, cavalry, caisson, and mounted color guard units employ over 300 equines that serve the important mission of preserving military tradition, tactics, and heritage. Many of these units perform publicly in venues across the country in support of military recruitment efforts and serve as ambassadors of good will to the American public. The units in existence today have not served continuously with an equine component; rather, that component has been reestablished.

These units are staffed by a variety of people, including assigned active duty personnel and volunteer organizations. Personnel serving in these units commit themselves to the welfare of their mounts as well as to preservation of their traditions and perfection of their performance. Frequently, units employ one or more permanent civilians as trainers to provide long-term continuity. They may have an organic veterinary technician or may assign an equestrian member as veterinary liaison to coordinate the team’s medical information and treatment.

The specific compositions of, and missions completed by, these reformed units varies by the installations they are assigned to; for example, each morning, two teams of horses in Arlington, Virginia, deliver an American service member to his or her final resting place. The 3rd Infantry Division “Old Guard” Caisson Platoon ensures the military burial honors at Arlington National Cemetery are meticulously carried out, day in and day out. This platoon maintains two teams of matched horses: a black team consisting of Percheron draft horses and a gray team consisting of Lipizzaner horses. Each team works as a six-horse hitch, pulling a black artillery caisson (minus the cannon) bearing the casket of the deceased. Similarly, at Ft Sam Houston National Cemetery, a matching team of black Percheron horses pulls the black caisson, adding honor and dignity to official military funerals.

Although most caisson horses have already received training prior to purchase by the government, caisson duty requires extensive specific training and preparation for the animals and riders to present the most dignified appearance in the solemn funeral procession. The job of the caisson horse is both mentally and physically demanding. Horses must be quiet in harness, tolerant of spectators and vehicular traffic, and able to work together as a team, and they must not be prone to panic. Additionally, the horses must be physically fit, with excellent conformation to pull the heavy World War I-era wagons. Meticulous attention is given to the selection and health maintenance of these valuable animals to ensure their longevity.45,46

The “Half Section” from Ft Sill, Oklahoma, also known as the “Flying Artillery,” represents the only remaining horse-drawn field artillery section in the US Army. (Horse-drawn artillery became obsolete with the advancements of mechanized weapons between World War I and World War II.) Currently, the field artillery maintains one horse-drawn artillery unit for ceremonial purposes. A small group of color- and size-matched geldings furnish the six-horse hitched team to pull an authentic gun wagon, complete with cannon. The team is known as the “Half-Section” because it consists of the gun wagon only and is not accompanied by the munitions wagon. The Half-Section supports military ceremonies, including changes of command, funerals, retirements, reveille, and retreat, and also participates in many other events within Oklahoma and the surrounding states, including parades, rodeos, and demonstrations. The six-horse team is capable of pulling the heavy gun wagon at a full gallop, demonstrating the operational flexibility of the historic horse-drawn artillery and thrilling crowds of spectators (Figure 8-10).47,48

Several installations, including Ft Hood, Ft Riley, Ft Carson, Ft Irwin, and Ft Huachuca, maintain mounted cavalry and mounted color guards.49,50,51,52 These units proudly perform at official military ceremonies, including changes of command, retirements, and commemorative events, in addition to carrying out hundreds of community performances annually in support of national and regional events. These units’ missions include representing the history of the US Army and cavalry, aiding in recruiting efforts, and fostering a sense of pride and esprit de corps within their communities. The units strive to maintain as much historic accuracy as possible, using period saddles, weapons, and uniforms and accurately depicting cavalry maneuvers that were employed on the historic battlefield. A crowd favorite at change-of-command ceremonies is the traditional cavalry charge, complete with pistol firing and saber drawing, to demonstrate the intimidation imposed on the enemy by the cavalry forces.

Figure 8-10. Current use of ceremonial horses in the Army, the Ft Sill Artillery “Half Section.” This image shows the section in action during the Tournament of Roses Parade at Pasadena, California, on January 1, 2016.
Reproduced from the Ft Sill Public Affairs website. https://www.flickr.com/photos/fortsillcannoneer/albums/72157663021794919. Accessed January 19, 2016.

The same horses that perform these feats of speed and skill must also perform calmly and safely in parades through the nation’s cities and with quiet dignity as the color guard in a wide variety of venues. Cavalry and color guard horses must possess an exceptionally calm and willing temperament as well as excellent conformation to withstand the mental and physical rigors of their daily tasks. Similar to those of the caissons and Half-Section, cavalry and color guard horses are purchased with their basic training already accomplished and go on to receive extensive specific training once they join the unit. These performance horses are highly valued by their units and may serve 20 years or more.

Equine Units Reformed to Support Human Well-Being

Caisson, cavalry, and color guard horses also make ideal mounts for equine-assisted therapy or “hippotherapy” because of their size, strength, and extensive training in maintaining composure in novel situations. Hippotherapy is a popular treatment modality that helps disabled children and adults improve strength and mobility through exercising the core muscles used in riding. The freedom of movement offered by a horse also provides substantial psychological benefits to many patients. Several military horse units actively participate in hippotherapy programs within their communities, often helping with the recovery of the human warriors with whom they serve. (See Chapter 6, Human-Animal Bond Programs, for more information about hippotherapy and other animal treatment programs that support human healing and morale.)

In certain locations, Morale, Welfare, and Recreation (MWR) horses are also used to support hippotherapy programs or to offer a healthful benefit to service members and their families: the opportunity to enjoy horses without the challenges of owning a horse while being a highly mobile military or military family member.[52] Numerous MWR programs use nonappropriated funds to purchase horses that are available for rental or riding lessons for many styles and levels of riding on a short- or long-term basis; MWR activities also frequently sponsor equine recreational events on many installations. The horses purchased by MWR are typically already trained prior to purchase and are chosen for their ability to be safely handled and rode by potentially inexperienced riders.

ROLE OF VETERINARY OFFICERS IN MILITARY EQUINE HEALTH

As already noted in this chapter, Army veterinarians play a critical role in selecting equines for military use; horses selected for purchase must be of good temperament and sound, mandated conformation. For example, each cavalry and caisson unit has strict requirements for uniformity of size and color, in keeping with their historic traditions and to present the most pleasing appearance. In accordance with Army regulation, veterinarians conduct a thorough physical examination of each animal considered for purchase.[53] This examination is generally conducted after the military horse unit has evaluated the animal for the appropriate level of training and conformity to standards of color, size, breed, and gender, as established within their statement of work.

The veterinary examination consists of a thorough inspection of all body systems, first looking for any signs of infectious disease, then paying particular attention to the cardiovascular, neurologic, and musculoskeletal systems to ensure the animal will be structurally sound for the intended purpose. In addition, the veterinarian must determine the approximate age of the horse by dental examination. Animals frequently have scars from old injuries that must be evaluated to determine whether they will limit future use. Animals are also observed carefully for behavioral characteristics that might be incompatible with their intended use (eg, pulling back when tied; biting, striking, or kicking when handled; shyness around the head; or hyperreactivity to sudden movements or noises). Any of these behavioral flaws could result in serious injury to handlers and would interfere with the use of the animal in a public setting.

Veterinarians also play a crucial role in the long-term preventive care of military equines. Barring accidents or bad luck, horses can easily live into their thirties and can often perform the level of work demanded by cavalry or caisson duty into their late twenties if they are well cared for and regularly exercised. Preventive military equine healthcare, which is designed to keep animals in top performance condition throughout their lives, includes the following: regular physical examinations to identify potential problems early; routine dental examinations, reduction of excessive enamel points, and early intervention for dental abnormalities; annual testing for equine infectious anemia virus; regular vaccination against common and devastating diseases; and strategic deworming to control intestinal parasites.

In addition to the preventive care listed above, military equines are routinely vaccinated against tetanus, rabies, Eastern and Western equine encephalitis, West Nile virus, equine influenza, and equine herpesvirus and may be additionally vaccinated against other diseases at the discretion of the supporting veterinarian.[53] Strategic deworming, applied to military equine populations, is a herd health strategy designed to minimize selection pressure on parasites to develop resistance, minimizing pasture contamination and maximizing the animals’ health.

Daily horse care, including grooming, feeding, manure removal, and grounds maintenance, is also essential to maintaining healthy animals. Veterinarians provide training to horse handlers on proper grooming and handling as needed. They also evaluate feeding practices and make recommendations on the type and quality of feeds to be used to optimize the performance potential of each animal. Veterinarians inspect stable and pasture facilities regularly to ensure manure is removed to minimize parasite infestation and nuisance flies. They also inspect the grounds for hazards that could result in illness or injury, including damaged fences, structures, metal hazards, toxic plants, and standing water. Quarterly inspection reports are provided to the responsible commander and maintained on file at the veterinary office.[53]

Military equines used for ceremonial purposes may spend several weeks per year on the road attending events. Military veterinarians inspect the animals prior to travel to ensure they are healthy and to issue the certificates required for interstate travel. To ensure animals will not be inadvertently exposed to an active infectious disease situation, veterinarians must be aware of existing disease situations within the horses’ state of origin and also within each state through which the animals will pass. Occasionally, travel routes must be varied to avoid areas with active quarantines. Care en route is also important, and military veterinarians must work with unit commanders to identify the appropriate veterinary care facilities along the route in case of emergency. These care providers are routinely contacted by the supporting veterinary officer prior to the trip to ensure their availability and determine the best contact method in an emergency.

At the end of their active service life, military horses are typically retired and made available for purchase or adoption. When the horse is no longer able to comfortably perform its military duties, the supporting veterinarian provides a medical disposition letter to the horse unit commander, detailing the reasons for the medical disposition, ongoing medications required by the animal, and prognosis (if known) for use as a riding or pet animal. This serves the dual purpose of informing the commander of the need to retire the animal and notifying the potential adopters of the animal’s ongoing medical needs and future use potential.

SUMMARY

The US Army Veterinary Corps was established by an Act of Congress on June 3, 1916, though, as veterinary equine history reveals, veterinarians have cared for US Army horses for over 200 years—in peace and in war—on and off divergent, ever-changing battlefields. Army veterinarians continue to care for equines across the globe, from the comfortable and secure caisson stables and the MWR-sponsored equine activities in America to the battlefields of Afghanistan and the stability operations in Central and South America and Asia. Equipment, medicine, and supplies are sometimes sparse in certain irregular operations locales, but Army Veterinary Corps officers educate owners, manage herd healthcare, and treat individual horses with as much expertise and professionalism as their predecessors have since 1776.

US Army veterinarians have played a crucial role in the acquisition of healthy, suitable equines for military service for over 100 years and continue to play an ongoing role in maintaining the health and welfare of military-owned animals. Education provided by military veterinarians to these animals’ handlers minimizes the risk of disease and injury while improving their quality of life. Veterinary care for sick and injured equines helps them recover faster and retain their function within their unit, conserving funds and unit integrity.

The reliance on horses for use in military operations has waned in importance over time. Still, it is profoundly ironic that, in Afghanistan, the US military, the most technologically advanced military superpower in recorded history, has found itself relying once again on the horse, a creature who served the dominating armies of Alexander the Great in the same country centuries earlier. Together, the US Special Forces operators and their Afghan Northern Alliance allies were the first to employ cavalry charges in the 21st century, proving that the equines’ unique qualities can make them assets for imaginative military leaders when the correct situation and circumstance present themselves. Even as modern warfare continues to evolve, the horse will continue to have some sort of role in future campaigns.

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Section III: Food Protection and Public Health Services

A US Army Veterinary Services Staff Sergeant, Chief, Food Inspector, 245th Medical Detachment, inspects cans of orange juice for rust that might have occurred during shipment to Vietnam in 1968.

Image: Courtesy of the US Army Medical Department Center of History and Heritage Archival Collection, Joint Base San Antonio-Ft Sam Houston, Texas.

Chapter 9

FOOD SAFETY AND FOOD DEFENSE

JOSEPH A. GOLDSMITH, MS; JERROD W. KILLIAN, DVM; SARAHJOY P. PATRICK; ADRIENNE T. DENHAM; KEITH A. PRITTS, MS; DONALD SCOTT; ERIK W. MONTGOMERY; WILLIAM D. WARREN; QWENTINA R. RIDEOUTT; JOHN ANTHONY O. MANGLONA; MICHAEL P. KILLIAN; HAROLD E. SHERIDAN, JR.; STACI L. MITCHELL; JUAN A. MARIN; CURTIS F. HAYES; TONY D. HEMPHILL; RONALD BIDDLE; SEAN M. LONNECKER, MS; KENNETH R. JAMES; SCOTT E. HANNA, DVM; ESTHER J. PFAU, MPH; CARRIE A. KILBY, MSN; KAREN DEAVER; LAURA A. PACHA, MD, MPH; CAROLINE M. KALINOWSKI, MS; THOMAS J. MCNEIL, MS; RONALD L. BURKE, DVM; EMILY M. CORBIN, DVM; NIKKI N. JORDAN, MPH; EILEEN RESTA, MS; MATT WATTERSON, MS; RONALD R. JECH; RICHARD A. BELCHER; KEVIN M. GILL; AND JAMES E. WESTOVER, JR., BBM

INTRODUCTION

Tracing the Roots of Food Preservation

Developing Food Regulations in Industrial America and Today’s Global Society

Weighing the Consequences of Civilian Food-borne Illnesses

Reviewing the Impact of Food-borne Illnesses on the Military

Transitioning to a Broader Military Mission

FOOD SAFETY PROGRAMS

Installation Support Plans

Commercial Food Protection Audits and Certification Program

Destination Monitoring Program

Military Sanitation Inspections

Salvage Operations for Subsistence

Army Food Management Information System

Operational Rations Program

Prime Vendor Destination Audits

Support to the Navy and Marine Corps Food Management Teams

Ship-Rider Program

Surveillance Food Laboratory Program

National Science Foundation Programs

FOOD SAFETY SUPPORT TO OTHER AGENCIES AND ACTIVITIES

Defense Commissary Agency

Army and Air Force Exchange Service

Defense Logistics Agency-Troop Support

Joint Culinary Center of Excellence

United States Army Natick Soldier Research, Development, and Engineer Center

Counterinsurgency Operations

Emergency Response Activities

FOOD DEFENSE

Food Defense Initiatives

Food Defense Training

CONCLUSION

JA Goldsmith: Chief Warrant Officer 5, Veterinary Corps, US Army; Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, 2250 Taylor Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

JW Killian: Colonel, Veterinary Corps, US Army; Commander, 264th Medical Battalion, Army Medical Department Center and School, 2745 Harney Path, Joint Base San Antonio-Fort Sam Houston, Texas 78234; formerly, Chief, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas

SP Patrick: Staff Sergeant, Veterinary Services, US Army; Training/Advisor/Counselor (TAC), A-Company, 187th Medical Battalion, 2355 Harney Path, Joint Base San Antonio-Fort Sam Houston, Texas 78234

AT Denham: Chief Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, Public Health Command District-North Europe, Rhine Ordnance Barracks, Building 2928, APO AE 09067; formerly, Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas

KA Pritts: Chief Warrant Officer 4, Veterinary Corps, US Army (Retired); formerly, Deputy Director Field Operations, Food Analysis and Diagnostic Lab, US Army Public Health Command, Joint Base San Antonio-Fort Sam Houston, Texas; currently, Food Technologist, Defense Logistics Agency Troop Support, 700 Robbins Avenue, Building 6 (6B109), Philadelphia, Pennsylvania 19111

D Scott: Chief Warrant Officer 2, Veterinary Corps, US Army; Food Protection Officer, US Army Public Health Command Region-Central (Provisional), 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

EW Montgomery: Chief Warrant Officer 2, Veterinary Corps, US Army; Food Protection Officer, US Army Public Health Command District-Fort Gordon, Jackson Branch, 2498 Knight Road, Fort Jackson, South Carolina 29207

WD Warren: Chief Warrant Officer 4, Veterinary Corps, US Army; Chief, Operational Rations, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

QR Rideoutt: Sergeant First Class, Veterinary Services, US Army; Noncommissioned Officer in Charge, US Army Public Health Central Pacific Command-Fort Shatner Branch, 936 Duck Road, Schofield Barracks, Hawaii 96857; formerly, Writer/Instructor, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas

JAO Manglona: Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, 463rd Medical Detachment (Veterinary Services Support), 6603 Welsh Avenue, Fort Benning, Georgia 31905

MP Killian: Chief Warrant Officer 5, Veterinary Corps, US Army (Retired); formerly, Chief, Training Programs Manager, Department of Veterinary Science, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas; currently, Department of Defense Food Protection Officer, Defense Health Agency, 4270 Gorgas Circle, Building 1070, Joint Base San Antonio-Fort Sam Houston, Texas 78234

HE Sheridan Jr: Senior Quality Assurance Specialist, US Army Public Health Command District-Fort Bragg, 1938 Gilbert Street, Norfolk Naval Station, Norfolk, Virginia 23511

SL Mitchell: Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, Texas 78234

JA Marin: Chief Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, US Army Public Health Command District-Fort Knox, Naval Station Great Lakes Branch, 305 West A Street, Building 43H, Naval Station Great Lakes, Illinois 60088

CF Hayes: Chief Warrant Officer 4, Veterinary Corps, US Army; currently, Senior Food Protection Officer, Quality Assurance Division, Joint Culinary Center of Excellence, 1831 A Avenue, Building 4225, Fort Lee, Virginia 23801; formerly, Supervisory Consumer Safety Officer, Defense Commissary Agency, Fort Lee, Virginia

TD Hemphill: Chief Warrant Officer 4, Veterinary Corps, US Army; Consumer Safety Officer, US Department of Defense, Defense Logistics Agency-Troop Support (Philadelphia), 700 Robbins Avenue, Philadelphia, Pennsylvania 19111

R Biddle: Chief Warrant Officer 5, Veterinary Corps, US Army (Retired); formerly, Master Veterinary Service Technician, Veterinary Services Portfolio Department, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

SM Lonnecker: Chief Warrant Officer 5, Veterinary Corps, US Army; Food Safety Officer, US Army Central Command-Surgeon, 1 Gabreski Drive, Building 1947, Shaw Air Force Base, South Carolina 29152; formerly, Food Safety Officer, Quartermaster Academy, Joint Culinary Center of Excellence-Quality Assurance Division, Fort Lee, Virginia

KR James: Warrant Officer 2, Veterinary Corps, US Army; Food Safety Officer, 218th Medical Detachment (Veterinary Service Support), Building 3070B Evergreen Avenue, Joint Base Lewis McChord, Washington 98433

SE Hanna: Lieutenant Colonel, Veterinary Corps, US Army; Director, DoD Food Analysis and Diagnostic Laboratory, 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

EJ Pfau: Health Analyst, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

CA Kilby: Health Analyst, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

K Deaver: Statistician, Health Operations Directorate, Public Health Division, Defense Health Agency, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010; formerly, Senior Command Statistician, Army Public Health Center (Provisional), Aberdeen Proving Ground, Maryland

LA Pacha: Lieutenant Colonel, Preventive Medicine, US Army; Manager, Disease Epidemiology Program, Army Public Health Center (Provisional), Epidemiology and Disease Surveillance Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

CM Kalinowski: Sanitarian, Drinking Water and Sanitation Program, Army Public Health Center (Provisional), Environmental Health Engineering Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

TJ McNeil: Sanitarian, Drinking Water and Environmental Sanitation Program, Army Public Health Center (Provisional), Environmental Health Engineering Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

RL Burke: Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Service Division, Public Health Command-Pacific (Provisional), Box 339500, MS 115, Joint Base Lewis-McChord, Washington 98431

EM Corbin: Captain, Veterinary Corps, US Army; Chief, Public Health Command District-Fort Belvoir, Fort Meade Branch Veterinary Services, 2018 Annapolis Road, Fort Meade, Maryland 20755; formerly, Chief, Fort Shafter Branch Veterinary Services, Honolulu, Hawaii

NN Jordan: Senior Epidemiologist, Army Public Health Center (Provisional), Epidemiology and Disease Surveillance Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

E Resta: Health Communication Specialist, Health Information Program, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

M Watterson: Chief Warrant Officer 4, Veterinary Corps, US Army; Food Protection Officer, 1st Medical Brigade, Clinical Operations, Building 33026, 72nd and Support Avenue, Fort Hood, Texas 76544

RR Jech: Chief Warrant Officer 5, Veterinary Corps, US Army (Retired); currently, Instructor/Writer, Department of Veterinary Science, Food Protection Branch, Army Medical Department Center and School, 2250 Taylor Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

RA Belcher: Chief Warrant Officer 3, Veterinary Corps, US Army; Chief, Food Safety, Food Defense, Army Public Health Center (Provisional), 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

KM Gill: Sergeant First Class, Veterinary Services, US Army; Senior Noncommissioned Officer, Army Public Health Center (Provisional), Veterinary Services Portfolio Department, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010

JE Westover Jr: Food Defense Officer, US Army Public Health Command-Central, 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

INTRODUCTION

Food-borne illness has often shaped global history. For example, although the exact cause of US President Zachary Taylor’s death is still being disputed by some historians, the president may have contracted a fatal food-borne illness from microbes such as Salmonella after attending a groundbreaking ceremony for the Washington Monument. Some scholars also believe that the fledgling English settlement at Jamestown, Virginia, was devastated, not by hostile Indians or mosquitoes, but by repeated outbreaks of Salmonella typhi. In the Spanish-American War, American soldiers were far more likely to succumb to typhoid than to enemy fire. More than 20,000 recruits contracted the disease, and thousands died, many while training in southern states. Similarly, during the South African War of 1899 to 1902, the British lost 13,000 troops to typhoid—far more than the number of troops lost in battle.[1]

Tracing the Roots of Food Preservation

At the close of the 18th century, France was at war, and Napoleon’s armies were faring poorly on inadequate rations that frequently included spoiled meat and other unwholesome or unpalatable items. Navy and merchant shipping personnel faced similar wholesomeness problems, including the inability to maintain enough consumable vitamin C-rich foods onboard to prevent scurvy while sailing for long periods of time.

To encourage development of food preservation methods, countries such as France began offering their researchers prizes. In 1809, Nicolas Appert was honored and awarded 12,000 francs for introducing the world to the art of food canning. (Appert discovered that if food was sufficiently heated in a sealed container, and the container was not opened, the food would be preserved.) Although Appert used glass jars in his studies, Peter Durand, an English merchant, later substituted durable tin cans for the breakable jars. Some 50 years later, Louis Pasteur, another Frenchman, proved that microorganism growth is a major cause of food spoilage. Pasteur experimented with heat as a method of preventing microbial growth in milk and wines, eventually developing “pasteurization,” a technique that supported and better explained Appert’s method of food preservation.[2]

Developing Food Regulations in Industrial America and Today’s Global Society

Despite advances in food preservation worldwide, at the turn of the 20th century, regulations to govern either US food processing or retail establishments were virtually nonexistent, resulting in filthy and dangerous conditions at American food industry factories. The dangers inherent in US meat processing plants were uncovered when journalist Upton Sinclair conducted an investigation at a Chicago plant. Sinclair’s published exposé, which was later published as a novel (ie, The Jungle), helped secure the passage of both the Pure Food and Drug Act and the Meat Inspection Act of 1906—acts, which, in turn, initiated a series of regulations that the United States still uses to control most foods consumed by Americans today.

Although US food regulations can greatly reduce the chances for people to contract food-borne illnesses from American products, the globalization of the food industry has created potentially new risks for consumers. Some foods now available in US markets or restaurants may have arrived only days earlier from distant countries where regulatory requirements are not as stringent as those enforced in the United States. In many countries, effective food safety is undermined by fragmented legislation, multiple jurisdictions, and weaknesses in surveillance, monitoring, and enforcement.[3]

Weighing the Consequences of Civilian Food-borne Illnesses

The US food safety mission requires numerous regulatory institutions, thousands of trained personnel, supporting diagnostic laboratories, and many other resources to attain and sustain the current level of food safety in the United States. Although this mission involves substantial financial investments, the absence of a comprehensive food safety system could create even more costly expenditures because, despite current US efforts to keep food safe, illness from contaminated food is still a serious, expensive US public health threat. The Centers for Disease Control and Prevention (CDC) estimate that over 48 million Americans become ill from food each year; this figure includes the 3,000 who die from food-borne illness and the 128,000 who require hospitalization. When tallied, the consequences of food-borne illness, including doctor visits, medication, lost work days, and pain and suffering, cost the United States an estimated $152 billion annually.[4]

Reviewing the Impact of Food-borne Illnesses on the Military

In addition to being a risk to civilians, food contamination presents an asymmetric threat to US forces because a conventionally outmatched force can strike fear in American troops by undermining confidence in their food sources. Historically, food has been used as an effective and covert vehicle to intentionally poison troops, with food poisoning being recognized as a threat as early as when Hippocrates conducted toxicology studies in Greece (circa 400 BCE).[5] More recent military intelligence, such as that gleaned during Afghanistan operations, reinforces the harsh reality that resourceful adversaries leverage food to harm US service members.

Emerging food safety risks also must be continuously evaluated to prevent disease and, ultimately, conserve combat power. A common counterinsurgency strategy used in Iraq and Afghanistan, which involves US personnel sharing meals prepared by local nationals, is one example of a monitored food safety risk. Although mission success often hinges on the ability of US service members to build relationships and bridge cultures with local populations, the lack of local food sanitation practices places US service members who eat meals prepared by non-US military sources at a higher risk of contracting food-borne illnesses than those who eat only US military-provided rations. The potential for the loss of troop readiness should be weighed carefully against the strategic advantages gained by sharing meals prepared by local nationals. (See also this chapter’s section about food safety in counterinsurgency [COIN] operations.)

To better understand the military’s current food-borne risks, the Army Public Health Center (APHC) disease epidemiology program reviewed the statistics of gastrointestinal (GI) illnesses reported by Army medical treatment facilities (MTFs) from 1996 to 2011. Overall, 2,268 cases of GI illnesses in active duty service members were reported to the APHC through either the Reportable Medical Events System (RMES) or Disease Reporting System-Internet (DRSI) from 1996 to 2011. Of these cases, Campylobacter was the most frequently reported causative agent for illness, followed by Salmonella, Giardia, and Shigella. This pattern of frequency is similar to trends seen throughout the United States. The least commonly reported agents were Escherichia coli (Shiga-toxin producing) and norovirus. (Note, however, that reported cases of norovirus are not a good estimate of the disease burden in the active duty population because norovirus only became reportable in 2010, and laboratory testing is infrequent. Note also that although the true burden of all food-borne illness is likely greater than Department of Defense [DoD] disease-reporting systems currently estimate, evolving detection and reporting technologies and methods will provide increasing clarity about the impact of food-borne illness on future active duty service populations.[6])

Transitioning to a Broader Military Mission

In concert with DoD guidance, Army Veterinary Services (VS) leaders have responded to the rising costs of food-borne illnesses and the increasing threats of intentional food contamination by transitioning from a focus on food safety and quality assurance to food protection, which encompasses food safety, quality assurance, and food defense. Current food protection programs are designed and integrated to protect personnel, especially warfighters; prevent food-borne illness; prevent monetary loss to the government; and provide food protection support throughout the DoD.

The shift to food protection has greatly increased mission scope, and, consequently, resource requirements. Although estimates indicate that the Food and Drug Administration (FDA) inspects only 2.3% of the subsistence being imported into the United States, hundreds of trained US Army inspectors stationed worldwide work around the clock to protect the military’s global food supply.[7]

The DoD food protection program encompasses a gamut of food safety and defense activities, including food inspections, commercial establishment audits, special event assessments, and installation food vulnerability assessments (IFVAs). These diverse activities shield service members and their families from intentional and nonintentional disease threats throughout the food chain—from the harvest or slaughter of raw products—to product processing—to service and consumption.

The food protection mission executed by the VS is not only immense in scope, this mission also uniquely involves other service branches and addresses individual needs. For example, the US Army VS provides support to the US Navy, such as inspecting subsistence that goes on board submarines or Nimitz-class aircraft carriers; works with Army Special Forces units; and offers services to the National Science Foundation in the Antarctic. To provide a more detailed view of the broad VS mission, all of the major food protection programs required to ensure safe food for warfighters are described in this chapter, beginning with the installation support plan (ISP) program.

FOOD SAFETY PROGRAMS

Installation Support Plans

The ISP program was developed as a way to more efficiently and effectively manage personnel, monitor activities, and support installation customers. First implemented to quantify and depict the level of support provided to an installation (for both food protection and animal medicine), ISPs now “assist the installation veterinary officer-in-charge [OIC] make risk-based assessments of veterinary public health requirements” and “wisely match resources against the entire spectrum of food safety, food defense, animal programs, and customer needs for a given installation.”8(p8)

The ISP program includes active duty Army, Reserves, National Guard, Marine Corps, Coast Guard, and Navy missions and limited Air Force missions. Personnel in the military occupational specialty (MOS) of 68T, animal care specialist, report animal health-related functions within this system, including bite and scratch reports, animal facility checks, and government-owned animal care. Veterinary food inspection specialists (MOS 68R) conduct visits at every installation food facility, including temporary and mobile facilities serving ready-to-eat food.[8]

There are three types of ISP reports: (1) agency contact, (2) facility contact, and (3) customer visit. The agency contact report details the initial face-to-face meeting between the veterinary OIC or a senior veterinary representative and a senior food agency manager (ie, from the Defense Commissary Agency [DeCA], Army and Air Force Exchange Service [AAFES], and Morale, Welfare, and Recreation [MWR] programs). The purpose of this initial meeting is to discuss all of the services to be provided for the particular agency and the frequency at which these services will be conducted. The meeting’s end product is an agreement that is validated annually.[8]

A facility contact report is produced for every facility on the installation. Both the agency contact report and facility contact report focus on the people using the services and establish a standardized approach to the services supplied. Both reports are also created according to the individual need, manpower, and mission requirements of each agency or facility and implement standing operating procedures specifically designed for each agency or facility.[8]

The final ISP program report is the customer visit report, which is completed for every visit by a 68R veterinary food inspector (VFI), regardless of the services provided by the facility. During these site visits, VFIs conduct product inspections on all food within storage areas, perform receipt inspections of deliveries that have arrived at that time, and verify that the foods delivered are safe (ie, confirming that food is wholesome and originates from approved sources).[8]

Food recalls are another focus of the VFIs’ site visits; inspectors ensure that recalled subsistence does not enter or remain in the military food supply. Since VFIs are the first to examine vendor-provided subsistence, they serve as the first line of defense for food safety, food defense, and quality assurance. VFI reports describe the inspection in detail, including any deficiencies observed, and all nonconformances are posted on a database. For ISP inspections on facilities that fall under preventive medicine jurisdiction, VFIs do not conduct “formal” sanitation inspections unless agreed upon in writing.8,9

The ISP program, designed to provide prompt feedback, increased accuracy, efficiency, and standardization of all reports, also serves as an organizational platform for many food programs presented in this chapter. For example, customers can find summaries of their contractual nonconformances in the ISP-distributed summary reports. In essence, the ISP program is the framework that the VS implements at the branch level to achieve mission goals while promoting customer-focused execution of services.

Commercial Food Protection Audits and Certification Program

A critical first step in ensuring that the DoD receives safe food is purchasing products only from reliable sources that demonstrate excellent food protection practices. In order to be sold to the US government, food products are required to originate from a sanitarily approved source, as listed in a federal directory, or be “exempt” from such listing. (“Exempt” means the product can be bought and sold without restrictions or audits imposed by the military.[10])

Products can be exempt for a number of reasons: namely, they are inspected either by a federal agency (eg, the FDA, US Department of Agriculture [USDA], or US Department of Commerce) or by a state agency with a federal-equivalent program in place. Regardless of the type of listing, the subsistence must be evaluated by a recognized food safety or public health agency, or the product and process to produce the subsistence must be deemed of sufficiently low risk to consider it safe without a military audit.[10]

If a commercial producer is not exempt, the subsistence must pass a food protection audit performed by professionally trained, certified VS personnel, usually a Veterinary Corps officer (VCO). A commercial producer that fails to meet standards could be denied an initial approved source listing, or, if it is already listed as approved, the producer’s contract with the government could be canceled.

In 2000, Military Standard 3006, Sanitation Requirements for Food Establishment (MIL-STD-3006) and Military Handbook 3006, Guidelines for Auditing Food Establishments were published. These two companion documents transformed the VS mission of assessing commercial food establishments from facility sanitation inspections to systems-focused sanitation audits. While sanitation inspections observe and count defects and symptoms, sanitation audits observe cause and effect, consider objective evidence, and determine the root causes of problems. (See the Food Defense Initiatives section of this chapter for more recent, notable revisions of MIL-STD-3006.[11])

Sanitation inspections and sanitation audits also use different checklists. Sanitation inspections use an observation-based checklist whereas sanitation audits use a process-based checklist, which focus on each process relative to the system. Regardless of the checklist used, all scored food protection requirements are tied to Title 21 of the Code of Federal Regulations, Part 110 (21 CFR 110), current Good Manufacturing Practices.11,12

Only qualified auditors may perform sanitation audits. Based on their rank, education, experience, and technical ability, qualified auditors are certified to perform commercial sanitation audits as well as formal military inspections. The auditor certification program ensures that VS auditors have the knowledge and ability with which to perform these audits.

The auditor certification program applies to audits conducted in the continental United States (CONUS) and outside the continental United States (OCONUS) and to military active component, reserve component, and civilian VS personnel whose career track includes performing commercial sanitary audits or military inspections. The prerequisite training is provided by the Army Medical Department Center and School, Health Readiness Center of Excellence (AMEDDC&S, HRCoE), at the Department of Veterinary Science Warrant Officer Basic Course (for newly appointed warrant officers), the Basic Officer Leader Course (for Army veterinarians), and several other functional courses (for officers and reservists).

The need for, and amount of, prerequisite training that civilians must complete prior to performing audit or inspection work is based on the civilians’ previous experiences. For example, Department of the Army civilians with little or no commercial audit or military sanitation inspection experience are required to attend training at the AMEDDC&S, HRCoE. However, former VCOs and noncommissioned officers (NCOs) are given credit for relevant training received on active duty.

The auditor certification program is implemented in two phases. Phase I, the instructional stage, is comprised of didactic, hands-on, and practical exercises, focusing on required knowledge such as food microbiology, food chemistry, hazard analysis critical control point, food deterioration, food processing, and preservation. Instruction is also given on the auditor’s roles and responsibilities, conducting an audit, and using the field database system. Reserve personnel can receive Phase I training either in their VS courses or from an adjunct trainer who has been certified by the AMEDDC&S, HRCoE.

Phase II consists of the field experience trainees (staff auditors) receive by shadowing experienced auditors (lead auditors). After participating in a few audits as staff auditors, trainees advance to the position of lead auditors. With their trainers close by, the trainees conduct additional audits of a variety of food commodities, gaining exposure to as many different manufacturing systems as possible. After completing these additional audits, trainees are evaluated by lead auditors to determine if the trainees are ready to perform audits independently or if additional training is appropriate. If deemed proficient, trainees are then considered certified auditors and are authorized to conduct audits independently.

In addition to any required initial training, certified auditors must participate in continuous self-study to keep their knowledge-base current. Numerous additional regulatory and industry training courses are available, and all auditors are encouraged and expected to take advantage of any opportunity to attend such courses.

Destination Monitoring Program

The destination monitoring program (DMP) was established to provide surveillance capability, which allows military personnel and scientists to target higher-risk food items through product laboratory sampling. Using DMP guidelines, qualified personnel first identify high-risk items, then make recommendations about which products to sample. In CONUS, the program is tracked via the US VS application portal of the VS information management system. Using this portal, applicable personnel can view the status of all products that must be sampled.[10]

All the APHC regions receive a tasking that lists the type of samples required for the quarterly submission to the DoD Food Analysis and Diagnostic Laboratory. After the regions receive the quarterly tasking, the district food safety officers (FSOs) direct that samples be taken from government food-producing and retail agencies at each military establishment within their area of responsibility. Since the DMP is executed at the installation level, food inspectors collect samples in accordance with the DoD Food Analysis and Diagnostic Laboratory Submission Guide.[13] In addition to specific command directives, the DMP also allows inspectors the flexibility to collect other potentially hazardous foods (eg, foods identified in local customer complaints).

One of the most valuable benefits of the DMP is that it triggered VS to develop an infrastructure of personnel, equipment, and procedures to properly collect and transport food samples to supporting laboratories, including developing guidelines for handling perishable items. Collecting and shipping perishable items requires extensive training because there are many control points within the overall process that require attention to detail (eg, collecting the right number of products to sample, aseptically packing these samples so that the collection process does not damage or contaminate the product, preparing sample containers, and ensuring the containers’ proper transportation to the laboratory). When samples are prepared for transportation, great care must be taken to ensure that the proper refrigerant is used and all necessary documentation is complete and accurate. When an emergency situation such as a natural disaster or increased force protection condition level necessitates a surge in sample collection, the DMP also outlines the equipment, trained personnel, and processes necessary for seamlessly shifting the mission priorities and supporting the ground situation.

Military Sanitation Inspections

The military sanitation inspection program is designed to ensure that food safety and food defense programs and procedures comply with their applicable governing regulations and standards. The objective of this inspection program is to protect the health of service members and their families while acting as a good steward of resources. The program’s sanitation inspections are implemented at the branch level by means of the ISP program and are conducted at all military facilities that either store or display subsistence,[10] including military food facility establishments, retail food sale stores (ie, DeCA commissaries), AAFES mini-marts, storage facilities such as Troop Issue Subsistence Activities, and warehouses.[8]

Military sanitation inspections include walk-through (cursory or partial); routine (normal, comprehensive inspection); and follow-up (required after unsatisfactory routine inspections). VFIs perform walk-through inspections daily. These daily inspections, which are not as comprehensive as monthly inspections, usually cover specific areas of a store, focusing on high-risk operations (eg, the deli department) and inspecting any food processing operations (eg, making salads and sandwiches and slicing different types of deli products). Special attention is paid to any cooking processes such as preparing rotisserie chicken.[8]

Although these daily walk-through inspections can cover the entire store, they are generally focused on common findings such as products that exceed their shelf-life, unapproved sources, improperly executed pest control programs, and items that are susceptible to infestations. By conducting such continual inspections, VFIs are not only able to maintain a higher level of safety, but are also able to identify potential trends and problems more immediately. Typically, walk-through inspections provide the stores with a less formal means of internally adjusting their operations without the concern of higher-level supervisors becoming involved. However, VCOs and senior enlisted food inspectors also jointly review the results of these daily efforts in preparation for the more formal, comprehensive monthly inspections.

The routine inspections performed at facilities run by AAFES and DeCA are more comprehensive than those performed at other facilities (eg, nonfood-preparation facilities such as food warehouses), culminating in a rating that indicates the facilities’ ability to comply with food sanitation and food defense requirements. The APHC regions and districts ensure that standing operating procedures providing guidance on conducting sanitation inspections of the military facilities, including the establishment of qualified inspection and training criteria, are in place and that the inspections are completed in a timely, efficient manner. Any inspection that results in an unsatisfactory rating triggers a required follow-up inspection limited to the violations causing the failure. Since facility supervisors review the sanitation inspection reports, report ratings create an incentive for store sanitation compliance (ie, nonfailure).[8]

The application portal, previously mentioned as a means of tracking DMP results, is also the primary means of entering military sanitation inspection results and the most efficient way to externally oversee APHC branch-level activities. The branch, the tactical arm of the military sanitary inspection program, is where standard operating procedures are finalized and executed according to guidance from the regions and districts. Branch-level warrant officers and VCOs ensure that the inspectors who conduct military sanitary inspections are properly trained in accordance with all appropriate inspection documents and procedures.[10]

Salvage Operations for Subsistence

The VS has developed programs to “inspect” and “salvage” (“survey” in the Navy) distressed foods. Specifically, these programs are designed to identify and inspect any food product that has been damaged or stressed and to enable informed, science-based decisions regarding the disposition of inspected products. These programs have proven to be extremely beneficial in reducing the threat of food-borne illness and increasing cost savings.

The two programs involving salvage operations are (1) salvage and distressed foods at government retail and storage facilities and (2) inspection of perishable foods exposed to refrigeration failure. The former program covers the salvage of physically damaged, overaged, or otherwise distressed military-owned semi-perishable subsistence, and the latter program deals specifically with perishable products that have been exposed to temperature-stress. Both programs are designed to address compromised food products, thus protecting service members and their beneficiaries from consuming higher-risk food products.[8]

The first military salvage operation, the salvage and distressed foods at government retail and storage facilities, is primarily performed at DeCA stores. When executing this program, the VFIs follow military regulations and DeCA directives to ensure food safety and food defense standards are maintained. Additionally, VFIs train DeCA employees (salvage coordinators) to perform routine salvage operations in an effort to increase in-store salvage capabilities. The salvage coordinators cull, consolidate, and make salvage determinations. More specifically, these employees segregate food products from nonfood products and further segregate those food products with minor damage that is easily identifiable (ie, products that exhibit moderate to severe damage). The VFIs then make disposition decisions on the more severely damaged products, eventually ensuring all salvaged items have been inspected prior to being offered for sale.[14]

Although DeCA stores present their own food salvage risks, troop issue subsistence activities, dining facilities, depots, and warehouses pose other unique risks such as extended storage of subsistence and subsistence returned from the field. In these situations, food quality and safety issues may trigger the reclassification, segregation, and tracking of degraded food products. For example, any products returned from the field must be reinspected before they are returned to inventory.[10]

The second salvage operation, the inspection of perishable foods exposed to refrigeration failure, mainly governs refrigerated and frozen perishable products. Although this program is primarily designed to support DeCA facilities, AAFES food stores, dining facilities, and subsistence storage warehouses, program guidelines can be applied to any perishable, temperature-stressed product.

When military-owned perishable foods are compromised by refrigeration failure or by improper storage, VS personnel must inspect the affected food and determine if an unacceptable risk exists. An elevated threat of food-borne illness exists when food is exposed to the temperature danger zone (ie, temperatures above 41°F and below 135°F); prolonged or repeated exposures to these higher temperatures accelerate the growth of bacteria (eg, spoilage or pathogens). Whether the refrigeration failure is affected by power outages, refrigeration breakdowns, or human error, the requirement to salvage temperature-stressed foods remains: safety first. When determining risk levels for temperature-abused foods, qualified VFIs may have to make the very costly decision to throw away potentially edible government-purchased rations to spare troops the even costlier risk of eating potentially spoiled foods.[8]

To help with the sometimes difficult decision-making process when inspecting distressed foods, VFIs are trained to use scientific-based guidelines developed by the US Army Natick Soldier Research, Development, and Engineering Center (NSRDEC). Additionally, VFIs and VCOs undergo extensive training in microbiology, chemistry, food deterioration, food technology, and package defects in the AMEDDC&S, HRCoE, courses.

Since time and temperature abuse greatly reduce the shelf-life of food products and increase the potential of food-borne illnesses, a quick response to a refrigeration failure is critical to promoting military food safety, preventing significant illness, and saving government resources. For example, in 1995, a power outage at a Lackland Air Force Base facility in San Antonio, Texas, caused the potential loss of over $40,000 worth of product. After an inspection in which NSRDEC’s Guide to the Salvage of Temperature-Abused Food Products in Military Commissaries[15] was applied to the situation, the loss was reduced to approximately $20,000. These savings were passed on, in turn, to DeCA patrons, when these patrons were able to purchase the food items that were deemed wholesome at discount prices (Chief Warrant Officer 5 [Retired] Joseph Goldsmith, chapter author, unpublished data, April 1995). Salvage reviews of foods compromised during emergency conditions (such as the Lackland example), or of potentially distressed foods culled during routine daily inspections, limit DeCA losses and frequently provide consumer discounts on items found safe for consumption.

Army Food Management Information System

The Army Food Management Information System (AFMIS) provides automated support to control the management and operation of the US Army’s worldwide food service program, enabling military personnel to order, inventory, and invoice subsistence supplies, including field rations. For example, to assist the Army G4 (supply and logistics) in tracking the condemnations of Army-owned subsistence, VS personnel record condemnations in AFMIS. (This practice is logical because VFIs are able to determine the proper disposition of stressed products and act as a neutral third party for product accountability.) The G4 then uses the AFMIS information to track the quantity of a condemned food item and the reason for its condemnation (eg, overaged products, product adulteration, pest infestation, or temperature abuse).

Access to the veterinary condemnation section of AFMIS, which is granted to VFIs by installation food program managers, enables food service personnel at all levels to better manage their food supplies.[16] AFMIS also supports dining facilities’ menu planning, automated head-counts, labor scheduling, cash collection, and equipment replacement.

Operational Rations Programs

The Defense Logistics Agency (DLA) Troop Support, Directorate of Subsistence, Operational Rations Division manages all operational rations programs and employs a comprehensive strategy for integrating the nation’s industrial base in supplying these rations. The DLA responds to military ration requirements by implementing and providing operational rations programs and items and the logistical infrastructures necessary to support their use. Modern battlefield requirements demand subsistence support that not only meets the needs of service members in extremely intense and mobile combat situations, but also adapts quickly to humanitarian assistance operations.[17] Only the US Air Force Public Health Service or the US Army VS are authorized to provide inspection services for operational rations, as appropriate.[18]

Types of Operational Rations

Currently, the 14 types of “go-to-war” operational rations used by the US military are divided into three main categories: (1) individual rations, (2) group rations, and (3) survival rations. The characteristic common to all operational rations is the extensive research and development involved in the formulations, processing, packaging, and packing materials required to enable the rations to withstand extreme environmental conditions and the ongoing challenges of logistical support. Each ration, regardless of type, is developed to be palatable and to have a reasonable shelf-life (18 months–3 years at 80°F), and each is produced in sufficient quantities to support military requirements.[17]

Individual Rations. The first category of rations is the individual ration, which is designed for various missions and specific individuals. This chapter highlights a few of the module options from the DLA website, the first being meals ready to eat (MREs).

MREs are designed to sustain an individual engaged in vigorous activity such as military training or actual military operations that preclude the warfighter from eating at usual food service facilities. Each MRE is a complete meal packed in a flexible meal bag (Figure 9-1) that is lightweight even when full and fits easily into military field clothing pockets. Each meal bag contains an entree and a variety of other components such as cookies, desserts, dried fruit, candy, powdered drink mixes, coffee packets, sugar, and salt. The contents of one MRE meal bag provide approximately 1,250 kilocalories (13% protein, 36% fat, and 51% carbohydrate), which equals about one third of the military recommended daily allowance of vitamins and minerals as determined by The Surgeon General of the United States.[19]

Figure 9-1. Typical packaging for Meals Ready to Eat.
Reproduced from a photograph taken by Air Force First Lieutenant Kay M. Nissen. https://www.troopsupport.dla.mil/events/news140401.asp. Accessed March 9, 2016.

Another individual ration is the first strike ration (FSR), an eat-on-the-move assault ration. Designed for consumption by individual warfighters during short durations of highly mobile, high-intensity combat operations (ie, the first 72 hours of a conflict), the FSR is more compact than the MRE. However, even though the FSR is substantially reduced in weight and volume to increase a service member’s combat mobility, this ration is packed with nutrition. The FSR is equivalent to one full day of food for one person and contains approximately 2,850 kilocalories. One FSR is consumed in lieu of three MREs.[20]

The last example of an individual ration is the meal, religious, Kosher or Halal, issued to individual service members who maintain a strict diet based on Jewish or Islamic laws. Each meal consists of one Kosher- or Halal-certified entree and religiously certified and acceptable complementary items sufficient to provide the service member with the recommended daily nutritional intake.[21]

Group Rations. The next category of rations is the group ration, which includes unitized group ration-heat and serve (UGR-H&S), unitized group ration-A option (UGR-A), B-rations, and unitized group ration express (UGR-E). Group rations are used when ample time and equipment are available for heating and serving specially processed and packaged meals designed to feed more than one service member at a time (eg, during operations that allow for organized food service facilities). Almost everything needed for a complete 50-person meal, including necessary disposable items (eg, trash bags and paper cups), is provided, and all of the pre-prepared meals are packaged in sealed containers that serve as heating pans and serving trays.22,23

Both UGR-H&S and UGR-A provide 1,450-calorie meals and maximize use of commercial items to more easily provide high-quality food service to troops in a field environment. However, mandatory supplements such as milk and cold cereal and optional enhancements such as bread, fresh fruits, and vegetables are not included in all the group meal options. For example, B-ration meal options use only canned or preserved ingredients that can be served without adequate refrigeration or freezer facilities. The UGR-H&S module provides the usual group tray-pack entrees plus starches and desserts, but the UGR-A module also may include some perishable, fresh, and frozen entrees, commonly known as A-rations. A-ration meals may be served in field kitchens and in more fixed military dining facilities.24,25

Unitized group ration-express (UGR-Es) are compact, self-contained modules that provide complete, hot meals with necessary disposable items for 18 warfighters without the necessity of equipment, cooks, fuel, or power. Similar to UGR-H&S tray packs, UGR-E precooked meals are served in trays and take only 30 to 45 minutes to warm via provided heater modules. Since UGR-Es are an alternative to individual MREs as the sole source of subsistence in austere, remote locations, certain small combat groups (eg, special operations forces, military police, and military transition teams) benefit the most from UGR-Es.22,23

Survival Rations. The last of the three operational ration categories is the survival ration, which includes the survival, general purpose, improved; survival, abandon ship; and survival, aircraft, life raft rations. All survival rations are uniquely designed and packaged to withstand their intended environment and are calorically dense. For example, the survival, aircraft, life raft ration is a small food packet used to provide short-term sustenance to survivors of air crashes at sea. The small packets, along with other essential equipment, are stowed in the emergency kits carried aboard naval aircraft; each packet supplies approximately 300 calories.[24]-[26]

Types of US Army Veterinary Services’ Operational Rations Support

According to an old adage attributed to both Napoleon and Frederick the Great, an army “marches” on its stomach. In other words, throughout history, armies have relied on good and plentiful food to preserve full fighting strength and mobility. The current US Army travels with food inspectors and officers who not only ensure fit rations are maintained, but who also consult commanders on the courses of action they can take to maximize the life and safety of those rations.

The VS bears the overall responsibility for the operational rations food protection mission, and the extensive infrastructure support system for this mission includes the DLA-Troop Support (TS); NSRDEC; AMEDDC&S, HRCoE; and APHC districts, regions, and headquarters. In the forefront are the US Army VFIs who maintain and inspect operational rations throughout the US armed forces’ areas of operation.[14]

To ensure the welfare of the fighting forces and the financial interest of the government, VFIs first perform a variety of onsite inspections, checks, and controls at assembly plants to ensure that the rations being produced are ready for either war or humanitarian support. The various types of inspections conducted for depot assembly operations require VFIs to receive specific technical training, use mandated guidelines, and implement a responsive inspection process to determine the rations’ usability and, if conditions permit, extend their shelf-life. From the time operational rations are initially collated at the ration assembly plant throughout the government storage, time of issue, and potential return of residual stocks, VFIs perform these inspections in a variety of locations under divergent constraints (eg, from a climate-controlled Army warehouse in Japan where rations display longevity to a nonair-conditioned shipping container in Iraq or Afghanistan where heat impacts shelf-life).

These rations present unique challenges for inspectors and supervisors alike because of mandatory nutritional requirements and the method by which some rations are packed. For example, MREs include smaller, component packages of food in a larger plastic pouch. Each packed component contributes a certain amount of the protein, carbohydrates, and fat required for a balanced meal and, within those components, sufficient calories to sustain troops serving in demanding conditions. As the meal ages or is exposed to harsh conditions, it slowly deteriorates. In the case of an MRE containing multiple products, the components degrade at different rates, thus presenting a host of questions as to whether an item should be replaced, removed, issued with instructions, or condemned. To make decisions about such rations, inspectors leverage their experience, training, education, standard operating procedures, regulations, and officer oversight to maintain both food safety and fiscal stewardship.

Prime Vendor Destination Audits

The prime vendor destination audit program is a VS feedback mechanism that verifies the quality, condition, and wholesomeness of subsistence procured for feeding US military troops and provides all military services with targeted data on specific products. Prior to this program’s inception, inspectors at all duty sites were required to perform cursory, routine, and special product compliance evaluations. These earlier program guidelines emphasized completing as many routine evaluations as was possible but with the accuracy equivalent to that of USDA commodity graders. Initially, the inspectors, who originated from all ranks and experience levels, tended to routinely examine high-dollar, high-use food items.[27]

Over time, program designers decided the sheer volume of reports generated by the program’s emphasis, coupled with the wide-ranging variability of the reports produced by the diverse graders, was not fulfilling the program’s intended purpose of value-added commodity surveillance and reporting. A new direction for the program was initiated in the mid-2000s and remains the standard today. The current program streamlines the reporting system; limits audit personnel to those with increased rank and experience; dramatically reduces the number of product audits required; adds the skilled, technical review of reports to the program; and increases the knowledge and capabilities of product auditors.[27]

The current prime vendor destination audit program also trains qualified personnel to comprehensively audit food products for all terms of the contract. If any nonconformances are found, monetary reimbursement may be sought, and future contractual requirements or catalog modifications may be implemented. VFIs are certified as prime vendor destination auditors during a 40-hour course emphasizing the advanced contractual requirements associated with four commodities: (1) red meats, (2) poultry, (3) processed fresh fruits and vegetables, and (4) seafood. Each attendee is assigned a particular commodity to master but also may be responsible for auditing any or all other commodities if required.[27]

To most accurately determine the safety and quality of these products before their imminent consumption, audits focus on food products that are ready to be purchased. All audits are performed in accordance with comprehensive audit data packets created by formally trained civilian destination audit coordinators within the VS, and generated product data is used to validate and improve the quality of food served to the US military.[28]

Support to the Navy and Marine Corps Food Management Teams

Navy Food Management Team

The VS has maintained a long-standing working relationship with the US Navy, providing food safety and food inspection support for the Navy’s troop feeding operations. In 1997, the Navy Supply Systems Command prepared for the roll-out of the subsistence prime vendor program by the DLA to provide support to its fleet and shore facilities. To ensure a smooth transition with minimal disruptions, the Supply Systems Command collaborated with the US Army Veterinary Command (VETCOM) (later replaced by USAPHC, now APHC) to establish a memorandum of agreement (MOA), mandating that seven senior enlisted (specifically in the rank of E-7 or E-8) VFIs (military occupational specialty 91R) serve on the existing Navy food management teams (NFMTs). These soldiers, who replaced Navy corpsmen on the existing NFMTs, are referred to as Army veterinary food safety instructors (AVFSIs) (Colonel Jerrod Killian, chapter author, personal knowledge).

The seven initial AVFSIs were “hand-picked” by their respective chains of command. Per the MOA, only senior enlisted can be selected in order to equip the teams with the legitimate authority they need to enforce the applicable requirements and regulations. Although these senior AVFSIs have extensive and beneficial experience in food hygiene, safety, inspection, quality assurance, and contractual compliance, they receive additional training hosted by the AMEDDC&S, HRCoE, Department of Veterinary Science prior to reporting to their team assignments at various Navy installation locations, including Norfolk, Virginia; New London, Connecticut; Mayport, Florida; San Diego, California; Pearl Harbor, Hawaii; Yokosuka, Japan; and the Pugent Sound Naval Shipyard in Washington (Colonel Jerrod Killian, chapter author, personal knowledge).

An NFMT’s primary responsibility is solving major problems that may be experienced by food service operations on ships, submarines, and shore facilities throughout the team’s region of responsibility. The team’s ultimate goal is excellence in food service, which is accomplished by improving the quality and raising the standards of food service in all Navy troop feeding operations to boost the health and morale of personnel as well as the Navy’s overall operational readiness.

Each NFMT provides a variety of seminars and training in addition to onsite assessments. The assessments, which include periods of observation as well as hands-on training, can be tailored to meet the specific needs and schedules of the particular food service operation. Initially, a full-spectrum assessment is conducted to identify any weak areas that need to be addressed. Next, the team members work side-by-side with the operation’s personnel and provide hands-on training on all required food service operation processes. To ensure each process is fully understood and is being executed properly, another period of observation follows completion of the hands-on training.

Marine Corps Food Management Team

The VS has also maintained a lengthy working relationship with the US Marine Corps via a standing MOA to support the Marine Corps food management teams (MCFMTs). This agreement stipulates that VETCOM (replaced by USAPHC, now APHC) will provide three senior 91R VFIs (E-6 or E-7) to support teams at three global locations: (1) Camp Lejeune, North Carolina; (2) Camp Pendleton, California; and (3) Marine Corps Base Okinawa, Japan. The Marine Corps refers to the VFI team members as Army veterinary technicians (AVTs) (Colonel Jerrod Killian, chapter author, personal knowledge).

The mission of the AVTs on the MCFMTs is similar to that of the AVFSIs on the NFMTs: training personnel on food hygiene, safety, inspection, quality assurance, and contract compliance. The goal of the MCFMT is to enhance troop feeding operations so that they function with maximum efficiency while minimizing costs at all points of the process. Throughout the year, the AVTs provide training by means of various seminars and classes, participate in formal staff assistance visits, and provide technical expertise regarding the combat operational rations used by the Marine Corps. Team members attend DLA operational ration symposiums and provide input and briefings based on the Marine Corps’ current needs. They also assist with field feeding operations during training missions and at locations such as the Marine Corps Mountain Warfare Center near Bridgeport, California.

Ship-Rider Program

The VS supports the Military Sealift Command combat stores ships by providing VFIs who serve as ship-riders (Figure 9-2) during scheduled deployments. The basic food protection duties and responsibilities of ship-riders are executed in accordance with Army and Navy guidance documents.[29] Supported combat logistic force ships are government-owned, run by civil service mariners, and may have a small contingent of Navy personnel aboard for operational, supply coordination, and helicopter operation support.

Ship-riders perform receipt inspections OCONUS (ie, foreign ports); execute surveillance inspections and shelf-life extensions on subsistence in storage; conduct pest management evaluations; and issue certificates of unfitness when required. Ship-riders also conduct training classes on food sanitation, personal hygiene, salvage (survey) operations, subsistence condition monitoring, time and temperature effects on potentially hazardous foods, and proper packaging and staging of subsistence for at-sea replenishment operations.

Figure 9-2. Cruiser USS Normandy, oiler USNS Leroy Grumman, aircraft carrier George Washington, fast combat support ship USNS Supply, and combat stores ship USNS Saturn sail together. US Army veterinary service personnel participate in the Ship-Rider program, providing food protection support to naval resupply ships.
Reproduced from a photograph taken by Petty Officer Third Class Summer M. Anderson, US Navy. http://www.msc.navy.mil/annualreport/2002/organization.htm. Accessed February 16, 2016.

In addition to routine inspection and training duties, ship-riders participate in activities not normally experienced at traditional duty sites such as deploying aboard Navy vessels, fire-response training, and “abandon ship” drills. Ship-riders are afforded these unique work experiences by authority of an MOA between the Military Sealift Command and the APHC.[29]

When deployed onboard, ship-riders are required to have the appropriate equipment and all documents and regulations necessary to perform their mission. A key food safety duty that ship-riders perform in support of Navy operations is coordinating and overseeing the DoD Hazardous Food and Nonprescription Drug Recall Program, known in the field as the All Food Activities Program or ALFOODACT. ALFOODACT is a worldwide notification system for placing food products that may pose legal or health concerns on medical hold, thus preventing their sale or consumption. Affected products remain segregated on medical hold until a final disposition message is disseminated.[29] (More detailed information about the ALFOODACT system and its procedural process for non-naval activities is found in the Defense Logistics Agency-Troop Support section of this chapter.)

During deployment, ship-riders maintain contact with their respective veterinary units and liaison with the US Army Veterinary senior quality assurance specialist assigned to the Naval Supply Command, Fleet Logistic Center, in the geographical area or areas where the naval vessels are deployed. (Senior quality assurance specialists monitor the ALFOODACT communications and provide current ALFOODACT information to the ship-riders.) Contact is primarily electronic while the ship-riders are at sea and in person when the ship-riders arrive at their ports of debarkation. Once deployment contact is initiated by the ship-rider (VFI), specific local information regarding approved food sources and important food safety concerns is disseminated to the VFI’s home duty station, the ship’s supply officer, and the food service officer for inclusion into APHC’s ISP food recall database.[29]

After completing a tour of duty, the ship-rider participates in a structured lessons-learned process that includes after-action reports highlighting aspects of the deployment that went well, areas that need improvement, and special challenges such as a lack of appropriate mission support and resources. Meeting DoD food protection challenges requires the VS to forge relationships with the DoD and other governmental organizations by means of MOAs. Specifically, the VS’s relationship with the Military Sealift Command exemplifies how a previously unmet need for safe foods for military personnel serving onboard naval vessels created a VS program that strives to provide monitored foods from approved sources.

Surveillance Food Laboratory Program

The surveillance food laboratory program was initiated to develop different field tests that could provide military personnel with quicker results than those furnished by fixed reference laboratories. More immediate results are often needed for several interrelated reasons: (a) many food products are perishable items; (b) primarily fixed reference laboratories are widely dispersed; (c) lengthy transportation times often cause samples to be nontestable upon delivery; and (d) difficulties in shipping food from one country to another may delay or even prevent needed laboratory testing.

Other times, more immediate results are necessary because of operational considerations. For example, smaller forward operating bases and many expeditionary units have limited food supplies and must quickly ascertain the safety of their food using surveillance food laboratories to ensure continuous operations.

Two food testing sets specifically designed for use on the battlefield, as well as in food production plants and storage facilities, were fielded in the mid-2000s: the unit assemblage 913A veterinary equipment set (VES) field microbiology kit and the 914A VES food testing kit. Initially, the 913A VES kit was to be used for rapid screening of food and water samples as a means of ensuring food safety and supporting food defense initiatives. This VES kit had the capability to perform indicator microorganism screening of foods and was designed to provide flexibility in lab testing, regardless of whether the entire kit was set up in a tent or select components were used to perform limited testing in a hotel room.[30]

In 2009, the 913A VES kit was revised to include animal testing capabilities, thus changing the focus from surveillance food laboratory testing to veterinary surveillance laboratory testing. Some of the animal testing included Giardia, heartworm, Lyme disease, Anaplasma phagocytophilium, and Ehrlichia canis. The revised kit was also designed to make the laboratory more rugged (ie, better protecting the equipment in the battlefield environment).[30]

The kit currently in use features a handheld instrument that detects luminescence for adenosine triphosphate, which is associated with microorganisms, food and organic residues, and pesticides. The kit also is capable of indicator microorganism screening using Petrifilm (3M Corporation, Maplewood, Minnesota). VS support teams of Medical Detachment VS are authorized to use revised 913A VES kits, which are fielded to each team (squad) in a table of organization and equipment unit.[30]

The 914A VES food testing kit also provides rapid screening of indicator microorganisms but with expanded chemistry capabilities. This kit features a small bench-top analyzer that uses a liquid scintillation counter to test for aflatoxin and antibiotics and a bioluminescence counter for testing pesticides. Food procurement teams of the Medical Detachment VS are authorized to use the 914A VES kit.[30]

While the purpose of surveillance laboratories is to support commanders’ missions, these labs were not designed with the capability to recover and identify pathogens. Rather, they have served to more quickly identify potential problems (based on indicator testing) or to refer testing samples to a reference laboratory (eg, the Veterinary Laboratory Europe or the DoD Food Analysis and Diagnostic Laboratory) for confirmation. Components of these labs have been used at offsite special events in real-world food defense missions, for OCONUS food and water risk assessments, and on the battlefields of Iraq and Afghanistan. The surveillance food laboratory program has expanded greatly over the years, evolving as equipment has been modified or updated. Continuing efforts are underway to develop new equipment and methods to meet ever-changing battlefield needs by means of expanded testing capability, quicker turn-around times, and more definitive identifications of certain food-borne microorganisms.[30]

National Science Foundation Programs

The Antarctic Treaty, entered in 1961, sets aside Antarctica as a scientific preserve, establishes freedom of scientific investigation, and bans military activity on the continent. This joint treaty originally involved 12 nations but now involves over 50. The United States continues to conduct research and collaborate with foreign nations on this frontier continent.[31]

The polar regions are unique natural laboratories in which a wide range of research is carried out, including discerning the effects of climate change, understanding the region and its ecosystems, and studying the upper atmosphere and space. However, since Antarctica’s remoteness and extreme climate result in field science that is more expensive to conduct than in most locations, research is performed in the Antarctic only when it cannot be performed in more convenient, less expensive locations.

US polar science research is coordinated through the National Science Foundation (NSF), which maintains three research stations in Antarctica: (1) Palmer Station, (2) McMurdo Station, and (3) South Pole. Because these three stations are so remote and have only minimal medical capabilities, food safety is of the utmost importance to the programs and all personnel involved in them. A food-borne illness outbreak in this austere environment would not only hinder the NSF’s global scientific mission but could also result in serious human consequences, including casualties. To prevent such a potential outcome, the NSF entered into a memorandum of understanding with the APHC that enables the APHC to perform sanitation audits and inspections of NSF food and facilities.[32]

The facilities audited and inspected are located worldwide and include the three remote stations, manufacturing and distribution facilities, transportation and resupply vessels, and supply and depot sites. The NSF utilizes the APHC’s audits and inspections to ensure contracted companies fulfill food quality and food safety obligations.

VS personnel from APHC are selected to support NSF based on their locations and skill sets. CONUS support consists of depot facility inspections and is generally provided by 68R VFI noncommissioned officers stationed geographically near the inspection site. A VCO (either a veterinarian or warrant officer) assigned to APHC Region-Pacific typically provides OCONUS support, which is divided into two areas: (1) McMurdo Station and South Pole, both of which are located south of New Zealand; and (2) Palmer Station, located south of Chile.[32]

Figure 9-3. The Lawrence M. Gould research vessel resupplies Palmer Station, Antarctica. US Army veterinary service personnel conduct pier receipt inspections prior to loading the vessel.
Photograph courtesy of Captain Emily M. Corbin, chapter author.

Figure 9-4. A C-17 Globemaster III drops pallets of cargo during the first C-17 airdrop to the South Pole, December 20, 2006. Airdrops such as this one offer flexible support to the National Science Foundation mission, delivering high volumes of supplies in emergencies and when landings are not possible (eg, during blizzards). US Veterinary Services personnel deploy via a ship to provide food safety checks of the delivered supplies.
Reproduced from a photograph taken by Lieutenant Colonel James McGann, US Air Force. http://www.af.mil/News/ArticleDisplay/tabid/223/Article/128633/c-17-makes-1stever-airdrop-to-antarctica.aspx. Accessed February 16, 2016.

A Veterinary Corps food safety warrant officer provides support to McMurdo Station and South Pole typically by means of quarterly deployments. The NSF provides administrative support, including office space, to the warrant officer assigned at the International Antarctic Centre located in Christchurch, New Zealand. A VCO assigned to APHC District-Central Pacific in Hawaii typically provides annual support to Palmer Station, the smallest of the three stations. This officer travels to Punta Arenas, Chile, near the southern tip of South America, then travels by ship, the Lawrence M. Gould research vessel (Figure 9-3), for 4 days across the Drake Passage to Palmer Station. The officer remains on-station until the ship departs again for Chile, typically 7 to 9 days later.[32]

The support the NSF requests from APHC varies from mission to mission and may include subsistence procurement inspection; verifying approved sources; observing the contractor’s food receipt and inspection process; providing technical guidance; observing all aspects of food storage procedures (ie, segregation of raw and ready-to-eat items, removal of distressed or compromised food products, and proper stock rotation); observing food handling and food preparation within dining facilities and kitchens; observing vessel offload operations; and reviewing temperature logs.[33]

Figure 9-5. The Army’s 331st Transportation Company built the steel pier (pictured) when the ice pier used at McMurdo Station, Antarctica, failed. Supplies from the USNS Green Wave are being received on this pier.
Reproduced from a photograph taken by Captain Christina Shelton, US Army. http://archive.defense.gov/news/newsarticle.aspx?ID=67819. Accessed February 16, 2016.

Unlike the majority of the APHC’s deployed locations, in Antarctica, temperature stress is usually not an issue—the exception being food products damaged by freezing. However, the stations’ remoteness presents issues typical of end-of-supply-chain dynamics: expired products and poor quality perishable foods such as fresh fruits and vegetables (Captain Emily M. Corbin, chapter author, personal knowledge).

The severe and unpredictable weather also impacts the food supply and personnel transport via aircrafts (Figure 9-4). Planes supply food and personnel to the South Pole station and transport personnel and some foodstuffs to McMurdo Station; however, when the artic weather is too cold, aircrafts may not be able to fly. Other changes in weather can affect the Antarctic supply operation as well. In 2012, for example, the ice pier at McMurdo Station was not stable enough to support the annual delivery load (warm weather caused it to melt), so the NSF enlisted the support of a US Army Transportation Corps unit to install and later remove a modular causeway system to facilitate the annual resupply vessel offload (Figure 9-5). In 2012, spring flooding in Punta Arenas, Chile, caused an abrupt halt in the supply chain to Palmer Station (Captain Emily M. Corbin, chapter author, personal knowledge).

FOOD SAFETY SUPPORT TO OTHER AGENCIES AND ACTIVITIES

Defense Commissary Agency

Although supplying quality groceries to US service members worldwide is no easy task, ensuring that these large quantities of groceries are wholesome and safe for consumption is equally as daunting. To meet this challenge, the US Army provides food safety, food quality, and food defense programs at US Army, Navy, and Marine Corps military commissaries across the globe. The Air Force utilizes its public health inspectors at Air Force bases for DeCA support.

Additional oversight of food safety operations is provided by DeCA regional FSOs (military or civilian) and DeCA headquarters military and civilian personnel, one of whom is an Army staff veterinarian. Unlike civilian establishments that are inspected by local and state regulatory agencies on a limited basis, DoD commissaries have military food inspectors on-site and on-call at all hours. These inspectors conduct constant surveillance to ensure food safety and enhance the confidence of service members and DoD beneficiaries. Key surveillance activities include food delivery inspections, pest surveillance, food vulnerability assessments, sanitation inspections, refrigeration failure salvage operations, food item recalls, and approved source verifications.

Those departments within a commissary that process potentially hazardous foods such as sushi bars and delicatessens are monitored carefully to ensure sanitation programs are meticulously followed. VFIs perform preoperational inspections as well as bioluminescence testing to ensure the food processing equipment in these areas has been adequately sanitized. Hazard analysis and critical control point plans are also monitored and verified to ensure product safety.

When commissaries experience a power outage, VFIs are on-site to perform salvage operations, ensure food safety, and, where applicable, to prevent the total loss of thousands of dollars’ worth of food products that are stressed but are still safe for consumption. The final disposition authority rests with the VCOs, who sign food condemnation certificates when necessary.

VFIs also conduct preliminary investigations of customer concerns ranging from quality issues related to the product and its production to storage along the supply chain. In the event of product adulteration, these investigators attempt to locate the root source and determine whether the issue is an isolated case or a systemic problem. If the latter is the case, or if the isolated incident is critical in nature, other agencies and the manufacturer are notified, and the product may be recalled. During a product recall, commissaries and VFIs receive an ALFOODACT alert and take immediate action by coordinating with commissary management to remove the affected products from distribution, thus preventing their consumption.

As noted previously in this chapter, all products sold in commissaries must originate from an approved source, so VFIs must vigilantly screen all products available for sale. When a nonapproved product is found on commissary shelves, the local veterinary inspection unit conducts a risk assessment to determine the product’s use or removal. The approved source program also ensures that the facilities where the products originated have been inspected by a federal agency or a VCO.[8]

To ensure contract compliance, VFIs must understand myriad food protection provisions within the various types of contracts in use at DeCA commissaries. Suppliers’ contracts with DeCA stipulate provisions and requirements that maximize food quality, safety, and cost savings. Copies of all contracts are available at the commissaries for VFIs to review as needed to ensure delivered products meet food protection requirements.

VFIs also provide needed food safety and defense training to commissary employees, either by commissary request or as deemed necessary by the inspectors. Commissary employees who are aware of food defense risks are extremely valuable in identifying food defense threats (eg, products that have been tampered with).

Army and Air Force Exchange Service

The APHC plays a vital role in ensuring food safety and defense in the over 2,400 AAFES facilities worldwide, including shoppettes, main exchanges, exchange gas stations, and fast food restaurants. Deployed service members can go to AAFES restaurants for a taste of home and to escape the stress of deployment, if only for the duration of a meal. Exchanges and shoppettes also supply deployed troops a taste of home by stocking foods shipped from the United States.[34]

VS food safety and defense support to AAFES facilities, similar to that provided to DeCA, is described within the ISP, is executed by VFIs daily, and includes performing the following duties: food delivery inspections, food recall actions, shelf-life extensions, refrigeration failure support, approved source verifications, sanitation inspections, and food defense activities.[9]

Food defense concerns are heightened in deployed environments where food may be left unattended and vulnerable to intentional contamination. For example, food destined for the small exchanges located on forward operating bases throughout Afghanistan can be trucked for long distances by local nationals or third-country nationals without oversight by US forces. Aggressors may seek to target these food establishments’ products because creating a food-borne illness inexpensively reduces the effectiveness of US or allied personnel. Army VFIs lower such food defense risks by performing food vulnerability assessments and providing food defense training to exchange employees.

Defense Logistics Agency-Troop Support

History

Defense Logistics Agency-Troop Support (DLA-TS) is a joint service activity with member support from all five uniformed services as well as the civilian sector. The agency’s roots trace back to the 1800s, with the construction of the Schuylkill Arsenal in Philadelphia, Pennsylvania. Initially, the arsenal was erected as a warehouse for ammunition and other military supplies such as the uniforms that local seamstresses were contracted to make by hand at home. The first opportunity for the arsenal to serve the nation in wartime came during the War of 1812 when the arsenal supplied guns and ammunition, as well as clothing and textile materials, to American troops. The Schuylkill Arsenal relinquished its ammunition and arms mission in 1819 and became fully dedicated to the manufacture, storage, and distribution of clothing and textile materials.[35]

In ensuing years, the Schuylkill Arsenal grew, relocated, and was renamed the Philadelphia Quartermaster Depot. In 1965, the Defense Personnel Support Center was officially established on the site, and the facility’s mission expanded to include providing food, medicines, and medical supplies, as well as its essential clothing and textile supply responsibilities. In addition, both the Defense Subsistence Supply Center in Chicago, Illinois, and the Defense Medical Supply Center in Brooklyn, New York, moved to the Philadelphia location. Concentrating all three directorates in one space provided a level of efficiency that was immediately tested by the Vietnam War.[35]

The Defense Personnel Support Center was renamed the Defense Supply Center Philadelphia (DSCP) on January 13, 1998. Effective July 3, 1999, materiel management responsibilities for the Defense Industrial Supply Center’s assigned commodities—general and industrial items—were absorbed by the DSCP. In 2010, the DSCP was officially renamed the DLA-TS. The organization’s many functions are vital to the military, and the VS is an essential partner in DLA-TS’s efforts.[35]

Mission

The mission of the subsistence section within DLA-TS is to serve as the focal point for issues pertaining to food quality, food safety, and customer complaints. In essence, DLA-TS serves as a liaison between military and other government agencies in support of the subsistence acquisition process. The following key sites[36]-[41] ensure that the acquisition process flows smoothly from beginning to end:

(1) Defense Logistics Agency-Troop Support-Philadelphia-Consumer Safety. DLA-TS Philadelphia-Consumer Safety (P-CS) serves as the focal point of the DoD Hazardous Food and Nonprescription Drug Recall System. VS personnel serve here in a joint service capacity within DLA-TS Philadelphia’s Subsistence Directorate. Product recalls pertaining to subsistence as well those of nonprescription drugs are managed from DLA-TS Philadelphia. Regardless of whether a manufacturer failed to declare an allergen, found a pathogen, or mislabeled its product packaging, an effective mechanism with which to stop the distribution or sale of these identified items must be in place. In fact, manufacturers often recall food products because of public health concerns or for reasons that concern the manufacturer.[39]

In addition to providing advice on matters related to nonprescription drugs, the DLA-TS-Philadelphia consults with the US Food and Drug Administration (FDA), USDA, US Department of Commerce, and other entities on all matters pertaining to recalls. Continuous coordination with the FDA and USDA is necessary for determining the classes of hazardous recalls and evaluating suspected hazardous foods and nonprescription drugs.

ALFOODACT messages serve as a means to quickly and effectively disseminate information pertaining to both food and nonprescription drug recalls. Such messages are generated by the DLA-TS-P-CS based on information received through coordination with other government agencies. The DLA-TS-P-CS generates an ALFOODACT message when and if a suspect product is likely to be found in DoD supply channels. A message concerning the specific product or products is then disseminated DoD-wide to veterinary food safety representatives, accountable officers, prime vendors, and the general public. The DLA-TS-P-CS officer’s responsibilities include receiving the initial notification from the recalling authority and interpreting, researching, drafting, and sending the official ALFOODACT message. However, the activities that occur in reaction to such a message determine the effectiveness of the recall system overall.[39]

The VCO, FSO (MOS 640A), and food inspector (MOS 68R) are responsible for ensuring compliance with ALFOODACT messages. Although many organizations receive these messages and take initial action to respond appropriately, VS personnel contact the organizations, assist them, and confirm that the recall was properly executed and completed.[39]

In addition to working with the FDA, USDA, and the US Department of Commerce, the DLA-TS-P-CS’s work has also fostered and strengthened partnerships with NSRDEC and APHC. Continual communication and coordination between DLA-TS-P-CS and military and government agencies is essential and enhances food safety and security.

Other functions of the DLA-TS-P-CS include reviewing and submitting initial audit requests; establishing requirements for unapproved sources, source verifications, and prime vendor nonconformances; serving on technical panels; managing significant quality issues; and updating internal regulations and policies. The DLA’s Food Safety Office monitors prime vendor programs, produce inspection programs, and significant trends in the DLA-TS Subsistence Directorate’s worldwide mission.

(2) Defense Logistics Agency-Troop Support-Philadelphia-Quality Assurance. DLA-TS Philadelphia-Quality Assurance (P-QA) performs duty on a joint staff subsistence inventory control point, providing quality assurance and technical support to the subsistence supplier operations directorate for its subsistence quality audits. These audits are conducted at vendor as well as government facilities to evaluate product conformance and DLA contractual requirements. Subsistence quality audits may also be conducted to investigate facilities and verify compliance of contractual requirements and operational rations quality systems.

Data received from inspection agencies (ie, the USDA and FDA), the Defense Contract Management Agency, and VFIs are collected and analyzed for later use. Government source inspections at vendor facilities located worldwide are also analyzed, and the data is compiled into a quality history. This information can then be used during contract awards, option quantity reviews, and pre-award actions and evaluations of DLA contracts.

In addition to providing technical guidance in the fields of statistical sampling, analytical testing, food safety, pest management, sanitation, food defense, and aspects of food quality, DLA-TS-P-QA reviews and evaluates the quality system plans, hazard analysis and critical control point plans, and food defense plans of government contractors. Routine vulnerability assessments are performed using the CARVER plus Shock Method (Exhibit 9-1). DLA-TS-P-QA also provides the quality assurance and food protection regulations, manuals, handbooks, and directives to ensure the safe, regulated procurement of wholesome, quality subsistence.[40]

(3) Defense Logistics Agency-Troop Support-Pacific. DLA-TS Pacific spans 16 time zones in the US Pacific Command. With over $150 million in sales each year, DLA-TS Pacific supports more than 670 DoD customers.[38] DLA-TS Pacific monitors the quality and wholesomeness of all subsistence that is procured, stored, and distributed within the region and maintains close communication with all veterinary field inspection elements.

To sustain sanitation and quality requirements, DLA-TS Pacific conducts routine visits (surveys) of its region’s vendor processing facilities. Technical evaluation panels are conducted routinely for long-term produce contracts awarded by the Hawaii Procurement Office. DLA-TS Pacific also ensures the availability of up-to-date technical recommendations on quality assurance topics for use by contracting officers and field logistics specialists.

(4) Defense Logistics Agency-Troop Support-Europe & Africa. DLA-TS Europe & Africa provides support for Europe and Africa and performs many of the same duties in the European theater of operations as DLA-TS Pacific does in the Pacific theater, including providing technical recommendations, overseeing quality assurance, and ensuring wholesomeness. Additionally, DLA-TS Europe & Africa provides support to the DLA-TS Europe and Africa Food Service and Operational Rations Unit, which in turn provides subsistence prime vendor and operational rations support. Full-line commercial distributors provide customers with one-stop shopping and back-door delivery to military dining facilities and ships.[37]

The DLA-TS Europe and Africa Produce and Local Market Ready Unit provides fresh fruits and vegetables, dairy products, water, beverages, fruit juices, specialty items, and bakery products to US forces dining facilities throughout the United Kingdom, the Netherlands, Spain, Germany, Belgium, Italy, Greece, Turkey, Egypt, Saudi Arabia, and Africa, as well as to ships calling on ports in the Atlantic Ocean, Baltic Sea, Mediterranean Sea, and Black Sea.[37]

Joint Culinary Center of Excellence

The Joint Culinary Center of Excellence (JCCoE) is the “corporate headquarters” for Army food service worldwide. Located at the US Army Quartermaster School at Ft Lee, Virginia, the JCCoE provides joint proponent food preparations training and serves as the executive agent providing direction for the Army’s food program. The JCCoE is also the focal point for joint services basic and advanced food service skills training.

EXHIBIT 9-1

CARVER PLUS SHOCK METHOD FOR FOOD SECTOR VULNERABILITY ASSESSMENTS

The CARVER plus Shock method is an offensive targeting prioritization tool that has been adapted for use in the food sector. This tool can be used to assess the vulnerabilities to an attack within a system or infrastructure by identifying the most attractive targets for an attack from the perpetrator’s point-of-view. By conducting such a vulnerability assessment and determining the most vulnerable points in the system or infrastructure, resources can be focused on protecting the most vulnerable points. CARVER is an acronym for the following six attributes used to evaluate the attractiveness of a target for attack:

- Criticality - measure of public health and economic impacts of an attack

- Accessibility – ability to physically access and egress from target

- Recuperability – ability of system to recover from an attack

- Vulnerability – ease of accomplishing attack

- Effect – amount of direct loss from an attack as measured by loss in production

- Recognizability – ease of identifying target

In addition, the modified CARVER tool evaluates a seventh attribute, the combined health, economic, and psychological impacts of an attack, or the SHOCK attributes of a target.

The attractiveness of a target can then be ranked on a scale from one to ten on the basis of scales that have been developed for each of the seven attributes. Conditions that are associated with lower attractiveness (or lower vulnerability) are assigned lower values (eg, 1 or 2), whereas, conditions associated with higher attractiveness as a target (or higher vulnerability) are assigned higher values (eg, 9 or 10). Evaluating or scoring the various elements of the food sector infrastructure of interest for each of the CARVER-Shock attributes can help identify where within that infrastructure an attack is most likely to occur. Federal agencies, including the Food Safety and Inspection Service and Food and Drug Administration, have used this method to evaluate the potential vulnerabilities of farm-to-table supply chains of various food commodities. The method can also be used to assess the potential vulnerabilities of individual facilities or processes.

____________

Adapted from: Catlin M, Kautter D. An Overview of the Carver Plus Shock Method for Food Sector Vulnerability Assessments. http://www.fsis.usda.gov/wps/wcm/connect/483f86d5-a566-44f8-90d5-05a16dbe3f78/CARVER.pdf?MOD=AJPERES. Accessed December 2, 2015.

DoD VS supports the JCCoE with an FSO currently assigned to the Quality Assurance Division within the Operations Directorate. The directorate provides the central direction, management, and oversight of the Army’s worldwide food service program for the Quartermaster General and Department of the Army G4. The FSO serves as technical advisor for the development and enhancement of food safety and food defense strategies, procedures, and standards and serves as a critical source of evaluation for new product development within the Quality Assurance Division.

Duties of the FSO include not only technical and scientific evaluations and recommendations, but also a significant liaison function in concert with the JCCoE executive agency functions for the Army G4. The position requires recurring interaction with joint committees and organizations such as the NSRDEC, Food Risk Evaluation Committee, Combat Rations Network, North Atlantic Treaty Organization Support Agency, and various DoD and Army committees and organizations that provide input on the safety of food consumed within the purview of military field or garrison feeding systems. The FSO’s additional duties include teaching food safety concepts and policy to joint services active duty and reserve personnel enrolled in advanced food service professional development courses.

United States Army Natick Soldier Research, Development, and Engineer Center

As part of the Army Materiel Command’s Research, Development, and Engineering Command, NSRDEC’s Combat Feeding Directorate (CFD) provides the DoD with a joint service program responsible for the research, development, integration, testing, and engineering of combat rations, food service equipment technology, and combat feeding systems. The Combat Feeding Research and Engineering Board oversees CFD activities and includes joint technical staff representatives from the Army G-4, Marine Corps, Air Force, Navy, and DLA.

Figure 9-6. Water reticulation is an example of the Combat Feeding Directorate leveraging advanced technologies in Kandahar, Afghanistan.
Photograph courtesy of Chief Warrant Officer 5 Sean Lonnecker, chapter author.

Eleven primary facilities comprise NSRDEC’s CFD: the (1) Advanced Food Processing Laboratory; (2) Analytical Chemistry Laboratory; (3) Food Microbiology Laboratories (BSL2+); (4) Food Safety Testing Laboratory; (5) Flexible Food Packaging Laboratory; (6) Food Analysis Laboratory; (7) Sensory and Consumer Testing Laboratory; (8) Refrigeration Calorimeter Test Chamber; (9) Polymer Film Center of Excellence; (10) Navy Equipment Laboratory; and (11) Burner Test Facility.[41]

The CFD also actively leverages leading-edge technologies (Figure 9-6) to ensure the warfighter is provided the decisive advantage in all aspects of combat feeding (Figure 9-7). The use of integrated products teams involving the DLA, joint services, combat feeding program teams, academia, industry, and other government agencies consistently optimizes costs, scheduling, and performance. These teams’ combined efforts provide the science and technology base, as well as engineering support, to fulfill the unique feeding requirements of each service.[41]

Currently, nine teams work to develop innovative combat feeding technologies for warfighters in coordination with the CFD and across the following disciplines: (1) advanced materials engineering; (2) food processing, engineering, and technology; (3) performance optimization research; (4) combat rations; (5) equipment and energy technology; (6) systems equipment and engineering; (7) food engineering services; (8) food service and equipment; and (9) food protection.

Figure 9-7. Military food service professionals from Alaska prepare a three-course meal inside an Army mobile kitchen trailer at Joint Base Elmendorf-Richardson, Alaska. The mobile kitchen trailer enhances combat feeding operations, significantly reducing food safety risks in austere environments.
Reproduced from a US Army photograph (released) taken by Staff Sergeant Jeffrey Smith. http://www.usarak.army.mil/main/stories_Archives/
Mar_3-7_2014/140305_FS1.asp. Accessed March 9, 2016.

The food protection team’s primary mission is supporting food safety and defense for the VS. The VS collaborates with the CFD on various forums and issues, including occasional joint research projects with the food safety warrant officers who attend the Long-Term Health Education and Training program. The VS also has one dedicated chief warrant officer (VS technician) who holds a minimum of a Master of Science degree in food science or technology. This individual is an organic member of the CFD, serving as a project manager in the food protection team and the veterinary liaison who coordinates activities between NSRDEC laboratories, the DoD VS Activity, and the APHC.[41]

Counterinsurgency Operations

US service members often assume that the food they eat during deployments is safe, especially when it is consumed on a military base. This assumption may put service members at increased risk for food-borne illness when they deploy to less-developed countries, including Afghanistan, where the risk of food-borne illness is higher than it is in the United States. For various reasons, including jurisdictional constraints, the local foods that are available on- or off-base during deployment are not necessarily subjected to the same scrutiny by preventive medicine and veterinary personnel as military-provided foods. Thus, service members who consume local foods, especially those who are not acclimated to eating regional cuisines, could be at an increased risk for food-borne illness. Furthermore, although service members need to better understand the risks of eating locally during deployment and learn to recognize the differences between high- and low-risk foods, consistent access to local food consumption guidance is difficult, mainly because service members are deployed across a broad geographic area.[42] The next section of this chapter examines the impact of local food consumption during COIN operations, the difficulty of quantifying the burden of food-borne illness on military missions, and the challenges of communicating food safety in deployed settings. This section also provides an indepth look at a successful collaborative food safety communication effort that targets deployed personnel.

Studying the Impact of Local Food Consumption on Service Member Health During Counterinsurgency Operations

During COIN operations, service members must work to bridge various cultural, linguistic, and often generational differences (eg, when young service members engage with Afghan elders). A significant culture-bridging activity, which helps to build trust and morale, involves sharing meals and beverages with local populations (Figure 9-8 and Figure 9-9). Because this sharing primarily occurs off-base, these dining experiences increase service members’ exposure to local foods, which are rarely acquired from approved sources, are less likely to be handled properly, and, thus, pose a higher risk for food-borne illness.42,43

Figure 9-8. Ninewa provincial reconstruction team members share a meal at a command-initiated small business site in Bashika, Iraq, October 3, 2010.
Reproduced from a US Army photograph (released) taken by Staff Sergeant Edward Reagan. https://www.dvidshub.net/image/331315/prt-bashika#.VsX__XnVy70. Accessed February 18, 2016.

Figure 9-9. An Afghan teenager from the Satara III orphanage offers tea to Navy personnel in Kabul, Afghanistan, after services members distributed boxes of supplies to the orphanage on December 5, 2010.
Reproduced from a US Navy photograph (released) taken by Mass Communication Chief Jason Carter. https://www.dvidshub.net/image/346668/haven-afghanchildren#.VsYAQHnVy70. Accessed February 18, 2016.

As noted in a VS-authored risk communication campaign journal article, gastrointestinal illness, which includes various food-borne illnesses stemming from the consumption of local food products, is a common problem when US service members are deployed.[42] This article highlights several military studies of deployed US personnel in which gastrointestinal illness and other food-borne threats were either prevalent, underreported, or both; this article also features subsequent studies focusing on specific prevalent infectious agents and risk associations:

- “Between 1990 and 2005, infectious gastrointestinal illness was listed as the fourth most commonly reported diagnosis during US military deployments, following noncombat orthopedic injuries, respiratory infections, and skin diseases.”42(p51)

- According to a 2003 survey of self-reported diarrhea in operations Iraqi Freedom and Enduring Freedom, “diarrhea” is defined as “three or more loose stools in 24 hours, or two or more loose stools associated with other gastrointestinal symptoms.”42(p61) A survey of the impact of illness and noncombat injuries on military personnel deployed to Afghanistan during 2003-2004 found that “[while] 54.4% of respondents reported experiencing [such] diarrhea while deployed, the number of diarrhea cases in theater [was] likely underreported.”42(p51)

- A 2006 study of US military personnel deployed to the Middle East also noted a high prevalence of diarrhea but low treatment numbers in theater. While 60% of survey respondents reported an episode of diarrhea or vomiting or both during their deployment, only 30% reported seeking care.[42]

- In a summary of pathogen prevalence and diarrhea incidence among US military and similar populations by region, the most common infectious agents identified in the Middle East and northern Africa were enterotoxigenic Escherichia coli (28.3%), enteroaggregative Escherichia coli (16.8%), norovirus (7.1%), and Shigella (7.1%). Infection with multiple pathogens (9.3%) was more common than infection with some single agents such as norovirus and Shigella.[42]

- In a survey published in 2006, time spent off base and the consumption of local food were identified as the most important risk factors for diarrhea, and consumption of local food was strongly associated with reports of multiple episodes of diarrhea. This survey of US military personnel deployed to Afghanistan found that 52.8% of survey respondents reported eating local food at least monthly while deployed, and 8.8% reported eating local food daily. The consumption of local food from unapproved sources remains a risk behavior for contracting diarrheal illness in Afghanistan.[42]

- A round-table discussion on emerging infectious diseases that affect US service members deployed to the Middle East, which was published in 2010, revealed that “a number of infectious agents commonly associated with diarrhea and certain food-borne illnesses, such as brucellosis, hepatitis E, and typhoid fever, are present in Afghanistan and can pose a potential threat to US forces stationed there.”42(p51)

After consideration of prevailing research, on September 29, 2010, the US Department of Veterans Affairs published a final rule that recognized the existence of an association between the risk of certain food-borne illnesses and deployment to Southwest Asia. This rule also outlined a positive association between service in Southwest Asia during certain periods and the subsequent development of nine infectious diseases, including brucellosis, Campylobacter jejuni, nontyphoid Salmonella, Q fever, and Shigella.[44] (See also this chapter’s section on food defense for more information about food-borne illnesses that affect US troops who are deployed.)

Research also shows that there is an increased risk of illness after consuming local foods among deployed service members in South and Central America. In 2012, a diarrhea outbreak occurred during a US military training and humanitarian assistance mission in El Salvador. Although service members frequently report suffering from diarrhea during similar short deployments, indepth investigations, such as the one performed by the Naval Medical Research Unit No. 6 after the El Salvador outbreak, usually are not conducted. This naval investigation, which used epidemiological surveys, microscopy, and polymerase chain reaction analysis of stool samples, “concluded that the consumption of food from on-base local vendors (RR = 4.01; 95% CI, 1.53–10.5; and P < .001) and arriving on base within the previous 2 weeks (RR = 2.79; 95% CI, 1.35–5.76; and P <.001) were associated with increased risk of developing diarrheal disease.”43(p64)

Challenges in Quantifying the Food-borne Illness Burden on Military Missions

In addition to special studies of reported food-borne illnesses, daily and weekly rates of infectious gastrointestinal illness are recorded in the Joint Chiefs of Staff disease nonbattle injury reports submitted through the Joint Medical Work Station. Notifiable infectious gastrointestinal illness can also be reported through service-specific reporting systems. Another means of quantifying the potential disease burden is the review of medical diagnoses entered in applications such as AHLTA-T and TC2 (also known as TMIP-J Composite HealthCare System [CHCS] Caché [TC2] [InterSystems Corporation, Cambridge, Massachusetts]), which capture outpatient and inpatient care, respectively.

However, barriers to reporting and system utilization are common, and laboratory diagnostics are limited; therefore, it is difficult to surmise how complete the data are. Disease nonbattle injury reporting often has been shown to underestimate rates of illness and injury and, accordingly, their impact on military missions.[45] For example, a 2006 systematic review discussing the impact of diarrhea among US military and similar populations showed that diarrhea incidence based on self-reporting was much higher than incidence based on passive surveillance data such as that recorded in the Joint Medical Work Station.[46]

Furthermore, deciphering the true extent to which gastrointestinal symptoms are related to food or water versus noninfectious causes (eg, stress, side effects of certain medications, and changes in eating habits) is challenging. These factors illustrate the limitations of deployment health surveillance as well as those of food-borne illness detection in general, all of which result in an incomplete understanding of diarrheal incidence and its impact on military operations.

While infection from acute food-borne illness can significantly impact military operations, that impact can be magnified by postinfectious sequelae that may not be immediately apparent. For instance, postinfectious irritable bowel syndrome has been identified as a sequela of infectious gastroenteritis in a number of studies.[47] Given the increased emphasis on COIN operations in Afghanistan and other areas of the world and the potential for long-term sequelae resulting from infectious gastroenteritis, the acute and chronic impacts of food-borne illnesses will probably increase across populations of veterans in the coming years.

The inability of current data systems to demonstrate the true burden of food-borne illness on military missions may cause medical leaders to incorrectly assume that the impact of food-borne illness is limited. To mitigate this threat to service members’ health and to operational success, increased focus and resources should be directed to preventing service members’ exposure to food-borne illnesses and ultimately to reducing the incidence of food-borne illness (eg, both infectious gastroenteritis and its sequela may be preventable).[47]

Using a Food Risk Communication Campaign to Empower Deployed Service Members

As noted earlier in this chapter, successful COIN operations often hinge on building trusting relationships between military members and local nationals. Sharing endemic foods can play a large role in bridging different cultures and forging good relationships, including those built among leaders (Figure 9-10). However, two key problems stemming from the consumption of local foods should make US commanders wary of extending command approval to this commonly accepted trust-building practice: (1) the higher potential for US service member illness and (2) diminished US troop readiness. In addition to the findings already cited in this chapter,[42] studies from various Middle East deployments offer more proof in point:

- Of the US personnel deployed to Iraq and Afghanistan between 2003 and 2004, “78.6% of troops in Iraq experienced diarrhea, with 80% seeking care from their unit medics,” and eating local foods from non-US sources was associated with an increased risk of their illness.43(p64)

- A study of acute diarrhea in US military personnel deployed to Sinai, Egypt, conducted between May 2004 and January 2005, revealed that one of every five individuals who became ill with diarrhea while deployed to Egypt reported not being able to work because of this food-related illness (missing an average of 2 days); two out of five reported that their work performance decreased because of their illness.[43]

The Egypt study also noted that “multiple episodes of diarrhea during deployment equate to a large number of lost and diminished duty days for warfighters and [should constitute] a cause of concern for their leaders,”43(p64) especially when preparing troops for deployments. Historically, predeployment training focused on instructing service members to consume only those foods approved by veterinary personnel to decrease the risk of food-borne illness. Service members were not given information about how to make informed local food choices during deployments.

To address this information gap, the APHC, VS, and AMEDDC&S formed a multidisciplinary food safety communication team (FSCT) comprised of health information analysts, epidemiologists, food safety and environmental health specialists, and recently deployed preventive medicine and veterinary personnel. The goal of this collaboration was to craft and evaluate a comprehensive health communication package to empower service members to make informed food choices during deployment. The team leveraged a broad range of expertise among its members to develop, disseminate, and evaluate a risk communication campaign to prevent disease among US service members.

Figure 9-10. Ninewa provincial reconstruction team members and key leaders for the district of Quarakosh eat lunch after conducting a meeting at the Women’s Development Center, near Mosul, Iraq, December 5, 2009.
Reproduced from a US Army photograph (released) taken by Private First Class Ali Hargis. https://www.dvidshub.net/image/229375/iraqi-farmersreceive-greenhouse-equipment#.VsX_rHnVy70. Accessed February 18, 2016.

Research shows that tailored and targeted communication strategies and messages have been associated with changes in various health-related behaviors.[48]-[52] The FSCT focused its communication strategies on changing deployed service members’ local food consumption behaviors as a means of mitigating food-borne illness and used Rogers’ innovation-diffusion theory as a framework to develop its targeted health communication package messages and products.[52] (Rogers’ innovation-diffusion theory has been examined in a variety of studies, has contributed to a greater understanding of behavioral change, and has been found to have numerous applications in public health.[50]-[52])

The communication package designed for service members provides information on how to identify the risk level of common local food items and the importance of avoiding high-risk food items when possible. This package includes the following five products: the (1) Predeployment Local Food Choices briefing, which generates awareness of the risks of eating local foods, provides information on choosing lower-risk local foods, and emphasizes the importance of making smarter local food choices; (2) Food Risk smart card, (3) Avoid Higher Risk Foods sticker; (4) Be Smart When You Eat Local poster, which outlines lower-risk and higher-risk local food choices and is formatted for use throughout a deployment; and (5) Be Smart When You Eat Local electronic card, which is intended for distribution midway into deployment and reaffirms the benefits of making smart local food choices.[42]

In addition to the five aforementioned products targeted at service members, two communication package products were developed especially for leaders: the (1) leader smart card (provides leaders with information about the risks of eating local foods and ways to communicate with their personnel about making smarter local food choices); and (2) toolkit for leaders (provides information on how leaders can communicate with their personnel about the risks of eating local foods, the benefits of choosing lower-risk local foods, and the importance of making smarter local food choices). Tools contained in the leader toolkit include messages and talking points, frequently asked questions, and guidance for effectively disseminating available communication products to service members.[42]

The entire communication package was designed for use during deployment to any area of responsibility where service members may encounter local foods. Care was taken to ensure that no communication product compromised the mission or superseded command guidance or policy regarding service member interactions with local populations. Most of the package’s products are available online from the APHC Health Information Products eCatalog.[42]

Evaluating Food Risk Communication Campaign Results

A pre- and post-test design was used to evaluate the effectiveness of the Predeployment Local Food Choices briefing and three of the communication package products: (1) the Food Risk smart card, (2) Avoid Higher Risk Foods sticker, and (3) Be Smart When You Eat Local poster. In May 2012, a group of more than 100 service members completed a prebriefing survey to evaluate their baseline knowledge and perceptions about local food safety when deployed. Following the pretest, a preventive medicine physician presented the briefing and the three aforementioned communication package products to the group. A post-test was then administered to determine whether the participants gained any new knowledge from the material and gauge their perceptions of the communication products.[42]

Results showed that, overall, the food safety briefing was effective in educating service members about the risk level of 12 of 13 categories of local foods and beverages. The categories included bread; raw, leafy vegetables; fully cooked vegetables, beans, and rice (kept and served hot); milk and other dairy products; hot tea; meats (boiled or well done and eaten within 2 hours of cooking); bottled water or canned carbonated drinks; and hard-skin fruit (peeled before eating).

Following the briefing, over 85% of all 106 respondents, regardless of their starting knowledge, were able to correctly identify the risk level of each category. Across all of the categories, an average of 44% of respondents moved from answering incorrectly on the prebriefing survey to answering correctly on the postbriefing survey. The specific knowledge gain for the individual categories ranged from 6.7% to 80%, depending on the category.[42]

Furthermore, most respondents viewed each of the four products (briefing, smart card, sticker, and poster) positively. Virtually all respondents agreed, and approximately 60% strongly agreed, that the purpose of the four products was clear and that they were easy to understand, provided enough information about risks, and enabled smart local food choices. The same proportions of respondents would recommend these communication products to other deploying service members. About 86% of respondents agreed that the products grabbed their attention and were easy to read (50% of the 86% in agreement strongly agreed). More than 80% of respondents indicated they would refer to the products during deployment.

Evaluation of the communication products yielded insights about the service members’ overall perceptions of the materials as well as the efficacy of their messaging. The evaluation also revealed information gaps and improvements that needed to be addressed when designing future communications about the risks of consuming local foods and beverages during deployments, especially concerning certain locally prepared or provided meats and beverages, canned and packaged foods, and hard-skinned fruits peeled by the service member.[42]

Continuing Efforts to Limit Food-borne Illness Risks in Deployed Environments

Since COIN operations will likely continue in Afghanistan and in other areas of the world, service members’ interactions with local populations and exposure to local foods will remain a public health focus for years to come. To protect service members’ health, medical leaders, including VS personnel, must understand and communicate the limitations of the food-borne illness data collected in theater and focus on reducing service members’ exposure to food-borne illness in deployed settings and, ultimately, its incidence. The FSCT project is an example of what can be achieved when public health professionals and communication experts from varied organizations and disciplines collaborate to protect the health of service members. (See also this chapter’s sections on food defense, including the food and water risk assessments [FWRAs], a decision-making tool often used by commanders during COIN operations.)

Emergency Response Activities

The Army’s VS engages in a wide variety of emergency response activities worldwide. Whenever service members, their families, and their pets are threatened by emergency events (eg, natural disasters such as earthquakes and hurricanes), the VS responds (eg, noncombatant evacuation operations). A recent example of the VS’s capabilities and contributions during disasters is the 2011 earthquake in Japan and its aftermath.

On March 11, 2011, the eastern seaboard of Japan was struck with a devastating 9.0 magnitude earthquake that resulted in two more destructive side effects: (1) a massive tsunami and (2) the subsequent devastation at the Fukushima I Nuclear Power Plant. US Army–Japan and its subordinate units were tasked to support the US military’s recovery efforts through Operation Tomodachi (トモダチ作戦) or Operation Friends (“Tomodachi” means “friends” in Japanese). The soldiers of the Japan District Veterinary Command (JDVC), later known as the US Army Public Health District–Japan, provided food and water safety monitoring, animal health care, and public health support during Operation Tomodachi.53,54

A VCO stationed in Japan prior to and during the emergency response efforts offers the following account of initial events: On Friday, March 11, 2011, at 2:46 PM (local), the ground began to shake uncontrollably. JDVC is located at Camp Zama, in the city of Sagamihara and the prefecture of Kanagawa, 24 miles southwest of Tokyo and almost 250 miles from the earthquake’s epicenter. The JDVC headquarters personnel reported that they had to evacuate because the building was shaking violently, and pictures and books were falling from the walls. Outside, the staff was joined by workers from neighboring buildings. This group watched as nearby trees and telephone poles swayed and cars in the parking lot shook back and forth on their suspension systems. Many onlookers reported that the ground beneath their feet felt as if it would open and swallow them (Colonel Margery Hanfelt, US Army Veterinary Corps, former JDVC Commander, personal knowledge).

Because of the power outages at many of the bases occupied by US forces, food and water safety became an immediate concern. Additionally, because of reports in the news media, service members, DoD civilians, and their families became increasingly concerned about the safety of their food and water supplies. The JDVC used public service announcements, interviews with news media, and participation in town hall meetings to address most of these fears (Colonel Margery Hanfelt, US Army Veterinary Corps, former JDVC Commander, personal knowledge).

Other immediate responses included implementing the following general safety measures: the frequency of ISP visits was increased; special emphasis was placed on warehouses, retail sales, and troop feeding; the recently completed Surveillance Food Laboratory was fully staffed with JDVC soldiers and augmentees; and rapid sampling techniques were used to increase the monitoring of food preparation areas and food products (Colonel Margery Hanfelt, US Army Veterinary Corps, former JDVC Commander, personal knowledge).

More specific actions also were quickly undertaken, especially regarding radiation risk control and local food procurement. For example, specially trained and credentialed teams of VFIs were swiftly dispatched with radiation monitoring equipment. Health Physics specialists at APHC–Pacific assisted with training and the selection of sampling points and then monitored the results of all readings daily. Over the next several months, thousands of radiological readings of food (surfaces), food packaging, and warehouse storage areas were taken. No significant threat to human health was ever detected, and no US forces reported illness attributed to radiation poisoning (Colonel Margery Hanfelt, US Army Veterinary Corps, former JDVC Commander, personal knowledge).

On April 1, 2011, ALFOODACT 04-2011, “Suspension of Food Procurement from Specified Regions and Prefectures of Japan,” was coordinated and published to officially announce that most of the locally procured food supplied to US forces from north and west of Tokyo was suspended. Since the area near the Fukushima nuclear power plant is largely agricultural, the suspension of this locally procured produce for a few months following the disaster had a significant effect on the availability of fresh produce for troops stationed in Japan.[55]

In early April 2011, the unit FSOs and their interpreter also began surveying commercial food plants in the region to determine the overall effect on food procurement as a result of the “triple” disaster. Many of the commercial plants suffered from a lack of power and limited fuel for back-up generation systems as well as raw material supply chain interruptions. A few plants sustained direct physical damage from either the earthquake or tsunami (Colonel Margery Hanfelt, US Army Veterinary Corps, former JDVC Commander, personal knowledge).

The commercial audit program was adjusted to ensure that comprehensive audits of all suspended and suspect plants were performed in the areas of greatest concern, primarily the Tohoku, Chubu, and Kanto regions. The usual predisaster audit team of one veterinarian, one FSO, and an interpreter was augmented by two VFI noncommissioned officers when radiation surveillance and extensive sample selection became the new standing operating procedure. Since the initial March 11, 2011, earthquake, the people of Japan and the soldiers of US Forces Japan have made significant adjustments to ensure food safety. However, inspection frequencies will remain at heightened levels until new reports of contaminated food and food products diminish further. The Fukushima I Nuclear Power Plant disaster, the second-worst nuclear accident ever behind Chernobyl (the 1986 nuclear accident in Pripyat, Ukraine), remains the most complex catastrophe, given the residual effects of both natural and nuclear disasters (Colonel Margery Hanfelt, US Army Veterinary Corps, former JDVC Commander, personal knowledge).

FOOD DEFENSE

The US Army VS food protection program executes food defense activities to prevent the intentional contamination of food, bottled water, and ice from chemical, biological, radiological, nuclear, or physical agents. Protection of the nation’s food supply has economic, social, political, and psychological significance that is magnified by the DoD’s growing role in preventing terrorism. The threat of intentional contamination is further amplified in deployed settings, creating a real and present danger not only in terms of possible casualties, but also in terms of potential mission failures.

Prevention against bioterrorism is an ambitious goal, given the quantity of food destined for DoD personnel and the complexity of food production and delivery systems. As noted earlier in this chapter, myriad food items, which are grown on countless farms, are sometimes transported over long distances through hostile territory before reaching the site where they are finally consumed. This complexity creates opportunities (eg, during transportation, storage, and preparation) for aggressors to intentionally contaminate food. An integrated effort between key experts (eg, intelligence, antiterrorism and force protection, police force, and public health personnel) is critical to systematically evaluate and deliberately mitigate vulnerabilities.

For example, the bulk of food delivered to US forces in an operational environment is harvested, processed, and packaged in the United States, then transported to a stateside port and loaded onto a ship that is bound for another country. At a foreign port, food shipments are off-loaded onto contracted trucks with contracted drivers and transported (often through several countries) before eventually arriving at multiple, geographically dispersed forward operating bases. This example clearly outlines numerous opportunities for those who seek to intentionally contaminate the food supply destined for DoD personnel abroad. However, the threat of intentional contamination is not limited to deployed combat operations; it also applies to stateside DoD assets.

Terrorists know that a successful agroterrorism incident threatens America’s economic welfare and its standing as a leading exporter of agriculture products to the world. Agriculture-related products comprise nearly 10% of all US exports, which amounted to nearly $68 billion in 2006.[57] Although there are numerous US targets that would provide terrorists with high-profile results, these targets are often well protected. Consequently, terrorists now seek softer targets such as US agricultural resources, the destruction of which would still produce crippling economic and psychological effects. The cost-versus-reward ratio of targeting agricultural production is also attractive to terrorists because many methods of implementing this tactic are low tech and low cost. The VS employs a proactive approach to food defense programs to confront these threats by working closely with the USDA, FDA, and local agricultural groups; identifying potential vulnerabilities in food systems; and developing simple, low-cost mitigation strategies to reduce or eliminate such threats from various aggressors.

Aggressors can be divided into four categories: (1) disgruntled employees, (2) criminals, (3) protestors, and (4) terrorists. Terrorists are usually politically or ideologically motivated and often work in small, organized groups. Although terrorists pose a threat to DoD food supplies, other types of aggressors, such as those mentioned in the examples below, pose a greater national risk and must be addressed when a risk mitigation strategy is being developed. Understanding what motivates aggressors is critical to crafting effective risk mitigation strategies to stop them at home and abroad.[56]

While numerous examples of intentional poisoning of fellow citizens exist worldwide, “home-grown threats” have also been noted in the United States. In 1984, members of a cult headed by Bhagwan Shree Rajneesh used cultivated Salmonella bacteria to contaminate restaurant salad bars in Wasco County, Oregon; their intent was to sway a local election’s outcome. More than 750 people were infected. The motivations for poisoning can be varied, but this cult was politically motivated.[57]

A high-profile incident of an insider threat occurred in Dallas, Texas, in 1996, when a former laboratory employee pled guilty to contaminating a tray of doughnuts and muffins with the food-borne pathogen Shigella and inviting 45 other laboratory workers to enjoy these pastries in a break room. Only 12 of the 45 employees consumed the contaminated pastries, but these employees suffered severe gastrointestinal illness as a result. An investigation later revealed that the perpetrator was a disgruntled employee who had also poisoned her boyfriend with the contaminated food. It is clear from these examples that knowledge of aggressors’ possible motivations can be an important tool for shaping effective prevention and mitigation programs.[57]

The authority to execute food defense activities stemmed from the Bioterrorism Act of 2002. This act authorized the Secretary of Health and Human Services, acting through the US Food and Drug Administration, to issue regulations to protect the nation’s food and drug supplies against bioterrorism. Additionally, DoD Directive 6400.04E designated the responsibilities of the Secretary of the Army as the DoD executive agent for DoD Veterinary Public and Animal Health Services and provided the VS the authority to plan and deliver food. The DoD now implements several food protection programs in which food defense requirements have been embedded, including food protection audits, installation food vulnerability assessments, special events assessments, higher headquarters assessments, and FWRAs protection (Colonel Scott Severin, US Army Veterinary Corps [Retired], personal knowledge of the effects of the Bioterrorism Act of 2002’s effects on veterinary food defense activities).

Food Defense Initiatives

The Need for Revised Food Audit Programs and Other New Assessment Programs

The attack on the World Trade Center on September 11, 2001, exposed homeland vulnerabilities that stimulated the United States and its military to change its mindset about food defense. US leaders immediately recognized that if terrorists could target symbolic American buildings and kill nearly 3,000 people, they could also contaminate US food production facilities; the resulting food injuries and food-borne illnesses could severely impact DoD personnel worldwide.

Consequently, multiple food defense initiatives were systematically undertaken, and food defense was immediately combined with preexisting food safety programs. For example, one initiative stipulates that the commercial food facilities currently listed in USAPHC Circular 40–1, Worldwide Directory of Sanitarily Approved Food Establishments for Armed Forces Procurement (better known by its shortened title, Worldwide Directory) should have their food defense programs evaluated. One of the many benefits of adding food defense to the food protection audit program is the increased ability using new guidance to safeguard those plants that produce critical food supplies such as MREs. Military Standard 3006C (MIL-STD-3006C) is the current standard under which food protection audits are performed (supersedes Military Standard 3006A, 2002, and Military Standard 3006B, 2008). MIL-STD 3006C expands the philosophy and scope of force protection audits to include food defense findings.10,11

A food defense finding is defined as “any condition, practice, step or procedure noted (during a food protection audit) relating to the risk of intentional food tampering or increased food vulnerability.”11(p2) Food defense findings can occur at any stage of subsistence procurement, including receipt, storage, processing, packaging, packing, warehousing, and distribution.[11]

The adoption of other food defense initiatives (eg, the IFVA program) provides a broader level of protection for the food supplies destined for military installations.[58] In 2002, the US Army Center for Health Promotion and Preventive Medicine, in coordination with the DoD VS Activity, created Technical Guide 188, US Army Food and Water Vulnerability Assessment Guide (TG 188).[59] TG 188 establishes the guidance and framework to reduce the vulnerability of food and water supplies to terrorist attacks by identifying soft targets and providing commanders with recommendations to prevent or mitigate such attacks.

The current food defense reference is USAPHC Technical Guide 355, IFVA Program Handbook (TG 355), released in November 2012.[60] This handbook was published to complement TG 188 and provides further policy, procedures, and guidance for the implementation and management of the IFVA program at the installation level, including clearly outlining how IFVAs are conducted to standardize the process across all DoD installations.

The IFVA is a critical tool in shaping an installation’s food defense programs, which are further nested within installations’ antiterrorism and force protection programs. The annual IFVA evaluates the vulnerabilities of all food-related activities (ie, receipt, storage, preparation, and distribution) on DoD installations. The results of this evaluation become part of an overall installation risk assessment, which is consolidated by the installation antiterrorism and force protection officer and compiled into a briefing for the installation commander.[60]

Recommendations for the mitigation of identified vulnerabilities are also incorporated into an installation’s force protection condition program and are used to develop the food VS annex to the installation’s emergency response plan. These plans help personnel who are involved in the installation food defense program to better understand their defined roles during an emergency situation.[60]

Special events assessments, conducted by food and water defense (FAWD) teams, are a collaborative effort designed to reduce the vulnerability of food and beverage service to intentional contamination or disruption by terrorists or criminals at events where DoD personnel present an attractive target. Unique risks associated with special events may include the following factors: (a) most are at off-installation locations with potentially varying levels of security; (b) these types of events are well publicized and may be open to the general public; and (c) when off-installation special events are held, facilities may not be required to meet DoD public health standards, and contractors may not meet federal security or training criteria. A FAWD team must view potential targets from the terrorist’s perspective and accurately communicate identified risks to the special event security manager.[60]

The VS currently collaborates with DoD security teams to execute FAWD assessments at special events to mitigate risk and safeguard DoD personnel. This collaboration is initiated when a security team supporting a special event requests a FAWD assessment. A FAWD team generally consists of veterinary and preventive medicine officers who generate a joint report for the security team lead for inclusion in the overall facility risk assessment. Based on the FAWD team’s recommendations, the security team lead determines whether a food defense team is needed on-site during the special event to provide further food protection. FAWD team personnel may need to be present well before the event begins to ensure that food supplies are properly received and stored prior to being prepared and served. Another key aspect of supporting any special event is the collection of food samples for submission to a diagnostic laboratory should a food-borne outbreak occur.[60]

Higher headquarters assessments are an evaluation of an installation’s ability to protect its personnel from terrorist attacks. Installations are inspected at various frequencies by two higher headquarters levels: (1) the Defense Threat Reduction Agency and (2) higher headquarters assessment (HHA) teams. The Defense Threat Reduction Agency executes a joint staff integrated vulnerability assessment (JSIVA) program conducted at the DoD level. The HHAs are conducted on a more frequent basis by major commands such as the Army Materiel Command and the Installation Management Command. An important aspect of both the JSIVA and HHA is the evaluation of the DoD food vulnerability assessment benchmarks, including a review of the annual IFVA conducted by local VS food defense personnel. Findings made during the JSIVA and HHA are reported to the respective team leaders and the installation’s command group for the elimination or mitigation of all identified vulnerabilities and concerns.[60]

The Emergence of Food and Water Risk Assessments for Use During Deployments

The purchase and consumption of subsistence procured in some overseas locations can be risky because, in many countries, endemic food-borne diseases are exacerbated by poor hygienic practices in restaurants and other commercial catering establishments. Sanitation risks include the “lack of potable water and sanitizing supplies, improper sanitizing procedures, poor sanitary standards, questionable health standards among workers, a poorly trained workforce, and the use of manual or hands-on food processing techniques.”43(p63) Risks unique to particular countries or regions include “lack of food sanitation hygiene laws; insufficient oversight by the local civilian government (regulators); lack of animal herd health monitoring programs and associated controls for endemic diseases; inadequate health care systems; improper use of pesticides and chemicals; and the lack of food vendor accountability in the event of food-borne illnesses.”43(p63)

To address these risks, OCONUS commercial food establishments that sell to the DoD are audited by VS VCOs, thus ensuring compliance with regulatory, industry, and DoD requirements. As noted earlier in this chapter, when a food production facility passes a food protection audit in accordance with military standards, the facility is listed in the Worldwide Directory. A facility’s placement on this global list assures that it has achieved the established food protection (food safety and defense) benchmarks, thus reducing the risk of food-borne disease to service members and their families worldwide.[43]

Unfortunately, when growing numbers of service members were deployed to various remote locations such as Beyond the Horizon exercises in Panama and foreign humanitarian assistance operations in Pakistan, purchasing food from listed, DoD-approved food sources became increasingly difficult. Although most major exercises are usually conducted near larger cities where DoD-approved food sources are more readily available and logistically feasible, the main thrust of remote exercises and operations is to serve the most in-need populations, which are often located in rural areas where DoD-approved food sources may be unavailable or impracticable.[43]

Problems also surfaced when military standards were used to assess developing countries’ food operations, especially in more rural areas where local food safety practices were less stringent and often did not meet audit requirements. VCOs had to assign failing ratings to the majority of audited facilities in developing countries, leaving commanders without realistic feeding options, which, in turn, affected the VC’s ability to support the worldwide missions the DoD considered essential.[43]

Over time, VC leaders recognized that a new evaluation system had to be developed to support commanders and their missions while still preventing food-borne disease. A collective new system, the food and water risk assessment (FWRA) program, was developed so that trained assessors could “identify, assess, and communicate food-borne illness risks associated with food preparation operations such as hotel kitchens, restaurants, caterers, and military feeding operations, including facilities used during exercises and host nation dining facilities.”43(p63) The actual document created to assess such food operations is called Military Standard 3041, Requirements for FWRAs (MIL-STD-3041).[61]

Both MIL-STD-3006C and MIL-STD-3041 are based on the same US federal food safety laws. However, while MIL-STD-3006C is coupled with a form of a “pass” or “fail” audit of a food establishment, MIL-STD-3041 mandates use of an FWRA to identify associated risks and assign an overall level of risk. Commanders then can determine their acceptable level of risk based on VC risk mitigation recommendations.[43]

Currently, the FWRA program is transitioning to MIL-STD-3041, new handbook guidelines, and checklist improvements, which were released in 2013. The consolidated and updated checklist allows assessors to systematically evaluate food operations for exercise feeding plans and provides assessors with tools to recommend exclusion of higher-risk food items (eg, unpasteurized dairy products that pose a threat of brucellosis) from food operations.[43]

Integrating Department of Defense-Approved Food Sources and Food and Water Risk Assessments During Military Exercises. Military exercise planners who support service members in deployed areas must construct the safest feeding plan possible within the mission requirements. Although there is usually no single solution that will prevent an outbreak of food-borne illness, using an integrated risk-based intervention approach to food protection is the most efficient and effective means of reducing service member morbidity rates. The goal is to prevent service members from consuming higher-risk local foods from sources whose employees’ food service training is questionable and whose sanitation conditions are poor (Figure 9-11).[43]

DoD-approved food sources are the foundation of food protection for US troops stationed anywhere in the world and, thus, should be the first choice for feeding small groups during military exercises. Operational rations are the next preferred food safety option—above higher-risk local food sources—when DoD-approved sources are not available.

Figure 9-11. Food-borne disease risk curve for local foods.
DoD: Department of Defense
FWRA: food and water risk assessment

If planners cannot rely on either DoD-approved food sources or operational rations when feeding small groups of deployed troops, they may need to request an FWRA, the first step toward local food procurement. FWRAs are not required when deployed service members are reimbursed on a per diem basis because their purchased meals are not US government-contracted meals. (Troops usually choose which local establishments they would like to eat at when they are provided daily allowances for expenses.) However, planners who implement the per diem feeding option should still consider using FWRAs, particularly to evaluate those local food operations that military members frequent most, as a means of lowering the risk of troops incurring food-borne illnesses from these popular establishments.

Another feeding option for small groups who are deployed is to contract meals from local restaurants or caterers. Because this option mandates that service members eat local foods provided by US-government contracted local food operations, an FWRA is required to ensure that any food protection risks are understood and mitigated and only the safest local food operations are selected for the contracted meals.

FWRAs can be loosely divided into two groups: (1) those evaluations performed on upscale hotels (often large hotel chains) that host DoD-sponsored conferences in major cities and (2) those evaluations conducted in support of military exercises, often outside urban areas, where impoverished rural populations are generally located. Currently, the majority of FWRAs are group one evaluations. A case in point is the US Southern Command’s area of focus; here, upscale hotels are routinely assessed every 6 months.[43]

Generally, upscale hotel assessments are facility-based evaluations of individual urban hotel kitchens, which maintain food protection practices that are comparable to those in use at similar hotels in the United States. Although upscale hotel assessments are usually not performed to support military exercises, they do establish current risk assessments for hotels that are highly frequented by US service members.[43]

Unlike urban assessments, FWRAs conducted in support of exercises in less-developed areas often require assessors (usually VS personnel) to evaluate higher-risk, moderate-scale hotel kitchens and consider the complete (beyond-the-hotel) exercise feeding plan. For example, heightened water quality concerns in rural areas (often stemming from inferior water distribution systems and increased agricultural use) create a need for safer bottled water sources. Fresh fruits and vegetables and, as previously mentioned, local restaurants and caterers must also be assessed for their potential inclusion in feeding plans. A case in point, during Operation Martillo (Spanish for “hammer”) in Guatemala in August 2012, multiple food options were leveraged in the exercise feeding plan. Bottled water was procured from a DoD-approved source in Guatemala City. Fresh fruits and vegetables were delivered from a local supermarket. UGRs and MREs were served at operation sites, and, occasionally, meals were catered by a local hotel restaurant.[43]

Of these various food and water sources, the highest risk of food-borne illness usually stems from local restaurants (ie, stand-alone establishments or those in hotels). Common risks include unapproved raw materials, inadequate refrigerator or freezer space, unsanitary food preparation surfaces, and improper handling of potentially hazardous foods such as ice. Food service personnel often fail to recognize ice as a ready-to-eat food that is easily contaminated by improper handling. Examples include restaurants in developing countries that, in an attempt to save money, may make their own ice or serve the same ice used to keep foodstuffs cold (ie, as a refrigerant) to customers ordering drinks in beverage glasses.[43]

Assessors also advise contractors and commanders on less obvious risks. For example, a hotel kitchen with a moderate risk of food-borne illness when serving below its maximum capacity may present an extremely high food-borne illness risk if required to double the number of meals served.[43]

Understanding the Process and Challenges of Providing Effective Food and Water Risk Assessment Risk Communication. Providing ongoing risk communications to commanders and service members who may encounter higher-risk local foods can significantly reduce the incidence and impact of food-borne diseases. Other key stakeholders in the risk communication process include the assessor and the contractor. “The assessor evaluates food operation risks and assists the contractor in embedding food safety requirements into a contractor’s statement of work. This relationship with contractors is crucial to affect the most change within the food operation.”43(p65-66) A statement of work may direct a food establishment to replace excessively worn cutting boards, purchase additional freezers to ensure ample cold storage, or make kitchen and building improvements. This statement could even direct the use of thermometers to enable the food establishment to provide foods or food services to US service members.[43]

The assessor communicates risk using the risk assessment matrix (Figure 9-12) similar to the one found in Field Manual (FM) 5–19, Composite Risk Management.[62] Because commanders are accustomed to this type of risk communication, they can place food-borne illness threats in the same context as other operational risks and assign an appropriate weight to this information in comparison with other risks present on the battlefield. Use of this matrix system must remain central to the command’s planning process if all threats are to be communicated to leaders as transparently as possible.43,63

In fact, effective risk communication presents, possibly, the greatest challenge within the FWRA program. Although VCOs do an outstanding job of identifying threats and assessing food protection risks, those threats and risks must be communicated properly to the commanders and service members who will use the particular food operations. As commands improve and expand their use of FWRAs, great care should be taken to develop processes that do not substitute effective risk communication with convenient contracting. Specifically, food operations should not receive a “Pass” or “Fail” designation based on the FWRA. Rather, informed commanders must weigh the FWRA risk level assigned against mission requirements and either accept or reject the risk. Contracts should only be formed after risks have been accepted by supported commanders, and those risks should be fully reevaluated prior to any contract renewal.

Despite the risks that exist within the FWRA program, it presents several means by which food safety can be improved, including the food operations recommendations and onsite training. Such training creates an opportunity for skilled assessors to impart their expertise. The program’s capability to directly engage partner nations and deliver simple and sustainable food protection training that impacts host nation health may also open the door to exercise-related training engagements apart from the FWRA program.

Figure 9-12. Risk management matrix for measuring operational risks, including food-borne illness threats.
Hazard Probability: (A) Frequent: occurs very often and continuously experienced; (B) Likely: occurs several times; (C) Occasional: occurs sporadically; (D) Seldom: remotely possible, but could occur at some time; and (E) Unlikely: can assume hazard will not occur, but is not impossible Hazard Severity: (I) Catastrophic: loss of ability to accomplish the mission or mission failure (example indicators include death or widespread illness); (II) Critical: significantly or severely degraded mission capability or unit readiness (example indicators include multiple food-borne illness incidences); (III) Marginal: degraded mission capability or unite readiness (example indicators include sporadic food-borne illness and loss of confidence in food supply safety); and (IV) Negligible: little or no adverse impact on mission capability
Adapted from Figure 4 in Killian JW, Burke RL, Westover JE. Food and water risk assessments: empowering commanders and protecting service members. US Army Med Dep J. 2013 Jan-Mar: 66.

Even when DoD-approved food sources or operational rations are maximized, FWRAs are leveraged, and onsite training is conducted, service members still encounter higher-risk local foods, often by choice. When such encounters occur, troops also must be armed with sufficient food protection knowledge to enable them to make safer local food choices. Online educational materials provided by government websites provide realistic guidance on reducing the incidence of food-borne diseases associated with local food consumption. For example, information on diseases ranging from acute bouts of diarrhea from Campylobacter to life-long spondylodiscitis and sacroilitis from diseases such as brucellosis (contracted by consuming unpasteurized milk) is located on the APHC’s page, “Local Food Choices During Deployment.”[64]

The FWRA program has experienced rapid growth because of its tremendous value to supported commanders: it empowers them to make confident decisions, meshes with COIN operations, and is more applicable to developing countries. Overall, the FWRA program allows higher-risk food operations to be considered for use during deployments but requires an increased focus on food-borne disease mitigation. Commanders should not assume that food operations contracted under the FWRA program are as safe as DoD-approved sources or naively form contracts based on convenience rather than accepted food safety risks and mission requirements.[43]

The Emergence of Food and Water Risk Assessments During Foreign Humanitarian Assistance Operations

Foreign Humanitarian Assistance (FHA) operations generally require quick responses to counter the immediate human suffering caused by natural disasters and other humanitarian crises. However, because these incidents often occur in regions of the world where DoD-approved sources often are not present in the first place, establishing a formal supply system (ie, securing DoD-approved sources or operational rations) may be impossible. Conducting the sanitary food protection audits necessary to secure approved suppliers in a timely manner may not be practical for two other key reasons: (1) those that were available are often severely crippled (and sometimes even wiped away) by the disaster; and (2) the transient nature of the FHAs limits the long-term value of the audits as the operation may conclude before final approval is granted. Consequently, commanders leading FHA operations often rely on FWRAs as a valuable alternative for providing sustainment to US service members while continuing to ensure force health protection.[43]

A case in point is the DoD flood relief effort in Pakistan in 2010. During these FHA operations, FWRAs were conducted at three US base camps in Pakistan, where the initial overall risk assessment for all three locations was “high,” primarily because microbial contamination threatened both food and water. By implementing recommended FWRA control measures, the overall risk was reduced to “moderate.”[43]

The key recommendations included the following safeguards: (a) the removal of all ruminant meat and meat products from the menu (because of the potential risk of bovine spongiform encephalopathy or “mad cow disease”); (b) increasing the cooking times and temperatures to US-required levels; (c) using bottled water (from an approved source) for cooking; (d) substituting high-risk food items on the menu with lower-risk food items that were exempt from requiring approval (eg, replacing locally manufactured products with products imported from Europe); (e) chlorinating bulk water tanks used for washing dishes and cookware and testing them monthly for residual chlorine; and (f) establishing mess trailers for food preparation and dining. Implementing these recommendations did not completely eliminate the risk of food-borne illness, but they did reduce the overall risk to a level that was acceptable to the commander without negatively impacting FHA operations in Pakistan.43(p67)

Food Defense Training

The emergence of a robust food defense program required the legacy VETCOM to create a food defense training cell to instruct NCOs and VCOs on the performance of food defense initiatives. Increasing the number of trained food defense personnel was critical in building a food defense expertise base. Upon VETCOM’s deactivation, the AMEDDC&S, located at Joint Base San Antonio-Ft Sam Houston, Texas, assumed full responsibility for food defense training, which includes embedding and updating food defense training materials in all its active duty and reserve courses.

In February 2015, the AMEDDC&S was designated as the Army’s HRCoE, and the food defense mission of the DoD is now fully embedded in the daily duties of veterinary and preventive medicine personnel who provide technical support and guidance for food and water vulnerability assessments and food defense at the installation level. This service also has been elevated to the forefront of food defense NCOs’ daily mission priority. Additionally, the AMEDDC&S, HRCoE, delivers worldwide food defense training via veterinary training and assistance teams. These teams are in high demand and have traveled to DoD installations in Japan, Germany, and Kuwait (Colonel Jerrod Killian, chapter author, personal knowledge).

As the food defense mission expands and budgets decrease, it is critical that financial resources be carefully aligned with personnel assets to obtain the most effective food defense posture possible. This targeted approach must anticipate risks, match the enemy’s resourcefulness, and remain sufficiently flexible to adjust rapidly when new intelligence is provided or old intelligence changes.

CONCLUSION

The VS is a key DoD food protection agent. Prior to the terrorist attacks on September 11, 2001, the VS’s mission was monitoring security concerns and protecting food from intentional contamination; however, these attacks catalyzed the US military’s new multifaceted, integrated food defense posture. The VS’s current mission is twofold: to protect service members and their families from intentional and unintentional food-borne illness while also protecting the financial interests of the government. This dual mission is commonly referred to, respectively, as “conserve the fighting strength” and “financial stewardship.”

Regardless of the mission title, prevention—both of illness and monetary loss—is the VS’s primary goal. The VS remains adaptive and committed to excellence when investing in personnel, prioritizing training, and ensuring mission execution. This proactive and adaptive posture was the cornerstone when valuable contributions were made during Operation Tomodachi in Japan and continues to guide the VS when food risks are encountered during COIN operations, when FWRAs are instituted, and when critical food defense missions are launched.

The VS could not accomplish such missions without the integration of various federal, state, and local agencies; commercial industry; and academia and continues to forge new relationships to better integrate its food defense efforts. For example, the VS mission on military installations is deliberately embedded within tailored ISPs that are developed to prevent the intentional and unintentional contamination of food. However, food defense and food safety must be developed individually—as well as jointly—to eliminate any gaps that could create weaknesses if these missions were only approached separately.

While the food safety mission has increased in priority, quality assurance remains an important aspect of the VS mission, and financial stewardship, the second tenet of the mission, is becoming increasingly critical in today’s era of fiscal responsibility. The cost savings to the government is not one-dimensional. Achieving the most savings possible is the result of careful planning and the implementation of programs designed with an emphasis on saving money.

In some instances, a more expensive product, package, or process will yield the most savings. A case in point is the Cook Chill system (Plascon Group, Traverse City, Michigan) installed at the US Military Academy at West Point, New York. The academy kitchen used to cook what soups and gravies were needed for service and then continue using what was left over for the next day or two. This conventional production process seemed—on the surface—to be the best way to make and use these food items. Conversely—at the outset—the new Cook Chill system was more expensive to use, including the packaging material it required; however, this initially large investment ultimately saved thousands of dollars a year and improved operations. Since the packages were sealed in sizes that allowed more control of how much was used and an ice bath was utilized to rapidly cool down the heat-vacuumed bags, the end results were substantially favorable: less waste; a safer, more consistent, higher-quality product with a much longer shelf-life; the capability to ship products to other facilities for consumption; and overall cost savings (Colonel Jerrod Killian, chapter author, personal knowledge).

Other areas in which VS programs and procedures have saved defense dollars include the shelf-life extension program (OCONUS), contract procurement, salvage operations, management and control programs, organizational inspection program visits, and consultations and corrections in food storage and shipping operations.

Although the food protection goals of safeguarding warfighters and saving government resources remain constant, the methods to achieve these goals must deliberately evolve to address emerging threats. Attempts to improve every aspect of food protection include a constant search for better processes, equipment, and training. To that end, efforts are underway to increase the readiness and capabilities of VS personnel by placing personnel more precisely, promoting quality advanced schooling, and leveraging modern technology. The VC is challenged to identify, evaluate, and incorporate any system or product that will improve job performance, cost savings, and safety.

Finally, the interconnected global food market has created additional challenges in implementing food protection for US personnel serving at home and abroad. Although food supply-chain logistics—purchasing, storing, shipping, preparing, and serving safe food—have always been important command considerations, the VS must continue to help commanders realize that food-borne illness, an inherent risk that is intensified in deployed locations, is preventable, especially when FWRAs are implemented and service members are empowered with knowledge about local food safety risks.

Acknowledgments

The authors wish to thank chapter authors Lara Pacha and Estheer Pfau from the APHC for their efforts in obtaining the figures included in this chapter. Additionally, Michael Killian, one of the many contributors to this chapter, volunteered his time to review, edit, and improve the entire draft of this chapter. Mr. Killian’s contributions and guidance cannot be overstated and are much appreciated.

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54.   Rafferty, JP. Japan earthquake and tsunami of 2011. Encyclopedia Britannica website. http://www.britannica.com/event/Japan-earthquake-and-tsunami-of-2011. Accessed February 3, 2016.

55.   Defense Logistics Agency, Troop Support, Subsistence. https://www.troopsupport.dla.mil/subs/fso/alfood/11afamess.asp. Accessed 20 October 2015.

56.   US Department of Agriculture Economic Research Service. Foreign Agricultural Trade of the United States (FATUS) Monthly Summary, December 2006. http://www.ers.usda.gov/Data/FATUS/MonthlySummary.htm. Accessed March 11, 2016.

57.   Food and Drug Administration. http://www.fda.gov/downloads/Training/
ForStateLocalTribalRegulators/UCM218900.pdf. Accessed 20 October 2015.

58.   US Army Public Health Command. Worldwide Directory of Sanitarily Approved Food Establishments for Armed Forces Procurement. Aberdeen Proving Ground, MD: DA; 2012. Circular 40-1.

59.   US Army Center for Health Promotion and Preventive Medicine. US Army Food and Water Vulnerability Assessment Guide. Aberdeen Proving Ground, MD: DA; 2008. Technical Guide 188.

60.   US Army Public Health Command, Installation Food Vulnerability Assessment (IFVA) Program Handbook. Aberdeen Proving Ground, MD: DA; 2012. Technical Guide 355.

61.   US Department of Defense. Department of Defense Standard Practice: Requirements for Food and Water Risk Assessments (FWRA). Washington, DC: DoD; 2013. Military Standard-3041.

62.   US Army Center for Health Promotion and Preventive Medicine. Guide for Deployed Preventive Medicine Headquarters, Department of the Army. Composite Risk Management. Washington, DC: DoD; 2006. Field Manual 5–19 (FM 100–14).

63.   Personnel on Health Risk Management. Aberdeen Proving Ground, MD: DA; 2001. Technical Guide 248.

64.   US Army Public Health Center (Provisional) website. http://phc.amedd.army.mil/topics/foodwater/ifs/Pages/Local-FoodChoicesDuringDeployment.aspx Accessed March 11, 2016.

Chapter 10

ARMY VETERINARY LABORATORY SERVICE

SCOTT E. HANNA, DVM, MS*; MARGERY M. HANFELT, DVM, MS†; JERRY R. COWART, DVM‡; KELLEY L. EVANS, DVM¥; AND ROBIN K. KING, DVM, MSS¶

INTRODUCTION

FOOD ANALYSIS CAPABILITIES

Department of Defense Food Analysis and Diagnostic Laboratory

Public Health Command Region-Europe, Department of Laboratory Services

Other Military Laboratory Resources

VETERINARY DIAGNOSTIC CAPABILITIES

Department of Defense Food Analysis and Diagnostic Laboratory

Public Health Command Region-Europe, Department of Laboratory Services

LABORATORY ACCREDITATION

SUMMARY

*Lieutenant Colonel, Veterinary Corps, US Army; Director, DoD Food Analysis and Diagnostic Laboratory, 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

†Lieutenant Colonel, Veterinary Corps, US Army; Commander, 463rd Medical Detachment Veterinary Service Support, PO Box 53571, Fort Benning, Georgia 31905

‡Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Pathology Division, Laboratory Sciences, USAPHCR-Europe, CMR 402, Box 910, APO AE 09180

¥Major, Veterinary Corps, US Army; Staff Officer, Headquarters, Public Health Command-San Antonio, 2748 Worth Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

¶Colonel, Veterinary Corps, US Army; Commander, Public Health Command Region-West, Building 9783, McKinley Avenue, Joint Base Lewis-McChord, Washington 98433

INTRODUCTION

Three pillars form the core of the US Army Veterinary Service’s force health protection mission: research and development, animal medicine, and food safety. The Veterinary Laboratory Service has always supported each pillar and continues to do so. For example, veterinary officers currently hold key positions in medical research laboratories, particularly in toxicology, virology, pathology, and laboratory animal medicine. In public health, veterinary personnel in food analysis laboratories provide the science that complements the art of food inspection, and veterinary diagnosticians maintain the health of military animals, service members, and military families and their pets.

Throughout the last two centuries, veterinary laboratory personnel also offered diverse support to multiple military conflicts, from testing ice chlorination potability in Vietnam[1] to providing food testing and rabies diagnostics for Operation Iraqi Freedom and Operation Enduring Freedom. They also collaborated in myriad civil-military functions, supporting international missions (eg, Joint Task Force Bravo in Latin America) as well as operations closer to home (eg, relief efforts for Hurricane Katrina and the 2010 Gulf oil spill).

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 that included six or seven laboratory officers.[2] By the end of World War II, about 100 veterinary officers served worldwide in the veterinary laboratory sections of 32 Army medical laboratories.[3] (See also Chapter 1, Military Veterinary Support Before and After 1916.)

Since 1945, the number of veterinary laboratories has greatly decreased. Base realignment and closures, along with the advent of overnight shipping services, allowed various regional laboratories to be consolidated into the current Department of Defense (DoD) Food Analysis and Diagnostic Laboratory (FADL) at Joint Base San Antonio-Ft Sam Houston, Texas, and the Public Health Command Region-Europe, Department of Laboratory Sciences (LS) in Landstuhl, Germany, formerly known as Veterinary Laboratory Europe. With the activation of the US Army Public Health Command, these two laboratories have taken on increased roles in public health surveillance, zoonotic disease diagnosis, and entomologic testing. Smaller food analysis laboratories in Hawaii and Korea cover those parts of the world that cannot quickly get samples to the two larger laboratories.

FOOD ANALYSIS CAPABILITIES

The mission of the Army’s food analysis laboratories has also changed through time. Although food safety is always a primary concern, early mission focus was on quality assurance testing and contract compliance for large subsistence stockpiles. Dairy testing comprised a large portion of the food analysis laboratory work, as did packaging testing of operational rations and can analysis. Initially, most laboratories were aligned under the Quartermaster Branch; later, food analysis became a medical mission and, ultimately, the responsibility of the Veterinary Service.

More recently, particularly with the advent of prime vendor and direct delivery contracts, food protection has become a main focus for food analysis laboratories. Quality assurance checks are still performed, but usually in the context of verifying the producer’s own quality assurance program. Detection of harmful pathogens, toxins, and chemicals, and providing laboratory testing for food-borne illness outbreaks have taken priority. Also, food analysis laboratories are now increasingly involved with food defense and have expanded their capabilities to quickly detect intentional subsistence contamination with either traditional food-borne threats or bioterrorism agents. (See also Chapter 9, Food Safety and Food Defense, for more information about the veterinary food defense mission.)

Department of Defense Food Analysis and Diagnostic Laboratory

The DoD FADL, the Army’s largest food analysis laboratory, performs a wide variety of microbiological and chemical tests on food and bottled water samples and provides global support to military and nonmilitary customers. Food microbiology assays at the DoD FADL run the gamut from basic, conventional microbiology using agar plates to advanced, rapid techniques, such as real-time polymerase chain reaction and genetic typing. The microbiology section tests for routine quality indicators as well as specific food-borne pathogens and toxins, and it tests samples associated with food-borne illness outbreaks (Figure 10-1). Although most of the samples submitted for microbiological testing come from North and South America, the section also receives samples from the Pacific region and confirms laboratory results for the laboratories in Hawaii and Korea when needed.

Figure 10-1. A Department of Defense Food Analysis and Diagnostic Laboratory microbiologist examines a cell culture plate for colonies while performing a membrane filtration test on bottled water samples.
Photo courtesy of Lori Newman, Public Affairs Officer, Joint Base San Antonio-Ft Sam Houston, Texas.

The DoD FADL’s food chemistry section also has specific capabilities, including detection of cyanide; pesticides, in food and water; histamine, in certain seafood; and antibiotic residues, in food and dairy products. In addition, the chemistry section conducts heavy metals analysis; proximate analyses, such as fat content of ground beef; and radiological screening of bottled water. DoD FADL chemists are also routinely called upon to identify foreign objects in food samples, respond to customer complaints, and handle other laboratories’ samples when advanced chemistry testing is needed.

The DoD FADL works closely with the US Food and Drug Administration and the US Department of Agriculture, sharing results when food-borne pathogens are detected, so affected food items can be quickly removed from the US market. The DoD FADL is part of the Food Emergency Response Network, headed by the US Food and Drug Administration, and the Defense Laboratory Network, headed by the DoD.

In addition to fulfilling routine testing and watchdog functions, DoD FADL personnel work with the Army Medical Department Center and School, Health Readiness Center of Excellence, to teach students about food laboratory operations and sample submission procedures. The DoD FADL also tests animal feed, bedding, and drinking water at military medical research facilities. This testing helps military laboratories maintain their accreditation, keeps study animals healthy, and ensures that research results are valid.

Public Health Command Region-Europe, Department of Laboratory Services

The laboratory arm of Public Health Command Region-Europe, LS conducts microbiological testing of food and water for safety and wholesomeness utilizing classical agar-based media, rapid and field-expedient methods, and identification of microorganisms using classical biochemical and immunological techniques. LS also performs a limited number of food chemistry procedures, primarily pH in low-acid foods; however, the LS chemistry division performs a full spectrum of bottled- and source-water procedures, including testing for pesticides, herbicides, heavy metals, and radiation activity.

In addition, LS provides response to food-borne illness outbreaks in support of military members throughout the Central Command (ie, Southwest and Central Asia), Europe, and Africa. LS customers include Army, Air Force, Navy, and Marine personnel and state department assets, and LS receives sample submissions from more than 40 countries.

Other Military Laboratory Resources

Two smaller laboratories support the Pacific theater. The Food Safety Laboratory at Tripler Army Medical Center, Honolulu, Hawaii, performs microbiological screening for food samples from the entire Pacific theater, using a variety of rapid and miniaturized methods. The 106th Medical Detachment (Veterinary Service Support) Laboratory, Yongsan, in Seoul, South Korea, provides microbiological screening and limited chemical analysis of subsistence (ie, fresh, canned, bottled, and frozen food and beverage products) procured from the Korean peninsula.

Despite the wide geographic dispersion of the fixed laboratories, sometimes, other more flexible military laboratory resources are needed to ensure adequate and timely testing. Many food products are perishable; long transport distances can cause these samples to degrade significantly, rendering them unsuitable for assessment. Difficulties shipping food samples across borders or out of combat zones can also delay or even prevent needed testing. In other situations, operational circumstances demand more immediate preliminary results on-site, precluding shipment to fixed laboratories.

To help mitigate these problems, each deployable Medical Detachment (Veterinary Service Support) contains a food procurement and laboratory team (FPLT). The FPLT’s role is to rule out problems based on indicator testing before sending referrals to a reference laboratory such as the DoD FADL or LS. The FPLT uses two specialized equipment sets to screen food and water samples for microbiological indicators of contamination and a few chemical contaminants such as pesticides and aflatoxin (Figure 10-2). The FPLT also utilizes the Joint Biological Agent Identification and Diagnostic System, a ruggedized polymerase chain reaction platform to test food and water samples for biological warfare agents. The Joint Biological Agent Identification and Diagnostic assays for more typical food-borne pathogens such as Salmonella are in development, which will further enhance the food protection capabilities of the FPLT.

Implementing these laboratory teams has greatly enhanced local surveillance and destination monitoring, allowing potential problems to be identified before they affect consumers. In addition, the equipment sets provide the FPLT some veterinary diagnostic capability, enabling the team to test for several animal disease agents that can also impact human health.

Figure 10-2. An Army Veterinary Corps officer evaluates bacteria cultured from a sports drink at Kandahar Airfield, Afghanistan.
Photo courtesy of Lieutenant Colonel Scott Hanna, chapter author.

VETERINARY DIAGNOSTIC CAPABILITIES

Like the food analysis mission, the veterinary diagnostic mission has evolved. For example, although rabies testing remains a priority, modern technology has eliminated the need to maintain mouse colonies for disease diagnosis. The rabbits formerly kept for pregnancy diagnosis are now similarly archaic. Today, veterinary diagnosticians increasingly concentrate on the diagnosis and surveillance of zoonotic diseases—those diseases shared between humans and animals—as part of an overall public health system.

Department of Defense Food Analysis and Diagnostic Laboratory

As its name suggests, the DoD FADL promotes current animal and zoonotic disease diagnostic objectives. Because rabies is foremost among the important zoonoses, the DoD FADL provides rabies testing for both human and animal samples. The laboratory team performs rabies testing of all animal specimens, including bats, to determine if humans bitten or scratched by a potentially rabid animal need postexposure treatment to prevent disease contraction (Figure 10-3).

The DoD FADL also provides the fluorescent antibody virus neutralization blood test for both government and privately owned animals; this test determines the rabies vaccine’s efficacy and is a requirement for animals to travel to many rabies-free countries and regions. The DoD FADL performs a similar rabies antibody test for humans to determine if high-risk personnel, such as veterinarians, who have been vaccinated for rabies, are protected against the disease or if they need a booster vaccination. (See also Chapter 12, Rabies and Continued Military Concerns.)

In addition to rabies, the DoD FADL analyzes human, animal, and arthropod specimens for diagnosis and surveillance of several diseases of public health and zoonotic significance, including serologic and molecular diagnostic testing for leptospirosis, leshmaniasis, Chagas disease, and West Nile disease. In fact, the DoD FADL conducts all the mosquito and bird testing for West Nile virus on military installations throughout the southern United States and was the first to detect the virus in the San Antonio, Texas, area in 2012. The laboratory team also tests for several tick-borne diseases in military working dogs and avian influenza in birds.

Figure 10-3. A Department of Defense Food Analysis and Diagnostic Laboratory technician prepares the brain of a skunk for rabies testing.
Photo courtesy of Lori Newman, Public Affairs Officer, Joint Base San Antonio-Ft Sam Houston, Texas.

Besides testing, DoD FADL personnel assist US Army South in evaluating and building laboratory capacity in partner nations throughout the Southern Command area of responsibility, primarily Central America. The laboratory participates in multiple research projects, funded by diverse entities, such as the Global Emerging Infections Surveillance and Response System and the US Army Edgewood Chemical and Biological Center. A primary mission is evaluating new technologies and test methods that might be used someday by the FPLT and other deployable laboratories. The laboratory also conducts disease surveillance work to protect the health of military working dogs and humans.

The DoD FADL is part of the National Animal Health Laboratory Network, headed by the US Department of Agriculture, specifically for response to avian influenza. The laboratory team assists Texas with its state feral animal rabies control program and supports the San Antonio Military Medical Center with laboratory testing for diseases such as rabies and leptospirosis. It also maintains a military working dog serum repository, similar to the DoD human serum repository, that can be utilized for retrospective disease surveillance studies.

Public Health Command Region-Europe, Department of Laboratory Services

Public Health Command Region-Europe, LS, provides rabies diagnostic testing, vector-borne disease testing, and anatomic pathology diagnostic services and is the front-line testing laboratory for units located in or deployed to the Central Command, Europe, and Africa. LS also cooperates with veterinarians from indigenous laboratories to establish rabies diagnostic capabilities within these operational areas.

Samples submitted for rabies testing are primarily from animals that have bitten a service or family member. LS provides after-hours and weekend on-call testing services for rabies submissions to ensure medical personnel are provided timely and accurate test results to make appropriate treatment decisions.

In addition to testing for rabies virus, LS provides vector-borne disease analysis of arthropod specimens. The team uses molecular diagnostic testing for surveillance of several diseases of public health and zoonotic significance, including anaplasmosis, ehrlichiosis, Lyme disease, Sicilian sandfly fever, Crimean Congo hemorrhagic fever, dengue disease, leishmaniasis, West Nile disease, tick-borne encephalitis, malaria, and chikungunya disease.

LS also has a board-certified veterinary anatomic pathologist assigned to the team, which allows it to provide diagnostic histological and cytological analysis of animal tissues, necropsy services, and training in support of local and deployed military working dogs and service members’ privately owned pets.

LABORATORY ACCREDITATION

Although veterinary laboratories have strived to maintain quality systems to ensure the accuracy and validity of their results, until recently, each laboratory adhered to individual standards. In 1999, the International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) issued ISO/IEC 17025, The General Requirements for the Competency of Calibration and Testing Laboratories, which was adopted as an American national standard. The ISO/IEC 17025 incorporates many of the management and quality system requirements found in the widely used ISO 9000 but includes a technical requirements section specific to analytical laboratories.[4] Independent accreditation agencies use ISO/IEC 17025, which was updated in 2005, as a template to ensure that analytical laboratories worldwide continue to consistently produce valid results and meet stringent competency requirements.

In the early 2000s, both the DoD FADL and Veterinary Laboratory Europe (now LS) underwent rigorous assessments by the American Association for Laboratory Accreditation to ensure the competency of their laboratory operations and the validity of their results. This accreditation provides further confidence in the accuracy and reliability of these laboratories’ analytical results and allows them to act as confirmatory testing laboratories. In addition, this accreditation ensures that test results are legally defensible and readily accepted by other government agencies. More recently, LS expanded its scope of accreditation, becoming the first DoD laboratory to be ISO/IEC 17025 accredited for veterinary anatomical pathology diagnosis.

The DoD FADL is also accredited by COLA, the Commission on Office Laboratory Accreditation, for its zoonotic disease testing of human samples. This certification allows this veterinary laboratory’s test results to be fully accepted by human clinical laboratories.

SUMMARY

While the focus and number of veterinary laboratories may have changed over the years, the Army Veterinary Laboratory Services’ primary missions of food analysis and zoonotic disease diagnosis have remained more constant. In fact, with the continued, collaborative focus on the One Health concept, the recurring demand for public health and veterinary laboratory services will continue to increase. The recently published DoD Directive 6400.04E, DoD Veterinary Public and Animal Health Services, affirms the importance of the laboratory mission to military operations. It assigns the Army, and specifically the Army Veterinary Service, the responsibility to “maintain laboratories or contract the capability for laboratory examinations (organic or purchased) for wholesomeness and quality of food products and diagnosis of animal diseases.”5(p5)

Currently, two key fixed veterinary laboratories serve most geographic needs and offer a full spectrum of food, water, and disease testing options. Two smaller veterinary laboratories plus newly organized veterinary laboratory teams capable of providing services to deployment areas provide even greater global flexibility and timeliness, especially when circumstances demand rapid field expediency. Finally, the recently adopted accreditation process continues to guarantee that individual veterinary laboratory resources provide valid and accurate testing that veterinary personnel, civilian and military health care providers, and military commanders can rely upon to make informed and accurate decisions. As they always have, Army veterinary laboratories will adapt and respond to the changing needs of their customers—needs that will endure as long as humans and animals continue to serve their country.

REFERENCES

1.   Neel S. Vietnam Studies: Medical Support of the US Army in Vietnam 1965–1970. Washington, DC: US Department of the Army; 1991:137.

2.   Miller EB. United States Army Veterinary Service in World War II. Washington, DC: Office of The Surgeon General, US Department of the Army; 1961:381.

3.   Randall R. Wartime Army medical laboratory activities: wartime activities of the Army veterinary laboratories. Am J Pub Health. 1947;37(7):829–835.

4.   American Society for Quality. General Testing Requirements for the Competence of Testing and Calibration Laboratories. Milwaukee, WI: Quality Press; 2005. ANSI/ISO/IEC 17025:2005.

5.   US Department of Defense. DoD Veterinary Public and Animal Health Services. Washington, DC: DoD; June 27, 2013. DoD Directive 6400.04E.

Section IV: Preventive Medicine and Public Health Services

A US Army veterinarian from the 490th Civil Affairs Battalion Functional Specialty Team and a community animal health worker (second from left) work together to treat a young camel during an 8-day Veterinary Civic Action Program in Negele, Ethiopia, August 23, 2011. Using deployed US veterinary personnel helps develop the host nation’s surveillance programs and laboratory capacity, which is not only critical to global zoonotic disease control and surveillance and preventive medicine programs, but also supports the concepts of One Health and nation-building.

Photograph: by US Air Force Captain Jennifer Pearson. Reproduced from: https://www.army.mil/article/65682/helping_an_ethiopian_
community_survive_severe_drought. Accessed April 26, 2018.

Chapter 11

ZOONOTIC AND ANIMAL DISEASES OF MILITARY IMPORTANCE

RONALD L. BURKE, DVM, DRPH; TAYLOR B. CHANCE, DVM; KARYN A. HAVAS, DVM, PHD; SAMUEL YINGST, DVM, PHD; PAUL R. FACEMIRE, DVM; SHELLEY P. HONNOLD, DVM, PHD; ERIN M. LONG, DVM; BRETT J. TAYLOR, DVM, MPH; REBECCA I. EVANS, DVM, MPH; ROBIN L. BURKE, DVM, MPH; CONNIE W. SCHMITT, DVM; STEPHANIE E. FONSECA, DVM; REBECCA L. BAXTER, DVM; MICHAEL E. MCCOWN, DVM, MPH; A. RICK ALLEMAN, DVM, PHD; KATHERINE A. SAYLER; LARA S. COTTE, DVM; CLAIRE A. CORNELIUS, DVM, PHD; AUDREY C. MCMILLAN-COLE, DVM, MPVM; KARIN HAMILTON, DVM, MPH; AND KELLY G. VEST, DVM, MPH, DRPH

INTRODUCTION

Zoonoses in Service Members

Diseases in Military Animals

ZOONOSES OF IMPORTANCE IN THE VETERINARY TREATMENT FACILITY

Anthrax

Brucellosis

Equine Encephalitides

Leishmaniasis

Leptospirosis

Lyme Disease

Plague

Q Fever

ANIMAL DISEASES OF IMPORTANCE IN MILITARY WORKING ANIMALS

Distemper

Parvovirus

Heartworm Disease

Tick-borne Diseases: Ehrlichiosis and Babesiosis

Staphylococcus Aureus

TRANSBOUNDARY ANIMAL DISEASE OF MILITARY IMPORTANCE

New and Old World Screwworm

African and Classical Swine Fever

Foot and Mouth Disease

Highly Pathogenic Avian Influenza

SUMMARY

Ronald L. Burke, DVM, DRPH: Lieutenant Colonel, Veterinary Corps, US Army; formerly, Deputy Director, Division of Global Emerging Infections Surveillance and Response System, Armed Forces Health Surveillance Center, Silver Spring, Maryland 20904; currently, Chief, Veterinary Services Division, Public Health Command Region West, Box 339500, MS 115, Joint Base Lewis-McChord, Washington 98433

Taylor B. Chance, DVM: Lieutenant Colonel, Veterinary Corps, US Army; Biodefense Research Pathologist, Pathology Division, United States Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Building 1425, Fort Detrick, Maryland 21702

Karyn A. Havas, DVM, PHD: Major, Veterinary Corps, US Army; formerly, Veterinary Epidemiologist, US Army Public Health Command, Aberdeen Proving Ground, Maryland 21010; currently, Deputy Director, Division of Integrated Biosurveillance, Armed Forces Health Surveillance Center, 11800 Tech Road, Silver Spring, Maryland 20904

Samuel Yingst, DVM, PHD: Lieutenant Colonel, Veterinary Corps, US Army; Chief, Epidemiology and Disease Surveillance, US Army Medical Component-Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi, Bangkok, 10400 Thailand

Paul R. Facemire, DVM: Major, Veterinary Corps, US Army; Director of Pathology, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, Maryland 20910

Shelley P. Honnold, DVM, PHD: Lieutenant Colonel, Veterinary Corps, US Army; Biodefense Research Pathologist, United States Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Pathology Division, 910A, Fort Detrick, Maryland 21702

Erin M. Long, DVM: Captain, Veterinary Corps, US Army; Battalion Veterinary Surgeon, 92nd Civil Affairs Battalion (Airborne), Building 2-4059, South Post Road, Fort Bragg, North Carolina 28310

Brett J. Taylor, DVM, MPH: Lieutenant Colonel, Veterinary Corps, US Army; Instructor, Army Medical Department Center & School, 2250 Stanley Road, Building 2841, Room 1108, Joint Base San Antonio-Fort Sam Houston, Texas 78234

Rebecca I. Evans, DVM, MPH: Lieutenant Colonel, Veterinary Corps, US Army; Doctoral Student of Epidemiology, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, 300 West Drake, 1678 Campus Delivery, Fort Collins, Colorado 80523

Robin L. Burke, DVM, MPH: Major, Veterinary Corps, US Army; Chief, Veterinary Medicine Department, US Army Medical Component-Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi, Bangkok, 10400 Thailand

Connie W. Schmitt, DVM: Major, Veterinary Corps, US Army; Veterinary Pathologist, Veterinary Services Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Building 503, Room 1505, Silver Spring, Maryland 20910

Stephanie E. Fonseca, DVM: Major, Veterinary Corps, US Army; Chief, Veterinary Specialist Branch, Army Medical Department Center & School, 2310 Hardee Road, Suite 47, Joint Base San Antonio-Fort Sam Houston, Texas 78234

Rebecca L. Baxter, DVM: Captain, Veterinary Corps, US Army; Battalion Veterinary Surgeon, 98th Civil Affairs Battalion (Airborne), Building D-2815 Street, Fort Bragg, North Carolina 28310

Michael E. McCown, DVM, MPH: Major, Veterinary Corps, US Army; Chief of Operations, US Army Public Health Command-Europe, CMR 402, Box 172, APO, AE 09180

A. Rick Alleman, DVM, PHD: Professor, University of Florida College of Veterinary Medicine; Service Chief, Clinical Pathology Service, 2015 Southwest 16th Avenue, Room V2-151, Gainesville, Florida 32610

Katherine A. Sayler: Senior Biological Scientist, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, Room V2-240, Gainesville, FL 32610

Lara S. Cotte, DVM: Captain, Veterinary Corps, US Army; Chief, Clinical Veterinary Services, Navy Marine Mammal Program, 49620 Beluga Road, Room 204, San Diego, California 92152

Claire A. Cornelius, DVM, PHD: Lieutenant Colonel, Veterinary Corps, US Army; Deputy Commander/Operations Officer, 218th Medical Detachment Veterinary Service Support, 3369 Evergreen Boulevard, Joint Base Lewis-McChord, Washington 98433

Audrey C. McMillan-Cole, DVM, MPVM: Major, Veterinary Corps, US Army; Chief of Operations, Public Health Command Region-Pacific, 1 Jarrett White Road, Building 102, Room 102, Tripler Army Medical Center, Honolulu, Hawaii 96859

Karin Hamilton, DVM, MPH: Major, Veterinary Corps, US Army Reserve; formerly; Veterinary Preventive Medicine Officer, 407th Civil Affairs Battalion, Arden Hills, MN 55112; currently, Ecosystem Health Fellow, University of Minnesota College of Veterinary Medicine, 1988 Fitch Avenue, 385 Animal Science/Veterinary Medicine, Saint Paul, Minnesota 55108

Kelly G. Vest, DVM, MPH, DRPH: Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Assistant Director, Global Emerging Infections Surveillance and Response System, Silver Spring, Maryland 20910; currently, Deputy Chief of Staff, Armed Forces Health Surveillance Center, 11800 Tech Road, Silver Spring, Maryland 20904

INTRODUCTION

The US military veterinarian is responsible for ensuring not only the health of the Department of Defense (DoD) private and military-owned animals but also the health of US service members and their family members. Although these two populations are distinctly different, they are closely linked, especially regarding infectious diseases. Globally, zoonoses account for over 60% of known human pathogens, and 75% of emerging or reemerging infectious diseases are zoonotic.[1]

The majority of military important diseases are also zoonotic. The US DoD Tri-Service Reportable Events: Guidelines and Case Definitions lists specific notifiable diseases that have clear case definitions and pose an “inherent, significant threat to public health and military operations.”2(p7) Sixty-three of the 67 listed case definitions are of an infectious nature, and of these, 33 (52%) are true zoonoses in which animals either serve as the primary reservoir of the disease or as an important host or vector for the disease. In an additional seven other reportable diseases (eg, yellow fever), animals serve as incidental hosts or reservoirs. Taken together, zoonoses account for 63% of all infectious disease reportable medical events within the DoD. This number is even higher when some diseases that affect only humans but are theorized to have a zoonotic origin (eg, acquired immune deficiency syndrome or AIDS) are considered.[3]

Zoonoses in Service Members

Disease and nonbattle injury (DNBI) has historically been a significant source of mortality within the US military.[4] Prior to World War II, more US service members died from DNBI than from combat. During World War II, DNBI remained problematic, causing General Douglas MacArthur to famously lament: “This will be a long war if for every division I have facing the enemy I must count on a second division in hospital with malaria and a third division convalescing from this debilitating disease!”5(p2) Although advances in preventive medicine and treatment have helped to reduce the impact of DNBI on mortality, its effects are still felt, especially in terms of overall morbidity where DNBI still accounts for more lost duty days than battle injuries. Zoonoses such as Brucella melitensis and rabies continue to be associated with recent military operations in Afghanistan and Iraq, and others such as leishmaniasis have resulted in large outbreaks among deployed service members.6–8

Knowledge of local zoonotic diseases is necessary for early identification of these agents and appropriate treatment of infected patients. A retrospective serum study of hospitalized military personnel in Iraq found 10% of the sampled service members seroconverted to Coxiella burnetii, the causative agent of Q fever, as a result of their deployment to Iraq, suggesting a need to increase animal disease awareness among deployed physicians.[9] Awareness of local animal zoonoses is even more important for diseases that have long incubation periods or lack treatment options (eg, echinococcosis and bovine spongiform encephalopathy). Ignorance of the local zoonoses unnecessarily places service members at risk of infection through a failure to enact proper preventive measures. When infected with these diseases, service members may not develop symptoms until after they have redeployed or left military service, leading to potential misdiagnosis, improper case management, and development of long-term sequelae or death.

Knowledge of infectious diseases is also vital to maintaining military readiness. For centuries militaries have actively used biological agents during combat and have studied numerous other organisms as potential weapons, many of which are zoonotic. In fact, a 1997 report determined that 80% of the most likely biowarfare pathogens were zoonoses.[10]

One of the earliest examples of biowarfare involved the zoonotic organism Yersina pestis, the causative agent of plague. In 1346, near the end of a failed siege of Caffa, attacking Tatar forces catapulted plague-infected corpses over the city walls, which presumably triggered a bubonic plague epidemic among the defenders.[11] Centuries later, in 1710, Russian troops reportedly repeated this tactic against Swedish military forces.[12] During World War II, plague was again employed as a bioweapon, this time by the Japanese army in China where plague infected-flea vectors were examined as potential weapons against US troops.[13]

In the Cold War, the US and Soviet Union militaries both maintained substantial chemical and biological weapons programs. Although the US officially renounced the use of biological agents as offensive weapons in 1969 under President Richard M. Nixon, the United States continued defensive research, largely in response to the Soviet Union’s ongoing bioweapons program.[14] Even with the end of the Cold War and the eventual scrapping of the Soviet Union’s bioweapons program, biological threats persist (eg, the 2001 attacks on the US mail system with another common zoonotic agent, Bacillus anthracis or anthrax).[15] Biological threats throughout history are further discussed in Chapter 15, Veterinary Pathology.

Diseases in Military Animals

Infectious diseases are also of military concern even when only animals are infected. Up until the first part of the 20th century, many armies, including the US Army, relied heavily on horses, mules, and other animals for transportation, logistics, and combat. Outbreaks among these service animals had the same potential to negatively impact the operating force as outbreaks among soldiers themselves.

Consequently, just like their human counterparts, animals became biowarfare targets. In World War I, German agents reportedly used B anthracis and Burkholderia mallei to attack Allied equine supplies in Argentina, Spain, and the United States which subsequently affected military operations.16,17 In a separate but related incident, German-sponsored saboteurs unsuccessfully attempted to attack Norwegian pack-reindeer with anthrax-laced sugar cubes to disrupt communication and transportation. Because of these historic incidents, during the Cold War, the United States maintained a defensive bioweapons program for animals at Plum Island, New York, similar to the human programs at Ft Detrick, Maryland, and other locations.[18]

The armies of today are much more mechanized and less reliant on animals for logistics; however, animals are still employed for military operations and therefore still affect human disease exposure, perhaps even more so. Today, military working animals (MWAs) are used by all five of the US armed services: (1) Army, (2) Navy, (3) Air Force, (4) Marines, and (5) Coast Guard. Military working dogs (MWDs), marine mammals, and solipeds (eg, horses and mules) routinely accomplish a wide variety of missions, including drug interdiction, mine detection, special operations, and general force health protection. Failing to prevent infections and maintain MWA health can detrimentally affect not only individual animals but also attending handlers, units, and entire missions.

Often the infectious agents that threaten MWA health are the same agents that threaten human health. A retrospective analysis of predeployment and postdeployment sera from US MWDs deployed to the Republic of Vietnam reported that a significant percentage of the dogs demonstrated seroconversion to Group B arboviruses, meliodosis (ie, Burkholderia psuedomallei), and scrub typhus (ie, Orientia tsutsugamushi) as a result of their deployment.[19] A lesser percentage of the MWDs also demonstrated seroconversion against leptospirosis, plague, and Rickettsia canada. Another retrospective serum study examining French MWDs found that 9.7% of the dogs were seropositive for Q fever exposure, with those living close to sheep having a 6-fold increased risk of being seropositive.[20]

ZOONOSES OF IMPORTANCE IN THE VETERINARY TREATMENT FACILITY

Animals are the primary source of infection for several human diseases of military importance, including anthrax, brucellosis, hanta viruses, leptospirosis, Q fever, rabies, toxoplasmosis, tularemia, and viral hemorrhagic fevers (Arenaviridae, Bunyaviridae, and Flaviridae).[21] In several other military important diseases, infected animals generally pose little risk of directly infecting humans but may serve as important diseases reservoirs for arthropods and vector-borne disease transmission. Military important arthropod-borne zoonoses include the equine encephalitides (Eastern, Western, and Venezuelan encephalitis), ehrlichiosis, Japanese encephalitis, leishmaniasis, Lyme disease, plague, tick-borne encephalitis, trypanosomiasis, and typhus.[22]

Zoonoses of military importance and the associated diseases in humans are identified and comprehensively described in the Military Preventive Medicine: Mobilization and Deployment, Volume 2 textbook.[23] This chapter’s overview of some of these same diseases is more limited, given this textbook’s military veterinary medicine point of view:

- Focus is on veterinary medicine applications and the pathogenesis and clinical features, diagnostic approaches, and recommendations for therapy, prevention, and control in animals. When human recommendations are presented, the focus is on how humans, including deployed veterinarians, can limit the spread of infections and disease through current therapy, prevention, and control methods.

- The overview is limited to those pathogens and disease carriers military veterinarians are most likely to see or treat when working with government, military, and privately owned animals on military installations. In other words, although diseases such as Japanese encephalitis have zoonotic reservoirs (eg, swine) and can produce serious or potentially fatal outcomes, swine are not typically seen at US military veterinary treatment facilities, stables (eg, Morale, Welfare and Recreation program facilities), or on military installations in deployment areas; thus, Japanese encephalitis is not covered in this chapter. Lyme disease is covered in this chapter because military veterinarians may still see the disease among government, military, or privately owned animals, even though military veterinarians do not work with the reservoir population for this disease (ie, wild rodents).

- Rabies is not presented in this chapter because a thorough overview of this disease can be found in Chapter 12 of this textbook.

Since all diseases covered in this chapter appear in alphabetical order, readers should not infer importance by order of appearance.

Anthrax

Introduction and Military Importance

Anthrax, a disease of domesticated animals, wild animals, and humans caused by B anthracis, is especially pathogenic in most herbivorous animals (ie, goats, sheep, and cattle) and humans.[24] The clinical signs of disease vary with the species of animal infected and route of exposure.24,25 The most lethal form of disease is inhalation of anthrax spores, with death occurring within a few days if clinicians fail to recognize the etiology and treat appropriately.[26]

Army veterinarians are concerned with anthrax because of its potential use as a biological weapon and the possibility of human and animal exposure from domestic and wild animals in places with inadequate anthrax eradication and control programs. The 2001 mail incident in which 22 US citizens were infected and 5 died of anthrax, despite treatment after exposure to contaminated letters, reveals the significant threat anthrax poses as a potential biological weapon.[27] Additionally, Army veterinarians, other service members, civilians, and MWAs deployed in Afghanistan, Iraq, and other foreign humanitarian assistance missions throughout the world face the risk of anthrax exposure from wild animals and unvaccinated livestock.

Description of the Pathogen

B anthracis is a large, Gram-positive bacillus measuring 1 to 1.5 by 3 to 10 µm.24,25,28,29 The bacillus itself is virtually nontoxic; however, the organism produces an array of toxins that can kill animals, even after the organism’s death from antibiotics.[24] The main toxins produced by B anthracis are three complementary components designated as lethal factor, edema factor, and protective antigen; factors I, II, III, respectively.24–26,28–31 Lethal factor and edema factor bind to the protective antigen to form the two exotoxins, lethal toxin and edema toxin.24,25,28 The combined effects of these toxins are impaired function of phagocytes, decreased coagulation, increased capillary permeability, and impairment of the complement system.24,28,29,31

The organism’s vegetative form (ie, the one producing active disease) survives only a short time, which correlates with the short duration of animal and human infection. In carcasses, these vegetative forms are rapidly killed by putrefactive bacteria.24,29,32 But, in live animals, vegetative forms (ie, antemortem bacilli) are expelled in all natural excretions and pathological exudates.26,33,34 When exposed to oxygen, these expelled bacilli form spores that are very stable and can survive in the environment for decades. These dormant spores have minimal capacity for growth in the external environment, except under unique conditions of alkaline soil, abundant organic debris, intermittent periods of drought and rain, and constant temperatures above 15.5 °C.26,34

Epidemiology

Transmission. There is no definitive consensus on how animals acquire anthrax infection; however, most animals allegedly become ill after ingesting B anthracis. Herbivores (ie, goats, sheep, and cattle) ingest contaminated food and water; the bacteria likely enters the body through traumatized mucous membranes. Herbivores can also inhale spore-laden dust, although this route of infection is uncommon. Cutaneous infection in herbivores is also rare. In horses, anthrax infection is likely acquired from ingesting contaminated vegetation, but infection may also stem from blood-sucking insects. Dog and pigs may acquire anthrax by eating from an anthrax-infected carcass or ingesting the inadequately cooked meat of anthrax-infected animals.[24]

Humans contract various types of anthrax via many means, most commonly through the handling of spore-laden carcasses, hides, wool, hair, and bones. Such handling usually causes exposed body parts to become infected (eg, hands, arms, and neck) and develop cutaneous anthrax.28,31,32 Humans, like animals, can also contract ingestional forms of anthrax by eating poorly cooked, contaminated meat.[32] But humans rarely develop deadly inhalation anthrax by inhaling anthrax spores. Inhalation infection usually occurs only in people who handle contaminated animal products (eg, wool and hides) in an enclosed space or people who are exposed to aerosolized anthrax spores in the form of a biological weapon.28,31,32

Geographic Distribution. Anthrax spores have been found worldwide, including the Americas, Europe, Africa, and Asia.24,25,32–34 Spores have even been discovered in such extreme climates as Antarctica.[35] In countries with effective public health services and veterinary management, the incidence of anthrax is very low due to effective eradication programs and herd health management.24,32–34 Anthrax exposure is always possible in countries without effective public health and veterinary management, especially in environments with temperatures above 15°C and a prolonged drought.[24]

Incidence. Within the United States and other developed nations, anthrax infection is exceedingly rare in domesticated and companion animals.24,29 However, sporadic outbreaks do occur in some developed nations’ wild animal populations.32,34 During the 1990s, an average of one natural case of cutaneous anthrax a year occurred in humans within the United States,[32] and as mentioned previously in this chapter, anthrax spores have been used as a lethal biological weapon against US citizens.27,30 This incident shows the dangers anthrax poses as a biological weapon.

In developing countries, accurately determining the exact incidence of anthrax is impossible because of insufficient reliable data. Army veterinarians deployed to areas without anthrax eradication programs should be vigilant about the possible presence of B anthracis in the environment, livestock, and wild animal populations.

Pathogenesis and Clinical Findings

Anthrax pathogenesis depends on the primary route of infection: cutaneous, ingestion (ie, gastrointestinal or GI), or inhalation. Cutaneous anthrax, the most common form of disease in humans, is less common in animals and is named for the Greek word “anthrax,” meaning “charcoal” or “coal.”28,30,31 Cutaneous anthrax develops when organisms enter a cut or abrasion in the skin, begin to multiply, and produce toxins within the infected skin, resulting in vesicle formation that becomes necrotic and blackens. Cutaneous anthrax usually resolves itself without medical treatment; however, antibiotic administration is recommended to prevent potential fatal septicemia.28,30–32

Gastrointestinal anthrax develops when anthrax organisms are ingested and is most common in carnivores and omnivores.24,25 The toxins of the swallowed organism first cause local inflammation, necrosis, and edema in the upper GI tract (ie, oropharynx and esophagus) with swelling of the head and neck and resultant anorexia.[25] The bacteria travel to local lymph nodes via afferent lymph, and septicemia develops.24,25,28,29 Bacteria then infect the lower GI tract, resulting in a hemorrhagic gastroenteritis and subsequently, dysentery, and diarrhea.24,25,30-32 Anthrax can also spread from the stomach and intestines to the mesenteric lymph nodes, spleen, and liver, with concurrent or subsequent development of septicemia.

Figure 11-1. Ruminant: Marked congestion and enlargement of the spleen (“blackberry jam”) with infection from Bacillus anthracis.
Photo courtesy of Bruce H. Williams, Doctor of Veterinary Medicine, Senior Pathologist, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

Inhalation anthrax occurs when inhaled spores within alveolar lumina proliferate and are phagocytized by alveolar macrophages.26,36,37 These macrophages travel to local lymph nodes (ie, tracheobronchial lymph nodes) where they continue to proliferate. Toxins produced by bacteria in the lungs and local lymph nodes cause massive pulmonary edema, pleural effusion, edema within the mediastinum, and necro-hemorrhagic lymph nodes with resultant dyspnea, coughing, and fever.24,25,28–32 From the lymph nodes, bacteria enter the blood and infect the spleen and other organs.

Septicemia may occur with all three routes of infection but is rarely reported with cutaneous infections.24,25,28–32 Septicemia results when anthrax bacilli are present in large numbers within blood vessels. The three major toxins, factors I, II, and III, result in diffuse edema, hemorrhage, and congestion.24,28,29,31,32 More specifically, parenchymatous organs swell and become congested; ecchymoses of mucous membranes, serosal surfaces, and subcutaneous tissues occur; and loose connective tissue (eg, adipose tissue) and body cavities may be filled with blood-tinged gelatinous fluid (Figure 11-1). The blood in septicemic animals will be thick, dark, and tarry and will either not clot or form soft friable clots that are easily separated.24,29

Often, especially with very susceptible species like ruminants, veterinarians will encounter animals that have died acutely from anthrax with few or no antemortem signs of disease. These animals show little or no rigor mortis; have dark, nonclotted blood oozing from the anus, mouth, and nasal cavity; and exhibit rapid decomposition, massive bloating, and a “saw horse” positioning of the legs. In endemic areas, Army veterinarians still consider anthrax on their differential diagnosis for acute death in animals, especially ruminants, because, as noted, even when indigenous, this disease is frequently asymptomatic.26,31

Diagnostic Approaches

Although anthrax can be diagnosed in many ways, a necropsy should never be performed on an infected animal because anthrax spores could be released into the environment.24,25,29,32–34 The easiest method of field diagnosis is to collect a smear of the animal’s blood or local exudate on a slide and stain the specimen with old methylene blue. B anthracis will stain pink and will usually be in pairs or short chains of three to four organisms with rounded free ends and square apposed ends.24,25,26

In people and animals with inhalation anthrax, nasal swab smears, pleural effusion smears, or pulmonary biopsy specimens also can be examined with direct fluorescent antibodies to B anthracis to confirm a diagnosis.[25] Polymerase chain reaction (PCR) can be used to confirm a diagnosis with sterile body fluids (ie, blood, abdominal effusions, and pleural effusions).25,30,31 Serologic testing using enzyme-linked immunosorbent assay (ELISA) with a 4-fold increasing titer also might confirm a diagnosis; serologic testing is sensitive but not specific for anthrax.24,25,30–32

Because strict guidelines mandate the handling of shipments thought to contain B anthracis, veterinarians must alert shippers and laboratories when sending them such specimens.33,34 If applicable, veterinarians also must notify public health authorities or the appropriate chain of command in theater of possible anthrax cases.

If a necropsy is inadvertently performed, extensive gelatinous edema is present within the mediastinum with inhalation anthrax or along the GI tract from the oral cavity to the rectum with GI anthrax.24,25,28,29,32,36,37 Associated thoracic or GI lymph nodes are enlarged, edematous, and hemorrhagic. If the animals are septicemic, splenomegaly, an enlarged friable liver, and petechial hemorrhages on serosal surfaces are visible. If the brain is exposed, diffuse meningeal congestion, often referred to as a “cardinal’s cap,” is present.28,30,31,36,37

Recommendations for Therapy, Prevention, and Control

Therapy. Cephalosporin antibiotics and potentiated sulfonamides are ineffective against anthrax. The traditional treatment of choice for anthrax is penicillin G, but the treatment of a known attack with anthrax spores should be based on antibiotic sensitivity testing because weaponized spores may be resistant to traditional antibiotic treatments.25,27,30–32 B anthracis is also susceptible to ciprofloxacin, enrofloxacin, doxycycline, and tetracycline. Initially, antibiotics should be administered intravenously (IV) to mitigate the potential for development of bacteremic or septicemic anthrax. Additional supportive care may be necessary to include fluid therapy, oxygen, vasopressors, and anti-inflammatory drugs.25,30,32

As noted earlier in this chapter, death from anthrax can occur despite effective killing of organisms by antimicrobials due to the persistence of bacterial toxins.26,27,30,31,38 Antitoxins are being developed to combat these effects and will likely be utilized in the future in conjunction with antibiotics and supportive care to reduce the number of deaths incurred from anthrax exposure.[39] In all cases of anthrax exposure, IV antibiotics should be continued for 7 to 14 days and postexposure prophylaxis with oral antibiotics should be administered for at least 60 days to combat the possibility of environmental or pulmonary spore persistence.25,27,30,31,38

Cutaneous exposure to anthrax should be immediately treated by cleaning of the exposed area with soap and water.25,32 A solution of 0.5% sodium hypochlorite can be used initially to treat cutaneous exposures because of its effectiveness in killing spores, but caution is warranted because prolonged use is caustic to the skin.25,30,31 IV antibiotics should also be used as well to prevent the development of bacteremia or septicemia. Any bandages or dressings should be treated as biohazardous waste and autoclaved or incinerated.24,32

Prevention. All service members on deployment should take basic precautions to avoid exposure to anthrax. First, service members should avoid all contact with animals, hides, or products made from hides.30–34 Second, all meats acquired from local host country sources should be thoroughly cooked. Third, all service members deployed to endemic areas should be vaccinated with anthrax vaccine at 0, 2, and 4 weeks and 6, 12, and 18 months to provide immunity, and they should receive annual booster injections for maintenance.25,30–34 Finally, military personnel responding to a suspected anthrax terrorist attack should wear proper protective clothing and a respirator.25,27,32–34 While on deployment, MWD handlers should ensure their MWDs are protected from local animals and products made from local animals and feed their MWDs an approved diet.

Control. Samples from sick or dead animals suspected of being infected with anthrax should be tested to confirm the diagnosis; veterinarians or other trained personnel should wear necessary protective gear such as gloves and surgical masks when taking test samples to prevent accidental contamination (eg, unintentional contact with broken or exposed skin).25,32 Animals that test positive should be incinerated, with remaining bones buried at least several feet deep; if incineration is not possible, animals should be buried at least 6 feet deep and covered with lime. All buildings and equipment exposed to infected animals should be cleaned and disinfected with 5% hypochlorite or 5% phenol.25,33,34 Confirmed cases of anthrax should be reported to commanders and local public health agencies immediately. Decisions whether to implement anthrax eradication programs should be made by host nations, but commanders can implement controls for scavenging animals and insects.

Brucellosis

Introduction and Military Importance

Brucellosis, a zoonotic infection of wild and domesticated animals, is caused by one of several bacteria of the genus Brucella. Contact with contaminated animal tissues, inhalation of aerosolized bacteria, and ingestion of infected animal products such as unpasteurized milk cause human infection. Captain David Bruce, a Scottish pathologist and microbiologist, first isolated one causative agent of brucellosis in mammals, B melitensis. When Bruce sailed to Malta in 1857 to transport goats from Malta to the United States for the US government, all of his crew drank the local raw goat milk and became ill. Sailors stopped getting sick only after Malta’s naval station imposed a moratorium on goat’s milk. Disease associated with B abortus, another causative agent, was first recognized in the United States in a US Army officer who contracted the disease in Puerto Rico.[40]

The military importance of brucellosis is severalfold. First, it can cause an acute food-borne illness outbreak, especially when service members eat and drink products from locales that lack sanitary food systems. If many troops are exposed to contaminated food or liquids, an entire military unit and its mission can be impacted. Next, because the chronic complications of this disease are most commonly osteoarticular in nature, affected service members frequently lose duty time and may have to be medically discharged. Finally, the acute and chronic manifestations in combination with the highly infective nature of Brucella organisms and their ease of transmission via aerosol make them ideal bioterrorism agents.[41]

Description of the Pathogen

Brucella organisms are facultative, Gram-negative coccobacilli. Six species of Brucella that infect terrestrial mammals are traditionally classified as B abortus, B canis, B melitensis, B neotomae, B ovis, and B suis. Due to the homology between the species, there is an argument that the species should all be classified as B melitensis with the current species classified as biovars.[42] This discussion will maintain the traditional naming nomenclature of separate species. These species are broken down into two distinct types based on the presence of smooth lipopolysaccharide (LPS) on the outer cell membrane or a rough LPS. Smooth LPS species are zoonotic.

Each species contains a number of biovars; of the four zoonotic species, B abortus has seven biovars, B melitensis has three, B suis has five, and B canis has the one biovar that is defined by the species classification. These biovars have differing zoonotic potentials. Among the nonzoonotic species, B neomotae and B ovis are both made up of only one biovar each.[42]

Marine mammals have a distinct Brucella species that is classified in two ways. First, the species can be called B maris with two biovars based on the species they infect. The other naming methodology identifies two species based on the animal reservoir: B pinnipediae and B cetaceae.[43]

The three species of Brucella that cause human disease in decreasing order of virulence are B melitensis, B suis, and B abortus. B canis can cause human infections but rarely causes disease. When cultured, species and biovars can be distinguished using biochemical tests.[44]

The focus of this chapter is the terrestrial Brucella species (ie, land animals).

Epidemiology

Transmission. Brucellosis is a pure zoonosis—meaning it can be transmitted from animals to humans with virtually no human to human transmission. Animals spread disease among themselves horizontally and vertically (ie, from mother to offspring) by direct and indirect contact. For example, suckling lambs can sometimes be infected while nursing an infected dam.[44] More commonly, the disease is spread by ingestion of grass or other feed contaminated by an infected animals’ vaginal discharge, aborted material, or postparturient discharge. Sexual transmission is also possible and is most commonly seen with B suis, B canis, and B ovis.42,44

There are three primary routes of transmission of brucellosis to humans from infected animals: (1) through ingestion of contaminated dairy products, (2) direct contact, and (3) aerosolization. Despite the fact that many mammals carry Brucella species, hares, reindeer, and horses are not typically implicated in zoonotic transmission. Usually sheep, goats, cattle, and swine, and, rarely, dogs are implicated in human disease transmission.40,45,46

In general, Brucella species are primarily associated with their natural host mammalian species, but B melitensis and B suis infections can become established in cattle as well.[42] Also, camels can be infected with and shed B melitensis and B abortus.[40]

Geographic Distribution. The most widespread species, B suis, appears in many countries throughout the world; B melitensis is documented throughout Spain, much of Eastern Europe, effectively the entire Asian continent, and parts of South America; and B abortus is found in North America, South America, sub-Saharan Africa, south and southeastern Asia, and parts of Europe. Although B canis is also found throughout the world, especially in the Americas, Asia, Europe, and Africa, this species appears to be absent from Australia and New Zealand. The nonzoonotic species, B ovis, is found in most areas of the world that raise sheep, including New Zealand, Australia, the Americas, Central Asia, Russia, and Europe.[47]

Pathogenesis and Clinical Findings

Infection with zoonotic Brucella species is nearly always through intact mucous membranes, following exposure to feed or water contaminated with aborted materials. Although human infection from animal milk products is common, dam-to-progeny transmission via milk is not viewed as an important mechanism of transmission, even though this means may contribute to the spread of B melitensis among small ruminants.[42]

Pathogenic Brucella species of ruminants (B melitensis and B abortus) are intracellular organisms that evade the lysosomal activity of infected macrophages residing in lymph nodes or bone marrow, causing little to no pathology until pregnancy occurs. During times of stress, particularly pregnancy, Brucella organisms are able to lyse the macrophages by unknown mechanisms. This recurrent cell lysis causes febrile states in infected animals and individuals.[48]

Although these organisms can colonize anywhere in the body, they favor the reproductive tract and joint capsules. Specifically, Brucella species have a strong predilection for the ruminant placenta in naïvely infected animals and the udder in recurrently infected animals. The site of replication in the placenta is primarily at the cotyledons, which has been attributed to the unusual local production of erythritol. Brucella species proliferate wildly in the placenta, causing inflammation and necrosis of the cotyledons, resulting in fetal stress and abortion.[49] In aberrant hosts, such as humans, granulomas also form at the site of colonization.[50]

Adult animals in endemic areas may appear clinically normal. For acute infections, however, Brucella species can cause orchitis, epididymitis, testicular abscessation, and balanaposthitis in rams, boars, canine species, and bulls.[40] Among naïvely infected females, abortion is the more frequently observed manifestation, most frequently in late gestation. Aborted fetuses due to B melitensis, B suis, and B abortus are frequently intact but sometimes autolyzed. Abortions caused by B ovis are exceptionally rare, but mummified fetuses are sometimes reported. Placentae generally have fairly severe cotyledonary edema and necrosis and may have intercotyledonary inflammation, often described as “leathery thickening.” Placentitis and abortion may also occur in pigs but usually earlier in gestation. Brucellosis also has been reported as a cause of fistulous withers and “poll evil” in horses.51–54

Diagnostic Approaches

For several reasons, definitive diagnosis using serology is exceptionally challenging and requires a high degree of technical expertise.[55] First, animals remain seropositive for life, with a cross-reactivity between B abortus and B melitensis antibody. Next, antibody in smooth-phase and zoonotic species, such as B melitensis, B abortus, and B suis, is primarily generated against an O-chain polysaccharide on the LPS. All smooth strain species have this O-chain, but rough strain (ie, nonzoonotic) species, do not contain this O-chain on their LPS. The vaccine strains, strain 19 and Rev1 for B abortus and B melitensis, respectively, are both smooth strains. Thus, antibody induced by immunization with smooth-phase vaccines cannot easily be differentiated from antibodies produced by natural infection. RB51, a rough-phase B abortus strain, was developed to address this problem during the latter phase of the US brucellosis eradication program. False-positive serological reactions may also result from exposure to Yersinia entercolitica and some other similarly related Gram-negative organisms.[56]

Even when laboratory tests are performed correctly and results are determined accurately, astute judgment is required to interpret results and then the policy to take legal action such as quarantine or culling needs to be codified. With no firmly established international protocol for this process, individual government authorities must determine how to screen animals and what tests to use for definitive determination of individual animals or herds as “reactors.” Guidance for establishing protocols is available in the terrestrial manual from the World Organization for Animal Health (OIE).[57]

Although B melitensis is the more serious animal and public health threat in most of the world, the US brucellosis eradication program has traditionally focused on B abortus because B melitensis has never been endemic in US livestock. The commonly used diagnostic tests and laboratory methods presented below are primarily used for B abortus diagnosis in cattle; they are generally applicable in sheep and goats using the same reagents but do require some procedural modifications. In other species, serosurveillance is generally not practiced.[57]

Screening Tests. Numerous screening tests approved for use in international trade by the OIE rely on antibody presence. Two common test types are (1) the buffered serum agglutination tests such as the rose bengal test (RBT) and the buffered plate antigen test and (2) the milk ring test. Both types of tests are excellent for screening and technically simple, but the milk ring test, which is useful in cattle, is ineffective in sheep and goats.[57]

For the RBT, the antigen is whole, killed B abortus cells conjugated to rose bengal, a purple-colored dye. Use of the RBT with sheep or goat serum for diagnosis of B melitensis in cattle requires individual laboratory validation and a slightly modified testing method, often referred to as the modified RBT. The buffered plate antigen test uses killed whole cells conjugated with brilliant green and crystal violet.[55]

The MRT allows testing of multiple animals at one time. The testing sample volume is increased as the herd increases. The antigen used is a whole, killed B abortus cell that is conjugated to haematoxylin stain.[57]

Traditional, unbuffered serum agglutination tests, including the tube or slide agglutination tests, do not meet international trade standards and are not required by either the OIE or the World Trade Organization. Still, these traditional tests are used by veterinarians in many national and local control programs. However, because these tests use killed whole cells and require subjective determination of agglutination, their utility highly depends on technical expertise.

Since all screening tests capture only animals that test positive, these tests have a higher rate of false-positives than more specific tests. A positive result from any screening test must be followed by a positive result on a confirmatory test to declare the animal positive.[58]

Confirmatory Tests. Confirmatory tests are used to validate screening test results. If both results are positive, then the sample is deemed positive, though consequent legal action (eg, indemnification) generally requires further confirmation such as a positive culture. Numerous tests, including serologic tests, can be used as confirmatory tests and are prescribed by the OIE for international trade.

The complement fixation test and the fluorescence polarization assay are two such confirmatory serologic tests (ie, tests detecting antibody presence in animal samples). The complement fixation test is a well-validated, universally accepted but technically challenging test requiring extensive laboratory support. The fluorescence polarization assay is simpler to run, using either a plate or a tube format or with specialized equipment in the field. This assay is also well validated and prescribed for international trade but is not widely used yet.

Many ELISA tests are also available for brucellosis testing. When run within OIE specifications, ELISA tests are well validated and considered to be confirmatory tests. In addition, the competitive ELISA or cELISA is identified as being able to differentiate vaccinated cattle (given S19 vaccine) from naturally exposed cattle based on titers.[55]

Antigen and Deoxyribonucleic Acid-Based Diagnostics. Blood culture of infected but apparently healthy adult animals is generally unrewarding because bacteremia is rarely pronounced (ie, the organism concentration in the blood is generally below detection limits) at the first signs of disease, often abortion, and is usually brief. Culture is still possible following abortions if the aborting dam’s fetal tissues (eg, abomasal contents, lung, liver, and spleen), abortive tissues (eg, placental cotyledons), milk, or vaginal swabs are used. Culturing these samples is relatively straightforward with appropriate selective media (eg, Casteñada’s media, Farrell’s media, and Thayer-Martin media) and a CO_2 incubator.[57]

However, because laboratory-acquired infection from cultures is a serious hazard and safer PCR tests can now do what only cultures could before, PCR is probably the better option. Numerous PCR assays (eg, BRUCE-ladder) are currently available for genus identification of Brucella that can distinguish between the species B abortus, B melitensis, B ovis, and B suis.55,59

Recommendations for Therapy and Control

Treatment is cost-prohibitive in animals because the disease commonly recrudesces, and acute disease is rarely recognized. Typical control programs are exclusion, movement control, vaccination, and test and slaughter. Exclusion requires that replacement animals are disease-free prior to being introduced to the herd; movement control limits the sharing of grazing land among herds and flocks of unknown disease status; vaccination is used for B abortus and B melitensis; and test and slaughter programs ensure seropositive adult animals are slaughtered to reduce overall disease prevalence. (Vaccination is effective but will not eradicate disease and does little once the prevalence falls below 2%. At this point, test and slaughter and disease-free replacements are used to maintain a disease-free flock or herd.60,61) Because many Brucella vaccines are available, only the most commonly used are overviewed in the last paragraphs of this section below.

Cattle vaccines include the S19 and RB51, with the latter replacing the former in many countries. The United States has converted to only using the RB51 vaccine on its replacement and heifer stock without any noticeable limitations to its effectiveness, though it is not clear if this is due to equivalent efficacy with the S19 vaccine or the United States practice of slaughtering all brucellosis-positive cattle to prevent disease spread. The RB51 vaccine is based on a rough strain mutant of B abortus and does not interfere with testing. On the other hand, S19 vaccination (ie, short-term with reduced doses) causes an immune reaction and antibody production that interferes with serologic testing, which can have an impact on prevalence studies and international trade.[62] In small ruminants such as goats or sheep, the Rev 1 strain vaccine is used to increase herd immunity against B melitensis. Rev 1 also interferes with serologic testing.[56] Vaccinations are approximately 60% to 70% effective but can cause abortion in pregnant animals.57,61

Equine Encephalitides

Introduction and Military Importance

Although the first-recorded epidemic of equine encephalitis occurred in the 1830s, it was not until 100 years later, in the 1930s, that three distinct but antigenically related virus complexes were recovered from horses with severe equine encephalitis[63]; the (1) western equine encephalitis virus complex (WEEV) was isolated in the San Joaquin Valley in California in 1930[64]; (2) eastern equine encephalitis virus (EEEV), in Virginia and New Jersey in 193365-67; and (3) Venezuelan equine encephalitis virus complex (VEEV), in Venezuela in 1938. These three viruses, typically known as the equine encephalomyelitis viruses, are members of the genus Alphavirus.[68]

Natural infections with these three viruses are acquired by the bite of an infected mosquito. All these viruses cause similar clinical syndromes in horses; however, human disease manifestations vary by virus complex. For example, only about 4% to 5% of human EEEV infections result in encephalitis, but it is the most severe of the alphavirus encephalitides; case fatality rates range from 30% to 70%, with severe neurologic sequelae in those that survive.[69] Infection with WEEV results in encephalitis less often; case fatality rates in epidemics range from 8% to 15%.70,71 VEEV epidemics are explosive, often resulting in thousands of cases, but it is the least neuroinvasive of the encephalitic alphaviruses. The vast majority of these human cases present as undifferentiated “flu-like” illness, with less than 1% of adults and 4% of children developing encephalitis.[72]

Alphaviruses are also highly infectious by aerosol. In fact, EEEV, VEEV, and WEEV possess many of the required characteristics for strategic or tactical weapon development, including ease of large-scale production, virus stability, potential for aerosolization, and virulence.[71] VEEV is of particular concern because it produces overt disease in nearly all human infections and can produce a self-sustaining natural outbreak. For these reasons, the encephalitic viruses are listed as Category B priority agents by the National Institute of Allergies and Infectious Diseases and the Centers for Disease Control and Prevention (CDC).[73] (See also Chapter 15, Veterinary Pathology, for more information on the biologic agents and toxins with the potential to endanger public health.)

Description of the Pathogen

Alphaviruses are single-stranded, enveloped, positive-sense ribonucleic acid (RNA) viruses that belong to the Togaviridae family. Currently, 28 virus species are in the Alphavirus genus, which can be classified into at least seven groups based on antigenic complex homology. The EEEV complex is divided into four distinct lineages, I through IV, which differ in geographic, epidemiologic, phylogenetic, and pathogenic characteristics.74,75

Group I is composed of the strains enzootic along the eastern seaboard and Gulf Coast of North America and the Caribbean. The strains in this group are highly conserved, monophyletic, and temporally related and are responsible for the majority of human cases, with significant mortality rates in humans and equines. Groups II, III, and IV are composed of the strains enzootic in Central America and South America. The strains in these groups are highly divergent, polyphyletic, cocirculating, geographically associated, and primarily result in equine disease.[74]

The VEEV complex consists of six closely related subtypes that differ in respect to ecology, epidemiology, and virulence for humans and equines. Subtypes IA/B and IC are known as the epizootic strains and are responsible for large-scale epidemics in North, Central, and South America. Subtypes ID, IE, and IF are the enzootic strains, which may cause disease in humans but lack virulence for equines.71,76

The WEEV complex includes four viruses that differ in their ecology and virulence: WEEV, Highlands J virus, Ft Morgan virus, and Aura virus. Only WEEV causes disease in humans.[77]

Epidemiology

Geographic Distribution. Although the alphaviruses have worldwide geographic distribution, members of this genus have classically been described as Old World or New World viruses based on their predominant distribution. The Old World viruses, typically found in Africa and Asia, primarily cause a rash and arthritis. Examples include Chikungunya virus, O’nyong-nyong virus, and Ross River virus. The New World viruses, including EEEV, VEEV, and WEEV, are found in the Americas and can result in encephalitis. Based on phylogenetic analysis, alphaviruses most likely originated in the Americas and later spread to the rest of the world.[77]

Transmission and Incidence. Alphaviruses cycle between invertebrate insect vectors and vertebrate reservoir hosts. For most alphaviruses, the insect vectors are mosquitoes and the vertebrate hosts are birds and small mammals. In most cases, humans and equines are incidental hosts.

In North America, the enzootic cycle of EEEV is maintained in shaded swamps along the eastern seaboard, Gulf Coast, and Great Lakes region, where the virus cycles between ornithophilic mosquitoes, primarily Culiseta melanura, and passerine birds. Humans, horses, and other mammals are considered dead-end hosts and generally only become infected when bridge vectors (ie, zoophilic mosquitoes such as Aedes species and Coquillettidia species) feed on an infected bird and then a mammal. Outbreaks in humans, often seen in the late summer or early fall, are frequently preceded by cases of equine encephalitis and are usually associated with heavy rainfall and warmer water temperatures.77,78 On average, six human cases of eastern equine encephalitis are reported in the United States per year. However, 2010 was a particularly bad year with 10 human cases, including five deaths, and over 200 equine cases, most of which resulted in death.69,79

Enzootic strains of VEEV, found primarily in Central America and northern South America, cycle between Culex mosquitoes and small mammals, especially rodents. While these strains can cause disease in humans, they are generally considered avirulent in horses. More importantly, horses are not amplifying hosts for enzootic VEEV. An epizootic or epidemic only occurs when a mutation in an enzootic strain develops into an epizootic strain of VEEV, allowing transmission to a bridge vector such as Ochlerotatus or Psorophora mosquitoes and infection of both humans and horses.

Equids, especially horses, are very susceptible to epizootic VEEV, leading to high morbidity and mortality. Horses are also amplifying hosts for epizootic VEEV. The resulting viremia permits mosquito transmission and therefore fuels epizootics. Epidemics are the consequence of spillover during epizootics: humans become infected by mosquitoes that previously fed on infected horses.76,80 The most recent significant outbreak occurred in Venezuela and Colombia in 1995, resulting in over 75,000 human cases and 300 deaths. The total number of equine cases was not reported but was probably similar in magnitude to human numbers. Epizootic VEEV has not been isolated in the United States since 1971.[81]

WEEV is widely distributed in the western plains and valleys of the United States and Canada, and in South America. The endemic cycle in North America is maintained in the Culex tarsalis mosquito and domestic and passerine birds, especially finches and sparrows. Historically, WEEV has caused epizootics and epidemics in the western United States; however, few cases have been reported in recent years. Nevertheless, morality can be as high as 20% to 40% in horses.[77] WEEV is the least virulent to humans. The elderly and infants are more susceptible groups to clinical illness with case fatality rates up to 10%.[71]

Pathogenesis and Clinical Findings

While encephalitic alphaviruses primarily cause disease in equids and humans, a number of other animals also are susceptible. Following natural infection, initial viral replication may occur at the site of inoculation or in secondary lymphoid tissue, depending on the virus’s cellular tropism. The virus replicates within the cytoplasm of infected cells, shutting down host-cell protein and nucleic acid production, which causes cytopathic damage and often apoptosis. Viremia ensues, and, in most cases, neuroinvasion occurs by the vascular route. Typically, no gross lesions are evident; however, microscopic changes consist of suppurative or nonsuppurative encephalomyelitis, with a predilection to gray matter areas in the cerebrum and midbrain (ie, thalamus and hypothalamus).[82]

Initial clinical signs may consist of fever, anorexia, and depression. Not all cases result in neuroinvasion and encephalitis. When encephalitis occurs, central nervous system signs such as circling, ataxia, weakness, depression, paralysis or hyperexcitability, and convulsions may be observed. Depressed mentation, sometimes called sleeping sickness, can cause clinical signs such as head pressing, drooling, and drooping ears, lips, and eyelids.[82]

Clinical signs may appear as early as 2 days or up to 2 weeks following infection. Because the clinical signs for encephalitic alphaviruses are not specific, differential diagnoses should include infectious and noninfectious diseases such as equine herpesvirus-1, rabies, equine protozoal myeloencephalitis, West Nile virus, hepatic encephalopathy, and neurotoxins.82,83

Diagnostic Approaches

In horses, definitive diagnosis is commonly determined postmortem via virus isolation, PCR, or histopathologic analysis and immunohistochemistry. However, a few antemortem procedures facilitate a presumptive diagnosis of an alphavirus encephalitis infection, including cytologic evaluation of cerebral spinal fluid (CSF). In most cases, a mononuclear pleocytosis with an increased protein fraction is present; in acute cases, a neutrophilic pleocytosis may be observed. Serology is also a useful tool with presumptive diagnosis based on virus specific IgM antibody detection in the CSF. Although no hematologic or biochemistry values indicate alphavirus infection, neurologic signs from hepatic encephalopathy can be ruled out in the absence of liver enzyme value abnormalities.82,83

Recommendations for Therapy and Control

Treatment is often limited to supportive care, which may include IV fluids, corticosteroids, mannitol (to relieve cerebral edema), and flunixin meglumine (to reduce inflammation). In horses with neurologic symptoms, xylazine or detomadine may be used for sedation in order to minimize self-inflicted harm. There is limited data showing the reliability of antivirals and immunoglobulin therapies. Overall, the prognosis is poor; most horses die within 3 to 5 days of onset of clinical signs of encephalitis.[82]

Control and prevention are key to minimizing encephalitis. Environmentally, reducing mosquito breeding areas such as standing water decreases the number of competent vectors. Insecticides are an additional control measure; however, in large rural areas, logistical feasibility and effectiveness should be considered. Topical insect repellents also help reduce the incidence of horses being bitten by infected mosquitoes.

Vaccinating horses is another major factor in minimizing disease. Various formulations provide immunologic protection against eastern, western, and Venezuelan equine encephalitis. Current recommendations for unvaccinated horses 6 months and older include a primary series of two immunizations, with 4 to 6 weeks between doses and annual boosters thereafter. However, in areas where mosquitoes are active year-round, horses should be vaccinated every 6 months. Additionally, previously vaccinated pregnant mares should receive a booster 4 to 6 weeks prior to foaling. Previously unvaccinated pregnant mares should receive a two-dose primary series, with a 4-week interval between doses and a booster 4 to 6 weeks before foaling.[79]

Leishmaniasis

Introduction and Military Importance

Leishmaniasis is a vector-borne zoonotic disease caused by various species of the protozoan parasite Leishmania. Humans exhibit a variety of clinical disease manifestations, including visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis.[57] Domestic dogs are the principal reservoir host for human visceral leishmaniasis in the Mediterranean, parts of Asia, and Latin America.84–86 Canines harboring the parasite may experience clinical or subclinical canine visceral leishmaniasis (CVL). MWDs may be exposed to Leishmania species during deployments or assignments to endemic areas. Thus, leishmaniasis is an important diagnosis to consider when a working dog that has been traveling presents with clinical signs characteristic of the disease.

Description of the Pathogen

Caused by Leishmania infantum, CVL is now known to be genetically indistinguishable from Leishmania chagasi, the commonly recognized agent in the Americas.57,86,87 While other Leishmania species have been isolated from the host, L infantum is the most significant to canine disease.57,84,85 Leishmania organisms are diphasic protozoa of the family Trypanosomatidae, order Kinetoplastida.84,87,88 They parasitize the macrophage as amastigotes in the mammalian host and as extracellular flagellated promastigotes in the gut of the blood-sucking female vector, the phlebotomine sandfly.85,87,88

Epidemiology

Transmission. Leishmania species require both a vertebrate and an insect host to complete their diphasic life cycle. Vectors of leishmaniasis are phlebotomine sandflies of the genus Phlebotomus in the Old World and Lutzomyia in the New World. The Old World vector is characterized by a crepuscular and nocturnal pattern of seasonal activity from late spring to late autumn. The New World vector is active year-round.57,87,89

After the vector’s blood meal from an infected mammal, Leishmania organisms multiply in the sandfly’s gut and migrate to the foregut where they become infective, nonreplicative promastigotes. When the infected female vector takes another blood meal from a minimally haired area of the mammalian host (eg, head, nasal bridge, ear pinnae, or inguinal and perianal areas), she inoculates promastigotes into the dermis.[85] Host dermal macrophages then phagocytize the parasites, transforming them into the nonflagellated amastigotes.[87]

Within the macrophage, Leishmania organisms are able to evade phagosomal elimination mechanisms, and replicate rapidly. Eventually, the cell ruptures, and the freed amastigotes undergo phagocytosis by additional macrophages. During subsequent bites, intracellular and extracellular amastigotes are ingested by the vector and transformed into promastigotes, perpetuating the Leishmania life cycle.87,89 The parasite survives within infected dogs during winter; no transovarial has been documented.[87]

In addition to known vector-borne mechanisms, vertical transmission of leishmaniasis among specific breeds within North American dogs has been documented.88,89 While four species of Lutzomyia are mammalian feeders in North America, no competent vector has been definitively identified.87–89 A potential vector, Lutzomyia shannoni, is capable of harboring Leishmania infantum following a blood meal from an infected canine; however, whether these flies can complete the transformation of L infantum into infectious promastigotes is not known.88,89 Confirmed Leishmania infections among North American canines, particularly in foxhound lines, suggest that vertical and horizontal transmission mechanisms exist.87–90 Proposed vertical transmission mechanisms require L infantum-infected cells to be passed to pups via transplacental or trans-mammary routes. Exposure may also occur during parturition.89,90 Horizontal transmission requires blood-to-blood contact; transmission via infected blood products has been documented.[87]

Geographic Distribution. In humans, leishmaniasis is considered the third most important vector-borne, parasitic disease after malaria and lymphatic filariasis. The disease is endemic in 88 countries and four continents, putting more than 350 million humans at risk.[87] Leishmania species known to infect dogs are present in the Mediterranean Basin (ie, Spain, Italy, and Portugal), the Middle East, Southwest and Central Asia (ie, Iran, Armenia, Afghanistan, and China), Central and South America, and East and North Africa. Animal importation or travel, along with disease propagation through nonvector-borne mechanisms (eg, direct contact and transplacental) may increase transmission in nonendemic areas.85,87,90

Incidence and Prevalence. In endemic areas, Leishmania transmission is sometimes focused, leading to dramatic variation in infection prevalence.[87] Several studies in the Mediterranean region show infection rates between 1.6% to 40% in the canine population. However, infection rates in endemic areas are much higher than actual clinical disease rates. For example, a combination of serology, cellular immunity testing, leishmaniasis antigen skin testing, and clinical evaluation in endemic areas reveals that 5% to 10% of Leishmania-infected dogs are sick, and 90% to 95% of infected dogs are clinically healthy.[84] Further, hypothetical models based on previous studies reveal that, in endemic areas, apparently healthy animals can be divided into approximately two-thirds infected and one-third uninfected.[87]

Pathogenesis and Clinical Findings

Host response plays a significant role in susceptibility or resistance to clinical leishmaniasis infection.84,85,87 Activity of T-helper system CD4+ lymphocytes can shift the immune system toward a humoral (ie, Th2) or cell-mediated (ie, Th1) response, resulting in susceptibility or resistance to disease, respectively.87,89 Compared to dogs with clinical disease, asymptomatic dogs tend to develop strong cell-mediated immune responses characterized by increased interleukin-12, tumor necrosis factor, and interferon compared to dogs with clinical disease. Resistant dogs generally have low anti-Leishmania antibody production.84,89

Some dogs that lack an appropriate cell-mediated immune response mount an exaggerated humoral response to Leishmania infection. These dogs are typically symptomatic and clinical consequences are often a result of excessive immunoglobulin G production, autoantibody formation, and immune complex deposition.84,85,87

While significant research supports the cell-mediated mechanism of resistance versus susceptibility, whether other factors such as age, breed, gender, nutrition, host genetics, coinfections, immunosuppression, parasite burden, and virulence play a role in determining if a dog becomes clinically ill with leishmaniasis is not known.[87] Additionally, the complex interaction between host immunity and Leishmania infection creates the potential for immunosuppression to incite clinical disease in previously subclinical patients.[85]

Leishmaniasis affects many organ systems, but because divergent host immune responses determine the extent of clinical disease manifestations, clinical presentations vary greatly. In general, clinical signs are the result of immune complex deposition (ie, glomerulonephritis, polyarthritis, meningitis, vasculitis, and uveitis) and autoantibody production against platelets or RBCs (ie, thrombocytopenia, anemia, and coagulopathy).[85] Common findings on physical exam and patient history include skin lesions (Figure 11-2), generalized lymphadenomegaly, chronic weight loss, muscle atrophy, decreased appetite, lethargy, hepatosplenomegaly, polyuria and polydipsia, ocular lesions, epistaxis, onychogryphosis, lameness, vomiting, and diarrhea.84,87,89,91

Skin lesions are the most common manifestation of CVL in dogs admitted for treatment due to the disease.[87] In fact, in one study from endemic areas in Greece, over 80% of clinically affected dogs demonstrated cutaneous lesions of varying types.[84]

Fever, brittle or dull hair coat, distended abdomen, bilateral symmetrical alopecia, hyperkeratosis, excessive scaling, and depigmentation are also characteristic of the disease.[86] Laboratory abnormalities associated with leishmaniasis include nonregenerative anemia, hyperproteinemia with gammaglobulinemia, azotemia, isosthenuria, proteinuria, hyperphosphatemia, hypermagnesemia, and elevated alkaline phosphatase and alanine transferase.84–86

Diagnostic Approaches

Diagnosis of leishmaniasis in dogs requires an integrated approach. Patient history, signalment, age, clinical findings, basic laboratory findings, and specific test data should all be considered when determining if the canine’s illness is leishmaniasis.

Figure 11-2. Canine tongue: Glossitis due to infection with Leishmania donovani infantum.
Photo courtesy of Dr Elvio Lepri, Faculty of Veterinary Pathology, University of Perugia, Italy.

Gathering an accurate travel history is essential, especially when clinical signs consistent with the disease present after travel to endemic areas. Signalment also provides practitioners valuable diagnostic information because some breeds may be predisposed to developing overt disease secondary to Leishmania infection, including German shepherd dog, Rottweiler, cocker spaniel, and boxer breeds.85,87 Prevalence of infection within certain age groups has a bimodal distribution, with peaks at less than 3 years and greater than 8 years.85,87,92

When clinical signs and clinicopathologic data are characteristic of leishmaniasis, the simplest way to confirm the diagnosis is through cytologic demonstration of the parasites in stained smears of affected tissues (Figure 11-3).[85] Unfortunately, detection of the Leishmania organisms may be difficult using simple cytology; even dogs with significant clinical disease may be harboring low numbers of detectable parasites.86,87

Biological fluids can also be obtained for analysis if clinical signs suggest they may be affected (synovial fluid in the case of arthritis and CSF in the case of neurologic disease). Fine needle aspiration should be performed on any clinically affected tissues such as papular, nodular, or ulcerative skin lesions; bone marrow (in the case of anemia); and lymph nodes. If no clear lesions exist, tissues most likely to contain Leishmania organisms besides bone marrow and lymph nodes include spleen, skin, and buffy coat from whole peripherally obtained blood.57,87 Heavily infected cells may burst, and extracellular amastigotes may be observed along with those found within the macrophage.[85]

Figure 11-3. Intracellular leishmaniasis amastigotes within macrophages.
Photo courtesy of Jennifer Scruggs, Doctor of Veterinary Medicine; Resident, Clinical Pathology, University of Tennessee, Knoxville, Tennessee 37996.

Histologic sections obtained from affected tissues may reveal the parasite using routine hematoxylin and eosin staining. Additionally, pathologic changes noted in affected tissues can increase the clinical suspicion of this illness even in the absence of observable parasites.[85] Lymphoplasmacytic or granulomatous-pyogranulomatous inflammation and lymphoid hyperplasia of reticuloendothelial organs are all characteristic of leishmaniasis.85,87 When parasites are not observed but strong clinical suspicion remains, immunoperoxidase staining may also improve the diagnostic value of histologic samples.[85]

Available molecular methods that detect Leishmania organisms are particularly useful when cytology is negative and there are no obvious lesions to histologically sample. Quantitative PCR, a highly sensitive and specific molecular model, detects extremely low parasitic loads and, due to the quantitative nature of its results, is used to monitor treatment.57,85,87 Various biological samples can be used for such molecular diagnosis, including (in decreasing order of sensitivity) bone marrow, lymph nodes, spleen, skin, conjunctiva, buffy coat, and whole peripherally obtained blood.57,85,87

Because Leishmania’s deoxyribonucleic acid (DNA) can be detected in clinically healthy, even seronegative, dogs living in endemic areas,87,89 PCR results must be interpreted cautiously; some clinically healthy PCR-positive animals do not require treatment. However, use of molecular diagnostic methods in clinically healthy dogs is appropriate in cases of importation to nonendemic areas with competent vectors or in screening for blood donor suitability.85,87

Serologic methods also can be used to diagnose CVL, although some limitations exist. Typically, seroconversion in naturally infected dogs occurs between 1 and 22 months (median 5 months). Several reference and commercial tests for detection of serum antibodies against Leishmania are available, including the immunofluorescent antibody test (IFA), ELISA, and rapid immunochromatographic strip test. The IFA delivers highly sensitive and specific results; in fact, the OIE recommends the IFA as the reference serologic method.[85]

Quantitative results provide useful information for distinguishing subclinically infected dogs (ie, usually low titers) from those with dissemination and clinical disease (ie, usually high titers).85,87,93 (High titers can be reasonably defined as at least 2 to 4 times the reference positive value.[85]) In sick patients, presence of a high-level antibody titer generally confirms the diagnosis of leishmaniasis[87]; however, cross-reactivity due to exposure to similar organisms, especially Trypanasoma cruzi, in areas where both parasites are present (eg, South and Central America and southern parts of the United States) is possible.86,87 Especially in patients with low antibody titers, additional diagnostics (see below) are required to confirm clinical disease.[85]

The Canine Leishmaniasis Working Group has developed a step-by-step diagnostic approach for dogs with clinical signs and pathologic changes consistent with leishmaniasis:

- Cytologic evaluation should be performed first; direct observation of parasites in and around infected macrophages confirms the diagnosis, and these patients should be classified as sick from leishmaniasis.[85]

- In the case of negative cytology, quantitative serology should be performed next. Patients with negative or doubtful antibody titers should be evaluated for other differential diagnoses. In very rare cases, an infected patient may be evaluated prior to seroconversion.[87]

- If a patient is seronegative, but there is a very strong suspicion of leishmaniasis, it is reasonable to pursue additional diagnostic testing. Patients with high antibody titers (as defined by the testing laboratory) should be classified as sick from leishmaniasis. Patients with positive but low antibody titers require additional testing.[85]

- In patients with cutaneous lesions, biopsies can be sent for histologic evaluation with or without immunohistochemical staining.[85]

- PCR can also be performed on biopsy samples. In dogs without cutaneous lesions, PCR should be performed on bone marrow, lymph node tissue, or other high-yield biological samples associated with clinical signs. Patients with positive PCR or histopathologic findings should be considered infected, but clinical signs may be attributable to other disease. Patients with negative PCR or histopathologic findings should be considered exposed to, but not sick from, leishmaniasis.[85]

To guide classification further, the Canine Leishmaniasis Working Group has proposed the following four-stage clinical system:

1. Stage A (Exposed): These dogs have negative cytologic findings and negative histologic or molecular results, despite positive but low-level serum antibody titers. These dogs may be clinically healthy. Clinical signs exhibited by these patients are attributable to other disease.

2. Stage B (Infected): These dogs have negative cytologic findings and positive histologic or molecular diagnostic results with low-level serum antibody titers. These dogs may be clinically healthy, and any clinical signs are likely associated with other disease.

3. Stage C (Sick): These dogs have either positive cytologic findings, regardless of serologic results, or high serum antibody titers. Rarely, infected dogs with lower titers will be classified as sick from leishmaniasis. These dogs display one or more clinical signs consistent with leishmaniasis.

4. Stage D (Severely sick): These are sick dogs with one or more additional clinical signs, including proteinuric nephropathy; chronic renal failure; ocular disease with functional loss; severe joint disease that requires immunosuppressive therapy; concomitant neoplastic; metabolic or endocrine disease; or unresponsiveness to repeated courses of anti-Leishmania drugs.[85]

Recommendations for Therapy, Prevention, and Control

Treatment for CVL is rarely curative. Treatment objectives vary by stages, but all are aimed at clinical remission by reducing parasite load, treating organ damage secondary to Leishmania, restoring effective immune response, and treating clinical relapse.86,87,93

Stage A dogs (exposed) do not require treatment. Serology should be repeated 2 to 4 months following the initial evaluation. Any change in titer or clinical condition warrants reevaluation and possibly reclassification.85,83 Stage B dogs (infected) require treatment only if parasites detected by direct methods cause a rise in antibody response, as evidenced by an increased titer on repeat serology 2 weeks following initial results. Stage C dogs (sick) require treatment by anti-Leishmania drugs and may also require ancillary treatment targeted to clinically affected systems. Stage D dogs (severely sick) require both anti-Leishmania therapy and one or more ancillary therapies targeted at reducing severe clinical disease.[85]

The most widely used treatment protocol combines a pentavalent antimonial compound (eg, megulmine antimoniate) with allopurinol.87,93 Meglumine antimoniate selectively inhibits leishmanial glycolysis and fatty acid oxidation, leading to a reduction of parasite load and a temporary restoration of cell-mediated immune response. Allopurinol inhibits the enzyme xanthine oxidase, which catalyzes hypoxanthine to xanthine and xanthine to uric acid. When incorporated by Leishmania organisms, allopurinol is converted into a toxic compound that kills the parasite.[93] When these two drugs are used in combination, dogs experience longer remission times than when treated with either drug alone.87,93

Therapy with megulmine antimoniate typically lasts 4 weeks; however, lifelong allopurinol therapy may be required to maintain clinical remission.[87] The first line of treatment for canine leishmaniasis should include meglumine antimoniate at 75 to 100 mg/kg/day subcutaneously for 4 to 8 weeks, with allopurinol 10 mg/kg every 12 hours orally for several months.[85] Other treatment methods exist, although this combination is most commonly used.87,93

Prognosis for CVL is difficult to establish because no controlled studies have evaluated prognostic factors. However, based on the clinical staging system, a reasonable assumption would be that more severe clinical and clinicopathologic derangements carry a less favorable prognosis.[87]

CVL prevention strategies are aimed at avoiding sandfly bites. Employing a combination of preventive measures (eg, reducing outdoor activity from dusk to dawn, reducing sandfly microhabitat, using environmental insecticide treatments, and using individual topical insecticide treatments) achieves the greatest results.[87] Indoor residual spraying with organophosphate, carbamate, or pyrethroid compounds is effective against the sandfly vector. Topical insecticide use is effective if the vector spends sufficient time on the reservoir to absorb a lethal toxic dose of the chemical, or if the vector becomes disoriented and irritated during short contact with the reservoir, leading to reduced feeding rate.[91]

Deltamethrin-impregnated protector bands also have proven effective in preventing CVL in field studies.91,94 One study suggests a 72.3% protection rate in kenneled dogs[92]; other studies suggest 80% to 96% protection.89,91 Deltamethrin-impregnated collars release the pyrethroid slowly, distributing it within the animal’s subcutaneous adipose tissue conferring full protection after 1 week.87,91 Under optimal conditions, this treatment is effective for up to 6 months with continual collar use.[87]

Permethrin-based spot-on treatments offer high levels of protection as well. The maximum effect is achieved between 24 and 48 hours following application and extends for 3 to 6 weeks, depending on permethrin concentration.87,91 Typically, spray application of permethrin is more immediately effective but may have equal,[89] or shorter, duration (ie, approximately 2 weeks).[87]

When a dog is living in an endemic area, deltamethrin collars should be applied 2 weeks prior to travel and changed every 5 months. Spot-on treatments should be applied 2 days prior to travel and repeated every 2 to 3 weeks, depending on the product (ie, spray versus spot-on) and concentration.[87]

Leptospirosis

Introduction and Military Importance

Leptospirosis, an emerging infection affecting humans and over 150 different species of animals,[95] is caused by highly motile, obligate aerobic spirochetes of the genus Leptospira and is one of the most widespread and prevalent zoonotic diseases in the world.[96] Geographically, most human disease occurs in tropical areas of Asia and South America, as well as, to a lesser extent, Eastern Europe.[97] Among various animal populations, the disease appears worldwide in its distribution.[98] All domesticated animals are potential disease hosts, although cats are particularly resistant.98,99 The disease was first described in humans in 1886[100] and in animals in 1899.[97] Three characteristics of this disease underscore its military relevance: (1) Military expeditions into endemic areas have historically been linked to the incidence of disease in service members21,100,101; (2) MWDs can potentially be infected; and (3) human infection from contact with wild and domestic animals, including pets and MWDs, is also possible.

Description of the Pathogen

Leptospires are flexible, highly motile, helicoidal rods with one or both ends hooked in shape. Darkfield microscopy or special staining techniques are necessary for visualization (Figure 11-4). As of 2013, nearly 300 antigenically distinct pathogenic serovars have been identified, with more being discovered continuously.96,97

The taxonomy of the genus Leptospira is complex due to separate and coexisting methods for classifying the organisms. Genotypic classification is based on DNA hybridization studies, grouping the genus into species defined as being at least 70% DNA-related with no more than 5% divergence.[102] Antigenic classification is more useful from a clinical perspective; this method organizes the organisms into serological groups based on the lipopolysaccharide structure present on the organism’s outer envelope. Under the latter system, pathogenic leptospires are typically classified as serovars and serogroups within Leptospira interrogans sensu lato. Similarly, several saprophytic leptospires have been identified in the environment, and may be described either as separate species or as a complex of strains under a single species (eg, Leptospira biflexa sensu lato).[101]

Figure 11-4. Spirochetes (Leptospira).
Photo courtesy of Jeremy Bearss, Doctor of Veterinary Medicine, Chief–Resident Training, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

Epidemiology

Transmission. After exposure, pathogenic leptospires colonize the proximal tubules of a wide variety of wild and domestic animal species; however, transmission potential varies by host type (eg, primary, carrier, and incidental hosts). Primary hosts (ie, those that harbor mature or adult parasites) do not typically develop clinical signs of disease, but they may become chronic shedders. For example, a 2003 study from Kansas assessed 500 seemingly healthy dogs and revealed 41 to be PCR-positive for leptospires via urine sample.[103] Because contact with infected primary animal hosts is one potential route of transmission to humans, animal-intensive professions such as farming, slaughterhouse work, and veterinary medicine have long been identified as occupational risk factors.

There are two other types of infections, depending on the host pathogen’s degree of adaptation. Hosts that are evolutionarily well adapted to the serovar they have been infected with are called “carrier hosts.” Carrier hosts are usually not harmed by the infection but are an important source of infection of other more susceptible hosts. Hosts that are not as well adapted to a particular serovar are called “dead-end” or “incidental” hosts. Incidental hosts often develop clinical disease and either clear the infection or perish from it; they rarely continue to excrete the pathogen and are generally not an important transmission source.[97]

A 2004 study from California found that 10% of the human cases of leptospirosis in California over the preceding 20 years had resulted from contact with pets.[104] This finding is somewhat at odds with a 2011 study of 91 German veterinary clinic staff exposed to dogs clinically diagnosed with leptospirosis, in which none of the 91 humans developed antibodies to any leptospiral serovars.[105] In both studies, infected humans excreted leptospires for weeks to months after infection but remained incidental hosts. Thus, humans are not considered an important source of further infection.[101]

Domestic animals and MWDs most commonly come into contact with leptospires through contact with soil or water contaminated with urine from infected wild animals. After urinary excretion, pathogenic leptospires can survive in stagnant water or damp soil for up to 6 months[21] and last in undisturbed liquid culture for years.[101] Abrasions to a host animal’s skin promote likely infection, although the organism is also able to enter the body through intact mucous membranes. Additionally, leptospires may be transmitted directly between hosts through venereal routes, placental transfer, bites, or ingestion of infected tissue.[97]

Geographic Distribution. Leptospirosis has a global distribution, with human and animal cases occurring in nearly every country.[21] The incidence of infection is higher in the tropics than in temperate regions, likely due to the organism’s inability to survive freezing temperatures. In humans, recent epidemics have occurred in Nicaragua in 2007, Sri Lanka in 2008, and the Philippines in 2009, each affecting several thousands of people and causing hundreds of deaths.[96] Within the United States, the majority of cases have been noted in Hawaii and the southeastern states.[21]

A clear link also exists between increased rainfall and increased incidence of disease; flooded areas are especially prone to outbreaks.[97] A recent study found a 4-fold increase in the incidence of leptospirosis in Guadeloupe from 2002 to 2004, when the El Niño phenomenon produced heavy rainfall.[106]

Interestingly, one factor may limit the number of pathogenic serovars in an environment: the potential host population’s biodiversity. For example, on small islands and in urban environments, the number of native infectious serovars would be expected to be relatively low when compared with environments such as the Amazon Basin or Southeast Asia that have a richly biodiverse host population.[101]

Incidence and Prevalence. Incidence of leptospirosis is grossly underreported in both humans and animals. In humans, mild cases are often misdiagnosed as nonspecific influenza-like illness. In animals serving as asymptomatic, primary hosts for their particular serovars of Leptospira, the true incidence or prevalence is even more difficult to define.

However, recent estimates do exist from a few specific animal populations. For instance, a 2003 study of the prevalence of positive antibody titers in beef cattle within a Texas slaughterhouse was found to be 22% (262 of 1200 tested). Of these infected animals, approximately 35% tested positive by PCR for urinary shedding of leptospires.[107] A similar 2011 study of 478 beef cattle from western Canada determined the prevalence of positive antibody titers in unvaccinated cattle to be between 6.1% to 9.6% for the various serovars tested.[108] A 2002 study of data from 22 veterinary teaching hospitals across North America determined the prevalence of clinical leptospirosis among dogs in the United States and Canada to be 37 cases per 100,000 dogs.[109] Finally, a 2007 study conducted among veterinary clinics in the lower peninsula of Michigan found a 24.9% prevalence of leptospiral antibodies among healthy dogs.[110]

Pathogenesis and Clinical Findings

Leptospirosis can develop in dogs of any signalment, although working dogs may be at increased risk compared with other breeds, and male dogs are more commonly affected than female dogs.[109] (This same sex association is noted in humans.[100])

After the leptospire’s initial entry into the host’s body through mucous membranes or abraded skin, the organism disseminates throughout the body. Many organs may be affected, but the two most classically associated with this disease are the kidneys and liver. Incidental hosts that survive and clear the infection are unlikely to maintain Leptospira anywhere in their bodies afterwards, but primary hosts often maintain a clinically silent infection within their renal tubular epithelium. When present, clinical signs vary from mild fever to severe kidney, liver, and pulmonary disease.[98]

A wider spectrum of signs is possible in secondary host infections. Typically, dogs initially present with nonspecific signs such as anorexia, depression, tachycardia, tachypnea, pale mucous membranes, and vomiting, which can progress quickly into a uremic crisis in 80 to 90% of cases characterized by dehydration, lumbar pain from renomegaly and nephritis, and tongue-tip ulceration and necrosis. Nonuremic dogs will generally develop icterus and bilirubinuria, suggestive of cholestasis or hepatic necrosis.[111]

In dairy cattle, sometimes a sudden drop in milk production (by as much as 75%) or change in milk viscosity signals leptospirosis. The infected cow’s milk may become clotted, thick, and blood-tinged, with a high somatic cell count. Cattle are also the definitive host for serovars pomona and hardjo; infections, with these strains typically manifesting as abortion and stillbirths. Thus, within a breeding herd, an “abortion storm” may be another indicator of leptospirosis infection, given that mild initial renal and hepatic signs often pass unnoticed. In endemically infected herds, abortions are sporadic and occur mostly in younger animals.[111]

Diagnostic Approaches

The microscopic agglutination test (MAT) is a widely available and inexpensive diagnostic test for leptospirosis. Three factors limit the MAT’s usefulness, however: (1) false-negative results in early disease progression, (2) lack of specificity between serovars, and (3) potential hazards from maintaining a necessary stock of live leptospires in the testing laboratory. Nonetheless, the current advantages of the MAT, coupled with the large amount of historical data regarding its use, make the MAT the most frequently used method of diagnosis to date.[98]

Other diagnostic tests such as darkfield microscopy, silver staining, and immunohistochemistry are used less frequently in veterinary medicine. Organism culture from blood or urine may be useful from a herd health perspective; however, this method requires an incubation period of up to 6 months, which is not practical for diagnosing individual animals.[98] PCR tests, recently developed for individual leptospiral serovars, will probably replace the MAT as the preferred diagnostic test in the future.[97]

Recommendations for Therapy, Prevention, and Control

Treatment of leptospirosis in dogs consists of supportive care, treatment of specific renal or hepatic manifestations, and antibiotics. Antibiotics should be administered as soon as disease is suspected and samples have been drawn. Rapid treatment eliminates the potential for bacteremia and live organisms in the urine that pose a zoonotic risk to humans.[97] Antibiotic therapy should also be started before diagnosis confirmation because treatment initiated after 4 to 7 days of illness is less effective at promoting clinical recovery.[98]

The antibiotic of choice is doxycycline at 5mg/kg either orally or intravenously, twice daily for 2 weeks. Concurrent aggressive intravenous fluid therapy is critical to prevent further kidney damage. Hemodialysis also benefits dogs that develop anuria or oliguria.[98]

Prevention of leptospirosis in both humans and domestic animals centers on animal vaccination and avoidance of contaminated water sources. Although no effective vaccine for humans is currently available,[100] animal vaccines for serovars icterohemorrhagiae, canicola, grippotyphosa, and pomona have been accessible for many years and provide good protection for at least 12 months.[97] Vaccination of domestic animals provides a buffer between humans and wild animals where leptospiral infection is likely to be endemic.

Leptospires are also susceptible to ultraviolet radiation, desiccation, and routine disinfectants, although they may be able to survive and remain infective in urine-soaked hair or bedding materials. Caution is recommended, particularly on the part of pregnant or immunocompromised humans, when handling animals suspected of infection. Bleach solutions (ie, 10%), iodine-based disinfectants, accelerated hydrogen peroxide, and quaternary ammonium have all effectively inactivated the pathogen on surfaces, as has normal laundering of potential fomites (eg, soiled bedding).[98]

Lyme Disease

Introduction and Military Importance

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of an infected tick. Symptoms in humans include fever, headache, fatigue, and a characteristic skin rash called erythema migrans (EM). If left untreated, infection can spread to the joints, heart, and nervous system.[112] All symptoms cause loss of productive man-hours, which is disruptive to military training, deployment, and operations. Because of its military importance and its potential to become a significant public health threat, Lyme disease is listed as one of the DoD triservice reportable events.[2]

In humans, Lyme disease is diagnosed on the basis of physician-observed clinical manifestations and a history of probable exposure to infected ticks. Laboratory tests are neither suggested nor required to confirm diagnosis for patients with recent onset (ie, 2–3 weeks) of a characteristic EM rash.[113] Unfortunately, symptoms and physical findings can be vague, and knowledge of tick exposure is often unreliable or unavailable. Despite these limitations, the Annual Lyme Disease Report compiled by the Armed Forces Health Surveillance Center in 2011 showed that case counts increased over 1.5 times from 2001 to 2007, posing a concern for military communities, especially in Germany and the Northeastern United States.114,115

Domestic dogs are also susceptible to Lyme disease. In fact, given their higher tendency to be in close proximity with ticks, canine seroprevalence has been proposed as a sensitive and independent measure of human Lyme disease risk.[116] The CDC published a Lyme disease study in September 2011 corroborating this proposed measure. The study showed a positive correlation between canine seroprevalence and human incidence, suggesting that regions with high canine seroprevalence may anticipate increased human infection rates.[117]

Description of the Pathogen

Lyme disease (SYN Lyme borreliosis or borreliosis) is caused by infection with a Gram-negative spirochetal bacterium of the genus Borrelia. The genus Borrelia contains at least 31 species and is further divided into specific genospecies. Borrelia burgdorferi sensu strict, the primary isolate found in the United States, is the one associated with disease among humans and companion animals.[118] In Eurasia, the three main isolates are (1) Borrelia garinii, (2) Borrelia afzelii, and (3) B burgdorderi sensu stricto. The greater diversity among Eurasian species suggests that the organisms may have originated there.[119]

Epidemiology

Transmission. Borreliae cannot survive as free-living organisms in the environment; they are host-associated and require a hematophagous arthropod vector for transmission to the vertebrate reservoir host. The principal vectors are the slow-feeding hard ticks of the Ixodes family, and their distribution is directly associated with the prevalence of disease. In the United States and Canada, these ticks include the black-legged Ixodes scapularis, Ixodes pacificus, and Ixodes neotomae. There are approximately 50 to 80 competent vertebrate hosts across North America. Nymphal and larval stages prefer small mammals in the north and lizards in the south; adults prefer deer and other larger mammals.[118]

In Europe, borreliosis appears to be associated with Ixodes ricinus ticks, and eastward in Eurasia, it appears to correspond with Ixodes persulcutus. Studies show that together these ticks parasitize over 200 vertebrate species, with mice, voles, rats, squirrels, hedgehogs, shrews, and birds all playing an important role as reservoir hosts.[118]

Ixodes ticks have a 2-year life cycle and maintain infection in nature by harboring the organism over the winter in their larval form.[120] Direct transmission of borreliae between reservoir hosts is unlikely, and transovarial transmission in ticks is practically nonexistent.[121]

Nymphs are thought to be the most important life stage for transmission to humans. Often less than 2 mm in size, these tiny vectors feed relatively undetected, which is important because they must be attached for at least 36 to 48 hours before the borreliae bacterium can be transmitted. Adult female ticks tend to be the ones transmitting the infection to larger mammals such as white-tailed deer, dogs, and livestock.[118]

Geographic Distribution. In general, Lyme disease occurs throughout the Northern Hemisphere in temperate latitudes with cooler climatic conditions. In North America, the majority of canine and human cases have been reported in the mid-Atlantic to New England coastal states, northeastern states into southern Canada, and upper midwestern states.113,122 Specifically, a serosurvey of dogs in the United States showed overall positive prevalence rates were highest in the Northeast (11.6%), followed by the Midwest (4.0%), West (1.4%), and Southeast (1%).[122] In Europe, most cases have been documented in the Scandinavian countries and in central Europe in areas with moderate temperature and moderate humidity (eg, Austria, Belgium, Croatia, Czech Republic, parts of France, Germany, Hungary, Netherlands, Portugal, Slovenia, and Switzerland).[118] Data derived from the United States military Defense Medical Surveillance System mirror these distributions, showing a high number of Lyme disease cases reported from military medical facilities in the northeastern part of the United States and Germany.[114]

Incidence. Lyme borreliosis is still a relatively young disease. Since first being described in 1977, it has become the most commonly reported vector-borne illness among humans in the United States, with over 30,000 cases reported in 2010. From 1992 to 2006, the number of reported cases more than doubled. The majority of cases are in children and young males, with most new infections occurring in the spring and early summer when the ticks reemerge and seek their blood meals.[112]

However, divergent surveillance practices limit the reliability of state incidence reports. Because cases are reported based solely on where the patient lives (ie, state residence) it is difficult to definitively determine where the patient was exposed (ie, in which state, perhaps not same as the state of residence). Also, reporting practices and case definitions between states are not uniform, making determinations of true incidence difficult.112,113

Many prevalence studies have been conducted on canine populations, primarily to determine their effectiveness as sentinel animals when assessing human disease risk.116,122–125 These canine studies demonstrate a correlation with Lyme disease incidence in humans, given three limiting factors. First, like collected human surveillance data, these canine studies only indicated the state the animals were tested in, not the state the animals were exposed in; dogs testing positive may have been exposed elsewhere.

Second, the testing conducted only determined antigen or antibody presence in the animal, not the existence of the agent in that particular area. Third, in many studies, only distinct subsets of dogs were sampled, namely those that were brought to a veterinarian and whose owners opted to have their animals tested.

Pathogenesis and Clinical Findings

The borrelia spirochete is injected into the vertebrate host’s tissues through the infected tick’s saliva. Organisms replicate from the tick bite site and migrate through skin and connective tissues, later colonizing many different tissues, including the joints. In some humans and animals, the host immune response reduces spirochete numbers to nondetectable levels within a few weeks of infection, even without the aid of antibiotics. In others, the immune reaction may actually be strong enough to prevent infection altogether.[118] However, in some instances, B burgdorferi acts as a persistent pathogen, evading host antibodies by varying its immunoreactive proteins and existing extracellularly in protected tissues. This may explain why B burgdorferi can still persist and be detected in tissues by PCR or occasionally culture months after antibacterial treatment.

Clinical disease associated with B burgdorferi results from the host’s own inflammatory response. The clinical hallmark of Lyme disease in humans is the characteristic bull’s eye lesion around the tick bite (ie, EM). As noted earlier in this section, documentation of this characteristic lesion categorizes a patient as positive for Lyme disease in existing human surveillance programs.

Animals, on the other hand, do not reliably develop any dermatological lesions, and when they do, their hair coat often masks it. The most frequently reported presenting clinical sign is an acute mono- or oligoarthritis in large joints such as the shoulder, elbow, or knee combined with lymphadenopathy in the draining local lymph node.126,127 Affected joints are very painful, swollen, and warm, but often the lameness is transient and resolves within 3 to 5 days, regardless of treatment.126,127 (In studies, animals developed signs of arthritis approximately 2 to 3 months post known exposure and generally occurred in the joints closest to the original tick bite.[127])

Protein-losing glomerulopathy and acute renal failure have also been reported.[125] Often, the addition of acute systemic signs such as fever between 39.5°C to 40.5°C, anorexia, and general malaise raise a clinician’s suspicion of Lyme disease; however, the combination of these signs is equally observed in dogs with and without B burgdorferi specific antibodies. Therefore, these symptoms should be considered nonspecific indicators of Lyme disease.118,126

Diagnostics Approaches

No specific hematologic or biochemical changes are associated with borreliosis. Cerebrospinal fluid, joint fluid, and urine may show evidence of inflammatory changes, and hematologic abnormalities can include leukopenia and thrombocytopenia. Unfortunately, these changes may also be observed with other tick-borne diseases and may even be attributed to coinfection with these other pathogens.[118]

There is also no pathognomonic test for Lyme borreliosis. The presence of an elevated antibody titer to B burgdorferi signifies exposure to the spirochete but does not prove that the current clinical illness is caused by the organism. In endemic areas, asymptomatic animals are often seropositive, possibly from an adequate host immune response, exposure to a nonpathogenic form of B burgdorferi, or exposure to a closely related nonborrelia spirochete organism.118,126

The first available immunodiagnostic tests were done with antigens from whole spirochete preparations. Unfortunately, these tests were not standardized, had a high level of cross-reactivity with other bacteria (eg, Leptospira), and could not differentiate between vaccinated and naturally exposed dogs. Because of these shortcomings, most of these serologic tests have been discontinued. ELISA and IFA tests for immunoglobulin M and immunoglobulin G (IgM and IgG, respectively) also are available, but because dogs don’t develop clinical signs of Lyme disease early in the course of infection, the usefulness of testing for these is questionable as well. In general, the acute rise in IgM is missed altogether, and because clinical signs develop so late in disease (well after seroconversion), paired IgG titers are not useful.[126]

In 2001, the SNAP® 3DX (IDEXX Laboratories, Westbrook, Maine) point-of-care test became commercially available for Lyme disease testing. This test was designed to detect the presence of serum antibody to C_6, a synthetically produced peptide encoded by specific surface lipoproteins of B burgdorferi. Because this surface lipoprotein’s genes (ie, IR_6) are only expressed during infection of and replication of the spirochete in the mammalian host, the presence of serum antibodies to C_6 indicates host invasion and infection with B burgdorferi, allowing differentiation between vaccination and true infection. The IR_6 surface protein is also genetically, structurally, and antigenically highly conserved among many B burgdorferi strains. Experimentally, the C_6 antibody response is detectable 3 to 5 weeks postinfection and stays positive for at least 69 weeks. Test positivity occurs earlier than with conventional assays and even before onset of clinical lameness.128,129

In 2006, with the addition of Anaplasma phagocytophilum, the SNAP® 3DX test became known as the SNAP® 4DX. Unlike previous ELISA tests, the C_6 antibodies detected in the SNAP® 4DX® are not increased in dogs infected with dirofilariasis, babesiosis, ehrlichiosis, Rocky Mountain spotted fever (RMSF), or leptospirosis.126,128

Even though currently available disease screens are growing increasingly more useful in diagnosing clinical illness from B burgdorferi infection, they are still not conclusive. Thus, the American College of Veterinary Internal Medicine consensus statement notes that the presumptive diagnosis of Lyme disease should include (a) evidence of exposure to B burgdorferi, (b) clinical signs consistent with Lyme disease, (c) consideration (and exclusion of) other differentials, and (d) response to treatment.[126]

Recommendations for Therapy and Control

Because of the difficulty obtaining an accurate diagnosis, antibacterials are often given empirically to try to make a therapeutic diagnosis. Extrapolating from human medicine, the animal drugs of choice are tetracycline derivatives or amoxicillin. Most clinicians, including a survey of American College of Veterinary Internal Medicine diplomats, recommend using doxycycline at 10 mg/kg orally, once daily, for a minimum of 1 month.[126]

However, clinical improvement should be viewed with caution for several reasons. First, an animal’s improvement does not confirm that the clinical illness is caused by B burgdorferi. Second, the intermittent nature of the acute arthropathy often resolves spontaneously within days to weeks, regardless of antimicrobial therapy. Third, doxycycline has antiflammatory properties and may work at resolving the clinical signs of lameness, regardless of cause. Finally, doxycycline is effective against other diseases with similar clinical signs such as RMSF, anaplasmosis, and ehrlichiosis, and they may actually exist as coinfections with Lyme disease.[126]

Whether antimicrobial therapy truly clears the B burgdorferi organism is also still debatable. Research shows that although clinical signs improve and antibodies decrease with antimicrobial therapy, study-infected dogs were still PCR-positive for the organism in various tissues. The research also showed that suppressing the host immune system with administered corticosteroids caused some dogs to develop Lyme arthritis.[127]

Prevention. The mechanism behind the Lyme vaccinations is to prevent the Borrelia spirochete from infecting the host. When ticks feed, outer surface lipoprotein (Osp) A converts to OspC, allowing the spirochete to detach from the tick’s midgut and migrate to its salivary gland and, subsequently, to the host. OspC may also help the spirochete avoid detection by the host’s immune system. The vaccine-induced immune protection begins in the tick before spirochetes even enter the host.[118]

Four Lyme vaccines are available in the United States: (1) monovalent bacterin, (2) bivalent bacterin, (3) nonadjuvanted recombinant (r) OspA, and (4) adjuvanted rOspA.118,126 Both the bacterin and the rOspA vaccines induce anti-OspA antibodies in the host, but the bacterin vaccines are also marketed as stimulating the production of anti-OspC antibodies, thereby proclaiming higher preventive efficacy.[126] The downside is that bacterin-containing vaccines may put dogs at higher risk of developing immune-mediated reactions and adverse effects.[118]

Lyme vaccine effectiveness studies are difficult to interpret mainly because making an accurate diagnosis of Lyme disease is also difficult. Studies report preventive fraction ranges from 92% with whole spirochete bacterin vaccines to 60.3% with OspA vaccines. However, the enhanced resistance to infection seen in dogs vaccinated before infection is not seen in dogs that have recovered from natural infection, and vaccinating infected dogs does not help clear infection. Dogs should be selected for vaccination based on geographic location (ie, where they reside or travel) and by their outdoor activities and habits. For example, dogs that participate in outdoor activities in known high tick-exposure areas should receive priority for vaccination.[118]

Depending on the product, vaccines are recommended for use beginning at 6 to 12 weeks of age. Primary vaccination schedules consist of two inoculations 3 weeks apart. Higher antibody titers are induced in dogs given a third dose, so extra-label recommendations in highly endemic areas may include the use of a third immunization 6 months after the two initial doses. Annual boosters are recommended in high-risk dogs because vaccinations do not sustain protective titers. Because heterologous vaccines produce weak antibody cross-reactivity, species-specific vaccines are probably necessary for adequate protection.118,126

In Lyme-endemic areas, tick control measures are not only important to prevent Lyme disease, but also to prevent the many other tick-borne diseases. The carriers, Ixodes ticks, are field ticks that look for hosts by waiting in leaf litter and overgrown lawns, low-lying vegetation, overhanging branches, and wooded and brushy areas. Tick control begins with avoidance of these tick habitats, careful landscaping when possible, and routine checks for ticks after being in or around such environments.[118]

Because of the relatively long duration of attachment required for the transmission of B burgdorferi (at least 36 to 48 hours) any product that effectively reduces the duration of attachment can be effective in reducing transmission. Tick control products include fipronil, amitraz collars, permethrin with imidacloprid, and other permethrin-containing products. Many veterinarians recommend the combination of amitraz collars with fipronil in endemic areas.[122] Using these collars is not without risk, though; they are very toxic when ingested, and veterinarians should have the antidote yohimbine on hand when recommending this product. Fipronil and permethrin with imidacloprid also have been shown to be effective, and they are not washed away by swimming or bathing.[126]

Public Health Considerations. Although Lyme borreliosis is classified as a zoonosis, animals and humans are incidental hosts for a sylvan cycle that exists in nature. Dogs do not appear to be a source for infection in humans because dogs do not excrete infectious organisms in their fluids. In addition, because ticks do not refeed after detachment, the risk of a pet bringing infected ticks home to their owners is minimal. However, because of their greater exposure risk, dogs may be very useful sentinel hosts for human infection.

Plague

Introduction and Military Importance

Plague, an infectious disease of animals and humans, is caused by the Gram-negative bacterium Yersinia pestis that circulates in the environment among susceptible rodent species, including rats, rock squirrels, ground squirrels, and prairie dogs.130,131 Humans are usually infected with bubonic, primary septicemic, or pneumonic plague from flea bites during an epizootic event.[131] However, they can also be infected by other means, including exposure to blood or tissues of infected rodents, rabbits, or domestic cats[132]; exposure to infectious aerosol droplets, generally from infected humans or household cats[132]; or through laboratory exposures.[131] Carnivores such as dogs, cats, coyotes, raccoons, and skunks also can become infected, but clinical signs rarely appear in species other than cats.[131] Cats develop clinical manifestations of bubonic, pneumonic, or septicemic plague, with 50% mortality rates in untreated animals.[132]

Because plague is a life-threatening disease that can be spread through aerosol transmission, the US military is concerned with plague as an endemic disease and a biological warfare threat.[131] All suspected or confirmed plague cases, in animals and humans, must be reported to local or state health departments. Plague is classified as a Category A critical biological agent because of its potential as a bioterrorism agent.[73] (See Chapter 15, Veterinary Pathology, for additional details on agent categorizations by the CDC and the National Institute of Allergy and Infectious Diseases.) In order to facilitate prompt diagnosis and treatment, veterinarians must understand preventive medicine concepts, including the plague’s natural mechanisms of transmission.[133]

Description of the Pathogen

Y pestis is a Gram-negative, nonmotile member of the family Enterobacteriaceae. When stained with Wright, Geimsa, or Wayson stains, it takes on a characteristic “safety pin” bipolar staining effect.131,132 Y pestis can grow at a wide range of temperatures in the laboratory, although optimal growth occurs at 28°C.[131] The bacterium is relatively slow growing, with pinpoint colony growth requiring more than 24 hours’ incubation. If cultures are discarded prior to 48 hours, a diagnosis of plague may be missed.[132] Despite the slow growth, Y pestis readily grows on standard laboratory media, including sheep blood agar, MacConkey agar, nutrient broth, and unenriched agar.131,132

Epidemiology

Transmission. More than 200 species of mammals and 150 species of fleas are capable of transmitting Y pestis. While the Oriental rat flea (Xenopsylla cheopis) has been responsible for large bubonic plague outbreaks, the most important vector in the United States appears to be Oropsylla montana, which is commonly found on rock squirrels and California ground squirrels.130,131

Although plague has two distinct patterns—epizootic or enzootic outbreaks—it generally occurs in the enzootic form where a stable cycle of rodents infecting fleas exists. Questions still remain about how the enzootic form is maintained; however, there is thought to be no excess mortality in a largely resistant population.[131] Epizootics occur about every 5 years, where climatic or environmental conditions result in a higher-than-normal host susceptibility and corresponding high mortality. Under such circumstances, fleas are more likely to migrate and, subsequently, encounter and bite humans and other nonrodent animals.[134]

Generally, plague is also a seasonal disease, with most reported human cases occurring between March and October.[134] However, cases associated with domestic cats occur year-round, without a seasonal pattern.130,133

Almost any mammal can become infected by plague, but most species do not show clinical disease signs. For example, Y pestis infections are rarely identified in ungulates (eg, bison, deer, pigs) in the United States, and these animals probably pose relatively little risk to humans.[132] However, because of their interaction with wildlife during hunting behaviors,[130] both domestic dogs and cats are epidemiologically important sources of human plague cases. Although dogs seldom exhibit clinical disease signs, they pose a potential human health risk because they may transport fleas into homes.131,132

Cats pose a double risk: not only do they show clinical signs, but they are also particularly efficient at transmitting disease to humans.[131] Although there were no reported cases of human-to-human transmission since 1924, 7.7% of the 297 US human plague cases from 1977 to 1998 were associated with transmission from cats.130,133

Geographic Distribution. Plague occurs in various regions of all continents, except Australia. It is endemic in the former Soviet Union, the Americas, Asia, and especially in parts of Africa. In fact, the World Health Organization reports from 2003 indicate that over 95% of cases worldwide came from Africa.131,135

In the United States, plague is endemic in the western states, with most human cases coming from New Mexico, Arizona, Colorado, and California. In the early 1900s, most cases in the United States were found in urban areas. Since then, the distribution pattern has altered: 80% of cases reported since 1925 are sylvatic or peridomestic. The World Health Organization notes that plague distribution also coincides with the geographical distribution of its natural foci.135,136

Incidence. Historically, plague has resulted in significant human loss, often impacting entire civilizations. In the 1300s, plague (ie, the “Black Death”) killed an estimated 30 percent or more of the population of Europe. Since these times, improved sanitation standards and antibiotics have reduced infection and mortality rates, lessening the plague’s dramatic impact. Globally, the World Health Organization reported a total of 2,118 plague infections in 2003, including 182 deaths.[135] In the United States, human cases are relatively rare, with the CDC reporting less than 15 cases annually.130,136

Pathogenesis and Clinical Findings

As few as 1 to 10 bacilli can cause plague infection.[131] The organisms are susceptible to phagocytosis and killing by neutrophils; however, some bacteria may proliferate in tissue macrophages. In humans, clinical plague infection occurs in three forms, depending on the route of infection: (1) bubonic, (2) septicemic, and (3) pneumonic. Infected cats present with similar manifestations of disease, and bubonic plague is the most commonly observed form of plague in cats and humans, affecting 53% of cats with plague in a New Mexico clinical survey.[132]

A primary risk factor is hunting behavior in plague-endemic areas. When killed infected rodents are ingested, Y pestis organisms inoculate the cat’s oral lacerations or interdental crevices, resulting in swollen submandibular and cervical lymph nodes. Although approximately 75% of plague-infected cats show submandibular lymphadentitis, abscessed lymph nodes may be clinically indistinguishable from abscesses caused by different means (eg, bite wounds).[133] Other, more distinguishable, initial symptoms include fever, lethargy, and anorexia. Cats also can develop pneumonia or disseminated intravascular coagulopathy, multiorgan failure, and other complications associated with a Gram-negative septic condition. Like human cases, untreated bubonic plague in cats frequently progresses to septicemic or pneumonic plague.133,137

Pneumonic plague in cats is a serious and rapidly progressive disease. The incubation period ranges from 3 to 4 days, and symptoms include fever, cough, and, frequently, bloody sputum.[138] Cats infected with pneumonic plague pose a serious hazard to owners, veterinarians, and others who handle or have close contact with these animals because feline plague infection is a risk factor for human plague infection.[139] Between 1977 and 1998, 23 cases of cat-associated human plague were identified in eight states: New Mexico, Colorado, California, Arizona, Nevada, Oregon, Utah, and Wyoming.[133] Five of these human cases (21.7%) resulted in fatal infections. Six of the 23 cases (26.1%) occurred in veterinarians or their staff,[133] suggesting that veterinary staff in plague-endemic areas may be at increased risk of occupationally acquired infection.[130]

If used as a biological weapon, the plague’s pathogenesis and clinical manifestations must be altered from those of naturally occurring disease. In humans, primary pneumonic plague would result from inhalation of aerosolized Y pestis. The time from exposure to clinical signs would likely range from 2 to 4 days. Initial symptoms would include a fever with a cough and dyspnea, progressing rapidly to a severe progressive pneumonia similar to secondary pneumonic plague. An intentional aerosol release of Y pestis also causes feline primary plague cases, especially among exposed feral or free-roaming cats.[137]

Diagnostic Approaches

Because early plague cases foreshadow a larger epidemic, laboratory or clinical suspicions of plague must be immediately reported to appropriate health professionals. Definitive tests can be arranged through a state reference laboratory or the CDC, and early interventions can be implemented, even though no rapid assays for plague are widely available. Antigen detection, IgM enzyme immunoassay, immunostaining, and PCR (all human confirmatory tests) are available at some state health departments, the CDC, and military laboratories. Confirmatory testing for feline cases can be most effectively achieved by performing fluorescent antibody testing on lymph node aspirates.130,138

If possible, diagnostic samples should be taken prior to administering antimicrobials. Samples should be placed on ice or frozen (not in preservatives) and shipped overnight to a reference laboratory.[130] However, the state health department must be notified prior to shipment of any plague suspect’s biological samples.

Recommendations for Therapy, Prevention, and Control

Therapy. While bubonic plague in either cats or humans can be successfully treated with antibiotics if diagnosed early,[131] pneumonic plague is one of the most deadly infectious diseases. Fatality rates approach 100 percent in untreated pneumonic plague cases, and mortality rates depend on how soon treatment is started. In fact, patients with primary pneumonic plague are unlikely to survive if antibiotic treatment is not initiated within 18 hours of symptom onset. Further, most plague fatalities are a result of a delay in appropriate antimicrobial therapy.[136] The drug of choice for human plague is streptomycin131,137; however, this drug is not available for veterinary use. Alternative drugs for veterinary use include gentamicin, doxycycline, tetracycline, and chloramphenicol.[130]

Prevention. Plague prevention in domestic cats is critically important because the disease can rapidly kill cats and trigger human plague. Although feline plague’s clinical signs may be similar to those of other diseases, a high fever, especially when coupled with lymphadenopathy or sublingual abscesses, in a free-roaming cat from the western United States is a strong indicator of plague.[137]

Pet owners who live in plague-endemic areas should exercise the following precautions to prevent plague infection: (a) Cats should be prevented from free-roaming behaviors; (b) all domestic cats and dogs should be regularly treated for fleas, especially during the summer months; (c) cats and other mammalian pets should not share sleeping areas with family members to avoid potential flea bites; and (d) outdoor areas providing harborage for rodents, such as wood piles or junk piles, should be eliminated.[133]

Veterinarians and their staffs, especially those in plague-endemic areas, also need to remain vigilant to protect animal and human health. Personnel in contact with an infected cat should consult their physicians and local or state health departments, and they should advise owners of cats with suspected plague to do the same.132,133 Staff should immediately treat cats with suspected plague for fleas and isolate these animals to prevent human contact with infectious exudates or respiratory aerosols.[132] All personnel also should use a respirator mask—preferably one approved by the US National Institute of Occupational Safety and Health—and gloves when handling live or dead cats suspected of plague infection.[138]

In the event of a bioterrorism event, feral or free-roaming cats may become infected,[132] so staff members should notify animal shelters and control facilities of potential feline infection and associated human health implications. To the extent possible, the staff should also advise their pet owners and local animal providers that cats and other animals remain indoors until qualified experts complete environmental safety assessments.

Q Fever

Introduction and Military Importance

During World War II, US troops and other militaries experienced multiple, large outbreaks of “Query fever” (Q fever) that sometimes affected more than 1,700 troops at a time, causing manpower losses between 23% to 77%.[140] These outbreaks occurred primarily in the European theater of war and were associated with exposures to contaminated farm buildings, straw, and hay in agricultural areas where sheep and goats were raised. In the 1950’s and 1960’s, additional outbreaks were reported in US and allied troops in Europe and northern Africa. During and after the Persian Gulf War, four US cases were reported from the region while supporting Operation Desert Storm, with one case identified from Saudi Arabia.140,141

Multiple articles and case reports also have been published on the diagnosis of Q fever in military personnel returning from and serving in the Middle East during Operation Iraqi Freedom and Operation Enduring Freedom.9,142–148 For example, in early 2007, the US Army Public Health Command initiated a Q fever surveillance program that identified more than 135 US military cases between January 2007 and January 2011 (S Scoville, DrPH, epidemiologist, US Army Public Health Command, unpublished data, February 2011). Exposures occurred in various occupational specialties, including administrative, aviation, and infantry personnel.

In 2010, the CDC published the following guidance in a health advisory to enable healthcare providers to capture and better identify returning military individuals who might be exhibiting symptoms and signs of Q fever: “Healthcare providers in the United States should consider Q fever in the differential diagnosis of persons with febrile illness, pneumonia, or hepatitis who have recently been in Iraq or the Netherlands.”149(p1)

Description of the Pathogen

Q fever was first described in 1937 as “query” or “Q” fever, a disease produced by an unnamed pathogen infecting abattoir (ie, slaughterhouse) workers during outbreaks in Brisbane, Queensland, Australia, in 1935.150,151 During 1935, a similar organism was found in ticks collected from Nine Mile Creek, Montana, and was isolated by using guinea pigs.152–154

Additional research was performed on the guinea pigs that recovered from the illness produced from the agent isolated from the ticks. In 1938, these guinea pigs were challenged with, and demonstrated protective immunity against, the Q fever agent from Australia.[155] In 1948, the organism was named Coxiella burnetii after the two researchers who were instrumental in identifying the new species causing Q fever: Herald Cox (United States) and Macfarlane Burnet (Australia).[156]

C burnetii is a Gram-negative coccobacillus and an obligate intracellular organism. Historically, it has been categorized as Rickettsia-like, but phylogenetic analysis reveals a closer relationship to Legionella and Francisella. The organism has two distinct forms or life cycles: (1) vegetative form—large cell variant where the organism resides and replicates in monocytes and macrophages; and (2) infective form—small cell variant where the organism is extracellular and spore-like.157–158

Epidemiology

Transmission. The reservoir of C burnetii for human disease is commonly found in food animals, including cattle, sheep, and goats; however, it is also found in a wide range of other domestic and wild mammals (eg, cats), arthropods, and birds. The organism is shed in infected animals’ milk, urine, and feces and in higher concentrations in their placenta and amniotic fluids. Contact with just one of these infected cells can cause infection in humans and other animals. The infective form, which is resistant to drying and most disinfectants, also can remain viable and stable in most environments for a long time.[157]

The primary modes of transmission to humans are inhalation of aerosolized bacteria (eg, infected barnyard dust) and direct contact with the infective form in droplets and fomites. Ingestion of the organism in unpasteurized or uncooked animal products (eg, raw milk), infected blood transfusion, sexual transmission, and tick bites are rarer human transmission modes. Ticks can also transmit the organism between animals.[158]

Geographic Distribution. Q fever became a notifiable disease in the United States and the OIE in 1999 and is distributed worldwide, except for New Zealand. Locations of frequent reports and outbreaks include Europe, Australia, United States, northern Africa, and Southwest Asia. A large outbreak occurred in the Netherlands (2007–2010) with a reported human incidence reaching 14.5 cases per 100,000 people.[159] Out of 426 dairy goat and sheep farms nationwide, animals from 99 dairy farms were reported to be infected with this organism.160,161

Incidence and Prevalence. Q fever is enzootic in the United States. Among animals, seroprevalence has been reported from 3.4% among cattle and as high as 41.6% among goats.[162] A 2002 to 2004 study found a greater than 93% prevalence of Q fever in bulk milk samples from US dairy herds.[163] Similarly, another study found that 92% of US veterinary school dairy herds had positive Q fever specimens in bulk tank milk.[164]

In humans, Q fever is a zoonotic but largely occupationally associated disease. Proof in point: while a published serosurvey conducted among 508 US veterinarians during 2006 detected a 22% seroprevalence,[165] another 2006 study found the total US average annual incidence between 2000 and 2004 was only 0.28 cases per million persons.[166] Moreover, the CDC reported that the 2003 to 2004 National Health and Nutrition Examination Survey listed the seroprevalence level of Q fever antibodies at only 3.1% in US individuals over 20 years old. In 2008, the annual US incidence reached 2.7 cases per million persons (depending on location) with an overall incidence of 0.6 cases per million persons, which is still lower than the 2006 veterinarian rates.167,168

Pathogenesis and Clinical Findings

Most animals do not demonstrate signs or symptoms of illness, and the acute form usually remains inapparent. When visible, acute signs include abortion storms, premature births, weak newborns, metritis, and retained placenta. Mortality is rare in animals. In humans, acute infections are also often subclinical but can sometimes include symptoms of high fever, chills, and sweating.169,170 Other signs and symptoms may include headache, myalgia, pharyngitis, nausea, vomiting, diarrhea, disorientation, coughing, and chest and abdominal pain. Atypical manifestations include granulomatous hepatitis, myocarditis, acute cholecystitis, aseptic meningitis, and acute respiratory distress syndrome.145,169 Mortality is reported at 1% to 2% in untreated cases.[140]

Chronic Q fever appears to be uncommon and may not develop until years after initial infection. Chronic infection commonly manifests as an endocarditis, usually among patients with preexisting valvular heart disease.146,169–177 Mortality among individuals with chronic infections has been reported up to 65%.[145]

Diagnostic Approaches

Due to the infectious nature and ease of transmissibility of C burnetii, the CDC lists Q fever as a Category B bioterrorism agent, and a Biosafety Level 3 laboratory is required for organism culturing and safe handling. (See also Chapter 15, Veterinary Pathology, for more information about bioterrorism agents and biosafety levels in laboratories.) Organism isolation is a method of diagnostics but is not regularly performed for clinical diagnostics. Other tests include immunohistochemical staining for organism antigen detection in tissue and PCR tests for nucleic acid detection.

Most diagnostic testing is performed using paired serologic testing for IgM and IgG immune responses in animals and man. Testing platforms include IFA, ELISA, and complement fixation. The IFA is most commonly used.

In humans, antibody response occurs against phase I and phase II Q fever antigens, producing phase I and phase II antibodies. In acute infections, antibodies to phase II antigens increase first, followed by a slow but defined increase in antibodies to phase I antigens; overall, however, more phase II antibodies are produced than phase I antibodies. In chronic infections, phase I antibodies tend to be at equal or higher levels than phase II antibodies.

In animals, the antigen antibody response is not as defined as in humans, and seroconversion is not indicative of organism shedding. In fact, because seroconversion often is delayed or even nonexistent and animals may remain seropositive after recovery, antigen detection in placental tissues is a better infection determinant.

Recommendations for Therapy, Prevention, and Control

Animal treatment is limited, although prophylactic treatment with tetracycline or doxycycline reportedly reduces shedding. Currently, no animal vaccine is approved for US use; in fact, preventive vaccine use is not universally well understood. Prior to 2010, two animal vaccines were produced by two different French pharmaceutical companies.[178] One was commercially available in France (Chlamyvax FQ®, Merial, Lyon, France) and the other was commercially available in Slovakia (Coxevac®, CEVA-Phylaxia Veterinary Biologicals Co. Ltd., Budapest, Hungary).[179] At first, neither vaccine was approved by the European Medicines Agency to be widely used throughout the European Union. However, with the advent of the Q fever outbreak in the Netherlands and after much scrutiny and discussion, the European Medicines Agency approved Coxevac® for marketing throughout the European Union in September 2010 under the caveat of exceptional circumstances.[180]

For example, during the 2007 to 2010 outbreak in the Netherlands, vaccination was used as a method of outbreak response and control among goats and sheep in conjunction with other measures.181,182 Prior to the outbreak, an increase of abortions and stillbirths in dairy goats attributed to C burnetii infections had been noted during 2005 and 2006. Likely reasons for these increases are the endemic nature of the disease, the high shedding rates in birthing tissues and fluids, and the dense concentration of dairy goat farms coupled with the housing systems used and seasonal cleaning methods performed.[183]

The Netherlands government instituted a voluntary animal vaccination control measure in 2008, which became compulsory in 2009 with bulk-milk PCR monitoring. During 2010, all pregnant animals were culled on infected farms, and a nationwide breeding ban for dairy goats and sheep was instituted, combined with the compulsory vaccination. Also, breeding was only allowed on noninfected vaccinated farms. In 2011, annual vaccination of dairy goats and sheep continued as did monitoring for new infections.

Use of these control methods seemed successful. Human Q fever cases peaked in 2009 and sharply dropped in 2010 and 2011, eventually leveling off to preoutbreak levels in 2013. The result of one study during this vaccination period also suggests that vaccination reduces animal shedding of the organism, which, in turn, reduces environmental contamination.[184] Thus, in conjunction with vaccination, instituting more drastic measures that reduce breeding of infected animals (ie, culling and breeding bans) may be required to decrease the proliferation and shedding of the organism into the environment to prevent and control Q fever outbreaks.

Because of the hardiness and resistant nature of the organism to heat, drying, and common disinfectants and the ability for the organism to become aerosolized, environmental cleaning during an outbreak should be conducted cautiously, using proper protective equipment, clothing, and boots. Steps preventing airflow from an infected animal housing area to other areas used by animals or humans also should be implemented. Other means of strengthening biosecurity include restricting access of wild birds and companion animals to stable areas, controlling the source of straw used for bedding, and using quarantine procedures, especially when adding new animals to the herd or flock.185,186

ANIMAL DISEASES OF IMPORTANCE IN MILITARY WORKING ANIMALS

In addition to zoonotic disease threats, countless infectious diseases affect only animals. Because a full discussion of all diseases infecting MWAs is beyond this textbook’s scope and they are detailed in other texts such as The Merck Veterinary Manual,111,187 just a representative sample of military important diseases affecting MWAs is covered in this chapter’s section on animal diseases. In general, these diseases meet one or more of the following criteria: (1) highly transmissible between members of the same species with the potential for explosive outbreaks, especially in kennels; (2) generally severe, potentially fatal, outcomes if left untreated; or (3) no specific treatment (eg, symptomatic only).

Although the risk of infection for many of these diseases can be reduced through regular application of prophylactic measures (eg, annual vaccination, monthly preventative tablets, and antiparasitic topicals), the fact that prophylaxis must be routinely used for many of these diseases speaks to the clinical and military importance of the diseases themselves. Even with routine prophylaxis, these diseases remain a threat to MWAs because of possible reduced effectiveness from missed doses (eg, monthly tablet), inadequate immune response (eg, vaccination), or developed resistance among arthropod vectors (eg, topicals).

Distemper

Introduction and Military Importance

Canine distemper is an important infectious disease affecting a wide range of terrestrial carnivores, including Canidae (ie, wild and domestic dogs); wild Felidae; Mustelidae (eg, ferrets, weasels, minks, skunks, and badgers); Procyonidae (eg, coati, raccoons, and red pandas); and seals.188–190 The canine distemper virus (CDV) causes serious respiratory, gastrointestinal, and central nervous system diseases.[188] Other manifestations include ocular disease, cutaneous lesions, dental defects, and abortion.[188] Additionally, viral infection of lymphocytes and macrophages can lead to widespread destruction of lymphoid tissues and subsequent immunosuppression.188,191

Description of the Pathogen

CDV is in the genus Morbillivirus, family Paramyxoviridae, and is a 150- to 250-nm diameter, single-stranded, negative-sense RNA virus closely related to human measles, rinderpest, peste des petits ruminants, and phocine distemper viruses.188,191 The viral envelope is studded with hemagglutinin glycoproteins that mediate viral attachment to host cells and fusion glycoproteins that allow penetration of host cells and fusion of infected with uninfected cells.[188]

Epidemiology

Transmission. CDV is shed in the respiratory tract secretions of infected animals and, to a lesser extent, from other secretions (eg, urine) within 7 days postinfection. Naïve animals become infected when they inhale aerosolized secretions or come in close contact with infected animals.[189]

Geographical Distribution. Canine distemper is a ubiquitous disease with worldwide distribution.188,190

Incidence and Prevalence. The prevalence rate of spontaneous canine distemper in cosmopolitan dogs is greatest between 3- and 6-months old, corresponding with loss of maternal antibodies in weaned puppies.[189]

Pathogenesis and Clinical Findings

CDV gets trapped in the nasal turbinates’ mucosa, infects local macrophages, and spreads to the retropharyngeal lymph nodes and tonsils within 24 hours of infection.190,191 The virus then replicates within local lymphoid tissues. Replication is followed by a primary viremia that rapidly disseminates the virus to lymphoid tissues throughout the body, reaching the thymus, spleen, and systemic lymph nodes within 48 hours of exposure.188,190

Clinical signs of fever, lethargy, decreased mentation, and anorexia develop when viremia occurs, approximately 5 days after infection.188,191 Further disease progression is highly dependent on host immune status, antibody titer against viral glycoproteins, host age, and virus strain and virulence. For example, dogs with adequate humoral and cellular immunity neutralize and clear the virus within 14 days of infection. Dogs with intermediate levels of cellular and humoral immunity may experience infection of mucosal epithelium and brain at the viremic stage.[188] Dogs with a poor ability to mount an immune response develop systemic infection of epithelial tissues, resulting in clinical signs of respiratory and enteric disease, central nervous system infection, and viral secretions.188,189

There are four typical clinical presentations. The first, classical canine distemper, is seen in young puppies between 12- to 16-weeks old as passive immunity declines.188,192 Disease begins with fever and conjunctivitis with rapid progression to respiratory and gastrointestinal signs, including coughing with a variable serous to mucopurulent oculonasal discharge, vomiting, and diarrhea, with other nonspecific signs such as depression and inappetence.188,191,192 Affected animals may die, fully recover, or progress to the neurologic form of the disease 1 to 4 weeks later in which seizures, paraparesis, myoclonus (ie, tremors, twitches, and “tics”), or ataxia may be observed.188,192

A second form of canine distemper is multifocal distemper encephalomyelitis in mature dogs, which occurs when a naïve dog, ages 4- to 8-years old, becomes infected. This rare, chronic disease is not preceded by the classic signs of canine distemper but is characterized by a slow progressive course during which the dog develops pelvic limb weakness, generalized incoordination, and, occasionally, head tremors, with no seizures or personality changes.[193]

The third form, old dog encephalitis, is also considered a rare variant of canine distemper and has an insidious onset with neurological signs such as circling, swaying, and weaving. Compulsive walking with pushing against fixed objects is typical, but paralysis and seizures are not observed. The disease progresses to coma or death after 3 to 4 months.[193]

The fourth clinical presentation of CDV is postvaccinal canine distemper encephalitis, which occurs in young animals 1 to 3 weeks after being vaccinated with attenuated CDV vaccine. This disease has an acute to subacute course of 1 to 5 days with clinical signs resembling the furious form of rabies.[193] (See also Chapter 12, Rabies and Continued Military Concerns, for more information about rabies.)

Diagnostic Approach

A diagnosis of canine distemper is usually based on clinical suspicion. A characteristic history of a 3- to 6-month-old unvaccinated puppy with a compatible illness supports the diagnosis. Abnormal hematological findings typically include absolute lymphopenia caused by severe lymphoid depletion. Regenerative anemia and thrombocytopenia have been found in experimentally infected puppies but are not consistently observed in older or spontaneously infected dogs. The magnitude and type of serum biochemistry changes in acute systemic infections are nonspecific.[189]

Recommendations for Therapy and Control

Treatment is supportive and nonspecific; efforts should be made to prevent spread of infection to susceptible animals. Dogs with upper respiratory infections should be kept in areas that are clean and warm, and the eyes and nasal passages should be kept clear of discharges. Pneumonia is often complicated by secondary bacterial infection, and broad-spectrum antibiotics may be administered with good success. Nebulization and coupage are good adjunct therapies.[189]

When diarrhea is present, food, water, and oral medications should be avoided. Parenteral nutrition may be necessary if diarrhea is protracted. Supplemental fluid therapy is also often required to maintain adequate hydration status.[189]

Although therapy for neurological symptoms can be unrewarding, euthanasia should not be recommended unless the neurological disturbances progress to a point that they are no longer compatible with life. Seizures, myoclonus, and optic neuritis are often irreversible neurological manifestations, but are ones owners may tolerate because the animal can still live productively.[189] MWDs with canine distemper infections require consultation with the local kennel master, regional clinical medicine consultant, and the US Military Working Dog Center to determine whether they will remain on active duty or be medically retired. (See also Chapter 4, Medical Evacuation of the Military Working Dog, for additional details on the MWD disposition process.)

Immunity to natural CDV infection is long lasting and the virus’ immunologic homogeneity has made disease prevention through vaccination possible. Maternal antibodies acquired in utero and in colostrum block immunity development in puppies from birth until after weaning. A puppy that has not had colostrum is probably protected for 1 to 4 weeks, while maternal antibodies in nursing puppies are probably lost by 12 to 14 weeks of age. The typical vaccination strategy in puppies that have received colostrum for CDV is to vaccinate every 3 to 4 weeks from 6 to 16 weeks of age. Because older vaccinated dogs can still develop distemper, periodic boosters are recommended for this disease, despite long-lived immunity provided by vaccination.[189]

CDV is extremely susceptible to disinfectants. Because infected animals are the primary source of the virus, they should be kept apart from healthy susceptible animals. Dogs usually shed the virus for 1 to 2 weeks following acute systemic illness, although those that develop later neurologic signs without systemic disease may still shed virus.[189]

Parvovirus

Introduction and Military Importance

One of the most common causes of infectious diarrhea in dogs, canine parvovirus type 2 (CPV-2) or parvo primarily affects young dogs (ie, less than 6 months of age).[194] CPV-2 is generally of little significance in the stateside MWD population, primarily because dogs are procured for training after they are 1 year old and have received a full set of vaccinations. However, given the worldwide distribution of CPV-2, its long lifespan in the environment, and lack of control through vaccination in the majority of the world, the likeliness of exposure for the deploying MWD is high. The emergence of a new strain, CPV-2c, also demonstrates a potential increased risk to the MWD population because this variant may cause morbidity and mortality in fully vaccinated, healthy adult canines.[195]

Description of the Pathogen

The causative agent of canine parvovirus enteritis is a parvovirus, of the genus Parvovirus in the family Parvoviridae, a nonenveloped single-stranded DNA virus that requires rapidly dividing cells for replication such as intestinal epithelial cells. No virus of the genus Parvovirus is known to infect humans. However, humans are affected by different viruses within the family Parvoviridae, the most common being parvovirus B19 virus, which causes erythema infectiosum, or fifth disease, in children. Other Parvovirus genera of the family Parviviridae are also associated with disease in several different animal species, including feline panleukopenia, porcine parvovirus, minute virus of mice, Aleutian disease virus of mink, and mink enteritis virus.194,196

Epidemiology

Transmission. CPV-2 is highly stable in the environment and can persist for many months. The virus is readily spread to dogs via contact with contaminated feces; fomites (eg, veterinary equipment and grooming tools); insects; rodents; and even a dog’s hair coat. The virus is also transmissible to cats; CPV-2a and -2b variants readily replicate in the feline intestinal tract and may cause clinical disease, especially in cats concurrently ill with feline panleukopenia virus. Cats shedding virus in their feces also serve as a potential reservoir to infect susceptible dogs.[197]

Geographic Distribution. CPV-2 is distributed worldwide and seems to evolve frequently. It was first isolated and identified in 1978, after emerging in Europe in 1976, spreading, and causing high morbidity and high mortality in global naïve canine populations.195,198 Differing opinions exist as to the origin of CPV-2 but generally it is thought to have emerged from either the feline panleukopenia virus or an existing wild carnivore parvovirus.[195] Its name (CPV-2) distinguished it from a previously identified, but unrelated, minute virus of canines (CPV-1), a less common and less virulent strain generally causing mild diarrhea and disease.194,198

Serologic studies indicate that the original CPV-2 strain circulating in the dog population was replaced by a new variant named CPV-2a around 1980. Interestingly, results indicate that the spread of CPV-2a and replacement of CPV-2 occurred in three years, between 1979 and 1982, similar to that of the original spread (between 1976 to 1978) of CPV-2 but in a population that was considered to be immune.[198] The virus quickly mutated again, and the CPV-2b variant was discovered in circulation in 1984. In 2000, CPV-2c, was discovered in Italy and is now widely distributed in circulation with the 2a and 2b variants.[199]

The most common variant now seen in the United States and Japan is CPV-2b, replacing earlier identified strains. In Europe and the Far East, both CPV-2a and -2b are found in approximately equal incidence.[194] As of 2007, CPV-2c was found to be present in several US states and has been reported in Europe; in South America in Uruguay; and in Asia, including India, Vietnam, and Japan199,200; there were no reports of CPV-2c in Africa or Australia.[200]

Incidence. Although acute CPV-2 enteritis can be seen in dogs of any breed, age, or sex, young, rapidly growing pups aged 6 weeks to 6 months are most susceptible to developing severe disease, especially if they have a concomitant intestinal parasite burden or an intestinal bacterial infection (eg, Salmonella, Campylobacter, or Clostridium species).[194] This age span also corresponds to waning maternal antibody levels that create a window of susceptibility, particularly in the absence of a proper vaccination program. Breeds demonstrating an apparently increased risk of developing disease include Rottweilers, Doberman pinschers, Labrador retrievers, American Staffordshire terriers, German shepherd dogs, and Alaskan sled dogs.194,201 Whether a breed predilection truly exists is somewhat debatable; as of 2007, none was identified for CPV-2c emerging in the United States.[200]

Pathogenesis and Clinical Findings

CPV-2 spreads rapidly between dogs via oronasal exposure to contaminated feces or fomites; the incubation period is generally between 3 days and 1 week.[195] The virus enters the oronasal cavity and begins replicating in the tonsils’ regional lymphoid tissues, retropharyngeal lymphoid tissue, and mesenteric lymph nodes.[202] Upon becoming viremic (approximately 3 days following infection), the virus disseminates to systemic and intestinal lymphoid tissues such as Peyer’s patches, followed rapidly by infection of the gastrointestinal epithelium.[203]

The most common gross lesions found on necropsy, typical of Parvovirus infection, are segmental enteritis, including segmental discoloration (ie, reddening) and roughening of affected serosa; fibrin adhered to serosal surfaces; and intestinal mucosa appearing smooth and glassy from villi loss (Figure 11-5). The small intestinal contents may vary from watery to yellow mucoid to bloody.195,202 The large intestine is rarely affected.[195] The severity of intestinal lesions relates to the severity of systemic lymphoid tissue lesions and the magnitude and duration of viremia.[203]

Histologically, Parvovirus enteritis is characterized by shortened or obliterated villi and necrosis and loss of intestinal crypt epithelium; the presence of lymphoid necrosis helps differentiate parvoviral enteritis from coronaviral enteritis.[202] Intranuclear inclusion bodies within the crypt epithelial cells also may be observed in acute cases.195,202 Other findings include lymphoid necrosis and bone marrow hypocellularity due to depletion of myeloid cells, erythroid cells, and megakaryocytes. Myocarditis with intranuclear inclusion bodies may be observed in a small number of cases, especially in younger animals.[195]

Some dogs who are naturally infected with CPV-2 may never demonstrate clinical disease signs; however, the typical presentation of a newly infected host is the acute onset of vomiting, followed by foul-smelling bloody diarrhea, anorexia, and subsequent dehydration. Destruction of germinal cells, leading to blunted intestinal villi, impaired absorption ability, and eventually villi death, causes the common clinical sign of diarrhea.195,202

Viral infection of the rapidly growing precursor cells in lymphoid organs (eg, thymus, lymph nodes, bone marrow, and spleen) may cause neutropenia, with counts as low as 500 to 2,000 white blood cells per µL, and less pronounced lymphopenia.[195] Secondary bacterial infections may occur subsequent to the disrupted intestinal architecture and impaired local immunity, leading to bacteremia, septicemia, and disseminated intravascular coagulation. Neurologic disease may occur, usually as a result of hemorrhage into the central nervous system during disseminated intravascular coagulation, or from hypoglycemia, sepsis, or acid-base electrolyte imbalances; CPV-2 itself is rarely a sole cause of neurologic disorders.[194] Sudden death (ie, within 24 hours of developing clinical signs) may occur, especially in younger animals.[195]

Pups infected with CPV-2 in utero, or when infected at less than 8 weeks of age, may develop the myocardial form, which commonly causes sudden death, with or without preceding signs of illness, such as dyspnea or GI disease. Puppies that do not die immediately and unexpectedly often develop congestive heart failure and die suddenly weeks to months later.[194]

Figure 11-5. Canine intestine: Segmental enteritis as demonstrated by reddened loops of small intestinal loops. Serosa has dark red patches and appears roughened. Note fibrin strands attached to serosal surfaces.
Photo courtesy of Bruce H. Williams, Doctor of Veterinary Medicine, Senior Pathologist, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

Diagnostic Approaches

CPV-2 infection should be considered for all puppies presenting with acute, foul-smelling diarrhea. However, because these signs are not specific for CPV-2 infection, other enteric pathogens should also be considered.

A fecal ELISA, commercially available for in-hospital use, is relatively sensitive and specific for detecting CPV-2 infection but is not without critique. Although conducting the patient-side test is simple and rapid, it requires a large amount of viral antigen to produce a clearly visible band and detects approximately only 50% of infected dogs.[195]

Detection failures might stem from the short window of fecal viral shedding (ie, about 10 days, corresponding to days 5–7 of clinical illness) or improper testing procedures, resulting in false-negative results.[195] Subjectivity in the accuracy of reading the results might also lead to false-negatives, especially with low antigen levels.[204] False-positives may occur if the pup has been recently vaccinated with an attenuated live virus vaccine (ie, within the past 5–12 days).[194]

A single serum sample demonstrating a high hemagglutination inhibition titer, collected after a dog has been clinically ill for 3 or more days, is diagnostic for CPV-2 infection because Parvovirus causes hemagglutination of erythrocytes. Seroconversion, demonstrated by rising titers in paired sera using HI or virus neutralization tests, can also be used to diagnose Parvovirus infection antemortem.[194]

Other diagnostic options include electron microscopy on feces or tissues and conventional or real-time PCR for detecting antigen in feces. Of these testing methods, real-time PCR is sensitive, specific, and more reproducible, quantifying CPV-2 nucleic acid within a few hours and detecting over 90% of infected animals.195,204 PCR may also be used to distinguish between virulent and vaccine CPV strains.[194]

Postmortem histologic examination of tissues is definitive. Parvovirus identification in tissue may be demonstrated by IFA; in situ hybridization may be used on formalin-fixed or wax-embedded tissues.[194]

Recommendations for Therapy and Control

Therapy consists of supportive treatment, such as correcting dehydration and electrolyte imbalances and preventing secondary bacterial infections. Fluid therapy, the mainstay treatment for Parvovirus enteritis,[205] should continue as long as vomiting or diarrhea persists. Antiemetics, motility modifiers, and broad-spectrum antibiotics, such as a combination of penicillin and an aminoglycoside, are recommended; antidiarrheal agents are usually contraindicated. Contrary to most GI-treatment advice, nutritional support, via nasogastric tube or per os, is also recommended; clinical disease duration is shortened by maintaining body weight and minimizing hypoglycemia.[194]

Depending on clinical presentation, other therapies include administration of whole blood, plasma, or colloids to correct anemia or hypoproteinemia. Antiendotoxin sera, glucocorticosteroids, and flunixin meglumine may treat early endotoxemia or sepsis. However, neither a recombinant bactericidal-permeability-increase protein, which counteracts endotoxemia, nor recombinant human granulocyte colony-stimulating factor, which treats severe neutropenia, improve clinical outcome.[194] Administering a single dose of immune plasma containing high anti-CPV antibody titers to dogs within 24 hours of onset of clinical CPV enteritis also did not improve hematologic values, length of hospital stay, or cost of treatment.[206]

Although puppies who survive a natural infection have immunity for at least 20 months, and likely for life,194,195 using commercially prepared attenuated or modified live vaccines is the recommended means of preventing disease. Vaccination invokes both humoral and cell-mediated immune response, making even low levels of maternal antibodies less of an inhibitant.[207]

Currently available CPV-2 vaccines contain either CPV-2 or CPV-2b variant.[207] However, one problem with this prevention method is that puppies are susceptible to CPV-2 infection 2 to 3 weeks before they can be vaccinated.194,195 This window of susceptibility is further affected by maternal antibody interference for a period of time once vaccination begins. Such interference is the most common cause for vaccine failure.194,207

For best results, the initial vaccination series should be administered every 3 to 4 weeks between 8 and 16 weeks of age. This schedule allows the puppy to receive at least one dose of vaccine once the maternally derived antibody levels have waned enough to not interfere with vaccine-induced immunity. The administration of a single, initial dose of a vaccine to any dog greater than 16 weeks of age is considered protective and acceptable. Accepted practice is to booster a year later, followed by every 1 to 3 years. AAHA guidelines recommend any modified live or attenuated vaccine be boostered a minimum of every 3 years based on extensive research.[207]

Vaccinating pups less than 6 weeks of age is not recommended because these pups’ immune systems are probably too immature to produce a sufficient immune response.[207] Vaccination effectiveness ranges from 25% in 6-week-old pups to 95% in 18-week-old pups.[195]

Parvovirus-related disease can occur after vaccination, probably from infection with a wild-type strain, rather than reversion of the vaccine strain. Additional factors contributing to clinical disease after vaccination include infection with variant strains, overwhelming viral dose, and route of exposure.[195]

A small percentage of dogs (an estimated 1 out of 1,000 dogs) are considered “nonresponders,” meaning they are genetically incapable of developing an immune response to CPV-2 vaccines. This genetic component may explain why some breeds demonstrated a perceived susceptibility to CPV-2 in the 1980s; when compared to the general population, certain breeds and family lines had a higher prevalence of low or nonresponders.[207]

Serologic testing to determine or monitor for immunity is available and frequently used for CPV-2, especially upon completion of the puppy vaccination series. The “gold standard” tests for antibodies to CPV-2 are virus neutralization and HI, performed by many commercial laboratories. Although most results are reported as titers, some results are reported simply as positive (ie, antibodies present) or negative (ie, no antibody detected). US Department of Agriculture (USDA)-approved in-hospital tests are also available to determine presence or absence of antibodies. With the HI test, a positive result indicates the serum sample has an antibody titer greater than 20; a negative result indicates either the titer is less than acceptable or there are no antibodies.[207]

Figure 11-6. Canine heart with heartworms (Dirofilaria immitis).
Photo courtesy of Bruce H. Williams, Doctor of Veterinary Medicine, Senior Pathologist, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

According to the American Animal Hospital Association, all CPV-2 vaccines currently available on the market provide sustained protection from all CPV variants, including the newest, CPV-2c.[207] However, because confirmed cases of CPV-2c infections in adult dogs with complete vaccination histories have occurred in the United States and Italy,195,200,208 concern is growing that current vaccines may not actually provide cross-protection against the emerging CPV-2c.

Because CPV-2 is one of the most resistant viruses in dogs, contamination of the environment is also of great concern. In fact, CPV-2 persists for months to years if not properly disinfected or exposed to direct sunlight. Recommended disinfection is bleach diluted with water (1:30). This solution should be used on any equipment, bedding, or surfaces that are tolerant to bleach and should remain on the surface for a minimum of 10 minutes. Upon release from isolation, this same concentration can be used to dip puppies to kill any virus contaminating their fur. Items that cannot be exposed to bleach may be steam cleaned.[194]

Heartworm Disease

Introduction and Military Importance

Heartworm disease, diagnosed worldwide, is endemic in many areas, but as vectors continue to expand their territories, environmental conditions continue to change, and animals continue to move throughout the world, the potential for contracting heartworm steadily increases. Virtually all MWDs are at some risk for exposure and infection. However, the worldwide locations of US military bases and vast number of places where MWDs travel increases their infection risk and potentially contributes to the disease’s spread. In fact, a microfilaremic dog can be a reservoir of infection anywhere favorable climatic conditions exist, spreading further disease and creating more endemic areas around the globe.

Description of the Pathogen

Heartworm disease is caused by Dirofilaria immitis, a parasitic filaroid nematode.209–212 The normal definitive host and main reservoir for this pathogen is the domestic dog and some wild canids. Other susceptible species include cats, ferrets, wild felids, wild mustelids, monkeys, marine mammals, and rodents,[212] but these incidental hosts generally have low-level transient microfilaremias and rarely serve as sources of infection.[209] Humans are aberrant hosts and can develop ocular, pulmonary, or subcutaneous disease syndromes resulting from migration of larvae.[212]

Epidemiology

Transmission and Life Cycle. The developmental cycle of D immitis is approximately 7 to 9 months from microfilaria (L1) to adult (L5). The life cycle starts when a mosquito feeds on an infected host and ingests stage 1 larvae (ie, microfilariae). Over the next several weeks, the larvae mature to the L3 stage, then migrate to the mosquito’s mouthparts. When the mosquito feeds, the infective L3 enter the host’s body via the bite wound, beginning the mammalian portion of their life cycle. The larvae develop from L3 to L5 in the subcutaneous tissue before migrating to pulmonary vasculature, where they sexually mature and reproduce 180 to 210 days postinfection. Generally, adult worms reside in the pulmonary arteries but can move into the right ventricle, right atrium, or vena cava if the worm burden is high (Figure 11-6). Adult worms typically survive for 3 to 5 years in dogs and 1 to 2 years in cats. The microfilariae can survive 1 to 2 years in the bloodstream, where they serve as a reservoir for the disease.209–211

Geographic Distribution. D immitis can be found in warm climates worldwide. In the United States, it has been found in all 50 states and is locally endemic within areas of the lower 48 states, Hawaii, Puerto Rico, the US Virgin Islands, and Guam. As climates change and the ranges of the vector mosquitoes expand, D immitis will continue to thrive, potentially becoming endemic in many more areas.[209]

Incidence and Prevalence. Prevalence of heartworm infection varies greatly and depends on multiple factors, including the animal population (ie, owned vs. stray), the environment or location, and the mosquito population. Prevalence is much higher in stray dogs and cats than owned pets and is also higher in dogs that spend most of their time outdoors. In the United States, surveys show prevalence in dogs to be as low as 0.06% in Nevada and up to 7.4% in Mississippi. The highest rates in dogs are found within 150 miles of the Atlantic Coast from Texas to New Jersey, along the Mississippi River, and in dogs not on heartworm preventative.[212]

Pathogenesis and Clinical Findings

Pathogenesis. Worm numbers, infection duration, host activity level, and host immune response are all important factors that determine the severity of cardiopulmonary pathology in dogs with heartworm infection.209,211 Long-term infections lead to chronic lesions and scarring via a combination of immune response, worm death, and direct irritation. In fact, live adult worms often cause pathology to pulmonary arterial walls through direct mechanical irritation. This irritation chronologically leads to (a) perivascular cuffing with eosinophil infiltration, (b) thickened vessel walls, and (c) pulmonary hypertension.211,212 In severe cases, sustained hypertension causes right-sided heart failure. Live worms are also believed to immunosuppress the host.[211]

Unlike live worms, dead worms are known to elicit a strong host immune response. Wolbachia, an intracellular Gram-negative Rickettsial bacterium, an endosymbiont of D immitis, may help invoke this response in this way: dead worms release the bacteria into the bloodstream; the host then produces antibodies against the Wolbachia surface protein.211,212

Clinical Findings. Heartworm disease in dogs usually has an insidious onset with slow progression.[212] Patient activity level and lung pathology have a strong correlation with the frequency and severity of clinical signs. The more active the patient is, the more severe the lung pathology will be.[209] Many infected dogs are identified with serologic screening prior to the onset of signs. Common clinical signs of heartworm infection in dogs include coughing, dyspnea, exercise intolerance, unthriftiness, syncope, epistaxis, hemoptysis, cyanosis, and possibly ascites, due to right-sided heart failure as the disease progresses.[211]

Canine heartworm disease is classified as Class I to IV based on physical exam, hematology, urinalysis, and thoracic radiographic findings. Dogs without clinical or radiological signs or laboratory abnormalities are Class I, asymptomatic to mild. Dogs that present with an occasional cough, moderate exercise intolerance, increased lung sounds, loss of condition, possible anemia and proteinuria, and mild to moderate radiographic changes (ie, right ventricular enlargement) are Class II, moderate heartworm disease.[209]

Class III is severe disease. These dogs may present with marked anemia, persistent coughing, weight loss, exercise intolerance, syncope, tachypnea at rest, hemoptysis, ascites, anemia, thrombocytopenia, and proteinuria. Radiographic findings may include right ventricular hypertrophy, diffuse pulmonary densities, and main pulmonary artery enlargement.[209]

Class IV is caval syndrome, which is usually fatal if not treated immediately via surgical extraction of the worms. Dogs with caval syndrome will present with sudden onset of severe lethargy, dyspnea, pale mucous membranes, and weakness, along with hemoglobinuria and hemoglobinemia.210,211

Diagnostic Approaches

Antigen testing (ie, ELISA and immunochromatographic tests)—the most sensitive diagnostic method and preferred method for screening asymptomatic dogs—detects a protein secreted mainly by female adult worms.[209] The earliest a dog should be antigen tested is 7 months postinfection.[211] False-negatives, caused by unisex (ie, male) adult worm infection, immature adult worms, low worm burdens, or incorrect testing procedures, may occur. Another limitation of antigen testing is that worm burden levels cannot be determined based on the color intensity of a positive result.[209]

In antigen-positive dogs, microfilaria testing should always be utilized as a complimentary test to validate serologic results and determine if the infective L1 life-stage is present in the dog. This testing has high specificity, but due to variable sensitivity, should not be used as the primary screening test to identify infected dogs. The modified Knotts test and the filtration test are the two types of concentration techniques used to identify microfilaria. The modified Knotts test is preferred because it enables observation of morphology and measurement of body dimensions to differentiate between D immitis and other nonpathogenic filaroid species. Microfilaria tests may be negative in infected dogs that are not microfilaremic or that have been on macrolide prophylaxis.[209]

Echocardiography or radiography may provide additional information to support a diagnosis of heartworm disease, but neither should be used as the sole diagnostic test. Also, although echocardiography can provide definitive proof of infection through direct visualization, it is not a preferred method in dogs because it can be inefficient, depending on the location and number of worms.[209]

Radiography provides the most objective method of assessing the severity of heartworm cardiopulmonary disease secondary to heartworm infection in both dogs and cats, according to American Heartworm Society guidelines. Radiography can also be used to monitor regression or progression of disease. Typical radiographic findings include enlarged and tortuous branches of pulmonary arteries, variable degrees of pulmonary parenchymal disease, and potentially right heart enlargement.210–212

Recommendations for Therapy and Control

Preadulticide evaluation should include a thorough history, physical exam, antigen test, and thoracic radiography, with additional clinical and laboratory data gathered as necessary based on the patient’s clinical status.209,211 The infection’s severity, dog’s activity level, and extent of concurrent pulmonary vascular disease are the most important factors influencing the treatment’s outcome and the probability of postadulticide thromboembolic complication. Active dogs like MWDs with severe infections displaying radiographic signs of pulmonary arterial obstruction are at highest risk for this complication.211,212

Adulticide Therapy. Melarsomine dihydrochloride is the only US-approved adulticidal drug for heartworm treatment and is effective against worms that are over 4 months old.210,212 The three-dose protocol for melarsomine is recommended by the American Heartworm Society for patients with all classes of disease except caval syndrome and has been demonstrated to be more effective and safer than the two-dose protocol.[209] (Spreading the three adulticide injections over 31 days kills the worms more gradually, reducing worm emboli impact on pulmonary arteries and lungs. This protocol also allows larvae that are too young to be susceptible at first injection to mature, so they can be killed by the second and third injections.)

Melarsomine is administered as an intramuscular injection into the epaxial lumbar muscles. In approximately one-third of dogs, injection site swelling and soreness develops. Strict exercise restriction, the key to minimizing postadulticide pulmonary thromboembolism, should begin at the time of diagnosis and continue for 4 to 6 weeks after melarsomine injections.209,211,212

Adjunct Therapy. Multiple adjunct therapies can increase adulticide therapy’s safety and efficacy. The patient’s clinical condition should always be considered when determining the management protocol to be used for treatment. If the clinical presentation does not demand immediate intervention, a macrocyclic lactone (ie, heartworm preventive) should be administered for 1 to 3 months prior to starting adulticide therapy. Benefits include reduction or elimination of D immitis microfilariae, reduction of female worms’ mass by destroying their reproductive systems, and stunting growth of immature worms. By collectively reducing antigenic mass in the ways described, macrocyclic lactone therapy also reduces the risk of pulmonary thromboembolism from adulticide therapy.[209]

However, in dogs determined to have high microfilariae counts prior to treatment, macrocyclic lactones may cause anaphylaxis due to rapid death of large numbers of microfilariae. To minimize potential reactions, patients may be pretreated with glucocorticoids and antihistamines. Administering glucocorticoids at diminishing anti-inflammatory doses can control clinical signs of pulmonary thromboembolism, which is especially important in patients suspected to have a high worm burden and thus have more risk for this complication.[209]

Using doxycycline also improves the safety and efficacy of management protocols. Administering doxycycline orally for the initial 4 weeks reduces the Wolbachia numbers in all stages of heartworms and the pathogenesis of the host immune response. In addition to its effect on Wolbachia, doxycycline is lethal to L3 and L4 larvae and gradually suppresses microfilaremia in dogs with adult infections.209,212

Alternative Therapy. In cases where melarsomine therapy is contraindicated or not possible, a protocol using a macrocyclic lactone in combination with doxycycline and daily exercise restriction may be considered. The macrocyclic lactone and doxycycline should be administered monthly, and dogs should be antigen tested every 6 months with continued treatment until there are two consecutive negative antigen tests.[209]

Long-term administration of just macrocyclic lactones for a slow kill is not recommended. This method could take 2 years or longer, during which time pathology could continually worsen.[209]

Caval Syndrome Treatment. In cases of caval syndrome, surgical removal of worms from the right atrium and tricuspid valve’s orifice is necessary to prevent death. The procedure of choice for heavily infected and high-risk dogs is insertion of either rigid or flexible alligator forceps introduced through the right external jugular vein. 209–211 All worms that can be identified and reached should be removed. Fluoroscopy can assist with the identification of worms and their locations.

Prevention. Heartworm infection is preventable with appropriate chemoprophylaxis and surveillance.209,211,212 Oral, topical, and parenteral formulations of macrocyclic lactones are available and are all effective against microfilariae and L3 and L4 larvae. Ivermectin and milbemycin oxime are given orally on a monthly basis. Moxidectin and selamectin are available in topical formulations and are applied monthly. A slow-release formulation of moxidectin-impregnated lipid microspheres is available for parenteral use and provides continuous protection for 6 months.[209]

All of these formulations are safe, and many are also effective against other endo- and ectoparasites. Because MWDs may deploy to endemic regions at any time, chosen preventives should be administered year-round.

Annual antigen testing is recommended for dogs on heartworm preventive to ensure that prophylaxis is maintained.209,211,212 In cases of missed doses with less than a 6-month gap between doses, dogs should immediately be restarted on prophylaxis, antigen tested 6 months after the initial dose, and then antigen tested annually thereafter. Antigen testing at the time of restarting is optional but not required; results are likely to be negative because not enough time has passed for adult worm development.[212]

Tick-borne Diseases: Ehrlichiosis and Babesiosis

Introduction and Military Importance

Because of the worldwide distribution of tick-borne diseases (TBDs) and the tick’s ability to transmit a variety of zoonotic pathogens with each blood meal, TBDs are relevant to the military.

TBDs, more broadly classified as vector-borne diseases, are rapidly emerging and globally distributed.213,214 In fact, in recent years, a large number of emerging infections and zoonotic diseases are described to be caused by tick-borne pathogens, and more than 800 tick species exist worldwide. These ectoparasitic arthropods feed on mammal, bird, and reptile blood and are extremely vigorous, effective vectors for a large number of pathogens, transmitting viruses, rickettsial agents, alpha-proteobacteria species, spirochetes, and protozoal parasites.[213]

TBDs affecting only animals are relevant to the military because of potential mission failures and inadvertent importation upon redeployment. Canine populations are susceptible to most tick-borne pathogens known to infect mammals, including humans.122,215–219 MWDs are routinely deployed to many regions of the world where exposure to various TBDs is possible.216,219–222 If infected MWDs spread these debilitating infections to a larger number of animals, military missions are directly compromised, and casualties are possible.

Description of the Pathogens

Two TBDs are of main concern to the military, especially for MWDs: (1) ehrlichiosis and (2) babesiosis. Ehrlichia canis, the causative agent for canine monocytotropic ehrlichiosis, is an intracellular organism infecting circulating and marginal lymphocytes and mononuclear cells in the mammalian host (Figure 11-7). These organisms are typically only seen during the acute, febrile stage of infection. If undetected and untreated, they can persist for years in an infected host, potentially causing chronic, cyclic illness and mortality rates upwards of 25%.[223] Rhipicephalus sanguineus, the brown dog tick, (Figure 11-8) is one of the few species with a worldwide distribution and is the primary vector in dogs.[224]

Babesia canis, an intracellular, erythrocytic parasite infecting dogs and other canine species, is approximately 4 to 7 µm in length, and is often described as teardrop in shape (Figure 11-9). Like E canis, B canis is most commonly transmitted by the brown dog tick, R sanguineus, but depending on the subspecies of E canis and the geographic location, may also be transmitted by tick genus Dermacentor (eg, the American dog tick) or Haemaphysalis (eg, the yellow dog tick).[225]

Figure 11-7. Ehrlichia canis. Peripheral blood from a dog, Wright Giemsa, 100X objective. A blue, stippled, round morula, consistent with E canis or Ehrlichia chaffeensis, is adjacent to and indenting the round nucleus of this intermediate lymphocyte.
Photo courtesy of Heather L. Wamsley, Doctor of Veterinary Medicine, Assistant Professor, Clinical Pathology Residency Coordinator, Department of Physiological Sciences, University of Florida, College of Veterinary Medicine, Gainesville, Florida 32608.

Figure 11-8. The brown dog tick, Rhipicephalus sanguineus, adult male, adult female, and nymph.
Photo courtesy of Katherine Sayler, chapter author.

Figure 11-9. Babesia canis. Peripheral blood from a dog, Wright Giemsa, 100X objective. Two pyriform, basophilic intraerythrocytic piroplasms consistent with a large Babesia, such as B canis, are present.
Photo courtesy of Heather L. Wamsley, Doctor of Veterinary Medicine, Assistant Professor, Clinical Pathology Residency Coordinator, Department of Physiological Sciences, University of Florida, College of Veterinary Medicine, Gainesville, Florida 32608.

Epidemiology

Transmission. Transmission for both E canis and B canis is primarily from infected tick bites but may also occur as a result of blood transfusion or inadvertent inoculation of blood (eg, bite wound or contaminated needle) from an infected carrier animal.[226]

Geographic Distribution. Infections with E canis have been reported in all 50 states and regions in Canada, Asia, South America, and Africa. Canine babesiosis also is of worldwide significance. Subspecies of B canis can be found in the United States, Africa, Asia, Australia, Europe, and other parts of North and South America.[225]

Incidence and Prevalence. Prevalence varies with tick density. For example, certain areas of the western and southeastern parts of the United States have high seroprevalence, ranging from 1.9% to 7.4%. Although published data is limited, areas in South America and the Caribbean Islands may have a much higher seroprevalence and more pathogenic strains of E canis.[227] Seroprevalence of B canis is highest in the southern region of the United States, ranging from 3.8% to upwards of 50%; parts of Europe and South Africa have similar rates.[228]

Pathogenesis and Clinical Findings

Erhlichiosis. E canis infection is a multisystemic disease potentially involving multiple organs and organ systems. The course of infection may present in three clinical phases: (1) acute, (2) subclinical, and (3) chronic. The acute phase of infection is often seen 2 to 4 weeks after tick inoculation and typically manifests in transient illness that largely goes unrecognized. Many infected dogs recover spontaneously without medical attention.[229]

However, depending on the strain’s virulence and the dog’s health status, clinical signs and symptoms, including fever, anorexia, lethargy, oculonasal discharge, and petechiation, might be visible. Lymphadenomegaly and splenomegaly also have been observed in about 20% of symptomatic cases. Common laboratory findings for acute stage infection include thrombocytopenia, mild leukopenia, and mild anemia (usually nonregenerative).[229]

If clinical findings go undetected during the acute stage, the infection progresses into the subclinical phase, during which the patient appears clinically healthy, but remains persistently infected, possibly exhibiting thrombocytopenia or mild nonregenerative anemia. Some animals then progress to the chronic phase of infection. During this stage, various clinical findings reemerge in varying degrees of severity among patients: weakness, anorexia, weight loss, fever, pallor lymphadenopathy, hepatomegaly, splenomegaly, retinal lesions, edema, nonseptic polyarthritis, and CNS disease.[229]

The most common hematologic abnormality observed in chronic disease is thrombocytopenia. In severe cases, pancytopenia develops as a result of severe, typically irreversible bone marrow damage. Other common laboratory abnormalities seen with chronic ehrlichiosis include granular lymphocytosis, elevated liver enzymes, and hyperglobulinemia. The prognosis for such chronically infected dogs is grave, with mortality rates of up to 25%.[229]

Babesiosis. The severity of babesiosis varies with the animal’s age and strain of Babesia involved. For example, although US strains generally cause mild or unapparent disease in nonimmunosuppressed adults and severe disease in puppies or immunocompromised dogs, South African (and possibly South American) strains cause severe disease or death in pups and healthy adult dogs. Clinical signs may include lethargy, anorexia, pale mucous membranes, fever, emesis, amber to brown urine, splenomegaly, icterus, weight loss, rapid respiration, and rapid heart rate.[225]

Infected animals are also usually anemic, primarily resulting from intravascular hemolysis and less commonly from extravascular erythrocyte destruction. A regenerative response (ie, reticulocytosis) is present in most cases. Mild to severe thrombocytopenia is also often present, with no hemorrhaging. Clinical chemistry profiles can be normal, but they may demonstrate bilirubinemia and abnormalities related to anemic hypoxia. Although bilirubinuria is common, prominent hemoglobinuria is rarely noted in US dogs.[225]

Diagnostic Approaches

Microscopic Evaluation. Detecting E canis morula in leukocytes is not a reliable means of diagnosis because it is so difficult, even during the acute infection stage. Detection is optimized by performing buffy coat smears of peripheral blood or by evaluating tissue aspirates taken from the spleen or lymph nodes, which typically harbor the organism.[229]

A definitive diagnosis of B canis infection is usually made by identifying the organisms in stained blood films. Blood collected from capillaries (typically by performing an ear prick) may have higher concentrations of parasites than blood collected from a large vein, such as the cephalic or jugular vein. However, when parasites are not observed in the blood film, this disease is often confused with autoimmune hemolytic anemia because most animals with babesiosis are Coombs’ test positive, and sometimes have autoagglutination.

Serology. Detection of antibodies to E canis is the most reliable and frequently used method for confirming a diagnosis. A negative antibody response in animals suspected to be acutely infected should be repeated in 2 to 3 weeks. As with other vector-borne infections, a positive serology could indicate active infection, latent infection, or previous exposure.

Most veterinarians use the in-house ELISA assay (SNAP® 3DX, 4Dx, and 4Dx-Plus) as their go-to qualitative method. If quantification of antibody levels is desired, the IFA test can be used. IFA tests for E canis are offered at most commercial diagnostic laboratories. Although this assay is highly sensitive in detecting E canis antibodies, false-positive reactions can occur from cross-reactive antibodies and nonspecific binding. Serological diagnosis can also be made for babesiosis using IFA tests, but some cross-reactivity occurs between babesial species, sometimes resulting in false-positive results. High titers suggest current infection, but IFA tests may be negative in acutely infected animals, especially pups.[225]

Polymerase Chain Reaction. Nucleic acid detection is rarely performed in the diagnosis of E canis infection but can be used to differentiate between organisms of the genus Ehrlichia. PCR testing for E canis is available at national and state diagnostic laboratories. Dogs in the acute phase of clinical disease may be PCR-positive, even prior to seroconversion. However, PCR analysis is not reliable in detecting subclinical, seropositive persistently infected carriers or animals in the chronic phase of the disease. Many false-negative results occur from the scarcity of circulating organisms in these animals. Unlike ehrlichiosis diagnosis, PCR analysis is the most reliable and accurate method to diagnose active infection or subclinical carrier animals with babesiosis. This assay can be performed at most commercial laboratories and requires a whole blood sample collected in anticoagulant.[225]

Recommendations for Therapy, Prevention, and Control

E canis must be treated early. Doxycycline is the current antimicrobial drug of choice, with a recommended dose of 5 to 10 mg/kg, twice daily for a period of 28 to 30 days. In dogs with acute or mild chronic illness, clinical signs will usually go into rapid remission within 2 to 3 days after initiating therapy. Dogs with severe chronic disease or those with pancytopenia may not respond to antimicrobial therapy.[229]

The currently recommended therapy for infection with B canis is Imidocarb dipropionate along with supportive care (eg, transfusions and fluid therapy). In treated dogs, Imidocarb dipropionate eliminates the infectivity of feeding ticks and provides prophylactic activity for up to 6 weeks following a single injection. However, antibabesial drugs are potentially dangerous, causing neuromuscular signs and liver or kidney damage. Treated and untreated dogs may also remain carriers even after clinical signs have resolved.[218]

Tick-borne disease surveillance is a prevention and control technique that provides period- or point-prevalence rate information. Past studies demonstrate the value and need for such zoonotic and infectious disease surveillance to the military.222,226–230 In fact, in order to effectively decrease disease exposure risk and occupational and environmental hazards, medical and military planners must know the risks for contracting tick-borne pathogens in each and every deployment. This information must then be disseminated to service members so that other preventative measures can be appropriately implemented and tick-borne disease symptoms can be recognized sooner for more immediate medical intervention. The proper use of protective clothing and application of acaracides and repellants are important measures for all service members and MWDs that engage in activities where the risk of tick exposure is high. In addition, frequent examinations for embedded ticks should be conducted after at-risk civilians and service members receive instructions regarding proper techniques for tick removal. Surveillance of tick-borne pathogens—combined with aforementioned preventive measures, treatment regimes, and other disseminated information—best ensures continued health and well-being of deployed MWDs, handlers, and other service members.

Staphylococcus Aureus

Introduction and Military Importance

Although many infectious diseases are reported in marine mammals, Staphylococcus aureus is currently the most significant single pathogen for the cetaceans within the US Navy Marine Mammal Program (MMP) population[231] (see also Chapter 7, Marine Mammal Program), and it is an important cause of pneumonia within managed dolphin populations.[232] Outside of the MMP population, S aureus has been isolated not only from animals with pneumonia, but also from animals with septicemia, embolic nephritis, cerebral abscesses, and cutaneous lesions.[233] Within the MMP population, S aureus has been isolated from animals with overwhelming sepsis, acute septicemia with renal and hepatic involvement, bacterial bronchopneumonia, fulminating bacterial pneumonia, fibrinous pleuritis, mastitis, placentitis, abortion, vaginitis, abscesses, and skin infections. Additionally, rare methicillin-resistant S aureus or MRSA infections have been identified within the MMP population (MMP, unpublished data, 2011).

Description of the Pathogen

S aureus is a facultative anaerobic, Gram-positive cocci that occurs singly, in pairs, and tetrads, and is typically an opportunistic pathogen, with infection resulting from bacteria invading a breach in the integrity of the immune system or integument. Along with Streptococcus and Pneumococcus, S aureus is classified as a pyogenic cocci.[234]

Evidence also suggests that S aureus is part of the normal microbial flora in marine mammals[235] and has been isolated from healthy dolphins in both managed and wild populations.[236] A 2-year study of managed healthy dolphins in coastal open seawater found that in 20% of the animals (ie, 11 out of 55) S aureus was isolated from the blowhole.[237] Additionally, S aureus was cultured from tongue and oropharynx samples from healthy animals within the MMP population (MMP, unpublished data, 2011).

Epidemiology

Transmission. Transmission is suspected to be through the respiratory tract, mucocutaneous surfaces, and broken skin. While air exchange in humans is 20% per breath, consisting mainly of air in the upper airway, dolphins take short and deep breaths, with an exchange of 75 to 90% of air in one-third of a second, enabling deep lung exposure to airborne threats at the marine surface. This large volume exchange increases the risk of respiratory infections.[238] The risk of deep lung infections also is increased because dolphins have no turbinates or nasal hairs to filter inhaled foreign material and pathogens.[238]

Anecdotal evidence suggests that a preexisting skin infection may lead to systemic infection. Within the MMP population, several cases reveal a route of infection through skin lesions with more systemic clinical signs appearing later (MMP, unpublished data, 2011).

Geographic Distribution. S aureus occurs throughout the world on skin and mucocutaneous surfaces of terrestrial animals and birds.[239] Because this organism is ubiquitous, evidence of the bacteria in dolphin blowhole swabs or other samples does not establish pathogenicity. In fact, S aureus has been found in several MMP dolphin blowhole samples with no indication of concurrent disease (MMP, unpublished data, 2011), providing further evidence that this organism may be part of the normal dolphin microbiota.

Incidence and Prevalence. Within the MMP population, S aureus infections resulted in 15 significant clinical cases in the last 20 years and accounted for 5.2% of total bacterial isolates (MMP, unpublished data, 2011). Of the dolphins necropsied from 1980 to 2010, 50% were diagnosed with pneumonia, and 19% of these cases were caused by S aureus.[240] Again, while incidence has been tracked, the actual prevalence is difficult to determine because the organism is ubiquitous and often considered normal flora. Additionally, within the marine mammal veterinary field, determining antemortem infection is further complicated by the presence of commensal and environmental microorganisms.[231]

Pathogenesis and Clinical Findings

As a prey species, dolphins may be stoic, often not exhibiting expected clinical signs until significant disease is present. Because initial clinical signs of systemic disease are often subtle and nonspecific, the animal care staff often serves as the most significant source of history, observing minor changes in behavior and alerting the veterinary team about potential disease indicators. Within the MMP population, such observed early clinical signs included reluctance to perform trained behaviors, blepherospasm, abnormal odor from the blowhole, increased blowhole discharge, lethargy, and partial to complete anorexia (MMP, unpublished data, 2011).

As disease progressed, observed clinical signs included abnormal respiratory character, tachypnea, shallow breaths, dull eyes, anorexia, skin desquamation, lethargy, foul breath odor, disorientation, mucohemorrhagic vaginal discharge, abortion, difficulty maintaining buoyancy, dyspnea, and acute death. In one case, frothy purulent discharge from the external auditory meatus was observed when the dolphin was out of the water. Clinical pathology findings include leukocytosis with a mature or left-shift neutrophillia or severe leukcopenia, low iron, low alkaline phosphatase, and increased erythrocyte sedimentation rate, an indication of inflammation (MMP, unpublished data, 2011).

The highest risk infections within the MMP (and other managed dolphin populations) are usually associated with septicemia and pneumonia.[231] In managed populations other than the MMP, early clinical signs for systemic infections include pyrexia, lethargy, and inappetence.[241] More progressive clinical signs include acute onset of vomiting, anorexia, diarrhea, lethargy, and significant leucopenia. Potential sequelae of S aureus infection are not limited to superficial necrotizing enteritis,[242] necrotizing suppurative bronchopneumonia, pyelonephritis, pyogranulomatous myocarditis, fibrinous suppurative epicarditis, osteomyelitis, leptomeningitis, abscesses within lymph nodes and skeletal muscle,[243] suppurative nephritis, pneumonia, myositis, and encephalitis.[232]

S aureus skin infections can present with clinical signs that are similar to other superficial infections, such as eruptive or ulcerative skin lesions, abscesses, refusal to perform trained behaviors, and a history of exposure dermatitis. Infections occur following exposure dermatitis, lacerations, tooth rake wounds, or any other insult to the integrity of the integument. Clinical pathology findings are similar to systemic infections but usually less dramatic (MMP, unpublished data, 2011).

Diagnostic Approaches

Initial diagnostics include, as appropriate, a full physical exam, complete blood count, chemistry panel, and full body ultrasound. Ultrasound findings may reveal ascities, pleural effusion, focal to multifocal areas of consolidation in the lung field, increased comet tail artifacts, irregularities noted on the pleural surface, and hypoechoic foci on the pleural surface (MMP, unpublished data, 2011). If respiratory involvement is suspected, evaluation of the blowhole and its sinus cytology is useful. At the MMP, S aureus has been cultured from blood, milk, ear exudates, feces, abdominal masses, abscessed lymph nodes, lung abscesses, and blowhole swabs (MMP, unpublished data, 2011).

Other diagnostic modalities employed may include bronchoscopy, ultrasound-guided biopsies and aspirates, radiography, and computed topography. S aureus has been isolated on necropsy samples from the lung, pleural fluid, blood, liver, spleen, kidney, stomach, duodenum, jejunum, adrenal gland, lymph nodes, oropharynx, blowhole, and placenta (MMP, unpublished data, 2011).

Recommendations for Therapy and Prevention

Depending on disease severity and organism sensitivity patterns, therapeutic regiments used at the MMP usually include oral, intravenous, or intramuscular antibiotics. Antifungals are often used concurrently because fungal overgrowth in the gastrointestinal and respiratory tracts is likely during long-term antibiotics regiments. Supportive care is also an essential part of therapy and often includes fluid support, gastrointestinal protectants, pain medication, and appetite stimulants.

Again, because marine mammals are often stoic, clinical signs alone are not useful when determining treatment length. Clinical pathology and other diagnostic tools, including culture, cytology, and ultrasound monitoring, better formulate disease resolution and therapy length.

The preventive medicine program established by veterinary personnel within the MMP is the cornerstone to limiting severe infection occurrences, including those caused by S aureus. This program consists of five main components: (1) routine physical exams, (2) sanitation and nutrition oversight, (3) record keeping, (4) animal care education, and (5) deployment support.

Although daily medical checks, routine comprehensive physical exams, routine animal morphometric analysis, detailed record keeping, regular deworming, high quality diet, environmental monitoring and maintenance, and mental and social enrichment when training or when deployed all play a role in maintaining a healthy population, aggressive topical treatment of any break in integument integrity is also essential to prevent severe systemic S aureus infections. The MMP’s multimodal approach to animal health and preventive medicine also facilitates early detection of disease, which impedes development of severe systemic S aureus infections.

TRANSBOUNDARY ANIMAL DISEASES OF MILITARY IMPORTANCE

The Food and Agriculture Organization of the United Nations defines transboundary animal diseases (TADs) as “those that are of significant economic, trade and/or food security importance for a considerable number of countries; which can easily spread to other countries and reach epidemic proportions; and where control/management, including exclusion, requires cooperation between several countries.”244(p6) Although many TADs are categorized as foreign animal diseases in the United States, they are often endemic in developing countries where US service members deploy. Eradication of endemic diseases requires a coordinated, multinational response that far exceeds DoD abilities. However, during redeployments, military veterinarians work to prevent accidental transfer and importation of TADs into the United States caused by movement of infected animals, introduction of contaminated feed or garbage to livestock, exposure to fomites, and contact with infected humans. An overview of some common TADs and what military veterinarians do to control them at home and abroad follows.

New and Old World Screwworm

Introduction and Military Importance

Several types of larval dipterans can infest the subcutaneous skin or organ tissues of domestic animals and humans, leading to a condition known as myiasis.[245] The New World Screwworm (NWS), Cochliomyia hominivorax (Coquerel), and the Old World Screwworm (OWS), Chrysomya bezziana (Villeneuve), are obligate parasites of mammals during the larval stages of their life cycle, targeting sites of fresh epidermal wounds and mucous membranes. Aggressive larvae feeding and additional oviposit by subsequent female flies can cause traumatic myiasis, secondary infections, disfigurement, and, if left untreated, host death.246–250

Generally, NWS flies are found in the Western Hemisphere while the OWS flies are found in the Eastern Hemisphere.[248] However, with the increasing ease of global movement of humans, animals, and cargo via ships and aircraft, cases of C hominivorax transferring to regions or resurfacing in countries where the flies had previously been eradicated have been documented.249,251–254 For example, in 1988, C hominivorax was discovered in Libya, immediately threatening neighboring countries on the African continent until eradication occurred in 1991.[255] Additionally, imported cases of C hominivorax were reported in screwworm-free nations such as the United States, Mexico, the United Kingdom, and Australia.249,251,252

Military personnel and working and companion animals stationed in areas where the two flies remain endemic are at risk for infestation and possible trans-location to the United States. Programs used by the US Army Veterinary Corps to prevent C hominivorax entry from military installations in Central America (eg, Panama) and the Caribbean (eg, Cuba) should be applied in countries harboring C bezziana, especially in those with high troop populations and movement (eg, Iraq and Afghanistan).251,256,257 Physicians and other human health care professionals should also be aware of potential screwworm infestation in wounded soldiers.258–260

Description of the Pathogen

The adult C hominivorax is 8 to 10 mm long and has a blue to blue-green metallic color, with three dark longitudinal stripes on its thorax’s dorsal surface. C bezziana is similar in size and color but has two horizontal thoracic bands, and its squamae have more fine hairs. As third instar larvae, both screwworm species have prominent spiny rings around the body, giving them a “wood screw” appearance, and their dorsal tracheal trunks are darkly pigmented (Figure 11-10). In the NWS, the pigmentation extends from the ninth to the twelfth segment in the NWS; in the OWS, only the twelfth segment is pigmented.249,261

Figure 11-10. Bovine: New World screwworm (Cochliomyia hominivorax).
Photo courtesy of Bruce H. Williams, Doctor of Veterinary Medicine, Senior Pathologist, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

Epidemiology

Transmission. The NWS and OWS flies prefer fresh uncontaminated cutaneous wounds, including insect bites, and mucous membranes of warm-blooded mammals.248,262 Adult gravid female flies oviposit up to 400 eggs in overlapping rows, arranged in a shingle-like pattern on the wound’s dry margin.[263] After 12 to 21 hours, the larva hatch and creep into the wound, burrowing deep into the flesh. The larva then feed on fluids and live tissue using their hook-like mouthparts and pass through three larvae stages or instars. Odor emitted from the infested and infected wound attracts other gravid females who contribute additional eggs.264,265

After approximately 5 to 7 days, grown larvae emerge from the wound, fall to the ground, and burrow into the soil to pupate. The pupal period varies dramatically from 1 week to 2 months. The life cycle length is also divergent, depending on ambient temperatures. In tropical climates, the life cycle is completed in 18 to 21 days; in more temperate conditions, 24 days; and during cooler weather, 60 days.[249]

Geographic Distribution. Before initiation of eradication programs using the sterile insect technique, C hominivorax extended from the southern United States southward to Uruguay, northern Chile, and Argentina. At present, the following areas are considered screwworm-free: the United States, the Virgin Islands, Mexico, Curacao, Puerto Rico, Guatemala, Belize, El Salvador, Honduras, Nicaragua, and Costa Rica. However, C bezziana is distributed throughout much of Africa, the Middle East, the Indian subcontinent, and Southeast Asia.249,266

Prevalence. Although the NWS and OWS are included on the World Health Organization Global Early Warning System for major animal diseases and zoonoses,[267] infestations continue to be underreported, particularly for C bezziana. In endemic areas up to 100% of livestock neonates can become infected, typically through their umbilicus.[248]

Pathogenesis and Clinical Findings

The pathogenesis and clinical findings are the same for both C hominivorax and C bezziana: suppurative, malodorous enlarged wounds with extensive tissue destruction, an active maggot population, and a serosanguinous discharge. In addition to the major wound, smaller openings in the skin posterior to the main wound may be present. For concealed or pocket-type wounds, animals may also be febrile, uncomfortable, and anorexic. In livestock, the patient might separate from the rest of the herd and exhibit weight loss and reduced lactation.248,262,268

Diagnostic Approaches

Larvae should be mechanically removed from the deepest part of the infested animal’s wound and fixed in 80% ethanol or isopropyl alcohol for identification under a stereomicroscope at a certified reference laboratory.249,268 Recently, cuticular hydrocarbon analysis, mitochondrial DNA analysis, random amplified polymorphic DNA PCR, and PCR-restriction fragment length polymorphism also have been explored as identification and geographical distribution mapping options.264,269,270 Serological tests have not been standardized yet, but remain a promising diagnostic tool for determining exposure.[271]

Recommendations for Therapy and Control

In companion animals, the affected animal’s wound is debrided of necrotic tissue, irrigated with saline or an antiseptic solution, and accessible larvae are manually extracted on successive days until the wound heals. Oral and topical flea and tick control, nonsteroidal anti-inflammatory drugs, analgesics, and antibiotics may be indicated. Ivermectin injections and pyrethrin or pyrethroid sprays also work well.[272] In domestic livestock, effective wound management as described above, in conjunction with the administration of organophosphate insecticides (eg, coumaphos, dichlofenthion, and fenchlorphos); carbamat; and pyrethrtoid compounds as dips or sprays not only successfully clears newly hatched larvae and immature forms, but also repels adult gravid female flies.[249]

In endemic areas, wound prevention, time management, and direct observation of animals are crucial preventative and control measures. Animal husbandry practices such as castrating, dehorning, docking, and ear tagging should be modified, avoided, or done during seasons when screwworm flies are at low levels, as should planning newborn animal arrivals, if feasible.248,249,251 Prophylactic measures may include organophosphate dips and sprays, ivermectin and doramectin injections, and topical applications of insect growth regulators such as dicyclanil.[273]

Because vaccines and other associated biologicals have not been developed to prevent screwworm infestation,248,249 sterile insect technique is the only proven method for successfully eradicating the screwworm from infested areas.274–277 The sterile insect technique is comprised of the following consecutive steps: (a) Male pupae are irradiated with gamma rays rendering emerging males infertile[278]; (b) a higher number of sterile males than exists in the local screwworm population is released via aerial dispersion into the endemic area; (c) the sterile males mate with female screwworms flies, and (d) unfertilized eggs are oviposited. Male screwworm flies mate several times while female screwworms mate only once, a physiological feature contributing to the technique’s overall success.[279] This procedure, in concert with topical insecticide application, decontamination of animal conveyances, aggressive and committed government regulatory support, and public information campaigns, is vital to eradication programs.249,280

For example, animals should be rigorously inspected before and after shipment using consistent quarantine procedures. Within 5 days prior to shipment, MWAs and companion animals returning to the United States from screwworm endemic areas need a valid health certificate specifically stating that the animal in question has been inspected and found to be free of screwworms. Additionally, transport vehicles, other conveyances, and holding equipment should be treated with insecticides to kill any adult or immature screwworms.248,249,251,280

African and Classical Swine Fever

Introduction and Military Importance

African swine fever (ASF) and classical swine fever (CSF), also known as hog cholera, are highly contagious, viral pig diseases. Both have devastating impacts on a country’s pig industry and can lead to trade restrictions.

ASF and CSF are reportable diseases not only in the United States, but also to the OIE.[47] According to the Food and Agriculture Organization of the United Nations, ASF is also considered a transboundary disease because of the contagious nature of the disease, high mortality rate of some strains, potential for very rapid spread across national borders, and substantial effect on national economies.[281]

ASF and CSF viruses are easily introduced into an area via imported infected pork products; pigs that eat unprocessed garbage containing infected tissue; and fomites such as vehicles, equipment, and personnel.[211] DoD personnel—military and civilian—contribute to disease transmission by transporting infected pig products or acting as fomites for the viruses during movements between countries (eg, foreign humanitarian assistance or veterinary stability operations missions) and upon redeployment. While ASF and CSF are highly contagious diseases in swine, humans are not susceptible to either virus.[47]

Description of the Pathogen

ASF virus, an enveloped DNA virus, is the only member of the genus Asfivirus, family Asfarviridae,47,211,282 and the only arthropod-borne DNA virus. Although different strains have varying virulence, there is only one recognized serotype.47,249,282

CSF virus is an enveloped RNA virus and a member of the genus Pestivirus, family Flaviviridae. Only one serotype has been identified, although there are many strains. CSF virus is closely related to the ruminant pestiviruses responsible for bovine viral diarrhea/mucosal disease complex and border disease of sheep and goats. Ruminant pestiviruses can infect pigs, producing congenital infections similar to those seen with CSF.47,211

Epidemiology

Transmission. ASF virus is transmitted oronasally by contact with infected animals, infected body fluids and tissues, especially blood, and via the soft tick Ornithodoros moubata.47,211 Viral transmission in ticks occurs transovarially, transstadially, and sexually, which means infected tick colonies can maintain the virus for years.47,282 O moubata lives in warthog burrows, infecting newborn hogs shortly after birth.47,211

CSF virus is spread orally or oronasally by direct or indirect contact with infected tissue, blood, secretions, and excretions including semen.[47] The virus is also transmitted transplacentally.47,249 Mechanical transmission by birds, insects, and other wild or domestic animals may occur. In studies, airborne transmission up to 1 km has been reported.[47]

Most ASF and CSF infections are introduced through the practice of feeding garbage containing unprocessed infected pig products. The viruses can also be transmitted by contaminated vehicles, equipment, and clothing.47, 211

Geographic Distribution. Although ASF has never been reported in the United States, it is endemic in most of sub-Saharan Africa and the islands of Sardinia and Madagascar, with the highest incidence occurring just north of the equator.47,211,282 During the 1970s, ASF was confirmed in the Caribbean and South America but has now been eradicated from these countries. The disease also has been eradicated from most of Europe, with confirmations only in Armenia, Azerbaijan, the Republic of Georgia, and Russia.47,282

CSF can be found worldwide. Although the prevalence of the disease on the African continent is unknown,[283] it is endemic in Asia, with a higher prevalence in East and Southeast Asia, India, and China as well as the island of Madagascar; Mauritius; the Caribbean islands of Cuba, Haiti, and the Dominican Republic; Central America, with the exception of Belize and Panama; and South America, with the exception of Chile and Uruguay.47,211,283

The disease is endemic in southern Mexico where there is a large number of backyard pig populations.[283] While vaccination is used in southern Mexico to control CSF, Central Mexico is considered a control zone where vaccination is not practiced, and northern Mexico is CSF-free. CSF also has been eradicated from Australia, New Zealand, the United States (the last case was reported in 1976), and Canada. CSF has been eradicated from domestic herds in most of Western and Central Europe as well, but the virus remains endemic in the wild boar population in certain parts of Europe.47,211

Host and Reservoir Species. ASF produces clinical disease in domestic swine, feral pigs, and European wild boars.47,211 The virus infects warthogs, bush pigs, forest hogs, and the peccary, but these species are asymptomatic. The first three species are considered reservoirs for the virus in Africa, and the peccary is a potential reservoir in the Americas. In Africa, the disease is maintained by transmission between the warthog and Ornithodoros species.47,211,282 Unlike ASF virus, domestic pigs and wild boars are the only reservoirs for CSF virus; there is no vectorborne component.[47]

Pathogenesis and Clinical Findings

ASF’s incubation period varies from less than 5 days after tick exposure to 5 to 19 days following direct contact with infected pigs.47,211,249 The more virulent strains produce peracute or acute disease in less than 1 week. Less virulent strains spread more slowly through herds, often lingering for several weeks, causing chronic disease that produces milder symptoms easily confused with other diseases (eg, emaciation, stunting, swollen joints, and respiratory problems).47,282

With more virulent strains, mortality rates may be as high as 100%; death occurs within 7 to 10 days from onset of clinical signs, especially in young animals. Although sudden death may be the first sign of ASF infection in herds,[47] other characteristic clinical signs of peracute and acute disease include high fever, inappetence, recumbency, and cyanotic skin blotching or petechial hemorrhages on the skin, especially the ears, tails, legs (Figure 11-11), and abdomen.47,211,249 Epistaxis and hematochezia also may be observed. Pregnant animals frequently abort. At necropsy, hemorrhagic lesions are observed in the spleen, kidneys, heart, and lymph nodes (Figure 11-12). Animals that recover from acute or chronic ASF are persistently infected and serve as carriers.47,49

CSF’s incubation period ranges from 5 to 15 days. With low virulence strains, the only observable signs may be poor reproductive performance, decreased litter size, stillbirths, and piglets born with neurological deficits. Piglets appearing asymptomatic at birth are viremic and invariably develop clinical disease within a few months, with 100% mortality occurring within the first year.47,211,284,285

Figure 11-11. Swine: Cyanotic discoloration of the skin seen with African and Classic Swine Fevers.
Photo courtesy of Dr Jens Teifke, Institute of Molecular Biology, Friederich-Loeffler Institute, Federal Research Institute for Animal Health, Riems, Germany.

Figure 11-12. Swine: Swollen kidney with petechial hemorrhages seen in acute disease with African and Classic Swine Fevers.
Photo courtesy of Dr Jens Teifke, Institute of Molecular Biology, Friederich-Loeffler Institute, Federal Research Institute for Animal Health, Riems, Germany.

Acute CSF is usually associated with highly virulent strains, with corresponding high morbidity and mortality.[47] Clinical signs include fever, anorexia, weakness, constipation followed by diarrhea, and incoordination progressing to hind limb paralysis.47,211 Convulsions may be observed during the terminal stages of the disease. Death occurs within 2 to 3 weeks following onset of clinical signs.47,211

Petechial hemorrhages and cyanotic discolorations may also develop on the ventral abdomen, medial thighs, ears, and tail. At necropsy, petechial and ecchymotic hemorrhages are seen on the lymph nodes, kidneys, spleen, bladder, and larynx. Nonsuppurative encephalitis with vascular cuffing may also be present.47,211

The subacute form of CSF is typically seen in older pigs.[47] Although subacute morbidity and mortality rates are lower than the acute form, detection is more difficult. Fever may be the only symptom.[285]

The chronic form of CSF occurs with less virulent strains or in partially immune herds. Affected pigs appear to recover within a few weeks, but symptoms recur, wax, and wane for several weeks to a few months, with progressive loss in condition and eventual death.47,211

Morbidity is lower with chronic CSF infections (ie, only a few animals in the herd may be affected) but results in 100% mortality. At necropsy, necrotic foci or button ulcers are observed in the mucosae of the larynx and epiglottis and in the intestinal mucosae near the ileocecal junction. In young, growing pigs that survive more than 30 days, bone lesions may be seen at the ribs’ costochondral junctions and on long bones’ growth plates.47,211

ASF and CSF are clinically indistinguishable.[211] Differential diagnoses include acute porcine reproductive and respiratory syndrome, porcine dermatitis and nephropathy syndrome, erysipelas, other septicemias, warfarin, and heavy metal toxicoses.[47] When congenital infections are observed, infections with ruminant pestiviruses also must be ruled out in breeding pigs. As with other viral infections, concurrent bacterial infection (eg, porcine dermatitis and neuropathy syndrome, salmonellosis, and erysipelas) can mask and delay the diagnosis of underlying ASF virus and CSF virus infections.[249]

Diagnostic Approaches

To confirm ASF, laboratory diagnostics are necessary and include virus isolation, fluorescent antibody tests, and PCR. Virus isolation, particularly the hemadsorption test, is the preferred diagnostic methodology because a positive result is a definitive diagnosis. During this procedure, blood, spleen, lymph node, tonsil, or kidney tissue is inoculated into pig leucocytes (ie, monocytes or macrophages) or bone marrow cultures. A positive result is obtained when pig erythrocytes adhere to pig monocytes or macrophages infected with ASF virus (ie, hemadsorption).47,249

PCR is the most sensitive test for detecting the virus in persistently infected animals or when virus isolation cannot be performed. In endemic areas, serology using serum or tissue fluids also is utilized. A combination of the ELISA and indirect fluorescent antibody test or immunoblotting test is used to detect subacute or chronic disease. The ELISA is also the prescribed test for international trade.

The laboratory diagnostics necessary to confirm CSF have inherent pros and cons. Virus isolation, the “gold standard,” is labor intensive and takes 3 to 7 days to obtain results.211,284 The virus neutralization test, the most sensitive and specific test for antibodies, can cross-react with ruminant pestivirus infections in pigs. Direct IFA and ELISA are rapid tests, but these antigen detectors require skilled personnel and specific samples. In general, tissue samples from the tonsils, distal ileum, spleen, lymph nodes, and kidney are the preferred submissions for CSF virus antigen testing. However, tonsils are the best tissue to sample for testing during acute disease because they are infected first. During subacute or chronic disease, the distal ileum may be the only tissue to yield a positive result.47,211,249

Because CSF virus antibodies do not develop until 2 to 3 weeks after being infected but persist for life,[47] serology is more appropriate for testing sows with poor reproductive performance or who are producing piglets with neurological deficits and for surveillance in wild boar and feral pig populations.47,211,284 Congenitally affected pigs, though viremic, are usually negative on serology.

The two prescribed tests for detecting CSF in international trade are the neutralizing peroxidase-linked assay (NPLA) and the fluorescent antibody virus neutralization test (FAVN).[249] Either test will differentiate CSF from ruminant pestivirus infections in breeding animals.[47]

Since hemadsorption does not occur in cells infected with CSF, the hemadabsorption test is used to distinguish ASF from CSF. Reverse-transcriptase PCR can also differentiate the two diseases. Based on overall testing advantages and disadvantages, the three tests used most commonly for ASF and CSF are the NPLA, FAVN, and ELISA.47,211,249

Recommendations for Therapy and Control

No treatment or vaccine is available for ASF, so preventing ASF virus introduction is critical. Control methods include eliminating importation of infected pork and pig products, safeguarding movement of carrier animals, providing adequate biosecurity, and banning use of unprocessed garbage containing infected pig blood or tissue as feed.47,211 (If pigs must be fed trash, it should be cooked for 30 minutes at a temperature of at least 70°C to prevent ASF.[47]) Effective tick control with acaricides also should be implemented in O moubata endemic areas.

Because the virus can survive for extended periods of time on fomites, strict quarantine, sanitation, and disinfection must be enforced as well. Effective disinfectants include sodium hypochlorite and some iodine and quaternary ammonium compounds. Rapid diagnosis, slaughter of infected and contact animals, and proper disposal of carcasses are also essential to successful eradication programs.

Animals diagnosed with CSF should not be treated. All symptomatic and contact animals must be slaughtered and the carcasses properly disposed of. All animals on affected premises and neighboring premises within a 500-m radius should be depopulated. Similar to control and prevention measures for ASF, strict quarantine, movement control, and thorough cleaning and disinfecting of infected premises should be enforced.

A live attenuated vaccine is available and used in endemic areas.211,284 While vaccination does control clinical disease, it allows the CSF virus to continue to circulate subclinically. Vaccination is, therefore, not recommended if the goal is eradication because it is not possible to differentiate between vaccinates and field-infected animals. The European Union (EU) controls CSF by stamping out or depopulation. However, central and eastern European countries do vaccinate during an outbreak.

Methods to prevent introduction of CSF into a country or region are similar to those for ASF. Additional methods include decreasing the pig density in high-risk epidemic areas, minimizing live animal markets, and monitoring the disease in the wild boar and feral pig population.[285] In CSF-free countries, periodic surveillance sampling of domestic herds is recommended to monitor for reintroduction of the disease.[47]

Some methods to prevent introduction of CSF virus into a country or region are similar to those for ASF virus. CSF virus is readily inactivated or destroyed by heat, drying, ultraviolet light, and most detergents, including sodium hypochlorite and phenolic compounds.[47] The virus is destroyed by cooking to a temperature of 65.5°C for 30 minutes. However, CSF virus can survive for weeks in refrigerated meats and bodily secretions and for years in the frozen state. Smoking or salt curing pork and pig products also does not destroy or inactivate CSF virus because these proteinaceous environments protect it.47,211

Additional CSF virus control methods that differ from ASF virus measures include decreasing the pig density in high-risk epidemic areas, minimizing live animal markets, and monitoring the disease in the wild boar and feral pig population.[285] Because some countries import European wild boar for the purposes of hunting, such vigilance is necessary.[283] In CSF-free countries, periodic surveillance sampling of domestic herds is also recommended to monitor disease reintroduction.[47]

Because the impact these viruses pose on the swine industry and trade is tremendous, certain control measures are also mandated. For example, during a CSF outbreak in the Netherlands in the late 1990s, over 8 million pigs had to be slaughtered, costing $2.3 billion.[286] Now the EU mandates that live pigs and fresh pig products may only be imported from countries or regions where no cases of CSF or vaccination against CSF has occurred within the past 12 months.[284] The United States will only import pigs and pig products from countries declared CSF-free by the OIE. Furthermore, if any EU nation has a CSF outbreak, the United States will prohibit imports of all pigs and pig products from all EU nations and will not resume trade with the EU until 6 months have passed since slaughter of the last infected herd.[286]

To honor these mandates, returning DoD personnel who have been to ASF and CSF endemic areas should neither smuggle in illegal pig products or inadvertently introduce the viruses via their clothing or equipment if they have been in contact with wild or domestic pigs in these areas.

Foot and Mouth Disease

Introduction and Military Importance

Although foot and mouth disease (FMD) affects cloven-hoofed animals, military personnel are still concerned about this severe, highly contagious disease because inadvertent spread can result in serious socio-economic and trade consequences similar to those caused by swine viruses. FMD is an OIE-listed disease based on its proven ability to spread internationally with serious socio-economic consequences and the potential for significant trade and travel restrictions.[281]

In general, FMD is endemic in developing countries already prone to food insecurities; spread of the disease only intensifies subsistence problems because surviving animals are less efficient for work and meat and milk production. In FMD-free countries, which are often developed, introduction of FMD would result in export bans, which, in turn, would lead to long-term, significant economic consequences. Because of these concerns, military personnel worry about FMD being used as a bioterrorist weapon.[287] According to a Government Accountability Office report, just one case of FMD in the United States would cause international trading partners to prohibit exports of US live animals and animal products, resulting in losses of up to $6 to 10 billion a year until the United States regained disease-free status.[288]

The USDA has identified key pathways through which this highly contagious disease might enter the United States, including on imported live animals or in animal products; on the shoes of, or in packages carried by, international passengers; in international mail; and in garbage from international carriers.[288] The USDA recommends that travelers from countries with FMD avoid contact with susceptible animals for 5 days after entry into the United States.[289] These recommendations are important for service members and their families to follow, given their frequent travel to FMD-endemic countries. In addition, service members and their families should heed recommendations protecting foreign regions and countries when deployed or stationed overseas. For example, during the 2010 to 2011 FMD outbreak in the Republic of Korea, the US 8th Army advised personnel to avoid travel to certain areas and implemented numerous other precautions such as vehicle spray points.[290]

Description of the Pathogen

FMD is caused by a virus from the genus Aphthovirus of the Picornaviridae family. There are seven immunologically distinct serotypes (A, O, C, SAT1, SAT2, SAT3, and Asia1) and over 60 strains within these serotypes.47,291 All cloven-hoofed animals, including cattle, pigs, sheep, goats, buffalo, deer, antelope, wild pigs, elephants, and giraffe can become infected with FMD virus (FMDV). Old World camels appear to be resistant to FMD, while alpacas and llamas are only mildly susceptible, so neither likely plays an epidemiologic role.[291] Cattle are usually the most important maintenance hosts, but certain strains are found mostly in pigs, sheep, or goats.47,291 Wildlife, other than African buffalo, have not been shown to be maintenance hosts.[291]

FMDV is preserved by refrigeration and freezing but becomes progressively inactivated starting at 50°C and is quickly inactivated at a pH less than 6.0 or greater than 9.0. FMDV typically remains viable in the environment for less than 3 months, although it can survive up to 6 months in very cold climates. Organic materials can also protect the virus from sunlight and drying and interfere with disinfectant effectiveness, prolonging environmental viability.47,291

FMDV also survives in lymph nodes and bone marrow at a neutral pH, and especially when chilled or frozen, but is destroyed in muscle at a pH less than 6.0, which occurs with rigor mortis.47,291 The virus can survive high temperature, short-time pasteurization of milk and milk products but is inactivated by ultra-high temperature pasteurization.[291]

Epidemiology

Transmission. FMDV is easily transmitted via numerous pathways, including direct contact between infected and susceptible animals, indirect contact via contaminated fomites, inhalation of aerosols, artificial insemination with contaminated semen, ingestion of contaminated milk by calves, and consumption of untreated contaminated meat products by pigs. FMDV is found in all secretions and excretions of acutely infected animals up to 4 days before clinical symptoms are observed. Studies estimate airborne FMDV can travel up to 60 km over land and 300 km over sea.[291]

The FMDV transmission process is further complicated by the asymptomatic carrier state and human exposure to the virus. Some animals with either natural or vaccine-induced immunity enter into this state if exposed again to FMDV and harbor the virus in the oropharynx for over 28 days.[291] Approximately 15% to 20% of cattle become carriers upon reexposure, and most will remain carriers for less than 6 months. Domestic buffalo, sheep, and goats are only carriers for a few months; however, African buffalo may remain in the state for up to 5 years.47,287,291 Humans can harbor the virus in the respiratory tract for up to 48 hours.[47]

Geographic Distribution. Anywhere cloven-hoofed animals exist, a risk also exists for FMDV. However, it is only endemic in parts of Asia, Africa, the Middle East, and South America. Serotype O, the most common worldwide, was responsible for the Pan-Asian epidemic that started around 1990.[47]

In general, serotypes A and O are found in Africa, Asia, and South America; serotypes SAT1, 2, and 3 are currently only in Africa; and Asia1 is only found in Asia. Given these parameters, Afghanistan is of particular worry because serotypes A, O, and Asia1 are all endemic.[292]

Serotype C is extremely rare now. North America, New Zealand, Australia, Greenland, Iceland, and most of Europe are FMD-free.47,292,293

Incidence. Although the 2001 FMD serotype O outbreak in the United Kingdom was the single largest FMD epidemic recorded in history, numerous other countries that were previously FMD-free have recently experienced serotype O outbreaks, including Japan, in 2000; France and the Netherlands, in 2001; and the Republic of Korea, in 2002.[292] Since 2010, ongoing serotype O outbreaks have emerged in the Republic of Korea, Japan, China, North Korea, Russia, Hong Kong, and Mongolia.[294]

In fact, according to the OIE disease outbreak maps, 43 countries reported FMD outbreaks in the year 2011 alone, with Iran and Turkey each reporting over 1,000 outbreaks. However, because not all countries reported data, including many of the countries known to have endemic FMD, the number of actual outbreaks should be significantly higher. (FMD is underreported for numerous reasons, ranging from trade implications at the country level to risk of having animals culled at the individual and community levels.) Despite these relatively high numbers, according to the OIE, as of 2011, 65 countries are considered FMD-free without vaccination, while Uruguay is considered FMD-free with vaccination. Fifteen more countries have FMD-free zones with or without vaccination.[293]

Pathogenesis and Clinical Findings

Depending on virus dose and route of infection, the incubation period for FMDV ranges from 2 to 14 days.47,291 Morbidity can reach 100%, with severity of signs varying by strain, exposure dose, age, breed, species, and level of immunity. Young animal mortality can be over 20%, with myocarditis as the main cause of death. In adult animals, mortality is low (1%–5%), with recovery in approximately 2 weeks in uncomplicated cases.[291]

While cattle, pigs, and small ruminants all can be infected with FMD, their clinical signs differ somewhat. Cattle show the most severe signs, exhibiting pyrexia, anorexia, shivering, and reduced milk production for about 2 to 3 days before vesicles appear. These vesicles are 2 to 10 mm in diameter, appearing on buccal and nasal mucous membranes, between claws and coronary bands, and on mammary glands. Because the vesicles are painful, cattle may smack lips, grind teeth, drool, show lameness, or stamp and kick their feet. After about 24 hours, the vesicles rupture, leaving ulcers or erosions (Figure 11-13) leading to complications such as superinfected lesions, mastitis with permanently impaired milk production, hoof deformation, myocarditis, abortion, permanent weight loss, and loss of heat control. The ulcers and erosions also may become covered in a fibrinous coat and appear like a dry, necrotic lesion.47,291

Pigs develop pyrexia, anorexia, and then, vesicles. The vesicles can occur on the snout (Figure 11-14) but are more severe on the feet. Vesicles may cause claw horn detachment, resulting in such severe pain that infected pigs might crawl rather than walk. In addition, ulcers and erosions in the pig’s oral cavity tend to have a fibrinous coat, appearing like the cattle’s dry, necrotic lesions. Small ruminants tend to not show as many clinical signs as cattle and pigs, but infected sheep and goats may display signs of pyrexia, mild lameness, mild oral lesions, and agalactia.[295]

Figure 11-13. Ulceration of a bovine tongue following rupture of vesicles caused by the foot and mouth disease virus.
Photo courtesy of Bruce H. Williams, Doctor of Veterinary Medicine, Senior Pathologist, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

Figure 11-14. Vesicles on a pig snout caused by the foot and mouth disease virus.
Photo courtesy of Bruce H. Williams, Doctor of Veterinary Medicine; Senior Pathologist, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

Diagnostic Approaches

FMD is clinically indistinguishable from vesicular stomatitis, swine vesicular disease, and vesicular exanthema of swine and has a long list of other differential diagnoses, making field diagnosis extremely challenging.[291] Diagnosis can be made in the laboratory via virus isolation, detection of viral antigens or nucleic acids, and serology.[47] The best samples for laboratory testing include tissue and fluid from an unruptured or recently ruptured vesicle and esophageal-pharyngeal fluid collected with a probang cup. Any laboratory testing for FMD virus should meet OIE requirements for Containment Group 4 pathogens and numerous precautions need to be taken prior to sending suspect FMD material within and between countries. The recent availability of commercial pen-side tests may help to mitigate these restrictions.[291]

Recommendations for Therapy, Prevention, and Control

Because FMD impacts not only animal health and productivity, but also trade restrictions and the economy, FMD must be prevented from entering countries or regions that are currently virus-free, and disease outbreaks in endemic areas must be controlled. Prevention occurs via both sanitary and medical prophylaxis. Because FMD is often introduced into a country via contaminated feed or infected animals, border control, surveillance, and quarantine are important for protecting FMD-free zones.47,291

In the event of an FMD outbreak, quarantine and movement restrictions, euthanasia of infected and contact animals, and cleaning and disinfection of premises and equipment are necessary for control. Carcasses, bedding, and contaminated animal products should be incinerated, buried, rendered, or disposed of via other appropriate techniques. Premises and all contacted material, including vehicles, equipment, and clothing, should be cleaned and disinfected, removing as much organic material as possible from fomites and surfaces prior to disinfection.

The decision to vaccinate as medical prophylaxis must be carefully considered from scientific, economic, political, and societal perspectives because consequences vary, based on choices made. For example, live attenuated vaccines can revert to virulence, making it difficult to differentiate natural infection from vaccination. Two types of inactivated vaccines are available—(1) a commercially produced standard potency vaccine, providing 6 months of immunity for use in endemic regions, and (2) a high-potency vaccine for use in outbreak situations47,291—but vaccination against one serotype does not provide protection against other serotypes; even variation within serotype strains causes vaccination failure.[292]

Further, if vaccination is used to control an outbreak and vaccinated animals were not culled, a country may not be declared FMD-free until after 1 year with no evidence of infection because vaccinated animals may become carriers. However, if vaccination is not used, a country may be declared FMD-free after only 3 months with no evidence of infection.[291]

Service members and US government agencies can initiate several control measures to keep the FMD virus out of the United States. Similar to civilians clearing US customs, service members must declare agricultural products and disclose whether they were on farms or in contact with animals while overseas. Because contaminated items will not be allowed into the United States, all personnel’s clothing, gear, and equipment (eg, tents, weapons, and vehicles) should be thoroughly cleaned and arrive at US Customs free of any soil, manure, or debris.[295]

The USDA also works to ensure military units or groups returning stateside (eg, animal disease eradication missions) do not harbor infectious agents such as FMD virus. With advanced notification (7 or 30 days, depending on small-scale or large-scale operations) the USDA can determine if extra cleaning facilities are available at the first port of entry, should anything be deemed contaminated and inadmissible when first checked.[295]

Because humans can harbor FMDV in the respiratory tract for up to 48 hours, personal protective equipment needs to be used when disinfecting items utilized in endemic areas. A 3- to 5-day personal quarantine should also be implemented if exposure is suspected.[291]

Highly Pathogenic Avian Influenza

Introduction and Military Importance

While highly pathogenic avian influenza (HPAI) has had little to no direct impact on the US military, it remains a significant threat and is in the top 20 diseases of military importance[296] because of its potential impact on service member health and military readiness, as evidenced by the 1918 to 1919 influenza pandemic. Although most influenza viruses typically kill the very young or old, the 1918 virus resulted in significant morbidity and mortality rates among young adults of military age.[297] Influenza attack rates exceeding 70% were reported among US and Australian naval warships, and an estimated 1.1% of the entire US Navy force died of influenza-pneumonia during the pandemic.[298] Additionally, militaries may have played an important role in the transmission and global spread of the 1918 to 1919 pandemic virus.[299]

As a result of its military importance and potential global impact, the US military maintains an extensive global influenza surveillance system. During the 2009 influenza pandemic, this system not only detected the initial virus, but also contributed a seed virus for the vaccine.[300] This surveillance network also detected the 2009 pandemic virus in US service members stationed abroad prior to initial detection in the local population, again suggestive of the military’s potential role in facilitating global virus spread (Armed Forces Health Surveillance Center quarterly surveillance reports, unpublished data, 2010).

Description of the Pathogen

Influenza viruses are single strand RNA viruses within the Orthomyxoviridae family and belong to one of three genera: influenzavirus A, B, or C. Influenza A viruses are further subtyped according to 16 hemagglutinin and nine neuraminidase surface proteins. Birds, able to be infected with all known subtypes of influenza A viruses, are considered to be the primary virus reservoirs, but other species including cats, dogs, horses, and pigs, and humans can also be infected.[301]

The classification between high and low pathogenic avian influenza (AI) refers to the virus’ ability to cause illness in domestic poultry. While any influenza A subtype can theoretically become highly pathogenic, to date, all HPAI viruses have been H5 and H7 subtypes. Since 2004, the majority of HPAI outbreaks are of the H5N1 subtype.[302]

Epidemiology

Transmission. Among birds, HPAI is primarily transmitted through direct contact and through fecal contamination of feed, water, and other fomites (eg, clothing, shoes, and farm equipment). Fecal-oral transmission is especially important as virus persist in water for at least 30 days at 0°C. While movement of infected waterfowl is believed to be the primary means of global transmission, movement of infected domestic poultry or poultry products may also be an important exposure route. Airborne transmission is also possible among birds living in close proximity but is of lesser importance than direct contact or fecal-oral transmission.[303]

Swine, and on rare occasions, humans may also serve as sources of avian infection.304,305 While the majority of human cases result from direct contact with poultry or poultry products, human-to-human transmission of HPAI has occurred on rare occasions but is generally limited and inefficient without sustained transmission. Swine may become infected with H5N1, HPAI, and other AI viruses, with the potential to serve as an intermediate host between avians and humans. Canine and feline infection with H5N1 has been reported, primarily through consumption of infected meat; however, their role as infection sources for avians and humans is unclear.[306]

Geographic Distribution. All countries are theoretically at risk for HPAI introduction because wild birds, especially waterfowl, which serve as the natural reservoir for AI viruses, may travel large distances during seasonal migrations. Additionally, any low pathogenic AI (LPAI) virus can theoretically mutate and become highly pathogenic through genetic drift and shift. In practice, though, HPAI, specifically H5N1, is only considered endemic in southeastern Asia and northern Africa, specifically Egypt, where the majority of outbreaks among domestic poultry are reported. Occasional outbreaks have also been reported from Australia, the Americas, Europe, the Middle East, and other regions in Africa and Asia. Since 2008, no human case of H5N1 has been reported outside of southeastern Asia and northern Africa.[302]

Incidence. Since 1955, when AI viruses were discovered, over two dozen HPAI epidemics have occurred globally.302,303 The most recent H5N1 outbreak (ongoing since 1997 when it was first reported) affected 1.4 million domestic chickens in China. Since then, it has affected dozens of countries and hundreds of millions of domestic birds. In 2011, 15 countries officially reported outbreaks of H5N1 among domestic birds to the OIE. In addition to the ongoing H5N1 epidemic, several smaller and better-controlled HPAI epidemics involving H5N2, H7N3, and H7N7 viruses have occurred in recent years.[302]

Estimating the true incidence of HPAI is difficult for multiple reasons. Initial detection of HPAI within domestic poultry and duck populations often triggers mandatory culling and depopulation of infected flocks on home farms and potentially neighboring farms as well. Because depopulation often destroys hundreds of thousands of bird carcasses, individual testing is generally not feasible. Mandatory flock destruction may also cause underreporting: poultry owners may be unwilling to report or test ill birds fearing the possibility of losing their flock and investments.

Estimating the incidence of HPAI infection among wild waterfowl and birds is even more problematic because these species may be asymptomatic and thus not be sampled or tested. HPAI prevalence in wild birds also varies by species, season, and geography. For example, only 0.82% of 3,000 fecal, cloacal, and nasal swabs from wild birds, domestic poultry, and swine in Uganda were influenza PCR-positive, and none were HPAI-positive.[307] Conversely, among 728 fecal samples from wild birds in Mongolia, 14 samples (1.9%) were positive for HPAI viruses. Routine surveillance has also detected HPAI viruses along flyways in Europe and elsewhere in Asia.[308]

Pathogenesis and Clinical Findings

HPAI refers to a particular viral strain’s virulence in chickens only. Wild birds, especially waterfowl, may show little to no overt signs of clinical illness, despite being infected with an HPAI virus. The incubation period is generally between 1 to 7 days; however, the OIE recognizes a 21-day period.[309]

Morbidity and mortality vary by strain and infective dose but may approach 100% in HPAI infections. In fact, the sudden death of large numbers of birds without clinical signs or gross lesions is a common finding in HPAI infections. In those birds that do show signs, the majority will die within 72 hours or less of the onset of clinical signs, which are not specific, and with the exception of depression, vary by viral strain. These signs include decreased feed and water consumption, decreased egg production, ruffled feathers, and watery diarrhea. Respiratory disease is reported to be less common in HPAI infections than LPAI infections but may be present. In broiler flocks, clinical signs may be less obvious, and birds may also exhibit neurologic symptoms such as ataxia, paralysis, and torticollis.[309]

While LPAI infections in domestic poultry may also be asymptomatic, when present, the most common clinical signs of LPAI are respiratory related and include difficulty breathing, swollen sinuses, and nasal discharge. Decreases in feed and water consumption are common, and ill birds may huddle together or near heaters. Laying thin-shelled and misshapen eggs and producing fewer eggs (ie, a 5%–30% production drop) are also common signs, especially among turkeys.[248]

In most other infections, edema and cyanosis of the feet, head, and legs (Figure 11-15), as well as splenomegaly, are commonly reported. Splenomegaly is generally more pronounced with later deaths. Renomegaly with urate accumulation of the ureters is another repeated finding. Pulmonary congestion, edema, and hemorrhage are frequently reported in chickens, guinea fowl, and turkeys but less so in Chukars, pheasants, and quail.310,311

Histopathologically, common lesions are encephalitis, myocarditis, pancreatitis with acinar necrosis, myositis, and edema and inflammation of the comb. Neuronal necrosis is generally diffuse but particularly involves Purkinje neurons that also may contain intranuclear, eosinophilic inclusion bodies that stain positive for influenza nucleoprotein. Cardiovascular lesions include endothelial cell hypertrophy and multifocal lymphocytic myocarditis with necrosis. Lymphocyte depletion and necrosis in primary (eg, thymus) and secondary (eg, spleen and cecal tonsil) lymphoid tissues and mild to moderate interstitial pneumonia have also been reported.310,311

Figure 11-15. Poultry: Cyanosis, edema, and hemorrhage of the comb.
Photo courtesy of Bruce H. Williams, Doctor of Veterinary Medicine, Senior Pathologist, Department of Defense Joint Pathology Center, Silver Spring, Maryland.

Diagnostics Approaches

A presumptive field diagnosis may be made in affected flocks with high mortality and the aforementioned clinical signs. In live birds, oropharyngeal and cloacal swabs are the preferred samples, although fresh feces are an acceptable alternative. Preferred or alternative samples plus samples from the trachea, lungs, air sacs, intestine, spleen, kidney, brain, liver, and heart should be collected. All samples should be shipped on dry ice in phosphate-buffered saline and tested as soon as possible. When immediate testing is not possible, samples may be stored at minus 4°C for up to 4 days.[249]

Samples can be screened for AI viruses via agar gel immunodiffusion or AGID, ELISA, or hemagglutination inhibition. Recently, reverse transcriptase PCR has frequently been used to detect AI virus because it provides results in 3 hours. One such tool used within the Veterinary Corps is the Joint Biological Agent Identification and Diagnosis System or JBAIDS, a ruggedized PCR platform.[307] Using this platform, deployed veterinary personnel can detect the AI matrix gene and identify H5 and H7 genes in field samples. However, while reverse transcriptase PCR and rapid antigen capture immunoassays may be used to detect Type A influenza antigen, additional testing is required to definitively diagnose HPAI versus LPAI.

Virus pathotype may be determined by sequencing the hemagglutinin cleavage site and comparing this to known amino acid sequences of HPAI viruses or through in vivo pathogenicity testing in chicks. Viruses are considered highly pathogenic if mortality in eight, 4- to 8-week-old, intravenously infected chickens is at least 75% within 10 days postinoculation; or the intravenous pathogenicity index in ten, 4- to 8-week-old chicks is greater than 1.2.[249]

To calculate the intravenous pathogenicity index, each bird is examined once daily for 10 days and scored as normal (0), sick (1), severely sick (2), or dead (3). The index is the mean score per bird per observation over the 10-day period. All isolates that meet either of the above definitions or have sequences similar to other known HPAI viruses are classified as HPAI. H5 and H7 isolates that are nonvirulent and lack similar hemagglutinin cleavage-site amino acid sequences to known HPAI viruses are classified as LPAI. All nonvirulent, non-H5, and non-H7 isolates are similarly classified as LPAI viruses.[249]

Recommendations for Therapy and Control

Detection of any HPAI virus in domestic poultry requires OIE notification through the host nation’s chief veterinary officer. All H5 and H7 viruses, regardless of virulence, are also notifiable diseases because these viruses mutate into more virulent forms.

Control of HPAI is generally directed at prevention of initial infection and subsequent spread. Although several antivirals, including adamantanes and neuraminidase inhibitors, are available for use in humans, they are not approved for use in birds. Treatment of infected birds is symptomatic but is not recommended. Instead, the USDA recommends this rapid, five-step reaction when responding to HPAI outbreaks: (1) Quarantine: restrict movement of poultry and poultry-moving equipment into and out of the control area; (2) Eradicate: humanely euthanize all infected flocks; (3) Monitor disease within the region: implement a broad area of testing to identify other infected farms and subsequent spread of disease; (4) Disinfect farms: clean and disinfect equipment and premises (most detergents and disinfectants kill AI); and (5) Test: confirm that the poultry farm is AI virus-free prior to restocking.[312]

Conventional and recombinant vaccines are available for several influenza viruses, including HPAI types. Most routine vaccinations are directed towards circulating LPAI strains; however, they have been used to prevent spread during past HPAI outbreaks and may be used in highly endemic HPAI countries or regions.[249]

Vaccination can reduce clinical signs and mortality in subsequent infections, decrease viral shedding, and increase the infective dose required for transmission; however, effectiveness varies by species and, more importantly, may not consistently prevent infection. Vaccination is also limited by three other factors: (1) the need to match the vaccine virus with the circulating wild type virus, which is inhibited by viral shift and drift; (2) the need for manual injection of vaccines into individual birds; and (3) the difficulty in identifying infected birds within vaccinated flocks.

Although vaccination may help control disease spread, effective prevention relies more on implementation of proper biosecurity measures. All live birds imported into the United States must spend 30 days in an approved USDA quarantine facility where they are tested for HPAI. Returning US origin birds may be home quarantined, and birds arriving from Canada are exempt.[312]

Transportation of equipment between farms is discouraged; however, when necessary, all equipment should be thoroughly cleaned and disinfected prior to transport. In endemic regions, all equipment should similarly be cleaned and disinfected prior to redeployment.

Visitor access to farms should also be restricted, and all personnel should change into clean clothing and disinfect their shoes prior to entering hen houses. Clothing should be removed and shoes disinfected again upon exiting the hen house to further prevent transmission.

Finally, personnel should be familiar with the clinical signs of AI and report all sick or dead birds immediately, especially in HPAI-endemic regions or countries. Personnel should also wash their hands and avoid touching their mouths and noses after handling raw products and use recommended cooking times and temperatures (ie, 165°C for 15 seconds) to inactivate AI viruses in all raw meat, eggs, and egg products.[312]

SUMMARY

Infectious diseases have long posed a threat to military health and will likely continue to do so for the foreseeable future. Although naturally occurring smallpox and rinderpest have been eradicated, countless other diseases cause concerns for both human and animal military components. Eliminating these diseases within reservoir animal populations will not only protect MWAs but will also protect humans from zoonotic diseases. While military veterinarians may not be able to directly eradicate all diseases, they can work to control them within military-associated populations. By maintaining awareness of military-relevant diseases, veterinarians and other health and military professionals can implement preventative measures to reduce disease transmission and administer timely therapies when such diseases are diagnosed, thus maintaining the overall health of military and civilian populations.

Acknowledgments

The authors wish to thank Dr Bruce H. Williams and MAJ Jeremy J. Bearss of the Department of Defense Joint Pathology Center for their efforts and contributions in obtaining the figures included in this chapter.

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Chapter 12

RABIES AND CONTINUED MILITARY CONCERNS

NICOLE CHEVALIER, DVM, MPH,* AND KARYN HAVAS, DVM, PhD†

INTRODUCTION

A Historical Perspective

The US Military’s Involvement

ETIOLOGY AND EPIDEMIOLOGY

Rabies Virus Variants and Distribution

Rabies-free Definition and Areas

Rabies Transmission Process and Conditions

CLINICAL REVIEW

Clinical Signs of Rabies in Animals

Diagnosis of Rabies in Animals

Animal Management After Bites from Rabies Suspects

Human Postexposure Treatment for Rabies

PREVENTION AND CONTROL

Animal Vaccination

Human Vaccination

Military Animal Bite Reports

Surveillance

RABIES IN AN OPERATIONAL ENVIRONMENT

Difficulties Posed by Certain Animal Populations

Stray Animal Control Efforts in Afghanistan and Iraq

Global Lessons Learned About Stray Animal Control Measures

INTERNATIONALLY SUPPORTED RABIES CONTROL PROGRAMS

Rabies Surveillance

Mass Parenteral Vaccination

Oral Vaccination

Population Management

Euthanasia

Human Preexposure Vaccination

Human Postexposure Prophylaxis

RABIES CONTROL IN FUTURE CONTIGENCY OPERATIONS

SUMMARY

*Lieutenant Colonel, Veterinary Corps, US Army; Veterinary Capabilities Developer, Directorate of Combat and Doctrine Development, 2377Greeley Road, Building 4011, Joint Base San Antonio-Fort Sam Houston, Texas 78234

†Major, Veterinary Corps, US Army; Veterinary Epidemiologist, US Army Public Health Command, Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, Maryland 20910

INTRODUCTION

A Historical Perspective

Rabies may be the oldest infectious disease known to humanity. First noted in Mesopotamian dogs around 2200 BCE,[1] the modern name, rabies, comes from the Latin word rabere, which means “to rage or rave.” Aristotle later used the Greek word lyssa, which means “madness” to describe the symptoms of rabid dogs in his book, the Natural History of Animals, in 400 BCE. Although Aristotle incorrectly concluded that humans were immune to rabies infections, the scientific community continues to honor the Greek description, classifying rabies’ etiologic agent as one of several related viruses from the genus Lyssavirus and its disease name, lyssa.[2] Rabies is sometimes also called hydrophobia.

For as long as warriors have turned to dogs as protectors and companions during conflicts worldwide, rabies has been a notable concern of military forces and their respective societies around the world. One of the first battle references to rabies may be found in Homer’s The Iliad; in this poem, Homer compares the frenzied fighting style of the Trojan warrior Hector to a “raging dog.”[3] The Roman writer Cardanus later expresses his concerns about rabies regarding public safety and canine–human contact, given the “infectivity of the saliva of rabid dogs.”2(p1) He further describes the canine saliva’s highly infectious material as “a poison (for which the Latin [word] was ‘virus’).”2(p1)

Still other Roman writers (ie, Pliny and Ovid) describe rabies as “dog tongue worm” and list a common canine rabies prevention procedure used up until the 19th century: cutting the dog’s tongue attachment and removing its fold (some practitioners erroneously believed that a worm lived in this mucous membrane and that this worm caused rabies). Numerous Old World Syrian and Arabic doctors note rabies as well, usually characterizing it as an incurable hydrophobic disease. By the 18th century, rabies was also recognized within certain wildlife populations in the eastern United States, namely skunks. However, in the years following the Civil War, this sylvatic virus traveled westward with the early pioneers, spreading rabies across the United States.[2]

The US Military’s Involvement

After the Civil War, US military veterinarians played an important role in controlling rabies on installations through vaccination and education. Burlin C. Bridges, Ft Bliss veterinarian in 1927, described the decreasing threat posed by canine rabies in El Paso, Texas, during the early 20th century:

…there were 300 cases of rabies reported during 1925, 40 cases during 1926, and 12 cases during the first 6 months in 1927. …The decrease in number of rabies cases can only be accounted for by the education of the owners of dogs relative to preventive vaccination, by annual dog shows where only vaccinated dogs are shown, and by the capture of stray dogs on the reservation [Ft Bliss] with no tags of vaccination.4 (p262)

During 1930, prevention efforts continued with similar success on all Army posts: 4,012 dogs were vaccinated for rabies; only seven positive rabies cases were reported; of these, four were in stray dogs.[5]

During World War II, rabies again became an active threat, but its risk varied by theater location.[6] For example, during World War II, rabies was present in all operational sites, including the Middle East, China, Burma, India, Austria, Germany, northwestern Europe, North Africa, and Italy.[7] However, of the 65 laboratory samples from the United States tested for rabies by the 4th Service Command Medical Laboratory at Ft McPherson, Georgia, only 37% were positive. In theaters outside of the United States, such as China, Burma, and India, positive results approached 75%.[8] Seven US service members died from the disease while serving in the United States, the Philippines, Panama, and Italy.[6]

The danger posed by rabies to US military in Italy increased throughout the war. From June 1944 through June 1945, over 2,000 people suffered animal bites, and 400 suspected cases and 58 confirmed cases of rabies occurred in dogs. A shortage of rabies vaccine thwarted initial efforts to mitigate the outbreak; control was eventually achieved via impounding strays and leashing and muzzling pets. The Army Veterinary Service was well established by World War II, and it provided additional rabies prevention and control services such as animal vaccination, detection of rabies in military-owned and civilian animals, laboratory testing of animal specimens, and oversight of animal quarantine and country reentry procedures.

In the Pacific theater, Army Veterinary Service personnel developed plans for quarantine and other rabies control procedures. However, Korea also experienced a vaccine shortage during World War II, which caused rabies to reemerge and become widespread in animals by 1946. Although documentation exists of at least one US service member contracting and dying from rabies during the Korean War, lyssa was not a major human threat in Korea at this time. Nonetheless, during this time period, laboratories regularly tested animal specimens that were suspect for rabies and potentially exposed laboratory personnel were treated with immune serum and vaccine.[9]

During the Vietnam War, rabies was the most widespread zoonotic disease hazard to American forces and Vietnamese nationals. Although the government of South Vietnam did not track rabies statistics, the Pasteur Institute in Saigon surveyed Saigon, Na Trang, and Da Lat in 1966 and estimated that, in just these three cities, at least 10,122 Vietnamese were potentially exposed to the virus; 4,845 received postexposure prophylaxis (PEP) treatment (a detailed overview of this treatment plan appears later in this chapter); and six people died. Of the 470 animal specimens examined during this time, 51% were positive for rabies.[10]

The danger rabies posed to US military forces during 1966 was also substantial. In 1966 alone, some 1,506 US military personnel were potentially exposed to rabies; 628 were treated with rabies PEP; and 21.5% of rabies specimens submitted to military laboratories tested positive.[10]

Several factors led to increasingly significant numbers of animal bites and exposures, with a correlative increase in the use of rabies PEP, including growing troop numbers; the lack of rabies and stray animal control measures for the large number of stray dogs that roamed the Vietnamese villages; and the large number of mammalian mascots and pets (eg, tigers, cheetahs, bears, roe deer, monkeys, dogs, and cats) maintained by US troops.[11] (Eagles, snakes, and other reptiles were also cared for as pets and mascots but did not pose a rabies threat because these are nonmammalian species; only warm-blooded mammals are susceptible to Lyssavirus.[10])

The primary threat for rabies infection in Vietnam came from one specific mammal: dogs, especially young puppies. In fact, over 25% of the dogs’ rabies cases were diagnosed in puppies 8 to 16 weeks of age. These puppies posed a particularly insidious threat to humans because they were almost always asymptomatic when they died.[10] However, the veterinary advisor to the Military Assistance Command, Vietnam, soon recognized the canine rabies threat and initiated a vaccination campaign to protect US and Vietnamese troops. This campaign targeted dogs in villages near US military installations and used a proven, US-manufactured vaccine.

In 1966 through 1967, the US Army Veterinary Service also started vaccination campaigns for mascots and pets of US service members. Unfortunately, these programs were difficult to implement and did not reach enough targeted dogs because of numerous logistical problems. For example, in 1967, only an estimated 7,000 dogs owned or maintained by US service members (ie, only about half) were vaccinated; the majority of these vaccinations were for rabies, although other vaccinations such as canine distemper vaccination were also given.[12] Other rabies control efforts implemented by US Army veterinarians included registration and control of military mascots and pets, quarantine of rabies suspects, and tracking of rabies statistics.[10]

In 1969, there were 2,967 potential rabies exposures within the US Army forces in Vietnam, resulting in 1,628 patients receiving rabies PEP. By 1970, these numbers had decreased to 1,905 and 1,039, respectively. From January to June 1969, 17.8% of dog specimens submitted to the laboratory tested positive for rabies. This was a small decrease from the 21.5% positive samples reported by US military laboratories in 1966. Additionally, none of the cat, monkey, bat, or rodent samples submitted tested positive.[13]

During the withdrawal of US forces from Vietnam, both the stray dog population and rabies incidence increased as mascots and rabies control efforts on US installations were abandoned. In fact, in 1972, rabies reached near epidemic proportions. Forty percent of suspect rabies samples submitted to laboratories tested positive throughout South Vietnam, and nearly 60% tested positive in Saigon. Over 7,000 Vietnamese were treated with rabies PEP, and at least twelve people died.[10]

Despite the difficulties encountered in implementation and the limited numbers of dogs vaccinated, rabies control efforts performed by the US Army Veterinary Service during the Vietnam War were considered successful. The magnitude of the rabies threat was considered so enormous that even though up to five American deaths occurred from rabies (the actual number of rabies deaths is disputed), limiting the disease to only up to five deaths was considered a great accomplishment.10,13

Following the Vietnam War, rabies was again recognized as a disease threat during Operations Desert Shield and Desert Storm; however, protocols for rabies control and treatment, similar to those used today, may have diminished the threat to US forces.[14] In Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), rabies also proved to be a menacing zoonotic disease; its effects during these conflicts and lessons learned are discussed later in the chapter.

ETIOLOGY AND EPIDEMIOLOGY

Rabies Virus Variants and Distribution

Rabies can infect any mammal, although it is primarily a disease of carnivores (eg, dogs, skunks, raccoons, and cats) and bats, and the rabies virus exists on every continent except Antarctica. The etiologic agents that usually cause “classic” rabies in humans and animals are bullet-shaped RNA viruses: genus, Lyssavirus; family, Rhabdoviridae (Figure 12-1).[15]

Figure 12-1. The structure of the rabies virus, genus Lyssavirus.
Reproduced from the Centers for Disease Control and Prevention Rabies website. http://www.cdc.gov/rabies/transmission/virus.html. Accessed January 23, 2014.

Several variants of rabies virus are also maintained in different host species that are often used to characterize the strain of virus. The canine variant of rabies causes the most human rabies cases on a global basis, but other strains are of particular concern in certain animals in certain parts of the world (eg, the coyote in Texas). Raccoon, skunk, and fox variants are widespread in the United States (Figure 12-2) and can infect other wildlife.[15] The red fox variant is the primary cause of rabies in Europe. The United States, Europe, Central and South America, and Canada also have widely distributed bat rabies.

Spillover of variants into other species is common, and frequent interaction between hosts can result in adaptation of one variant to species-specificity in the spillover host. For example, in the United States, genetic testing has determined that the canine variant of rabies is the ancestor to the fox variant of rabies in Texas, and the skunk variant of rabies originated in raccoons.[16] Although not documented to have species-specific strains, mongooses in the Caribbean, South Africa, and parts of Asia; jackals in Africa; and wolves in northern Europe also play an important part in transmitting the virus.[17] A puzzling feature of the rabies virus is that no feline strain of the virus has ever been detected, nor has any documented cat-to-cat transmission of the virus occurred, although the number of rabid cats has outpaced that of rabid dogs in the United States every year since 1988.16,17

Historically, the canine variant of rabies was the primary strain in the United States; however, this variant was almost entirely eradicated by a robust animal vaccination campaign and other control efforts that began in the late 1940s and continued through 1970. In 1938, there were 8,452 rabies cases diagnosed in dogs; by 1965, this number was only 412. A similar drop is found in human cases: in 1938, there were 47 rabies cases; by 1965, there was only one.[2] In the past 10 years, the bat variant caused most of the human cases in the United States, although canine variant rabies still occasionally appears along the Mexican border.[18]

A new variant of the lyssaviruses, first identified in 1996 in several species of flying foxes and bats in Australia, has been associated with two human deaths from rabies-like illness. This virus, provisionally named Australian bat lyssavirus, is closely related, but not identical to, the classic rabies virus.[18]

Rabies-free Definition and Areas

Although rabies is present almost everywhere in the world, certain areas are considered virus-free. The World Health Organization (WHO) confers “rabies-free” status on countries that have had no indigenously acquired cases of rabies in humans or animals over the previous 2 years. Rabies-free areas include the United Kingdom, Sweden, Norway, Iceland, Japan, New Zealand, Singapore, Papua New Guinea, the Pacific Islands (including Hawaii), most of Malaysia, and some of Indonesia. These countries have strict animal import requirements to help maintain their rabies-free status. Countries that are not rabies-free have varying degrees of rabies risk as defined by the WHO.[19]

Rabies Transmission Process and Conditions

Rabies is transmitted between mammals, typically through introduction of infected saliva through broken skin, which usually occurs during a bite incident. Rabies virus can also be transmitted through mucous membrane contact with infected saliva. In extremely rare cases, aerosolized virus can be inhaled, resulting in infection. Two documented human cases of rabies occurred through this type of exposure when spelunkers spent time in a cave where a large colony of bats resided.[1] (Bats can also pass the virus to other members of the colony under these conditions, although bites are still the primary method of intraspecies transmission among bats.) Other aerosolized virus infections have occurred in laboratories, resulting in at least two known human rabies cases.[20]

Figure 12-2. A map of terrestrial rabies reservoirs in the United States, 2010.
Reproduced from Centers for Disease Control and Prevention website. http://www.cdc.gov/rabies/resources/publications/2010-surveillance/reservoirs.html. Accessed January 23, 2013.

During a bite from a rabies-infected animal, a particular set of conditions determine whether virus transmission results in victim infection, including time and wound depth. Because the rabies virus is encapsulated by an envelope (see again Figure 12-1), the virus is extremely susceptible to inactivation by drying and, therefore, is incapable of surviving outside the host for any extended period. Viral contamination of only the skin surface or superficial wounds is unlikely to result in infection.

Saliva from the infected animal also must carry an appropriate viral load to cause disease.[21] (A study in Africa showed that a bite from a rabid dog to another dog carried only a 49% probability that the victim would become rabid.[22]) Additionally, the species of biting animal and volume of saliva introduced into the wound affect whether the victim develops clinical signs of disease, and bites nearer to the head result in rabies symptoms developing more often and more quickly than bites on extremities.[2]

Once rabies is introduced into the body, the virus replicates locally for a variable period of time and then proceeds along peripheral nerves toward the central nervous system (CNS). The duration between inoculation and arrival at the CNS varies widely between cases and depends on factors such as the proximity of the inoculation site to the CNS (ie, the distance of the bite from spinal cord and brain) and the viral load delivered. In animals, the incubation period varies from 14 days to several months, with an average of 3 weeks.[18] In humans, the average incubation period is 3 to 8 weeks, although one documented case of rabies occurred more than 6 years after the man was exposed to the virus.[17] Fortunately, the relatively lengthy incubation period for humans allows an adequate amount of time for people exposed to rabies to receive postexposure treatment and prevent clinical disease development.

After rabies reaches the CNS, the virus produces paralysis consistent with spinal cord involvement and mania from brain involvement. The virus continues to replicate in the brain and travels down peripheral nerves to the salivary glands, where rabies can be transmitted to new hosts through bites or licks from the infected animal.[19]

CLINICAL REVIEW

Clinical Signs of Rabies in Animals

Signs of rabies in animals are consistent with derangement of the CNS and are characterized into two syndromes or forms: (1) furious rabies and (2) dumb or paralytic rabies, which are actually two phases of a three-part disease process that includes the prodromal, excitatory, and paralytic phases. The first 2 to 3 days of infection in either form is the prodromal phase. In this early symptom phase of the disease, animals exhibit minor temperament changes, often subtle enough to go unnoticed.[17]

The next stage, the excitatory phase, is either so transient that symptoms continue to go unrecognized or is so prominent that symptoms are obvious. The label “furious rabies” describes animals exhibiting a pronounced excitatory phase; the label “dumb rabies” typifies animals with a transitory excitatory phase but a marked paralytic phase. During the excitatory phase, animals’ pharyngeal muscles become more and more paralyzed, resulting in drooling and frothy saliva when they pant heavily. Animals also become restless, vocalize, attack inanimate objects, lose their fear of people, swallow foreign objects, and eventually experience ataxia and severe, often fatal, convulsions.[19]

Animals that do not die during seizures enter the paralytic phase. In this final stage, muscular incoordination advances into total body paralysis, causing animals to lapse into a coma and die from respiratory failure. Death occurs 2 to 6 days after the onset of clinical signs for animals exhibiting the dumb form of rabies and 4 to 8 days after onset of the furious form.[19]

Any species can exhibit either of the forms of rabies. However, cats most often manifest with furious rabies, while livestock species and dogs commonly exhibit the dumb form of rabies.[17]

Unfortunately, even though rabies produces well-characterized clinical stages in animals, behavior is not a reliable indicator of whether an animal is shedding virus in its saliva. An animal can act normally and still be shedding virus, which can have significant implications for human exposures. Studies have documented that virus can be recovered from skunk saliva up to 14 days prior to any clinical signs and 1 to 5 days prior to clinical signs in dogs and cats. Moreover, viral shedding may be intermittent once clinical signs occur, or the animal may never shed virus in its saliva, despite the onset of rabies behavior that ultimately ends with the animal’s death.[2] Also, since animals can demonstrate a variety of clinical signs along the entire spectrum of the disease, rabies should be a differential diagnosis for any animal exhibiting behavioral changes or unexplained paralysis.[19]

Diagnosis of Rabies in Animals

Diagnostic testing of animals is performed for two purposes: (1) verification of disease status for animals that have exposed humans or other animals and (2) rabies surveillance. All non-human diagnostic tests for the presence of the virus are performed postmortem on brain tissue because antibodies are not produced until the terminal stages of the disease. (See also Chapter 10, Army Veterinary Laboratory Service.)

When submitting samples to diagnostic laboratories, medium-sized animals’ heads such as dogs and cats are decapitated by disarticulating the vertebrate and shipped (in accordance with state and federal guidelines) with the brain vault intact. For large animals such as cattle or horses, the brain is removed from the brain vault prior to shipping. Small animals such as bats or rodents are shipped whole.

All samples should be shipped chilled, but not frozen. Dry ice should never be used because it can inhibit the rabies testing process and is considered a hazardous substance to ship.[15] All personnel involved in handling rabies specimens should receive the preexposure rabies vaccination series and proper training on preparation, packing, and shipping of samples.

Currently, few tests are available to expediently verify rabies infection in operational environments. The direct fluorescent antibody (DFA), considered the “gold standard” for rabies diagnosis, is a highly sensitive and specific microscopic test that is 98% to 100% reliable.[19] DFA protocol is dictated by the Centers for Disease Control and Prevention (CDC). However, because specialized equipment, trained personnel, and a controlled environment are necessary to perform this testing, DFA is difficult to use in a field or combat environment. Animal samples obtained in these environments must be airlifted back to fixed facility military laboratories (ie, in Germany or the United States) for DFA testing.

Other tests being developed for rabies surveillance include the direct rapid immunohistochemical test (dRIT) on brain or brainstem tissue. This test, which is also regulated by the CDC, requires a minimal amount of equipment and expertise and has a sensitivity and specificity similar to that of the DFA. However, the dRIT is not yet a prescribed test approved for use in field environments as a replacement for the DFA, according to the World Organization for Animal Health,23,24 even though the US Army Veterinary Service participated in field trials of the dRIT during OIF.

Animal Management After Bites from Rabies Suspects

Because rabies is nearly always fatal once symptoms appear, no treatment is attempted for animals showing clinical signs of rabies, and no PEP is available for animals that have just been bitten by another rabid animal. However, when combined with canine rabies vaccination requirements (see the section on animal vaccination below), legally mandated quarantine procedures (also described below) have resulted in the near eradication of canine variant rabies within the United States. These quarantine procedures are recommended by the National Association for Public Health Veterinarians and are used uniformly throughout the United States, although each state does have the ability to implement unique criteria.[15]

When a nonvaccinated animal is bitten by a rabid animal, the exposed animal should be euthanized immediately. If the owner is unwilling to euthanize the animal, the exposed animal must be quarantined for 6 months in a secure location where it will not have contact with other animals or pose a risk to humans. Should the animal shows signs consistent with rabies during quarantine, it must be euthanized and tested. If the animal shows no signs of rabies during its 6-month seclusion, the animal can be released after a licensed veterinarian certifies it is healthy and vaccinates it for rabies.[15]

On US military installations, when a vaccinated animal is bitten by a rabid animal, the exposed animal remains under observation for 45 days, usually in the owner’s home. During quarantine, it should not have contact with other animals and should be revaccinated immediately. (These aforementioned guidelines used on military installations are standard protocol throughout the veterinary profession as recommended by the National Association of State Public Health Veterinarians, so they also apply to military family pets that are bitten off-base or receive treatment from a civilian veterinarian.[15])

Animals with overdue vaccinations are dealt with on a case-by-case basis, often relying on the professional opinion of the treating veterinarian.[15] For example, if the animal had multiple vaccinations and is a month overdue, the veterinarian may choose to vaccinate the animal and put it under 45-day quarantine or run an antibody test to determine the animal’s immune status. If the animal had an inconsistent vaccination history, the veterinarian may treat the animal as if it were unvaccinated and require a 6-month quarantine followed by proper vaccination.

Human Postexposure Treatment for Rabies

After a person is bitten by an animal, the wound should immediately be flushed and cleaned with soap and water. As previously noted, the rabies virus is surrounded by an envelope, so this virus can be inactivated by a mild detergent or soap. If available, povidone iodine can also be applied to the wound.[18] However, since it is impossible to determine if immediate wound care destroyed all of the virus introduced in the bite, the victim still must be assessed for the rabies PEP treatment regimen.

PEP is the cornerstone of medical treatment to interrupt the course of disease in people infected by rabid animals. The medicinal regimen consists of human rabies immunoglobulin and a series of four to five rabies vaccinations. Initially, as much immunoglobulin as possible at the dose of 20 IU/kg body weight is infiltrated around the wound site and, then, is given intramuscularly. The vaccine is also given intramuscularly, ideally in the deltoid muscle. In order to successfully abort rabies infections, the regimen generally must be given prior to the onset of clinical signs. As previously mentioned, the duration of the incubation period varies, depending on factors such as the distance of the bite from the CNS, the amount of saliva introduced into the wound, the viral load in the saliva, the species of biting animal, whether or not immediate local wound care was performed, and several biological factors within the victim, including immune competency and comorbidities.[20]

As recently as 2003, rabies was considered 100% fatal once clinical signs became apparent. However, in 2004, a high school student in Wisconsin was bitten by a rabid bat and became the first recorded survivor of a clinical manifestation of rabies. Physicians administered a novel treatment now known as the “Milwaukee protocol,” which included a medically induced coma and artificial life support, allowing the body time to mount an effective immune response against the virus.[25] The Milwaukee protocol was used to treat 28 other rabies victims since 2005, four of whom have lived.[26] Despite this handful of survivors, rabies has the highest case fatality rate of any known infectious disease if PEP is not provided.[22]

Because there is a limited window after exposure—before symptoms appear and patients die—rabies poses a significant, pressing public health concern. Effective management requires rapid identification of all potential contacts or exposures to confirmed rabid animals or human rabies patients, including individuals who had mucous membrane contact with a rabid human patient’s saliva (eg, after sharing utensils or drink containers with an infected patient).[20] Identification must be done as quickly as possible to abort potentially fatal clinical disease via treatment with PEP.

PREVENTION AND CONTROL

Animal Vaccination

As already noted, no PEP regimen exists to eliminate infections in animals; therefore, prevention in animals is entirely dependent on preexposure vaccination, which is usually administered as a “parenteral” or injectable vaccine. Several federally approved parenteral vaccines provide 1 to 3 years of immunity. In the United States, dogs and cats are given 1.0 mL of subcutaneously administered vaccine containing killed rabies virus and can be vaccinated as early as 12 weeks of age. Before that age, puppies and kittens may not be able to mount a sufficient immune response to the vaccine; maternal antibodies that the neonates ingest shortly after birth while nursing interfere with the antigen exposure to the animals’ immune systems, negating the vaccine’s effects.[15]

Regardless of the product label, the first rabies vaccination is only considered effective for 1 year; every dog and cat needs to be revaccinated 1 year after the first vaccination is administered. After the second vaccination, the product label can be followed for the frequency of revaccination, providing the state in which the animal resides recognizes 3-year rabies vaccinations. Although not all states have laws requiring rabies vaccination of owned dogs and cats,[15] all dogs, cats, and horses that reside on military installations are required to maintain current rabies vaccination status, regardless of whether the state mandates vaccination.[27] Dogs and cats are usually issued a rabies tag and certificate of vaccination.

Rabies vaccine is also licensed for horses; they receive double the feline or dog dose: 2.0 mL administered in the neck muscles. Other species for which certain parenteral rabies vaccines have been licensed include ferrets, cattle, and sheep, but most livestock are vaccinated routinely only in rabies-endemic areas or as a response to a local outbreak.[15]

Parenteral rabies vaccine is also often used off–label to vaccinate species for which no approved vaccine exists. This type of vaccination is generally considered harmless and probably protects species other than those in which it has been tested. However, any animal other than those for which a specific rabies product is licensed, including wolf-hybrid dogs, must be considered as an unvaccinated animal for the purposes of rabies control. The National Association of State Public Health Veterinarians recommends that a licensed veterinarian administers (or supervises the administration of) all parenteral rabies vaccinations. Many states have included this provision in their laws relating to rabies vaccination.[15]

An oral rabies vaccine product has been developed for use in wild animals but has only been tested and approved for coyotes and raccoons. The vaccine (1.5 mL) is contained in a plastic sachet placed inside a hollow, edible shell made of fishmeal or dog food, commonly referred to as “bait.” When the animal bites into the bait, the plastic sachet breaks and coats the inside of the animal’s mouth with killed virus vaccine, which is absorbed through the animal’s mucous membranes and lymphatic throat tissues. This product, most effective when distributed from the air, contributed greatly to controlling rabies outbreaks in raccoons along the eastern coast of the United States and in coyote and fox populations in Texas. In 2007, 18 states distributed over 12.5 million rabies baits.[28]

Human Vaccination

In humans, rabies prevention occurs before or after exposure to the virus. Preexposure measures consist of a series of three injectable vaccinations containing killed virus. All Army Veterinary Service veterinarians and animal care specialists must be vaccinated. Rabies titers are checked every 2 years to ensure effectiveness.[27] Other military (eg, special operations forces) and contract personnel are vaccinated based on occupational risk of rabies exposure. Preexposure vaccination does not negate the requirement for PEP if personnel are bitten by a rabies suspect, but it decreases the number of postexposure vaccinations required and the necessity for human rabies immunoglobulin administration during PEP treatment.[20]

Military Animal Bite Reports

Military physicians, veterinarians, and preventive medicine personnel follow specific reporting requirements after receiving a potential rabies case, based on Defense Department (DD) Form 2341: Report of Animal Bite-Potential Rabies Exposure.[27] This four-part form, commonly referred to as a “bite report,” is used on military installations worldwide whenever an authorized beneficiary of the military healthcare system receives a bite from an animal or has a nonbite exposure to an animal that could potentially have rabies. Examples of events that would trigger the initiation of a DD Form 2341 include a bat found inside the barracks room of a sleeping soldier (ie, aerosolized exposure potential), a stray cat biting a child, and a vaccinated dog biting its owner.

The triservice animal bite report is the primary mechanism for detecting and documenting rabies risk, rabies cases in animals, and follow-up treatment in potentially exposed DoD personnel. From January 2001 through December 2010, these forms documented animal bites in 20,522 US active duty, reserve, and civilian contractor personnel.[29]

Normally, the DD Form 2341 is initiated in the emergency room of the DoD medical treatment facility or other military clinical setting. On Part I of the form, the treating physician and medical staff question the victim about the bite incident and document as much information as possible about the offending animal.

On Part II, the DoD physician records any wound treatment and characterizes the risk of rabies as low, medium, or high, depending on the circumstances of the exposure. The physician also documents whether or not rabies PEP treatment was initiated for the victim. Decisions about potential rabies risk and initiation of PEP are based on whether the bite was provoked or unprovoked, the rabies vaccination status of the animal (if known), the animal’s behavior, the rabies risk in the area, and other factors such as the healthcare provider’s professional judgment.

After the physician completes Part II, the form is forwarded to the servicing Army veterinary treatment facility, and attempts are made to track down the animal involved in the potential rabies exposure. Stray or wild animals may be located by the military police or installation wildlife officials; owned animals may be tracked back to their owners by the veterinary treatment facility staff. If the animal is located, it is brought into the facility to be examined by the military veterinarian, who determines its disposition. The animal is either quarantined for 10 days at the owner’s home (for healthy, vaccinated animals) or at the veterinary treatment facility (for healthy, unvaccinated, or aggressive owned animals), or it is euthanized and submitted for rabies testing (for stray or wild animals or any animal demonstrating signs consistent with rabies).

Aggressive vaccinated animals may be quarantined at the veterinary clinic to prevent additional bite incidents during the quarantine period. The National Association of State Public Health Veterinarians defined the 10-day quarantine because animals—aggressive or not–can shed virus 1 to 5 days before exhibiting clinical signs.15,17 Thus, the 10-day quarantine at the home or at the clinic allows enough time for the rabid animal to exhibit clinical signs and present back to the veterinarian who will recognize those signs. If the animal develops any neurologic signs of disease during the 10-day period, it is euthanized and submitted for testing.[15]

At the end of the quarantine period, the animal is reexamined by the DoD veterinarian and released to the owner if it remains clinically healthy. Any overdue rabies vaccinations are administered at this time. Once the animal is released or the test results have been received from the laboratory, Part III of the DD Form 2341 is completed in detail and forwarded to the respective service’s preventive medicine personnel.

Preventive medicine personnel advise the treating physician on the initiation or continuation of PEP based on the health of the animal during and at the end of the quarantine period or the results of rabies testing, if performed. If rabies PEP is indicated, the preventive medicine department is responsible for interviewing the victim and performing an investigation to ensure all possible human contacts of the rabid animal are identified and receive PEP. Actions taken by preventive medicine personnel and the results of their investigation are documented on Part IV of the DD Form 2341.

Once Part IV is completed, the report is forwarded to the Rabies Advisory Board (RAB) for review and discussion. The RAB’s membership varies by installation but usually includes the installation veterinarian, representatives from the emergency room staff and hospital administration, preventive medicine personnel, and possibly military police and installation wildlife officials.

The RAB meets periodically to review each bite report and discuss the handling of each case. The board identifies any problems with the installation’s bite reporting system and case follow-up and discusses methods to improve tracking and timely case closure. The RAB may also discuss general issues about rabies awareness in the area, individuals who should receive PEP, and any other issues pertaining to rabies and how it affects the local military community. The RAB chair, or another senior medical official from the treating facility, countersigns Part IV of each DD Form 2341 once the review and discussion are completed.

Surveillance

Rabies surveillance programs are a critical component of any successful rabies control effort. The majority of surveillance information comes from testing animals that have potentially exposed humans. In the United States, rabies—in either humans or animals—is a reportable disease. The CDC requires information on the species, location, and date of capture for animals testing positive for rabies. The agency uses this information to determine the annual incidence of rabies across the country and the most common vectors for human exposures.[16]

Active surveillance programs are also common elements of viable rabies control efforts within wildlife populations across the United States. For example, an epizootic of the coyote strain of rabies occurred in domestic dogs in southern Texas between 1988 and 1994.[30]

Concurrently, rabies in the fox population began expanding in west-central Texas. At the time, the associated human exposures cost to the state was projected to reach $63 million by the end of 2004. In an attempt to control the problem, the state initiated an oral rabies bait vaccine program that included surveillance efforts to target geographic bait distribution and postbaiting vaccine efficacy. Animals from the target area were trapped and tested to determine if they had an antibody titer against rabies. These efforts were successful; in fact, the epizootic spread of 72 to 80 km per year ceased after the program was implemented, and rabies cases fell from 142 in 1995 to 0 by 2000. Only one case was reported in 2001, and none were reported in 2003, so the bait distribution continued.[30] In 2012, Texas distributed 2 million doses of oral rabies baits statewide over a 2-week period.[31]

The US military assisted with such state rabies surveillance and control programs on several occasions. In 2004, the DoD Food Analysis and Diagnostic Lab, currently part of US Army Public Health Command Region-South, assisted with the oral bait surveillance laboratory testing in Texas.31,32 Army veterinary personnel at Ft Huachuca, in southeastern Arizona, assisted with a skunk study and surveillance program run by the Arizona Wildlife Service between 1985 and 2004. During this time, 506 skunks tested positive for rabies in Arizona; all but 26 of these cases came from the southeastern area of the state.[33]

The DoD supports the National Cooperative Rabies Management Program, including skunk rabies surveillance efforts at Ft Riley, Kansas, and oral rabies baiting programs at Ft Drum, New York, and on the Navajo Army Depot, Arizona.31,34 Personnel on Air Force and Navy installations also cooperate in support of this program.

RABIES IN AN OPERATIONAL ENVIRONMENT

The magnitude of potential rabies exposures in operational environments is often judged by the number of bite reports collected from these areas. From 1 January through 31 May of 2012, US military veterinarians tracked 242 reports of animal bites or potential rabies exposure using DD Form 2341 for US service members in Afghanistan. Only four of these reports were initiated to track animals that were submitted for testing because they exhibited neurological signs of disease; the other 238 reports were initiated because of human contact with a potentially rabid animal that was not yet exhibiting signs of disease.

Of the 16 animals submitted to the laboratory for rabies testing, only four (25%) tested positive, and one was indeterminate. At least 189 of the victims received some form of rabies PEP, as indicated by attending officers’ notations on the bite report or clinical notes in patient records (Lieutenant Colonel Derron Alves, Afghanistan Theater Veterinary Consultant, June 2011–January 2012; Lieutenant Colonel Greg Saturday, Afghanistan Theater Veterinary Consultant, December 2011–June 2012).

Unfortunately, rabies risk cannot always be accurately measured by the number of bite reports. The tragic story about an Army soldier deployed as a cook to OEF from May 2010 to May 2011 illustrates how underreporting or false reporting can have lethal consequences: the cook adopted a stray dog from the local area in Afghanistan, and in January 2011, another stray dog got into a fight with the adopted dog. The soldier intervened to protect his pet and was bitten on the right hand by the stray dog. He mentioned this incident during a phone call with his family and told them he had sought medical care and received rabies vaccinations in the abdomen. He also told his mother that the dogs were tested for rabies and were found negative.

During follow-up investigations, no record of a bite report was found for this soldier, nor was there any record that he had received medical care. Additionally, no records existed for any animals submitted for testing from the location where this soldier was stationed during the time period of his service there. His claims to his mother also seemed unfounded, given that the intraabdominal vaccinations he said he received were not the current standard of practice for rabies PEP. For these reasons, the investigation concluded that the soldier actually had not reported the bite from the stray dog, he did not receive any medical care for the bite, and rabies testing had not occurred on either dog involved in the incident.[35]

A few months after the soldier’s redeployment to Germany, he was routinely reassigned to Ft Drum, New York. During the plane flight to Ft Drum in August 2011, the soldier began experiencing pain in his right arm and neck, which he attributed to physical activity and the plane flight. Over the next few days, the pain worsened, and he developed nausea and vomiting and had presyncopal events. Physicians in New York recognized signs of hydrophobia, and upon questioning, the soldier revealed his history of a feral dog bite 7 months earlier in Afghanistan. Physicians tested the soldier for rabies, and upon confirmation of positive results, initiated the Milwaukee protocol. Despite extensive medical treatment, the soldier died of complications associated with rabies infection on August 31, 2011, becoming the first US service member to die of rabies since the Vietnam War.[35]

Figure 12-3. A US Army Public Health Command’s rabies risk poster, part of an awareness campaign.
Photograph courtesy of US Army Public Health Command.

In the months following the soldier’s death, the US Army Public Health Command initiated a rabies awareness campaign in Afghanistan, including posters, interviews with media outlets such as Stars and Stripes, the development of a website as a point source for information, and updated medical threat briefings. These awareness efforts (such as Figure 12-3) may have contributed to the sharp increase in potential rabies exposure reporting in Afghanistan in the months following the soldier’s death from rabies. The number of bite reports and the animal species involved in generating these bite reports are detailed in Figure 12-4 and Figure 12-5.

Figure 12-4. The number of bite reports in the Afghan theater of operations, April 2011–May 2012.

Interestingly, another study published in September 2011 documents only 643 animal bites in combat theaters from January 2001 through December 2010.[30] However, the study author collected this data from the Theater Medical Data Store and notes that many animal bites were likely not captured in this repository because of incomplete record capture in the data store system through 2007 due to service members’ misperceptions regarding minor bite wounds or scratches from feral animals. Many service members did not consider such wounds to be a serious health threat that required reporting.

Figure 12-5. The number of bite reports by species in the Afghan theater of operations, January–May 2012.

For comparison purposes, the number of bite reports recorded over a 4-year period during OIF and the species of animals involved in these bite reports are shown in Figure 12-6 and Figure 12-7. Although it appears that the potential rabies exposures measured by animal bite report numbers are greater in OEF, it is possible that significant underreporting occurred in OIF, similar to the underreporting that occurred in OEF prior to the soldier’s death. Interestingly, in both countries, feral dogs and cats are among the top three animals responsible for bite reports, which seems to indicate these ferals are more of a threat to US service members than other wild animal species.

Difficulties Posed by Certain Animal Populations

Animal populations in operational environments can generally be divided into three categories: (1) owned dogs (eg, military working dogs, mascots, and pets), which are readily accessible for disease and reproductive control; (2) community dogs (eg, force protection dogs), which are also reasonably accessible for disease and reproductive control but at greater cost because it is unlikely that the expense of vaccination and neutering will be covered by the community; and (3) stray or unowned animals that experience little human contact, which are often unable to be caught for disease or reproductive controls without considerable effort and resources. Each of these three categories of animals presents challenges to effective stray and rabies control programs, as outlined by the WHO.36-39 Some of these challenges are presented below.

Figure 12-6. The number of bite reports in the Iraqi theater of operations, January 2005–October 2009.

Problems with Enforcing General Order 1B for Local Pets and Mascots

A military-unique challenge to stray animal and rabies control is the long-standing tradition within the US military of adopting mascots and pets while on campaign or deployed. Perhaps one of the most famous military mascots was General Patton’s bull terrier, Willie, who was with him during World War II from 1944 to Patton’s death in 1945. But Willie was an exception to the tradition; he was purchased by Patton prior to deployment and was not a local stray.

During the Civil War, soldiers often brought their pets with them from home or, while deployed, adopted a mascot that traveled with the unit. In World War I, small dogs and cats were common pets of troops along the front lines. The soldiers described the animals as providing a normal experience within the highly abnormal experience of war.40–42 A 1932 Veterinary Bulletin also describes an incident in which five sailors, disregarding regulations, smuggled a stray dog aboard a Navy vessel and subsequently died from rabies transmitted by the locally adopted dog.[5] The same report recognizes the attraction between soldiers and these stray dogs:

The homeless dog always finds a friend in the average soldier. An army camp is a powerful canine attraction. The plentiful food supply beckons to dogs from remote corners, everywhere. With a little attention on the part of some soldier, the dog soon forgets its old master and adopts the new…. Post Orders may attempt to regulate the dog population, but the stray dog will not be regulated. He recognizes no restrictions. He may be exterminated, but, like the cat, his lives are multiple. He soon returns in a stranger’s garb.5(p107–108)

The last decade of war reaffirmed the popularity of local adoption.[43] For example, after the onset of OIF, several nongovernmental organizations formed to assist service members with importing animals into the United States from Iraq and Afghanistan. These organizations reunited adopted pets with the soldiers who cared for them and shared happy reunion stories worldwide. In addition, news coverage of OEF and OIF showed service members repeatedly interacting in unofficial capacities with many different local animals, despite the directives of General Order 1B (GO-1B).

GO-1B was issued by the US Central Command on March 13, 2006. Its official title is “Prohibited Activities for US Department of Defense Personnel Present with the United States Central Command (USCENTCOM) Area of Responsibility.”[41] The purpose of the order is to promote good order and discipline by providing guidance to all US military and civilian personnel working in diverse capacities.

Figure 12-7. The number of bite reports by species in the Iraqi theater of operations, January 2005–October 2009.

The basis for the rule of good order resides in protecting soldiers from behaviors that may be considered normal or common within American culture but that could threaten the health of the force in the area of operations. Restricted activities in GO-1B include purchasing and possessing privately owned firearms; introduction, purchase, possession, sale, transfer, or consumption of alcoholic beverages, controlled substances, or pornographic items; entering mosques or proselytizing; gambling; and possession of war trophies or archeological artifacts.

GO-1B also prohibits adopting pets or mascots or caring for any type of domestic or feral (stray) animals. The reasoning behind this prohibition is that service members who illegally adopt these animals while deployed put others at increased risk of rabies transmission, especially in areas where rabies is enzootic. These personnel also create risk when they use nongovernmental agencies to ship strays stateside.

For example, in 2008, 24 dogs and two cats were brought into the United States from Iraq. Because these animals lacked proper vaccination certificates, they were quarantined for 30 days. During that period, one of the dogs developed neurologic symptoms and tested positive for rabies. (This dog had been a pet of a US service member in Iraq for 7 months and was kept in an indoor-outdoor run.) By the time the rabies diagnosis was confirmed, the other animals in the shipment group had been sent to destinations in 16 states.[44] Despite controlling the infected dog’s movement, the animal still potentially exposed numerous caretakers, the soldier who adopted it, and the other 25 animals in the shipment, who in turn had the potential to spread disease to 16 other areas in the United States.

In the media coverage of this Iraqi incident, soldiers reported that their leaders were aware of nongovernmental efforts to ship animals back to the United States, but these leaders allegedly “turned a blind eye.”[45] Similar GO-1B irregularities were revealed during the OEF investigation conducted after the soldier’s death from rabies. Over 8,500 soldiers, sailors, airmen, and Marines were interviewed during this inquiry.[46] Multiple accounts emerged of US service members in Afghanistan keeping pets as well as having commanders who condoned pets or had some of their own, demonstrating inconsistent or poor enforcement of GO-1B.[35]

However, as stated in the article “Protecting Service Members in War–Non-Battle Morbidity and Command Responsibility,” the ability to protect US service members from disease and nonbattle injury such as rabies has as much to do with consistent command awareness and good discipline as it does with medical care. Regulations must be followed in order to maintain stray populations and for the safety and good discipline of service members, despite the myriad attractions of canine and feline companionship during war. Violations of GO-1B also may result in legal action in accordance with the Uniform Code of Military Justice for US service members and administrative and criminal prosecution for civilian personnel.[5]

Problems Posed by the Force Protection Dog Program

One reason GO-1B was difficult to consistently enforce may have been the unintended problems associated with the short-lived military-sponsored Force Protection Dog program for certain bases. When functioning, the Force Protection Dog program allowed units on smaller operating bases in Iraq to officially maintain one or two stray dogs to act as alert systems for unknown personnel approaching the base. Unofficially, it also allowed these units to maintain a “pet” or “mascot” that was authorized Army veterinary care, including rabies vaccinations. Units maintaining these dogs were responsible for contacting Army veterinary detachments in Iraq to register the dogs and ensure they were vaccinated for rabies. Ideally, service members in units with a Force Protection Dog program would be able to interact safely with vaccinated animals, which would not pose a potential rabies threat.

Despite the projected benefits, the program proved difficult to properly maintain. Authorized force protection dog numbers, locations, and their associated points of contact were constantly fluctuating because units redeployed, vaccinated dogs died and disappeared, and new dogs were authorized. Under these fluid circumstances, maintaining accurate records and getting every dog vaccinated was nearly an impossible challenge. In some cases, units owned a dog that was not vaccinated for rabies, increasing the risk of rabies exposure to troops and civilians.

Another unintended effect of the Force Protection Dog Program was the development of strong human-animal bonds between some service members and their unit’s dogs. These bonds were beneficial when the unit was deployed, but many US service members experienced difficulty leaving the dogs behind when the unit redeployed to their home station (eg, adverse secondary mental health effects that were not immediately apparent).

Although shipping these animals to the United States was unauthorized, as noted earlier in this chapter, several US service members worked with nongovernmental organizations to export their beloved dogs to the United States. Problems with these adoptions (eg, the 2008 example cited above), coupled with the aforementioned maintenance issues, forced the Force Protection Dog Program to begin phasing out in 2009 and cease completely in 2010.

Stray Animal Control Efforts in Afghanistan and Iraq

According to the WHO, stray animal population densities on US operational bases increase from reproduction and animal migrations until “carrying capacity” is reached. The carrying capacity of a given environment is a function of available food and area for establishing territories and is defined as the upper limit of the dog and cat population density that can be supported by the habitat based on the availability of resources (eg, food, water, and shelter) and human acceptance.[36] Carrying capacity expands when military forces begin to set up base camps in contingency environments because the large population influx and base camp build-up increases the local animals’ access to vital resources. When these stray animals have easier access to such resources, their generally low reproductive rates increase, further expanding population density.[38]

Primary efforts for stray animal and rabies control in OIF focused on trapping and euthanizing stray dogs, cats, and wildlife. In Iraq, the goals of the feral animal control policy were to reduce human-animal contact, the zoonotic disease reservoir populations, and the likelihood of human injury by an animal.[47] In Afghanistan, the goal of the feral animal control policy was to, “reduce feral animal populations on areas of US military bases where their presence may negatively affect human life, property, or military missions.”48(p2) Both policies also reiterated the enforcement of GO-1B and restricted compassionate feeding of stray animals and animal access to trash and burn pits.

Global Lessons Learned About Stray Animal Control Measures

The military’s experiences in Iraq and Afghanistan showed that euthanasia as a primary, standalone effort for animal control is counterproductive and may even contribute to the spread of rabies in the area. When dogs are removed from operating base populations, other dogs quickly fill the void. Operating bases are particularly attractive because they provide stray animals with access to food and water that cannot be found in their normal environment. Standalone euthanasia programs also likely intensify interdog aggression because of the breakdown of pack dynamics, thus increasing bites between dogs and the potential for rabies transmission.[38]

Worldwide experts in animal control and rabies prevention also have demonstrated that trap and euthanize policies are ineffective when used alone. The WHO has concluded that standalone euthanasia programs are ineffective: “There is no evidence that removal of dogs alone has ever had a significant impact on dog population densities or the spread of rabies… attempts to control dog populations through culling…have generally been unsuccessful.”38(p53) A World Organization for Animal Health conference on eliminating rabies in Eurasia similarly concluded that culling dogs as a primary means of rabies control has no impact on rabies transmission. As a result of these findings and recommendations, most countries have discontinued using euthanasia as a standalone method in favor of a more effective, comprehensive approach.[49]

Stray animal euthanasia programs can also have less quantifiable but deleterious mental health effects on those who perform these duties. During the deployment of the 64th Medical Detachment, Veterinary Service, to OIF from December 2008 through December 2009, veterinary personnel were euthanizing up to 20 animals every day at each operating veterinary clinic, resulting in hundreds of euthanasias across Iraq each month as shown in Figure 12-8 (Unpublished data, Lieutenant Colonel Nicole Chevalier, chapter author, Operation Iraqi Freedom, 2008–2009).

Veterinarians and animal care specialists who deployed with the expectation that they would be improving animal health and saving the lives of combat-injured working dogs may have been mentally unprepared for the unexpected daily challenge of euthanizing stray dogs, cats, and various wildlife species. On more than one occasion, reports emerged of veterinary personnel suffering from nightmares related to euthanasia duties, refusing to euthanize, and departing the facility in tears. At least one soldier deployed to Iraq visited the combat stress control detachment because of the stress of daily euthanasia duties. Discussions between detachment personnel and unit leadership indicated that this soldier may have been suffering from acute stress disorder, a potential precursor to posttraumatic stress disorder (Lieutenant Colonel Nicole Chevalier, chapter author, oral communications [staff meeting with Combat Stress Control Detachment and personal conversation with Lieutenant Colonel David Galloway, Commander, 64th Medical Detachment, Veterinary Service, Balad, Iraq] 2009). During discussions with other veterinary detachment leaders, additional anecdotal reports emerged of veterinary personnel in units in Afghanistan experiencing similar difficulties as those in Iraq (Lieutenant Colonel Nicole Chevalier, chapter author, oral communications [personal conversations with veterinary detachment commanders and medical brigade staff], International Veterinary Symposium, Garmisch, Germany, May 2010).

Figure 12-8. The number of animal euthanasias performed by the US Army Veterinary Services in Iraq, December 2007–October 2009.
*No euthanasias were performed in the International Zone (Baghdad) due to clinic renovation and closure.

To mitigate such problems, the veterinary detachment leadership deployed in Iraq took steps to decrease the burden of euthanasia on their personnel, including performing a comprehensive feral animal control policy review and recommending changes to the policy; discontinuing trapping and euthanizing of Iraqi wildlife species because data analysis indicated they did not pose a threat to soldiers; decreasing euthanasia duties to 3 days each week; training nonveterinary teams on various installations to perform humane euthanasia of trapped feral dogs and animals that posed a threat to soldiers; and encouraging subordinate leaders to support soldier visits to combat stress control detachments and chaplains.

INTERNATIONALLY SUPPORTED RABIES CONTROL PROGRAMS

Successful internationally recognized and scientifically supported rabies control programs are comprehensive and multifaceted. Components of an effective program include rabies surveillance, mass parenteral vaccination, supplementary oral vaccination, and stray animal population management.[38] Although research indicates that a stray animal and rabies control program will likely be ineffective on US base camps without the inclusion of all of these components, implementing the necessary comprehensive program is logistically difficult, if not impossible, in a contingency environment.

Rabies Surveillance

Surveillance is the foundation of any successful rabies control program. The goal of surveillance programs is to provide information on human and animal rabies incidence using laboratory disease diagnosis, effectiveness of control efforts, estimates of the stray and wildlife population numbers, and locations to distribute oral rabies baits in the areas of concern.[38] This information is already tracked in operational environments to some degree using the animal bite reporting system previously described in this chapter. However, underreporting is of great concern, especially given that very few of the animals involved in these bite reports are captured and tested. Therefore, it is probable that current surveillance efforts by US military veterinarians and preventive medicine personnel vastly underestimate the rabies burden in contingency environments.

Mass Parenteral Vaccination

“Herd immunity” is the concept that a majority of an animal population needs to be vaccinated in order to disrupt the spread of disease in a population. To confer “herd immunity” for rabies in a given population, at least 70% of the animals within the population must be vaccinated.38,50 The high level of herd immunity required for rabies control in stray animal populations is associated with the high birth and death rates in stray dog populations. The death rate results in a loss of vaccine-immune adults, while the birth rate contributes to the numbers of the susceptible fraction of the population; the overall result is an increased susceptibility to disease. Unfortunately, the difficulty associated with trapping and parenterally vaccinating at least 70% of the strays on large base camps would be substantial. Compounding this difficulty is the fact that every vaccinated animal would require a rabies booster vaccine after 1 year to ensure lasting immunity.[22]

Oral Vaccination

Oral rabies bait vaccines, mentioned earlier in this chapter, are recombinant vaccines. Typically, a biomarker is also included as part of the vaccination. Biomarkers allow researchers to assess whether or not a particular animal ingested a bait vaccine and analyze how many animals that ingested bait seroconverted, facilitating surveillance of bait-efficacy in the targeted area.31,49

Numerous oral bait vaccines currently meet the WHO’s requirements for efficacy, defined by the ability of the vaccine to protect a dog against a local canine rabies virus administered at a dose that would kill 80% of unvaccinated dogs.[37] Oral bait vaccine programs were successful in numerous field studies worldwide, including the Philippines, Tunisia, India, and Turkey.38,51–53 These studies also indicate that the vaccine protected from infection even when there was not a sufficient rabies-neutralizing antibody titer of 0.5 IU/mL, the titer recommended for animals by the World Organization for Animal Health to be considered vaccine immune to rabies.[54]

Given these successes, countries with long-term governmental commitments to rabies control and the associated infrastructure should incorporate oral rabies bait programs into their enzootic rabies control programs. However, according to the WHO, oral baiting is meant to be a supplement to established parenteral vaccination programs, not an initial control program. Oral baiting can be particularly effective in areas where a large percentage of the animal population is inaccessible or free-ranging and where the targeted population is wildlife.[49]

Not all groups agree with the WHO’s recommendations for the best use of oral bait vaccinations. Some recommend that oral bait vaccines be employed as a primary vaccination effort when a majority of the canine population is inaccessible for vaccination or when parenteral vaccination is not as viable as the use of an oral bait vaccine program (eg, for stray animal populations in a contingency environment).49,51

Population Management

Successfully decreasing a population’s rabies carrying capacity includes implementing strategies for movement restriction, habitat control, and reproduction control. On base camps, movement restriction is accomplished by repairing breaks in fences where animals can enter. Habitat control includes eliminating stray animal access to food sources such as burn pits and trash collection sites and eliminating compassionate feeding of animals. Reproduction control involves methods to prevent animals from breeding. This comprehensive approach to population management reduces animal turnover, decreases the animal populations susceptible to rabies, and limits male dog behavior (eg, fighting and roaming) that contributes to human-animal interactions and rabies spread.[38] When coupled with a vaccination program, this comprehensive approach also results in a stable population of animals on base camps that are essentially immune to rabies infections.

Trap, neuter, and release programs are a major component of population and reproductive control in the United States and other nondeployment areas. Currently, surgery is the most common form of reproductive sterilization used by these programs, but chemical sterilization may become increasingly available as research continues. The US Department of Agriculture is studying an injectable antigonadotropin releasing hormone vaccine called Gonacon (US Department of Agriculture/Animal Plant Health Inspection Service/Wildlife Services/National Wildlife Research Center, Ft Collins, Colorado), which has shown significant promise in sterilizing vaccinated dogs without impacting rabies vaccine effectiveness.54-56 Free-roaming animals can be identified as sterilized and vaccinated by using an ear notch or tag, collar, tattoo, or some other distinguishing marker.

In addition to Gonacon, several other chemical sterilants have been developed, and one has been approved by the US Food and Drug Administration for use in dogs and cats: Zeuterin (Ark Sciences, Irvington, New York) was released for sale in the United States in February 2014. This male sterilant uses zinc gluconate, which binds with arginine in the animal’s body, resulting in testicular sclerosis and permanent sterility.[57] Products approved for use in other countries include Infertile (Brazil) and Suprelorin (Australia, New Zealand, and several European Union countries).58,59

Historically, surgical sterilization of stray dogs and cats in operational environments has been logistically infeasible because of the large number of animals trapped compared to the small number of veterinarians assigned to these theaters. In a contingency environment, chemical sterilization could prove to be an efficient reproduction control option. Currently, Gonacon is only approved for use on deer and other cervids, Zeuterin can only be used on cats and dogs, and both of these products are only approved for use in the United States. Until more chemical sterilants are approved to be utilized by DoD authorities, the trap, neuter, and release programs commonly implemented by stateside personnel will continue to be beyond the scope of deployed DoD forces.

Euthanasia

Euthanasia programs have their place in comprehensive rabies control programs. All animals that are neurologically ill (including aggression) or overtly ill or lame at the time of capture should be euthanized humanely in accordance with American Veterinary Medical Association guidelines and disposed of properly.[60] Indiscriminate trap and euthanize efforts should be avoided as part of a comprehensive rabies control program because animals vaccinated parenterally or through oral rabies baiting would likely be euthanized, inhibiting the goal of achieving herd immunity. However—if combined with stringent movement restriction (ie, no way for animals to enter the operating base) and habitat control efforts—trap, euthanize, and dispose programs could be successful.

Human Preexposure Vaccination

Another option for protecting US service members from rabies in operational environments is to confer rabies protection on the individual versus attempting to control rabies in the animal population. Ideally, if this option were implemented in its entirety, each deploying US service member and civilian contractor would receive the three preexposure rabies vaccination series, but this option is currently fiscally untenable. In 2011, the Defense Logistics Agency procured vaccine for $121.23 per one-dose vial (Written communication, email from Defense Logistics Agency, December 2011), making the cost of the preexposure vaccination series $363.69 per person. Vaccination of one million personnel would cost $363,700,000, which does not include the cost of titers and booster vaccinations throughout a person’s career. It also would not relieve personnel potentially exposed to rabies from the requirement to receive rabies PEP. Finally, preexposure vaccination of all US personnel does not offer any benefit to the local population such as would occur with broad-spectrum animal population vaccination. Therefore, only personnel considered “at-risk” currently receive the initial three preexposure vaccinations and any necessary boosters throughout their service (eg, veterinary personnel and contractors involved in trapping animals).

Human Postexposure Prophylaxis

Despite the accuracy of modern laboratory tests for infection, PEP is often a precautionary part of any successful rabies control and prevention program, given the complex nature of the disease and certain environmental constraints. As noted earlier, providing preexposure vaccination for all troops, DoD civilians, privately owned pets, and feral animals is currently not possible. Rabies is prevalent in contingency operations, can be contracted via several different routes (eg, scratches, bites, and inhalation), has variable but often rapid incubation periods in multiple animal species, and is almost always fatal after symptoms appear. Therefore, once exposure is suspected, the military quickly uses PEP to safeguard troops, whether they are deployed or stationed stateside.

Figure 12-9. A Department of Defense Food Analysis and Diagnostic Laboratory (DoD FADL) veterinary technician performing rabies testing under a hood on a submitted bat. The bat featured above is not the bat received from the Joint Base San Antonio-Lackland incident described in this chapter’s text, but it is the same species (ie, a Mexican free-tail bat), and the same diagnostic procedures were used on both free-tail bat submissions.
Photograph courtesy of Deputy Director, Major Karl J. Hochstein, DoD FADL, Joint Base San Antonio-Ft Sam Houston, Texas.

A case in point is the recent capture of a Mexican free-tail bat at Joint Base San Antonio-Lackland. Although the captured bat tested negative for rabies at the DoD Food Analysis and Diagnostic Laboratory located at Joint Base San Antonio-Ft Sam Houston (Figure 12-9), more than 200 trainees who were living in the dormitory where the bat was caught were given PEP before test results were completed. A joint base spokesman noted that these “vaccinations were given as a precaution” and that even though it was “unlikely” that any trainees had “physical contact” with the captured bat or any other bats, the “primary concern [was] for the health and welfare of the trainees.”61(p1)

RABIES CONTROL IN FUTURE CONTINGENCY OPERATIONS

In early 2013, the directorate of combat and doctrine development at the Army Medical Department Center and School convened a triservice integrated process action team (IPAT) to examine feral animal risk mitigation in future contingency operations. The IPAT used lessons learned; focus groups; surveys; joint operating concepts and doctrine; frameworks for rabies and stray animal control from the WHO and World Organization for Animal Health; research from a review of military policy, doctrine, and scientific literature; and professional military judgment to conduct a capabilities-based assessment. Their analysis identified the capabilities required to mitigate traumatic injury and zoonotic disease risks posed by feral dogs and cats in future conflicts, current capability shortfalls, and potential solutions for identified shortfalls.

The IPAT assumed that US service members will always choose to interact with animals, despite the risks involved or theater orders (eg, GO-1B). Therefore, the IPAT developed the following “solutions” to help mitigate the chances of spreading or contracting rabies in various military environments, given these inevitable interactions: increasing awareness among US service members as to what constitutes a potential rabies exposure and the importance of prompt reporting and treatment; standardizing reporting and treatment procedures for US service members potentially exposed to rabies; increasing awareness among leaders of feral animal threats; publishing technical guidance to standardize feral animal control measures for dogs and cats in contingency environments; clarifying various responsibilities for feral animal control and feral animal risk mitigation procedures in policy and doctrine; instituting triservice measures to collate and analyze bite reports (ie, DD Form 2341) to estimate traumatic injury and rabies risk to US service members in various environments; and publishing policy to ensure that all appropriately categorized “at risk” personnel receive preexposure rabies vaccination prior to deployment.

The documents outlining these proposed solutions have initially been approved by the Headquarters, Department of the Army, and are currently being reviewed by DoD staff. The proposed timeline for implementing the final approved solutions began in the fall 2014 and continued through fiscal year 2015.

SUMMARY

Because the risk of exposure to Lyssavirus is high in areas where the United States will deploy its military in the future, rabies continues to be a legitimate disease threat to force health protection. Compounding this risk is the likelihood of stray animals on and around military base camps in contingency environments and the reality that US service members will likely choose to interact with animals, despite this risk and command regulations against doing so. Controlling rabies is a complicated problem for which the ultimate prevention and control program has yet to be found, especially in operational environments. However, efforts are underway to implement improved measures to mitigate rabies risk to deployed US forces.

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43.   Abizaid JP. General Order 1B (GO–1B): Prohibited Activities for U.S. Department of Defense Personnel Present within the United States Central Command (US CENTCOM) Area of Responsibility (AOR). US Central Command. March 13, 2006.

44.   Mangiere N, Sorhage F, Campbell C, et al. Rabies in dog imported from Iraq—New Jersey, June 2008. MMWR. 2008;57(39):1076–1078.

45.   Kopelman J, Roth M. From Baghdad, With Love: A Marine, the War, and a Dog Named Lava. Guilford, Conn: The Lyons Press; 2008: 17.

46.   Chretien JP. Protecting service members in war—non–battle morbidity and command responsibility. N Engl J Med. 2012;366(8):677–679.

47.   Headquarters, Multi–National Corps–Iraq. Policy and Procedures for Animal Control and Animal Bite Management in the Iraqi Theater of Operations. Multi–National Corps–Iraq Standard Operating Procedures. Baghdad, Iraq. December 4, 2008.

48.   United States Forces–Afghanistan Headquarters. U.S. Forces Afghanistan Policy Letter #25–Feral Animal Control on FOBS/COBS. Memorandum for All USFOR–A Personnel. Kabul, Afghanistan. June 29, 2010.

49.   World Organization for Animal Health. Toward the Elimination of Rabies in Eurasia. Joint OIE/WHO/EU Conference May 27-30, 2007. http://www.oie.int/fileadmin/Home/eng/Publications_%26_Documentation/docs/pdf/A_Rabies_Final_Resolution.pdf. Accessed October 18, 2013.

50.   Totton SC, Wandeler AI, Zinsstag J, et al. Stray dog population demographics in Jodhpur, India following a population control/rabies vaccination program. Prev Vet Med. 2010;97:51–57.

51.   Estrada R, Vos A, De Leon R, Mueller T. Field trial with oral vaccination of dogs against rabies in the Philippines. BMC Infect Dis. 2001;1(23). www.biomedcentral.com/1471–2334/1/23. Accessed October 18, 2013.

52.   Vos A, Aylan O, Estrada R. Oral vaccination campaigns of dogs against rabies. Seventh SEARCH Meeting, Ezulwini: Epidemiology, Dog Ecology, and Oral Vaccination. May 12–15, 2003.

53.   Cliquet F, Gurbuxani JP, Pradhan HK, et al. The safety and efficacy of the oral rabies vaccine SAG2 in Indian stray dogs. Vaccine. 2007;25:3409–3418.

54.   Biological Standards Commission. Rabies. In: Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. 7th ed. Paris, France: World Organization for Animal Health; 2012: 6.

55.   Miller LA, Rhyan J, Killian G. GonaCon, a versatile GnRH contraceptive for a large variety of pest animal problems. Proc Vertebrate Pest Conf. 2004;21:269–273.

56.   Bender SC, Bergman DL, Wenning KM, et al. No adverse effects of simultaneous vaccination with the immunocontraceptive GonaCon and a commercial rabies vaccine on rabies virus neutralizing antibody production in dogs. Vaccine. 2009;27:7210–7213.

57.   Levy JK, Crawford PC, Appel LD, Clifford EL. Comparison of intratesticular injection of zinc gluconate versus surgical castration to sterilize male dogs. American Journal of Veterinary Research. 2008; 69(1): 140-143.

58.   Cowan D, Kerr K. ZeuterinTM launch delivers innovative non-surgical procedure, product to sterilize male dogs. Ark Sciences, Inc. New Release. February 17, 2014.

59.   Alliance for Contraception in Cats and Dogs. Current Approaches. http://www.acc-d.org/About. Accessed April 8, 2014.

60.   American Veterinary Medical Association. AVMA Guidelines on Euthanasia. Schaumburg, Ill: American Veterinary Medical Association; 2007.

61.   Christenson S, Huddleston S. Bat caught at Lackland negative for rabies. San Antonio-Express News. January 22, 2014. http://www.mysantonio.com/news/local/military/article/Bat-caught-at-Lackland-negative for rabies-5164989.php. Accessed January 27, 2014.

Chapter 13

GLOBAL ZOONOTIC DISEASE SURVEILLANCE AND CONTROL

KELLY G. VEST, DVM, MPH, DRPH*; ROBERT S. DOLE, DVM, MPH†; KAY D. BURKMAN, DVM, MPH‡; ANDREW L. MCGRAW, DVM, MS§; BORIS BRGLEZ, DVM, MPH¶; MARTIN M. LAGODNA, DVM**; AND RONALD L. BURKE, DVM, DRPH††

INTRODUCTION

Background of the One Medicine, One Health Concepts

Implementation of the One Health Concept

NATIONAL VETERINARY ACCREDITATION AND THE MILITARY VETERINARIAN

Program Background, Mission, and Veterinary Accomplishments

Accreditation Process, Requirements, and Credentialing

VETERINARY ELECTRONIC HEALTH RECORDS AND HEALTH EXAMS

DEPLOYMENT SURVEILLANCE AND DISEASE CONTROL

THE ARMED FORCES HEALTH SURVEILLANCE CENTER AND DEPARTMENT OF DEFENSE LABORATORY NETWORK

Background and Overview

Zoonotic Disease Surveillance and the Military Veterinarian

US NORTHERN COMMAND CIVIL SUPPORT AND THE ONE HEALTH CONFERENCE

VETERINARY CORPS PARTICIPATION IN INTERAGENCY AND EMERGENCY RESPONSE

Venezuelan Equine Encephalomyelitis Outbreak, Texas, 1971

H5N2 Highly Pathogenic Avian Influenza Outbreak, 1983

SUMMARY

*Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Deputy Chief of Staff, Armed Forces Health Surveillance Center, 11800 Tech Road, Silver Spring, Maryland 20904; currently, Science Director, Cooperative Biological Engagement Program, Center for Global Health Engagement, 11300 Rockville Pike, Suite 707, Rockville, Maryland 20852-3065

†Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Services Division, US Army Public Health Command Region-South, 2899 Schofield Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

‡Lieutenant Colonel, Veterinary Corps, US Army (Retired); Subject Matter Expert, US Army Public Health Command, Veterinary Services Systems Management Program, 4270 Gorgas Circle, San Antonio, Texas 78234-2639

§Lieutenant Colonel, Veterinary Corps, US Army; formerly, Chief, Internal Medicine and Outpatient Clinics, Department of Defense Military Working Dog Center, Joint Base San Antonio-Lackland Air Force Base, Texas; currently, Commander, 218th Medical Detachment (Veterinary Service Support), Joint Base Lewis-McChord, Washinton 98433

¶Lieutenant Colonel, Veterinary Corps, US Army; Veterinary Plans Officer, 248th Medical Detachment Small Animal Veterinary, Fort Bragg, North Carolina 28310

**Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Command Veterinarian, Office of the Command Surgeon, US Army Europe, Unit 29351 Box 95, APO, AE 09014-9355

††Lieutenant Colonel, Veterinary Corps, US Army; formerly, Deputy Director, Division of Global Emerging Infections Surveillance and Response System, Armed Forces Health Surveillance Center, Silver Spring, Maryland; currently, Chief, Veterinary Services Division, Public Health Command Region West, Box 339500, MS 115, Joint Base Lewis-McChord, Washington 98433.

INTRODUCTION

Background of the One Medicine, One Health Concepts

Although many credit the late Dr Calvin Schwabe with coining the term “One Medicine” in 1964, the recognition that healthy animals are important to human health is far from new.[1] Nearly 90 years earlier, Rudolf Virchow, popularly acknowledged as the father of modern comparative pathology, and Sir William Osler, a Canadian physician who is often called the father of modern medicine, both supported the One Medicine concept (ie, the well-being of humans is affected by disease control in animals).[2]

Historically, One Medicine also symbolized the close association between physicians and veterinarians. Decades before the first veterinary school was established in 1761, physicians were charged with responding to animal diseases such as the 1713 outbreak of “Rinderpest” (the German word for “cattle plague”) in Rome, and long before human medicine was established as a formal profession, humans had been caring for the health and welfare of animals.[3] Much of this attention to animal health was due to the critical roles animals played in preindustrial society; at this time, they were used for food, transportation, clothing, and farming. Even today, in many developing countries, the family cow or goat is not only a potential source of milk, meat, and clothing, but also represents a significant savings investment or liquid asset against future needs and expenses. The loss or death of the animal can negatively impact the health and welfare of the family.

Although most people today do not depend so heavily on animals for their basic needs, attention still must be paid to animal health because of the significant role animals play in disease transmission: over 60 percent of the infectious diseases affecting humans are zoonotic.[4] Since 1964, One Medicine has evolved into the global concept “One Health,” an initiative that continues to recognize the connection between human and animal diseases and strives to emphasize the more recent, holistic idea that health is a whole, which is based on a fluid, shared ecosystem (ie, humans, animals, and their environments). In 2007, in recognition of the interdependency of human and animal health, the American Medical Association adopted a One Health resolution, and the American Veterinary Medical Association convened a One Health task force to examine the ways to promote the concept between the two organizations.[5]

Implementation of the One Health Concept

Although many associations and institutions continue to promote One Health, perhaps no organization is better able to implement the concept than the US military, particularly the US Army. In the civilian sector, the practice of medicine is generally fragmented by patient species. Physicians tend to care for humans, veterinarians care for nonhuman animals, and neither doctor interacts with the other on a regular basis. However, within the military, even though military physicians and military veterinarians still care for the same separate populations, the two professions tend to interact more than their civilian counterparts for several reasons, including more collaborative training.

Collaboration begins on day one of their military careers when medical and veterinary officers attend the same Basic Officer Leaders Course and continues throughout the military education cycle, fostering close working relationships and information sharing between the two professions. Officers and enlisted service members may also have multiple assignments with their counterparts throughout their careers, particularly at research organizations (eg, Walter Reed Army Institute of Research or the overseas research laboratories), further promoting cross-professional relationships and information sharing.

In addition to greater collaboration, the One Health concept may succeed more in the military than in the civilian sector because the military treats a relatively closed population, using a consolidated health system. Not only are human and veterinary medicine separate in the civilian sector, but the civilian human health care system also tends to be fragmented. The high degree of specialization in human medicine results in patients being seen by multiple physicians, often at several, individual institutions, which may result in each physician only seeing a portion of a patient’s medical history. While military medicine is equally specialized, military patients generally receive all or the majority of their care within the military health system, which allows military providers to view a more comprehensive patient record.

Veterinary care is similarly consolidated, especially at remote or overseas installations where the majority of privately owned animals receive their care from the military veterinary treatment facility. This comprehensive care, combined with the development of cross-profession relationships, facilitates the rapid communication of mutual concerns and, potentially, the early detection of significant disease trends and activities that would otherwise not be readily visible looking at only a portion of a single population.

The recent establishment of the Army Public Health Center should further enhance detection capabilities as this command extends the reporting and analysis of human and animal disease activities from a single installation to the entire military. These coordinated surveillance activities are also conducted at the overseas research laboratories where military researchers partner with local ministries of agriculture, health, and defense to identify reservoirs and vectors and determine disease prevalence and incidence in animal and human populations. Additional information on military veterinarians’ roles in conducting zoonotic disease surveillance and control is presented in the following sections, including how service member animal practitioners become accredited.

NATIONAL VETERINARY ACCREDITATION AND THE MILITARY VETERINARIAN

Program Background, Mission, and Veterinary Accomplishments

The eradication of livestock and poultry diseases such as contagious bovine pleuropneumonia, foot and mouth disease, and screwworm has had a tremendous impact on public health, livestock productivity, and, thus, the United States economy.[6] The United States is currently on the verge of eradicating brucellosis, tuberculosis, and pseudorabies.[7] Military veterinarians have played, and will continue to play, a pivotal role in the eradication process via various means, including becoming accredited practitioners who partner with other veterinarians to promote animal health.

The United States Department of Agriculture (USDA) established a national veterinary accreditation program in 1921 so that accredited veterinarians could assist federal veterinarians in executing the mission of controlling animal diseases and facilitating the movement of healthy animals. According to a USDA publication, “[t]he mission of the National Veterinary Accreditation Program [NVAP] is to ensure the health of the [n]ation’s livestock and animal population and to protect the public health and well-being,”; more specifically, “[a]ccredited veterinarians work cooperatively with USDA’s Animal and Plant Health Inspection Service (APHIS) and [s]tate animal health officials to protect and improve the health, quality, productivity, and marketability of US animals by preventing, controlling, and eradicating” both endemic and foreign animal diseases.[8]

Because of their unique missions worldwide, military veterinarians must be familiar with disease prevention, control, and eradication, and regulations governing interstate, intrastate, and international shipment of animals. Each year military veterinarians also evaluate and facilitate the exportation and importation of hundreds, if not thousands, of domestic animals worldwide, giving these veterinarians the opportunity not only to encounter foreign animal diseases, but also to prevent diseased animals from entering or exiting the United States. During the past decade, veterinary practitioners, particularly military veterinarians, performed key roles in the detection and eradication of several diseases not previously found in the United States: (a) contagious equine metritis, (b) exotic Newcastle disease, (c) West Nile virus, (d) screwworm, (e) monkey pox, and (f) H1N1 influenza virus.[9]

Accreditation Process, Requirements, and Credentialing

Currently, qualified veterinarians can earn accreditation in two existing categories: Category I and Category II. Category I includes all animals “except food and fiber species, horses, birds, farm-raised aquatic animals, all other livestock species, and zoo animals that can transmit exotic animal diseases to livestock.”[8] Category II includes all animals; nothing is excluded. Note that dogs and cats are included within Category I, whereas all bird species fall only into Category II. Category II accreditation may be most beneficial for military veterinarians because they are frequently required to examine dogs, cats, and birds and issue health certificates for interstate and international travel during deployments and permanent change of station reassignments.

Veterinarians applying for accreditation under the NVAP must fulfill the following four requirements: (1) possess a current and valid license and otherwise be legally able to practice in the state for which accreditation is desired; (2) complete the web-based initial accreditation training with a passing score of 80% or higher (website access can be obtained from the APHIS Veterinary Services Area Office in the state for which accreditation is desired); (3) complete the core orientation to include state-specific training in the state for which accreditation is desired; and (4) complete the NVAP application (VS Form 1-36A).[8]

Each veterinarian’s accreditation is not valid until written approval is obtained from APHIS, and initial APHIS accreditation is good for 3 years. After 3 years, APHIS-approved supplemental training is required for accreditation renewal, and this mandatory training is available online at no charge. As of this chapter’s publication, three units of supplemental training per renewal period are required for Category I veterinarians and six units for Category II veterinarians. Supplemental training options can be found at www.aphis.usda.gov/nvap.

Veterinary accreditation is usually not required for interstate shipment of cats and dogs. However, several states and territories do require health certificates be counter-signed by a USDA-accredited veterinarian (eg, Connecticut, Delaware, Indiana, Louisiana, New Hampshire, and the US Virgin Islands). Similarly, the shipment of dogs and cats internationally does not normally require signature by a USDA-accredited veterinarian; however, some countries do require accredited veterinary endorsement on the official certificate of veterinary inspection. Given the lack of standardization among states, territories, and countries, all military veterinarians must maintain knowledge of both interstate and international animal shipping requirements.

The current Army Public Health Center definition of a military veterinarian encompasses both commissioned officers and general schedule veterinarians employed by the Army Public Health Center.[10] Because the current definition includes these two groups of veterinarians, the US military has developed relationships with countries where many military and family members and accompanying pets reside (eg, Japan, Korea, and the European Union) that permit a military veterinarian to sign and stamp the health certificate in lieu of the required USDA endorsement. In this capacity the military veterinarian serves and is recognized as an US government official veterinarian.

In addition to accreditation, many military veterinarians become credentialed as foreign animal disease diagnosticians by attending the Foreign Animal Disease Diagnostic School at the Plum Island Animal Disease Center in Orient Point, New York. By so doing, the military adds to the number of credentialed US veterinarians capable of supporting a USDA response to foreign animal disease introductions to the United States.

VETERINARY ELECTRONIC HEALTH RECORDS AND HEALTH EXAMS

Humans have been using animals as sentinels of zoonotic diseases since ancient times. It only stands to reason that if one is looking for an outbreak of a zoonosis, the occurrence of such a disease should appear in the local animal population first. By studying this group, informed decisions can later be made regarding the preservation of health in the similarly exposed human population. When the population of domestic animals is routinely presented for veterinary care, health records are created that can be analyzed for the presence of zoonoses or effects of environmental exposures, which is crucial to the decision-making process. Traditionally, this zoonotic surveillance has been conducted using paper records or, more recently, locally maintained electronic records.

Unfortunately, both paper and local electronic records present numerous obstacles to real-time zoonoses surveillance. Neither form is accessible globally without the use of some means of transmission to a centralized surveillance center, thus increasing time to analysis. Paper records are also often difficult to read, must be abstracted to provide data for analysis, are easily lost, and are not usually standardized in terminology or format. These drawbacks predispose any analysis to errors based on the skill of the abstractionist and the interpretations of the investigator. Additionally, abstraction is manpower intensive and time consuming, adding increased cost and rendering most analyses retrospective in nature (much abstraction work is completed long after the occurrence of the zoonosis or exposure of interest). Abstracted surveillance data is even less useful on the battlefield, where more immediate decision support is required.

The global electronic health record (EHR) is designed to negate the aforementioned surveillance obstacles. Because the EHR is web-based, the individual record is updated immediately upon completion of a patient encounter, providing the ability to trend historical medical diagnoses and results. Operating over the internet also allows the updated data to be available anywhere and at any time, permitting simultaneous access to multiple users worldwide. Further, the data is stored in a secure, redundant, and mineable database that reduces the risk of data loss.

The EHR is particularly useful for tracking military working dog (MWD) health in a more timely and connected manner. The MWD undergoes a complete physical exam every 6 months, resulting in a lifelong longitudinal health history that is used in epidemiological studies to investigate potential exposures and theorized effects on health outcomes.11–17 Like other abstraction work, early studies of the MWDs tended to be time consuming, manpower intensive, and tardy (most being completed years after an exposure or zoonotic disease occurred). However, by using the EHR, animal location, environment, and complete health history is centrally located and available for multiple analyses. The EHR also provides the capability to follow a cohort of animals prospectively to an anticipated medical outcome, or lack thereof, with the data from all aspects of the epidemiological triad available for analysis, rapid reporting, and informed decision-making.

To be of optimum use, the EHR first must conform to recognized standards. Coding systems that support morphology, topography, and diagnostic terminology standardization need to be incorporated into the EHR application. The three most recognized coding systems in human medicine are (1) the International Statistical Classification of Diseases and Related Health Problems,[18] (2) the Diagnostic and Statistical Manual of Mental Disorders,[19] and (3) the Systematized Nomenclature of Medicine-Clinical Terms.[20]

In conjunction with the American Animal Hospital Association, starting in 2002, the veterinary community began the onerous task of developing a standard terminology for an animal coding system that is tied to the Systematized Nomenclature of Medicine-Clinical Terms coding system.[21] This system is now maintained for the veterinary community by the Veterinary Terminology Services Laboratory located at the Virginia Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia.[22] The ability to code to a standard set of terms allows the greatest flexibility in data analysis because cases are not erroneously included or excluded in the case definition based on disparate terminology. Standardized coding also dramatically improves the value of large, web-based databases for zoonotic surveillance.

Another critical element that affects EHR usability is network connectivity. The EHR is hosted on a server platform accessible to both military and commercial networks, enabling the capture of animal health encounters from any environment where the warrior animal may be found. Ideally, the application should be accessible through a multitude of devices and means (eg, laptop, tablet, handheld, and desktop end-user devices) by local area network or wireless network connections. This redundancy of data collection decreases the risk of data loss through misplaced or damaged paper records.

Security of data, both at rest and during transit, is vital to the security of the entire internet and also to the usefulness of the EHR system. The record system must be compliant with all current Department of Defense (DoD) security and information assurance directives and needs to be stored within a secure enclave. Common Access Card authentication is required for all users, and access is limited by role-based permissions. Such restrictions ensure all users are operating the application within the scope of their duties and credentials, preserving the medicolegal requirement of the EHR. A full audit trail is maintained for any transaction within a record with a date and time stamp as well as identification of the authenticated user.

The EHR system also contributes to a leader’s global zoonotic disease surveillance and control decision-making capabilities in multiple ways. For example, the system provides a centrally managed large enterprise veterinary practice, such as the military, with visibility at all levels of military veterinary care. Reportable disease triggers can be incorporated that will allow real-time data transfer of zoonotic outbreaks, not only to veterinary service command personnel, but also to DoD public health officials throughout the area of interest. Collection and reporting of this data in real time can result in improved decision support and employment of appropriate preventive measures by commanders.

Finally, EHRs provide the means to determine outcome-based best practices that result in improved health and treatment of zoonotic diseases. Secondary benefits can also be received from administrative and operational reporting capabilities, allowing for more efficient manpower distribution, better inventory management, and streamlined corporate practice management. All these capabilities lead to healthier animals and, ultimately, service member wellness.

The multiple benefits of the EHR system aside, the most important factor for its effective use is a willingness of the veterinary community to accept the system. The best-built application cannot function as designed if the user is allowed to resist conversion to it. Command emphasis from all levels is critical to the successful implementation of any EHR and practice management system.

DEPLOYMENT SURVEILLANCE AND DISEASE CONTROL

Vector-borne diseases (VBDs), many of which are considered enzootic, have long been studied in various parts of the world to aid in the development of new vector-control strategies for US military deployments. However, in Afghanistan, tick analyses, other indigenous animal seroprevalence, and molecular studies are lacking; the unavailability of such information is likely due to the austere state of Afghanistan’s infrastructure. Since VBD information is considered a vital component of a more complete and informative medical threat brief to medical and veterinary caregivers serving in Afghanistan, an effort to identify the VBD risk in Afghanistan was initiated in the spring of 2010.

Similar surveys have proven to be useful in comparing risk of disease for MWDs with the feral canine population in Iraq.[11] One objective of this survey effort was to determine the prevalence of the following VBDs in the tick and feral dog population within various regions across Afghanistan: Ehrlichia canis, Babesia canis/gibsoni, Rickettsia spp., Leishmania infantum, Bartonella spp., and Anaplasma phagocytophilum. The survey, which was not completed, was supposed to obtain samples from a minimum of 150 feral dogs being euthanized in accordance with vector control policies. Blood (serum and ethylenediamine tetraacetic acid-preserved whole blood) and tick samples were to be collected for analysis. Analysis was to consist of (1) tick species identification, (2) indirect fluorescent antibody serology, and (3) molecular polymerase chain reaction analysis on all serologically positive samples—as well as tick samples—to assess for correlation between infection and exposure and actual presence of pathogen deoxyribonucleic acid (LTC Andrew McGraw, chapter author, unpublished data, June 2012).

Unfortunately, although sampling materials and instructions were distributed to no less than six sites spread across Regional Command-South and Regional Command-East in Afghanistan, the follow-on and replacement veterinary and preventive medicine units within each Command elected not to participate in this survey. Furthermore, an inadequate number of specimens were collected to provide sufficient data to interpret any valuable results. If it were more complete, this survey’s conclusions and clinical relevance could have provided veterinary health care providers and handlers with vital medical threat information about which relevant VBD are present in this area of operations. Additionally, because some of these organisms possess zoonotic potential, this survey may have served as vital public health information for human health care providers and preventive medicine personnel (LTC Andrew McGraw, chapter author, unpublished data, June 2012).

Lessons learned from this unfinished study reinforce the precept that any disease surveillance initiative in a given theater of operations needs to be mandated in a “top down” fashion from the theater veterinarian to prevent these initiatives from being dropped before they are fully implemented or completed. Without buy-in from follow-on personnel, the enduring potential for new surveillance programs is weak.

THE ARMED FORCES HEALTH SURVEILLANCE CENTER AND DEPARTMENT OF DEFENSE LABORATORY NETWORK

Background and Overview

In 1996, President Bill Clinton issued the Presidential Decision Directive National Science and Technology Council-7 on Emerging Infectious Diseases,[23] which guided the establishment of the DoD Global Emerging Infectious Surveillance and Response System (GEIS). Under the GEIS umbrella, the DoD’s overseas and primary Military Health System research laboratories perform infectious disease surveillance, including the study of zoonotic infections within five infectious disease categories: (1) respiratory infections, (2) febrile and vector-borne infections, (3) gastrointestinal infections, (4) antimicrobial infections, and (5) sexually transmitted infections.24,25

Prior to GEIS (and beginning in 1985), the US Army Medical Surveillance Activity (AMSA) developed and managed the Defense Medical Surveillance System, a longitudinal database that included the outpatient and inpatient healthcare information of all active duty military members and some beneficiary information. AMSA also housed and managed the DoD’s serum repository, which is comprised of serum contributions from human immunodeficiency virus screenings and pre- and post-deployment donations conducted or collected throughout service members’ careers.[26]

In 2008, GEIS and AMSA were consolidated into the Armed Forces Health Surveillance Center (AFHSC), providing a centralized location for more rounded disease surveillance activities and a more integrated gateway to public health for civilian and military beneficiaries at home and abroad. By using the AFHSC’s combined resources, stronger epidemiological studies of disease occurrence among the military population, including deployed US military personnel, can be pursued. For example, by tapping into the surveillance and monetary resources within the AFHSC, the DoD infectious disease research laboratories can also study diseases of global military importance, including zoonoses.

In 2015, the AFHSC was realigned under the Defense Health Agency as a branch within the Public Health Division. The AFHSC maintains its key roles in disease surveillance, epidemiology, and biosurveillance activities.

Zoonotic Disease Surveillance and the Military Veterinarian

Military veterinarians serve critical roles within the DoD’s global infectious disease research laboratories. Because veterinary officers are responsible for surveillance project funding and providing oversight of an infectious disease steering committee, they significantly influence the research products and programs performed in these DoD laboratories.

The oversight of global surveillance programs that survey both human and animal disease profits from the inclusion of a veterinary perspective, especially with regards to the One Health concept. Since all tracked infectious disease categories—except for the human sexually transmitted infections programs—have a zoonotic or animal health component, veterinary preventive medicine proficiency and public health expertise are very beneficial management tools. Veterinarians are also integral to developing innovative solutions and programs to respond to outbreaks and emerging threats, and interfacing, collaborating, and consulting with senior representatives from the DoD, Centers for Disease Control and Prevention, Department of Homeland Security, Department of State, and other government and civilian agencies.

Zoonotic disease surveillance efforts that have capitalized on, and demonstrated the broad utility of, military veterinarians include development of diagnostic assays; epidemiologic studies defining reservoirs, disease prevalence, and transmission factors; disease surveillance within high-risk populations; and surveillance at the human-animal interface.[27] Military veterinarians have also played key roles in disease discovery,[28] outbreak response,29-31 epidemiologic descriptions,32,33 vaccine evaluation and development,[34] and pandemic prevention and response.[35] (See also Chapter 11, Zoonotic and Animal Diseases of Military Importance, and Chapter 15, Veterinary Pathology.)

Using deployed military veterinarians to develop and strengthen a host nation’s surveillance programs and laboratory capacity is critical to global zoonotic disease surveillance and control. Nation-building veterinary missions are discussed in more detail in other chapters of this volume. (See also Chapter 17, Veterinary Support in the Irregular Warfare Environment) As previously noted, the comparative knowledge and expertise about animals and humans is the strength of the veterinary medical officer. The veterinarian sees the military and medical environment from a different perspective: this officer brings a more encompassing view to public health and preventive medicine, a specialized perspective that leads to considering different approaches to disease surveillance, epidemiology, outbreak response, and prevention at home and abroad.

US NORTHERN COMMAND CIVIL SUPPORT AND THE ONE HEALTH CONFERENCE

In 2009, a novel human influenza virus, capable of causing serious disease to which the human population had no immunity, emerged in North America and swept the globe. Influenza A, H1N1, a virus that contained swine, avian, and human influenza virus gene segments, first caused human illness in Mexico in March 2009.[36] Shortly thereafter, on April 21, 2009, the Centers for Disease Control and Prevention reported the first cases of emerging H1N1 influenza A infection in the United States.[37] The virus rapidly spread to all 50 states and across the Northern Hemisphere, and in June 2009, the World Health Organization (WHO) declared the new strain of H1N1 a pandemic. By August 10, 2010, the date this iteration of the influenza pandemic was declared over by the WHO, more than 214 countries had been affected and 18,000 deaths had occurred.[38]

The global threat of pandemic influenza led federal authorities to seek civil support from the DoD. Exploding patient workload, coupled with high healthcare worker absenteeism, overwhelmed regional and national medical infrastructures. The pandemic influenza also had a major effect on the world economy and politics by impacting international trade, markets, travel, and investments.

However, care must be taken whenever the DoD provides civil support for pandemics. For example, as a group, DoD personnel are particularly vulnerable to respiratory viral infections based on their exposure to many different populations across the world, their frequent mobility, and their close contact in personal training environments and large-group work settings. DoD mission assurance can be compromised during a pandemic if entire military units or key personnel become ill. The DoD could be affected in other ways as well, including medical readiness, operational capabilities, and freedom of movement.

To mitigate the impact on mission assurance and to prepare to support civil authorities, US Northern Command (USNORTHCOM) operationalized pandemic influenza concept plans 3551—Concept Plan to Synchronize DOD Pandemic Influenza Planning[39] and 3591—USNORTHCOM Response to Pandemic Influenza.[40] USNORTHCOM’s Command Veterinarian Lieutenant Colonel Martin LaGodna monitored and analyzed biosurveillance information streams, collaborated to develop influenza mitigation and response plans, wrote force health protection guidance and instructions, and advised the command as a subject matter expert on infectious disease, animal health, food safety, and preventive medicine.

The experience of recognizing and responding to a human influenza virus of animal origin demonstrated the relevance of the One World-One Health concept (ie, effective public health is multidisciplinary and multifaceted). Global leaders must understand the inter-relationships between human, animal, and environmental health, and public health challenges and solutions need to be synchronized among medical, animal, food, agriculture, and environmental stakeholders. Since infectious diseases do not respect national boundaries, communication and cooperation is also essential across the international public health community.

To foster a shared vision of the One Health concept among the NORTHCOM Surgeon’s joint, interagency, and international partners, Lieutenant Colonel Martin LaGodna obtained a grant from the Armed Forces Health Surveillance Center to sponsor the first NORTHCOM Surgeon’s One Health Conference, June 14 through 15, 2011, in Colorado Springs, Colorado. This strategic health meeting brought together more than 100 senior civilian and military public health, food, agriculture, wildlife, and environmental health professionals from Canada, Mexico, the Bahamas, and the United States to discuss biosurveillance, the human-animal-environmental health triad, and emerging One Health infectious disease threats affecting North America and the Caribbean. A second One Health Conference was held the following year (June 12–14, 2012).

VETERINARY CORPS PARTICIPATION IN INTERAGENCY AND EMERGENCY RESPONSE

In addition to supporting global missions, the US Army veterinarian has played an integral role in responding to domestic emergencies. Some of the capability requested as part of the military response effort includes providing veterinary medical expertise and furnishing trained animal and food technicians and equipment to protect public health, domestic and wild animals, and the nation’s food supply. During domestic emergencies, these US military personnel primarily use their allocated resources and specialized training to accomplish the following critical tasks: (a) assisting efforts to prevent contamination of food; (b) preventing disease through vaccination programs; (c) supporting disease eradication programs; (d) establishing temporary animal shelters and hospitals; and (e) performing food inspections.

Today’s interagency relationship between the US Army Veterinary Corps (VC), the US Department of Agriculture (USDA) Animal Plant Health Inspection Service (APHIS), and the Federal Emergency Management Agency can be traced back to 1972 with the creation of APHIS and the Defense Civil Preparedness Agency (DCPA). In 1977, DCPA evolved into the Federal Emergency Management Agency (FEMA).[41]

Since its creation in 1916, the Veterinary Corps’ duties to respond to national emergencies has transformed from “ad hoc” response units to the more modern and sophisticated Medical Detachment Veterinary Service Support units. Every year, one Medical Detachment Veterinary Service Support unit is designated to remain on alert and trains continuously to respond to any national or state emergency.

The US Army VC senior leadership works closely with the USDA and other federal agencies in times of natural disasters. Two historical emergency response events in which the VC provided significant contributions to protect the nation from disease, food, and animal loss are highlighted below. (In addition to Chapter 17, Veterinary Support in the Irregular Warfare Environment, already cross-referenced in this chapter, see also Chapter 1, Military Veterinary Support Before and After 1916, and Chapter 9, Food Safety and Food Defense, for more information about other US veterinary efforts to aid military and civilian populations across the globe.)

Venezuelan Equine Encephalomyelitis Outbreak, Texas, 1971

The USDA and US Army began monitoring Venezuelan equine encephalomyelitis (VEE) outbreaks in Central and South American horses and humans since the viral disease was first identified in Venezuela in 1938. VEE contributed to the death of hundreds of thousands of horses in South America, and during the 1960s, a VEE epidemic slowly advanced from upper South America through Central America and into Mexico, threatening each country’s human and equine populations and the US horse industry.

The governments of Colombia, Ecuador, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and Mexico requested US assistance to halt this deadly emerging disease. US Army laboratories that had been studying and investigating the disease since its discovery evaluated VEE’s capabilities as a bioweapon and developed a live attenuated human vaccine called TC-83 to protect those scientists who studied the virus. In 1968, TC-83 was used in Colombia in horses, and the vaccine provided good immunity against VEE.

Overall, more than two million horses in Central and South America were immunized with the TC-83 vaccine from 1967 to 1970. Horse deaths ended 7 to 10 days after vaccination, and the vaccine protected 90 percent of equine populations. Furthermore, following the vaccination of the majority of horses in rural communities, human cases ceased to occur.[42] Despite such results, during this time, TC-83 was still considered experimental and was not approved for use in horses by the USDA.

In mid- to late June, VEE cases were identified among horses and humans in Mexico just south of the US border in Brownsville, Texas.[43] On June 19, 1971, a task force was assembled in Harlingen, Texas, to prevent the spread of VEE using vaccination as a primary mitigation measure. The objective was to protect horses and humans from VEE, and in the event of its appearance in the United States, to implement additional control measures such as aerial spraying and quarantines to halt the spread of the disease. The task force consisted of multidisciplinary specialists, including representatives from USDA, US Public Health Service, DoD (ie, US Army veterinarians, preventive medicine officers, and Air Force officers), Texas Animal Health Commission, and Texas State Department of Health. On June 25, 1971, vaccination in horses was started.42,43

Despite vaccination, VEE virus was isolated from a horse on June 30, 1971. During the first week in July, equine encephalitis fatalities were identified, and on July 5, 1971, the first confirmed human case was diagnosed (in a man). The Texas outbreak was the first documented VEE outbreak in the United States.[42]

The US Air Force began aerial spraying on July 10, 1971. Six days later, the Secretary of Agriculture Clifford M. Hardin declared Texas under a state of emergency. New Mexico, Oklahoma, Arkansas, and Louisiana were placed under quarantine to ensure VEE would be contained and not spread to other states. The USDA also obtained TC-83 from the military to vaccinate all horses in Texas, New Mexico, Oklahoma, Arkansas, and Louisiana.[42]

The disease peaked among Texas horses during the third week in July, but cases continued presenting until November 7, 1971. The role of the military veterinarian during this crisis included detection of equine cases, vaccination of horses, working cooperatively with county extension agents, and contributing to the newly established equine surveillance system. Prior to the outbreak, military veterinarians were instrumental in the study of VEE and development of the vaccine used to protect both humans and horses.[42]

H5N2 Highly Pathogenic Avian Influenza Outbreak, 1983

On April 22, 1983, the first cases of low pathogenic avian influenza H5N2 were diagnosed among layer flocks near Lancaster, Pennsylvania. Clinical signs included mild to moderate loss of production and mortality at less than 10 percent. This pattern of disease continued until October 1983 when the low pathogenic form became a highly pathogenic form and the state requested federal assistance. Poultry mortality reached high levels (ie, up to 90 percent) in Pennsylvania, and within a month, the disease spread to New Jersey, Maryland, and Virginia.[44] Each state determined its own quarantine areas and, with some federal assistance, enforced control measures to reduce the movement of infected animals or contaminated vehicles, equipment, and product.44,45

Depopulation, which focused only on flocks that resided within the quarantined areas, was determined to be the best control measure. This control was first implemented in Virginia and Maryland, followed by Pennsylvania and New Jersey. Over 17 million birds were euthanized from 448 flocks that were affected. Quarantine areas in New Jersey were released by state and federal quarantine authorities in March 1984 and in Virginia and Pennsylvania in September and October 1984, respectively; surveillance programs were set up thereafter and continued several months past the quarantine release.44,45

In order to accomplish the surveillance and control measures, the US Veterinary Corps provided over 40 veterinarians to assist in the areas of diagnostics, pathology, and epidemiology among the 200-plus DoD soldiers and civilian employees who deployed to the quarantined areas. The military also provided equipment for communications, transportation, and laboratory analysis and supplemented the control efforts to overcome the logistical challenges faced in this extensive animal disease outbreak.[44]

SUMMARY

Military veterinarians understand the One Health concept and promote this modern initiative’s implementation in various global and domestic endeavors: (a) they work collaboratively within the military health system and contribute to the health and well-being of the military member and their families; (b) they are extensively trained and can be accredited and credentialed in the specialized roles of disease surveillance and control, at home and internationally, as they provide care for animals, food safety, and security; (c) they proffer insights for zoonotic disease surveillance, epidemiology, prevention, and outbreak response at home and abroad; and (d) they track diseases of military importance and contribute to the health of military members using new technologies and data management that assist in surveillance. As coordinating participants within the US interagency, the US Army VCs contribute key subject matter expertise, experience, and capability to emergency response measures that keep the United States safe and secure from diseases that affect the economy, security, and health of animal and humans. Military veterinarians will continue to serve as valuable team members of the military health care team, helping to keep all service members fit and healthy to fight.

REFERENCES

1.   Schwabe CW. Veterinary medicine and human health. Baltimore: Williams & Wilkins; 1964: 516.

2.   Cardiff RD, Ward JM, Barthold SW. “One medicine---one pathology”: are veterinary and human pathology prepared? Lab Invest. 2008;88(1):18-26.

3.   Currier RW, Steele JH. One health-one medicine: unifying human and animal medicine within an evolutionary paradigm. Ann N Y Acad Sci. 2011;1230:4-11.

4.   Taylor LH, Latham SM, Woolhouse ME. Risk factors for human disease emergence. Philos Trans R Soc Lond B Biol Sci. 2001;356(1411):983-989.

5.   Conrad PA, Mazet JA, Clifford D, Scott C, Wilkes M. Evolution of a transdisciplinary “One Medicine-One Health” approach to global health education at the University of California, Davis. Prev Vet Med. 2009;92(4):268-274.

6.   Paarlberg PL, Seitzinger AH, Lee JG, Mathews KJJ. Economic Impacts of Foreign Animal Diseases. May 2008. ERR-57.

7.   Dunlop RH, Williams DJ. Veterinary Medicine: An Illustrated History. St. Louis, MO: Mosby; 1996: 692.

8.   U.S. Department of Agriculture. Factsheet: Update on the National Veterinary Accreditation Program. 2010:1-4. https://www.aphis.usda.gov/animal_health/vet_accreditation/
downloads/fs_vet_accrediation.pdf. Accessed June 12, 2012.

9.   U.S. Department of Agriculture. Why the New National Veterinary Accreditation Program Now? 2011; http://www.aphis.usda.gov/animal_health/vet_accreditation/
downloads/why-nvap.pdf. Accessed May 11, 2016.

10.   Galloway D, Walters BE. Point Paper: European Union Non-Commercial Animal Movement. Falls Church, VA: DoD Veterinary Service Activity; February 3, 2012.

11.   Havas KA, Burkman K. A comparison of the serological evidence of Coxiella burnetii exposure between military working dogs and feral canines in Iraq. Mil Med. 2011;176(10):1101-1103.

12.   Killian JW. The impact of leishmaniasis on military working dogs with Mediterranean basin exposure. US Army Med Dep J. Jul-Sep 2007:17-25.

13.   Evans RI, Herbold JR, Bradshaw BS, Moore GE. Causes for discharge of military working dogs from service: 268 cases (2000-2004). J Am Vet Med Assoc. 2007;231(8):1215-1220.

14.   Burkman KD, Moore GE, Peterson MR. Incidence of zoonotic diseases in military working dogs serving in Operations Desert Shield and Desert Storm. Mil Med. 2001;166(2):108-111.

15.   Hayes HM, Tarone RE, Casey HW, Huxsoll DL. Excess of seminomas observed in Vietnam service U.S. military working dogs. J Natl Cancer Inst. 1990;82(12):1042-1046.

16.   Hayes HM, Tarone RE, Casey HW. A cohort study of the effects of Vietnam service on testicular pathology of U.S. military working dogs. Mil Med. 1995;160(5):248-255.

17.   Hayes HM, Tarone RE, Casey HW, Jennings PB, Jr., Hildebrandt PK, Reardon MJ. U.S. military working dogs with Vietnam service: definition and characteristics of the cohort. Mil Med. 1994;159(11):669-675.

18.   World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th revision ed. Geneva: World Health Organization; 1992.

19.   American Psychiatric Association, American Psychiatric Association, Task Force on DSM-IV. Diagnostic and statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000.

20.   Côté RA, College of American Pathologists. SNOMED International: The Systematized Nomenclature of Human and Veterinary Medicine. Vol 4. 3rd ed. Northfield, IL, Schaumberg, IL: College of American Pathologists; American Veterinary Medical Association; 1993.

21.   JAVMA News. Veterinary Medical Database adopts SNOMED. J Am Vet Med Assoc. 2002; https://www.avma.org/News/JAVMANews/Pages/s041502f.aspx. Accessed May 12, 2016.

22.   Virginia-Maryland Regional College of Veterinary Medicine. Veterinary Terminology Services Laboratory - Veterinary Extension to SNOMED CT. April 2016; http://vtsl.vetmed.vt.edu/extension/. Accessed May 12, 2016.

23.   National Science and Technology Council. Addressing the Threat of Emerging Infectious Diseases. Washington, DC: The White House; 1996. Presidential Decision Directive: NSTC- 7.

24.   Russell KL, Rubenstein J, Burke RL, et al. The Global Emerging Infection Surveillance and Response System (GEIS), a U.S. government tool for improved global biosurveillance: a review of 2009. BMC Public Health. 2011;11 Suppl 2:S2.

25.   Sueker JJ, Chretien JP, Gaydos JC, Russell KL. Global infectious disease surveillance at DoD overseas laboratories, 1999-2007. Am J Trop Med Hyg. 2010;82(1):23-27.

26.   Rubertone MV, Brundage JF. The Defense Medical Surveillance System and the Department of Defense serum repository: glimpses of the future of public health surveillance. Am J Public Health. 2002;92(12):1900-1904.

27.   Burke RL, Kronmann KC, Daniels CC, et al. A review of zoonotic disease surveillance supported by the Armed Forces Health Surveillance Center. Zoonoses Public Health. 2011;59(3):164-175.

28.   Preston R. The Hot Zone. 1st ed. New York: Random House; 1994: 300.

29.   Faix DJ, Harrison DJ, Riddle MS, et al. Outbreak of Q fever among US military in western Iraq, June-July 2005. Clin Infect Dis. 2008;46(7):e65-68.

30.   Leslie T, Whitehouse CA, Yingst S, et al. Outbreak of gastroenteritis caused by Yersinia pestis in Afghanistan. Epidemiol Infect. 2011;139(5):728-735.

31.   Mustafa ML, Ayazi E, Mohareb E, et al. Crimean-Congo hemorrhagic fever, Afghanistan, 2009. Emerg Infect Dis. 2011;17(10):1940-1941.

32.   Earhart K, Vafakolov S, Yarmohamedova N, Michael A, Tjaden J, Soliman A. Risk factors for brucellosis in Samarqand Oblast, Uzbekistan. Int J Infect Dis. 2009;13(6):749-753.

33.   Mohamed M, Said AR, Murad A, Graham R. A serological survey of Crimean-Congo haemorrhagic fever in animals in the Sharkia Governorate of Egypt. Vet Ital. 2008;44(3):513-517.

34.   Van Gessel Y, Klade CS, Putnak R, et al. Correlation of protection against Japanese encephalitis virus and JE vaccine (IXIARO((R))) induced neutralizing antibody titers. Vaccine. 2011;29(35):5925-5931.

35.   Yingst S. A veterinary comparative medicine officer’s dream assignment. US Army Med Dep J. Jul-Sep 2007:38-43.

36.   Centers for Disease Control and Prevention. Outbreak of swine-origin influenza A (H1N1) virus infection—Mexico, March-April 2009. Morb Mortal Wkly Rep. 2009;58(17):467-470.

37.   Centers for Disease Control and Prevention. Swine influenza A (H1N1) infection in two children—Southern California, March-April 2009. Morb Mortal Wkly Rep. 2009;58(15):400-402.

38.   World Health Organization. Evolution of a Pandemic A(H1N1) 2009. 2nd ed. Geneva: World Health Organization; 2013.

39.   Headquarters, US Northern Command. Concept Plan to Synchronize DOD Pandemic Influenza Planning. Peterson AFB, CO: USNORTHCOM; 13 August 2009. USNORTHCOM CONPLAN 3551-09.

40.   Headquarters, US Northern Command. USNORTHCOM Response to Pandemic Influenza. Peterson AFB, CO: USNORTHCOM; 13 August 2009. USNORTHCOM CONPLAN 3591-09.

41.   Alfassa S. The Evolution of American Civilian Defense into Modern Emergency Management. Fire Engineering. 2012. http://www.fireengineering.com/articles/2012/08/the-evolution-of-american-civilian-defense-into-modern-emergencymanagement.html. Accessed November 20, 2013.

42.   Animal and Plant Health Inspection Service. The Origin and Spread of Venezuelan Equine Encephalomyelitis. Washington, DC: USDA: APHIS; 1973. APHIS 91-10.

43.   Zehmer RB, Dean PB, Sudia WD, Calisher CH, Sather GE, Parker RL. Venezuelan equine encephalitis epidemic in Texas, 1971. Health Serv Rep. 1974;89(3):278-282.

44.   Buisch WW, Hall AE, McDaniel HA. 1983-1984 Lethal Avian Influenza Outbreak. Paper presented at: United States Animal Health Association; October 21-26, 1984; Fort Worth, TX.

45.   Roth AJ. Avian Influenza Task Force Depopulation Concern in Virginia. Paper presented at: United States Animal Health Association; October 21-26, 1984; Fort Worth, TX.

Section V: Research, Development, and Public Health Services

This statue featuring a veterinary laboratory technician working “at the bench” represents one of the major duties of Army military veterinary services: making scientific discoveries at the laboratory bench, often using a microscope to study various samples sent to a US Army laboratory to support the military veterinary research, development, and public health mission. Other US Army veterinary statues, representing other key veterinary service missions, are located side by side outside the US Army Medical Department Museum at Joint Base San Antonio-Ft Sam Houston, Texas.

Photograph: Courtesy of Nolan A. Watson.

Chapter 14

LABORATORY ANIMAL MEDICINE

CHAD D. FOSTER, DVM†; TERRY BESCH, DVM, MS*; CHRISTINE A. EGE, DVM‡; BRETT TAYLOR, DVM, MPH§; JOSEPH G. HARRE, DVM, MPH¥; ANN SCHIAVETTA, DVM, MS¶; AND SARAH L. BRO, DVM, MPH**

INTRODUCTION

REGULATION OF ANIMAL USAGE IN THE DEPARTMENT OF DEFENSE

TRAINING OF MILITARY LABORATORY ANIMAL VETERINARIANS

ANIMAL CARE AND USE IN THE DEPARTMENT OF DEFENSE

DEPARTMENT OF DEFENSE ANIMAL CARE AND USE PROGRAMS AND COMPONENTS NECESSARY FOR PROGRAM SUCCESS

RESEARCH SUPPORT TO INVESTIGATORS

CLINICAL INVESTIGATIONS SITES

COMBAT TRAUMA TRAINING

SUMMARY

†Lieutenant Colonel, Veterinary Corps, US Army; Director, Center for Laboratory Animal Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814; formerly, Major, Chief, Research Support Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland

*Colonel, Veterinary Corps, US Army, (Retired); formerly, Consultant to the Army Surgeon General for Laboratory Animal Medicine, Fort Detrick, Maryland; currently, Veterinary Advisor, Nonclinical Studies, Joint Program Executive Office-Medical Countermeasure Systems, 1564 Freedman Drive, Fort Detrick, Maryland 21702

‡Lieutenant Colonel, Veterinary Corps, US Army; Chief, Department of Veterinary Medicine, Armed Forces Medical Research Institute of Medical Sciences, 315/6 Rajvithi, Bangkok, 10400 Thailand; formerly Infectious Disease Analyst, National Center for Medical Intelligence, Defense Intelligence Agency, Washington, DC

§Lieutenant Colonel, Veterinary Corps, US Army; Commander, 64th Medical Detachment (Veterinary Service Support), CMR 405, APO AE 09034; formerly, Instructor, Leader Training Center, US Army Medical Department Center and School, 2250 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

¥Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly Chief, Veterinary Resources, Keesler Clinical Research Laboratory, 301 Fisher Street, Keesler Air Force Base, Mississippi; currently, Veterinary Medical Officer, 724th Special Tactics Squadron, Building 3-1947, Pope Army Airfield, North Carolina 28308

¶Lieutenant Colonel, Veterinary Corps, US Army; Chief, Research Support Division, US Army Medical Research Institute of Chemical Defense, 3100 Ricketts Point Road, Aberdeen Proving Ground, Maryland 21010; formerly, Executive Officer, Veterinary Services Portfolio, US Army Public Health Command, Aberdeen Proving Ground, Maryland

**Lieutenant Colonel, Veterinary Corps, US Army; Executive Officer, Animal Care and Use Review Office, US Army Medical Research and Materiel Command, 504 Scott Street, Fort Detrick, Maryland 21702; formerly, Attending Veterinarian, Madigan Army Medical Center, Fort Lewis, Washington

INTRODUCTION

The laboratory animal medicine (LAM) veterinary specialist plays a valuable role in all aspects of Department of Defense (DoD) research, development, test, and evaluation (RDT&E) activities, as well as combat trauma and other training using animals. Animals are often the best asset available to support medical advances and train warfighters. This chapter articulates how Army veterinarians act as advocates for both animals and service members in support of DoD missions.

Scope

LAM specialists are those experienced in the discipline of using animals for RDT&E and training. Army LAM veterinarians supporting RDT&E and training missions strive to become board-certified by the American College of Laboratory Animal Medicine (ACLAM) because ACLAM board-certified veterinarians are recognized experts in the humane care and responsible use of laboratory animals. Military veterinarians who are not yet ACLAM board-certified must have extensive training and experience in the specialty in order to work in DoD animal care and use programs.

Because the DoD requires a veterinarian with training and experience in laboratory animal science and medicine to fulfill every RDT&E mission using animals, approximately 50 specialty-trained veterinarians are needed to adequately support these missions, making the DoD one of the largest employers of LAM veterinarians in the world.[1] In order to meet this requirement for highly qualified specialists, the Army established its own LAM residency program for military veterinarians, which has achieved notoriety especially for its exceptional success rate regarding the number of residents attaining the difficult and coveted board certification by the ACLAM. This chapter will overview this residency program as well as document its well-known achievements.

Roles and Goals

LAM veterinarians fulfill many roles within DoD institutes, the most important of which is to ensure that each institute and activity complies with all laws, rules, and regulations regarding animal care and use. LAM veterinarians and trained LAM technologists also play a critical role as animal advocates by promoting animal well-being and proper ethical use of animals in all situations. In addition to being experts on laws, rules, and regulations, LAM veterinarians must possess comprehensive expertise in a number of areas beyond traditional veterinary clinical care of animals, to include providing animal husbandry and environmental enrichment for a wide variety of species, ranging from traditional research species such as rodents and nonhuman primates to unusual species such as bats and dolphins.

Of the DoD personnel working with animal programs, LAM veterinarians and LAM technologists are probably most able to ensure species-suitable environments and security for DoD animals. Because facility design is so important to providing high-quality animal care and supporting the most advanced research, LAM veterinarians often advise engineers, architects, and design specialists on the construction and renovation of animal facilities, paying particular attention to housing systems, sanitation, lighting, and ventilation as appropriate to each species.

Procurement and care of the healthiest animals available are also objectives crucial to DoD research. The LAM veterinarian is the go-to specialist for procuring disease-free research animals and making certain that new animals are properly quarantined before integration with existing colonies or herds.

In addition to being involved with procurement, husbandry, and basic veterinary care of a wide variety of species, a LAM veterinarian provides guidance so that all DoD institutes uphold the standards necessary to remain fully accredited by the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALAC).[1] AAALAC is a private, nonprofit organization that promotes the humane treatment of animals in science through voluntary accreditation and assessment programs. This organization thoroughly reviews all aspects of a comprehensive animal care and use program, including institute policies, animal housing and management, veterinary care, and facilities.

Purpose and Oversight of Activities

The purpose of an RDT&E animal care and use program is to provide the infrastructure and resources needed by principal investigators (PIs). PIs are specialized scientists who develop and execute detailed scientific plans to achieve DoD RDT&E missions. Many of these research plans involve the use of animals. In the DoD, completed research plans translate into the products and information needed to support service members to better accomplish various DoD missions throughout the world. Such products and information improve military readiness and lower morbidity and mortality rates in military operations. Laboratory animal veterinarians, veterinary technologists, veterinary technicians, and animal care personnel provide the intellectual and technical competence needed for PIs to perform animal work in the conduct of scientific research in the diverse disciplines encompassed by DoD RDT&E programs.

The DoD uses animals for RDT&E and training both within DoD-owned institutes (intramural activities) and via contract or using other agreement mechanisms at various civilian institutes including academia and industry (extramural activities). About one third of the animals are used intramurally, with the remainder of the work performed extramurally, to include locations overseas when appropriate.[2] All animal work conducted by the DoD, whether intramurally or extramurally, requires review by a DoD LAM veterinarian. Three primary oversight offices, one each for the Army, Navy, and Air Force, are responsible for most of the oversight of DoD animal care and use programs both intramurally and extramurally.

Although the DoD continues to adopt animal use alternatives whenever possible, many DoD programs depend on the judicial use of animals in various education and training programs. For example, animals are used in DoD graduate medical education (GME) programs that train physicians to conduct clinical investigations requiring animals; the DoD also uses animals to instruct medical personnel in medical and surgical skills and combat casualty care. After more than 10 years of war in Iraq and Afghanistan, it has become very clear that use of animals to train people on life-saving medical techniques is invaluable and cannot yet totally be replaced by nonanimal training systems such as manikins and other simulation tools.3,4,5

REGULATION OF ANIMAL USAGE IN THE DEPARTMENT OF DEFENSE

The US government and the public directly influence how the DoD implements its animal care and use programs and animal use alternatives. DoD organizations using animals for RDT&E or training not only must follow all US laws, rules, and regulations pertaining to animal use, but also must abide by even more stringent requirements set forth by the DoD. The DoD currently endorses the use of animals to advance medicine and science when there are no suitable nonanimal alternatives and when the animals are used in an ethical and humane way.

As noted earlier, all DoD animal research facilities are expected to maintain AAALAC accreditation. The DoD uses three primary standards to evaluate animal care and use programs, which aids in the accreditation process: the National Research Council Guide for Care and Use of Laboratory Animals (known as the Guide),[6] the Federation of Animal Science Societies (FASS) Guide for the Care and Use of Agricultural Animals in Research and Teaching (known as the Ag Guide),[7] and the European Convention for the Protection of Vertebrate Animals used for Experimental and Other Scientific Purposes (known as ETS 123).[8] The ETS 123 serves as a pivotal guiding document when DoD RDT&E work or training is conducted in foreign countries.1,8 Any use of animals for RDT&E or training conducted or supported by the DoD must adhere to these standards, or, if in a foreign country, must be evaluated by a DoD veterinarian to verify comparable standards are used.

Moreover, the DoD follows the US Public Health Service (PHS) policy Humane Care and Use of Laboratory Animals[9]; the US government’s Principles for the Utilization and Care of Vertebrate Animals in Testing, Research, and Training[10]; and the DoD’s own regulatory guidance consisting of DoD Instruction (DoDI) 3216.01 Use of Animals in DoD Programs[1] and Army Regulation 40-33 The Care and Use of Laboratory Animals in DoD Programs.[11] At the time of writing, Army Regulation 40-33 delineated the Secretary of the Army as the DoD Executive Agent for Veterinary Services to develop and issue service regulations to implement DoDI 3216.01. This regulation has also been adopted by the Navy, Air Force, Defense Advanced Research Projects Agency (DARPA), and the Uniformed Services University of the Health Sciences (USUHS) to create uniform policies, procedures, and responsibilities among DoD components involved in the use of animals.

All of these guidance documents expand on federal requirements outlined in the Title 9 Code of Federal Regulations (Animals and Animals Products) Animal Welfare Regulations.[12] LAM veterinarians serve as the primary advisors to institutional officials, research directors, and commanders on regulatory issues.[13]

The next section is an overview of the DoD’s regulatory history and two oversight agencies’ recommended practices regarding animal use for research purposes from the 1960s forward. For more comprehensive texts covering the history of animal care and use laws and regulations, readers should consult 50 Years of the Institute of Laboratory Animal Research by TL Wolfe[14] or 50 Years of Laboratory Animal Science by CW McPherson.[15]

Evolution of the Department of Defense Regulatory Documents

In the 1960s, discussions within the federal government were leaning towards regulating the use of animals in research facilities. The DoD established an internal document, Policy on Experimental Animals in Department of Defense Research, in 1961 as a DoDI, in response to social concern about animal use in research.[16] In 1963, the Animal Care Panel, the predecessor to the American Association for Laboratory Animal Science, published an initial version of the Guide[14] to disseminate common standards for all research animal facilities to emulate. The DoD also incorporated the common standards articulated by the Guide into their 1966 revision of the DoDI. Thus, the professional standards of industry became requirements for the DoD.[17] Today, the Guide is a broad-reaching document that has become unquestionably the most influential document in the field of laboratory animal science and has been translated into at least twelve languages.6,18

Inspector General Review and Recommendations

During the 1980s through the 1990s, the public became discontented with the state of animal research. Disgruntlement culminated with a congressional hearing before the House Armed Services Committee on April 7, 1992. Representatives from the research community and animal welfare and rights organizations organized a concerted complaint to Congress. Many concerns were expressed, many focused on Institutional Animal Care and Use Committee (IACUC) function and DoD accountability, resulting in the House Armed Services Committee directing the DoD Inspector General (IG) to perform “a review of every program, project, or activity funded by the DoD that conducts any type of live animal research, and report on whether the animals used in each program, project, or activity are handled and treated in accordance with the Animal Welfare Act (AWA), DoD regulations, and rules of basic humaneness that govern live animal research.”19,20(p20) The outcome of the congressional hearings dictated emphases on the unique requirements of animal care and use programs in the DoD, thereby raising regulatory standards above civilian institution requirements.[20]

The IG’s visit to 36 DoD animal research facilities housing animals (as defined by the AWA) resulted in four best practice recommendations that every DoD facility now incorporates into its animal care and use programs: (1) ensure a strong training program for personnel using or providing oversight of laboratory animals, (2) use a formal checklist for IACUC semiannual inspections, (3) clarify requirements of the nonaffiliated member of the IACUC, and (4) develop a standardized protocol format to be used at all institutions.[21] These recommendations formed the building blocks of higher quality DoD programs and are the originating actions for many currently emphasized activities. The impact of these recommendations also has left lasting impressions on how the DoD conducts current animal care and use programs.

First Recommendation. The first best practice recommendation was strong command support for personnel training. During the course of its inspections, the IG found that facilities with the most complete and comprehensive animal care and use programs were those that received the strongest command support—both in time and money—for training all personnel using animals or reviewing animal activities. These facilities encouraged training of key staff to include IACUC members, principal investigators, veterinarians, and animal care staff. Although the type of training varied, the support for continuous education was strongly evident in these facilities.20,21

Second Recommendation. The second best practice recommendation was to use a formal, detailed checklist for the IACUC’s semiannual inspections. The IG found that those facilities that used a detailed checklist provided the most comprehensive reports while committees that did not have a formal checklist for semiannual inspections produced the least comprehensive reports.

Characteristics of the most comprehensive reports included the following items: a section for every room to be inspected; a list of all policies to be reviewed; a list of animal husbandry factors to be assessed (eg, housing, food and food storage, bedding, water, sanitation, animal identification, and animal records); a list of veterinary care required (eg, preventive medicine, surveillance, diagnosis and treatment, anesthesia and analgesia, surgery, aseptic procedures, euthanasia, and emergency care); a list of what to assess as part of the physical structure (eg, construction, floors, walls, ceilings, drains, lighting and power, temperature, humidity, ventilation, storage, and equipment sanitization); and a section for verification of the qualifications and training of animal caretakers, technicians, and research staff. Additionally, the best comprehensive reports involved all IACUC members in the review process, with documentation of concurrence and minority concerns in each report.20,21

Third Recommendation. The third recommendation made by the IG was for the DoD to standardize its approach for meeting the AWA requirement for unaffiliated member representation on IACUCs. The IG had noted that, within the DoD, it was unclear what the expectations were to be for the required number of nonaffiliated IACUC committee members, their professional characteristics, and their eligibility qualifications. On July 16, 1992, the General Counsel, Department of Defense, issued a memorandum entitled The Institutional Animal Care and Use Committee and the Federal Advisory Committee Act.[20] The memorandum addressed the issue of whether the DoD IACUC is covered by the Federal Advisory Committee Act,[20] and, ultimately, the issue of the relationship of the nonaffiliated member to the federal government. In this memorandum, the General Counsel stated that the IACUC does not fall under the definition of advisory committee as is stated in the Federal Advisory Committee Act and therefore is not subject to its requirements, including the one that the IACUC meeting must be open to the public.

The General Counsel further clarified that since the IACUC members do not merely advise but actually perform government functions, a member serving on the IACUC must have the necessary official status. Specifically, an individual who is not affiliated with the facility and is appointed as an IACUC member must be either a full-time federal employee or employed as an expert on the intermittent basis under Title 5, US Code, Section 3109.20,22 During the inspections, the IG found that the guidance provided by the General Counsel had not been disseminated to all DoD IACUCs, nor had many IACUCs implemented these limitations at the time of the review. Nonetheless, institutes still had trouble filling the nonaffiliated member positions. Most IACUCs had only one nonaffiliated member with no alternate member available if the primary member was unable to attend a meeting. One IACUC had experienced a vacancy for a few months when the nonaffiliated member resigned.[20]

The IG also recommended that the DoD provide clearer guidance with regard to eligibility requirements and professional characteristics of the nonaffiliated member. Additionally, while the AWA allowed for meetings to be held without all members present, the IG believed outside representation was desirable at all meetings.[20] The IG recommended that having alternates to the nonaffiliated member would help meet the goal of having outside representation at every IACUC meeting.[20]

Fourth Recommendation. The fourth recommendation advised that the DoD should develop and implement a standardized research protocol format for use throughout the DoD. Most facilities had developed their own form or format. However, the IG felt that a standardized DoD format would be beneficial, particularly with collection of information required for the annual report to the US Department of Agriculture (USDA).[20]

For example, IACUCs are required to report pain and distress levels in research animals to the USDA, and prior to the IG recommendations, collection of data for such reporting was inconsistent. Some IACUCs would make the determination themselves while other IACUCs considered the pain or distress level assigned by the PIs. However, when the pain or distress codes were defined differently than the pain or distress categories in animal welfare regulations (AWRs), the facility staff had to reclassify the codes to align with those required in the annual report to the USDA. The IG reasoned that a standardized protocol request form using the standardized pain or distress categories as defined by AWRs would serve to eliminate any confusion or misunderstanding when completing the annual report to the USDA, especially when experiments were performed at more than one DoD research facility.[20]

Similarly, some of the institution formats required that literature searches be performed but did not have a place to submit results of the search into the protocol. If a submission place had been a standard requirement, the IG felt the six instances in which literature searches were not complete may have been prevented.[20]

Inspector General Commendable Practices

The IG inspectors also advised all DoD research facilities to obtain AAALAC accreditation and identified seven commendable practices that each facility commander was to consider implementing if they weren’t already being used.[21] Sharing and suggesting these commendable practices throughout the DoD animal research program improved the entire DoD program as a whole.[20]

The seven commendable practices are as follows: (1) maintain a transparent animal care and use hotline but allow for anonymous reporting of violations concerning humane treatment of animals; (2) use an animal incident reporting form to describe animal care concerns or suggestions for improvement; (3) provide investigator handbooks; (4) maintain employee training records; (5) use animal facility and room logs; (6) ensure IACUC protocol review by both the DoD facility and contracting facility for any contract work performed extramurally; and (7) require PIs provide assurance statements for adhering to the four Rs (4 Rs) (refinement, reduction, replacement, and responsibility).[21]

Although prior standard practice within most research facilities was to consider the three Rs (3 Rs) identified in The Principles of Humane Experimental Technique by WMS Russell and RL Burch (ie, refinement, reduction, and replacement—all means to jointly diminish the level of inhumanity in animal experimentation),[23] one facility also required the PIs to adhere to one more principle—responsibility. The IG felt the practice of expanding the assurance statements to four principles would demonstrate a strong commitment to humane animal treatment and could be incorporated into the standardized protocol form.[20]

The IG felt publishing the name and contact information for the facility commander, the attending veterinarian, and key staff for notification of an animal use concern demonstrated the commander’s commitment and support to the animal care and use program. Anonymous written or verbal reporting on the form or via the hotline would ensure that no adverse action would be taken against any person reporting and would reassure staff and others that all animals were to be treated humanely. [20]

The IG also believed certain facility-generated and maintained documents were valuable standardization tools. Some facilities distributed handbooks to the research staff and IACUC members that were filled with information to help investigators prepare protocols, understand and support the animal care program, and serve as a reference text. Handbook categories included laws and regulations; protocol submission requirements; oversight procedures; organizational charts and narrative; procedures for ordering, housing, restraining, and handling animals; noninvasive procedures; surgical procedures; procedures on the use of pain-relieving drugs; procedures on euthanasia and handling of dead animals; and record-keeping requirements.[20]

Several facilities maintained training worksheets on every individual involved in the care and use of animals that detailed required training, training received, training date, and signatures of both instructor and employee. This practice ensured that all employees were provided all levels of training needed for their positions.[20]

Some facilities provided PIs with animal room logs and facility logs. Animal room logs indicated what was checked in the room on a daily basis, and facility logs described how the facility operated and how each room was used. Both logs recorded that the animals in each room were cared for every day.[20]

Finally, the IG found that most protocols indicated that animal work contracted out to extramural facilities was only required to be reviewed by the funding organization for a scientific need. However, at least one commander required that his IACUC perform an animal care and use review in addition to the commander’s scientific review. This practice ensured that the federal research facility was actively involved in oversight of research funded by the DoD.

Secretary of Defense Reports and Congressional Hearing Revisions

The Fiscal Year 1993 House Armed Services Committee Report, 102-527, included a request to the Secretary of Defense to provide a comprehensive annual report on animal care and use programs.[24] This report was prepared in accordance with a specific requirement to record all animal research conducted by the DoD including education, training, and testing both in DoD laboratories and by extramural projects funded by the DoD. Yearly data was prepared in an annual report from 1993 to 2002, then in a biennial report since 2004. The structure of the reports is comprised of indepth discussions of publicly accessible information on DoD research, policies, and procedures for oversight of DoD animal care and use programs, DoD animal use profiles, and DoD initiatives to promote alternative methods that replace, reduce, or refine animal use.[25]

During the 1994 Congressional Hearings, in which Congress heard the report from the IG on the DoD animal research program, the DoD indicated that revisions to the DoD Directive 3216 on the use of animals in research were already in progress. The new version, published in 1995, contains the following six significant changes, compiled in direct response to congressional involvement: (1) DoD facilities should apply for and maintain continued AAALAC accreditation; (2) the DoD is prohibited from purchasing or using dogs, cats, or nonhuman primates to (a) inflict wounds from any type of weapon, (b) conduct training in surgical or other medical treatment procedures, or (c) use in research conducted for developing biological, chemical, or nuclear weapons; (3) DoD standards for IACUC composition must include an alternate to the nonaffiliated member; (4) specific oversight requirements must be established for extramural research to include review and approval of animal use protocols, review of facility inspections by the USDA, and site visits by DoD veterinarians under certain circumstances; (5) channels for reporting noncompliance must be established; (6) a more formal structure for oversight, particularly for extramural research, had to be established; and (7) a special dual-hatted position—that of Commander, US Army Veterinary Command, and Director, DoD Veterinary Services Activity (a field-operating agency of the Army), Office of The Surgeon General, who would serve as a consultant to the Assistant Secretary of Defense for Health Affairs and the Director, Defense Research and Engineering, for technical and professional matters—would need to be established.[26]

The DoD also implemented Department of Defense Policy for Compliance with Federal Regulations and DoD Directives for the Care and Use of Laboratory Animals in DoD-Sponsored Programs.[27] This 1995 policy memorandum specified training requirements for nonaffiliated DoD IACUC members and implemented a standard format for animal use protocols, a standard checklist for IACUC inspections, and a standard reporting requirement for all animal use research to support the Biological Research Database (BRD). Through the use of the BRD, the DoD required all animal research projects, to include those involving clinical training or investigations, to be reported.[27] The BRD became publicly available, whereas the former reporting system, the Defense Technology Information Center database, had restricted public access.28,29

In 1995, House Report 103-499, issued by the House Armed Services Committee in its consideration of the National Defense Authorization Act for Fiscal Year 1995, directed the US Government Accountability Office (GAO) to examine several issues related to the DoD’s administration of its animal research programs, specifically, how the DoD was addressing unnecessary duplication of research done elsewhere and how it incorporated the commonly known and accepted 3 Rs.[30] Upon completion of this evaluation, via the GAO Report to Congressional Committees entitled DoD Animal Research: Improvements Needed in Quality of Biomedical Research Database,[31] the GAO recommended that the Secretary of Defense continue to take steps to improve the BRD; changes were suggested to ensure public accountability.

The GAO reported that the data collection and reporting procedures should be modified to ensure that the BRD contains accurate, detailed information about individual animal research projects, including information on the number and species of animals used in each project, the research goals and justification, and the pain categories for each project. The GAO also recommended that a uniform reporting format be used for all projects.[31]

Ongoing Department of Defense Regulatory Revisions

While Congress continues to assess and reassess the status of the DoD animal research program, and the DoD repeatedly modifies procedures to address concerns, the public and animal welfare groups still raise questions about whether the DoD uses animals appropriately, which prompts further government evaluations. In 1999, the GAO produced another report, DoD Animal Research: Controls on Animal Use Are Generally Effective, but Improvements Are Needed.[32] In this report, the GAO again addressed potential unnecessary duplication of research.

Two other specific recommendations, which were adopted by the DoD, were to (1) amend the DoD standard protocol format requiring researchers to identify refinement alternatives that were considered but not adopted (and to explain why they were not adopted) and (2) make another change in the literature search requirement, necessitating a search of the BRD and either the Federal Research in Progress database or the Department of Health and Human Service’s Computer Retrieval of Information on Scientific Projects database.28,33,34

A significant 2005 revision to the DoD Directive 3216 was the requirement for all DoD institutions housing animals for RDT&E or training to attain and maintain AAALAC accreditation. What was a recommended practice became a required action. In 2010, the DoD Directive 3216 was updated and became DoD Instruction 3216.01 (DoDI), which requires institutions to have a quorum including at least one veterinarian and one nonaffiliated member (or his or her alternate) to be present at all IACUC meetings. Until this time, the attendance of nonaffiliated members was highly encouraged but not required. These standards exceed regulatory requirements and industry standards, indicating the DoD’s dedication to humane care for animals used in research and training.[1]

In 2009, a bill to promote the Battlefield Excellence through Superior Training (BEST) Practices Act was introduced in Congress, which, if enacted, would have required a similar annual report to Congress and would have prohibited use of animals in combat-trauma training no later than October 2016. Although a phase-out date for animal use in combat-trauma training did not make it into the National Defense Appropriations Act for Fiscal Year 2013, the BEST Practices Act directly influenced its language by directing the DoD to report on their strategy to address transitioning away from animal use in certain medical training scenerios.35,36

Continued animal welfare group pressure on Congress to limit the use of animals in combat-trauma training led to further DoD direction to implement a strategy “to refine, reduce, and when appropriate, replace the use of live animals in medical education and training.”35(p188) Congress requested an initial report be submitted by the Secretary of Defense by March 2013 and an additional annual report on the development and implementation of human-based training methods (such as use of simulators that better replicate human anatomy, moulage, simulated combat environments, and human cadavers) be submitted beginning in 2014.[35]

TRAINING OF MILITARY LABORATORY ANIMAL VETERINARIANS

The Army is estimated to be one of the top three largest employers of laboratory animal veterinarians in the world (e-mail communication from Melvin Balk, Executive Director, ACLAM, to Lieutenant Colonel Brett Taylor, chapter author, October 2012). Consequently, its residency program has significantly impacted the training of laboratory animal veterinarians throughout the entire United States. In 1999, reportedly 32.7% ACLAM Diplomates (208 of the 636) had received training or experience while on active duty in one of the uniformed services (e-mail communication from Lieutenant Colonel [Retired] Susan Goodwin, former Director of the US Army LAM Residency Program [USALAMRP] to Lieutenant Colonel Brett Taylor, chapter author, September 2012).

As of 2012, the total number of ACLAM Diplomates increased to 872, and the percentage of these Diplomates who were trained in the uniformed services decreased to 11.5%.[37] This change reflects an increase in the number of civilian LAM residency programs and candidates across the nation during this period while the uniformed services’ program (currently composed only of Army candidates) has remained largely unchanged in size, making the DoD’s contribution proportionately smaller.

History of the Army’s Laboratory Animal Medicine Residency Program

For an aspiring VCO, the transition from Area of Concentration code 64A (field Veterinary Services officer) to 64C (veterinary LAM officer) begins upon selection for the Long-Term Health Education Training (LTHET) program, generally at about the 5-year point in his or her career.[38] A major recruitment venue for all of the veterinary research advanced training programs is the Army’s Research and Development Short Course. Instituted in the mid-1990s, this 1-week course invites prospective candidates to the Washington, DC, area and is designed to introduce VCOs to the specialties of pathology, laboratory animal medicine, and comparative medicine. The course provides candidates with a more indepth view of these specialties before they decide to apply to a particular LTHET program. The LAM Consultant to the Army Surgeon General (typically the specialty’s most senior officer) is responsible for recruiting junior VCOs into the specialty.

The first formal training program for civilian veterinary specialists in this field was developed in 1960 at Bowman Gray Medical School.[39] This civilian program was followed closely afterward by the establishment of the first uniformed services’ training program in 1961, under the auspices of the US Air Force School of Aerospace Medicine (USAFSAM) at the former Brooks Air Force Base in San Antonio, Texas. This program, developed by Air Force Colonel Robert Hummer, occurred in consultation with the faculty and staff of Texas A&M University. The 2-year program included coursework at the university, along with 15 months of instruction, residency training, and thesis research at USAFSAM. Upon completion, the student was awarded a Master of Science degree in LAM from Texas A&M and a residency certificate from USAFSAM. The program was discontinued in 1975 when the Air Force determined it was more economical to send students to other established civilian universities. Thirty-nine individuals completed the USAFSAM Texas A&M program; the last residents of the program graduated in 1977.[40]

In the US Army, veterinary-supported research was in place as early as the 1950s, and by the 1960s, a more structured but still informal, on-the-job-type training program existed at Ft Detrick, Maryland. This program was mentored by one of the ACLAM “founding fathers,” Dr Melvin Rabstein, a 1937 graduate of the University of Pennsylvania veterinary college. In 1966, a more formal program was proposed by Dr Robert Whitney while assigned at Edgewood Arsenal, Maryland; Dr Whitney would later serve as Acting Surgeon General of the United States from July to September 1993.

In 1968, the Edgewood program became the first program officially sanctioned by a US Veterinary Corps Chief (Colonel Wilson Osteen). Dr Harry Rozmiarek and Dr Bill Cole were the first graduates of the official Army Edgewood program in 1971. Dr Rozmiarek immediately took over as director upon graduation from the program and served in this position from 1971 to 1972 (e-mail communication from Dr Harry Rozmiarek, former Director of the US Army Edgewood LAM training program to Lieutenant Colonel Brett Taylor, chapter author, April 2013).

Edgewood remained the primary location for LAM training in the Army until 1974 when Walter Reed Army Institute of Research (WRAIR) began a LAM training program of its own. Dr Robert Beattie, Kansas State University veterinary college graduate, class of 1964, was the original director of this program, and he was later joined by Dr Cole to fully implement the program. The centerpiece of the program was the special topics seminar series, which remains in existence today.

Dr Rozmiarek went on to establish an additional formal training program at Ft Detrick in 1976, which combined the core seminar series with clinical and administrative training conducted at the Army’s premiere biodefense laboratory: the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The program also established a liaison with Pennsylvania State University; residents spent 12 to 18 months doing university course work at Pennsylvania State and then spent the remainder of the 4-year program at Ft Detrick (e-mail communication from Dr Harry Rozmiarek, former Director of the US Army Edgewood LAM training program to Lieutenant Colonel Brett Taylor, chapter author, April 2013).

Because of the physical proximity of Ft Detrick, WRAIR, and Edgewood, a joint program, designated the Combined Laboratory Animal Medicine Program, was established in 1984. Core and special topics seminars were presented by residents and board-certified mentors once weekly each academic year. This 4-year LAM residency remained in effect from 1984 to 1995.[40]

Starting in 1996, the Army residency was converted to a 3-year joint curriculum with the PHS at the Uniformed Service University of the Health Sciences (USUHS), which also awarded a concurrent Master of Public Health (MPH) degree. However, since didactic work for the MPH option consumed one full year of the program, residents had to maintain an accelerated pace of study in the practical application of LAM throughout the second and third years, in order to complete the joint curriculum. Complicating matters further, from 1996 to 2000, the MPH was sometimes considered a 2-year program by the PHS but a 3-year program by the Army. Because of very low participation by PHS students and confusion about program management, the US Army dissolved the joint curriculum program between 2000 and 2002 (email communication from COL [Retired] Terry Besch, former Army Consultant to The Surgeon General for Laboratory Animal Medicine to Lieutenant Colonel Brett Taylor, chapter author, April 2013).

In 2003, the Army provided separate options for the residents: pursue a university curriculum (combined MPH and LAM residency) or pursue the traditional model (LAM residency only). Also since 2003, residents have been assigned to one of the local DoD laboratories for 1 to 2 years of practical on-the-job training experience, which is required for candidates to achieve board eligibility status by ACLAM.[41]

In keeping with the traditional view of the early, long-established program, this year of experience is still referred to as the “fourth year” of the program because officers do not go on to post-residency assignments until the year of experience is complete, and they have (ideally) passed the ACLAM board examination. Residents in this final year typically form a weekly study group to prepare for the board examination. (See also Chapter 15, Veterinary Pathology, for information about the veterinary pathology residency program.)

Current Army Laboratory Animal Medicine Residency Experience

Upon acceptance into the LAM LTHET program, the LAM resident is assigned to one of five residency sites, all of which are located in the greater Washington, DC, area. In order of size from largest to smallest in terms of daily animal census, these five residency sites are as follows: WRAIR, USAMRIID, USUHS, the Armed Forces Radiobiological Research Institute (AFRRI) in Bethesda, Maryland, and the US Army Medical Research Institute of Chemical Defense (USAMRICD) at Edgewood. The total number of residents assigned to these sites at any time does not exceed 20 candidates, and the minimum ratio of one boarded Diplomate per every three residents is maintained at each location.[42]

There is an overall director of the USALAMRP, and each location also has its own USALAMRP site director. The program incorporates a Laboratory Animal Medicine Residency Advisory Committee (LAMRAC), which meets quarterly to discuss program issues and review student progress. The LAMRAC is comprised of the USALAMRP director, deputy director, and individual site directors. The LAM consultant (discussed in more detail later in this section) is invited to the LAMRAC in an advisory capacity.

Both of these training programs (MPH and non-MPH options) are 36 months in length. During this period, the residents meet (and in many cases exceed) the requirements set forth by ACLAM.[41] They are exposed to 340 to 380 hours of didactic training via the US Army LAM seminar series, journal reviews, and reviews of the various ACLAM-authored laboratory LAM textbooks (the “blue books,” so called because of their historically blue covers); they work 2,400 to 3,600 hours under the supervision of ACLAM Diplomates in a facility accredited by the AAALAC; and they design and conduct a research project for first-author publication in a peer-reviewed journal.[42]

Additionally, residents are encouraged to attend a variety of educational seminars and continuing education conferences offered by organizations such as the Association of Primate Veterinarians, the American Association for Laboratory Animal Science, the CL Davis Foundation, and many others. Certificates denoting successful completion of the program are conferred to the residents once residency program site directors are satisfied that candidates have met all requirements: didactic training, practicum experience, and research project.

While details of the residency experience vary from site to site, year one is typically a very intense time for new residents. From the very beginning, they are encouraged to begin after-hours study of the core regulatory and veterinary medical references while spending their days learning and performing a variety of medical and surgical techniques. Weekend and evening on-call duty is typically shared among residents at each site.

Responsibilities increase as officers progress through years two and three and become more integrally involved in ongoing research missions at their institute. Duty positions rotate among the residents each year and are typically distinguished by area of responsibility. Most residents are given the title Officer in Charge (OIC) of a subdivision within the Veterinary Medical Department or Division. Examples include OIC of Nonhuman Primate Section; Surgery and Radiology; Small Animal (Rodent and Rabbit) Section; Large Animal Research Facility; or Research Protocol Support. Specific assignment titles vary by institute, depending on the organizational arrangements at a particular location.

A 2006 estimate reported that ACLAM candidates spend an average of 1,100 hours total in preparation for the board exam, including review of textbooks and study notes,[43] although as the basic body of laboratory animal medicine knowledge continues to expand over the years, the typical number of study hours required to pass the exam may expand as well. One method of board preparation that has proven to be effective in any setting is the previously mentioned study group.[44]

The weekly Army-sponsored study group has produced an exceptionally successful board-exam pass rate. As far back as current records exist (approximately 1971), 78% of candidates from the uniformed services’ training program have successfully passed the board exam on their first attempt (e-mail communication from Lieutenant Colonel [Retired] Susan Goodwin, former Director of the USALAMRP to Lieutenant Colonel Brett Taylor, chapter author, September 2012), and 90% of these candidates passed on their second attempt. Since 1971, an impressive 96% of candidates from the Army have passed the board exam at some point, whether on their first or subsequent attempts. When comparing these success rates to the national average over the period of 2008 to 2012 (only about 55% percent of this group were successful on the first attempt), the military percentages loom even larger (e-mail communication from Melvin Balk, Executive Director, ACLAM, and former US Army Veterinary Corps officer, to Lieutenant Colonel Brett Taylor, chapter author, October 2012).

Additionally, between 1996 and 2012 (17 years), nine winners of the prestigious ACLAM Henry and Lois Foster Award for Academic Excellence were Army veterinarians who used study group resources. This award is presented each year to the board candidate with the highest exam score (e-mail communication from Lieutenant Colonel [Retired] Susan Goodwin, former Director of the USALAMRP to Lieutenant Colonel Brett Taylor, chapter author, September 2012).[37]

Assignments Following Laboratory Animal Medicine Residency

Following the successful completion of the USALAMRP, 64Cs (veterinary LAM officers) serve in a variety of utilization assignments. Currently, there are 30 different assignment locations around the globe, with 48 officer authorizations between them (Figure 14-1).

Many new graduates of the residency program head to clinical investigations programs. Clinical investigations programs are part of the military Graduate Medical Education program for medical doctors, typically at large military medical treatment centers: William Beaumont Army Medical Center (El Paso, Texas); San Antonio Military Medical Center (formerly, Brooke Army Medical Center, San Antonio); Tripler Army Medical Center (Honolulu, Hawaii); Eisenhower Army Medical Center (Ft Gordon, Georgia); and Madigan Army Medical Center (Joint Base Lewis-McChord, Washington).

These assignments are ideal positions for the newly boarded veterinarian as they are small programs but still require all the components of an AAALAC-accredited animal care and use program (ACUP). The medical management and leadership skills of these new 64Cs are tested as they become the attending veterinarians, responsible for the well-being and clinical care of animals used in RDT&E and training, with a much smaller staff of ancillary experts (eg, laboratory animal technicians, IACUC members, and facility engineers) than they are accustomed to from their residency experiences.

Other small programs ideally suited for newly boarded veterinarians include the US Army Public Health Command (Aberdeen Proving Ground, Maryland), Navy Clinical Investigations Services (San Antonio; Portsmouth, Virginia; and San Diego, California), the Keesler Air Force Base Clinical Research Laboratory (Biloxi, Mississippi), Wright-Patterson Air Force Research Laboratory (Dayton, Ohio), US Army Research Institute of Environmental Medicine (Natick, Maryland), and Joint Special Operations Medical Training Center (Ft Bragg, North Carolina).

More senior officers (ie, majors who have been recently promoted) tend to serve as department chiefs at larger institutes such as USAMRIID, WRAIR, or the Tri-Service Research Laboratory in San Antonio or in deputy director positions at smaller institutes such as AFRRI, USUHS, or USAMRICD. Follow-on assignments provide a continual increase in the officers’ scope of responsibility and may include any of the following job opportunities: (a) overseas and joint billets such as the Naval Medical Research Units in Cairo, Egypt, or Lima, Peru, and the Armed Forces Research Institute of Medicine in Bangkok, Thailand; (b) assignments focused on oversight and regulation of programs or contracts such as positions at the Office of the Army Surgeon General, US Army Medical Department Center and School, Health Readiness Center of Excellence (AMEDDC&S, HRCoE), or US Army Medical Research and Materiel Command Animal Care and Use Review Office.

Figure 14-1. US Army Laboratory Animal Medicine Duty Sites and Authorizations.
Data courtesy of Colonel Brian Ketzenberger, Consultant to the Army Surgeon General for Laboratory Animal Medicine.

After one or two assignments following board certification, most officers are senior majors or lieutenant colonels with experience in a variety of programs. Lieutenant colonels are then typically assigned as directors of smaller programs such as USAMRICD, USUHS, AFRRI, or the US Army Institute of Surgical Research or Naval Medical Research Center (co-located with WRAIR). By the time officers have 18 to 20 years of service, they are usually either senior lieutenant colonels or colonels capable of serving in the most challenging positions in the field that include Consultant to the Navy, Air Force, or Army Surgeon Generals; directors of Veterinary Medicine Divisions at large institutes such as WRAIR or USAMRIID; or Director of the Army’s Animal Care and Use Review Office (ACURO) under USAMRMC.

The consultant and ACURO positions are highly engaged in regulatory oversight activities for both intramural and extramural ACUPs. As the Army has been historically responsible for oversight of 70 to 80% of all funding used by ACUPs across the DoD,[45] the ACURO is a key assignment. Its director is often dual-hatted as the director of the USLAMRP.

The Consultant to the Army Surgeon General, typically one of the most senior and experienced LAM officers in the Army, is appointed by the Army Surgeon General (as compared to being assigned as a matter of course to the Air Force or Navy consultant positions). The Army Consultant is responsible for recruitment of officers into the specialty and recommending assignments for all officers from residents to the most senior officers to LAM duty positions. When making such recommendations, the Army Consultant attempts to put the right officer in the right place at the right time within the constraints of the available inventory of officers. The Army Consultant is also the DoD’s senior advisor for all laboratory animal matters.

ANIMAL CARE AND USE IN THE DEPARTMENT OF DEFENSE

Laboratory animal veterinarians are responsible for clinical care and promotion of animal well-being at all times and during all phases of an animal’s life, which requires an indepth understanding of physical, physiological, and behavioral indicators of health, all of which vary considerably across the species commonly used in research.[6] At times, their role as advocates for the animals may place laboratory animal veterinarians at odds with investigators and research staff in pursuit of scientific discovery or therapeutic developments, but, ideally, research scientists and the laboratory animal veterinarian work together to ensure appropriate and humane care and use of animals.

It has been said that the reliability of research data is only as good as the least reliable link in the chain of procedures used to derive it,[39] and the laboratory animal specialist’s role in ensuring the health and well-being of the animals used in research is an absolutely critical link in that chain.

The role of the attending veterinarian (ie, the individual within an institute or program with the responsibility and the authority to ensure appropriate animal care, handling, and humane use) is specifically defined and mandated by federal law[12] and is a position generally held by the senior laboratory animal specialist in each of the DoD’s institutes and programs. There may be many veterinary specialists working together in larger DoD facilities, but overall responsibility for the veterinary care program rests solely with the appointed attending veterinarian at each location. The individual in this position provides guidance and training to ensure appropriate procedures are followed throughout the procurement, transportation, husbandry, handling, medical treatment, immobilization, sedation, analgesia, anesthesia, surgical care, and euthanasia of animals within a particular institute or program.

Historically, Army laboratory animal medicine veterinarians have had unique opportunities to influence and shape the practice of animal research across the globe. For example, as the Director of the Veterinary Medical Department at USAMRIID in the late 1970s, Colonel Harry Rozmiarek helped establish the Laboratory Animal Use Review Committee with a structure and function that closely resembled what would later be described as an Institutional Animal Care and Use Committee (IACUC) in the 1985 PHS policy (e-mail communication from Colonel [Retired] Harry Rozmiarek, former Director of the US Army Edgewood laboratory animal medicine training program, to Lieutenant Colonel Brett Taylor, chapter author, April 2013).[40] In 1984 and 1985, Colonel Rozmiarek, along with several other 64Cs, also gave presentations at regional workshops conducted by the Scientists Center for Animal Welfare on consensus recommendations for effective animal care and use committees.[46]

Other contributions made by the Army include the assistance Colonel (Retired) Clifford Roberts, a former LAM veterinarian with the Walter Reed Army Institute of Research, provided to the nation of Kenya in developing modern animal research regulations in the early 1990s (e-mail communication from Colonel [Retired] Clifford Roberts to Lieutenant Colonel Brett Taylor, chapter author, April 2013). Additionally, Colonel Roberts assisted in developing the first breeding colony of cynomolgus macaques (Macaca fascicularis) in the country of Malaysia.[47] More recently, chapter author Lieutenant Colonel Brett Taylor had the opportunity to train laboratory animal scientists in the former Soviet Republic of Georgia and assisted them in standing up their own Georgian Association for Laboratory Animal Science, a new scientific member organization of the International Council of Laboratory Animal Science Associations as of 2016.[48]

Animal Care Considerations of Special Concern to the Department of Defense

Animal Mission Challenges

Several animal care challenges evolve from the types of research conducted by the DoD. In many cases, these challenges are unique to the missions of the institutes designed to conduct such studies, but some of them are consistent to the DoD as a whole. For example, personnel turnover is one of the pressing DoD-wide challenges. Military laboratory animal veterinarians and enlisted animal care technicians must rotate duty assignments approximately every 3 years,[38] which results in occasional periods of personnel underlap and a consistently recurring threat to institutional memory. Additionally, the execution of classified research projects at some facilities necessitates considerable security clearance procedures for all IACUC members as well as specially designed secure areas for the review of classified protocols and the execution of classified research.

Some examples of mission-specific challenges relate to the use of highly lethal chemical warfare agents at USAMRICD. One such challenge has been the modification of caging for larger animals (ie, swine and nonhuman primates) to fit inside a chemical hood. This equipment must pass rigorous industrial hygiene monitoring for maintaining proper laminar flow inside the hood to meet occupational health and safety standards. Ensuring appropriate animal welfare while conducting experimental manipulations inside biological safety cabinets such as blood collection under pole and collar restraint is also difficult to accomplish (e-mail communication from Lieutenant Colonel Richard Probst, Chief, Research Support Division, USAMRICD, to Lieutenant Colonel Brett Taylor, chapter author, April 2013).

Additionally, since chemical agent exposure of animals entails increased risk to the personnel who must handle them for biosampling or examination, a chemical surety team carefully manages the chemical agent and provides training to agent users and safety orientation to all personnel granted access to agent use areas. Methods for handling the animals are very clearly described in stepwise fashion and thoroughly reviewed at multiple levels within the organization. Personnel authorized to work in a room with an open agent keep an M-40 protective mask at arm’s reach in the event of power or ventilation failure. The chemical surety team also closely monitors these operations and tracks room usage on a board that is visible to all who come and go. Agent use and storage areas have considerable security measures in place as well (e-mail communication from Lieutenant Colonel Richard Probst, Chief, Research Support Division, USAMRICD, to Lieutenant Colonel Brett Taylor, chapter author, April 2013).

Similar to the procedures in place at USAMRICD, USAMRIID uses a closely monitored surety program to ensure the safety of the general public and the reliability of workers engaged in all studies involving use of highly pathogenic biological agents and toxins.49,50 For example, access to the biocontainment suites at USAMRIID requires a considerable amount of background training, immunizations for relevant pathogens, and a lengthy period of interviews and observation of personnel, all of which require months to complete. The military’s relatively short 3-year assignment cycle thus causes occasional challenges in maintaining veterinary officers with full biocontainment access, along with biocontainment-qualified technicians and caretakers.

Additional challenges arise periodically as new technology and items of equipment are introduced for use in conventional animal housing and husbandry, which must then be adapted for biocontainment use. Because of these ongoing challenges and the need for constant innovation, USAMRIID has remained at the forefront of a wide variety of advances in biocontainment procedures and technology since its inception (e-mail communication from Colonel Pedro Rico, DVM, Director of Veterinary Medicine Division, USAMRIID, to Lieutenant Colonel Brett Taylor, chapter author, April 2013).

Another category of mission-specific challenges exists at the AFRRI that relates to the use of ionizing radiation in research protocols. In addition to maintaining worker safety in this environment, the two most challenging aspects of animal care are performing post-irradiation blood draws and maintaining animal food intake and hydration. Since much of radiobiology work is geared towards finding novel biomarkers or measuring known markers in blood samples, multiple blood draws are critical. However, as platelet counts fall because of a compromised hematopoietic system from radiation exposure, stopping the bleeding caused by even minor blood draws from superficial veins becomes difficult. Given these circumstances, even minor, superficial scratches can become opportunities for sepsis. Following radiation exposure, animals also may lose their desire to eat and have decreased ability to digest and absorb what is being eaten (e-mail communication from Lieutenant Colonel Rebecca Holt, Head of the Veterinary Sciences Department, AFRRI, to Lieutenant Colonel Brett Taylor, chapter author, April 2013). Critical nursing care of such animals is paramount under these conditions.

Animal Procurement and Transportation

Since it is rarely economically feasible for the DoD to maintain its own breeding colonies (historical exceptions include the Strain 13 guinea pig colony at USAMRIID and various small rhesus macaque colonies worldwide), the DoD relies heavily on commercial vendors to provide animals. Thus, the animal procurement process typically begins with an evaluation of the quality of potential vendors’ animals. Vendors of purpose-bred research animals (USDA Class A dealers) provide information to DoD veterinarians and other prospective buyers, describing the pathogen status of colonies or individual animals, along with any relevant clinical history. The laboratory animal veterinarian’s responsibility and area of expertise in this process is the development of specific requirements for the animals to be purchased (eg, genetic background, specific disease-free status, preimplanted telemetry devices, and other requirements specified by investigators for a particular project).

The responsibility for writing contracts, placing them out for public bidding, and handling any contractual actions lies with trained DoD contracting officers who are advised by LAM veterinarians. Once animals arrive at an institute, LAM veterinarians become responsible for animal receipt and quarantine and ensure that vendors meet all contract specifications for animals purchased. (The subsequent section of this chapter covers quarantine and other receipt responsibilities.)

The vendor typically arranges transportation of animals purchased by the government. These vendors are required to comply with a number of US regulatory agencies and international bodies, including the USDA, International Air Transport Association, US Fish and Wildlife Service, and Convention on International Trade in Endangered Species of Wild Fauna and Flora.12,51,52,53

The DoD also must comply with these same laws on the rare occasions when it moves animals using government transportation assets. Typically, this type of DoD transport occurs only for small numbers of animals for short distances (eg, collaborative research between the five DoD institutes located in the greater Washington, DC, area). However, in the event of an emergency affecting DoD animal facilities, each institute typically has the capability to transport large numbers of animals specified as part of its internal disaster management plan. The attending veterinarian has the responsibility to oversee all of these processes and ensure that procurement and transportation of research animals are performed in accordance with all applicable laws, rules, and regulations.

Quarantine and Acclimation

Within the setting of a facility performing RDT&E or training using animals, the word “quarantine” refers to the separation of newly received animals from those already present in the facility, and quarantine is performed in order to prevent the spread of any infectious contaminants that may be harbored by new animals and potentially spread to animals already housed in the facility. Veterinary personnel evaluate the general health and pathogen status of all newly received animals using procedures that reflect acceptable veterinary medical practices, along with all federal and state regulations applicable to zoonoses.[54] Like their civilian counterparts, military veterinarians obtain information from vendors before or during procurement in order to define the potential risks to personnel and animals in the colony, establish an appropriate quarantine period and procedures, determine whether any therapeutic intervention is required during quarantine, and, in the case of rodents, may even determine whether special procedures (eg, cesarean rederivation or embryo transfer) are necessary to secure animals free of specific pathogens.[6]

In addition to an appropriate quarantine period, newly received animals are given a period of time for physiologic, behavioral, and nutritional acclimation before use.[55] The length of this acclimation period is dependent upon the species, the duration of their transportation, and their intended use. The need for such acclimation has been demonstrated in a wide variety of species and serves to ensure that the animals have recovered from any distress experienced during transit.[6]

Even after completion of quarantine and acclimation periods, most species are kept physically separated from others present in the facility in order to avoid interspecies disease transmission and eliminate the potential for anxiety and physiologic changes due to interspecies aggression.[56] This is most often accomplished through the use of separate rooms for different species; however, cubicles, laminar flow units, and cages with filtered air or separate ventilation may be equally as effective and are often used to accomplish species separation.[39]

Husbandry and Enrichment

As is true for civilian organizations, all species maintained in each of the DoD’s animal facilities are provided with appropriate food, housing enclosures, husbandry techniques, and environmental enrichment that takes into account their physical, physiologic, and behavioral needs. Given the large numbers of individual animals and the wide variety of different species maintained at each facility and across the DoD as a whole, this is a considerable effort that would be difficult without the assistance and expertise of dedicated animal caretakers and veterinary technicians. Many animal caretakers, along with the majority of veterinary technicians working in the field of laboratory animal science across the DoD, are certified by the American Association for Laboratory Animal Science. This certification recognizes the animal caretakers’ and veterinary technicians’ special skills and establishes them as among the most competent animal care professionals in their field.[57]

In the course of their duties, caretakers and veterinary technicians become very familiar with individual animals and are often the first to notice subtle changes in appearance or behavior that may indicate illness or injury. Thus, their involvement in the performance of daily rounds enhances the quality of care provided to each animal. Additionally, their assistance in developing environmental enrichment programs and in performing procedures to Good Laboratory Practices (GLP) standards is critical to the excellent quality of DoD research.

Preventive Medicine and Biosecurity

Effective programs in preventive medicine and biosecurity enhance the research value of animals in an institute by minimizing disease-related sources of variation between study groups. Preventive medicine consists of all the various policies, procedures, and equipment related to the quarantine and separation of animals by species, source, and health status. Animal biosecurity consists of the measures taken to identify, contain, prevent, and eradicate known or unknown infections that cause clinical disease or alterations in animal physiology or behavior.[6]

Biosecurity practices are applicable in all instances when animals are used in research, but these practices become critically important when large numbers of animals are maintained in a single facility. However, some DoD-specific factors necessitate even higher levels of preventive medicine and biosecurity practices, particularly those in the context of studies designed to develop new therapeutics against biological warfare agents.

Surveillance, Diagnosis, and Treatment of Disease

All DoD-owned animals are observed by trained personnel at least daily for signs of illness, injury, or abnormal behavior in accordance with industry standards[6] (veterinarians, animal caretakers, and veterinary technicians all contribute to these evaluations). Observations are performed even more frequently when animals are ill, recovering from a surgical procedure, or approaching a study endpoint. Unexpected deaths and signs of illness or distress are investigated promptly, and animals displaying signs of contagious disease are isolated from healthy animals. However, if an entire room or housing enclosure is believed or confirmed to be exposed to an infectious agent (eg, Mycobacterium tuberculosis in nonhuman primates or Syphacia infestation in rodents), the group is generally kept together throughout the treatment and eradication procedures.[6]

The principal methods for detecting microbial infections in animal populations are serologic assays, but many other methods (eg, polymerase chain reaction, microbial culture, clinical chemistry, and even histopathology) may be used to make or confirm a diagnosis. Laboratory animal veterinarians must be subject matter experts on infectious diseases for each species, along with the constantly evolving methods used to identify and treat such diseases. In the event that a disease or infectious agent is identified within the animal colony, the veterinarian must make therapeutic decisions in coordination with scientific investigators in order to maintain a balance between the requirement for healthy animals and the requirement for minimization of adverse or unexpected effects on the RDT&E or training program.

Clinical and Emergency Care

Treating and maintaining the health of laboratory animal species often requires specialized skills and knowledge beyond those of veterinarians in traditional companion animal settings. Two examples are the treatment of bite wounds in primates housed under Animal Biosafety Level 3 biocontainment and the placement and maintenance of telemetric implants and indwelling vascular catheters in small rodent species.

Because a wide variety of differences exists between veterinary care programs among the various DoD facilities that use animals (which correspond to the DoD’s wide variety of institutional missions and species used), LAM veterinarians also must be skilled at providing veterinary care to a wide spectrum of animal species undergoing diverse RDT&E or training methodologies. Similar to practices at civilian institutes, the attending veterinarian must institute procedures to ensure that animals are provided emergency care both during and outside of regular business hours.[6]

Restrictions on the shipment of animals or tissues due to the Convention on the International Trade in Endangered Species of Wild Fauna and Flora and benefits sharing contract requirements with host-nation governments (such as those in place at the AFRIMS facility in Thailand) may impact the ability of veterinarians to send biopsies and tissue samples from overseas laboratories to the United States for definitive diagnoses of disease. Consequently, some overseas facilities are forced to breed their own animals for use in research. Maintaining a high-quality research animal breeding colony is an expensive and labor-intensive method of acquiring research animals when compared to purchasing them from specialized and established dealers—and one that presents its own set of requirements for the clinical and emergency care of the animals used in such colonies (e-mail communication from Lieutenant Colonel Robin Burke, Chief, Department of Veterinary Medicine, Armed Forces Research Institute of Medical Sciences, to Lieutenant Colonel Brett Taylor, chapter author, April 2013).

Procedures to Reduce Pain and Distress

The alleviation of pain and distress associated with procedural and surgical protocols is an integral component of veterinary medical care in the laboratory setting. Unrelieved pain leads to unacceptable levels of stress in animals, making the proper use of anesthetics and analgesics in research animals an ethical and scientific imperative. Animal species vary considerably in their responses to pain; thus, pain assessment criteria differ accordingly.[6] The DoD adheres to the PHS policy, US Government Principles for the Utilization and Care of Vertebrate Animals Used in Testing, Research, and Training, which is comprised of nine principles, one of which asserts that (in the absence of evidence to the contrary) procedures which cause pain in humans should be considered to also cause pain in other species.[10]

“Distress” is generally described as an aversive state in which an animal fails to cope or adjust to the various stressors it encounters.[6] In the absence of immediately observable pathologic or behavioral alterations, distress can be challenging for the veterinarian to definitively recognize. Both duration and intensity of the inciting stimuli are important considerations when trying to prioritize the attention to and treatment of animal distress. For example, an injection requiring brief immobilization may produce an acute level of distress lasting only seconds while the long-term individual housing of a social species in a metabolic cage may produce chronic distress. As in the case of veterinary intervention to treat infection, veterinarians should make any decisions regarding the relief of pain and distress in coordination with investigators to maintain the balance between the requirement for healthy animals and the requirement for minimization of adverse or unexpected effects on the RDT&E or training program.

Figure 14-2. Researcher using a powered air-purifying respirator (PAPR). Ausculation of animals using a stethoscope is not possible while wearing a PAPR.
Photo courtesy of the US Army Medical Research Institute of Infectious Diseases, Ft Detrick, Maryland.

The assessment of both pain and distress in animals is further complicated by reduced-access environments such as those necessitated by the use of biological, chemical, or radiological exposure in research animals. The auscultation of heart or lung sounds is impossible in a powered air-purifying respirator or PAPR hood, much less in a BioSafety Level 4 “blue suit” such as those worn in biocontainment suites at USAMRIID (Figures 14-2 and 14-3). Additionally, the ability to palpate animals is impaired by the multiple layers of gloves worn in these environments. Direct observation and intervention for animals during the process of their exposure to radiation (such as in research performed at AFRRI) or chemical warfare agents (such as in research performed at USAMRICD) can be extremely challenging. All such considerations relating to the monitoring and reduction of pain and distress must be specifically addressed in the animal use protocol.

Figure 14-3. Another view of a powered air-purifying respirator. Researchers also use BioSafety Level 4 “blue suits” (not pictured). Ausculation of animals using a stethoscope is also not possible while wearing a “blue suit.”
Photo courtesy of the US Army Medical Research Institute of Infectious Diseases, Ft Detrick, Maryland.

Figure 14-4. US Department of Defense Animal Usage, 1994-2007.
Data courtesy of the Assistant Secretary of Defense for Research and Engineering, Human Performance, Training, and BioSystems. http://www.dtic.mil/biosys/au.html. Accessed April 9, 2013.

Figure 14-5. US Department of Defense Animal Usage by Species, 2007.
Data courtesy of the Assistant Secretary of Defense for Research and Engineering, Human Performance, Training, and BioSystems. http://www.dtic.mil/biosys/au.html. Accessed April 9, 2013.

Euthanasia Procedures

Euthanasia may be directed by the veterinarian to relieve animal pain or distress that cannot be alleviated by analgesics or other treatments. Euthanasia may also be planned in advance as part of a protocol-specific endpoint (such as a defined point of tumor size or disease progression). As with civilian organizations and in keeping with the American Veterinary Medical Association guidelines on euthanasia, all methods of euthanasia employed within DoD facilities must predictably induce rapid unconsciousness and death while minimizing the distress and anxiety experienced by the animal.[58] The specific selection of agents and methods for euthanasia are dependent upon the species involved, the age of the animals, and the research objectives of the protocol.[6]

Animal Usage Within the Department of Defense

Intramural animal use in the DoD is reported to the USDA on an annual basis. Since approximately 2002, more DoD work has been conducted in extramural programs than intramural. Figures 14-5 and 14-6 provide a summary and overview of all animal use for the purposes of research, development, testing, and evaluation and training from each of the branches of service. Although extramural animal use has been generally increasing since 1999, trends in intramural animal usage remain stable over that same period (Figure 14-4). The significant decline in both categories of animal usage from 1994 to 1996 is only the tail end of a trend of sharply decreasing numbers that started in at least 1987.[45]

Interestingly, the breakdown of the individual species used by the DoD has remained very similar over this same period of time. The most recent species-specific numbers available are depicted in Figure 14-5 and display a very clear preference (91%) for the use of rodents. In fact, mice alone account for approximately 80% of the total of all the animals used by the DoD in the year 2007.[45] Although the numbers differ slightly from year to year throughout the period from 1994 to 2007, the general percentages represented by each category (rodents, nonrodent mammals, and nonmammals) are similar.

Figure 14-6. Animal usage by Department of Defense Service, 2007.
Data courtesy of the Assistant Secretary of Defense for Research and Engineering, Human Performance, Training, and BioSystems. http://www.dtic.mil/biosys/au.html. Accessed April 9, 2013.

Another pattern that has remained relatively unchanged across the past 14 years is the percentage of the DoD’s total animal use that is performed by each service. Overall, the Army has a much more robust research and development program than the other services. In 2007 alone, the Army used more than three times as many animals as all other branches combined (Figure 14-6).[45]

The majority (92.1%) of the DoD’s intramural animal use in 2012 consisted of animals such as reptiles, fish, rats, birds, or mice (primarily mice) that are not required to be reported to the USDA. Of the USDA-reportable animal use that was conducted in 2012, the majority occurred at four different facilities: USAMRICD (26.9%); USAMRIID (22.6%); AMEDDC&S, HRCoE (15.3%); and WRAIR (10.5%).[59]

DEPARTMENT OF DEFENSE ANIMAL CARE AND USE PROGRAMS AND COMPONENTS NECESSARY FOR PROGRAM SUCCESS

As with civilian organizations, trained personnel, excellent facilities, and strict regulatory compliance are all integral parts of any complete, successful ACUP. This section describes some other necessary attributes and common program requirements of military ACUPs that help these programs operate effectively and achieve excellence in animal care and use within the DoD.

Adaptable and Comprehensive Programs and Functional Areas

Throughout the world, ACUPs are unique to their particular institutes, which is also true in the DoD. Although many program components are common among various organizations, each institute’s ACUP is tailored to its own research and accompanying missions. ACUPs must also be dynamic. As personnel and missions change; as standards and regulations evolve; and as research facilities, equipment, and methodologies advance, the ACUP is modified and adapted to support current operations utilizing up-to-date information and best practices.

Furthermore, an ACUP is comprehensive and includes the policies, procedures, standards, organizational structure, staffing, facilities, and practices adopted by an institution to achieve the humane care and use of animals by an organization.[6] ACUPs include all activities conducted by and at an institute that have a potential impact on the well-being of animals. Activities include animal husbandry and care, veterinary care, institutional policies and procedures, personnel and program management and oversight, occupational health and safety, IACUC functions, and animal facility design and management.[6] These activities are common to all ACUPs, including DoD programs; however, the extent and complexity of each specific functional area is determined by the size and scope of the individual institute and its particular research and mission focus. Large DoD biomedical research institutes (eg, USAMRIID, WRAIR, and USAMRICD) have more extensive animal care and use programs to cover their broader missions and a greater number of research and support personnel and functional areas than a smaller DoD clinical investigations facility supporting a military hospital’s GME program for physicians. At larger institutions with more complex programs, responsibility for the day-to-day operations of program activities may be delegated to various departments or staff members. However, at smaller institutes, the attending veterinarian may primarily be responsible for most or all program activities.

A large centralized research facility may include all of the various functional areas as separate departments within the same institute. A decentralized program may spread the functional areas out among multiple facilities with each individual facility relying on others to perform those functions they lack internally. Smaller programs may utilize services of their parent organization or may contract out some functional areas to civilian entities. For example, a DoD Clinical Investigation Program with a Department of Clinical Investigation (DCI) supporting a military medical center may rely on the military hospital to provide certain services or a portion of various functional area services (eg, logistical, pharmacy, and pathology services or facility and medical equipment maintenance), or they may establish contracts with outside agencies to perform some of the more specialized services.

Furthermore, outsourcing services is not an all-or-nothing approach. There are different degrees of functional area services that may be provided by a supporting institute or by civilian vendors. As an example, the DCI may be able to perform certain blood analyses in-house such as complete blood counts and serum chemistry panels with its own equipment, but they may rely on the hospital’s clinical laboratory to run other tests; specialized tests that neither the DCI nor the hospital laboratory is capable of performing would be sent out to a contract reference laboratory.

Flexible and Qualified Attending Veterinarians

To uphold appropriate oversight of these activities in accordance with relevant regulations, policies, and guidelines, the attending veterinarian needs to be adequately trained and experienced in laboratory animal science and medicine[6] and have direct or delegated authority over all animal activities. Regardless of how the attending veterinarians obtain their LAM training and experience, each veterinarian must be familiar with the species that fall within their scope of responsibility. As noted earlier in this chapter, because animal species may vary according to the institute, the mission, the research underway, and a particular period of time, the range of species-specific knowledge required to be a LAM veterinarian is extensive.

LAM veterinarians may be responsible for the health and well-being of common companion and agricultural species covered in most veterinary college curricula (ie, dogs, cats, horses, cattle, swine, sheep, goats, and poultry); traditional laboratory animal species (ie, mice, rats, hamsters, guinea pigs, rabbits, and nonhuman primates); more novel and specialized laboratory animal species (eg, laboratory fish, amphibians, transgenic rodents, miniature swine, and immunocompromised animals); exotic animal model species (eg, dolphins and sea lions); and even wild animals (eg, fish, wild birds, bats, and deer, as in the case of disease surveillance studies and field research).

Also, as previously highlighted in this chapter, just being familiar with the species is not enough. The attending veterinarian needs to understand proper husbandry and care standards; special regulatory requirements; appropriate handling and restraint procedures; suitable anesthesia, analgesia, and therapeutics; and how various manipulations may or may not affect research data collection for any particular animal species specified by each RDT&E or training activity.

Specified Animal Care and Use Program Management and Oversight Responsibilities

The attending veterinarian plays a key role in managing the DoD ACUP and shares this responsibility with the institutional official and IACUC; all work together to ensure the program remains current and effective in supporting an institute’s mission and humane use of animals. The attending veterinarian is primarily responsible for the health and well-being of all animals used in RDT&E and training by an institution.[6] This responsibility goes beyond just animal husbandry and veterinary care to include all aspects of the ACUP that have a direct or indirect impact on the lives of animals.

The institutional official is ultimately responsible for the overall ACUP and has authority to allocate resources necessary to support the program and is the signature authority for official documents and reports attributable to the institute’s program.[6]

The IACUC is the local body responsible for oversight of the institution’s ACUP. In addition to meeting frequently enough to effectively and efficiently carry out committee duties, the IACUC is also responsible for conducting semiannual reviews of the ACUP to include inspecting facilities that have an impact on animal care and well-being.[6] In addition to these local management authorities (ie, the attending veterinarian, institutional official and IACUC), DoD ACUPs fall under additional supervision from DoD component oversight offices. The primary DoD component oversight offices are those of the Army (Animal Care and Use Review Office, US Army Medical Research and Materiel Command); the Navy (Bureau of Medicine and Surgery, Veterinary Affairs); and Air Force (Office of Research Oversight and Compliance, Animal Use Program). DoD institutions must submit required documents and reports to their respective oversight office; in return, they receive correspondence, guidance, staff assistance visits, and compliance site visits from their respective oversight office.

Organizations that do not fall specifically under the Army, Navy, or Air Force include joint commands such as the US Special Operations Command (USSOCOM) or various geographic combatant commands (CCMDs) such as the Southern Command or Northern Command. With the exception of USSOCOM, little to no RDT&E or training occurs within the CCMDs. Historically, CCMDs have typically had one of the three primary oversight offices (Army, Navy, or Air Force) conduct animal use oversight activities under a memorandum of agreement or understanding. In 2016, the USSOCOM added a permanent 64C (LAM veterinarian) to its joint manning document and established a component oversight office within the Office of the SOCOM Command Surgeon.

Depending on the type of program and research, additional (both DoD and non-DoD) agencies may examine a particular DoD ACUP or a portion of that program. For example, institutions utilizing biological select agents or toxins (BSATs)[60] (as determined by the US Department of Health and Human Services and USDA) or institutes that utilize chemical agents in research receive additional inspections from DoD biological and chemical surety agencies (eg, the Army Medical Command and Department of the Army Inspector General)49,50 or other governmental agencies (eg, the Centers for Disease Control and Prevention [CDC]). Institutions working with radioactive materials may be inspected by the Nuclear Regulatory Commission (NRC); programs performing GLP studies are inspected by the Food and Drug Administration or Environmental Protection Agency.

Regardless of the size of the institute and its accompanying ACUP or the type of RDT&E and training conducted, a multitude of requirements exist that must be adhered to; oversight occurs within the institute and by DoD oversight offices, nonmedical DoD entities (eg, the Inspector General), and extramural agencies (eg, the CDC, Nuclear Regulatory Commission, and AAALAC) as described above. Thus, the program’s attending veterinarian must not only be trained and experienced in laboratory animal science and medicine,[6] but must also be well-versed in the various regulatory requirements, to include knowing which ones apply to their particular program.

Other Common Animal Care and Use Program Requirements

Attempting to cover how the DoD meets all potential requirements that may be encountered in managing the many DoD ACUPs would be very extensive and still fail to cover all possibilities. However, certain requirements are more universal than others; the following section highlights some of the more common ACUP essentials.

Animal Health Monitoring

The LAM veterinarian manages staff execution of a military ACUP’s animal health monitoring, which involves routine health testing and review, identification of potential infectious diseases, and effectively containing and eradicating any disease outbreaks that occur. Sentinels (additional animals utilized specifically for disease surveillance) are often housed within rodent colonies to be available to regularly test for subtle diseases without having to test and potentially stress the actual animals on study. Maintaining healthy research animals, verified through routine sentinel testing, is especially important because some diseases are subclinical but recognized to adversely affect research results.

A significant risk to overall research animal health is the use of improperly screened biologics (eg, mouse serum) purchased from outside sources. Such materials may harbor and transmit infectious agents to study animals, which, in turn, may spread disease to many other facility animals in a short period of time. Unfortunately, complete colony depopulation is sometimes the only way to eradicate certain infectious agents or stop an epidemic. The LAM veterinarian must maintain visibility and control of the potential introduction of agents from biologics or animals into the vivarium by ensuring that proper testing and quarantine is conducted before permitting entry.

Despite best efforts, animals sometimes experience unexpected, nonstudy-related health issues, and addressing these is another basic component of the general health monitoring program. Animal health monitoring in DoD research facilities is not significantly different from that done in civilian ACUPs.

Budget and Resource Projection

Also similar to civilian organizations, management of DoD animal research facilities includes projecting resource requirements for upcoming years as well as managing use of incoming resources throughout the year. Animal care resources typically account for a sizable percentage of an organization’s total budget. Costs associated with animal facility management and veterinary research support may include animal purchases, feed, bedding, enrichment items, waste disposal services, basic personal protective equipment, veterinary medical supplies, various medications and pharmaceuticals, animal caging, and sanitation equipment and supplies.

Military research organizations obtain funding through a variety of sources and funding agencies that may limit how the funds can be spent and the period of time in which the funds remain effective (eg, 1-year versus 2-year money), making resource projection and management unique to each duty site. Projecting and managing funds accurately requires an indepth understanding of categories of expenditures, accurate historical tracking of expenses, and ability to monitor and summarize purchases in an ongoing manner throughout the year. While seemingly not directly related to humane animal care and use, failure to appropriately project and manage resources can lead to shortages of food, supplies, personal protective equipment, or other critical materials, which can result in mission stoppage. Animals must be checked, fed, and cared for every day, a fact that makes a shortage in critical items—for even 1 day—unacceptable.

Personnel Management

The military LAM veterinarian is typically given responsibility for managing all components of the organization’s animal research support team. This team may include animal caretakers, veterinary technicians, additional veterinarians, and administrative staff. Animal caretaking involves all daily care of animals and maintenance of animal housing areas to include proper feeding, watering, and maintenance of housing and environmental conditions appropriate to the species in question, and the prompt resolution of any problems on-the-spot or through coordination with other members of the animal research support team. The animal caretaking staff is usually made up of civilians who may or may not possess any veterinary-specific training prior to first employment within an organization.

Veterinary technicians within DoD intramural programs may be either military or civilian; the proportion of each type of employee depends on the organization and whether or not specific support contracts are in place. Civilians are required to possess certain experience, training, and, in some cases, formal veterinary technician licensure or certification. Exact requirements are based on the organization’s mission, species used, and complexity of animal manipulations conducted (eg, whether work is conducted in biological or chemical containment areas or whether nonhuman primates are used).

The requirement for military LAM veterinarians to manage both the animal facility and the animal care staff can be notably different from some civilian institutions. Although many civilian laboratory animal veterinarians serve as facility and staff managers, others may be more typically involved only with direct veterinary support (eg, positions in contract research organizations or pharmaceutical companies) or in conducting their own animal research (eg, many academic positions).

Disaster Planning and Emergency Preparedness

All animal facilities, military and civilian, should have contingency plans in place to help mitigate the effects of any potentially unexpected conditions that could interfere with normal facility operations, including equipment failures, fire, and man-made or natural disasters. Power failures are probably the most common unexpected occurrences, and facility disaster plans should include emergency generators or backup power sources to maintain proper environmental conditions for animals and essential equipment.

In the event of a power failure, an institute that houses animals under biocontainment or barrier conditions needs a backup power system to immediately take over and maintain the proper airflow and pressure differentials to those areas. Similarly, essential equipment such as ventilated animal racks, biosafety cabinets, fume hoods, freezers holding agents or tissue specimens, intensive care units and surgical suite equipment, and security systems need automatic transfer to secondary power sources to prevent the loss of animal life and the compromise of animal health, personnel safety, research work, and facility security.

Each facility should also have detailed plans for those situations that are most likely to occur in their particular location and circumstances. As noted above, most facilities list actions to take in the event of a power failure, facility fire, or flooding in their emergency preparedness plans; however, only those facilities located in areas prone to hurricanes or earthquakes need to formulate plans for these natural phenomena.

Some portions of disaster plans may be generalized to apply to multiple situations, and the planning and preparedness requirements are generally the same for both civilian and DoD institutions, with some variations. For example, both civilian and DoD plans are usually required to designate essential personnel who may need to shelter within the facility to care for animals and keep the institute functioning when circumstances prevent the regular staff from accessing the facilities.

In civilian facilities, all essential personnel are civilians. However, in DoD facilities, active duty military personnel are typically designated essential personnel; which civilians are given what designations varies widely from institute to institute; and civilian staff (eg, DoD government civilians, contracted civilian staff, and foreign nationals working in DoD overseas laboratories) may be considered nonessential personnel. Situations limiting access to the institute include road closures due to winter storms, floods, vehicle accidents, chemical spills, and other incidents; curfews enacted following natural disasters or due to civic unrest, protests, or riots; a pandemic disease outbreak; or even a government furlough or budget crisis which prevents civilian staff from reporting to work.

It is important that the DoD institute’s contingency plan is incorporated into the parent organization’s (eg, the military installation’s) disaster plan and that the plans complement each other. Since the institute is a member of a local community, too, such integral planning must go beyond just installation personnel. Even a relatively small incident such as a chemical spill, a fire, or an act of vandalism contained to a single DoD laboratory may require assistance from the local authorities. Thus, the installation should be involved in the local community’s disaster planning, and reciprocally, the installation should involve the local authorities in their own planning. Plans also must be understood by all key players, including first responders, law enforcement, and nonfacility emergency personnel.

Institutes authorized to work with the US Department of Health and Human Services or USDA BSATs are required to regularly conduct emergency drills or exercises to evaluate the responsiveness and effectiveness of disaster plans. Some of these exercises necessitate involving the local community responders as well (eg, the fire department and HAZMAT teams). DoD laboratories or activities conducted in foreign countries must coordinate disaster plans through their military chain of command as well as with US Embassy assets of the host nation, especially with respect to security and evacuation procedures in the event host nation relations become strained.

Security

Security and access control are important components of all ACUPs to avoid complications due to the intentional or accidental introduction of factors that could interfere with operations or the reliability of the research conducted. Work involving BSATs (eg, anthrax spores, Ebola virus, and ricin toxin) inherently includes enhanced regulatory requirements for security and documentation such as storage requirements, key control, intrusion detection, emergency response capability, biological or chemical personnel reliability and surety programs, and other control measures.49,50 However, all ACUPs must consider and implement measures to protect the health and safety of animal subjects and personnel and safeguard research work, information, and data storage. Such measures go beyond just managing entrance onto an installation or into an animal facility to prevent vandals or domestic terrorists from disrupting operations. Measures may also include restricting access to animal rooms and investigator laboratories to only those individuals who require admittance and maintaining information technology security measures to protect data and intellectual property from theft or computer hacking incidents.

Controlling access to animal rooms may be as simple as limiting access into the vivarium through door locks, key pads, or card readers or as high tech as biometric fingerprint or retina scanners. Controlling access to a barrier room maintaining an immunocompromised animal species to properly trained personnel wearing the appropriate personal protective equipment (PPE) and working in accordance with established laboratory procedures helps prevent introduction of infectious and adventitial agents and protects the health of the animals and the integrity of the research conducted in such rooms.

Conversely, controlling access to Animal Biosafety Level rooms that maintain infectious animal species to properly trained personnel wearing the appropriate PPE and working in accordance with established laboratory procedures will help prevent spread of the infectious agent outside of the biocontainment rooms, protecting the health of other susceptible animals within the facility and the health of other personnel if the agent is zoonotic. Any breakdown in security measures or biosecurity practices can introduce variables into research studies, which may interfere with results, invalidate work already accomplished, or lead to catastrophic events impacting the health or safety of research animals and personnel.

Security concerns apply to all ACUPs—DoD and civilian. With the potential threat of animal rights extremists attacking enterprises using animals, any institute utilizing animals to conduct RDT&E and training can become a target. However, in the aftermath of the terrorist attacks of September 11, 2001, DoD facilities may have an advantage over some of their civilian counterparts in that all DoD research institutes are now located on closed military compounds with access controlled through security guards manning the installation gates. Most academic institutions and even many civilian contract research organizations lack this level of peripheral protection.

Additional measures within the civilian or DoD facilities themselves (eg, building security guards, cameras, x-ray scanners, and metal detectors at screening checkpoints) depend upon the nature of the RDT&E and training being supported and the level of security required. Such measures are particularly important for institutes working with chemical agents and BSATs that must follow regulations pertaining to chemical and biological agent safety (ie, safely handling agents under study) and agent surety (ie, ensuring defense against loss or theft of agents that could potentially be used as weapons).49,50

Occupational Health and Safety

Facilities must maintain a safe and healthy workplace environment for their employees through an established comprehensive occupational health and safety program that operates in accordance with all federal,[61] state, and local regulations. DoD facilities are fortunate in that they are usually either part of a military medical center (eg, Clinical Investigation Program) or operate as a tenant organization on an installation that has a medical treatment facility or clinic with professionals trained in occupational health and safety. Many non-DoD organizations that are not affiliated with a medical facility either have to hire their own medical staff and occupational health and safety professionals or contract out such services.

Though it requires significant coordination and continual communication, DoD research institutes generally utilize local military occupational health and safety assets because these trained professionals possess the knowledge and equipment necessary to perform required health and environmental surveys, conduct testing, and provide preventative vaccinations and treatments while properly protecting patient information (eg, maintaining Health Insurance Portability and Accountability Act Privacy Rule requirements).[62]

An institute’s occupational health and safety program should encompass all personnel working with animals or accessing areas utilized for animal RDT&E and training to include personnel who enter animal facilities but who are not considered routine animal husbandry, veterinary, and research staff (eg, facility maintenance workers, IACUC members, training attendees, student hires, and visitors). Occupational health and safety professionals perform risk assessments to determine the proper health and safety measures required for all personnel as well as differing personnel categories. These categories may vary based on the person’s expected level of animal exposure, any pre-existing conditions, and the facility areas that the person may be required to access.

Some DoD institutions experience difficulty providing similar occupational health and safety protection measures to divergent personnel because of existing situational contradictions: only some of the various categories of personnel covered by an institute’s occupational health and safety program may actually be authorized care through the allied military medical facility. For example, active duty military personnel receive their healthcare through the installation medical facility. However, government civilians working side-by-side with the military in the same research facility may or may not be authorized care at the DoD medical facility, and contract employees usually are not authorized care at military medical facilities. It is imperative that all employees regardless of status (ie, military, government civilian, or contract civilian) receive the same risk assessment and are offered the same occupational health and safety protection measures, even if the nonmilitary employees have to receive their healthcare through a separate provider. Often the military will register nonmilitary employees into their department’s occupational health and safety program to conduct risk assessments, but they may rely on contract healthcare providers to conduct health screenings and provide preventative vaccinations and treatment for civilian or contract employees.

Another potential predicament for DoD programs is related to the temporary nature of military assignments. Institutes with Animal Biosafety Level-3 and -4 laboratories in particular may have a very lengthy schedule of protective vaccinations and antibody titer checks of personnel, plus extensive training regimens that must be completed prior to gaining access into biocontainment suites. These preventive vaccine schedules, which may take 18 to 24 months to complete, severely limit the utility of these military personnel before they are eligible to move on to their next assignments. Such issues may be mitigated by extending the typical tour length for these particular military assignments or by relying to a greater degree on the already cleared, and more permanent, civilian staff to perform work in these specific areas.

Personnel Training and Qualifications

The AWRs federally mandate that personnel involved in animal care and use—to include husbandry, veterinary, research staff, and IACUC members—need to be qualified to perform their duties. These regulations stipulate that the research facility is responsible for ensuring qualifications are met and that the institute should provide necessary training and instruction. Required training includes the following seven subject areas: (1) humane animal care and handling; (2) experimentation methods and techniques; (3) basic surgical techniques; (4) proper use of anesthetics, analgesics, and tranquilizers; (5) infection control; (6) methods for reporting animal welfare concerns; and (7) instruction on how to perform appropriate literature searches for animal use alternatives.[12]

DoD instructions and regulations echo these training requirements and expand upon them by recommending continuing education and training commensurate with a person’s duties and responsibilities and encouraging certification for personnel involved in the care and use of animals in RDT&E or training.[1]

None of the aforementioned regulatory documents delineate how the required training must be accomplished to qualify personnel. Therefore, a variety of training options are available, including both didactic and hands-on methods, and most programs incorporate a combination of training methods. For example, basic information may be provided through printed material, online training modules, and lectures while species-specific techniques may be learned through instructional workshops (provided in-house or through off-site sources) or via on-the-job training with experienced staff or designated instructors.

If an institute lacks an established training department, then the responsibility for training and determining personnel qualifications often is delegated to the IACUC and veterinary staff. Given the wide variety of species used in DoD research, the military LAM veterinarian typically expends significant effort in ensuring a thorough training program is established and managed to achieve requirement mandates. Properly trained personnel not only maximize safety of the people and animals during interactions, but also minimize stress to both. One of the most important aspects of training involves understanding the previously discussed 3 Rs concept[23] (modified by the DoD to 4 Rs by adding responsibility to the previous 3 Rs: refinement, reduction, and replacement.) Incorporating the 4 Rs principles into all DoD animal RDT&E and training justifies the animal use and warrants the most humane treatment.

The military LAM veterinarian also is often responsible for developing and training staff on the animal facility disaster plan as veterinarians typically manage the animal facility and possess subject matter expertise with respect to disposition of all institutional animals. Depending on location, number of animals on-site, and health status, plans to evacuate and transport animals to other locations must be developed, as well as appropriate stock levels for emergency supplies such as feed, water, and bedding. If evacuation or transport is not feasible, mass euthanasia plans must be in place for potential use. Given the recent increased attention on animal care disaster plans, most institutes host training events during which such plans are exercised.

Emergency plans have long been an important component of all Army activities, but such training events have only relatively recently attained a similar priority in civilian facilities.[63] For the most part, the increased emphasis on this civilian training was in reaction to several high-visibility events involving various institutions and their ability, or lack thereof, to effectively respond to several natural disasters, specifically major hurricanes causing power outages and flooded animal rooms.[64]

Training for personnel performing RDT&E or training using animals in DoD institutions is very similar to training personnel working in non-DoD organizations. However, turnover of personnel in DoD facilities is often more frequent due specifically to active duty military staffing and typical 2- or 3-year assignments. Therefore, with military personnel regularly rotating in and out of DoD programs, the required training activities must recur almost continuously in order to train new incoming personnel.

The frequent turnover rate at military institutions affects the training needs of enlisted military personnel (eg, technicians) and the number of available experienced staff members at each military institution even more. Not only are newly arriving military technicians usually less experienced, but they are also probably stationed at their first RDT&E assignment, likely experiencing their first exposure to working with laboratory animal species. Training must begin at the most basic level for these personnel, and they will not become eligible for American Association for Animal Laboratory Science certification until they satisfy the 6 months to 1 year minimum laboratory animal experience requirement, which often leaves them little time to put their training to use before they are replaced by another set of inexperienced arrivals.

In contrast, civilian organizations may possess a more seasoned technician staff when compared to most DoD facilities, especially the smaller military institutes. Civilian institutes can make laboratory animal technician certification a prerequisite for hiring, allowing them to always have more experienced employees. Furthermore, civilian technicians have a greater opportunity to remain in place longer, even indefinitely, while they continue to increase their knowledge and technical skills, achieve greater levels of certification by American Association for Animal Laboratory Science, and progress to positions of higher responsibility. As noted earlier in this chapter, because of their broader missions, larger military institutes have the advantage of having both an experienced, stable civilian technical staff as well as new and more senior military veterinary technicians.

RESEARCH SUPPORT TO INVESTIGATORS

Properly executed ACUPs provide the essential tools by which DoD investigators achieve scientific progress in animal-based research supporting the warfighter.[11] These programs provide for the selection of appropriate animal models; safe, humane, and legally compliant use of selected species; and animal research support infrastructure and resources necessary for investigators to safely and efficiently execute research. In addition to administering ACUPs, laboratory animal veterinarians are an important part of research teams who lend medical and surgical expertise across the spectrum of laboratory animal species to principal investigators. The veterinarian’s knowledge of species-specific anatomy, physiology, behavior, and husbandry synergizes well with other scientists’ knowledge concerning specific animal models of human diseases or conditions. LAM veterinarians, therefore, often advise principal investigators on appropriate animal model development and selection relative to a scientist’s research goals, as well as providing or developing veterinary surgical and other technical support to scientists.

LAM veterinarians also have many opportunities to conduct independent or collaborative research in addition to their roles as clinical veterinarians and ACUP program managers. Similar to civilian institutions, the degree to which DoD veterinarians perform collaborative or independent research, or to which they are involved in animal model or technique development with principal investigators, will vary from institute to institute, depending on the organization and goals of institute leadership, the type of research underway, and the time available to the military LAM veterinarian.

Research Model Selection and Other Prestudy Consultation

The military LAM veterinarian’s role as an integral member of the research team begins well before the start of a research study. The AWRs mandate that all principal investigators consult with the attending veterinarian prior to conducting research to develop any plans for anesthesia, analgesia, surgery, and related activities. In most cases, prestudy consultation extends beyond these precursory plans to include research model selection, methods to minimize animal use, and even the possibility of using nonanimal models (ie, implementation of the 3 Rs to reduce, refine, and replace overall animal use).[11] AWRs require an explanation of the chosen research model and why nonanimal models are not suitable for use. As noted throughout this chapter, LAM veterinarians are uniquely qualified to assist principal investigators in answering these questions, given the research objectives at hand.

Technical Veterinary Support

Because of the vast array of species, many areas of research supported, and periodic rotations to different research organizations, the military LAM veterinarian must remain ready to learn or develop new techniques when needed to support the research goals at their assigned institute. Every project must be assessed independently based on the current research objective, state-of-the-art concepts and techniques, animal model involved, data required, and personnel and equipment available to perform procedures. Rarely will the LAM veterinarian perform the same procedure for years on end. Similar to civilian laboratory animal veterinarians, DoD veterinarians more commonly develop a procedure, refine it, and then train qualified research staff to perform that specific procedure for follow-on studies while moving on to the next research challenge.

Some of the complex procedures laboratory animal veterinarians have helped to develop include a myriad of surgeries for telemetry implantation permutations (from rodent intraabdominal implants to swine intracarotid devices), intracranial electrode emplacement for neurobiology studies, and related animal instrumentation procedures.65,66,67 The telemetric procedures have the important benefit of making data collection less invasive and, therefore, less stressful for animals on study.

Less complex procedures must also be developed to suit the specific research goals and species in use and are just as essential for accurate and humane data collection. Such procedures, developed with the help or lead of laboratory animal veterinarians, include the following three examples: (1) safe but frequent blood collection from species in biocontainment requiring long-term emplacement and maintenance of indwelling jugular catheters[68]; (2) maintenance of long-term anesthesia, possibly up to days, in large animal models[69]; and (3) chronic blood sampling over a 14-day period of nonhuman primates weighing less than a kilogram (this type of sampling requires new phlebotomy techniques be developed, intensive staff training initiated, and constant health monitoring of animals conducted to minimize any associated animal stress or adverse health effects).[70]

One of the most important missions the LAM veterinarian performs in direct care of animals is making expert judgment calls on when animals should be removed from study. Typically, this is done in consultation with the principal investigator. However, in the absence of such communication, AWRs grant the institute attending veterinarian the authority over all animal activities within the facility, including authority to remove an animal from study through euthanasia or other approved methods.[12]

Independent and Collaborative Research

During their specialty residency training—in order to qualify to sit the ACLAM’s board certification examination—both military and civilian laboratory animal veterinarians are required to fulfill the role of principal investigator in developing and executing an original, hypothesis-driven research project and to publish this research in a peer-reviewed journal.41,71 Through this process, veterinarians gain experience developing research models, writing original research proposals, interacting with the IACUC for proposal approval, and executing actual research, all from the perspective of the principal investigator. Such experience provides first-hand knowledge concerning the challenges faced by investigators conducting animal-based research as well as providing skills needed to develop additional research projects, either alone or in collaboration with other investigators within or outside the organization.

Since the primary mission for military LAM veterinarians is to manage execution of the military organization’s ACUP, any independent or collaborative research following board-certification eligibility is conducted as a supplemental mission based on time available and needs of the organization. Topics for independent or collaborative research range from areas directly related to the organization’s primary research goals to more peripheral topics focusing on refinement of the research process or use of animals (eg, development of new surgical techniques in a specific species to support other research, comparison of stress responses to different modes of animal housing that could impact data results, comparison of different methods for obtaining blood samples at various frequencies in a particular species, or comparison of analgesics specific to a species used in any given study). Given the wide variety of species used, the extensive variety of research occurring within the DoD, and the continuing obligation to minimize pain and distress and seek nonanimal alternatives to still achieve scientific objectives, the cumulative list of potential independent or collaborative research topics is virtually unlimited.

Because LAM veterinarians are the only military veterinarians who receive both training and experience in comparative veterinary medicine and surgery for all commonly used research species, principal investigators often utilize this expertise to review in-study clinical animal data, in light of experimental goals, known species-specific background lesions, and other relevant species-specific data. Collaboration between experts in various species anatomy, physiology and research uses, and principal investigators allows for the most accurate and comprehensive picture of animal health status changes during the course of a scientific study. Moreover, this review not only sheds significant light on direct treatment effects, but also identifies clinical markers that may reliably predict experimental outcomes at earlier time points, allowing for significant refinement of follow-on studies.

Based on their understanding of animal anatomy, physiology and husbandry requirements, civilian and military LAM veterinarians are uniquely qualified to assist investigators with developing a plan for humanely accomplishing the logistical aspects of data collection. A common misconception among investigators is that procedural logistics can be extrapolated across species. However, both collection sites and volumes of blood that can be realistically and humanely drawn may vary dramatically among species. For example, phlebotomy in dogs is wildly different than it is in 1-kilogram monkeys or 25-gram mice, as is evidenced by the numerous textbooks and handbooks devoted to detailing the differences among them.[72]

LAM veterinarians also provide advice on the amount of postsurgical or postprocedural recovery time an animal needs either during or prior to a study’s inception. Species (not to mention age, gender, and health status), anesthetic agent, type of procedure, and length of time to complete the surgery or procedure all impact time to full recovery and, therefore, impact the personnel and equipment needed for postanesthesia monitoring; because of the complexity and variance across species, textbooks are devoted to the recovery process.[73] Veterinarians review published literature as well as use their own training and experience to properly advise investigators on a myriad of other practical topics, all of which can make the difference between success and failure of data collection efforts.

Support Challenges

The wide variety of research areas and multitude of species used ensure that each research assignment a laboratory animal veterinarian holds is demanding. In addition to inherent veterinary technical support challenges, there are also more peripheral aspects of research support that consume as much time as actual direct veterinary support during the laboratory animal veterinarian’s day. These veterinary medical and logistical issues may be a result of the research site’s location, its physical facility structure, the nature of the research involved, or the ever-changing staff available for support.

Neurologic and Behavioral Studies

Neurological and behavioral studies in the DoD include research seeking to characterize the genetic, anatomical, and physiological mechanisms of the nervous system related to warfighter performance and resiliency before, during, and after military operations. Since much of this specialized research requires sampling and analysis of various structural and biochemical components of the nervous system both ante- and postmortem, it is critical that any pharmacologic interventions, to include sedation, anesthesia, or antibiotic therapy, preserve brain chemistry and anatomy as much as possible.

Virtually all anesthetics impact brain chemistry and can affect learning, memory, and pathologic analysis,[74] but there are also notable differences in these effects on animal welfare that must be considered, reviewed, and approved by the IACUC. One example is in the use of various euthanasia methods for rodents used in neuroscience research. Although both microwave irradiation and guillotine decapitation preserve brain chemistry, AWRs require training, documentation, and inclusion of details and justification within the animal use protocol for use of these specialized equipment and procedures.

Other behavioral studies restrict food intake to stimulate motivation. Such situations require close animal monitoring and recorded measurements of feed intake and body weight to ensure adequate nutrition of animals. LAM veterinarians work closely with principal investigators to meet both the regulatory and humane aspects of animal care while still ensuring valid scientific outcomes. Behavioral studies also have the potential to be derailed by environmental variables, which are often controllable but overlooked.

Routine sanitation activities are one important example of an environmental variable that can disrupt normal animal behavioral rhythms, cause animal discomfort and/or stress, and therefore impact data validity.[75] Conducting sanitation on a standard schedule with consistent personnel or allowing research staff to perform sanitation activities can minimize this impact. In addition, cleaning schedules normally conducted at frequencies mandated by the AWRs may be modified to achieve a balance of appropriate cleanliness and minimization of personnel and material movement into and out of containment areas; any such exceptions must be justified and approved by the IACUC. Pretraining and handling of rodents is known to reduce stress and increase their ability to learn how to operate in various tests of behavior and is, therefore, considered a benefit rather than a distracter to behavioral research.[76] However, whenever sanitation schedules or personnel performing sanitation are changed additional time is required; this is because changes require increased veterinary oversight and communication with the research staff to ensure sanitation continues to be executed to standard.

Feed enrichment, toy enrichment, and human interaction also may cause significant changes in behavior because of their impact on various neuronal pathways.[77] Similarly, pair-housing in nonhuman primates has been shown to affect memory and learning (pair-housed animals, not surprisingly, are not as motivated to learn as their single-housed counterparts).[78] Such findings do not mandate rejection of enrichment schemes outright but, rather, a collaborative review of the research objectives in light of AWRs to determine modifications of traditional systems that might meet goals of both.

Unfortunately, one of the greatest impacts on behavioral research is difficult, if not impossible, to control: the amount of vibration, noise, and other sensory stimuli detectable by animals. The LAM veterinarian, civilian or military, can mitigate noise and vibration as much as possible by locating behavioral study animals in less-affected areas, housing them near species not likely to cause olfactory or other sensory stress, or renovating or retrofitting rooms with soundproofing or other measures when necessary.

Of significant interest in the past decade, given the military mission and the number of service members affected by the wars in Iraq and Afghanistan, post-traumatic stress disorder and traumatic brain injury research provide special challenges for military and civilian laboratory animal medicine veterinarians. Military research goals in these two areas of research often require highly specialized facilities that replicate trauma scenarios faced by warfighters. Such facilities are often located remotely because of the space needed for simulated explosions or other high-impact events. Animal transport to and from such sites introduces numerous logistical challenges for the veterinary staff who may be required to transport sedated or anesthetized animals as well as deal with potential cross-contamination caused by transportation of animals through nonanimal areas, both indoors and outdoors. (Cross-contamination can lead to transfer of various opportunistic infectious agents back into a research facility.)

Infectious Disease Research

Infectious disease research makes up a large part of all DoD research conducted for two main reasons: (1) weaponized biological agents continue to pose a serious threat to US forces, and (2) infectious diseases remain a significant cause of nonbattle injuries, causing temporary incapacitation of military personnel deployed around the world. One of the largest military animal-based research programs is the biodefense program at the USAMRIID. All of the animal work in this institute is conducted in biocontainment facilities ranging from Biosafety Level 2 (BSL-2) through BSL-4 (the highest possible level of containment).

Working with animals at BSL-3 and BSL-4 presents significant challenges for the veterinary staff. Support to animal research in a biocontainment environment is subject to an intricate framework of facility infrastructure, institutional policy, DoD regulations, United States law, and actual direct health risks (to both animals and humans) posed by the select pathogenic agents and toxins under investigation. The military LAM veterinarian must, therefore, be knowledgeable of these logistical and veterinary medical factors when designing appropriate support so that optimal times and places for staff monitoring can be identified or intervention is conducted to ensure that critical scientific, regulatory, safety, and AWRs are met.

Details of biocontainment levels and minimum requirements for each are published in the CDC Manual 21-1112, Biosafety in Microbiological and Biomedical Laboratories[79]; US military, as well as civilian organizations, must comply with these requirements. The DoD has several additional regulations and policies concerning biosafety, biological surety, biosecurity, safeguarding and inventorying of BSATs, and biological (and chemical) personnel reliability programs.80,81,82

For example, BSL-1 practices, safety equipment, and facility design and construction are appropriate for laboratories in which work is done with defined microorganisms not known to consistently cause disease in healthy adult humans. For BSL-1 work, standard microbiological laboratory practices are used. BSL-2 containment is required for work done with a broad spectrum of indigenous moderate-risk agents that are present in the community and associated with human disease of varying severity. BSL-3 containment is needed for work with indigenous or exotic agents that may cause serious or potentially lethal disease as a result of exposure by the inhalation route. BSL-4 containment is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections and life-threatening disease that is frequently fatal and for which there are no vaccines or treatments or for work with an agent with an unknown risk of transmission.[79]

Facilities for biocontainment work are designed with clear physical separation of containment and noncontainment areas. Areas designated as BSL-3 and BSL-4 require a number of added procedures for entrance and exit of animals, personnel, equipment, and supplies. Such entry procedures include, but are not limited to, donning specialized positive-pressure protective, completely self-contained suits; using positive-pressure respirators; and wearing extra layers of standard PPE. Exit procedures require personnel to shower out, with decontamination of PPE, and sterilization or chemical decontamination of all materials and equipment prior to exit.[79]

Intensive, detailed training is required for personnel to wear specialized protective equipment, given the severe consequences that could occur in the event of a breach in such equipment. Because of the design of this protective equipment, even routine procedures in BSL-3 and BSL-4 take longer and often require modification to prevent breach of protective gear. Needle sticks, animal bites, or sharp objects can all lead to protective gear puncture.

To minimize these risks, venipuncture procedures may be modified to prevent the needle from coming anywhere near an individual’s protective suit or gloves; safety needles (retractable needle heads) are typically used; animals may be anesthetized instead of manually restrained (even for simple procedures such as peripheral small volume blood collections); and in all cases, procedures are done in a slower, more methodical manner to minimize human error. The specialized equipment and procedures required for work in BSL-3 and BSL-4 make entry and exit of personnel and materials and actual work in these areas much more time-consuming than work in other areas. All of these constraints must be considered by the laboratory animal veterinarian when arraying available personnel against the required support mission and scientific and animal welfare needs.

The movement of animals into and out of BSL-3 and BSL-4 areas and ensuring humane care and use of animals while in these areas pose perhaps the most difficult veterinary and logistical challenges to the laboratory animal veterinarian and staff. A key role for military LAM veterinarians is conducting risk assessments to identify those areas most likely to allow cross-contamination of infectious agents into noncontainment areas. Traffic patterns of humans and animals, available PPE, and routes of exposure typical for a particular agent all must be considered. Another key veterinary role is advising investigators on whether certain biological materials may pose risks to other animals within a facility. For example, some replication-competent viruses used as vectors to introduce infectious agents into test subjects may also contaminate other materials moving into and out of a room and possibly infect nonstudy animals or even humans.[83]

Because of the significant risk to human health posed by BSL-3 and BSL-4 infectious agents, as well as the risk of spreading contaminants from containment areas to the rest of the facility, institutes seek to minimize staff time spent working inside these areas as well as the amount of material traffic into and out of containment. Through the use of in-room, continuous cameras, monitoring of activities can be accomplished from noncontainment areas.

However, should problems arise, the ability to respond immediately is necessary, and advance consideration of all potential impacts on animal environmental conditions is needed. For example, environmental enrichment needs must be met at all times (as mandated by the AWRs, especially for nonhuman primates) regardless of the biosafety level. Since human contact is a critical component of animal enrichment programs, and biocontainment at BSL-3 and BSL-4 protective gear and equipment significantly limit this contact, other enrichment strategies must be enhanced to compensate for the lack of human interaction. These additional strategies may, and often do, require significantly more time to accomplish.

Since pair-housing, an excellent enrichment strategy now mandated as the default for nonhuman primates and many other species,[6] can increase the human safety risk of certain animal manipulations when done in containment areas, pair-housing may have to be discontinued during data collection periods. Of special concern are animals participating in long-term studies that, therefore, must be singly housed for extended periods. When there are few or no other animals in the room, isolation stress is a very real issue for animals, one that requires specific attention and mediation through other enrichment methods.[84]

Manipulation of animals within biocontainment areas also often requires modification of procedures to ensure desired data collection is achieved with minimal human intervention and minimal distress for animals. A common monitoring technique well-suited for containment use involves surgically implanted telemetric devices that can monitor a variety of physiologic parameters from outside the biocontainment suite.

Difficulty sometimes arises, however, when postsurgical complications require readjustment or removal of devices. In such cases, all corrective work must be executed within containment areas while within the confines of cumbersome protective suits or equipment. Similarly, central venous catheters are popular for certain studies because they obviate the need for repeated needle use for serial phlebotomy in containment, making collection much safer for humans and more comfortable for animals. Yet, when these same catheters lose patency and require removal or replacement, it is more difficult to accomplish in containment areas.

Additional requirements occur when certain agents are used, specifically, those listed as select agents and toxins by the National Select Agent Registry, which lists biological agents and toxins that have been determined to have the potential to pose a severe threat to both human and animal health, to plant health, or to animal and plant products. This list is developed and maintained jointly by the CDC and the USDA’s Animal and Plant Health Inspection Service. These agents are so identified because they have the potential to be used as weapons or in other ways harm public or animal health.

The select agent regulations (9 CFR Part 121, 7 CFR Part 331, and 42 CFR Part 73) define requirements for ensuring physical security of these agents during storage, use, transport, and disposal.85,86,87 To meet these requirements, all personnel having access to these agents at any time must be enrolled in a biological personnel reliability program (BPRP). (A similar program exists for working with chemical agents.)

The BPRP requires personnel to obtain and maintain security clearances, continuously report to management any factors that might impact their security clearance or reliability to work with dangerous biological (or chemical) agents to include medical conditions that may arise while employed for such work. Not everyone on the veterinary staff will qualify for the BPRP, making this requirement another management challenge to ensure that only BPRP-enrolled personnel are scheduled to work on studies requiring BPRP enrollment. (See Chapter 15, Veterinary Pathology, for more information about biocontainment levels and military biomedical and chemical research.)

Environmental Toxicology

On the surface, military environmental toxicologists address the same issues as their civilian counterparts: the effects of environmental compounds (naturally occurring or artificially deposited) that negatively impact human or sentinel animal species’ health. However, military research often focuses on environmental toxicants produced by military activities such as ammunition by-products found on firing ranges or components of other military weapons systems that, given their use, might cause chronic toxicity in service members operating those systems (eg, depleted uranium residues or aviation fuels).

In this field of study, a variety of animal models, to include many nontraditional ones, are often used, including birds, reptiles, New World rodents, amphibians, fish, and invertebrates. Success in maintaining these species can be achieved only through specialized training of the veterinary care staff, who must not only be knowledgeable in direct care and handling of the species used, but also in maintaining required species-specific environmental conditions for each. For example, optimal reptile housing provides a thermal gradient, allowing them access to both warmer and cooler areas in order to ensure proper body temperature regulation. Moreover, quail eggs require high temperatures for proper incubation and hatching, but adult birds need access to much lower temperatures to maintain normal health, similar to other bird species.[72]

Wild species do not easily adapt to a laboratory environment, so approaching environmental enrichment creatively for each species is also important. Facility stressors that might not harm more traditional laboratory animal species could lead to severe stress or even death in wild species, so minimization of these stressors and the ability of the veterinary staff to identify subtle species-specific signs of disease is critical.

Like other specialized studies, environmental toxicology studies require special equipment for housing and testing, to include inhalation chambers and incubators. The veterinary staff must be able to sanitize these items thoroughly without leaving cleaning material residue that could later influence the response of animals housed therein.

Additionally, many civilian and military studies submitted for acceptance by environmental regulatory agencies must adhere to GLP regulations. GLP regulations require meticulously controlled environmental conditions and documentation of all factors that could impact collected data integrity. Appropriate GLP compliance is possible only through implementation of rigorous administrative oversight of all test articles, animal handling technical methods, equipment maintenance, and environmental factors.

Because GLP regulations mention general standards for animal care but do not replace the AWRs that must be followed by all DoD research entities,[11] a major challenge within GLP-focused facilities is ensuring that compliance with both GLP and AWRs is achieved while still meeting scientific objectives. One example of overlap, where clear and standardized collaboration between the scientific and laboratory animal staff is critical, is the documentation required to make animal use protocol changes—since requirements differ slightly between the GLPs and AWRs.12,88,89

Another example of an area requiring close coordination is maintenance of facility conditions. The laboratory animal veterinarian must ensure careful monitoring of facility heating, ventilation, and air conditioning to ensure appropriate standards are met for both GLP and AWR requirements. Finally, the AWRs and the Guide specifically address the need for group housing whenever possible,[6] whereas certain GLP study designs may be determined by environmental regulatory standards that mandate single housing.[90] This duly noted, the challenges of meeting GLP and AWR requirements affect any area of research operating under GLP conditions, not just environmental studies.

Certain environmental carcinogen toxicity studies require long-term (12–24 months) housing of rodent species. GLP compliance requires strict oversight of measurement of both the test article and the food or water used as the vehicle for administering test material. While the investigative staff may conduct the test article administration, the veterinary staff must ensure that adequate animal nutrition is maintained, as well as ensure that care activities do not inadvertently confound strictly controlled feeding and watering regimens.[91] Another challenge of long-term studies is that, during this time, animals may develop age-and housing-related medical issues unrelated to test article or study design. In these cases, the laboratory animal veterinarian must work with investigators to determine what effect, if any, these background issues have on specific data or overall study results.

Field Research and Field Studies

Field research and field studies are used to assess animals in their “field” or natural environment, with or without invasive manipulation (field research or field studies, respectively) of the animals under study.[1] Whether field observations or sample collections are executed by military or civilian organizations, laboratory animal veterinarians must ensure that the AWR requirements for lawful procurement of animals is followed, typically through the investigator’s proper securing of permits for work with, or collection of, desired species.

There is an additional military application of field studies in which animals are tested for certain zoonotic diseases of interest occurring within a military area of operations (combat or otherwise). When such military zoonotic testing occurs internationally, the host country’s requirements must also be met, as well as all applicable US and DoD requirements. Further, the LAM veterinarian must appropriately advise the investigator on proper personnel protection for exposure to zoonotic disease since field animals are wild, not purpose-bred and, therefore, risk of exposure to disease is increased.

Capturing, anesthetizing, or euthanizing animals as well as appropriately collecting and storing samples is a significant challenge in field research and studies, particularly for military personnel operating in overseas combat zones far from established laboratory facilities. For example, certain controlled substances are difficult to legally transport to nonlaboratory areas or across international boundaries. Necessary equipment may be damaged or rendered inoperative when used outside the laboratory, and in all cases, procedures are rendered far more difficult when done in the field.

The DoD veterinarian also must specifically ensure that even deployment animal trapping plans take into account humane containment, handling, and release of animals. Traps should be checked often enough to ensure animals are not stressed by the inability to obtain food or water or exposure to excessive heat or cold.

Radiobiology Research

The DoD is concerned with radiation exposure of service members both in garrison environments (eg, health care facilities) and in deployed environments where service members may be exposed to radiation as a result of nuclear plant accidents (eg, Fukishima Daiichi nuclear power plant accident in Japan, March 11, 2011)[92] or intentional use of nuclear weapons by enemy forces.

Whole (ie, total) body irradiation of animals and other radiobiology research techniques require working with hazardous equipment and radiation-emitting substances that pose occupational health risks to military personnel. The LAM veterinarian is the primary advocate of, and responsible authority for, ensuring that veterinary staff members are appropriately prepared for and protected when performing such work.

Working with depleted uranium or other radioactive substances poses significant logistical hurdles. For example, test substances are often excreted in animal urine or feces, requiring radiation safety officials to ensure that the waste products are free of radioactive material prior to its removal from animal rooms. Radioactive bedding disposal creates a unique waste disposal challenge for the staff because this bedding must be disposed of in accordance with Nuclear Regulatory Commission or state requirements.[93] In many institutes, radioactive materials must be fully accounted for before animals are removed from that animal room. Work spaces may also be segregated based on presence of radioactive materials as well as on the type of radiation emitted (eg, beta-emitters require different protections than gamma-emitters).

Other logistical challenges of radiobiological research include collecting serial blood samples over extended time periods. In large animals, this is both time-consuming and labor intensive, and for rodents it is technically challenging because of limited total blood volumes and collection sites. When total body irradiation is combined with injury research, additional considerations related to trauma medicine come into play, such as how to create controlled radiologic and traumatic injuries, and whether such controlled injuries adequately replicate real-world scenarios (both a scientific and ethical question). Determining when full-spectrum post-injury supportive care may be applied, which still allows collection of valid data, versus when modification of post-injury supportive care is needed, with the potential for compromised scientific objectives, is another difficult yet unavoidable question faced by the IACUC and attending veterinarians. The LAM veterinarian is uniquely qualified to provide clinical perspectives on when supportive care may interfere with certain clinical outcomes necessary to meet desired research objectives.

Similar to what occurs in other areas of research, defining and implementing consistent and humane animal endpoints can be problematic. This is because, at the present time, previous work for some areas of radiobiological research is often absent, and the rapidity of onset of clinical signs can make timely identification of optimal endpoints very difficult. It is therefore incumbent upon the LAM veterinarian to advise the investigator and IACUC on those clinical signs, within a potentially rapid progression of clinical effects, that can best be used to assess whether research objectives have been met, at the earliest time point possible.

Diving Research

Because the DoD—in particular, the Navy—conducts a variety of underwater activities in support of military combat and training operations, understanding the physiology of diving effects on service members in this unusual military environment is a high priority for naval research organizations.

Currently, military diving research utilizes hyperbaric chambers in which animals are either conscious or anesthetized, depending on study objectives. Delivery and monitoring of anesthesia during hyperbaric procedures and general animal monitoring without direct human contact are major support requirements for the laboratory animal veterinary staff. Setting up vital sign monitoring equipment, which remains accurate for extended periods of time; staffing the equipment with trained personnel; and maintaining the capability to appropriately address problems promptly are key factors in success for this type of research.

When animals are recovered from dive procedures, postdive decompression becomes another important phase of such studies; this phase must be carefully controlled lest significant abnormal conditions arise. Such conditions include acute decompression sickness that may lead to death or prevent normal recovery, spinal cord decompression sickness in which limb paralysis is seen, or combinations of these conditions in a variety of species.94,95,96 These conditions must be proactively considered and prevented by the veterinary staff to ensure animals recover appropriately. Preventing loss of animal life, not to mention loss of valuable data and resources invested in the animal, require trained and ready veterinary monitoring during the postdive period. (For more information about US Army veterinary support for naval programs and military marine mammal care and missions, see Chapter 7, Marine Mammal Program.)

Overseas Research Sites

The DoD currently operates three research facilities located outside of the continental United States (OCONUS) that utilize animals: the Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand; the Naval Medical Research Unit Number 3 (NAMRU-3) in Cairo, Egypt; and the Naval Medical Research Unit Number 6 (NAMRU-6) in Lima, Peru.

The mission of all of these institutes is to conduct medical research and disease surveillance and develop and evaluate medical products for militarily important infectious and tropical infectious diseases of the particular region. AFRIMS is the largest DoD OCONUS laboratory animal facility that includes a large nonhuman primate breeding colony of Indian-origin rhesus macaques. An additional unit, NAMRU-2, and its various detachments have been located in a variety of places since its inception, to include Guam, Taiwan, Manila, and Jakarta.

The Jakarta facility closed in 2010 at the request of the government of Indonesia. The unit was then relocated to Pearl Harbor, Hawaii, and officially opened as NAMRU-2 Pacific in June 2010. However, the unit in this location was then disestablished in 2013 and relocated to Phnom Penh, Cambodia.[97]

OCONUS facilities that conduct DoD animal-based biomedical research are often located in countries that may be less developed or less politically stable than the United States. Local nationals are frequently hired for some or nearly all of the veterinary support staffing needs, which significantly impacts the daily challenges faced by the military laboratory animal staff in many ways. First, local national staffing can provide a stable and reliable workforce to optimize standardization and continuity of animal care and handling, two extremely important factors desired by investigators. Second, in many cases, work at a local US research site pays more and holds a higher social status than many other local jobs; therefore, US-hired local nationals are extremely dedicated to doing their best to maintain employment at the research site. Finally, in some countries (eg, Thailand), the predominant religious and cultural mores include a deep respect for animal life and welfare, so there is an inherent desire by the local national staff to ensure that animal care and use regulations are followed closely.

Procuring animals for OCONUS sites is challenging because the microbiological status of animals procured locally is often unknown. Other challenges of overseas locations include the lack of available high-quality feed and appropriate animal enrichment items. Consequently, many animals and supplies must be imported, adding expense and layers of importation requirements, quarantine challenges, and additional complicating procedures on top of the normal procurement process. Overall research costs are also increased because of importation taxes not normally incurred by continental US laboratories.

To avoid procurement issues, some sites choose to create and maintain breeding colonies to produce required animals in-house. Development of such breeding systems is costly, requiring specialized facilities as well as special training and experience of the veterinary support staff. In countries where governmental stability has been compromised, the military LAM veterinary support staff are considered essential personnel and have not only been required to take the lead on conducting research animal evacuation or euthanasia (when dictated by local regulations and institutional policies), but have also been required to act as part of the general veterinary force to execute evacuation of pets owned by the DoD or other US personnel.

A contemporary case exemplifying this duty is the uprising that led to the ousting of Egyptian President Mubarek in January 2011; the rapid evacuation of thousands of Americans resulted in a large number of unattended pets being left in the country, many of which were owned by embassy and DoD personnel. A US military veterinarian remained in-country to ensure care, safekeeping, and evacuation of these animals, in addition to providing care for the research animals housed at NAMRU-3 (e-mail communication from Lieutenant Colonel Nancy Merrill, Attending Veterinarian, US Naval Medical Research Unit No. 3, Cairo, Egypt, January 2011).

CLINICAL INVESTIGATION SITES

Upon completion of medical school, the military physician typically matches into a residency program at a major military medical center, and the doctor’s training continues in a specialty area such as surgery, obstetrics, or neurology. The Accreditation Council of Graduate Medical Education (ACGME) stipulates research and training requirements be fulfilled in order to maintain accredited residency programs. Clinical departments supporting residents for up to 7 years have recognized the value of adding a research rotation to the residents’ curriculum so they may learn about the science behind their chosen craft. To that end, military medical centers offering ACGME-accredited residency training programs in the United States have a Department of Clinical Investigation (DCI).

The overarching mission of most DCIs is to provide the tools, training, and expertise required to develop clinicians and scholars who engage in intellectually rigorous, safe, and ethical conduct of research that advances the science of medicine. The DCI provides excellent opportunities to train many in the medical and ancillary services using animal models. Trauma training is especially available at several DCIs, with an emphasis on validating physicians’ skills as first responders.

Of the twenty plus DCIs in the DoD, only two Air Force, two Navy, and five Army medical centers have animal care and use programs supporting preclinical research and training. Military laboratory animal veterinarians play a pivotal role at the following nine locations: Mississippi (Keesler Air Force Base Medical Center-KMC), Ohio (Wright-Patterson Air Force Base), California (Naval Medical Center San Diego-NMCSD), Virginia (Portsmouth Naval Medical Center-PNMC), Hawaii (Tripler Army Medical Center-TAMC), Georgia (Eisenhower Army Medical Center-EAMC), Texas (William Beaumont Army Medical Center-WBAMC and San Antonio Military Medical Center-SAMMC), and Washington (Madigan Army Medical Center-MAMC).

LAM veterinarians are assigned to one of the nine aforementioned DCIs and serve as the attending veterinarians for the institute’s overall animal care and use program. Training initiatives and research focus are unique to each location and fluctuate with the medical needs of warriors, both on and off the battlefield, and other populations served by the medical center (military retirees, DoD family members, or government civilians).

The principal roles of the attending veterinarian at a DCI include the following six duties: (1) provide adequate veterinary care; (2) serve as a voting member on the IACUC; (3) use appropriate methods to prevent, control, diagnose, and treat diseases and injuries; (4) provide guidance to principal investigators and other personnel in the care and use of animals; (5) maintain the program’s AAALAC accreditation status; and (6) exercise professional judgment to facilitate the science in the context of animal welfare.

Military veterinary roles at DCIs also may expand to cover unique circumstances. For instance, at EAMC, studies assessing methods to promote nerve healing in traumatized limbs require veterinary input to create formulations to provide maximum bioavailability in nervous tissue. At MAMC, limb reattachment studies in rats involve training animals to walk on a track after having the hind paws inked to leave prints for measurement. Another institute uses the new DigiGait analysis system (Mouse Specifics, Inc., Framingham, Massachusetts) for similar studies. Veterinarians must be familiar with methods of proper conditioning of animals for such behavioral tests.

One way to maximize the use of a DCI animal care and use program is to create long-standing animal models of disorders or wound conditions that may be studied in perpetuity by a succession of new clinician-scholars. In this manner, short-duration studies may be crafted to fit into the timeframe of a very busy resident and help keep a central research focus for the clinical department. The senior staff of such departments may then guide the residents in the choice of how to use the established model based on current issues, challenges, and injuries/conditions facing warriors.

LAM veterinarians work closely with physicians who have treated patients on the battlefield or who have implemented solutions to clinical problems based on research conducted in the DCI. While some physicians have had some exposure to animal research, many are unaware that animal models exist or can be developed to support research on a variety of clinical conditions. Outreach to department leaders within a medical center by DCI staff, including the LAM veterinarian, helps ensure maximum involvement by medical staff and residents, which serves to strengthen the training program of the medical center. The LAM veterinarian can also help identify animal model options not yet considered for use in training and research, thereby enhancing the quality and depth of DCI research or training programs.

Forging a strong collaboration between the new physician scientist and the LAM veterinarian is also a good long-term investment. Many residents understand the process of the institutional review board (IRB) for human-use studies, but few are aware of the IACUC process for animal studies or fundamental differences between these two committees. Training residents on the role of the principal investigator, coaching them on writing an animal care and use protocol, and mentoring them through the steps of data collection in animals can bring a much greater understanding of what lies behind a valid and useful scientific publication. Whether or not the military physician continues on active duty, this type of training also helps mold a scientific mind, which, in turn, enhances the physician’s capabilities and expertise such that he or she may be able to contribute to research programs throughout his or her career as a scientific mentor or even as an IACUC member or consultant.

COMBAT TRAUMA TRAINING

Animal models of human combat trauma have been used for decades as an adjunct to training provided to military medical personnel (unpublished data, LTC Chad D. Foster, chapter author and [former] attending veterinarian, US Army Medical Department Center and School, based on experience reviewing multiple past DoD policies and protocols related to animal use in human medical training from May 2003 to July 2016). This training, commonly referred to as combat trauma training (CTT), live tissue training, or animal-based medical readiness training, involves the creation of simulated combat injuries in an anesthetized live animal model, followed by the administration of emergency interventions by medical personnel. The purpose of such training is to teach medical personnel how to independently manage critically wounded patients at the point of injury on the battlefield and during the first few hours afterwards.

Prior to September 11, 2001, this training was limited to a small number of select military service members and often utilized as a component of the US military’s Advance Trauma Life Support courses. However, the nature and severity of the injuries encountered on the battlefield during more than a decade of war in Iraq and Afghanistan have made CTT a critical component of predeployment training for all medical personnel who might be called upon to treat combat casualties. In fact, Headquarters, Department of the Army Executive Order 096-09 (HQDA EXORD 096-09) mandated predeployment trauma training for all physicians, physician assistants, oral surgeons, dentists, nurses, nurse anesthetists, and combat medics deploying on or after October 1, 2009.[98]

The mandatory predeployment training is provided by the US Army Medical Department’s Center for Predeployment Medicine. Each of the predeployment courses involves use of animals for CTT. The Army, Navy, and Air Force all utilize CTT to some extent in training medical personnel as a supplement to extensive didactic, simulator, and buddy-aid training. The current combat trauma management training methods have contributed to the greatest survival rate in history for military personnel wounded in action—greater than 90%.[99]

Regulations and Oversight

Similar to the use of animals in biomedical research, the use of live animal models in CTT requires an IACUC-approved protocol and is governed by the Animal Welfare Regulations, DoDI 3216.01, and AR 40-33.1,11,12 These requirements include, in most cases, that institutions conducting CTT be AAALAC accredited. Each of these regulations mandates the involvement of veterinarians in all aspects of animal use. In accordance with the DoDI 3216.01, Use of Animals in DoD Programs, headquarters-level oversight of CTT programs is provided by board-certified, military LAM veterinarians in each respective component oversight office.[1] These veterinarians conduct compliance inspections and administrative reviews of IACUC-approved protocols and provide consultation services to CTT programs, just as they do for biomedical research institutions under their purview. Although many CTT programs utilize clinical (nonlaboratory animal medicine) veterinarians to provide veterinary care and anesthesia support during the conduct of CTT, three of the largest CTT institutions in the DoD (ie, AMEDDC&S, HRCoE; Joint Special Operations Medical Training Center; and Madigan Healthcare System) have permanent positions for LAM veterinarians. While these positions involve the traditional responsibilities associated with LAM veterinarians, they also present challenges that are unique to CTT programs.

For example, the LAM veterinarians at the AMEDDC&S, HRCoE, and the Joint Special Operations Medical Training Center may be the only persons at these institutions who have any outside training or experience with regulated animal care and use programs. This is an important consideration, given that each institution’s leadership may have little or no knowledge of the regulatory requirements associated with the use of live animals. To ensure regulatory compliance, the LAM veterinarian must work closely and communicate effectively with the institutional official, IACUC, public affairs officer, and individual unit commanders and instructors when providing expert consultation and guidance.

Program Development

The LAM veterinarian in CTT programs must be actively involved in developing all institutional policies and standard operating procedures related to animal use. Development of institutional policies and procedures is complicated by the fact that many animal use regulations and standards were developed with research institutions (and their fixed facilities), not CTT programs, in mind. For example, federal regulations require that all animal use areas be inspected semiannually and approved by the IACUC.[12] While this is not difficult for CTT programs that utilize permanent facilities for training courses, it can be exceedingly difficult for programs that conduct CTT at field-training exercise sites (eg, the Brigade Combat Team Trauma Training [BCT3] course is conducted on training ranges).

BCT3, the mandatory predeployment trauma training course for combat medics that involves the incorporation of CTT into realistic battlefield scenarios, is an exportable course conducted by trained dedicated staff. For each iteration of this course, temporary animal housing, as well as animal preparation areas, are constructed at field-training sites 1 to 2 days prior to animal delivery. These constructions are taken down immediately after conclusion of the training event. However, because the animals used in BCT3 CTT are housed for greater than 12 hours, they still must comply with AWRs.[12] Furthermore, in accordance with DoDI 3216.01 and AR 40-33, the temporary animal facilities used for CTT, which may only exist for 2 to 3 days, must comply with the animal housing requirements of the Guide.1,6,11

Developing compliant plans for animal housing and processes to ensure proper veterinary and IACUC oversight and approval may require creativity and ingenuity. Moreover, when these courses are conducted outside of the United States, the DoD organization conducting the training is responsible for ensuring strict adherence to both host country and US laws and regulations.[1]

Occupational Health and Safety Program

Another challenge encountered in CTT programs is the development of a comprehensive Occupational Health and Safety Program. Students attending CTT courses are unlikely to have received a medical evaluation and clearance specifically for animal contact. This is especially true for students attending exportable courses where students are not covered by the CTT program’s Occupational Health and Safety Office. Since the animals used in CTT programs are generally USDA Class B dealers (ie, these dealers are licensed by the USDA to purchase and resell animals, as opposed to Class A dealers who are licensed to sell animal bred on their own premises),[12] the animal’s background and previous exposures will likely be unknown. Therefore, it falls to the veterinarian and the IACUC, in cooperation with occupational health professionals, to ensure that occupational risks, namely zoonotic diseases and allergies, are mitigated to the greatest extent possible.

For example, if the animal model used in the CTT course is a goat, the veterinarian might require that only male castrated goats be used in order to minimize the likelihood of receiving animals with brucellosis or Q fever, both of which can be contracted by humans from contact with female goats that are lactating or giving birth. Vaccination and health screening requirements for animals to be purchased should also be developed and incorporated into contracts, and animals should be inspected upon delivery by a veterinarian for contract compliance (including any indications of zoonotic disease).

The veterinarian must also provide consultation regarding the use of PPE to mitigate any residual risk from animal exposure. The PPE selected must balance the principal instructors’ need for realistic training (ie, gloves, masks, and lab coats are not typically worn on the battlefield) with the necessity to ensure the welfare of the students. Moreover, it generally falls to the veterinarian to provide a pretraining briefing to all CTT participants. In addition to regulatory requirements, this briefing should include information on the risks associated with use of the animal model, steps to be taken to reduce that risk, and clinical signs of allergic reactions and zoonotic diseases associated with the species in use.

Protocol Development

The LAM veterinarian must also be consulted during the development of a CTT animal use protocol.[12] Although the veterinarian reviews and provides consultation on all areas of the protocol, the primary role in protocol development relates to model selection and development of an appropriate anesthetic regimen. The model selection should be based primarily on the principal instructor’s training goals.

The two most commonly used animal models in CTT programs are goats and pigs, each with their own advantages and limitations. Goats are commonly selected for use because of their anatomical similarities to humans with regards to subcutaneous fat thickness, blood vessel size and location, abdominal wall thickness, rib and intercostal space size, and tracheal diameter (which allows for instrumentation with human medical devices). Furthermore, goats not only possess a temperament and husbandry requirements that make them easily exportable to a field environment, but they are also readily available in and outside the United States. However, on the negative side, goats often require partial shearing and shaving prior to use.

Pigs may be selected as the CTT model of choice because of the similarity of their skin and internal anatomy to that of humans, which may be important if the CTT will focus on surgical interventions. Whichever model is used, the veterinarian will likely be responsible for providing appropriate training to students, instructors, and anesthesia support staff.

Development of an appropriate anesthetic regimen is the single most important way in which the LAM veterinarian serves as an advocate for animals used in CTT programs. The regimen must ensure that the animals are maintained at a surgical plane of anesthesia for the duration of the training, which is generally 2 to 5 hours. A wide variety of anesthetic approaches are used in support of CTT.

When deciding upon an anesthetic regimen, the veterinarian and the principal instructor must consider how the CTT will be incorporated into the overall training event. For example, if CTT is to be conducted in a fixed facility or an environment that simulates a battalion aid station or combat support hospital, then inhalant anesthesia may be appropriate. However, if the CTT will be conducted in the field where there is no suitable inhalant anesthesia equipment necessary for inhalant anesthesia, another approach may be necessary. In these situations, a constant rate infusion of intravenous anesthetics may be a better choice. If the training will involve significant patient movement (eg, evacuation), then the risk of dislodging endotracheal tubes and IV infusion sets may necessitate the use of intermittent parenteral injections of anesthetics.

In all cases, the animal must be closely and continuously monitored for appropriate anesthetic depth to avoid any pain or distress to the animal, which can be quite complicated. In order to better simulate combat scenarios, many CTT courses are conducted in austere environments that limit visibility and hearing, including the dark (simulating nighttime operations), heavy fog (simulating smoke), and noise (simulated gunfire and pyrotechnics). The veterinarian must be aware of these impediments to patient visualization and handling and have a plan for patient monitoring under such conditions. The veterinarian must also ensure that animals are humanely euthanized at the conclusion of the training event and carcasses are disposed of in accordance with local laws and regulations, which vary depending on where the training event takes place.

Future of Combat Trauma Training

CTT has contributed to what is currently believed to be the lowest battlefield fatality rate in military history, and the use of animal models is an essential component of that training.[99] The live animal patient, generally integrated into a culminating training event, presents students with realistic, unpredictable, physiological responses that hone rapid decision-making skills and expertise in providing life-saving interventions. Students experience the pressure associated with providing care to a critically wounded, actively bleeding patient.

For some students, it is their first time working on a live trauma patient. When successful, they gain confidence in their ability to save lives. In fact, 97% of students who completed the Tactical Combat Casualty Care course at the Madigan Army Medical Center reported that the training significantly improved the confidence they had in their ability to manage combat casualties. Furthermore, of those who completed the course and then deployed for 1 year to Iraq, 99% reported that it helped with their management of battlefield casualties.[100]

The DoD is committed to providing effective realistic training while ensuring compassionate and humane animal use. However, responsible animal use requires institutions to continually consider the use of nonanimal models which can potentially replace or reduce the number of live animals used. In September 2008, the Under Secretary of Defense (Acquisition, Technology and Logistics) formed the Use of Live Animals in Medical Education and Training Joint Analysis Team (JAT) to “address the technology maturity and readiness of medical models and simulations to replace the use of live animals in DoD medical education and training venues.”101(p3)

In July 2009, the JAT published a review on the use of live animals and nonanimal alternatives in medical training across all services, which concluded that simulation technology was widely being used to augment medical training but could not be used to fully replace live animals used in training. Furthermore, the JAT noted that three of the nine critical or high-stakes medical procedures could not be taught with current simulator technology. They also reported disadvantages in current simulation technology, including a lack of realism, limited real-time physiologic feedback capability, and lack of the intangible sense of urgency associated with caring for a living model.[101]

On the recommendation of the JAT, the DoD is working to develop methods to assess training effectiveness and make scientific comparisons between the live-animal and simulation teaching modalities. Additionally, the DoD is striving to identify gaps in simulation technology in order to facilitate targeted development to meet its training needs. The DoD is highly committed to completely replacing animal-based training methods with alternatives, as long as doing so will not adversely affect the provision and quality of care for injured warfighters. Until such simulation is validated and determined to be as effective as use of the live animal model, the training, experience, and confidence gained by the use of animals in teaching life-saving tactics, techniques, and procedures is critical and must remain intact.[99] Therefore, LAM veterinarians will continue to provide critical support and oversight.

SUMMARY

US Army LAM veterinarians have proven themselves essential to ensuring the humane care and proper use of animals in support of the DoD’s worldwide RDT&E and training programs. Since the LAM training program’s beginnings in 1961, the program has evolved to become a rigorous, successful training program that continues to produce an indispensable, uninterrupted source of highly trained LAM specialists (military occupational specialty 64C) to sustain the DoD’s numerous RDT&E and training missions.

The LAM veterinarian position encompasses many responsibilities; the foremost is ensuring that the DoD complies with all laws, rules, and regulations regarding animal care and use. Acting as an animal advocate by promoting animal well-being and proper ethical use at all times, the attending veterinarian has the additional task of managing an institute’s ACUP with its many functional areas. Military LAM veterinarian’s duties are very similar, if not identical, to those of civilian LAM veterinarians. However, there are situations and challenges that are unique to the military and to the specific types of research and training missions the various DoD units perform. These challenges demand a VCO who is a creative thinker who can readily adapt to ever-changing research missions, equipment, technology and methodology advances, and evolving standards, policies, rules, and regulations.

In addition to abiding by all international, federal, state, and local laws, rules, and regulations governing the use of animals in RDT&E and training, DoD institutes must also adhere to the DoD’s own instructions and regulations, which are often even more stringent. The military LAM veterinarian must be well versed in all of these regulatory requirements (including foreign regulations for work conducted overseas) and must ensure that programs attain and maintain AALAC accreditation.

Whether LAM veterinarians are assigned to a large specialized research institute such as USAMRIID or to a smaller DCI at a military medical center, military LAM officers must be the primary subject matter experts who assist scientific and clinical investigators with writing research or training protocols, supporting these investigators in the conduct of animal use studies. Similarly, LAM veterinarians are also best suited to assist units utilizing animal models to conduct CTT for deployable medical personnel because of the LAM veterinarians’ knowledge of the many rules and regulations required for animal care and use and their extensive experience with a wide variety of animal care and use programs.

As the standards of animal care progress, and as animal rights groups continue to pressure the DoD and others to discontinue using animals for various endeavors, military LAM veterinarians play a critical role to ensure that all DoD RDT&E and training activities involving animals are conducted in accordance with all pertinent rules, regulations, and industry standards; that animal alternatives are considered and incorporated where appropriate; that proper justification exists for the animal use; and that animals are cared for to the highest possible ethical and humane standards.

REFERENCES

1.   US Department of Defense. The Use of Animals in DoD Programs. Washington, DC: DoD; 2010. DoD Instruction 3216.01.

2.   Assistant Secretary of Defense for Research and Engineering. Department of Defense Animal Care and Use Programs: Fiscal Years 2006-2007. http://www.dtic.mil/biosys/docs/au-fy06_07_report.pdf. Accessed April 9, 2013.

3.   Martinic, G. Military live tissue trauma training using animals in the US – its purpose, importance and commentary on military medical research and the debate on use of animals in military training. Journal of Military and Veterans’ Health. 2012; Vol 20, No 4. http://jmvh.org/article/military-live-tissue-trauma-training-using-animals-in-the-us-its-purpose-importance-and-commentary-on-military-medcal-research-and-the-debate-on-use-of-animals-in-military-training. Accessed August 2, 2016.

4.   Baily, M. There’s a good reason military medics train on live animals and NOT dummies. Business Insider. February 7, 2013. http://www.businessinsider.com/theres-a-good-reason-field-medics-train-on-live-animals-and-not-dummies-2013. Accessed August 2, 2016.

5.   Carroll, C. Pentagon insists live animal testing saves lives. Stars and Stripes. August 20, 2013. http://www.military.com/daily-news/2013/04/20/pentagon-insists-live-animal-testing-saves-lives.html. Accessed August 2, 2016.

6.   Institute of Laboratory Animal Resources. National Research Council, National Academy of Sciences. Guide for the Care and Use of Laboratory Animals. 8th ed. Washington, DC: National Academy Press; 2011.

7.   Federations of Animal Science Societies. Guide for the Care and use of Agricultural Animals in Research and Teaching. 3rd ed. Champaign, IL: FASS; 2010.

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Chapter 15

VETERINARY PATHOLOGY

ERIC DESOMBRE LOMBARDINI, VMD, MSC, DACVPM, DACVP*; SHANNON HAROLD LACY, DVM, DACVPM, DACVP†; TODD MICHAEL BELL, DVM, DACVP‡; JENNIFER LYNN CHAPMAN, DVM, DACVP§; DARRON A. ALVES, DVM, DACVP¥; AND JAMES SCOTT ESTEP, DVM, DACVP¶

INTRODUCTION

DIAGNOSTICS

BIODEFENSE AND BIOMEDICAL RESEARCH

CHEMICAL DEFENSE

RADIATION DEFENSE

COMBAT CASUALTY CARE

FIELD OPERATIONS

SUMMARY

*Lieutenant Colonel, Veterinary Corps, US Army, Chief, Divisions of Comparative Pathology and Veterinary Medical Research, Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok 10400, Thailand

†Major (P), Veterinary Corps, US Army, Chief, Education Operations, Joint Pathology Center, 2460 Linden Lane, Building 161, Room 102, Silver Spring, Maryland 20910

‡Major (P), Veterinary Corps, US Army, Biodefense Research Pathologist, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Room 901B, Frederick, Maryland 21702

§Lieutenant Colonel, Veterinary Corps, US Army, Director, Overseas Operations, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Room 1W43, Silver Spring, Maryland 20910

¥Lieutenant Colonel, Veterinary Corps, US Army, Chief, Operations, US Army Office of the Surgeon General, 7700 Arlington Boulevard, Arlington, Virginia 22042

¶Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Chief of Comparative Pathology, Triservice Research Laboratory, US Army Institute of Surgical Research, 1210 Stanley Road, Joint Base San Antonio-Fort Sam Houston, Texas 78234

INTRODUCTION

“Taceant colloquia. Effugiat risus. Hic locus est ubi mors gaudet succurrere vitae.”

“Let idle talk be silenced. Let laughter flee. This place is where Death delights in succoring life.”)

—Anonymous Latin quotation often attributed to Giovanni Battista Morgagni1(p126)

During the 18th century (the Age of Enlightenment), medicine and the study of disease underwent extraordinary changes. Previously entrenched beliefs in imbalances and inconsistencies in the body’s “humors” as the cause of disease shifted to a more scientific, rational system of pathogenesis as the true source of health-related maladies. Giovanni Battista Morgagni, considered by some to be the father of anatomical pathology,[2] was among the pioneers of this change in thinking, and it was through his study of disease that the foundation of the veterinarian’s work, with the delicate interplay of diagnoses, prognoses, and treatment of illness, became irrevocably interwoven with a thorough and consummate understanding of the origin, nature, and course of disease. His early work also helped pave the way for others such as John Hunter, Claude Bourgelat, and Rudolph Virchow, to expand and ingrain the critical study of disease pathogenesis into the medical community.[3]

Hunter is known as the founder of pathological anatomy in England; Virchow as being the German physician who advanced public health; and Bourgelat as the French veterinary surgeon who advocated veterinary colleges in Lyon, France.

Because of Bourgelat’s persistence, the first internationally recognized school of veterinary medicine was established by King Louis XV in Lyon, France, in 1761.[4] The school emerged as an extension of the Lyon Academy of Horsemanship, with the inherent mission of producing an educated group of individuals capable of giving proper medical care to the horses of both the military and the gentry. Implicit in this mission was eradicating the rinderpest virus, a highly virulent morbillivirus known as the cattle plague or steppe murrain. Centuries later, in 2011, this virus became only the second disease in human history to be eradicated.[5]

During the 18th and early 19th centuries, American veterinary students studied in Europe or underwent coursework in institutions on the East Coast; almost 100 years passed from the founding of the school in Lyon to the establishment of the first American veterinary school. In 1852 the Veterinary College of Philadelphia was created, followed by the Boston Veterinary Institute (1854) and the New York College of Veterinary Surgeons (1857).6,7 Although veterinarians were well-established within the European militaries, the US Army did not establish regulation specific to veterinary medicine until 1835 and only began appointing veterinary surgeon graduates from accredited institutions in 1879.[7] Despite the late start of the US Army Veterinary Corps (VC) in comparison with its European counterparts, the VC’s contributions to military medicine, in general, and to pathology, in particular, have made up for lost time. (For more information about the VC’s contributions to military medicine throughout history, see also Chapter 1, Military Veterinary Support Before and After 1916.)

The current US Army military veterinary pathologists (area of concentration 64 D or “64 Delta”) are a diverse group of officers who contribute to the overall health and well-being of US service members. Their support of and integration into military medical research remains critical to the continued production of medical countermeasures such as vaccines, therapeutics, and medical devices to combat various disease and nonbattle injuries. Military veterinary pathologists are also in the first line of defense in diagnosing both veterinary-specific and zoonotic (ie, affecting both human and animal) diseases that could represent a threat not only to deployed forces, but also to the US population.

In 1980, the US Army Veterinary Services began providing all veterinary-related functions for every aspect of veterinary support for all military branches. The military veterinary pathology specialty has become refined over time and across continents into a small but extremely effective force multiplier within the VC. The “64 Deltas” train their own members through a residency program; support medical research in the development of chemical, biological, radiological, and nuclear (CBRN) medical countermeasures; sustain the military working animal mission through diagnostic assays; and deploy with the service members of all DoD services in various diagnostic support roles. This chapter will discuss the diverse roles of the veterinary pathologist within the US military of the past, present, and future.

DIAGNOSTICS

Definitions and Scope of Diagnostics in Veterinary Pathology

Pathology is the study of disease. As a medical specialty, pathology can be conceptually classified under various rubrics; for instance, pathology may be classified based on an organ system (eg, ocular, pulmonary, or neuropathology); or on groups of etiologies (eg, toxicologic or environmental pathology); or even by the species studied: medical pathologists study human disease, whereas veterinary pathologists generally study nonhuman, animal disease. But because they study diseases that affect all animal species, including humans, most military veterinary pathologists are traditionally considered comparative pathologists.

Functionally, pathology can be classified based on the nature of work supported. Examples include experimental, clinical, general, and diagnostic pathology. Diagnostic pathology is the study of tissue abnormalities at the gross (ie, macroscopic), histologic (ie, microscopic), ultrastructural, and molecular levels, in order to identify the nature of disease, and thereby make a diagnosis.[8] What follows is a brief history of diagnostic veterinary pathology in the US military, punctuated by selected achievements and contributions to the science as a whole; subsequent sections of this chapter address other functional areas of military veterinary pathology. The two overarching themes of this section are (1) that diagnostic pathology forms a cornerstone for both the education and practice of military veterinary pathology and (2) that military accomplishments in diagnostic pathology have not only contributed to the greater body of biomedical knowledge, but have also shaped the specialty of veterinary pathology as it is now organized in North America.

Diagnostic pathology was the primary professional forte of the specialty’s early pioneers; their efforts were driven by an urgent need to understand the pathogenesis and, thereby, the treatment and prevention of diseases affecting the livestock that society and the military depended on. The US military led the early evolution of veterinary pathology in the United States; the development of US veterinary pathology is, therefore, inextricably linked to that of military veterinary pathology.

Expertise in diagnostics is also an indispensable attribute of today’s US Army veterinary pathologists, regardless of duty assignment. Army veterinary pathologists provide diagnostic pathology support for all military working animals, including dogs in the DoD and other federal agencies; caisson and ceremonial horses; and marine mammals such as dolphins and California sea lions used by the Navy for search and recovery missions. Additionally, through the DoD Veterinary Pathology Residency (DODVPR), the postgraduate training program through which nearly all Army veterinary pathologists since 1983 have been trained in their specialty, Army veterinary pathologists provide diagnostic support for research animals within the DoD and other federal agencies, pets owned by eligible military service members, and second-opinion cases referred by civilian and military veterinary pathologists worldwide.

Moreover, the American College of Veterinary Pathologists’ (ACVP) board-certifying examination emphasizes diagnostic expertise. Since certification is among the major goals of residents in the DODVPR and a requirement for continued specialization in the area of concentration 64D, diagnostic proficiency ultimately forms a foundation for the practice of military veterinary medicine and for more specialized work in the comparative and experimental research arenas.

Historical Background of Diagnostics and Early Contributions to Veterinary Pathology

US military work in veterinary pathology began with a spotlight on diagnostics at the Army Medical Museum (AMM), a center established during the Civil War specifically for the collection of specimens for research in military medicine and surgery. Officially, veterinary activities at the AMM (redesignated the Army Institute of Pathology AIP in 1946 and redesignated again in 1949 as the Armed Forces Institute of Pathology AFIP to recognize its status as a triservice organization[9]) did not begin until 1943, when Major Charles Louis Davis became the first veterinary pathologist assigned to the AMM.[10] However, research in veterinary pathology at the AMM actually began much earlier: almost immediately after its organization by the Army surgeon general, Brigadier General William Hammond, in May 1862. By 1867, just 5 years after its founding, the AMM inventory already included specimens from a variety of animal species.[2] By 1876, the AMM’s comparative anatomical section listed 1,522 specimens.[9]

The first person in the United States to conduct veterinary pathology research was the physician Joseph J. Woodward. Woodward volunteered for military service at the onset of the Civil War, was commissioned in the US Army Medical Department (AMEDD) in 1861, and was assigned by Surgeon General Hammond as the first medical pathologist at the new AMM in 1862.[11] During the 1860s, a devastating epizootic of contagious pleuropneumonia of cattle prompted the US Commissioner of Agriculture to engage visiting professor John Gamgee, of Edinburgh, as a consultant to study the disease. Gamgee submitted tissues from affected animals to Woodward at the AMM, where Woodward performed the first histological study of the disease and submitted his report, complete with photomicrographs, to the US Commissioner of Agriculture in 1870. Woodward’s report on bovine pleuropneumonia is considered to be the first scientific contribution to veterinary pathology in the United States.[11]

Woodward later published a comparative report on the erythrocytes of humans and various mammals, particularly noting similarities with those of the dog. He went on to achieve recognition as a photomicrographer, bibliographer, and pathologist. In fact, he is the only pathologist to have participated in the autopsy of two American presidents (Abraham Lincoln and John Garfield), and his acclaimed Medical and Surgical History of the War of the Rebellion, praised by Rudolph Virchow, “the father of modern pathology,” is considered by some to be the most important contribution ever made to military medicine.[11]

Figure 15-1: Dr Thomas Carlyle (TC) Jones.
Photograph courtesy of the National Museum of Health and Medicine archives.

In the years following Woodward’s report on bovine pleuropneumonia, medical pathologists became more curious about the veterinary pathologists assigned to the AMM. However, it was not until 1943 that veterinary pathology became an official capability of the AMM. Colonel James Earle Ash, Medical Corps, US Army, served two terms as curator (the title was changed to director with the AMM’s name change to the AIP in 1946) of the AMM, from 1929 to 1931 and 1936 to 1946.[12] During the second of these terms, Ash mentored and supported a young Thomas Carlyle (TC) Jones (Figure 15-1), who was stationed as a veterinary officer at the Army Veterinary Research Laboratory in Front Royal, Virginia, conducting research on equine diseases of importance to the military at war.

Jones was particularly interested in equine ocular pathology and visited the AMM frequently to consult with the medical pathologists assigned there. Ash, a medical doctor who attributed his own favorable disposition toward veterinary medicine partly to his marriage to the daughter of a prominent veterinary professor at Cornell University,[13] collaborated with Jones, and the two coauthored a seminal paper on the histopathology of equine periodic ophthalmia (ie, equine recurrent uveitis).[12] Jones later wrote an editorial to honor Colonel Ash on his 100th birthday,[13] in which Jones emphasized the unique collaborative culture at the AMM. At that time, medical and veterinary pathologists were segregated as a matter of course; yet, at the AMM, Jones found a welcoming group of devoted professionals eager to share their expertise with the young veterinarian.

By the early 1940s, the AMM already housed several special pathology registries (ie, collections of histologic slides defining diseases with associated case descriptions) supported by various medical specialty societies. Jones proposed to Ash the establishment of a registry for veterinary pathology, an idea Ash had already envisioned. In 1943, with the support of the preeminent veterinary pathologist in the country at that time, William H. Feldman of the Mayo Foundation, Ash gained the backing of the American Veterinary Medical Association and the Army surgeon general to found the Registry of Veterinary Pathology at the AMM. In doing so, Ash officially made a place for veterinary pathology in the world’s largest, most productive pathology institute, setting the stage for Jones’ formal establishment of the specialty of veterinary pathology in North America.[13]

At the Registry’s helm during these groundbreaking events was the previously mentioned Major Charles Louis Davis, an Army reservist and pathologist with the US Bureau of Animal Industry, who had been called onto active duty during World War II and served as the first registrar from 1943 to 1945. At the close of the war, Davis was demobilized and succeeded as registrar by Major TC Jones.[12] The written transcript of Jones’ interview by Charles S. Kennedy (AFIP Oral History Program, Atlanta, Georgia, March 17, 1992) reveals that by the time Jones reported to the AIP in 1946, there were already 10,000 to 20,000 cases in the fledgling registry, thanks to Davis’ efforts.[14] Davis was later elected a charter member and fifth president of the ACVP.[10] Today, the nonprofit Charles Louis Davis DVM Foundation for the Advancement of Veterinary and Comparative Pathology supports veterinary and comparative pathology internationally through a variety of educational outreach programs.

Taking over after Davis, Jones continued to nurture the Registry of Veterinary Pathology as it grew into a robust collection. He personally contributed equine specimens from the research laboratory in Front Royal, where he was previously assigned, and began to add material from war dog centers, such as those at Front Royal and Ft Robinson near Crawford, Nebraska. He further expanded the Registry by offering diagnostic consultation to civilian veterinarians and veterinary pathologists in exchange for submitted specimens, beginning a tradition of symbiosis with the veterinary community at large that became a mainstay of the program for generations. In his AFIP interview, Jones recounted the fervor among medical pathologists for comparative pathology during the mid-1940s, around the time he arrived as the Registry of Veterinary Pathology’s second registrar. He quipped, “It wasn’t my charm or anything of the kind. The reason that my colleagues, the [medical] pathologists, were interested in the material that I showed them was that it gave them fresh ideas….”14(p7)

The collaboration between veterinary and medical pathologists at the AIP soon became evident in the scientific literature, where medical advances that resulted directly from this new cooperation were published. For example, in those days, pathologists from medical schools throughout the United States came to the AIP as consultants. One such pathologist, Henry Pinkerton, reported on the similarities between the microscopic lesions of human measles and canine distemper.[15] From this early observation, scientists later discovered that the diseases are caused by two closely related morbilliviruses.

Another important contribution made in comparative pathology at the AIP during this period was the discovery by ocular pathologist Helenor Campbell Wilder Forester of ocular larval migration of Toxocara canis nematodes in the eyes of human infants. At a staff conference, Wilder presented granulomas in the eyes of infants who had been enucleated in response to a clinical suspicion of having retinoblastoma, a form of ocular cancer. Jones noted the lesions’ striking resemblance to canine ocular granulomas caused by nematode larval migration,[14] prompting Wilder to reevaluate her specimens, ultimately leading to her discovery of the larval form of Toxocara canis in these eyes. Consequently, effective therapeutic and public health preventive measures were employed to combat the blinding disease.[16] In his biography of James Earle Ash, Leon Saunders summarized the unique collaborative culture of the AIP in the early years after veterinary pathology was formally added to the Institute: “In no other institution in the world did veterinary pathologists have the opportunity to work in such close contact with so many human pathologists….[I]n no other institution were the daily activities (of diagnosis, research and teaching) such a patent validation of Virchow’s concept that ‘there is only one medicine.’”12(p446)

Although Ash, Davis, and Jones all helped shape the Registry of Veterinary Pathology, TC Jones is credited with the establishment of veterinary pathology as an organized specialty in North America.[12] Born in 1912 in Boise, Idaho, Jones was heavily influenced in his interest in animals by years spent living and working on a nearby dairy farm owned by family friends. He received his DVM degree at Washington State College in 1935. During veterinary school, he worked under Hilton A. Smith in the pathology department, where Jones developed an interest in pathology and an awareness of the VC. Because he was without direct connection to the Army, Jones wrote a letter expressing his interest in joining the VC to (then) Lieutenant Colonel Raymond Kelser, who had authored a veterinary textbook that Jones used and liked. Buoyed by Kelser’s response, Jones sat for the highly competitive VC examination at Ft Douglas, Salt Lake City, Utah, and accepted a commission on October 1, 1935. (Kelser was eventually promoted to the rank of brigadier general and served as the VC chief from 1938 to 1946.)[14]

Recognition of veterinary pathology as an organized specialty in North America began with Jones’ observation of young medical officers fervently studying at the AIP for their board-certifying examinations. Admiring their diligence, Jones envisioned the potential such a stimulus might provide towards advancing the field of veterinary pathology. Again supported by fellow pioneer William H Feldman, who by now was a consultant to the AIP, Jones gained the American Veterinary Medical Association’s approval for the establishment of its first specialty group, the American College of Veterinary Pathologists (ACVP). The ACVP was born in a Chicago hotel room, where 15 pathologists, including Jones and Davis, met in 1948. Among the ACVP’s 42 charter members were Jones (secretary-treasurer), Davis, Feldman (president), and Smith.[17] From these humble beginnings grew today’s ACVP, which now encompasses some 1,400 active members and 140 emeritus members.[18]

Jones remained at the AFIP until 1950, when he was reassigned to West Germany; while stationed there, he became the first American elected to West Germany’s veterinary pathology association and promoted the veterinary pathology activities of the AFIP, even publishing a German article on the topic.[12] He returned as chair of the Veterinary Division at the AFIP from 1953 to 1957, during which time he established the AFIP’s first course on laboratory animal diseases, which was used for many years as an educational program for pathologists and laboratory animal veterinarians. The course remains a staple in veterinary pathology training and is now run by the Charles Louis Davis DVM Foundation for the Advancement of Veterinary and Comparative Pathology. Also, during his chairmanship, Jones co-authored the classic text Veterinary Necropsy Procedures, published in 1954, and began writing what would become the definitive textbook for veterinary pathology education, Veterinary Pathology, coauthored with Smith and first published in 1957.[12]

Lieutenant Colonel Jones retired from the Army in 1957, launching a second career that included distinguished service at Angell Memorial Hospital in New York, New York, and Harvard University in Cambridge, Massachusetts. Among his other lasting contributions to the specialty were co-writing authoritative texts on laboratory animal pathology, writing six editions of his Veterinary Pathology text (the last of which was published in 1996) and serving a term as president of the US and Canadian Division of the International Academy of Pathology.12,19

Evolution of the Department of Defense Veterinary Pathology Residency Program

Jones also merits recognition for initiating what would evolve into a rigorous postgraduate training program in veterinary pathology (DODVPR). During his first assignment at the AIP, Jones started a training program in which veterinarians could both learn pathology and obtain a graduate degree from George Washington University; the first graduate of the program, Andrew W. Monlux, earned his doctorate in comparative pathology.[12]

In the Report of the Committee on Registry of Veterinary Pathology for 1946, an internal account written annually for the AIP (and later, the AFIP), committee members recognized both the tremendous educational value of the Registry that Jones nurtured and the unique opportunity afforded by the AIP’s learning environment and advanced specialized training: “…[T]o best serve the veterinary profession, the Registry should be in a position to supply deficiencies in the teaching collections of the respective veterinary colleges and to provide facilities for graduate training in pathology….The [AIP] offers opportunities for this training to a degree found nowhere else. It is exceedingly important that the Registry of Veterinary Pathology have at all times a graduate student assigned for a year’s training in this unusually fine institution.”20(pp1–2) Although the original program lapsed during Jones’ tour in West Germany, Jones revived the residency for veterinary officers in the Army and Air Force when he returned in 1953 as chair of the Veterinary Division.[12]

By 1960’s Annual Report, the training program, hosting seven duty and resident officers working toward qualification for certification by the ACVP, was a 2-year residency consisting of “supervised casework, daily slide conferences, a minimum of three seminars a week, gross necropsies, numerous short courses available at the AFIP,” and integration into ongoing research projects at the Institute.21(p3) As the demand for veterinary pathologists in military medical research and diagnostic medicine increased, a preceptorship was developed in 1967 to train veterinary pathologists at various military research sites, of which the AFIP was just one. By the 1980s, however, leaders in military veterinary pathology advocated for the consolidation of all veterinary pathology training into a single 3-year residency program; as a result, The Army Surgeon General Lieutenant General Berhnard Mittemeyer established the DODVPR at the AFIP in October 1983. From then on, nearly all military veterinary pathologists were trained through the 3-year DODVPR, which soon gained worldwide recognition as one of the largest and most effective programs of its kind.

The AFIP was closed in 2011 as the result of the Congressionally directed 2005 Base Realignment and Closure law. However, as a testament to its value as the main provider of ACVP board-eligible military veterinary pathologists to support and conduct biomedical research and diagnostics for the DoD, the DODVPR was preserved and aligned under the Joint Pathology Center (JPC). Established by the 2008 National Defense Authorization Act to serve as the federal government’s pathology reference center providing diagnostic consultation, education, and research services to other federal agencies, the JPC assumed many of the core missions of its predecessor, the AFIP, including oversight of the DODVPR, which in June 2011 relocated from the AFIP in Washington, DC, to the JPC’s Forest Glen Annex in Silver Spring, Maryland.

At the JPC, residents are afforded the opportunity to study in consultation with international medical subspecialty pathologists. Upon successful completion of the program, participants are eligible for board examination by the ACVP and are assigned as biomedical research pathologists supporting or conducting DoD biomedical research as diagnostic pathologists or as staff members responsible for training new residents in the DODVPR.

New residents are competitively selected VC officers who apply through the Army’s Long-term Health Education and Training program. Usually four new residents are assigned each year, for a total of 12 residents in training at any given time. Before entering the program, residents have typically completed two assignments, including at least one overseas or operational tour and approximately 5 years of service in the VC.

The DODVPR’s current structure resembles the earlier curriculum in many ways: at a minimum, the program consists of supervised casework; daily case “rounds” in which residents present and discuss diagnostic cases with staff pathologists; twice weekly seminars in systemic pathology; weekly seminars in gross, clinical, and general pathology; a weekly international histopathology slide conference (ie, the Wednesday slide conference or WSC discussed later in this chapter); textbook and journal reviews; an oral case presentation at the Northeast Veterinary Pathology Conference; a poster presentation at the ACVP conference; attendance at several pathology courses offered by the Charles Louis Davis DVM Foundation for the Advancement of Veterinary and Comparative Pathology; and participation in external rotations at the Smithsonian National Zoological Park, National Institutes of Health, Frederick Animal Health Diagnostic Laboratory, and University of Minnesota Veterinary Diagnostic Laboratory. Seven ACVP diplomates (ie, board-certified pathologists), two civilian and five military veterinary pathologists, lead this training.

Throughout its existence, the DODVPR has contributed to the veterinary pathology specialty both by training residents and by freely sharing its template for educational success with the broader veterinary pathology community, including the diverse array of specimens available in its Registry of Veterinary Pathology. These core training materials are reviewed methodically by incoming residents over the course of their residencies and are eventually organized by body system, a model which has proven highly effective in preparing candidates for the ACVP examination. Today, thanks to a 2002 US Department of Education grant, this material is also available on the Internet as Veterinary Systemic Pathology Online.[22]

The WSC also illustrates the symbiosis between the DODVPR and the broader veterinary pathology community. The conference dates to 1953; today, it consists of 25 conferences per year, each comprising four cases.

Cases for the WSC are contributed by veterinary pathologists in roughly 140 veterinary diagnostic and research institutes worldwide, representing academia, industry, zoological parks, and state and national governments and their agencies. Cases encompass a wide variety of classic, rare, and recently published diseases for which microscopic or ultrastructural diagnoses are achievable. Residents receive and evaluate the cases as unknowns and develop histological descriptions and diagnoses independently in preparation for the weekly conference.

Each conference is led by an invited moderator, including military and civilian veterinary pathologists, many of whom are experts in their fields; most moderators also provide additional educational seminars for residents and staff when visiting. Because residents are selected at random during the conference to present their findings, interpretations, and diagnoses, under the scrutiny of the moderator and staff, the conference provides a valuable tool for developing the diagnostic and interpretive skills and descriptive techniques vital to the practice of veterinary pathology and success on the ACVP-certifying examination.

Each year, the conference is coordinated by a second-year resident who collects, selects, and redistributes cases; invites and schedules moderators; and compiles and publishes the conference proceedings. Following traditions that began in the early years of recruiting cases to grow the Registry of Veterinary Pathology, the WSC embodies a close, cooperative, mutually beneficial relationship between the DODVPR and the veterinary pathology community at large. In exchange for submitting cases, participating institutions receive glass or digital slides for all 100 selected cases and the conference proceedings compiled at the conclusion of the training year; these, in turn, become training materials in the libraries of veterinary pathology training sites worldwide. Conference proceedings dating back to 1964 are freely accessible online, along with virtual slides for all conferences since 2007, essentially offering anyone in the world with Internet access the opportunity to replicate the experience of participating in and learning from the WSC.[23]

Several more examples illustrate the strong collaboration between the DODVPR and the veterinary pathology community. In exchange for the opportunity for DODVPR residents to perform necropsies on a variety of species at the Smithsonian National Zoological Park, the civilian residents studying at the zoo are invited to participate in all training curriculum at the DODVPR. Similarly, beginning in 2009, the DODVPR began sending second-year residents for a 2-week rotation at the University of Minnesota Veterinary Diagnostic Laboratory to conduct necropsies in an academic setting; in return, residents from the University of Minnesota visit the DODVPR near the completion of their training program in preparation for the ACVP-certifying examination. Also, veterinary pathology residents and veterinary students from around the world visit the DODVPR to personally use the extensive training materials available for study.

Selected Military Achievements in Diagnostic Veterinary Pathology

The selected achievements listed in this section of the chapter provide only a few examples from military veterinary pathology accomplishments, particularly as related to the care of military working animals. Military veterinary pathologists have provided diagnostic support to the military working dog (MWD) since the inception of the Registry of Veterinary Pathology, when TC Jones furnished diagnoses on cases submitted from war dog centers in exchange for submitted case material to the Registry.[14] By the early 1960s, the AFIP, recognizing the value in consolidating MWD case submissions in one place for study, recommended to the armed services that all surgical and necropsy material from military sentry and scout dogs be submitted directly to the AFIP; by 1966, such action was mandated.[24]

As the Registry of Veterinary Pathology became a viable source of case material representing diseases of MWDs, veterinary pathologists at the AFIP were able to diagnose and report on diseases of importance to the MWD population as a whole. For instance, military veterinary pathologists published papers on the pathology and pathogenesis of tropical canine pancytopenia (ie, canine ehrlichiosis) in the early 1970s after its diagnosis in MWDs deployed during the Vietnam War.25–27 Most of the approximately 1,600 American MWDs that served in Vietnam were transferred to the Vietnamese or euthanized, the result of Army policies aimed at eliminating the threat of transmission of the disease, endemic in Vietnam, back to the United States.[28]

In 1978, during his third year of residency at the AFIP, another military veterinarian, Dr John Pletcher, diagnosed the first case of Chagas disease in an MWD in the United States.[29] While reviewing histopathology slides on an MWD necropsy case submitted from the dog center at Lackland Air Force Base in San Antonio, Texas, he spotted the tell-tale microscopic pseudocyst of Trypanosoma cruzi in the heart. Pletcher and collaborating clinicians assigned at the dog center determined that MWDs contracted the fatal disease by ingesting the vectors, triatomine bugs of the Reduviidae family, which dropped into their kennels after being zapped in the overhead lights; most affected dogs had oral mucosal lesions, a direct portal of entry for the protozoa to establish infection.

Pletcher also diagnosed an early case of canine parvoviral enteritis. At that time, canine parvovirus was just emerging in the United States, so when he observed intestinal lesions typical of feline panleukopenia (also caused by a parvovirus) in the intestines of submitted puppies, he first assumed that the consultation request form had been mislabeled and that he was actually looking at tissues from kittens. His eventual diagnosis confirming that the lesions came from puppy intestines soon led to one of the first scientific publications on the histopathology of canine parvoviral enteritis.[30] In time, the growing collection of surgical and autopsy specimens from MWDs at the AFIP allowed pathologists, epidemiologists, and clinicians from the AFIP and the DoD MWD Veterinary Service at Lackland Air Force Base to study and report on the lifetime occurrence of neoplasia and the causes of death, discharge from service, and euthanasia within large cohorts of MWDs.28,31,32

The Registry, as a concentrated source of MWD diagnostic case material, proved not only useful in studying MWD disease for the sake of MWD health and program management, but also as a source of information that could be extrapolated to the human veterans who accompanied MWDs on their deployments worldwide. Because MWDs and their American handlers shared similar physiologies and environmental exposures, MWDs became regarded as valuable sentinels for human disease.

One example that illustrates how MWDs can serve as sentinels of human disease is found in studies of MWDs that served in Vietnam. The observed increased risk of both seminoma (a type of testicular neoplasm) and testicular dysfunction in MWDs that served in Vietnam corroborated evidence of decreased sperm quality in human veterans who served in Vietnam (ie, “unexplained” and “significant” decreases in sperm quality were observed in human studies conducted by the Centers for Disease Control and Prevention or CDC).33(p1042) This correlation further suggested that testicular neoplasia should be studied as a potential experience-related cancer in veterans.[33]

In another example, veterinary pathologists at the AFIP studied lesions in deployed and nondeployed MWDs to get a better understanding of “Gulf War Syndrome” in veterans who served in the 1991 Persian Gulf War. However, this study found no significant difference in relative risk of neoplastic disease, neurologic mortality, or peripheral nerve disease associated with deployment to Southwest Asia in that war.34,35

Like their canine counterparts, marine mammals play vital roles as military working animals and receive diagnostic pathology support through Army veterinary pathology channels. (See also Chapter 7, Marine Mammal Program.) Military veterinary pathologists have made several key contributions to the body of knowledge of marine mammal pathology. For example, military veterinary pathologists studied and reported extensively on dolphin morbillivirus, considered the most important infectious disease of dolphins, responsible for at least two major epizootics resulting in large die-offs in US waters and, thereby, of significance to the Navy dolphin program.36–40 Lieutenant Colonel (Retired) Thomas P. Lipscomb (written communication, 2012), who studied the disease extensively during his years in the AFIP Department of Veterinary Pathology, enlisted the assistance of Jeffrey K. Taubenberger, Chief of AFIP’s Department of Molecular Pathology, to develop a polymerase chain reaction assay for morbillivirus to facilitate his studies of the dolphin epizootics.

Years later, Taubenberger and his team successfully sequenced the genetic code to the 1918 Spanish influenza, the influenza virus that killed over 50 million people worldwide in less than one year. The team used a specimen in the National Tissue Repository from a 21-year-old private who died in 1918 after being infected,[41] and Taubenberger later remarked that his experience using polymerase chain reaction to detect and sequence viruses from highly degraded dolphin specimens had proven very useful in the influenza study.

Other sea mammal and wildlife studies have also broadened the knowledge base of veterinary pathology. Lipscomb and colleagues at the AFIP characterized the pathology of genital carcinoma, a major disease of California sea lions and discovered a previously unknown gammaherpesvirus associated with the disease.[42] In the aftermath of the 1989 Exxon Valdez oil spill in Prince William Sound, Alaska, veterinary pathologists from the AFIP rotated through Seward, Alaska, at intervals to study the effects of the oil spill on coastal wildlife.[43] Their work was not only vital to the US Fish and Wildlife Department’s investigation, but also resulted in the discovery of a novel herpesvirus infection in northern sea otters.[44]

Diagnostic achievements by military veterinary pathologists are often measured by the number of scientific publications they produced, but these pathologists have also produced other substantial written contributions to the profession. For instance, the AFIP, under the auspices of the American Registry of Pathology, published the series of fascicles that make up the World Health Organization International Classification of Tumors of Domestic Animals, a reference standard for neoplastic diagnoses in veterinary pathology. Leon Z. Saunders, who was assigned to the AFIP as a veterinary officer in the US Air Force Reserve from 1954 to 1964, authored the exhaustive historical text on veterinary pathology, A Biographical History of Veterinary Pathology.[12]

Figure 15-2: Pathology of Laboratory Animals course participants, 1957.
Photograph courtesy of the National Museum of Health and Medicine archives.

Also among the prolific written contributions to the specialty are the works of the late Colonel Floris M. Garner, head of the Department of Veterinary Pathology from 1964 to 1972. Garner, who led a platoon in the Normandy Campaign of World War II in 1944 and received a Purple Heart after being severely wounded by mortar fire in Conde’-sur-Vire, earned his DVM degree in 1950 from Washington State College.[45] He began residency training at the AFIP in 1958 under the tutelage of Charlie N. Barron, who is recognized for his work as an ACVP president and Veterinary Pathology journal editor.[46] Garner oversaw the training of some 40 residents, directed the Pathology of Laboratory Animals course (Figure 15-2), coordinated the activities of the World Health Organization’s International Reference Center for Comparative Oncology, and served as president of the Washington, DC, Veterinary Medical Association. He later also served as president of the ACVP. Besides publishing some 90 scientific papers and various book chapters, he edited two textbooks, including the two-volume Pathology of Laboratory Animals.[45]

Projected Future of the 64D

The diagnostic contributions of 64Ds will continue to impact not only the veterinary pathology community, but also the military medical community at large. For example, the National Tissue Repository, now in the custody of the JPC, is the largest of its kind in the world, with over 7.4 million cases, including some 32 million tissue samples and 55 million glass histopathology slides, dating back to 1917. Branded a “national treasure” by researchers worldwide, the repository contains approximately 100,000 veterinary cases, including those submitted to the Registry of Veterinary Pathology throughout its existence, making it a valuable collection for retrospective study.[47]

Expertise in diagnostics will remain a strength of 64Ds for the predictable future for several other reasons. Diagnostics are important to the work conducted in the DODVPR, the standard and virtually the sole means by which today’s 64Ds are generated. Following this residency, Army veterinary pathologists on staff at the JPC use diagnostic proficiency to mentor and develop other residents in training. The JPC staff also provides important diagnostic services for government-owned and privately owned animals and for second-opinion diagnostic cases from civilian and military veterinary pathologists worldwide, in exchange for case material on which to train residents.

Moreover, the veterinary pathologist assigned to the veterinary laboratory in Landstuhl, Germany, is responsible not only for direct diagnostic support to MWDs and privately owned pets throughout the European Command (EUCOM) and Central Command (CENTCOM) areas of responsibility, but also supports the key mission of rabies diagnostics for CENTCOM, providing a critical link to public health. Even the 64Ds assigned to research institutions (ie, the vast majority of the area of concentration) must rely on their strength in diagnostic pathology to support the colony health of their research animals and effectively sustain and conduct research.

BIODEFENSE AND BIOMEDICAL RESEARCH

Definitions and Scope of Biodefense and Biomedical Research in Veterinary Pathology

A zoonotic disease is defined as an illness caused by an etiological agent capable of moving between species and is typically used to describe infection from a veterinary species to a human. Transmission from humans to animals is occasionally called reverse zoonosis or anthroponosis. In an evaluation of over 1,400 entities known to cause human disease, 61% were considered to be zoonotic.[48] Furthermore, the majority of pathogens that have been weaponized as potential terrorist biowarfare agents are classified as zoonoses, making them as much the domain of the veterinarian as of the medical community. Critically, many of these agents are common within veterinary species, or are at least studied intensively in the veterinarian’s training, while the same disease, although virulent in humans, may have only received a cursory treatment in a medical doctor’s training due to the rarity of infection.

At present, 47 diseases considered foreign to the United States are listed in the US Animal Health Association’s foreign animal disease compendium, known as “The Gray Book.” Many of these diseases are considered zoonotic, and at least four are listed as potential biological weapon agents.[49] (See also Chapter 11, Zoonotic and Animal Diseases of Military Importance.)

The concept of biodefense in protecting the United States against such diseases and agents is multifaceted. A terrorist attack on US domestic soil with a foreign animal disease could be as obvious as a detonated explosive device or be as dangerous as the covert introduction of foot and mouth disease into cattle populations at one of the many feedlots that dot the Midwest’s rural landscape. The former would have a known and horrific, though limited, effect. The latter could potentially spread more insidiously, yet have an economic impact magnitudes greater than that of the local effects of a bomb. This kind of bioterrorist or agroterrorist attack would not only affect every American who eats food, but could also cost billions of dollars to halt or control.

Histopathology, reinforced by laboratory techniques that allow for more specific identification of a viral or bacterial agent, often remains the “gold standard” for rapid diagnostics of any animal disease outbreak, be it an emerging disease or a maliciously introduced pathogen. The veterinary pathologist is therefore often the first line of defense in the diagnosis and eventual control and eradication of a zoonotic disease.

History is filled with examples of the use of pathogens as weapons. In 1346, the Mongol army hurled plague-infested corpses over the walls of the Crimean city of Caffa. Some speculate that this early biological attack precipitated the Black Death, which eventually killed one-third of Europe’s population.[50] During the French and Indian War of 1763, the British used smallpox-infected blankets to infect Native Americans in an effort to turn the tide of battle.[51] During World War I, German secret agents in the United States infected Allied horses bound for Europe with anthrax and glanders in an unsuccessful attempt to cripple them prior to their shipment into the European theater.[51] Additionally, in World War II, the Japanese physician Ishii and veterinarian Yujiro extensively tested and used bioweapons on the Chinese populace.[51]

The threat of such weapons is no less serious today. The US military and civilian leadership were reminded of this fact in the early 1990s after Soviet defectors revealed the enormous bioweapons program in the former Soviet Union. The use of anthrax-laced letters as terror weapons during several weeks in September 2001 further elevated the nation’s biodefense awareness and reinforced research efforts. These letters contained Bacillus anthracis spores, the dormant stage of anthrax, and were handled in or mailed to various locations in Washington, DC; Boca Raton, Florida; and New York, New York.[52] One letter intended for a US senator was misdirected and ended up in a Sterling, Virginia, post office. According to the CDC, 22 people were infected by this attack, with 11 developing the highly lethal inhalational form of anthrax. Of these 11 victims, 5 died of the disease while the remaining 6 survived due to aggressive medical intervention.[53]

As the United States enters the second decade of its struggle against terrorists, the role of the veterinary pathologist conducting biomedical research to protect service members continues to be a priority for the DoD. The same research that directly protects the deployed soldier ultimately plays a larger role in global civilian health; in fact, the vaccines, therapeutics, and diagnostic tests designed to protect soldiers often have far-reaching public health benefits. For instance, development of a vaccine to prevent malaria morbidity and mortality in military personnel will also benefit the approximately 220 million people worldwide affected by this disease every year.[54] Development of a treatment for cutaneous leishmaniasis will not only allow successful treatment of forward-deployed soldiers exposed to this disease, but also will benefit the 1.5 million people diagnosed with the debilitating disease every year throughout the world.[55]

The terrorist attacks of September 11, 2001, and continuing terrorist attacks have also heightened the recognition of, and underscored the importance of, the veterinary pathologists’ role in using animal models of disease in biodefense and biomedical research. Since these occurrences, myriad research projects have been conducted to improve the efficacy of currently available vaccines, therapeutics, and diagnostic tests for many biological agents, including anthrax,[56] as well as naturally occurring outbreaks of biomedical importance such as those caused by malaria.[57]

Because many highly virulent human diseases occur naturally in animals, veterinary pathologists play a key role in developing medical defenses and in elucidating animal models. These models of disease are critically important in understanding the pathogenesis of all zoonotic diseases. Animal models also represent the cornerstone of viable vaccine and antibiotic development because they provide an essential means of efficacy and side-effect testing of potential treatments prior to their use in humans. The remaining sections of this chapter provide more information about the veterinary pathologists’ roles in biomedical research, the key centers of pathology research, the history of this specialized field, the major contributions of its many pioneers, and the basic methodology of the US Army’s biodefense and biomedical research programs.

Military Institutes of Biodefense and Biomedical Research

In the past, most research on biological weapons was conducted solely by the military for a variety of reasons. First, the majority of pathogens employed as biologic warfare agents are seen only sporadically in nature and are not typically important chronic diseases. Therefore, they are not pervasive in the environment and do not provide a lucrative financial marketing incentive for most civilian pharmaceutical research.

Second, working with these agents requires maximum biocontainment facilities; the lofty costs associated with construction and maintenance of these facilities are often prohibitive for private businesses. Third, since dealing with these agents is extremely dangerous, the handling of these deadly pathogens has traditionally been the realm of military research scientists. In fact, military veterinary pathologists conduct perhaps the most dangerous work of all scientists who labor in biosafety level-4 suits. Because biocontainment suits are made of a soft plastic, they provide little protection to the military veterinary pathologists who must work with sharp instruments and handle jagged bones when conducting necropsies.

Despite these obstacles, some changes may be imminent. Total US public and private funding for biomedical research increased from $75.5 billion in 2003 to $101.1 billion in 2007.[58] Funding for directed biodefense research, as well as the number of federal and civilian institutions that conduct biodefense research, also has skyrocketed in recent years. A recent review of research dollars dedicated to this field revealed that US government civilian biodefense funding increased from $633.4 million in 2001 to $6.5 billion in 2011.[59] This marked augmentation in funding reveals a definite shift in the control over biodefense research. However, by virtue of longevity and technical expertise, the military remains the dominant group at the forefront of both biomedical and biodefense research.

The US Army Medical Research and Materiel Command (MRMC) provides management oversight for several key military research laboratories and holds the mandate for medical research, development, acquisition, and medical logistics management.[60] Two military institutes in the DoD dedicated to biodefense and biomedical research, respectively, are the US Army Medical Research Institute of Infectious Diseases (USAMRIID) at Ft Detrick, Maryland, and the Walter Reed Army Institute of Research (WRAIR) in Silver Spring, Maryland.

United States Army Medical Research Institute of Infectious Diseases

Biodefense research in the United States did not begin in earnest until 1941 when the Secretary of War Henry L Stimson asked the National Academy of Sciences to conduct a threat assessment of biological weapons.[51] The investigative panel confirmed the feasibility and gravity of the threat, prompting President Franklin D. Roosevelt to initiate the War Reserve Service with the mission to study and produce medical countermeasures to biological weapons. Camp Detrick, a nondescript National Guard base in western Maryland about an hour north of Washington, DC, was chosen as the site where this bioweapons research facility could be built.[51] Many years later, in 1969, USAMRIID was established at Camp Detrick to conduct basic research on some of the world’s most threatening diseases with potential use as biological weapons. With several high-level containment facilities, USAMRIID remains one of only a few laboratories globally that is capable of developing vaccines, therapeutics, and diagnostics to combat emerging biowarfare threats.

Initially, the bioweapons program focused on research directed toward the development of defensive countermeasure; the start of the Korean War changed this focus for a period. Because of potential use of biologic weapons by the North Koreans, Chinese, and Soviets in the Korean War, the United States felt compelled to intensify research into both offensive and defensive bioweapons.[51] The United States even went as far as developing offensive biowarfare agents in the 1950s and early to mid-1960s, but the military has never used them.[51]

The aggressive period of US research was short lived. On November 25, 1969, during a visit to Ft Detrick, President Richard M. Nixon publicly announced a halt to all offensive research into biologic weapon development, asserting that all US work with biologic agents would be strictly defensive in nature. President Nixon also affirmed that all biodefense efforts would be devoted solely to producing vaccines, therapeutics, and diagnostics to detect and fight biowarfare agents, not to propagate them.[51]

In 1972, the United Nations enacted the Biologic Weapons Convention which mandated an end to any offensive, malicious, or otherwise deleterious research on biologic agents.[51] Among the initial signatories in 1972 were the United States and the former Soviet Union.

Emphasis on defensive research of biological agents has led to public health advances in the United States and globally. Over the past 30 years, USAMRIID pathologists have made significant and timely contributions to the detection and response of disease outbreaks. One example is the 1989 outbreak of hemorrhagic fever that swept through a colony of research monkeys at a nonhuman primate quarantine facility in Reston, Virginia, less than 15 miles outside of the Washington, DC, beltway. Suspecting a deadly virus as the causative agent, the veterinarian employed to manage the colony contacted USAMRIID for assistance.[61]

USAMRIID researchers isolated and identified the virus as a new species of Ebolavirus that had never before been described in any animal species or humans (Figures 15-3a and 15-3b). The novel virus was named Ebola Reston in recognition of the location of the first confirmed outbreak of the agent. A US Army veterinary pathologist, Colonel (Retired) Nancy Jaax, played a role in the diagnosis of the disease by performing necropsies and pathologic analysis on several of the stricken monkeys. Her analysis also helped characterize and confirm the virus presence and subsequently led to efforts that halted the spread of the newly discovered virus.[61] (See also Chapter 1, Military Veterinary Support Before and After 1916, for a more complete story about the discovery of this novel virus and other veterinary contributions to public health.)

Ten years later, in 1999, another puzzling disease raged, this time in New York City, causing widespread, sporadic deaths of various species of birds, horses, and even humans in its wake. Initially, medical officials attributed the human disease cases to St Louis encephalitis virus, a disease spread by mosquitoes with historically sporadic outbreaks occurring within the United States.[62]

However, Dr Tracey McNamara, a veterinary pathologist at the Bronx Zoo, noted the alarming rate of bird deaths occurring during the fatal human outbreak and reached a different conclusion. She contacted the CDC with her theory that the disease outbreak was not due to St Louis encephalitis because this disease typically did not affect birds. McNamara believed the avian and human deaths were linked and were more likely caused by another deadly arthropod-borne virus, but she did not have the diagnostic capabilities to determine the cause. When researchers at the CDC dismissed her thoughts that the human deaths in New York City were caused by an “animal” virus, McNamara reached out to military veterinary pathologists at USAMRIID.

Figure 15-3: Lesions from Ebola virus. Liver and spleen from a rhesus macaque (Macaca mulatta) experimentally infected with Ebola virus. (a) Liver: Multifocal necrosis of hepatocytes with rare, eosinophilic, intracytoplasmic inclusions, HE 400×. (b) Spleen: Diffuse deposition of fibrin within the red pulp with lymphoid depletion in the white pulp. HE 200x.
Photomicrographs courtesy of Major Todd Bell, US Army Veterinary Corps, US Army Medical Research Institute of Infectious Diseases, Frederick, MD.

McNamara provided tissue samples from several of the dead birds (from the wild and from the Bronx Zoo collection) to military veterinary pathologists and virologists at USAMRIID, and they used polymerase chain reaction assay to identify the causative agent as West Nile virus (WNV). Transmitted by mosquitoes, WNV is an arthropod-borne virus closely related to St Louis encephalitis; this was the first time WNV was detected as a human pathogen in the United States.[62]

Following this discovery, several federal agencies and the CDC labs confirmed the diagnosis. However, the initial work done at USAMRIID was the corroborative evidence needed to definitively prove that WNV was indeed the culprit in this viral mystery (K Steele, personal oral communication, April 24, 2012). The identification of the disease allowed the public to be alerted and informed, helping mitigate the effects of this emerging viral threat. In subsequent scientific work, USAMRIID scientists collaborated to further characterize the virus.[62]

Emphasis on defensive research of biological agents for disease protection is not USAMRIID’s only current mission. The release of the anthrax letters on the heels of the September 11, 2001, attacks prompted a review of America’s preparedness to deal with biologically guided terrorist attacks. From this review was born the National Interagency Biodefense Campus initiative, designed to increase collaboration of basic infectious disease research as well as expedite development of diagnostic assays, vaccines, and therapeutics. USAMRIID, as representative of the DoD; the National Institute of Allergy and Infectious Diseases (NIAID), of the National Institutes of Health; and the National Biodefense Analysis and Countermeasures Center, of the Department of Homeland Security, collaborate jointly in this initiative. Their co-location on the Ft Detrick campus underscores the cooperative efforts to protect service members and civilians from infectious disease and to safeguard the nation from biological attack.

The Walter Reed Army Institute of Research

The WRAIR, originally named the Army Medical School, was founded in 1893 by US Army Surgeon General George Sternberg.[63] The WRAIR adopted its current title in 1955 and is named after Major Walter Reed, the pioneer in biomedical research who provided proof that yellow fever was spread by a mosquito vector. The WRAIR currently conducts biomedical research primarily focused on health and readiness to ensure that America’s service members are equipped with the most effective medical defenses and treatments against international health threats.

More specifically, the WRAIR conducts research on a range of militarily relevant matters, including operational health hazards, combat casualty care, and naturally occurring infectious diseases. It is a lead agency for infectious disease research through basic science and clinical research and a crucial source of research for medical product development. Because of its pioneering focus on disease prevention, the WRAIR is widely recognized as the oldest public health and preventive medicine institute in the United States. It is also the oldest subordinate laboratory of the MRMC and the largest biomedical research institute within the DoD.

The WRAIR hosts two centers: The Center for Military Psychiatry and Neuroscience and the Center for Military Infectious Disease Research. The Naval Medical Research Center, co-located with the WRAIR on the Forest Glen campus in Silver Spring, has an Infectious Disease Directorate and an Operational and Undersea Medicine Directorate. The Department of Pathology, which employs five military veterinary pathologists, provides research support for both the WRAIR and the Naval Medical Research Center. This department’s research support focuses on prevention and treatment of diseases and conditions relevant to the current operational environment, including blast exposure and traumatic brain injury; biomarkers to detect evidence of traumatic brain injury; animal model development to replicate posttraumatic stress disorder; vaccines and drugs for prevention and treatment of infectious diseases such as malaria, HIV/AIDS, dengue fever, and leishmaniasis (Figures 15-4a and 15-4b) and enteric diseases; and animal model development to improve treatment of decompression sickness. With current and ongoing operations in the Middle East, new research focuses on wound infection healing and treatment; medical countermeasures for multidrug-resistant organisms and their effect on wound healing of amputees; treatments for hemorrhagic shock; improved hemostatic dressings; and treatment of ischemia/reperfusion injury.

The research and development activities of the WRAIR extend worldwide, wherever disease agents that pose a threat to deployed US forces are endemic. WRAIR has four subordinate laboratories located on three continents where clinical trials are conducted and products are developed and tested to detect, control, and prevent infectious diseases of strategic significance to the US military: US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS); the US Army Medical Research Unit-Kenya (USAMRU-K); the US Army Medical Research Unit-Europe (USAMRU-E); and the US Army Medical Research Unit-Georgia (USAMRU-G).

USAMC-AFRIMS, in Bangkok, Thailand, and USAMRU-K, in Nairobi, have been integral in developing and testing improved means for predicting, detecting, preventing, and treating diseases such as malaria, infectious diarrhea, and HIV/AIDS. USAMC-AFRIMS and USAMRU-K also conduct surveillance, training, research, and response activities related to emerging disease threats. Additionally, these units provide regional support, enable capacity building, and nurture long-standing relationships with other militaries and governmental organizations.

Located in Sembach, Germany, USAMRU-E studies diseases and conducts applied psychological research to protect, optimize, and enhance soldier psychological resilience, including support and evaluation of the Army’s mental health advisory teams, more commonly known as MHATs. The newly established USAMRU-G, located in Tbilisi, focuses on endemic disease research, public health, and disease surveillance, as well as providing regional support and capacity building.

Figure 15-4: Cutaneous leishmaniasis. Haired skin from a BALB/c mouse experimentally infected with Leishmania major. (a) Necrosis and ulceration of the epidermis with replacement by a thick serocellular crust. The dermis and subcutis is markedly expanded by inflammatory cells, fibrin, and edema. HE 100X. (b) Higher magnification of inflammation in the dermis. Numerous macrophages are present and filled with intracellular amastigotes. HE 600X.
Photomicrographs courtesy of Lieutenant Colonel Jennifer Chapman, US Army Veterinary Corps, Walter Reed Army Institute of Research, Forest Glen, Maryland.

Prioritizing Major Emerging Threats to Civilian and Military Populations

How does the DoD decide what pathogens should be studied for biodefense purposes, and by extension, which biological agents will be targeted for vaccine and therapeutic development? Usually, the DoD develops its strategic plan from a classified military perspective after considering input from allied civilian agencies. For instance, the DoD, in collaboration with the US Department of Health and Human Services (HHS), the US Department of Homeland Security, and other federal agencies set biodefense research priorities based on one of two lists. The first is the HHS and US Department of Agriculture (USDA) Select Agents and Toxins, a list of biologic agents and toxins defined as having the potential to cause a grave threat to public health, plant health, or animal and plant products.[60] The second list, generated by NIAID, is referred to as the NIAID Category A, B, C Priority Pathogens list.[61]

The impetus for forming these lists was a 1995 event in which a rogue microbiologist was able to purchase a stockpile of Yersinia pestis, the causative agent of plague, through the US Postal Service.[60] At that time, no pertinent rules or regulations guided the transport of these agents in the United States. The US Congress responded with Section 511 of the Antiterrorism and Effective Death Penalty Act of 1996 (Public Law 104-132), which requires (a) the maintenance of lists of biologic agents and toxins with the potential to endanger public health; (b) the development of a system to govern the movement of these selected pathogens; and (c) the training necessary for individuals to work with or transfer these pathogens. The HHS turned to the CDC to administer this new program, and the CDC established the Select Agents and Toxins program for this purpose.[60]

The CDC uses the following six criteria to decide which agents are included on the HHS and USDA Select Agents and Toxins list: (1) virulence, pathogenicity, or toxicity of the agent; (2) availability of treatment (ie, vaccines, antibiotics, antitoxins, or other treatments); (3) transmissibility of the organism; (4) technical difficulty in reproducing or growing the organism; (4) ease of dissemination; (5) potential to cause public panic; and (6) known research and development by a state sponsor.[59] Agents that are highly virulent, have no known treatments, are easily transmitted, and can be easily grown or reproduced in a laboratory are of greatest concern.

In the NIAID Category A, B, and C Priority Pathogens list, Category A pathogens are the highest priority and are those agents that create the maximum risk to national security and public health because they (a) can be easily disseminated or transmitted from person to person; (b) result in high mortality and have the potential for major public health impact; (c) might cause public panic and social disruption; and (d) require special action for public health preparedness. Category B pathogens are the second highest priority and are those agents that (a) are modestly easy to disseminate; (b) result in modest morbidity rates and low mortality rates; and (c) require specific enhancements for diagnostic capacity and enhanced disease surveillance. Category C pathogens are those that are the third highest priority and include emerging agents that could be engineered for mass dissemination in the future because of (a) availability; (b) ease of production; and (c) potential for high morbidity and mortality rates and a large health consequence.[64]

The HHS and USDA Select Agents and Toxins list and the NIAID Category A, B, and C Priority Pathogens list are often confused. Significant overlap exists between these two lists, but NIAID’s is the most comprehensive. However, if an agent or pathogen is on either of these lists, it is a dangerous microbe for which the United States needs viable treatment modality available to protect citizens and military personnel.

Unlike public biodefense research, biomedical research in the DoD focuses more on diseases of military significance and is guided by analysis and risk assessment of infectious disease threats to deployed US forces. Therefore, the National Center for Medical Intelligence (formerly the Armed Forces Medical Intelligence Center) has defined infectious diseases of military significance based on the following criteria: (a) the disease is capable of degrading military operations; (b) the disease is severe; or (c) the disease has, historically, been a force health protection concern for commanders.[65] This list is reevaluated regularly to capture new or emerging diseases that have become established. The top three endemic disease threats, as defined in a 2008 study, are malaria, bacterial diarrhea, and dengue fever, all of which are priorities in DoD biomedical research.[65]

Understanding the Research Methodology of the Veterinary Pathologist

Research involving infectious microorganisms, especially those involved in biodefense activities, is conducted under strict guidelines, and the necessary biocontainment levels to conduct such research are set based upon the risk of a given agent. These biosafety levels are set by the CDC and published in the Biosafety in Microbiological and Biomedical Laboratories document. The standard biosafety levels in ascending order are biosafety level 1 or BSL-1, BSL-2, BSL-3, and BSL-4.[66] BSL-1 agents are well-studied and understood agents that do not commonly or consistently cause disease in healthy adults and are deemed a negligible hazard to those working with them. BSL-2 agents are considered a moderate hazard to those working with them. BSL-3 agents can cause serious or potentially fatal disease if personnel are exposed to them, but are agents for which there is a known treatment. BSL-4 agents are those that can cause severe disease or death and for which no known treatment is available.[66]

USAMRIID conducts research primarily on BSL-3 and BSL-4 agents, whereas WRAIR conducts research on agents in BSL-1 and BSL-2. Much of the DoD work conducted with biological agents on either the HHS and USDA Select Agents and Toxins list or the NIAID Category A, B, and C Priority Pathogen list is conducted in either BSL-3 or BSL-4 labs at USAMRIID. Work in biocontainment with agents that could be life-threatening is both physically and mentally taxing. As noted earlier, veterinary pathologists regularly put their lives at risk performing animal necropsies in biocontainment to advance research needed to develop medical countermeasures for the nation’s protection (Figure 15-5).

Once an emerging virus or other pathogen is identified for scientific research, several questions must be answered. How does the pathogen infect the host under typical natural conditions to cause disease? What physiological mechanisms does the pathogen use to cause disease in the host? What vulnerability can be exploited to allow a vaccine or therapeutic modality to be successful in combating disease or protecting an individual from infection?

Since the majority of diseases on the HHS and USDA Select Agents and Toxins list are zoonoses, the veterinary pathologist is a key subject matter expert when conducting research to answer such questions. Much basic disease research (ie, to elucidate pathogen behavior within a host and combat its effects) has been conducted at both the WRAIR and USAMRIID since the 1940s; veterinary pathologists have been instrumental to this research, contributing critical information establishing the infectious dose of a particular pathogen, the lethal dose required, the variability in disease manifestation depending on the route of exposure, and the pathogenesis of numerous disease-causing organisms.

The following is an oversimplified description of the process to develop a medical countermeasure for a disease with no existing drug, vaccine, or other therapy; this explanation is meant to give the reader merely the essentials of how the process is conducted. First, basic research is performed to characterize the pathogen and identify potential vulnerabilities in the organism’s physical or molecular structure that may serve as a means of attacking or preventing disease. The physiological mechanisms involved during infection of the host are then characterized and identified in an attempt to either capitalize on the host’s defenses against the organism, augment the host’s defenses to overcome infection, or possibly even mitigate a host’s immunological or inflammatory response to lessen the deleterious effects of inflammatory mediators in the host.

Once a potential medical countermeasure is deemed a viable candidate for further investigation, initial or “preclinical” testing is initiated. If the treatment shows promise by protecting tissue culture cells in a petri dish from pathogen challenge, small-scale testing in a progression of laboratory animal models is generally the next step, with the studies methodically advancing from small rodents through other animal species that have been developed and identified as appropriate models to more closely replicate the physiological response of humans. Safety, dosing, carcinogenicity, efficacy, and immunogenicity studies are performed in the preclinical phase; also, during this phase, a standard and repeatable method of producing the vaccine or treatment is established to ensure a quality product (ie, Good Manufacturing Practices). The veterinary pathologist is integrally involved in key aspects of this process, most crucially in analyzing and interpreting lesions caused by the disease, determining which lesions may be a result of the treatment modality and which lesions are neither pathogen-related nor treatment-related.

When efforts have proven successful and promising to this point and the treatment or vaccine is safe and efficacious in animal models against the disease of interest, the preclinical data is submitted to the US Food and Drug Administration (FDA) for an investigational new drug approval. All study data collected to this point is closely scrutinized for strict adherence to Good Laboratory Practices requirements. All parts of the study, from the housing and care of the animals to the paperwork documenting the study findings, are meticulously examined. Once investigational new drug approval is obtained, small-scale, limited testing of healthy, human volunteers can begin.

Figure 15-5: A military veterinary pathologist and military research technician work as a team to collect tissue specimens during a necropsy in a BSL-4 suite at the US Army Medical Research Institute of Infectious Diseases.
Photograph courtesy of Major Todd Bell, US Army Veterinary Corps, USAMRIID, Frederick, MD

Phase I clinical trials are defined as testing in limited groups of healthy adults to gather safety and immunogenicity data. Phase II clinical trials are defined as testing in larger groups to continue to refine the safety, efficacy, and dosing information.[59] Phase III testing is conducted in larger groups of people who are affected with the disease being studied or are likely to be exposed to the disease being studied (eg, the testing of anti-malarial drugs in people residing in malaria-endemic areas). If results are favorable at each step, overall approval is sought from the FDA.[59] If at any stage serious adverse events are encountered, the study is immediately halted, and researchers return to prior steps to reexamine the medical treatment regimen. (See Table 15-1 for trial or testing phase definitions and objectives.)

The medical countermeasure development process is rife with pitfalls and stumbling blocks, and false starts are common. The general timeframe from initial early research and development of potential treatment candidates to successful product development and FDA approval is over 10 to 15 years. The process may require about $800 million to $1 billion in capital outlay, with a very high likelihood of failure at any point. To confound this process further, in the case of military medicine and biodefense, the majority of agents studied in this field have the potential to cause severe disease or death in humans, morally precluding the standard use of human clinical trials, and there is no commercial market or alternative use for the medical countermeasure.

TABLE 15-1

THE THREE PHASES OF CLINICAL TRIALS

Phase

Participants

Objective

Phase I

Limited group of healthy adults

Safety and immunogenicity data

Phase II

Larger group of healthy adults

Safety, efficacy, dosing

Phase III

Very large groups of people affected by the disease or likely to be exposed to the disease

Safety, efficacy

Because of these constraints, development of appropriate animal models that mimic the human course of disease is crucial to understanding the effects of biological warfare agents. Recently, at the insistence of the DoD and the biodefense community, a new FDA requirement was instituted (informally termed the “animal rule”) that requires the use of at least two appropriate animal model species to establish the safety and efficacy of products against biological warfare agents.[67] The animal rule allows for the development of human treatments and vaccines based on animal models of disease when human testing would be either unethical or simply infeasible.

CHEMICAL DEFENSE

Overview of Chemical Defense Resources, Duties, and Roots

The US Army Medical Research Institute of Chemical Defense (USAMRICD), located at the Aberdeen Proving Ground-Edgewood, Maryland, is the federal resource tasked with product development, testing, and evaluation against a growing array of chemical threats to both soldiers in the field and to civilian responders in the United States.[68] USAMRICD is the DoD’s leading laboratory for medical chemical defense research and assists in formulating policies and medical doctrine related to traditional and nontraditional chemical warfare agents. To aid USAMRICD’s mission, the military veterinary pathologist provides a greater understanding of the pathological, biochemical, and toxicological consequences of exposure to chemical warfare agents and in the assessment of the efficacy of medical therapeutics and countermeasures.

USAMRICD’s roots stem from the US Army’s Chemical Warfare Service (CWS), precursor to the Chemical Corps; the CWS was established in 1917 with seven main divisions, each focused on different areas: (1) research; (2) training; (3) development; (4) proving ground; (5) gas defense; and (6) medical. Originally, the seventh division, the gas offense division, had its main facility on Edgewood Arsenal, just north of Baltimore, Maryland, and the current location of USAMRICD. In 1919, this arsenal was the center of training, stockpiling, and research and development of chemical warfare agents for the US Army.[69]

The medical division can trace its origins to the AMEDD and was responsible for the pharmacological aspects of medical defense against chemical weapons and for the treatment of chemical weapon casualties during World War I. The division was reorganized in 1922 as the Medical Research Division at Edgewood Arsenal. In the early 1960s, this division was renamed the US Army Biomedical Laboratory. In 1979, command of the laboratory was assumed by the US Army Medical Research and Development Command (now the MRMC) when the Army surgeon general assumed command of all medical chemical defense. In 1981, the laboratory received its current name, USAMRICD; it is now one of six medical laboratories and research institutes under the command of MRMC.

Brief History of Chemical Threats

As early as 3000 BCE, ancient Egyptian and Indian civilizations cultivated, studied, and accumulated poisons from plants, animals, and minerals.[69] In broad terms, chemical warfare agents can be described as any substance or compound (natural or synthetic) designed, intended, and used for the purpose of killing, seriously injuring, or incapacitating others. Early chemical warfare agents typically were simple and used in conjunction with wooden projectiles, fast-moving metal projectiles, and incendiary devices to develop poisonous, noxious, or irritant vapors. Although advocates in both the Union and Confederate armies proposed using chemical warfare agents such as liquid chlorine, chloroform, hydrochloric acid, sulfuric acid, and Chinese “stink bombs” during the US Civil War, historically, chemical weapons have not actually been used in attacks on the American homeland.69–72

Modern chemical warfare began in other countries in World War I. The lengthy stalemates associated with trench warfare during this war directly correlated with increased technological advances of chemical warfare agents for battlefield use. France first used chemical agents (eg, ethyl bromoacetate or tear gas) in 1914 against the Germans, but this implementation was ineffective.[69] In April 1915, during the Second Battle of Ypres, Germany delivered the first successful chemical warfare attack against the Allies using toxic chlorine vapors projected from cylinders.73–76 Later that year, Germany debuted the use of phosgene and diphosgene gases, followed by French use of hydrogen cyanide in 1916, and German use of chemical mustard gas in July 1917.[69] Mustard agent, feared most by American soldiers, caused 20,000 casualties in only 6 weeks after its introduction and ultimately debilitated over 27,000 Americans by the end of World War I.69, 77

In April 1917, despite an earlier position of strict neutrality, President Woodrow Wilson asked Congress for a formal declaration of war on Germany following increased German U-boat attacks on American merchant ships. Soon after, preparation for chemical warfare began, and the US Army’s CWS was established with full responsibility for all facilities and functions relating to toxic chemicals. (In 1946, Public Law 607 changed the name of the CWS to the Chemical Corps.[78])

Between World War I and World War II, Italy employed chemical mustard agent during their invasion of Ethiopia in 1935, and the Japanese deployed an extensive chemical weapons arsenal, in addition to biological warfare agents, during their invasion of China in the late 1930s. During the interwar period, the first nerve agents (derived from the organophosphorus or OP compounds tabun and sarin) also were developed and evaluated by German scientists. Nerve agents were considered ideal weapons because of their colorless and odorless nature and deadly effects.69,79,80 Despite an aggressive approach to the development of nerve agents as an offensive weapon, Germany’s reluctance to use nerve gas during World War II remains an enigma. Nonetheless, Germany, Japan, Great Britain, and the United States did have active plans to use various forms of chemical weapons in the event opposing forces used them first.69,80

Although smoke, flame, defoliants, and nonlethal riot control agents were used in the Korean and the Vietnam wars, there is no evidence that the US Army Chemical Corps ever employed debilitating chemical weapons during either war.[69] Still, the United States continued its chemical agent production program until 1969. By then, a combination of growing public hostility, US involvement in the Vietnam War, use of riot control agents and defoliants in Vietnam and in the United States, and a series of high-profile chemical agent-related incidents at Dugway Proving Ground, Utah, and in Okinawa, Japan, caused President Nixon to effectively halt the production of chemical weapons in America.69,81 Consequent plans to abolish the Chemical Corps entirely led to a temporary decline in the US chemical defense program in subsequent years.

However, interest has since increased for several reasons. The Arab-Israeli Yom Kippur War in 1973 and various skirmishes and wars in Southeast Asia and Afghanistan, directly (or indirectly) involving the Soviet Union throughout the 1970s and 1980s, strongly indicated that the Soviets were ready for, and potentially intended to use, extensive chemical warfare.[69] Iraq’s use of chemical warfare against Iranian soldiers during the 1980s also strongly signaled that formulating a plan to not only restore, but increase, US defensive capability against chemical warfare agents was prudent. Although no known chemical or biological attacks were made by Iraqi forces during Operation Desert Storm in 1991, all deploying US military units were fully equipped with the latest chemical and biological defensive equipment, and troops were administered prophylactic vaccines against anthrax and botulinum toxin. Additionally, pyridostigmine bromide tablets were dispensed as a nerve agent pretreatment, and the Mark I nerve agent antidote kit was issued to treat nerve agent poisoning.69,82,83

According to available US data, there was no known deployment of chemical weapons by insurgents during Operation Enduring Freedom in Afghanistan, which began in 2001, but there have been several documented cases of Iraqi insurgents using chlorine gas car bombs in Operation Iraqi Freedom in 2007.69,84,85 Future terrorist chemical attacks on US service members and civilians, both domestically and abroad, probably will be similarly isolated in nature, unlike the full-scale chemical warfare seen during World War I. However, in 2013, United Nations chemical weapons inspectors, consisting of a team of nonpartisan scientific experts, confirmed that surface-to-surface rockets containing the chemical nerve agent sarin had been deployed between parties and against civilians, including children, in an ongoing civil conflict in the Syrian Arab Republic.[86]

Overview of Chemical Agents and Military Research

Chemical agents used to kill, seriously injure, or incapacitate victims are typically classified according to their physical state (ie, solid, liquid, or gas); physiological action; and use. A persistent or nonpersistent nature does not definitively classify a chemical agent, but is used to signify the time the chemical agent remains in the area. In general, chemical agents are categorized as follows: vesicants (ie, blister agents); pulmonary choking agents (ie, lung-damaging agents); cyanide; nerve agents; riot control agents; or incapacitating agents. Although riot control and incapacitating agents have been extensively studied in military medicine, military veterinary pathologists have focused their research on nerve agents, vesicants, pulmonary choking agents, and, to a lesser extent, cyanide.

Nerve Agents

Nerve agents, the most toxic of the known chemical agents, are OP compounds that exert their biological effects through inhibition of the enzyme acetylcholinesterase (AChE).69,87 Originally produced during a search for ideal insecticides, OP compounds were evaluated for military use because of their toxicity. The five most common nerve agents of military interest are tabun (GA), sarin (GB), soman (GD), and the compounds simply designated as VX and GF. [88]

In the body’s cholinergic nervous system, action potentials stimulate release of the neurotransmitter acetylcholine from presynaptic vesicles within the neuromuscular junction, resulting in the formation of postsynaptic action potentials that trigger a contractile response of muscle and glands. AChE, found at the synaptic receptor sites, rapidly hydrolyzes and terminates acetylcholine’s activity. If AChE is absent, or altered, acetylcholine continues to stimulate the affected organ. Thus, clinical signs of OP nerve agent exposure include spasms, seizures, and/or hypersecretion in organs with cholinergic receptor sites, such as smooth and skeletal muscles, the central nervous system, and most exocrine sweat glands.

Vesicants

Three vesicant agents are of significance to the US military: sulfur mustard (HD), lewisite (L), and phosgene oxime (CX). Of the three, HD is the first and only vesicant known to be used as a chemical weapon on the battlefield.88,89 Generally, lesions caused by lewisite and CX are less severe than those caused by HD. Additionally, unlike HD and lewisite which cause blisters, CX is not considered a true vesicant, but rather an urticant, since it causes dermal erythema and swollen red bumps or plaques (eg, wheals and hives) on the skin surface.88,89

Pulmonary Choking Agents

Pulmonary choking agents, also known as lung-damaging agents or pulmonary edematogenic agents, are generally separated based on their pathophysiology and where they cause damage within the respiratory tract. Although HD is considered a vesicant, it is also considered a central pulmonary agent.

Central pulmonary agents such as HD and ammonia form strong acids or bases within central airways where bulk air flow occurs (ie, in the trachea, bronchi, and bronchioles) and irritate or damage the tissues, particularly surface epithelial cells.88,89

Conversely, peripheral pulmonary agents (ie, edematogenic agents) affect the gas-exchange regions distal to the terminal bronchioles where bulk air flow is absent during each breath (ie, the respiratory bronchioles and alveoli). These agents typically cause pulmonary edema by damaging the endothelial lining of alveolar septa, resulting in accumulation of fluid in alveoli and bronchioles and pleural effusion.88,90 Examples of peripheral pulmonary agents include phosgene (CG), perfluoroisobutylene (PFIB), oxides of nitrogen, and hexachloroethane (HC) smoke. In particular, PFIB, a product produced by the prolysis of polytetrafluoroethylene (PTFE, brand name Teflon, Dupont, Wilmington, Delaware), causes respiratory flu-like symptoms called “polymer fume fever.”91,92 Some agents, especially at higher doses, will affect both central and peripheral respiratory compartments (eg, chlorine).

Cyanide

Cyanide intoxication occurs following ingestion, inhalation, or injection of hydrogen cyanide (AC) and cyanogen chloride (CK), and it produces death in humans within 8 to10 minutes following exposure.75,76 Historically, cyanides have been termed “blood agents” although cyanide exerts its most pathogenic affects primarily outside the bloodstream, specifically in organs with high oxygen requirements and dependency on aerobic respiration (eg, brain, heart, and liver).93,94 At the subcellular level, cyanide inhibits mitochondrial cytochrome oxidase, causing impairment of intracellular oxygen utilization and depression of cellular respiration.[94] In the central nervous system, the effects of cyanide toxicity are related to the direct effect on neurons with glutamic acid receptors.94–96

Military Veterinary Pathologists in Chemical Defense and Animal Model Development

Nonliving chemical agent models can be used as a screening tool to investigate mechanistic interactions and to down-select potential treatment options; however, they cannot model the complex interactions that occur in live models during the injury and repair phases of chemically induced injury. Therefore, appropriate animal models must continue to be researched, developed, and used to define various chemical injury mechanisms and classifications and to further develop preexposure and postexposure protectants and therapies.[85]

DoD research has focused on developing countermeasures against nerve and HD agents. Study of the lethal effects of nerve agent exposures started in early 1980 and culminated in November 1990 with the fielding of the anticonvulsant drug diazepam, packaged as Convulsant Antidote Nerve Agent (CANA) and intended for use as an immediate field treatment of nerve agent-induced seizures.[97] Army veterinary pathologists, teamed with USAMRICD investigators, played crucial roles establishing the nonhuman primate and rodent animal models used to define the basic neuropharmacological mechanisms of nerve agent-induced seizures and to characterize the neuropathology and cardiomyopathy lesions in survivors and nonsurvivors following nerve agent exposure.97–104

Hallmark lesions, particularly in soman- and sarininduced toxicity, include myocardial degeneration and necrosis; neuronal degeneration and necrosis; and neuropil edema within the cerebral cortex, amygdaloid complex, hippocampus, and multiple thalamic nuclei. By 1987, additional studies clearly indicated that nerve agent-induced brain damage was primarily the result of prolonged seizure activity.97,105 This critical discovery resulted in the addition of diazepam (ie, as CANA, an autoinjector containing 10 mg diazepam) or other benzodiazepine anticonvulsant drugs to the standard nerve agent medical therapy in order to minimize or prevent brain lesion development and to enhance survival following nerve agent exposure.82,97,99,105–109

Like nerve agent research, HD studies have focused on determining mechanisms of action and exposure-related pathologies to advance development of preexposure and postexposure treatments. Animal models used to study HD exposure to skin include the hairless guinea pig, weanling pig, and the mouse ear and hairless mouse.[97] From work on these animals, USAMRICD researchers and military pathologists have defined a sequential preblistering phase that develops following HD exposure. In the prephase, epidermal basal cells and basement membrane constituents are targeted, eventually resulting in microscopic blisters at the epidermal-dermal junction.110–114

The effects of HD exposure on eyes and airways have also been scrutinized. Eyes are most sensitive to HD-induced injury, and the pathogenesis of HD ocular lesions has been described in studies using light and electron microscopy on rabbits.89,115,116 According to documented pulmonary studies, several sequential changes occur in airways following HD inhalation: first, necrosis of upper airway epithelium; next, lower airway necrosis and epithelial sloughing; and finally, obstructive pseudomembrane formation, an important cause of death in animals within the first 24 hours after exposure.82,88,117,118 Exposed animals died primarily from pulmonary injury complicated by infection (eg, bronchopneumonia). Complications from HD-induced bone marrow suppression, hemorrhagic pulmonary edema, and pleural effusion have also been documented in cases of high-dose exposures.88,114

Nerve agents and HD are not the only chemical agents that veterinary pathologists have studied using animal models. Rats, mice, and rabbits have long been part of phosgene pathogenesis and treatment studies.119–125 In fact, a mouse model was used by an Army veterinary pathologist and other USAMRCID investigators to first correlate histopathological acute phosgene-induced pulmonary injury to the presence of leukocytes in bronchoalveolar lavage fluid and elevations in serum protein and lactate dehydrogenase levels. Neurotoxic, cardiotoxic, and hepatotoxic lesions have also been described for acute and long-term cyanide intoxication studies in a wide variety of animal models, including mice, rats, rabbits, cats, dogs, pigs, goats, and monkeys.126–131

Although US military forces have not engaged in chemical warfare since World War I, lessons learned from chlorine-laced car bombs utilized by Operation Iraqi Freedom insurgents reinforce current beliefs that military personnel must always be prepared and equipped to operate in any environment where chemical agents may be used. The Aum Shinrikyo’s use of sarin gas to attack a Tokyo, Japan, subway tunnel in 1995 further underscores this sobering reality.132–135 Even though this cult was targeting greater lethality, approximately 1,100 people presented with mild to severe clinical signs and symptoms of sarin poisoning from this city attack. The clear and convincing evidence of munitions containing sarin being used with lethal consequences on a relatively large scale in Syria in 2013 is also concerning. US military forces will continue to rely on research conducted at USAMRICD, with its wide array of scientific expertise, including veterinary pathologists, to ensure chemical preparedness on battlefields and in urban environments.

RADIATION DEFENSE

Development of the Radiation Program

In 1957—2 years after a controlled test explosion of a thermonuclear device in the Pacific Ocean transcended the anticipated radioactive yield and contaminated Japanese fishermen outside of the expected fallout zone—President Dwight D. Eisenhower and the Soviet Union leadership struggled with the terminology of agreements and details of a moratorium on nuclear testing. Scientists from both sides of the Iron Curtain finally met during the summer of 1958 to debate test ban issues and put recommendations in place for a temporary moratorium.

In fall 1958, at the height of the Cold War, the US Navy Bureau of Medicine and Surgery recommended establishing the Armed Forces Radiobiology Research Institute (AFRRI) at the National Naval Medical Center in Bethesda, Maryland, to research the biological effects of nuclear radiation. The AFRRI plans included construction of a nuclear reactor specifically designed to study the effects of ionizing radiation on humans. The AFRRI proposal was initiated, in large part, to alleviate the concern that if the moratorium on nuclear testing persisted, biomedical research and training on the physiological effects of irradiation might be deemed irrelevant. To prevent this possibility, Congress approved the proposal. Groundbreaking for the AFRRI began in November 1960.

By the 1960s, the United States was entrenched in the Vietnam War, and in the wake of the Cuban Missile Crisis, the specter of nuclear annihilation was pervasive on both sides of the Iron Curtain. In 1960, France detonated a nuclear device in the Sahara desert; a year later, the Soviet Union violated the signed moratorium by exploding the AN602 hydrogen bomb in the Novaya Zemlya archipelago in the Arctic Ocean.

Construction and staffing of the AFFRI was not completed until January 1962. Given the unsettling events of previous years, the civilian and the military medical communities felt an urgent need to broaden their collective understanding of the impact of radiation on troops and civilians. Thus, the AFFRI’s initial mission statement emphasized conducting more comprehensive radiobiological scientific research essential to the medical support of US military services, national welfare, and global well-being.

Military veterinarians were involved in the AFRRI’s radiobiology research from its inception, instituting macroscopic evaluation and eventually histopathological analysis of laboratory animals exposed to varying degrees of ionizing radiation. By 1963, the AFRRI radiation pathology department’s roles were well delineated, specifying department responsibility for originating and conducting research projects in histopathology, cellular biology, and hematology. The radiation histopathology department was tasked with pathological analysis of biological tissue specimens, including laboratory animal necropsies and gross characterization of observed lesions, as well as the microscopic interpretation of all collected and key target tissues.

In 1968, the AFRRI added an experimental pathology department to its research hierarchy; personnel from this department were responsible for conceiving and executing radiobiological research on a variety of laboratory animal species, including nonhuman primates, dogs, cats, rodents, rabbits, pigs, and various exotic species. Using these animal models, the department evaluated the acute effects of radiation on sensitive individual cells and complete organ systems, with follow-on study of recovery and residual pathology associated with the initial insult.

The AFRRI veterinary pathologist now occupies a permanent position within the Department of Veterinary Science: division chief for comparative pathology. The current mission of this division chief is unique within the DoD and includes a broad spectrum of research in (a) medical countermeasure development evaluating pharmacological treatment modalities that prophylactically prevent or treat various pathologies associated with ionizing radiation injury; (b) biological dosimetry clinically assessing various animal models to establish high-precision analytical methods for triage and medical management of radiation victims; (c) combined injury examining the development of medical treatments for irradiated personnel whose exposure has been compounded by traumatic wounds, burns, hemorrhage, blast injury, and/or infection; and (d) internal contamination and metal toxicity evaluating not only the short- and long-term radiological and toxicological effects of embedded military metals, but also the treatment strategies for improved elimination of said metals from the body.

Lessons Learned in Radiation Pathology

Many well-known and well-documented incidents involving human casualties have provided inadvertent data for better understanding of radiation pathology. Lessons have been learned through military use of nuclear weapons, as in the 1945 decision to drop a nuclear bomb on Hiroshima and Nagasaki, Japan, to bring an abrupt halt to World War II; from nuclear power plant disasters, as in Chernobyl of the former Soviet Union in 1986 and in the Windscale fire in Great Britain in 1957; from the intentional destruction of nuclear sites, as in the Iranian bombing of the Al Tuwaitha nuclear complex in Iraq during the Iran-Iraq war of the 1980s; and from accidental mishandling of nuclear material, as seen in the 1987 Goiania radioactive contamination accident in Brazil.136–138

The research afforded by these unfortunate incidents reveals that the pathophysiological effects of ionizing radiation are silent and initially painless, unlike most other injuries to the soldier. However, ionizing radiation manifests both acute and chronic effects, attacks a single or multiple body systems, and causes primary as well as bystander effects.

Division of Radiation Syndromes

Radiation pathology is divided into three overlapping, dose-dependent, clinical, and histopathological syndromes caused by any large, external penetrating dose of radiation delivered to the entire body (or most of it) over a short period of time. Acute radiation syndrome (ARS) is the collective term for the three syndromes caused by varying doses of radiation exposure.

The first ARS syndrome is hematopoietic syndrome (more commonly known as bone marrow syndrome). Mild hematopoietic syndrome symptoms such as nausea and vomiting have been described at doses as low as 0.3 Gy of ionizing radiation; more acute symptoms usually occur with single doses greater than 0.7 Gy. The higher the radiation dose, the more DNA damage is done to the bone marrow and to the blood cells (ie, red cells, white cells, and platelets) produced within the marrow. The survival rate of affected victims is also proportionally related to the amount of damage that occurs within the rapidly dividing bone marrow cells. As mature white blood cells start to turn over without having a regenerative pool of replacements, systemic thrombocytopenia (ie, decreased blood platelets and lowered clotting capabilities) and immunosuppression develop (Figures 15-6a and 15-6b). The primary cause of death is hemorrhage and infection.139–145

The second ARS syndrome, gastrointestinal syndrome or GI syndrome, usually occurs at higher single radiation exposure doses ranging from 10 to 100 Gy. Survival from this syndrome is rare because mucosal stem cells in the GI tract are destroyed. GI tract ulceration follows, enabling bacteria to invade the bloodstream. The most critical effects of this irreparable damage are sepsis and mucosal cell nonregeneration, which leads to GI absorption problems, dehydration, intractable diarrhea, severe electrolyte imbalances, and usually, death.139–144

The third ARS syndrome, termed as the cardiovascular or central nervous system syndrome, is typically observed at doses greater than 50 Gy and is the most fatal of the three syndromes. No recovery is ever expected; death occurs within 3 days secondary to total cardiovascular collapse associated with severe intracranial edema, disseminated necrotizing vasculitis, meningitis, and neuronal necrosis and loss.139,140,142,143,144

These syndromes are not static; the pathology frequently overlaps from one to the next. A significant amount of research has been dedicated to the study of all organ systems and tissues in the body, in isolation with targeted irradiation and in bodily functions as a whole, and in conjunction with blast, thermal, and other injury modalities such as heat, shock, and blast, often associated with nuclear device detonations. In addition, there is ongoing research in multiple organ systems examining the many late effects of insult with varying doses of ionizing radiation exposure.136,138–140,144

The veterinary pathologist is integral to several components of radiobiological research. Typically, studies culminate with histological evaluation of multiple body systems in the animal model, including an assessment of the impact of varied forms of insult and the viability of proposed countermeasure treatment.

Figure 15-6: Bone marrow sections to show the effects of ionizing radiation. (a) Gottingen minipig, sternum, bone marrow: Normal population of myeloid and erythroid precursors. HE Bar = 50µm. (b) Gottingen minipig, sternum, bone marrow: Diffuse atrophy and loss of myeloid and erythroid bone marrow elements, with rare regenerative foci. HE Bar = 50µm.
Photomicrographs courtesy of Lieutenant Colonel Eric D. Lombardini, chapter author.

Late Effects of Ionizing Radiation

Much has been published about the carcinogenetic effects of ionizing radiation on the body. Literature topics range from the primary effects of such exposure on atomic bomb survivors to how therapeutic exposure can also lead to disease in patients (ie, acquired secondary or bystander effects of exposure to clinical radiation). For example, ample evidence indicates victims of nuclear explosions face an increased risk of developing hematopoietic neoplasia (ie, leukemia) and a propensity for solid tumor formation that correlates to ionizing radiation exposure; this propensity affects almost all body systems.138,140,142–144,146–148

The literature also includes debate on how radiation affects cells. Radiation carcinogenesis occurs when a cell’s genome is affected directly or indirectly by ionizing radiation. Various genetic mutations result, and, if maintained through multiple generations of cell turnover, can manifest as either tumor-promoting oncogenes or as defects in tumor suppressor genes that give rise to a monoclonal proliferation of the affected target cell and, ultimately, to neoplastic transformation.138–140,148–152

There are two primary opinions involving radiation-induced carcinogenesis. The more traditional of the two, “target theory,” is based on the idea that all radiation-associated changes originate within the target cell. As a result, only those cells directly exposed to ionizing radiation maintain the necessary genomic alterations for oncogenesis.139,140,153

Alternatively, an evolving paradigm suggests that downstream, or bystander, effects occur at very low radiation doses and are associated with altered intercellular signaling pathways. This theory postulates that molecular changes do not just appear in irradiated target tissue; cells not directly injured by irradiation also can undergo multiple molecular modulations after receiving signals from cells originating within the field of injury. According to this paradigm, the cells that receive these signals from the irradiated target tissue exhibit multiple downstream effects, including mutative responses, genomic instability, gene induction, cell transformation, and cellular apoptosis.139,140,153–156

Downstream or bystander theory is important because it helps medical personnel to examine the effects of radiation on the organism as a whole and the evolving pathology as a continuum. This theory also blurs the lines between the specific categories proposed in the more traditional radiation syndrome model, allowing clinicians to treat the whole body, not just tissues of interest at certain stages of illness.

Late Effects of Depleted Uranium and Other Military Metals

Depleted uranium (DU) is an extremely high-density variant of Uranium-235 often derived as a by-product of uranium enrichment for nuclear energy or nuclear weaponry. DU can be used by civilian aircraft industries and for radiation shielding because of its unique physical properties. Its military applications include armor plating in vehicles (eg, tanks) and in armor-piercing munitions. Multiple friendly-fire incidents in which veterans sustained injuries with shrapnel-derived, embedded DU fragments were reported in August 1990 through February 1991 in the Persian Gulf War. These included events in which US service members in armored vehicles were fired upon with DU penetrator, which produce variably sized shrapnel upon impact and aerosolized particulates.157,158

Little information is currently available about the potential long-term health consequences of such chronic, low-dose radiation exposure from these embedded fragments or on the combined effects of radiation and heavy metal toxicity. Ongoing animal studies continue to focus on the long-term effects of low-level radiation exposure on carcinogenesis and the ancillary effects on individuals in whom shrapnel is left in place, rather than surgically removed. Information from these studies is critically needed to determine appropriate medical management of DU fragment injuries and to decide if these sustained injuries require an alternative treatment, different from treatments for other embedded metal fragments.

Studies have examined the effects of other metals used in military munitions, however. In one notable group of experiments, AFRRI scientists observed how tissues in rats’ leg muscles were affected by embedded tungsten fragments and discovered a significant late effect: a highly malignant rhabdomyosarcoma developed around the embedded tungsten fragment[159] (Figure 15-7).

Figure 15-7: Rat, leg: Secondary to the experimental implantation of a military metal (tungsten) pellet into the leg of this animal, a rhabdomyosarcoma developed. The photomicrograph displays the few surviving normal skeletal muscle myocytes that are separated, surrounded, and replaced by neoplastic cells. HE 400x.
Photomicrograph courtesy of Lieutenant Colonel Eric D. Lombardini, chapter author.

Complications from Combined Injuries

A combined injury is defined as physical, thermal, and/or chemical trauma combined with radiation exposure at a dose that diminishes recovery and survival chances. In other words, a combined injury patient’s prognosis is more critical than those patients diagnosed with trauma alone or radiation exposure alone. To illustrate this heightened effect, consider a terrorist attack using a dirty bomb (ie, a combination of conventional explosives and radioactive material) within a subway system or another urban setting. The immediate impact of the actual radiation exposure would be obscured by the primary, instantaneous blast overpressure effects of the explosive detonation and the associated injuries sustained by airborne shrapnel and debris. A victim exposed to ionizing radiation probably would be subject not only to consequential thermal and/or radiation burns and internal organ hyperthermia, but also to blunt force and blast wave trauma and bodily lacerations that could obscure the initial clinical and histopathological picture of the radiation exposure effects.

Use of Medical Countermeasures

After a military tactical strike or natural or man-made disaster, first responders and occasionally military troops are required to enter into contaminated areas and function safely within that zone for an unpredictable amount of time. A clear understanding of the pathological effects associated with the radiation exposure syndromes, as well as an appreciation of potential long-term effects of any exposure, are critical in mission design and deployment, victim triage, and casualty treatment. Over the years, AFRRI personnel have examined the viability of hundreds of potential medical countermeasures that could be used (a) as prophylactic treatment for the military or first responders who might be required to enter into radiological- or nuclear-contaminated areas or (b) as postexposure treatment for individuals who have already received high doses of therapeutic or accidental ionizing radiation.

While the vast majority of research into finding radioprotective compounds has had limited success, the ongoing research at AFRRI has produced several investigational new drugs that are in various stages of development. Examples include granulocyte colony stimulating factor and different tocotrineols members of the vitamin E family, which have been evaluated in vivo in rodents and to a lesser degree in nonhuman primates. The military veterinary pathologists assigned to the institute also have been instrumental in examining the histopathological changes associated with varying degrees of irradiation combined with a range of countermeasure doses. This examination sheds light not just on efficacy, but also on potential toxicology and optimal dosing in humans and various other animal species.160–163

Future Demand for Radiation Studies

World-wide tensions about nuclear events have heightened since the March 2011 combined natural and man-made disasters in Japan. (A powerful earthquake off the Pacific Coast of Tohoku led to violent tsunami flooding, which in turn, caused a nuclear meltdown and release of radioactive materials at the Fukushima Daiichi nuclear power plant.) These anxieties are exacerbated by other international circumstances, including the persistent nuclear threats posed by an unstable North Korean government, the nuclear aspirations of an absolute Iranian political regime, and a laxity of control over Pakistani and former Soviet republic nuclear stockpiles.

Closer to home, the threat of a terrorist nuclear incident also remains an ongoing concern for the DoD. In the absence of readily available and effective commercial radiation medical countermeasures and minimally invasive biodosimetric tools, the AFRRI must continue its primary mission of using radiobiology research to develop beneficial medical products for soldiers, and military veterinary pathologists need to remain collaborating partners with civilian research scientists to extend similar protection to US citizens.

COMBAT CASUALTY CARE

Another important branch of ongoing veterinary military pathology research involves the physiological impact of traumatic injury, burns, and blast trauma. The US Army Institute of Surgical Research (ISR), located in San Antonio, Texas, is the DoD’s lead agent for combat casualty care, focusing on hemorrhage, tissue injury and trauma, resuscitation, medical devices, and clinical research. With the mission of providing requirements-driven medical solutions and products for injured soldiers—from self-aid through definitive care across the full spectrum of military operations—the ISR is also the DoD’s only full-service animal research facility that is co-located with a Level 1 trauma center. Thus, the ISR allows for professional scientific collaboration between veterinary pathologists, human pathologists, trauma surgeons, pain medicine providers, dental surgeons, and combat casualty care researchers.

Evolving Missions of the United States Army Institute of Surgical Research

The ISR, originally named the surgical research unit, was established in 1943 to evaluate the role of antibiotics, which had just been discovered as war wound treatments. The unit was first stationed at Halloran General Hospital, Staten Island, New York. In 1947, the IRS became a permanent unit and moved to Brooke General Hospital, Brooke Army Medical Center, Ft Sam Houston, Texas. It was assigned 12 personnel to continue research on antibiotics and to begin studying innovative surgical techniques and developments.

In 1949, given the potential for numerous nuclear weapons casualties, the unit’s mission expanded to include evaluation of thermal injuries. Study of these injuries led to improved skin grafting procedures and promoted continued use of antibiotics in new applications. During the 1950s, the ISR also served as a premier dialysis research center in South Central Texas and neighboring states.

The ISR was assigned to headquarters, US Army Medical Research and Development Command, in September 1958. Although it is colloquially known as the “Army’s Burn Unit,” the IRS serves all service branches and is a prototype for burn units all over the world. The ISR is also responsible for many forward-thinking medical research initiatives, including using plasma extenders and grafting and preservation of blood vessels.

As part of an AMEDD reorganization in March 1994, the ISR became a subordinate command of the MRMC, which is a major subordinate command of the newly formed US Army Medical Command. In 1996, the ISR moved to its current location, adjacent to the newly constructed Brooke Army Medical Center (now named the San Antonio Military Medical Center). Its current mission focus has changed from burn care management and treatment of thermal injuries to equal emphasis on the full spectrum of combat casualty care, including providing medical solutions for the injured soldier on the battlefield. Ongoing construction of the Battlefield Health and Trauma Research Institute, authorized by the 2005 base realignment and closure directive, will help consolidate all DoD combat casualty care research and personnel with the ISR at the San Antonio Military Medical Center.

Veterinary Pathology Contributions to Combat Casualty Care

Veterinarians have been involved at each step of the ISR’s changing mission: from cutaneous burn treatment, systemic burn therapy modalities, and pulmonary burn injuries to broader battlefield trauma. In fact, VC officers contributed to burn research since its inception in the late 1940s, and the first board-certified veterinary pathologists began studying wound infection in the late 1970s.[164]

When the ISR’s mission expanded to include inhalation burn injuries, Dr Gene Hubbard introduced sheep as the model of inhalation injury and published over 15 manuscripts presenting research results and treatment implications for soldiers recovering from smoke inhalation. His studies suggest that if initial toxic injury and inflammation can be controlled to prevent pneumonia, mortality rates should be reduced. Retired Army Colonel Basil A. Pruitt, Jr, MD, FACS, commander and director of the ISR for 27 years, summarized the overall contributions of veterinary pathologists such as Hubbard as follows: “they were true participants and added value in the research” and “they were key in the developments in wound infection, inhalation injury, and skin and tendon grafts” (oral communication, San Antonio, Texas, 2013).

More recent contributions by veterinary pathologists include research on Factor VII, a key component of the extrinsic clotting cascade[165]; topical hemostatic agents[166]; blood replacements[167]; tourniquets[168]; and safety evaluation of new hemostatic agents such as clay mineral smectite granules and kaolin-coated gauze in a vascular injury wound model in swine.169–171 Over 30 patents have been granted, and five designations for “Army Invention of the Year” have been awarded as a result of recent ISR medical countermeasures. These countermeasures also prompted life-saving modifications to the first-aid kits carried by deployed combat soldiers. Because of these changes, soldiers can now render self- and buddy-aid stabilization until definitive care is provided following evacuation to DoD and civilian hospitals.

FIELD OPERATIONS

Early Missions of Veterinary Pathologists

Much of the support mission of military veterinary pathologists is provided behind microscopes within the confines of various research institutes. Still, throughout history, military veterinary pathologists have served as field diagnosticians in more remote locations worldwide and near the front lines of global combat missions. Although the majority of this service is performed in the background (ie, assisting commanders to detect zoonotic diseases early—before troops are affected), deployed soldier-scientists have also undertaken more prominent roles to safeguard the combat strength of US and allied forces.

Several missions that veterinary pathologists have spearheaded warrant mentioning. One notable mission began decades ago when the AFIP developed an exchange program with the Onderstepoort Veterinary Institute (OVI) in South Africa. This cooperative venture lasted from 1963 to 1987; during its tenure, many US veterinary pathologists worked, conducted research, and lived in South Africa.

The OVI was established in 1908 by Swiss veterinarian Sir Arnold Theiler in the wake of a smallpox epidemic among miners in the Witwatersrand region of South Africa. The institute was founded as a center for diagnostics and vaccine production, and, under Theiler’s direction, it conducted research and prevention work on rinderpest (ie, morbillivirus), African horse sickness (ie, orbivirus), sleeping sickness (ie, African trypanosomiasis), malaria, East Coast fever (ie, Theileria parva), and various tick-borne diseases, including babesiosis and heartwater (ie, Ehrlichia ruminantium).[172]

The first military participant, Dr Robert M. McCulley, was assigned to Onderstepoort between 1963 and 1969. During his tour of duty, he studied parasitic infections of hippopotami in the Kruger National Park and took part in the discovery of Besnoitia cysts in blue wildebeest, leading to the production of a live vaccine to protect cattle against the disease.[173] He also studied hepatozoonosis in carnivores,[174] cytauxzoonosis in giraffe,[175] herpesvirus in elephants,176,177 and the parasites of kudu, bushbuck, and African buffalo.178,179

During their tours of duty at the OVI, subsequent military veterinary pathologists Dr Gene McConnell, Dr George Imes, and Dr John Pletcher collectively studied, catalogued, photographed, and published on the myriad diseases to be found in the South African wildlife. Examples of their work included the extensive study of baboon diseases, driven by an outbreak of Marburg virus in African green monkeys in Germany. The DoD was concerned about the potential introduction of a similar disease into the United States through wild-caught baboons destined for use in flight research.

While antibodies to the Marburg virus were not found in the native baboons, Dr McConnell’s extensive work on the Chacma baboon allowed the description of a novel parasite-host interaction upon the identification of coccidial oocysts within the skeletal muscle.180,181 Similarly, McConnell published manuscripts on nasal and laryngeal acariasis182,183; on cardiac, cerebral, and skeletal toxoplasmosis in baboons[184]; and on a case of reverse zoonoses in which myocardial tuberculosis was diagnosed in a baboon[185] that was exposed during capture.

Research by US military veterinary pathologists in South Africa was not limited to nonhuman primates, however. McConnell also reported about a case of anthrax in the African buffalo[186]; studied the pathology of exertional rhabdomyolysis in humans and both domestic and wild-caught animals[187]; and collaborated in the diagnosis and description of an abortion epizootic due to vibriosis in sheep.[188] Additionally, his work was pivotal to the identification and control of a transboundary foot and mouth disease outbreak in a region where eradication was deemed impossible due to the local populations’ cultural mores (oral communication, Washington, DC, May 22, 2012).

Later, images and materials garnered from McConnell’s OVI field operations were contributed to the AFIP and to the foreign animal disease diagnosticians course offered on Plum Island, New York. At this course, veterinarians from multiple areas of specialization and expertise are given hands-on training and familiarization with diseases not currently present in the United States, but which have high likelihood to be disastrous to the US agriculture economy should they arise in the United States.

While stationed at the OVI, Dr Imes conducted innumerable necropsies on hyena and lions; published manuscripts on initial descriptions of bovine protothecosis[189] and vitamin A deficiency in a lion cub[190]; examined and evaluated a trout mortality event due to streptococcus[191]; and reported the presence of coccidiae in the viscera of Nile crocodiles.[192] In one case, he reported on an interesting and obscure parasite behavior in which ticks congregated on lions’ ventral midlines in what was termed “tick islands.” He subsequently correlated the presence of ticks as the vector for blood-borne microfilaria that, on further study, were found microscopically present within sectioned ticks (oral communication, Washington, DC, May 22, 2012).

Dr Pletcher researched South African impala and warthogs, performing necropsies of these animals as part of a parasitology and disease survey of both species. The vast amount of data collected enabled the description of two associations: (1) between the nematode Cooperioides hepaticae and hepatic disease in impala[193] and (2) between the nodular abomasitis in impala lambs and the nematode Longistrongylus sabie.[194] Because of this work, a new species of filarial worm found microscopically infecting the lymph nodes of warthogs was also described.[195]

Emerging Force Protection Efforts

Although OVI research added much to the collective body of knowledge about animal disease, OVI data contributed more to homeland agricultural and economic defense. OVI study results continue to guide US preparations against emerging foreign animal diseases. By extrapolating from these earlier South African studies and through the study of both the macroscopic lesions photographed by these pathologists and the extensive archive of histopathological slides that they generated, the US Department of Homeland Security and the USDA have trained hundreds of civilian and military veterinarians to recognize and diagnose animal diseases foreign to US soil.[196]

Other veterinary pathology research has focused more specifically on force protection. For example, Dr Thomas Bucci, a veterinary pathologist who conducted missions in Egypt and the Sudan, concentrated on managing and controlling an epidemic of Rift Valley fever, a virus that affects humans and livestock. While Bucci’s primary responsibility of tracking arthropod-borne viruses was not the standard mission directive for a veterinary pathologist, he collected blood samples from animals and humans and identified 21 separate arthropod-borne viruses, including WNV, yellow fever, and Rift Valley fever viruses. He also conducted necropsies on, and scrutinized hepatic biopsies of, camels managed by the Egyptian Camel Corps. His research led to a more complete understanding of the epidemiology of a series of viral diseases of military importance and recognition of the zoonotic risk to deployed troops within the region (oral communication, Washington, DC, May 14, 2012).

Another mission with tangible connections to the battlefield is that of the Army veterinary pathologist assigned to the 520th Theater Area Medical Laboratory (TAML), activated in October 1995. The TAML was designed to be highly flexible and thus deployable: it was uniquely modular, tailored to varied missions, and equipped with high-tech, cutting-edge capabilities. In this unit, a military veterinary pathologist was embedded with a team of other military scientists because of the dual skill set the veterinary pathologist possessed: the veterinarian’s familiarity with diseases afflicting animal and human populations and the pathologist’s specialized ability to detect, identify, and describe diseases.

The TAML’s initial assignment was in December 1995 when it deployed to support stabilization forces in Bosnia-Herzegovina. It deployed again in the spring of 1998 to Kuwait as part of Operation Southern Watch. Army veterinary pathologists, in collaboration with biochemists, microbiologists, entomologists, and other AMEDD scientists, were sent on both missions to provide early gross and histopathological detection; diagnosis and confirmation of zoonotic diseases if biological warfare agents were employed in the area of operations against allied military forces; and assessment and diagnosis of environmental health risks.

At the onset of Operation Iraqi Freedom in March 2003, the TAML was embedded in the 86th Combat Support Hospital convoy heading north from Kuwait into southern Iraq. The convoy took approximately 2 days to reach the Iraqi Tallil Airbase, halting frequently to take protective posture from flyovers by tactical ballistic missiles (ie, SCUDs). For 10 months until redeployment in December 2003, the Army veterinary pathologist assigned to the TAML was involved in the unit’s fluid combat mission (Jo Lynne Raymond, Colonel [Retired], oral communication, Washington, DC, May 10, 2012).

The initial mission was to identify any potential weapons of mass destruction and to use rapid diagnostic assays to protect coalition forces if CBRN weapons were employed. When TAML personnel did not uncover any weapons of mass destruction, they addressed existing threats within the combat environment that might be significantly detrimental to the deployed troops’ combat efficacy, such as leishmaniasis.

Leishmaniasis is a protozoal disease responsible for significant morbidity among US military forces and allies throughout history. The organism is transmitted by the bite of phlebotomine sand flies, a species that also transmits the etiological agents of bartonellosis and pappataci fever. During World War II, about 1,200 cases of cutaneous leishmaniasis and 75 cases of visceral leishmaniasis were reported among Allied troops stationed in the Middle East. Both Israeli forces operating in the Jordan Valley during the 1967 Arab-Israeli Six-Day War and present-day personnel determined to be at risk among the multinational force and observers stationed in the Sinai Desert have experienced very high rates of leishmaniasis (50% among the former and 20% among the latter).[197]

From March 2003 to November 2004, the initial days of Operation Iraqi Freedom, 1,178 cases of cutaneous leishmaniasis were diagnosed in US military personnel, not accounting for civilian contractors, allied troops, or inherent underreporting by personnel afflicted with the disease.[198] Cutaneous leishmaniasis is also endemic in Afghanistan. The World Health Organization reported a significant resurgence of the disease since the early days of Operation Enduring Freedom in 2002. At that time, at least 250,000 individual cases were reported nationwide in Afghanistan, and of those, at least 200,000 were reported in Kabul alone.[197] (Cutaneous leishmaniasis typically presents as a self-limiting, ulcerative, and nodular dermatitis that can resolve into severely disfiguring scars.)

Early epidemiological medical assessments conducted prior to sending troops into Iraq did not initially account for the actual incidence rate of leishmaniasis encountered in theater. These assessments also failed to predict that sand flies would find a perfect habitat within the tent cities erected by the US military early in the conflict. Because of these mistakes, high numbers of military troops deployed without the necessary personal protective and preventive equipment; therefore, the exposure risk was extremely high. Even when troops did arrive with the appropriate gear, the extremely harsh environment and stifling heat resulted in personnel not using their protective equipment properly.

Scientists assigned to the TAML attacked the leishmaniasis problem cooperatively, capitalizing on the various medical specialties present and subdividing the tasks of identifying, understanding, controlling, and preventing the disease. For example, the TAML veterinary pathologist assisted preventive medicine entomology personnel, conducting an extensive assessment of the vectors and reservoirs of the disease.

All of the local wildlife, including feral dogs that roamed the base in packs, were assessed for the presence of leishmania. Necropsies were performed on trapped feral dogs, rodents, and small insectivores such as hedgehogs, in addition to a few lizards and snakes. Information garnered from histopathological assessment of tissues collected and local disease surveys established a map of animal reservoirs that eventually enabled construction of a risk assessment profile.

Such epidemiological studies help the DoD, especially in longstanding conflicts in which large numbers of troops move in and out of the theater of operations, potentially ending up in the military medical system once redeployed back to their home station. These epidemiological assessments educate military hospitals and the civilian medical system to ensure appropriate and quicker treatment of veterans who present with clinical signs of a foreign country’s endemic disease.[199]

In addition to the leishmania-specific postmortem surveys, military veterinarians conducted multiple humanitarian missions among the local Shi’ite tribesmen over the course of several months. While other military personnel conducted clinics for the Iraqi populace, veterinary officers performed herd health medicine by deworming sheep flocks; conducted basic field medicine on camels and a few cattle, chickens, and goats; and occasionally treated the rare semidomesticated dog or cat. When appropriate, veterinary officers also performed euthanasia and necropsy of severely ill animals and collected samples for histopathological assessment to add to the database on disease prevalence. The data collected on domestic animal disease prevalence is now proving invaluable; nongovernmental agencies rebuilding Iraq are using the accumulated information to improve the effectiveness and efficiency of their assistance.

The 502nd TAML elements were inactivated following deployment to Iraq in 2003 and reorganized into the more modular 1st and 9th Area Medical laboratories. These smaller deployable units are structured with the specific mission to provide rapid on-site diagnostic capabilities for the purpose of early health threat detection and confirmation and medical surveillance of various CBRN threats, as well as conditions associated with occupational, environmental health, and endemic diseases (Jo Lynne Raymond, Colonel [Retired], oral communication, Washington, DC, May 10, 2012).

SUMMARY

As this chapter briefly illustrates, the role of military veterinary pathologists is, by its very nature, dynamic. Military veterinary pathologists represent a small but diverse group of soldier-scientists whose research is necessary in an increasingly unstable world.

Since the end of the Cold War, ongoing diffusion of power from the bipolar geopolitics of the 1980s, which was governed by the United States and the Soviet Union, has developed into a global tapestry of failed nation states, such as the former Yugoslavia, Somalia, and Zimbabwe; extremist regimes within nations, such as Sudan, Niger, and North Korea; and political posturing by nations, such as Iran and Venezuela. Losing control of CBRN weapon stockpiles and regional instability also remain of critical concern in regions of India and Pakistan.

The world is also subjected to a revolution of technology and information, with terrorists possessing quick and easy access to both. Because of such instantaneous global threats, the US military is likely to continue devoting significant resources, strategic emphasis, and dedicated manpower to develop a protective shield against future attacks. In their mission to enable, support, and help evolve military research into effective medical countermeasures to combat modern CBRN threats, veterinary pathologists rely heavily on the research and the trained personnel provided by the DODVPR and on diagnostics. Military veterinary pathologists also seek to develop a better understanding of disease pathogenesis by studying the impact of these dangers in various government-owned laboratories and in combat and field environments.

Finally, the military veterinary pathologist has been a defender of the soldier and citizen in the past and will continue this role in the future. Pathologists are integral to basic research and discovery of new pathogens, vital to drug development, and critical to developing pertinent animal models for vaccine and therapeutic safety and efficacy. Contributions to scientific literature made by veterinary pathologists include reference texts, peer-reviewed journal manuscripts, military field manuals, and technical bulletins. These publications disseminate scientific discovery and crucial preventive and interventional strategies to promote biodefense and biomedical research.

Acknowledgments

The authors gratefully acknowledge the following current and past US Army Veterinary Corps veterinary pathologists who generously provided editorial assistance, technical advice, historical insights and material, and encouragement: doctors Terrell Blanchard, Tomas Bucci, Dale Dunn, R Keith Harris, George Imes, Todd Johnson, Thomas Lipscomb, Robert McCully, Robert Moeller, George McConnell, John Pletcher, Jo Lynne Raymond, Randall Rietcheck, and Bruce Williams, as well as Mr Sean Hahn.

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164.   Walker HL, McLeod CG, Leppla SH, Mason AD. Evaluation of Pseudomonas aeruginosa toxin A in experimental rat burn wound sepsis. Infect Immun. 1979;25:828–830.

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171.   Kheirabadi BS, Acheson EM, Deguzman R, et al. Hemostatic efficacy of two advanced dressings in an aortic hemorrhage model in swine. J Trauma. 2005; 59:25–34.

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176.   Basson PA, McCully RM, De Vos V, Young E, Kruger SP. Some parasitic and other natural diseases of the African elephant in the Kruger National Park. Onderstepoort J Vet Res. 1971;38:239–54.

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179.   Basson PA, McCully RM, Kruger SP, van Niekerk JW, Young E, de Vos V. Parasitic and other diseases of the African buffalo in the Kruger National Park. Onderstepoort J Vet Res. 1970;37:11–28.

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Chapter 16

VETERINARY BIOMEDICAL SCIENCE

CHAD C. BLACK, DVM, PHD*; JOHN M. CRAWFORD, DVM, PHD†; CHESSLEY R. ATCHISON, DVM, PHD‡; CINDY A. LANDGREN, DVM, PHD§; BRIAN D. MOORE, DVM, PHD¥; SANDI K. PARRIOTT, DVM, PHD¶; JAMES F. KOTERSKI, DVM, PHD**; JAMES W. BOLES, DVM, PHD††; DEBORAH L. WHITMER, DVM, PHD‡‡; SAMUEL YINGST, DVM, PHD§§; AND JENNIFER M. KISHIMORI, DVM, PHD¥¥

INTRODUCTION

VETERINARY BIOMEDICAL SCIENTISTS: AN OVERVIEW

Unique Skill Set

Scope of Duties

Mission Process

Role in Program and Product Management

Role in Department of Defense Policy

Special Missions

VETERINARY BIOMEDICAL SCIENTISTS: ANIMAL MODELERS

VETERINARY BIOMEDICAL SCIENTISTS: “BENCH” RESEARCHERS

DEPARTMENT OF DEFENSE MEDICAL RESEARCH LABORATORIES: A GLOBAL VIEW OF DIVERSE VETERINARY BIOMEDICAL MISSIONS

Military Medical Research in Infectious Disease

Military Medical Research for the Defense against Chemical Warfare Agents and Toxins

Military Medical Research for Defense Against Biological Warfare Agents

Military Medical Research in Physiology

Military Directed Energy Medical Research

Collaborative Medical Research in the Field

Military Medical Research in Toxicology

Biomedical Research at the Uniformed Services University of the Health Sciences

SUMMARY

*Major, Veterinary Corps, US Army, Chief, Drug Development Department, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland 20910

†Major, Veterinary Corps, US Army, Director of Field Operations, Armed Forces Institute of Medical Sciences, Enteric Diseases Department, US Army Medical Directorate-AFRIMS, APO AP 96546

‡Lieutenant Colonel, Veterinary Corps, US Army, Director Sponsored Programs, Research Directorate, US Army Institute of Surgical Research, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas 78234

§Lieutenant Colonel, Veterinary Corps, US Army, Division Chief (Acting), Warfighter Integration Division Chemical and Biological Technologies Department Defense Threat Reduction Agency, 8725 John J. Kingman Drive, Fort Belvoir, Virginia 22060

¥Lieutenant Colonel, Veterinary Corps, US Army, Director, Biocontainment, US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, Maryland 21702

¶Lieutenant Colonel, Veterinary Corps, US Army, Director, Force Health Protection/Command Veterinarian Clinical Operations Section 30th Medical Brigade, Sembach, Germany, Unit 29218, APO AE 09136-9218

**Colonel, Veterinary Corps, US Army, Director, Chemical, Biological, Radiological, and Nuclear Medical Countermeasures, Office of the Assistant Secretary of Defense, Health Affairs, Health Readiness, Policy and Oversight, 3M611, 7700 Arlington Boulevard, Falls Church, Virginia 22042

††Colonel, Veterinary Corps, US Army (Retired), Associate, Payson Pet Care Veterinary Clinic, 1010 North Beeline Highway, Payson, Arizona 85541

‡‡Colonel, Veterinary Corps, US Army, Commander, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, Maryland, 20910

§§Lieutenant Colonel, Veterinary Corps, US Army; Chief, Department of Epidemiology and Disease Surveillance, Armed Forces Research Institute of Medical Sciences, US Army Directorate, 31516 Rajvithi Road, 10400 Bangkok, Thailand

¥¥Lieutenant Colonel, Veterinary Corps, US Army; Director, Force Health Protection, US Army Medical Materiel Development Activity, 1430 Veterans Drive, Fort Detrick, Maryland 21702

INTRODUCTION

The US Army Medical Department (AMEDD) workforce is composed of medical and support professionals from several different employment categories to include civilian, contractors, and uniformed military. The AMEDD officers have been organized into six corps: (1) Dental Corps, (2) Medical Corps, (3) Medical Service Corps, (4) Medical Specialist Corps, (5) Nurse Corps, and (6) Veterinary Corps. The AMEDD further divides these corps into subspecialties called areas of concentration (AOC), which correspond with divergent medical missions, all supporting the US Army. Three AOCs within the Veterinary Officer Corps produce the majority of the corps’ medical research: (1) veterinary laboratory animal medicine (64C), (2) veterinary pathology (64D), and (3) veterinary biomedical science (64E). This chapter describes the unique roles the veterinary biomedical scientist (VBS) plays in the Department of Defense (DoD). The 64E is both an experienced doctor of veterinary medicine (DVM) and doctor of philosophy (PHD) in a medical research discipline. The VBSs work to solve some of the most challenging scientific and medical problems threatening the nation’s security. (See also Chapter 14, Laboratory Animal Medicine, and Chapter 15, Veterinary Pathology, for more information about the other two prominent medical research AOCs within the Veterinary Corps and about the various DoD research facilities where military medical studies are conducted.)

VETERINARY BIOMEDICAL SCIENTISTS: AN OVERVIEW

Unique Skill Set

As veterinarians, VBS officers are educated in the fundamental disciplines of biology, chemistry, pathology, pharmacology, physiology, and toxicology. They possess practical problem-solving skills gained through clinical experience. This educational and practical background, combined with a firm knowledge of research methodology, makes VBSs well prepared to conduct DoD research. In particular, their comprehensive knowledge of the diverse set of animal pathogens as well as the means to prevent and treat them are the key skills that enhance the VBSs’ capabilities for conducting research on DoD’s challenging medical threats.

Of the 40 pathogens listed in the Federal Select Agents that pose a severe threat to humans, 12 are animal pathogens or animals are a reservoir, and 11 are animal pathogens that pose a severe threat to animals.[1] Zoonotic pathogens with a primary animal host constitute the major offensive bioweapons for two likely reasons. First, modern animal pathogens’ interactions with the environment and potential human hosts are dynamic. Over time, as humans moved to cities, contact with animals decreased, leading to humans gradually being exposed to fewer and fewer animal pathogens, thus increasing the susceptibility of humans to those same pathogens. The complexity of these interactions have also increased because of advances in travel, increased urbanization, and encroachment into wildlife areas.2,3 Bioterrorists and other bad actors can take advantage of an immunologically naïve target population to enhance the effectiveness of a bioweapon.

Second, animal pathogens that can be processed for purposeful, malicious intentions with relatively unsophisticated means are readily available globally and relatively easy to store. Sometimes, a reservoir of agents and their processing facilities are cloaked under the guise of agricultural production or other dual-use technology. VBSs’ expertise in veterinary and zoonotic pathogens enables them to effectively conduct, manage, and lead research for bioweapons medical countermeasures.

VBSs are also uniquely qualified to support DoD chemical weapons defense missions. Veterinarians routinely educate clients on ways to prevent exposure to agricultural and household chemicals because—whether in agricultural or companion animal settings—humans unintentionally expose animals to chemicals that have similar properties to those used in warfare. Clinically managing an inadvertent intoxication is similar to treating exposure to a chemical threat agent of a similar class.

In clinical poisonings, veterinarians first recognize symptoms to identify the class of poison. Next, they deduce the likely causative agent. They then select the proper treatment or antidote, titrating that regimen to effect. Although not all poisons have an antidote, most chemicals have some regimen that can ameliorate the adverse effects or be supportive to the animal. Proper case management and preventive measures result from a thorough understanding of the exposure route, the mechanism of toxicity, and the pharmacodynamics of the therapy regimen. This knowledge and experience base prepares VBSs extremely well to conduct and support chemical weapons medical countermeasures research.

In addition to utilizing unique veterinary skills, as PHD graduates, VBS officers provide in-depth, specialized input based on their individual career paths that support DoD’s research needs. Traditionally, the VBS officers’ PHD studies focused on the shared fundamentals between animal and human medicine (quite often, the process and conditions of a specific disease behave similarly in several species). The study of these similarities and differences among and between species using basic and clinical sciences is commonly known as “comparative veterinary medicine.” In keeping with the prevailing designation, the US Army Medical Command (USAMEDCOM) originally titled the 64E AOC “veterinary comparative medicine officer.” However, by 2011, the specialty had evolved to include more sophisticated means to study many disease processes. These in vitro systems look at effects at the molecular, cellular, and tissue levels, devoid of animal models and less comparative in nature. USAMEDCOM then retitled the 64E AOC “veterinary biomedical scientist.”[4]

The AMEDD builds the VBS AOC in one of two ways: (1) a civilian veterinarian with a PHD in a medical discipline of interest to the DoD enters directly into military service as a VBS or (2) a relatively seasoned Veterinary Corps Officer (VCO) competes for the opportunity to obtain a PHD in a basic scientific discipline through Long-Term Health and Education Training and subsequently attends a medical, veterinary, or university graduate school PHD program. These routes bring diversely experienced individuals to meet DoD’s challenging medical threats. The scope of duties and assignments for these officers is also diverse.

Scope of Duties

The 64Es execute an array of duties at a number of positions across the DoD. Although most work in the US Army Medical Research and Materiel Command (USAMRMC) laboratories within the USAMEDCOM conducting research, some operate at other USAMEDCOM subordinate commands such as the Regional Health Commands (Provisional) and the Office of The Surgeon General, US Army. Key VBS billets also exist at US Navy laboratories within the Naval Medical Research Center (NMRC). Other DoD agencies and activities have billets for more senior VBSs such as the Uniformed Services University of Health Sciences (USUHS), the Defense Threat Reduction Agency (DTRA), and Health Affairs.

Those VBSs holding research and development positions throughout the DoD search for new products to battle numerous health threats to service members. A number of the adverse health effects studied by the DoD come from infectious disease; threat agents of chemical, biological, radiological, or nuclear (CBRN) origin; injurious environmental hazards; or toxic chemicals.

In addition to discovery research, VBSs also manage the development of research products starting from initial requirements generation and product inception. During early development, Army VBSs team with other professionals to determine a product’s proof of concept or proof of principle. The VBS role continues through advanced development, carrying the product through the regulatory process towards the final stage, US Food and Drug Administration (FDA) approval. The DoD and its partners fully evaluate candidate products; only those medical products approved by the FDA will be used by the DoD. Since these products fill unique needs in the DoD pharmacological armamentarium, policies must be in place prior to their clinical use. The VBSs and others promulgate these DoD policies at senior levels.

Mission Process

The 64E’s main mission is conducting scholarly research towards the development of medical defense products that have clinical and practical application to protect DoD personnel (and potentially others) from health threats, particularly those threats that are specific to the DoD. As noted in the previous section, this mission is guided by a process that starts with requirements, leads to discovery research and then development processes, and ends with deployment of the knowledge gained or a medical product. Gaining FDA approval, securing funding, and developing product policy are integral parts of this deployment. VBSs are among the few AOCs with the requisite skill sets to work the full spectrum of product development from product inception to developing policy on drugs, biologicals, and devices, because, as PHD researchers, they engage at the early stages of discovery and proof of concept studies. Nearly a quarter of the 64E population work products through the developmental stages. with the most senior VBSs managing product policy. Both roles take advantage of their DVM clinical skills (Colonel [Retired] James Boles, chapter author and The Army Surgeon General’s 64E consultant 2011–2015, personal knowledge).

As with all DoD research, requirements drive the medical research the VBSs conduct. The requirements strategy starts with an assessment of doctrine, organization, training, materiel, leadership and education, personnel, or facilities (DOTML-PF) identified through the Joint Capabilities Integration Development System (JCIDS). If the process determines that a material solution fills the gap, subject matter experts review preexisting materials for appropriateness. If no product exists, which is usually the case for military unique requirements, discovering and then developing a new product is often the means of closing the gap. Medical products designed to mitigate the adverse effects of CBRN agents and foreign infectious diseases often fall into the military unique category.

The medical materiel solutions approach employed by the DoD in the requirements stage always involves closing the capability gap to address threats that are military relevant. Military relevant drugs, biologicals, and devices, collectively known as medical countermeasures (MCMs), play a huge role in the prevention and treatment of disease and comprise a large segment of the 64E’s mission.

VBSs and others design, develop, and test proposed medical solutions. Unfortunately, the discovery of an MCM does not always proceed as desired. The DoD expects VBSs’ ideas and inquiries to evolve into experimentation and, eventually, a discovery or device to prevent or treat medical threats. However, in reality, VBSs’ experimental findings may only inform future studies, with the hope that further experimentation will finally lead to material solutions or changes in the way DoD operates to avoid the hazard. In other words, knowledge gained through 64E experimentation may alter the way the DoD uses existing personal or collective protective, detection, or diagnostic devices; tactics, techniques, and procedures; or even medical interventions. Other times, the experimentation has to cease and restart in another direction using the knowledge gained to define identified problems (eg, implementation) to determine the limits of a potential investigational drug or biologic.

As with discovery, development of MCMs is not necessarily step-by-step or linear either. Modern drug and biologic development is a complex process for several reasons, including the relatively high failure rate of new drugs and biologics. This forces developers to analyze cost-benefits in second generation or new prototype MCMs and plan accordingly to gain FDA approval. VBSs not only play a key role in product development, but also in gaining FDA approval, advancing only those products with the greatest chance for approval. An additional regulatory challenge stems from the ethical restriction of developing MCMs for threats that cannot be tested directly in humans. The “Animal Rule”[5] was established by the FDA to specifically address this dilemma, but it has been challenging to meet the human safety considerations with adequate pivotal animal study data. The specialized skills that enable VBSs to compare animal and human responses with study criteria are critical to the success of DoD MCM development.

In addition to navigating FDA approval, when possible, 64Es collaborate with industry to share costs and risks or gain a capability. For example, when working to find medical materiel solutions to military relevant threats that have broader societal implications, VBSs often partner with non-DoD commercial enterprises to help offset the additional costs in time and dollars required for broadening the labeling. As the end user for private companies is not limited to the typical DoD end user (ie, a healthy, 20- to 40-year-old service member), extra research must be conducted to ensure the materiel solution benefits the larger target group. By sharing the cost of expanding the label with non-DoD companies, the US government’s cost to develop the new solution may be less than if developed solely for service members.

In contrast, the limited ability to partner with others in the development of MCM for military unique threats may create funding challenges. For example, prior to the 2001 anthrax letter mailings, there was little interest in public or private investments in anthrax vaccine or antibiotics to thwart anthrax because the deliberate use of anthrax as a weapon was largely perceived as a military unique threat. However, after the general public learned about the tainted letters sent to civilian recipients, vaccine and antibiotic development against anthrax was energized (Colonel [Retired] James Boles, chapter author, personal knowledge).

Medical materiel solutions also may act as a deterrent to CBRN threats. If adversaries believe that US forces are well prepared to meet CBRN challenges, these enemies may be less willing to deploy CBRN agents. This deterrence is a multiplier when used in combination with the other elements of DOTML-PF geared toward avoiding or mitigating CBRN threats. Together, nonmedical DOTML-PF and medical materiel solutions make US warfighters a more difficult target for adversaries. This concept was made clear in the 2011 Deputy Surgeon Generals’ briefing on the small pox vaccine when two deputy surgeon generals commented that a vaccinated force is a positive medical readiness issue and a perceived deterrent (Colonel [Retired] James Boles, chapter author and The Army Surgeon General’s 64E consultant 2011–2015, personal knowledge). Thus, 64Es contribute to the complete development life cycle (from requirements through implementation policy) of DoD’s medical threats countermeasures.

One of the last tasks VBSs complete in the continuum of MCM product development is promulgating policy for warfighter use of developed products. In helping to develop preventive or therapeutic solutions and applicable use policies, 64Es support the AMEDD’s motto of “To Conserve Fighting Strength.”[6] These solutions should provide DoD service members not only the confidence that they can survive, but also that they can continue conducting the mission in environmentally hostile settings.

Although the concepts of conserving the fighting strength and deterrence each play a role in DoD policy decisions about the use of MCM, FDA labeling guides broader medical usage policy. FDA labeling includes specific information about a drug or biological such as its medical use, intent, and limitation information (the extent of its safe use in populations as a whole). DoD policies are linked to the broader FDA guidance and mandate MCM use on certain populations based on their risk of exposure to infectious or CBRN agents. For example, a number of DoD policies dictate mandatory use of antimalarials or vaccines and prophylactic drugs against CBRN agents (ie, antimalarials are required during operations within malaria-prevalent areas, while anthrax and small pox vaccines must be administered to personnel in high-threat areas). VBSs help create these policies to protect service members from harm in unique operational settings. No matter the population or operational setting, VBSs promulgate DoD policies according to FDA label instructions while addressing any special needs to better safeguard individuals at risk and the population as a whole.

Role in Program and Product Management

Program and product management is a required skill for all VBS officers. VBSs manage well-funded, large basic research programs in infectious disease, combat casualty care, military operational medicine, and congressional special interests. However, the ultimate goal of product and program management is to turn the research products of knowledge and materials into clinical drugs, biologics, devices, and diagnostics that protect service members against CBRN and other medical threats.

All VBS research programs depend on reliable funding, and the development of MCMs against the medical effects of weapons of mass destruction is no exception. The USAMRMC CBRN Defense Coordinating Office helps align MRMC CBRN-related research. This office, headed by a VBS, facilitates communications and interactions between the medical research community and the major funding agency, the Joint Science and Technology Office at DTRA. VBSs also provide crucial input on building the Program Objective Memorandum, which presents the planned allocation of available resources toward needed medical research over a 5-year period.[7]

Role in Department of Defense Policy

Currently, senior VBSs are positioned within the Office of the Assistant Secretary of Defense for Health Affairs and DTRA, where their experience in the community is leveraged to socialize and promulgate policy that can affect the DoD and interagency communities. VBSs are responsible for assisting a staff of physicians, nurses, scientists, and administrators and must understand MCM medical implications, the science behind their action, and potential adverse events. VBSs lead reviews on available FDA-approved products, those in early phases of study and those in advanced development. The VBS and staff are also responsible for promulgating policy regarding the use of MCMs in operational settings. Oftentimes, these policies direct select populations to follow product label instructions that are augmented with special instructions according to operational situations, including geographical settings or subpopulations at great risk.

VBSs serve a unique role in the development of CBRN MCMs and the science and technology (S&T) mission of DTRA. VBSs’ contributions include project management for a portfolio of chemical biological research studies; advising Regional Contingency Teams on medical issues such as recent Ebola outbreaks; strategic input to CBDP issues such as infrastructure support for the DoD laboratories that conduct chemical biological research; program-wide engagement seeking MCM development of cost and schedule improvement; representing the CBDP medical S&T in DoD medical research forums; and liaison with all the DoD laboratories partnered with the Joint S&T Office.

Special Missions

The 64Es also have opportunities to apply their unique skill sets during specific special missions. For example, in recent historical events such as the collapse of the former Soviet Union, VBSs utilized their specialized research skills and knowledge to strengthen vulnerabilities found in the scientific infrastructure security of biological agents. During the dissolution process, VBSs provided vital expertise and consultation to program leaders regarding the potential for collaborative efforts between the United States and former Soviet states for nonmilitary purposes (Colonel [Retired] James Boles, chapter author, personal knowledge).

During the Persian Gulf postwar period, several VBSs provided boots-on-the-ground expertise to United Nations Special Commission missions to Iraq and gave advice on potential biological threats. VBSs also were essential team members when making critical distinctions between the peaceful, and potentially nefarious, uses of scientific apparatus. Similarly, VBSs offered crucial skills and expertise during the 2001 anthrax letter mailings, supporting MRMC and MEDCOM missions via Operation Noble Eagle. Most recently, VBSs provided insight on the appropriate use of radiobiological MCM (ie, potassium iodide) during the 2011 tsunami and subsequent release of radiation from the Fukushima nuclear reactor (Colonel [Retired] James Boles, chapter author and The Army Surgeon General’s 64E consultant 2011–2015, personal knowledge).

Figure 16-1. Veterinary Bioscience Officer Deborah Whitmer, chapter author, served as a theater veterinarian and assisted an Agriculture Development Team’s veterinary capacity-building mission in Nangarhar Province, Afghanistan, during Operation Enduring Freedom. Whitmer, a lieutenant colonel during this mission, instructed fifth-year Afghan veterinary students on physical examination, necropsy, and pathology specimen collection methods.
Photograph courtesy of Colonel Deborah Whitmer.

Figure 16-2. Fundus photograph of multiple experimentally induced laser retinal lesions demonstrating variable visible injury. Left to right: Significant foveal lesion with overt hemorrhage into the vitreous; middle lesion with red rim and white center is indicative of retinal hemorrhage; upper right circular white lesion indicative of a minimal visible lesion. Injury variability is a function of the exposure dose and its location on retina, as well as the variables of the laser, including wavelength, pulse duration, retinal irradiance diameter, and pulse repetition frequency.
Reproduced from Whitmer DL, Stuck BE. Directed energy (laser) induced retinal injury: current status of safety, triage, and treatment research. US Army Medical Department Journal. January–March 2009:52.

VBSs can also deploy to assignments outside of their primary AOC. Assignment opportunities such as theater veterinarian provide myriad experiences, some that directly support operations and others that utilize the diversity of the 64E’s education and skills. For example, during deployments, VBSs have assisted host nations build veterinary capacity and capabilities and have facilitated training, including disease and injury prevention guidance (Figure 16-1 and Figure 16-2). Many times, the human and veterinary healthcare and issues encountered during deployments are closely related because the locations troops are sent to are often agrarian-based communities (Colonel Deborah Whitmer, chapter author, unpublished briefings on veterinary health sector development at International Security Assistance Force Health Sector Development Conference with Government of Afghanistan Ministry of Agriculture, 2010).

VETERINARY BIOMEDICAL SCIENTISTS: ANIMAL MODELERS

As noted earlier in this chapter, the VBS’s knowledge of interspecies differences facilitates a deeper understanding of unique host responses and disease processes. Scientists such as immunologists, physiologists, and microbiologists correlate endpoints or markers of protection in animals with those thought to be protective in humans. Protective drug studies also usually involve pharmacologists and toxicologists and, quite often, VBSs. Many times, the VBS handles the overall study design and is the subject matter expert for some aspect of the challenge agent, vaccine, or drug being tested.

As noted earlier in this chapter, VBSs often use a comparative medicine approach to extrapolate known and experimental findings in one species and apply them to another species of interest for the purposes of discovery. Using the comparative medicine approach to bridge the similarities and differences between species has dominated the VBS profession for years, especially when conducting efficacy testing of biologics and drugs. The observed differences sometimes lead VBSs to new hypotheses as to why the species behaved differently. Often, the differences have manifested as varying sensitivities to specific disease-causing agents, which leads to the discovery of new ways to disrupt a disease agent’s deleterious effects (eg, clinical signs and symptoms). In other instances, analysis of the observed differences resulted in a better understanding of an agent’s mechanisms of entry and action. The 64E’s analysis of the comparative host species’ defense mechanisms is instrumental when developing medical interventions designed to interrupt key events in a particular agent’s pathogenesis.

Another aspect of comparative medicine studies is predictive modeling, which utilizes interspecies differences to plan, affect, and interpret the testing of hypotheses using animals as models. In this construct, VBSs conduct detailed studies in a test species, draw conclusions from the data, and then extrapolate the animal findings to human medicine. Although VBSs seek a simple, well-designed study that extrapolates easily to humans, in reality, there are no perfect animal models and sometimes no single model that extrapolates well. Interspecies differences create limits in the modeling of human disease in animals, and 64Es must know the limits of any given animal model to best match it to the study’s intent and experimental conditions. Often the limit is caused by the way and degree to which etiological agents gain entry into different species and eventually affect their molecules, cells, tissues, organs, and organ systems. Since biological systems are prone to variation, often 64Es must use multiple animal models to support complex studies to produce improved predictive data on the efficacy of drugs and vaccines in humans.

VETERINARY BIOMEDICAL SCIENTISTS: “BENCH” RESEARCHERS

VBSs recently graduated from their PHD programs apply their academic experience with new technologies at the laboratory “bench” in the Army’s laboratories. These VBSs’ knowledge of improvements in experimental design as well as diagnostic and imaging technologies allow them (with other scientific officers) to start answering questions that were impossible to respond to only a few years ago.

Today’s more sensitive technologies have helped scientists uncover previously unidentified factors in cellular life processes that lead to cell or organ death. In addition, developments in molecular biology are applied by VBSs through relevant modeled in vivo studies to explain the roles certain genes play in response to simulating medical threat stimuli or events. For example, an environmental contaminant may elicit a specific response in a normal mouse. However, differences may occur in responses to that same environmental contaminant in mice that lack a gene of interest or in transgenic mice with multiple copies of the same gene. Changes in response between these study groups can be attributed to the targeted gene; these response findings would have seemed unfathomable before this type of genome manipulation became possible.

DEPARTMENT OF DEFENSE MEDICAL RESEARCH LABORATORIES: A GLOBAL VIEW OF DIVERSE VETERINARY BIOMEDICAL MISSIONS

US Army VBSs work in DoD laboratories scattered throughout the globe, from relatively remote sites in the field or in OCONUS (outside the continental United States) laboratories to state-of-the-art facilities in the national capital region. The MRMC- and NMRC-based laboratories and their subordinate CONUS (Continental United States) laboratories are the services’ laboratories to conduct research and testing in infectious diseases, CBRN defense, environmental stressors, surgery, and material toxicity.

Among the MRMC CONUS laboratories, USAMEDCOM assigns VBSs to the Walter Reed Army Institute of Research (WRAIR), the US Army Medical Research Institute of Infectious Diseases (USAMRIID), the US Army Medical Research Institute of Chemical Defense (USAMRICD), the US Army Research Institute of Environmental Medicine (USARIEM), and the US Army Institute of Surgical Research. The OCONUS laboratories with VBS assignments are the Armed Forces Research Institute of Medical Science in Bangkok, Thailand (a subordinate directorate of WRAIR), the Naval Medical Research Command (NMRC) Naval Medical Research Unit 3 (NAMRU-3) in Cairo, Egypt, and NAMRU-2 in Phnom Penh, Cambodia. (See Figure 14-1 in Chapter 14, Laboratory Animal Medicine, for a more comprehensive listing of laboratory site locations, CONUS and OCONUS.)

The OCONUS laboratories provide access to endemic infectious disease agents not found elsewhere, as well as the vectors and human populations naturally exposed to them. These laboratories also provide a staging platform to conduct studies in even more remote locations harboring infectious disease agents and vectors (eg, jungle rainforests only accessible by boat or foot). When study requirements exceed the local capacity of the OCONUS laboratory, VBS personnel are able to contact their peers at the MRMC and NMRC laboratories for support.

In addition to the MRMC and NMRC laboratories, VBSs have been routinely stationed at the Army Public Health Center (APHC). APHC supports the Army’s only Good Laboratory Practices toxicology laboratory, which investigates the toxicity of material with potential health hazards or effects on the Army’s operational environment.

In most duty assignment locations, the VBS works with other military research professionals to produce scientific products. One exception to the VBS being stationed in laboratories or in product-oriented institutes is the VBS who has been assigned to an academic position at the USUHS. The VBS’s mission in this academic setting has been to support and further the myriad research endeavors at the USUHS, not produce medical products per se.

Military Medical Research in Infectious Disease

The WRAIR is the Army’s flagship organization for infectious disease research. VBSs at WRAIR conduct research projects in a variety of scientific disciplines (eg, bacteriology, parasitology, and virology), performing bench work; serve in research management positions, leading and managing the projects; and even have served as the institute’s commanding officer.

Bacteriology

VBSs are an integral part of the burgeoning antimicrobial-resistance and wound-infection research effort at WRAIR. This effort was initiated in 2009 in response to an increase in antibiotic-resistant nosocomial pathogens infecting trauma wound patients from Operations Iraqi Freedom and Enduring Freedom.8,9 Isolate collection procedures were established in theater and throughout military health systems to capture ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) from affected patients. These multidrug-resistant isolates were phenotypically and genetically characterized and catalogued for follow-on use in drug discovery research.[10]

The WRAIR’s multidisciplinary antimicrobial-resistance team consists of infectious disease physicians, microbiologists, biochemists, and VBSs. The VBS’s initial research role was to develop foundational animal models that were capable of establishing infection in wounded tissue using the military-relevant multidrug-resistant ESKAPE isolates and measuring treatment effects of novel topical and systemic antimicrobial treatments. The team created mouse, rat, and pig models of wound infection. The mouse model is now well established and is utilized by DoD, academic, and industry researchers as a key preclinical assessment of the efficacy of candidate antibacterial compounds.11,12

VBSs also are applying the same molecular and epidemiological methods used in human studies to characterize the spread of multidrug-resistant bacterial pathogens in military working dog (MWD) populations, partnering with the DoD Food Analysis and Diagnostics Laboratory and the DoD MWD Veterinary Service to complete these animal studies.[13] The human and animal population goals are the same: identify best practices to prevent pathogen dissemination and create effective therapeutics to treat the infections that occur.

Parasitology

Parasitic diseases such as malaria continue to plague humanity and are a medical threat to DoD personnel deployed to areas where the organism and the vector are endemic. Malaria has the highest global mortality of all parasitic diseases, killing as many as 450,000 people each year, primarily children in Africa.14,15 VBSs play a critical role in the basic science of determining targets for interrupting the life cycle of malaria parasites. Although disease prevention is the preferred approach to countering malaria, effective treatment of this debilitating and lethal disease is also necessary. VBSs elucidate immunological targets for vaccines and discover prophylactic drugs, as well as drugs designed to safely rid the host of the parasite.

Along with laboratory animal medicine veterinarians, VBSs also actively develop animal models for testing vaccines and therapeutics.[16] The importance of animal models in malaria testing of vaccines and therapeutics is twofold: (1) the complex genome of the malaria parasite makes external gene manipulation difficult and (2) the host-parasite relationship necessary to sustain a viable parasite complicates in vitro testing. Animal models play a pivotal role in addressing these issues in both research and efficacy testing.[17] VBSs also assist in human studies that determine safety and efficacy of next generation antimalarials by conducting bench analysis of samples and managing animal models used prior to human trials, as well as managing the DoD research programs and laboratories that conduct these studies.

Virology

VBSs take part in the disease surveillance and diagnosis of viral illness in overseas DoD and Department of State personnel, leading to a greater understanding of the epidemiology and importance of a number of viruses. VBSs have studied the isolates from viral surveillance programs to determine mechanisms of pathogenicity for zoonotic pathogens such as West Nile virus and avian influenza. These studies have increased the proficiency and accuracy of viral identification, including novel pathogens, utilizing next generation sequencing.18,19

Military Medical Research for the Defense against Chemical Warfare Agents and Toxins

VBSs at the USAMRICD contribute to the development of MCMs that protect personnel against the medical effects of chemical warfare agents, toxins of biological origin, and toxic industrial chemicals. USAMRICD research supports both US warfighters through DoD-funded research as well as US civilians via National Institutes of Health-funded projects. VBSs serve as co- or principal investigators on research projects addressing relevant exposure routes (ie, inhalation and percutaneous) of traditional nerve agents, vesicant (blister) agents, and toxic industrial products such as cyanide and phosgene, and nontraditional chemical agents.20,21

VBSs support research projects at USAMRICD by implementing innovative research tools and models that contribute to the three R’s that commonly guide animal use in DoD research: (1) reduction, (2) refinement, and (3) replacement.[22] (See Chapter 14, Laboratory Animal Medicine, for more information about legislation and regulations regarding animal use in DoD research.) The 64E surgical support to implant improved telemetry instrumentation with multiple specialized and sophisticated physiological monitoring leads is an example of one such VBS innovation. This telemetry allows the collection of vast amounts of data in group-housed, instrumented animals. These data are not compromised by the frequent manipulation of the animals by handlers. This results in fewer variables affecting the physiological responses to chemical agent exposure and detection of MCM therapeutic effects. VBSs’ expertise also introduced another alternative research approach: expanding animal models to include zebrafish (Colonel Deborah Whitmer, chapter author, personal knowledge).

Additionally, VBSs have served in multiple leadership roles at the USAMRICD, from the branch and division chiefs and the commander’s planning staff to deputy commander and commander levels. Frequently, they hold these leadership and resource management positions while concurrently being actively and directly engaged in research. VBS officers’ contributions to USAMRICD’s chemical agent and biotoxin MCM research programs have directly contributed to the development of a novel therapeutic product—human serum butyrylcholinesterase—advancing this prophylaxis to the development stage of the DoD medical product acquisition process.[23]

Military Medical Research for the Defense Against Biological Warfare Agents

VBSs are involved in vaccine development as MCMs at many levels within DoD research. One vaccine development example at the USAMRIID involved the nonclinical evaluation of a DNA-based vaccine against lethal hantaviruses delivered via an FDA-cleared, handheld, needle-free jet-injection device (PharmaJet Stratis Needle-Free Injector; PharmaJet, Inc, Golden, Colorado). The study demonstrated that delivery of these vaccines via the handheld device induced binding and neutralizing antibodies in the serum in rabbits and nonhuman primates.[24] Previously, these DNA vaccines were shown to be protective against viral challenge but historically had required more complex techniques such as formulation with gold-beads and gene-gun injection or delivery via electroporation.[25] Unlike gene-guns or electroporators, the PharmaJet Stratis Needle Free Injector does not require any power source or compressed gases.

Typically, DNA vaccines are rapidly scalable, have specific targets, and have less stringent refrigeration needs. These aspects, coupled with the stand-alone PharmaJet device, offer much potential as a deployable MCM for the DoD. This combination of a DNA vaccine and needle-free delivery device, if effective in humans, will offer MCM protection that US forces could quickly field and rapidly scale for large-volume production in emergent situations.

VBSs at the USAMRIID also have been instrumental in describing the efficacy of the current anthrax vaccine (Biothrax, Anthrax Vaccine Adsorbed, or AVA; Emergent Biosolutions, Rockville, Maryland) and managing its development. VBSs were principal investigators for studies describing the effects of anthrax (Bacillus anthracis), staph enterotoxin B (Staphylococcus aureus enterotoxin B), botulinum neurotoxins (Clostridium botulinum toxins), and other biological agents in a number of animal species for the purpose of developing MCMs.26–28 These studies led to more definitive animal models that will lay the groundwork to support efficacy testing of future vaccines, treatments, and diagnostics.

Relevant animal models to support biodefense MCM development are essential, and VBSs draw on integration of their clinical and scientific expertise to develop sound and valid research models. As clinical efficacy trials are not possible with the majority of these pathogens, FDA licensure via animal efficacy studies is the critical path for most biodefense MCMs. VBSs study clinical parameters that can be extrapolated from animals to humans to support such critical paths. For example, a VBS study of nonhuman primates infected with Venezuelan equine encephalitis virus using cDNA microarrays and real-time PCR resulted in identification of molecular markers of early and late viral infection.[29] The study further characterized how host genes are altered in response to Venezuelan equine encephalitis virus, which could serve as clinical parameter endpoints or drug or vaccine development animal studies or clinical trials. (For more information about the treatment for this virus and other infectious agents and the control of zoonotic diseases that affect military personnel and public health, see Chapter 11, Zoonotic and Animal Diseases of Military Importance, and Chapter 13, Global Zoonotic Surveillance and Control.)

VBS scientific and military relevant contributions are also evident in development of assays used in biodefense. Early VBS-initiated work led to the development and implementation of a high-throughput assay to measure neutralizing antibodies against lethal viruses such as Sin Nombre virus and Andes virus.24,30 This assay was subsequently used in animal studies and clinical trials evaluating Ebola vaccines in response to the 2014 outbreak in West Africa.31,32 Collaborative work among the VBSs, Medical Service Corps officers, and civilian scientists at USAMRIID, USAMMDA, and the Joint Program Manager-Medical Countermeasure Systems (Diagnostics) resulted in the DoD deploying the first diagnostic test for Ebola virus infection under the FDA-issued Emergency Use Authorization process. This process enables clinical use of an investigational assay; this rapidly developed accurate diagnostic assay was deployed throughout the United States and to DoD overseas clinical laboratories in response to the 2014 Ebola outbreak in West Africa.[33] (More detailed information on the US Army veterinary response to Ebola and other disease prevention and public health missions can be found in Chapter 1, Military Veterinary Support Before and After 1916.)

VBS perform a vital role in coordinating critical and complex antibiotic resistance determination and testing of antibiotic MCM to treat diseases such as anthrax, glanders, meliodiosis, plague, and tularemia, all of which pose a significant risk to the warfighter.[1] Several cooperative research and development agreements with various pharmaceutical companies and universities led to the testing of nearly 200 unique compounds. VBS-supported research at USAMRIID also identified antibiotics to treat battlefield-related infections caused by multidrug-resistant microorganisms. VBSs’ efforts determined susceptibilities to 45 antibiotics for 30 genetically and geographically diverse strains of Yersinia pestis. These findings provide reference information for assessing new antibiotic agents and a baseline to monitor the emergence of resistance.[34] Other VBSs’ efforts identified novel compounds effective against tularemia and anthrax.[35]

Sometimes original solutions to complex problems come from unexpected sources, and VBS creativity often bridges these resource gaps. For example, how can a healthcare provider properly diagnose ill patients in developing countries or in theater when traditional tests require refrigerated storage? Often these fragile items sit in delivery trucks, on airport tarmacs, or in holding facilities at ambient temperatures, arriving nonfunctional at the point-of-use.

To address this challenge, VBSs sought a solution, and they discovered that cartilaginous fish and camelids produce a unique form of antibody, termed sdAbs, that retains functionality independent of storage temperatures.[36] Diagnostic tests based upon sdAbs are not constrained to narrow storage criteria; in fact, these diagnostic assays remain functional after exposure to near boiling temperatures, harsh chemicals, or contact with enzymatic digestion.[37] Both sharks and alpacas were vaccinated with BSL-4 hemorrhagic viral antigens, their sdAbs were collected, and inclusion of these antibodies in diagnostic assays yielded comparable data to traditional platforms.[38]

Military Medical Research in Physiology

VBSs at the USARIEM are recognized for their contributions to environmental extremes research such as the effects of heat, cold, and terrestrial altitude on human performance, health, effectiveness, and nutritional needs. USARIEM VBSs have served in key support and staff roles (ie, attending veterinarian and executive officer) as well as in the vital leadership role of USARIEM commander. VBSs at USARIEM have contributed to and produced performance optimizing and preventive medicine doctrine, health hazard assessments, and predictive algorithms for operational decision aids.[39] They have also provided clinical support of the research animal colony, conducted research as co-principal investigators, or supported projects through direct veterinary clinical skills on research protocols.

VBS leadership and collaboration was instrumental in USARIEM meeting a challenging new human performance mission in support of the Training and Doctrine Command. USARIEM conducted the physical demands study component of Training and Doctrine Command’s requirement to determine the physical standards for combat military occupational specialties opened to female soldiers. The impact of USARIEM’s study will have a lasting effect on US Army policy and manpower utilization based on rigorous evidence-based research (Colonel Deborah Whitmer, chapter author, personal knowledge).

However, USARIEM environmental research is not limited to just humans. Recently, the Army extended a study on the impact of environmental factors on mission capability to canine performance. VBSs have assisted in evaluating CBRN protective shelters for MWDs to combat negative physiological effects such as overheating. In this study, VBSs are using remote sensing to determine the effects of heat on MWD performance. (Remote monitoring of physiological parameters during military operations may serve as an early indication of physiological stress leading to performance degradation.) Although this ongoing study is focused on MWDs, the results may have applicability to humans as well. Eventually, leaders may use remotely monitored physiological parameters to determine that a mission or training event should be modified or terminated (Colonel Deborah Whitmer, chapter author, unpublished data, 2012).

Military Directed Energy Medical Research

VBSs have worked as collaborative members of Tri-Service and Army research teams to address directed energy (DE) medical threats. VBSs at the US Army Institute of Surgical Research have served as principal investigators using animal and nonanimal (cell-based) models for development of protective eyewear and treatment options for DE (laser) ocular injuries.[40] VBSs have also actively participated in team assessments and analysis of the conditions and clinical evaluation of suspected ocular injuries secondary to laser exposure in human patients (Colonel Deborah Whitmer, chapter author, personal knowledge).

Military uses of DE sources include lasers and high-powered microwave generators. The military application and numbers of DE devices on the battlefield is increasing dramatically. Examples of common military applications include target designators, live-fire training devices, illuminators and dazzlers, and range finders. The potential for ocular injury from the high-powered yet hand-held devices commonly used are significant (Figure 16-3a–d). This dynamic research area is linked to a preventive care force protection mission as well as establishing DE-safe ocular exposure thresholds.[41]

Collaborative Medical Research in the Field

VBSs support and conduct DoD research in numerous OCONUS laboratories in collaboration and coordination with the host nation’s government and medical and scientific staffs. Host nations may not favor multinational studies, especially when their local governments perceive few benefits or feel exploited. However, the presence of DoD OCONUS laboratories has, and continues to signal, a long-term commitment by the United States to fund and conduct regionally relevant disease research.

A symbiotic relationship can be created when the host nation facilitates the research and the DoD provides technical and financial support: in the end, both parties benefit from the training provided and the medical knowledge derived. While collaborative disease outbreak investigation under field conditions is not necessarily a fundamental or an exclusive role of the overseas laboratories, OCONUS laboratories are uniquely positioned and staffed for this type of mission. NAMRU-2, NAMRU-3, and the Armed Forces Research Institute of Medical Sciences all maintain VBSs on their manning documents.

The American Veterinary Medical Association defines “One Health” as the collaborative effort of multiple disciplines—working locally, nationally, and globally—to attain optimal health for people, animals, and the environment. As the concept of “One Health” becomes more firmly established within the public health community, VBSs assigned to overseas laboratories may play even more prominent roles in zoonotic infectious disease research, continuing to focus on serious force health protection threats such as anthrax, brucellosis, Q fever, plague, Rift Valley fever, and influenza. (See Chapter 13, Global Zoonotic Surveillance and Control, for more information about the “One Health” concept.)

In 2006, such an opportunity occurred when H5N1 avian influenza spread throughout Asia. Veterinary officers assigned to NAMRU-3 responded to disease outbreaks in Turkey, Iraq, and Afghanistan. These officers translated the outbreak response into immediate molecular epidemiology research efforts that contributed to global H5N1 genetic research and later established longer-term collaborative research efforts. Veterinarians assigned to the overseas laboratories have also worked through host country governments to develop or enhance avian, pandemic, and seasonal influenza preparedness and diagnostics in Afghanistan, Armenia, Azerbaijan, Bulgaria, Egypt, Iraq, Jordan, Kazakhstan, Kyrgyzstan, Macedonia, Nepal, Oman, Pakistan, the Republic of Georgia, Sudan, Tajikistan, Thailand, Turkmenistan, Ukraine, and Uzbekistan (Colonel [Retired] James Boles, chapter author, personal knowledge).

Figures 16-3a–d. Retinal lesions created by Argon lasers (directed energy) (DE) in a nonhuman primate models injury pathology and response to treatment for human DE retinal injuries. The panels shown are from the same right eye over a 30-day period. (a) Non-injured baseline retina photograph with fluorescein angiography (FA). (b) View of 3 days post-argon laser lesions with topical ocular medications and intravitreal injection treatment photograph FA. (c) View of 3 days post-injury with treatment optical computer tomography scan (OCT) demonstrating depth and specific layers of retinal injury. (d) View of 30 days post-injury with treatment OCT scan demonstrating progression of retinal tissue repair.
Images and data provided courtesy of an Institute Animal Care and Use Committee (IACUC)-approved protocol and Colonel Deborah Whitmer, chapter author.

Military Medical Research in Toxicology

Evaluating Military Materials

The Army acquisition process requires a health hazard assessment and a toxicity clearance for all new materiel proposed for entry into the Army supply system.[42] The program manager is responsible for selecting the material and ensuring that it is safe prior to use. Material assessments may be conducted on something as simple as a proposed commercial lubricant for weapons cleaning, a change in the formulation of a silicon liner in a facemask, or the potential human health exposures of redesigned munitions.

VBSs contribute to the scientific direction of the Army’s testing facility for toxicology of environmental and occupational exposures at the APHC. This laboratory determines hazard levels for military unique substances within the Army’s garrison and operational environments. Veterinary toxicologists play a vital role in translating research and environmental data into exposure limits to delineate what constitutes a “safe” level of exposure. The resultant hazard determinations influence the composition and use of weapon systems and equipment.

Additionally, because some materials (munitions, for example) have the potential to concentrate in training ranges over time, the chronic environmental contamination of these materials above “safe” levels of environmental or occupational human exposure levels could eventually limit the continued use of these contaminated training locations. In some cases, the technology is so new or militarily unique that insufficient information is available regarding the proposed components or the potential levels of soldier exposure. For these substances, VBSs conduct or support studies to provide better estimates of the potential human health impact should exposures occur.[43]

As VBSs develop original studies for material development assessments, several factors must be considered, coordinated, and integrated into the study design. Original studies require a collaborative effort to validate the chemical characteristics of the proposed formulation, physical characteristics in the environment of use, and accidental exposure scenarios that may occur. VBSs must incorporate all this information when making a recommendation of whether to use a major safety component of a weapons system. An example of the necessity and beneficial outcome of VBS-derived material toxicological studies occurred when APHC VBSs, in collaboration with investigators at the Armed Forces Radiobiological Research Institute, demonstrated that the toxicological effects of a promising replacement alloy for depleted uranium was unacceptable because of the high incidence of cancers in rodents.[44] (VBSs managed the Good Laboratory Practices toxicological studies conducted at APHC that led to this determination.)

VBSs also helped make a material decision regarding Army signal devices. Research has shown that repeated exposure to dyes in military training and operational environments could cause adverse health effects.45–48 Inhalation studies performed at APHC provided data that helped identify safe exposure levels of several proposed alternative colors for use in signal devices.[49] VBSs played a vital role in this testing by developing a viable animal model for inhalation exposure and designing inhalation chambers that would accurately and repeatedly dose test animals.[46]

Other VBS material studies focus on the health risks presented by certain weapons systems’ propellants, including perchlorate, cyclotrimethylenetrinitramine (an explosive known as RDX), chromium, lead, and other minor components of munitions.50,51 Additional potential routes of toxicant exposure from weapons systems include occupational exposure by production workers or ordinance personnel due to direct contact or inhalation following detonation.

As development of signal devices, material, and ordinance evolves, the potential for toxicological effects and inadvertent environmental contamination increases as new propellants are proposed and chemical characteristics of the mixtures change to meet different functional requirements. VBSs will continue to support and manage the research to evaluate these new formulations, with the goal of producing safer operational materials and training environments for US military members.

Evaluating Environmental Exposures

DoD public health leaders consult VBS toxicologists during and after any toxic event affecting the military environment, including the potential contamination of the food supply. The Deepwater Horizon oil spill that occurred in April 2010 in the Gulf of Mexico is one example of such contamination.[52] Of particular concern was whether the dispersants used to capture the ongoing oil spill (or their metabolites) would accumulate in food sources such as shellfish at potentially harmful levels. APHC, working with other DoD and federal agencies, developed a new assay to detect propylene glycol and 2-butoxyacetic acid and ensure seafood safety. APHC Laboratory Sciences personnel also validated the assay for reliability and accuracy to ensure a protocol was available for any subsequent oil spill catastrophes (Lieutenant Colonel Cindy Landgren, chapter author, personal knowledge).

Biomedical Research at the Uniformed Services University of the Health Sciences

At the USUHS Biomedical Instrumentation Center, VBS officers facilitate and coordinate the use of core research facilities in the health professional school of the armed forces. The facility includes microscopic imaging (electron, confocal, and fluorescent); translational imaging (positron emission and magnetic resonance); biochemical characterization (flow cytometry); proteomics and structural biology (mass spectrometry and crystallography); and genomics. The tools provided by the Biomedical Instrumentation Center inform and enable innovative research in a wide variety of disciplines, ranging from anatomy to zoonotic disease. Most notable of late is the application of these tools to investigate the pathogenesis and therapy of traumatic brain injury.[53]

The VBS also provides instruction for medical, nursing, and graduate students; advises the university on the instrumentation aspects of the research portfolio; and serves as a liaison between the academic and the administrative sides of the institution. Thus, the veterinary biomedical science staff plays a key team role at the USUHS in the continuing goal to provide and maintain a state-of-the-art core facility.

SUMMARY

The majority of adverse health effects encountered in the military come from infectious disease, threat agents of CBRN origin, toxic chemicals, and injurious environmental and occupational hazards. VBSs are frequently called upon by DoD leaders to answer critical questions related to these threats based on their specialized expertise in clinical practice, basic and applied research, product development, project management, and policy development. The VBSs’ knowledge on route, mechanism of toxicity, and drug pharmacodynamics is critical to identifying targets of intervention in chemical weapons defense research.

VBSs are also involved in myriad project and product management activities leading to approval and licensure of medical drugs, biologics, devices, and diagnostics to assist military service members and civilian communities worldwide. Veterinary biomedical science research on vaccines, drugs, antidotes, infectious disease, ocular injuries, toxins, and chemicals, together with global biosurveillance and countermeasures, are among their many contributions to military and public well-being.

In addition to being highly specialized officers, like other members of the Veterinary Corps, VBSs have deployed to fulfill missions outside their primary area of expertise while serving in positions that can make optimal use of their leadership qualities. Locally, nationally, and globally, the VBS officer is a key contributor to attaining optimal health for people, animals, and the environment through research.

Acknowledgments

The authors would first like to thank the superior technical editing skills of US Army Colonel (Retired) Peter Schultheiss. Without his efforts, the chapter would have missed several key points the authors would be remiss in conveying. In addition, the clarity and flow of the chapter would not have been the same without the keystroked comments from Ms Carrie Vander Linden, Public Affairs Officer, USAMRIID/USAMRMC. The authors thank them both.

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Section VI: Unconventional Missions and Other Evolving Services

The commander of the 51st Medical Detachment Veterinary Medicine, 248th Medical Detachment, checks an opened mouth of an unconscious young tiger March 24, 2010, at the Baghdad Zoo. The cooperation of Iraqi zoo workers and US Army veterinary forces during nation-building efforts at the zoo (eg, treating a tiger cub patient) was necessary to rebuild the zoo and save unconventional patients’ lives.

Photograph: By Sergeant Phillip Valentine. https://www.army.mil/article/36504/iraqi_us_veterinarians_
partner_to_help_baghdad_zoo_animals. Accessed April 26, 2018.

Chapter 17

VETERINARY SUPPORT IN THE IRREGULAR WARFARE ENVIRONMENT

PAUL HOLLIER, DVM, MPH, MPA*; JANICE BAKER, DVM, MS†; JAMIE BROWN, DVM‡; CHARLES DODD, DVM, PhD§; JERROD KILLIAN, DVM, MPH¥; LAURA MILLER¶; AND SAMUEL YINGST, DVM, PhD**

INTRODUCTION

HEALTH SERVICE SUPPORT AND RISK COMMUNICATION

VETERINARY SUPPORT TO TACTICAL CANINE PROGRAMS

The Tactical Canine Program Team

Combat Trauma and Canine Tactical Combat Casualty Care

Operational Hazards and Performance Considerations

Canine Emergency Planning and Tactical Medical Evacuation

BUILDING ANIMAL HEALTH CAPACITY

Global Animal Health Environment

Animal Health Activities and Engagements

Animal Health Surveillance Capacity

SELECTION, TRAINING, AND EDUCATION CONSIDERATIONS

Selection Criteria and Value

Canine Operational Medicine

Global Veterinary Medicine

SUMMARY

*Lieutenant Colonel, Veterinary Corps, US Army; Chief, Veterinary Support to Stability Operations, Department of Defense Veterinary Service Activity, 7700 Arlington Boulevard, Suite 5140, Falls Church, Virginia 22042

†Colonel, Veterinary Corps, US Army; Command Veterinarian, Joint Special Operations Command, Malvesti Road, Fort Bragg, North Carolina 28313

‡Major, Veterinary Corps, US Army; Regimental Veterinarian, 75th Ranger Regiment, 6420 Dawson Loop, Fort Benning, Georgia 31905

§Colonel, Veterinary Corps, US Army; Commander, 248th Medical Detachment (Veterinary Service Support), Building M-3019, Service Street, Fort Bragg, North Carolina 28310

¥Colonel, Veterinary Corps, US Army; Command Veterinarian, US Army South, 4130 Stanley Road, Building 1000, Joint Base San Antonio-Fort Sam Houston, Texas 78234

¶Master Sergeant, Veterinary Services, US Army; Canine Operations Sergeant Major, US Army Special Operations Command, Post Office Box 70660, Fort Bragg, North Carolina 28307

**Lieutenant Colonel, Veterinary Corps, US Army (Retired); formerly, Chief, Epidemiology and Disease Surveillance, US Army Medical Component-Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi, Bangkok, 10400 Thailand

“I have veterinarians, a large veterinarian corps within my civil affairs. Obviously, when you get out in the rural populations, the animals, the livestock, are key to their livelihood. Our ability to teach them good veterinary skills, to help them reduce the level of disease in their livestock, that kind of makes us local heroes. That’s an important piece of it.”[1]

—Admiral William H. McRaven, Commander, US Special Operations Command

INTRODUCTION

Joint Publication 1, Doctrine for the Armed Forces of the United States, defines irregular warfare as “a violent struggle among state and nonstate actors for legitimacy and influence over the relevant population.”2(pI-6) Irregular warfare can be population centric (counterinsurgency and stability operations) or focused on counterterrorism.[3] The preceding chapters of this textbook discuss and outline the doctrinal mission and core functions of the Department of Defense (DoD) Veterinary Service. This chapter captures the nontraditional functions of Veterinary Corps officers in support of counterinsurgency operations, stability operations, and counterterrorism efforts (Figure 17-1).

These responsibilities, outlined in DoD Directive 6000.04E, Department of Defense Public and Animal Health Services, include providing “veterinary coordination, manning, and support to plan and conduct agricultural, veterinary public health, and animal health activities across the range of military operations”; supporting “Department of Defense stability operations and medical stability operations”; and providing support for “global health strategic goals, to include veterinary and public health support to the National Strategy for Countering Biologic Threats.”4(pp6,7) This language makes explicit the DoD Veterinary Service’s responsibilities to engage in capacity-building activities targeting civilian and military populations, in addition to the traditional force health protection operational functions.

Veterinary Corps officers have a long history of applying their professional skills and health service support capabilities to stabilize and influence local populations in support of broader operational and strategic military objectives.[5] Building capacity in the agriculture and public health sectors and nontraditional health service support roles are growing components of the Veterinary Service’s mission. These missions will continue to grow as the DoD transitions its force structure into the 21st century.[4]

Figure 17-1. South Sudanese Ministry of Animal Resources and Fisheries staff work with veterinary personnel from the Sudanese People’s Liberation Army and advisors from US Army Africa on initiating a national vaccination plan in Mundari cattle camps around the capital city of Juba in December 2013.
Photograph courtesy of Master Sergeant Sandra Reeves, 82nd Civil Affairs Battalion.

According to Colonel Bob Walters, past director of the DoD Veterinary Service Activity, “there was a rapid growth of Veterinary Corps officer requirements in special operations from six officer authorizations in 2006 to over 20 in 2013.” Colonel Walters continues, “approximately 10% of the Veterinary Corps officer population, in the Active Component and Reserve Component, had a primary responsibility to support operations in the irregular warfare environment during my tenure” (Colonel [Retired] Bob Walters, Director, DoD Veterinary Service Activity, 2009–2015, personal communication with Paul Hollier, chapter author, August 25, 2014).

In his keynote speech at Sovereign Challenge VIII in December 2011, Admiral William H. McRaven highlighted the important role played by the Veterinary Service in the irregular warfare environment. The work done by Army veterinarians to build animal health capacity and improve the livelihoods of rural populations pays tremendous operational dividends and helps achieve theater strategic and operational goals.[1] Veterinary Service personnel can continue to accomplish this task by leveraging clinical knowledge, skills, and abilities and broadening their professional competency in global veterinary medicine, evidence-based operational medicine, and risk communication.

HEALTH SERVICE SUPPORT AND RISK COMMUNICATION

DoD Veterinary Corps personnel provide food protection and defense capabilities to prevent disease and conserve combat power for conventional missions and in the irregular warfare environment. The irregular warfare environment presents unique health protection and defense challenges because food plays an important role in cross-cultural communication. Through sharing food, common bonds are formed, enhancing communication and building trust. Although building relationships is central in population-centric irregular warfare, the consumption of many local foods greatly increases the risk of food-borne illness (Figure 17-2).

For example, consider a civil affairs team engaging with key leaders in an Afghan village. As the team sits on a carpet with village elders, they pass around several food and drink items: chai, panna (bread), milk, cheese, and cookies. Should the team refuse the generosity of these community leaders? If they eat these items, what are the risks? Will refusing to eat insult the elders and hinder the mission? These questions highlight the balance between the risk of food-borne illness and the benefits of shared meals in forming bonds and establishing trust across cultures. In this situation, the benefits of consuming local food, which would probably not meet the approved food source military standard, outweigh the risk of food-borne illness. Nevertheless, service members need to understand the short-term and long-term risks associated with food to enhance their ability to assess situations and make informed, real-time food choices. Civil Affairs and Special Forces units have Veterinary Corps officers assigned at the battalion, brigade, and group levels within the medical staff section who provide consultation and training on ways to mitigate the risk of food-borne illness during key leader engagements.

The complex food sourcing needs of multinational operations and training exercises occurring around the world has surpassed the capacity of the DoD-approved food sources program. An important tool used by veterinary personnel to communicate risks to key leaders and commanders in the irregular warfare environment is a food and water risk assessment. As commanders develop their troop feeding programs, they can request a food and water risk assessment. During these assessments, Veterinary Service personnel assess food establishments (eg, hotels, caterers, and production facilities) to determine the food-related risks associated with each, define the overall risk for each facility, make recommendations to the establishment, and communicate risk to commanders.

Figure 17-2. US soldiers with the 115th Mobile Public Affairs Detachment share a meal with Afghan National Army (ANA) soldiers on Forward Operating Base (FOB) Fenty, Nangarhar province, Afghanistan, December 4, 2012. The meal was served before a meeting between US Army and ANA public affairs officers to coordinate the arrival of local media onto the FOB.
US Army photo by Specialist Jenny Lui/Released. https://www.dvidshub.net/image/802621/afghan-meal#.U5duttzn-1s. Accessed December 4, 2017.

The Veterinary Corps, US Army Public Health Command, and Army Medical Department Center and School have developed risk communication strategies and innovative ways to collaborate across organizations to package and deliver risk communication products to prevent disease. Lessons learned from rabies and food safety risk communication campaigns show how collaborative efforts can protect service members. Also, collaborative communication efforts like those related to the Shiga toxin-producing Escherichia coli food-borne outbreak in Europe show how a robust interagency team can forge unified risk communication messages that can mitigate the further spread of disease.[6]

Operating in the irregular warfare environment carries an inherent risk. Veterinary personnel are not decision-makers when it comes to selecting risk mitigation measures. They serve as communicators providing expertise, describing and weighing risks, and ultimately empowering commanders and individuals to weigh operational goals against personal risk to make informed decisions. (For more information about food-borne illness risk assessments and rabies-safety campaign strategies used during deployments, see Chapter 9, Food Safety and Food Defense, and Chapter 12, Rabies and Continued Military Concerns.)

VETERINARY SUPPORT TO TACTICAL CANINE PROGRAMS

Special Operations forces recognized the potential of developing a canine capability just prior to the initiation of Operation Enduring Freedom in Afghanistan.[7] With the growth of Special Operations canine programs after the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, a nontraditional type of military working dog was developed, called the Special Operations forces multipurpose canine.

The multipurpose canine is a working dog capable of multiple uses in varied environments and operations. The multipurpose canine’s two main roles are explosive detection and patrol. These are also common roles for conventional military working dogs; however, the manner in which multipurpose canines are trained, deployed, and used in the operational environment is quite different from their conventional counterparts. The employment of the multipurpose canine on the battlefield is grounded in precision, validated end-user requirements, ethical use, and adaptability.[8] As a result, the multipurpose canine has proven itself an invaluable asset and force multiplier for special operations.

Just as multipurpose canines are nontraditional in their roles, so are the veterinary personnel who care for them. Providing veterinary care to multipurpose canines requires a detailed understanding of the Special Operations organizational structure and the nature of the missions, operational environment, and methods in which the multipurpose canine is used. The Veterinary Corps officer and animal care specialist fill roles analogous to occupational medicine specialist and nurse, canine medic, sports team physician, athletic trainer, flight surgeon, training officer, and noncommissioned officer, and, when the need dictates, canine handler. They provide canine veterinary care and act as advisors directly to the Special Operations unit.

Assignment of military veterinarians and animal care specialists directly to Special Operations tactical canine units provides immediate access to veterinary care, allowing rapid diagnosis, treatment, and, most importantly, rapid return to duty. Veterinary personnel become familiar with individual canines’ health status and behavior, and because they work directly with the canine, its handler, and its trainer on a daily basis, veterinary personnel can recognize and address slight changes in performance, behavior, and nutritional status without having to take canines or handlers out of their working environment, thereby reducing distractions and maintaining a mission focus.

In addition to clinical care of multipurpose canines, Special Operations veterinary personnel are integrally involved with research and development on canine preventive medicine, emergency care, canine tactical combat casualty care, and other aspects of managing canine care in a combat environment. While ensuring high standards of care in compliance with DoD standards, special operations tactical canine units and veterinary personnel are not constrained by rigid clinical protocols. Lessons learned and evidence-based research help tactical canine programs rapidly evolve and safely extend the effective range of multipurpose canine capabilities on the battlefield.

The Tactical Canine Program Team

Assignments of veterinary personnel in tactical canine programs have evolved to meet mission requirements. Some units have only a veterinarian, while others have only an animal care specialist. While most of these positions are filled by military personnel, some are filled by civilian employees. Other units have a combination of veterinarians, technicians, military personnel, and civilian staff. This variation is due to availability of billets, funding, and requirements of the tactical canine program. Typical tactical canine program team members are the Special Operations veterinarian, the independent duty veterinary technician, the canine handler, and the Special Operations paramedic.

The Special Operations veterinarian is an operational medicine expert and case manager responsible for preparing the medical team to take appropriate preventive medicine actions throughout the deployment cycle and to manage a working dog casualty from point of injury to final disposition. Whatever the operating environment, the Special Operations veterinarian understands the effects of the environment on the multipurpose canine in his or her care and uses this understanding to mitigate or treat any potential issues that may impact canine health or potentially degrade canine performance. The Special Operations veterinarian also maintains an understanding of regulatory, transportation, and medical evacuation procedures.

The independent duty veterinary technician (IDVT) is a 68T (military occupational specialty) animal care specialist in the rank of E7 or above who may be assigned to a Special Operations unit.[9] IDVTs assist the veterinarian, restrain the canine for examination, and carry out prescribed medical orders to dispense or administer medications to multipurpose canines. IDVTs also provide care to multipurpose canines remotely with a supervising veterinarian. In addition to functioning as the team medic for the multipurpose canine, IDVTs serve as veterinary operations planners, veterinary care trainers, and veterinary facility program managers, filling many management and leadership roles that are traditionally carried out by veterinarians. IDVTs also function as staff noncommissioned officers, assist with research and development activities, give formal military or professional veterinary presentations, and interact directly with Special Operations unit commanders and staff.

IDVTs understand the operational veterinary needs of Special Operations tactical canine teams and provide a bridge between enlisted canine program personnel and the special operations veterinarian. They interface with the canine teams throughout the deployment cycle and during medical evacuation. In most cases, the IDVT is the first person that the handler communicates with after initial stabilization of a canine casualty. The IDVT assists in arranging medical evacuation, referral for follow-on specialty care, and movement of a replacement dog into theater if needed. In nonlife-threatening (or routine) injury or illness, the team communicates directly with the IVDT for advice on field treatment, patient monitoring, and when or where to seek further veterinary care. Considering that the nearest veterinary care in theater might be hours away by helicopter, availability of on-call veterinary consultation significantly increases unit efficacy. This is especially beneficial when the veterinary advice comes from someone familiar with the physical condition of multipurpose canine and the capabilities and personalities of canine handlers.

Canine handlers usually receive basic first aid and limited trauma training during their canine handler certification. Some handlers have more extensive and indepth medical training and receive continuing education on a routine basis. Along with the canine handler, Army Special Operations medics, independent duty corpsmen, and pararescue jumpers generally provide initial emergency medical care to injured multipurpose canines during combat or other remote operations.

Special Operations paramedic trainees get an indepth introduction to canine medical care while attending the medical qualification course at the Joint Special Operations Medical Training Center at Ft Bragg, North Carolina. While attending the Special Operations Combat Medic course, students receive classroom and hands-on training for canine physical exams, fluid therapy, and tactical combat casualty care. During the Special Forces Medical Sergeant and Special Operations Independent Duty Corpsman courses, the Special Operations medics’ canine training is expanded to include fundamentals of preventive medicine, common noncombat-related diseases and medical conditions, and proper records-keeping and program management.

The Special Operations Combat Medic Skill Sustainment course is a biennial recertification course for all Special Forces Medical Sergeant course graduates and Air Force pararescue jumpers. During this refresher course, Special Operations medics receive a cursory review of canine trauma and discuss lessons learned from personal experiences downrange. This not only provides the students with a broader scope of canine medicine, but also gives the Joint Special Operations Medical Training Center instructors accurate feedback on course material in order to maintain the most up-to-date and applicable information for current operations.

Combat Trauma and Canine Tactical Combat Casualty Care

Tactical combat casualty care was first described in 1996 by Butler et al in a manuscript titled “Tactical Combat Casualty Care in Special Operations.” Published in Military Medicine, the article presented the results of a 2-year review of the effectiveness of civilian advanced trauma life support on the battlefield.[10] This review initiated a paradigm shift from adapting civilian clinical practices for combat to developing tactically appropriate algorithms.

Tactical combat casualty care has three objectives: (1) treat the patient, (2) prevent additional casualties, and (3) complete the mission. In contrast, advanced trauma life support focuses only on the first objective. The 75th Ranger Regiment adopted tactical combat casualty care in 1998, making it a priority to train all personnel assigned to the regiment. In 2011, Kowtal et al published “Eliminating Preventable Death on the Battlefield,” highlighting the success of tactical combat casualty care in significantly reducing preventable deaths on the battlefield.[11] Tactical combat casualty care is now the military standard.

Tactical combat casualty care outlines recommended actions that increase the success of casualty care and can be easily adapted to the canine patient on the battlefield. Many Special Operations units follow the “massive hemorrhage, airway, respiration, circulation, hypothermia and head trauma, and evacuation”12(p3) or MARCHE protocol to teach assessment and treat injuries systematically. The combat trauma protocol has replaced the previous “airway, breathing, and circulation”13(p2) or the ABCs method taught in basic first aid courses. Combat trauma protocol for canines has been adapted from the protocol for human patients found in the Ranger Medic Handbook by the Department of Defense, 2011 edition.

Canine tactical combat casualty care follows the same tactical care domains as tactical combat casualty care: care under fire, tactical field care, and tactical evacuation care. (For more information about the types of canine evacuations available for both military and other working dogs, see Chapter 4, Medical Evacuation of the Military Working Dog.)

Care Under Fire

This domain of care (care under fire) involves movement of the casualty to cover. If tactically feasible, a muzzle may be applied (see muzzle discussion in right column), and life-threatening hemorrhage is controlled. Generally, tourniquets have been the mainstay of this phase and the greatest advancement in human tactical combat casualty care because of the high proportion of extremity injuries in current conflicts.[14] However, based on limited data on combat injuries in dogs,[15] canines do not generally require tourniquet application in extremity injury to control bleeding. If massive bleeding is obvious, a quick pressure bandage should suffice; however, tourniquets are recommended with traumatic amputations or partial amputations. Most important is for the handler to remain engaged in combat operations and seek cover until it is feasible to lend aid to the downed multipurpose canine.

Tactical Field Care

This domain involves a thorough head-to-toe examination. Raking the hands through the fur from the head to the hindquarters helps identify wounds of the thorax and abdomen. Any tactical vest or equipment must be removed to properly assess the thorax. It is often helpful to remove collars, but it is important to maintain at least one method of control (collar, vest, or harness). Technical interventions, emergency surgical procedures, and drug administration predominate this phase of care.

Tactical Evacuation Care

This domain of care incorporates treatment provided during medical evacuation or casualty evacuation from the battlefield. All interventions outlined in previous domains of care are appropriate during transport; however, during tactical evacuation, medical personnel may or may not be present to provide continued care. Additionally, many medical evacuation personnel do not have specific training in managing canine casualties. The multipurpose canine handler or designee should stay with the multipurpose canine through the roles of care for safety and restraint (although this is not specified in doctrine at the time of writing, October 2017). Special Operations units generally cross-train personnel to be capable of handling a multipurpose canine in the event a handler is incapacitated or otherwise unable to evacuate with his or her injured or ill canine.

If a muzzle has not already been placed on the injured multipurpose canine, one should be placed before transport for safety. A muzzle disarms the canine weapon system (equivalent to removing a soldier’s weapon when consciousness is impaired). Multipurpose canines may become unpredictable when injured and will bite even with impaired consciousness, and safety for the animal care team is paramount at all levels of care.

A regular cage muzzle (hard style) is preferable for placement on an injured dog because this style allows the canine to pant with limited restriction. The soft mesh-style or “medical muzzles,” which are easier to carry while on patrol, can restrict a canine’s ability to pant and could contribute to hypoxia or hyperthermia. If the mesh-style muzzle is all that is available, it may be advisable to leave the multipurpose canine unmuzzled until a painful procedure is anticipated.

Many Special Operations units utilize canine combat cards and canine casualty cards. Combat cards outline drug dosages, vital signs, and interventions unique to canine patients, as well as normal ranges for vitals and laboratory tests. These cards facilitate treatments in stressful combat environments and potentially minimize complications of incorrect drug administration. The information on the combat cards also helps human healthcare providers triage and treat multipurpose canines in the absence of veterinary personnel. Canine casualty cards are comparable to human casualty cards and allow proper tracking of wounds, changes in condition over time, and all interventions.

Canine patients differ from human patients in anatomy, physiology, and pharmacokinetics; however, the principles of trauma treatment are universal. Key differences with regard to canine tactical combat casualty care guidelines and emergency care are outlined in Exhibit 17-1. Knowledge of these key differences, as well as prior training, will increase the success of resuscitative efforts for multipurpose canines.

EXHIBIT 17-1.

KEY DIFFERENCES BETWEEN CANINE AND HUMAN TACTICAL COMBAT CASUALTY CARE GUIDELINES

1. Tourniquets are not generally needed for extremity wounds unless traumatic amputation or partial amputation has occurred. Canine extremities do not bleed profusely like human limbs, and pressure bandages suffice to control bleeding.

2. Nasopharyngeal airways are not effective. Unconscious military working dogs (MWDs) should have their heads extended in a straight line, with their neck and tongue gently pulled forward to decrease the chance of obstructions.

3. Definitive airway support is accomplished through orotracheal intubation, which is much easier to perform in canines than in humans. However, MWDs may chew endotracheal tubes (ETTs) in half after regaining consciousness, dislodging them deeper in the trachea.

4. Orotracheal intubation is performed with the canine in sternal recumbency, mouth opened wide, neck extended, and tongue externalized. The ETT is placed between the arytenoids (similar to humans). Most MWDs require a size 9 to 10 ETT, but a 7 to 8 ETT can be used if it is the only size available. Tracheotomy, versus cricothyrotomy, is the generally preferred method of surgical airway in canines; however, cricothyrotomy has been performed successfully by Special Operations Forces medics on injured multipurpose canines on the battlefield with no adverse effects. Tracheotomy is performed similar to cricothyrotomy, but in the proximal third of the ventral neck instead of through the cricothyroid membrane. A size 6 tracheotomy tube is ideally placed between the third and fifth tracheal ring.

5. Due to the canines’ quadrupedal stance, the hemithoraces, and thus lung fields, are anatomically on the left and right sides laterally, as opposed to both hemithoraces visualized anteriorally in people. This has implications for anatomical placement of interventions. Placing an MWD sternally (chest to the ground) is the often most comfortable for the patient and helps visualize bilateral rise and fall of the chest.

6. Needle thoracocentesis is performed between the 6th and 8th intercostal space, at the most convex portion of the chest wall. Canines’ thin mediastinum often ruptures, making bilateral decompression necessary. Bilateral decompression is routinely performed regardless of location of entrance wound or suspected affected side of pneumothorax.

7. Occlusive dressings for penetrating chest wounds are difficult to place due to hair. It is often advised to place petrolatum gauze directly to the wound and/or lubricating gel on the hair around the wound before placing a seal. It is appropriate to circumferentially place a wrap around the thorax if a seal is difficult to achieve.

8. Fluid resuscitation should be reserved for MWDs experiencing severe shock. Many studies establish a reduced need for fluid resuscitation prior to arrival at definitive care. However, when indicated, low-volume hypotensive resuscitation with colloid or crystalloid solution to an endpoint of a palpable femoral pulse should be initiated either intravenously or intraosseously.

9. Intravenous catheterization is best achieved through the cephalic vein in the front limb, between the elbow and carpus.

10. Intraosseous catheterization is most easily attained in the medial tibial crest and proximal humeral head.

____________

Exhibit material adapted from US Special Operations Command (Army unit) (USSOCOM) human Tactical Casualty Combat Care (TCCC) guidelines, developed by the ad hoc USSOCOM K9 (canine) TCCC Committee, October 2010.

Vignette 17-1. Multipurpose Canine Breston: Tactical Combat Casualty Care Adapted to a Critically Injured Special Operations Multipurpose Canine

Care Under Fire. A 5-year-old intact male Belgian Malinois multipurpose canine incurred a gunshot wound to the thorax during a firefight at night in Afghanistan. Breston was working off leash when he was injured and immediately returned to his handler. The handler quickly assessed the dog but could not see a specific wound or immediate life-threatening injury so continued returning fire as appropriate. Within a few minutes of the injury, Breston displayed dyspnea and collapsed, losing spontaneous respiration and palpable femoral pulse.

Tactical Field Care. The handler called to the Air Force pararescue jumper paramedic for assistance. The handler and paramedic moved Breston to cover, removed his tactical vest, and found a 2-cm penetrating wound on the caudal right hemithorax and a 4-cm wound in the cranial right hemithorax, thought to be entrance and exit wounds on the same side of the dog. They covered the wounds with occlusive dressings and performed needle decompression of the right thorax to relieve suspected tension pneumothorax. Needle decompression resulted in immediate increase in level of consciousness and return of spontaneous breathing and palpable femoral pulse.

Enroute Care and Tactical Evacuation. The firefight continued for approximately 90 minutes, followed by a 5-kilometer exfiltration on foot, during which Breston had to be carried. Initial attempts to carry him on a litter were unsuccessful; he fell off the litter into water while being carried across a stream. After exfiltration of the team, Breston was evacuated on a nonmedical helicopter, with enroute care provided by a special operations physician and flight medic. During the course of the 90-minute firefight and 90-minute evacuation, Breston lost consciousness and spontaneous breathing three additional times. Each time, he was revived with needle decompression of the thorax. He also received supplemental oxygen by mask. He was evacuated straight to a combat support hospital, where continued treatment was provided by medical personnel until the veterinarian arrived.

Damage Control Resuscitation and Hospital-Based Care. On arrival at the combat support hospital, Breston’s rectal temperature was 91° F (normal range is typically 99°–102.5° F), so protocols to actively warm him and combat hypothermia were applied. Additional treatment included placement of a thoracotomy tube, oxygen support, antibiotics, intravenous fluid therapy, and pain control.

Medical Evacuation to Continental United States. Four days after Breston was injured, the thoracotomy tube was removed, and he was escorted home by a Special Operations IDVT via aeromedical evacuation to the Dog Center Europe in Kaiserslauten, Germany, for initial stabilization, then on to the United States for further care. Altitude restrictions of 5,000-feet cabin pressure were applied on the evacuation aircraft because of Breston’s history of tension pneumothorax.

US Treatment and Return to Duty. Upon arriving home, the special operations veterinarian responsible for Breston’s care facilitated a thorough evaluation by veterinary specialists, including cardiothoracic ultrasound. The Special Operations veterinarian advised Breston’s canine program managers that, despite a life-threatening injury and having “died” four times on the battlefield 1 week earlier, Breston was fit for return to duty once his body wall injuries from entrance and exit wounds were healed. Breston returned to duty 21 days after his initial injury and was immediately returned to Afghanistan, where he successfully completed the remainder of his deployment without incident.

Operational Hazards and Performance Considerations

The operating environment of the multipurpose canine presents challenges for the canine handler team as well as the veterinary care team. Understanding the challenges of operating in extreme heat and humidity, extreme cold and high altitudes, and maritime and airborne environments is essential to maintaining multipurpose canines at their peak performance.

Extreme Heat and Humidity, Desert and Tropical Environments

Multipurpose canines may be at increased risk for exertional heat injury due to the intense physical nature of the work, harsh working environments, necessity of wearing tactical gear, or extensive work in a muzzle. As noted earlier, veterinary references describe normal canine temperature as between 99° and 102.5° F. These references also define heat injury as occurring when rectal temperature reaches 106.0° F. However, over the last 40 years, at least four independent studies in canine working breeds have similarly shown that (a) the rectal and core temperatures of working dogs can reach 108.0° F during exercise with no adverse effect and (b) the rectal temperature of a well-conditioned multipurpose canine can routinely reach or exceed 106.0° F during exercise with no apparent adverse effect.16–19

Special Operations veterinary personnel work with their canine teams to establish normal working temperature ranges of individual canines and take into account appearance, behavior, and performance changes before concluding that an elevated rectal temperature is clinically significant.[20] Instead of focusing on complicated treatment protocols, training for handlers on management of heat injury emphasizes recognition of hazardous working conditions and subtle changes in performance and behavior that indicate a multipurpose canine’s status and heat tolerance at any given point in time. Instruction on field treatment is clear and concise: cool down the canine as quickly as possible with whatever resources are available and follow up with the veterinary team.

Adequate conditioning and acclimation at or above the level of expected work are possibly the most effective methods of preventing heat injury in multipurpose canines. However, with rapid deployment of multipurpose canines for contingency missions, extended periods of acclimation may not be possible. In these cases, additional measures must be taken to prevent heat injury while effectively extending the operational range of the multipurpose canine.

Tactical canine teams have used a variety of methods for prevention of heat injury with varying success, including the use of cooling vests and prehydration with subcutaneous fluids. Anecdotally, Special Operations canine handlers have reported that cooling vests were too bulky and not practical in an operational setting, and the handlers worried that the vest’s weight and bulk counteracted any cooling effect. Human studies of the effectiveness of cooling vests echo dog handlers’ anecdotes; the human studies show that some cooling vests help maintain a lower body temperature, but, in certain conditions, the vests are ineffective and may even be detrimental to cooling.21,22 Prehydration with subcutaneous fluid administration before and during extended operations has been used extensively in dogs deployed to Iraq and Afghanistan, as well as in hot weather US training environments. Handlers have reported that prehydration improves multipurpose canine performance and endurance. Also, Gordon reported that the use of subcutaneous fluid prehydration in search and rescue dogs deployed to hot environments subjectively appeared to benefit canine performance.[23]

Extreme Cold, Mountain, and High-Altitude Environments

The mountain environment poses several health hazards to multipurpose canines, including hypoxia, extreme cold, and rough terrain. No canine cases of acute mountain sickness, high-altitude pulmonary edema, or high-altitude cerebral edema have been documented in the literature. However, there are anecdotal reports of canines having acute or subtle decreases in performance at higher altitudes in Afghanistan, likely due to the effects of hypoxia at higher altitude, based on the signs reported by the handlers, absence of other clinical signs, and improved condition on descent to a lower altitude (personal knowledge, Colonel Janice Baker, chapter author). Canine “altitude sickness” has also been reported anecdotally by veterinarians working in high-altitude areas of the United States, but little is documented in the veterinary literature on this condition. Experimental studies in canines taken from sea level to high altitudes yield conflicting evidence regarding physiologic changes. Some studies demonstrated that pulmonary arterial pressures and pulmonary vascular resistance nearly doubled in canines taken to altitudes between 3,100 and 3,300 meters (10,170–14,107 feet),24,25 but other studies showed no significant increase in pulmonary arterial pressure in canines at 4,500 meters (14,764 feet).[26]

With conflicting results regarding the canine’s susceptibility to debilitating effects of rapid ascent to high altitude and the lack of significant morbidity or mortality reported in military working dogs, there is little evidence on which to base concrete medical guidelines. Thus, there are currently no general recommendations for preventing or treating altitude-related conditions in multipurpose canines. Special Operations handlers and medics are instructed that, although such effects have not been reported in multipurpose canines, high altitude can affect performance and may cause conditions such as acute mountain sickness, high-altitude pulmonary edema, or high-altitude cerebral edema. Signs of decreased performance, including rapid or labored respiratory efforts, coughing, or decrease in mental alertness, should be addressed rapidly, just as with a human patient. For mild cases, returning to a lower altitude may be sufficient treatment. There is insufficient evidence that pretreatment with pharmacologic agents is effective.

Canines deployed to forward operating bases at higher altitudes should be allowed to acclimate for 1 to 2 weeks if operationally feasible. A 1998 study in search and rescue dogs concluded that search time to find mock victims significantly increased at high altitudes compared to sea level but did not specify whether this was due to decrease in physical performance versus other environmental factors that might increase the difficulty of detecting scents.[27] The effect of rapid ascent to high altitudes on canines’ ability to detect explosive scents has not been determined; therefore, it is advisable to test the canine in a training situation at the high-altitude deployment location prior to the dog’s operational use.

Strenuous endurance exercise in athletic canines in extremely cold weather (between 0° and -40° F) has been shown to cause airway remodeling and responses similar to cold weather-induced asthma in humans.[28] Frostbite is common in sled dogs working for prolonged periods in conditions of ice and snow, typically affecting the prepuce and skin folds or the flank (Figure 17-3). However, frostbite has not been reported as a significant finding in military working dogs operating in cold weather in Afghanistan, likely because these canines are exposed to subzero temperatures for shorter periods than sled dogs.

Trauma from working on rugged terrain is also likely. Although not unique to mountain environments, hypoxia and fatigue may predispose multipurpose canines to injury. The seriousness of traumatic injuries in mountain environments may be increased if evacuation is delayed. Special operations paramedics operating in these areas must be prepared to provide prolonged care for an injured multipurpose canine, and the team must be prepared to carry the canine casualty over rough terrain during movement to exfiltration.

Figure 17-3. A Special Operations independent duty veterinary technician works with racing sled dogs to study the effect of cold weather on health and athletic performance in canines.
Photograph courtesy of Lieutenant Colonel Janice Baker, chapter author.

Maritime Environments

Naval special warfare canine teams operate in a variety of environments, including salt water and freshwater. While US Navy Sea Air Land teams, commonly known as SEALs, and other forces that conduct these special missions have extensive training and specialized equipment, the Navy special warfare canine comes equipped primarily with the drive for self-preservation in water. Accidental drowning, salt water ingestion, and hypothermia are the biggest concerns for the multipurpose canine in a maritime environment.

Lessons learned have shown that not all canines have an innate ability to swim, so canines that operate in maritime environments must receive water training. Modified flotation devices can reduce cases of accidental drowning. The physiologic effects of salt water drowning or near-drowning have been described in canines.29–38 Canines swimming in the ocean have the potential to ingest or aspirate salt water, even when water is calm and swimming occurs without struggle. Preliminary data on physiologic effects of working dogs swimming in the ocean shows that canines will occasionally swallow water while swimming, but 1 hour post-swim no adverse clinical signs and no appreciable change in electrolyte values were observed. Self-limiting vomiting and diarrhea were the most common results of limited salt water ingestion, and these reactions usually resolved completely within 24 hours after exposure.

When swimming in cold water, hypothermia is a concern. Special Operations soldiers may wear wet suits or dry suits during cold water operations. The canine’s fur may effectively act as an anatomical wet suit, protecting them from hypothermia to some degree. Preliminary data in canines swimming in 54° F water showed an initial rise in body temperature, presumably due to the work of swimming. However, once out of the water, the canines’ body temperatures dropped significantly to slightly below normal, to approximately 97° F (Figure 17-4) (unpublished study results, Colonel Janice Baker, chapter author, study conducted during her Joint Special Operations Command, 2005–2009).

Figure 17-4. A Special Operations independent duty veterinary technician monitors core temperature of a Navy special warfare multipurpose canine during maritime training.
Photograph courtesy of Lieutenant Colonel Janice Baker, chapter author.

Airborne and Air Assault Operations

Multipurpose canines may be inserted into operational areas with their handlers by parachute, fast rope, or rappelling techniques. These methods of insertion pose risks of blunt trauma from falls, as well as ocular trauma from rotor wash or wind during ascent. Protecting canines’ eyes with goggles may help decrease the risk of ocular injury. Risk of trauma is increased to both the canine and the handler if the canine struggles or resists insertion procedures.

Multipurpose canines are evaluated for suitability for multiple tasks during their training, and their behavioral response to these types of procedures will determine if they are suitable for airborne operations. Multipurpose canines that acclimate well to being lifted, hanging free by their harness, and undergoing transport in aircraft and that can execute their duties of detection or patrol immediately after insertion without showing signs of anxiety or distraction are most suitable for airborne and similar operations.

The altitude at which multipurpose canines can be inserted safely, without the use of supplemental oxygen, is unknown. It is likely that medical concerns for soldiers during rapid descent from high altitude also apply to multipurpose canines.

Canine Emergency Planning and Tactical Medical Evacuation

Planning for canine casualties is an essential part of pre-mission planning for any operation involving multipurpose canines.39–41 As previously noted in this chapter, when a multipurpose canine is injured, evacuation to veterinary care is managed like evacuation to medical care for human casualties. Further evacuation out of theater is managed using the same resources and methods as for human casualties.

Capabilities Assessment and Threat-Based Planning

Prior to an operation, medical planners assess the available tactical evacuation platforms and medical facilities and advise the operational commander on their plan in the pre-mission brief. Threat-based medical planning helps focus preparation of medical supplies and training on the injuries or illnesses that are most likely to occur on a given mission, while ensuring preparedness for worst-case situations.[42] Again, planning for treatment and evacuation of a multipurpose canine casualty occurs in the same manner, and, in most cases, is exactly the same plan as for human casualties.

A capability assessment considers the capabilities of military or host nation veterinary services in the location of deployment, as well as the medical threat to multipurpose canines in the operating environment. Special operations veterinarians and IDVTs work closely with their units and conventional veterinary forces in theater to ensure canine casualty and evacuation plans are up-to-date and accurate. These personnel conduct site surveys of their unit’s kennels and military veterinary facilities along all roles of care and assist medical operations planners in developing canine casualty evacuation plans. For continental US training away from their home station, Special Operations veterinary personnel often perform the same type of site survey, capabilities assessment, and evacuation planning (to local military veterinary treatment facilities or civilian veterinary emergency facilities) in advance to ensure the availability of immediate and appropriate care in the event of an emergency.

Veterinary treatment facilities are located throughout a theater of operations, often adjacent to a medical treatment facility. Many forward operating bases do not have veterinarians but do have medical treatment facilities capable of initial resuscitation treatment of canine trauma. In the initial response to a combined mass casualty event, in which both human and canine service members are injured, it is not operationally feasible to evacuate human casualties to one location and canine casualties to a veterinarian at another location. In these situations, the canine casualty plan, included in the medical casualty plan, stipulates that an injured canine be treated like any other injured team member and be evacuated using the same plan and evacuation resources as for human casualties. (See Chapter 4, Medical Evacuation of the Military Working Dog, for more detailed information about the types and locations of veterinary medical treatment facilities and casualty plans available to various types of deployed canines.)

Site Surveys and Capability Assessments

Veterinary capabilities in theater are constantly being reviewed, changed, updated, and validated to meet current and future veterinary medical requirements. Special Operations veterinary personnel visit veterinary treatment facilities on a routine basis to perform capabilities assessment and ensure the accuracy of their canine casualty evacuation plans and communication procedures between the unit and the facility. The capabilities of each location are evaluated for the level of care that can be provided at either the veterinary treatment facility or medical treatment facility, or a combination of both. (Chapter 4, Medical Evacuation of the Military Working Dog, provides more indepth information about the levels of care available for injured or ill deployed canines.)

The tactical evacuation plans resulting from these assessments will vary across locations. Plans may recommend over-flying a closer treatment facility to higher level of care farther away or flying to the closest location with a medical treatment facility, regardless of whether there is a co-located veterinary treatment facility. These evacuation plans are fluid, and the final decision about evacuation destinations will be based on the immediate tactical environment and the judgment of the canine handler or medical provider caring for the canine casualty.

Because Special Operations veterinary personnel are not always deployed with their unit, multipurpose canine handlers and medical operations personnel in theater communicate with theater veterinarians or veterinary operations noncommissioned officers regularly to ensure veterinary support is available at the designated veterinary treatment facility locations. Special Operations veterinary personnel provide multipurpose canine handlers and medical providers training on emergency veterinary care and tactical evacuation procedures prior to deployment. This training includes guidance on building a good working relationship with conventional veterinary units supporting the dogs during deployment.

Tactical Evacuation of Injured or Ill Multipurpose Canines

Army Field Manual (FM) 4-02.2, Medical Evacuation, and FM 8-10.6, Medical Evacuation in a Theater of Operations, state that the use of air or ground evacuation assets may be used to transport injured or ill military working dogs based on mission and capability.43,44 Dedicated medical evacuation platforms may be the preferred method of evacuation, by either ground or air, because these resources have standard medical supplies and equipment that can be used to treat an injured multipurpose canine. Prior training that includes training from Special Operations veterinary personnel, multipurpose canine handlers, and medical evacuation air and ground ambulance crews familiarizes the canines and their handlers with the ambulance platform and the air or ground ambulance crews with transport and handling of a canine within the vehicle.

Transport of a casualty from the point of injury to a medical or veterinary treatment facility may occur on a dedicated medical evacuation platform (MEDEVAC) or a nonstandard or nonmedical platform (CASEVAC). The more current term, tactical evacuation or TACEVAC, is used to indicate evacuation from point of injury to medical or veterinary care regardless of the medical capability of the evacuation platform.

As noted earlier in this chapter, most multipurpose canine casualties will be escorted by a Special Operations paramedic and, whenever possible, the handler as well. Treatment may consist of continued reassessment and monitoring or further resuscitative care; nonveterinary personnel have successfully provided advanced life-saving treatments during this phase of care, including needle decompression for tension pneumothorax, intravenous or intraosseous fluid administration, and emergency surgical airway.[15]

Also, as noted earlier, when a multipurpose canine is initially injured, the condition of the canine casualty is assessed and treated following the principles of canine tactical combat casualty (similar to the procedures for human casualties). When the initial steps of care under fire and tactical field care are completed and medical personnel or the canine handler determine that immediate evacuation is needed, the canine casualty is prepared for transport.

Depending on the operational environment, ground or air evacuation assets may not be able to access the area at the point of injury. Having the means to carry an injured multipurpose canine is crucial. Human litters are not well suited for canine casualties because conscious canine casualties are often not amendable to lying down or being restrained by the litter straps and easily slide off human litters (see Vignette 17-1). Some Special Operations canine handlers carry specially designed canine litters; others improvise litters for these situations or resort to carrying the canine casualty by hand. Prior scenario-based training in canine casualty evacuation prepares a team to use best methods if canine evacuation is needed in combat and increases the multipurpose canine’s confidence to comply with being carried in this manner.

The unpredictable nature of a canine’s possible fight-or-flight response also makes it essential to ensure the canine casualty cannot escape from the evacuation platform. A canine casualty might take drastic measures to escape, including through the cockpit or open gunner window or ramp. Even if the canine casualty appears unconscious, the aircraft or vehicle doors must be closed and the canine secured to the aircraft or vehicle by its tactical vest or other means.

If the canine casualty does not need immediate enroute care, securing it in a crate usually provides the most secure method of transport during evacuation. If a crate is not available or does not fit in the platform, a deployment bag or other medium-sized gear bag can be used to create a field-expedient “dog bag” to contain the canine casualty, with the bag closed up to the canine’s neck and its head protruding from the bag. This method, also used for containing a multipurpose canine during airborne operations, keeps the canine from running away, works as an improvised litter, and protects others on the aircraft from being scratched by the dog’s exposed feet (claws). Multipurpose canines typically tolerate this rigging.

Enroute Care

After arrival and stabilization at the first fixed-medical or veterinary treatment facility, the multipurpose canine may require further evacuation. It is recommended that both Special Operations and conventional veterinary personnel keep a medical evacuation aid bag and body armor or other personal protective gear ready at all times near their respective treatment areas, so they can rapidly respond to the need for emergency patient transfer via air or ground.

Veterinary care of canine casualties aboard air or ground evacuation platforms may be limited and difficult because of noise, low or no light, vibration, cramped spaces, and noncompliance of the canine casualty.[45] Prior familiarization with the working capabilities and limitations of various evacuation platforms is essential.

Canine Evacuation on Nonstandard Platforms

Nonmedical platforms of evacuation are routinely used in special operations medicine for tactical evacuation when medical assets are not available or cannot be used because of continued hostile fire. The use of nonmedical platforms is often less than ideal for several reasons, the first being that using them to evacuate a canine casualty takes valuable assets away from the fight. Second, they are generally not well equipped with medical supplies or monitoring equipment. Third, air assets may not be able to fly in adverse weather. Finally, nonmedical ground assets may not provide protection from the elements, usually have limited space, and are slower than air platforms.

When a multipurpose canine is injured, the tactical evacuation plan is implemented to transport the canine casualty from point of injury to the human or veterinary treatment facility designated during pre-mission planning. Depending on the injuries and/or recovery time needed, the Special Operations unit veterinary personnel, in conjunction with the attending veterinarian in theater, will decide if the canine casualty will be transported back to home station for recovery or remain in theater for recovery and return to duty. A Special operations Unit’s canine program may elect to have the handler remain in theater as a tactical team member even if his multipurpose canine is evacuated out of theater. In many cases, a canine casualty will immediately be replaced by another multipurpose canine. This practice differs from the “one handler, one dog” doctrine of conventional military working dog teams.

Selected Special Operations veterinary personnel have training and experience in basic noncombat handling of multipurpose canines because these personnel may be tasked to escort a replacement canine into theater and then escort the canine casualty to the Dog Center Europe and subsequently to the continental United States. When adequately coordinated with the aeromedical evacuation system out of Germany, the exchange can be a tail-side swap of multipurpose canines on the same medical evacuation aircraft, allowing the escorting veterinary personnel to complete the exchange and return home relatively quickly. With such delivery of the replacement multipurpose canine, a Special Operations unit is returned to full capacity within 48 hours of the canine injury.

Use of Human Medical Resources

Whenever possible and tactically sound, an injured multipurpose canine should be evacuated to the care of a veterinarian. However, past and current conflicts have shown that this is not always immediately possible.15,40,41 While 64F clinical veterinary specialists are assigned in theater, they are often located at large centralized bases far from the operational areas in which multipurpose canines are employed. Many canine casualties would not survive the lengthy evacuation to the specialist’s location without immediate resuscitative treatment. In these cases, the Special Operations veterinary and medical planners might choose to evacuate a canine casualty to the nearest human medical treatment facility capable of providing resuscitative trauma care. Many successful cases have been reported of canine casualties evacuated straight to a medical treatment facility and treated by a human trauma team remotely or in conjunction with a veterinarian.[15]

The deployed veterinarian, if co-located, assists the human trauma team and acts as an advocate for the canine casualty (rather than managing a complex trauma case without prior training or experience). This type of collaboration can effectively evolve a basic veterinary capability into an advanced trauma capability. (Chapter 4, Medical Evacuation of the Military Working Dog, presents examples of veterinary and human medical personnel working together at various treatment facilities to care for injured canines and, in some cases, their handlers.)

BUILDING ANIMAL HEALTH CAPACITY

In a population-centric model of irregular warfare, veterinary services have a role in building animal health capacity. By building capacity in agriculture, public health, and animal health, livelihoods can be improved, food sources can be stabilized, and the threat of zoonotic diseases can be minimized. These activities and intended outcomes support stability operations objectives in economic development and restoration of essential services, as well as helping to gain support from local populations in counterinsurgency operations. However, building animal health capacity in a global setting requires understanding of the global animal health environment and how activities and engagement can be leveraged to improve animal health systems. Perhaps more importantly, veterinary personnel must understand how animal health activities can support—or disrupt—international and interagency efforts.

Global Animal Health Environment

Multiple organizations are engaged in building global animal health capacity. Conducting animal health activities in the irregular warfare environment requires an understanding of the local, national, and international animal health systems, as well as the stakeholders and their priorities. Understanding the global animal health environment is best explained through the missions of major international and domestic organizations focused on improving animal health systems. These organizations include the World Organization for Animal Health, the Food and Agriculture Organization of the United Nations, and each partner nation’s ministry of agriculture.

World Organization for Animal Health

The World Trade Organization was created in 1995, institutionalizing previously ad hoc free trade agreements and globalizing the world’s approach to commerce. Members of the World Trade Organization agree to abide by international rules intended to reduce barriers to international trade (eg, customs, tariffs, and taxes).[46] Very few situations allow a country to block trade with another country that shares most favored nation status; however, plant and animal diseases that threaten economic security are valid justifications to implement trade restrictions. The World Organization for Animal Health is the intergovernmental organization that monitors economically important animal diseases and, in effect, regulates global animal agriculture trade through World Trade Organization-delegated authority.[47]

The World Organization for Animal Health describes four functional domains of national veterinary services: (1) human, physical, and financial resources; (2) technical authority and capability; (3) interactions with interested parties; and (4) ability to access markets through compliance with relevant international standards. The World Organization for Animal Health conducts assessments of national veterinary services along the four functional domains, utilizing the Performance of Veterinary Services tool, which can also be used to focus domestic and international donor resources on validated gaps in the national veterinary service system. A Performance of Veterinary Services report and ensuing investment can help a country comply with international standards and subsequently access global animal agriculture markets.[48]

Food and Agriculture Organization of the United Nations

Forty-four nations met in 1943 and committed to the establishment of an organization dedicated to strengthening food and agriculture systems. The United Nations Food and Agriculture Organization was created to focus on achieving food security for all people. Its mandate is to raise levels of nutrition, improve agricultural productivity, better the lives of rural populations, and contribute to the growth of the world economy.[49]

Ministries of Agriculture

A partner nation’s ministry of agriculture (equivalent to the US Department of Agriculture) is the primary government organization responsible for national veterinary services. The ministry is often organized into three tiers (ie, national, regional, and district) and has multiple regulatory as well as disease response and mitigation responsibilities. Some countries’ animal health systems rely solely on government-operated veterinary services that provide for the public and private good, while other countries rely on a mix of government-operated and privatized veterinary service delivery systems.

Animal Health Activities and Engagements

Understanding how veterinary services are delivered at the local level is as important as recognizing global animal health partners and stakeholders. This knowledge assists in planning activities that synergize rather than disrupt existing systems and animal health capacity-building efforts. For example, if the Food and Agriculture Organization is partnered with a local nongovernmental organization working to sustainably enhance the capacity of community animal health workers to deliver services in a market-based fee-for-service system, then a US Army-sponsored veterinary civic action program that provides free veterinary services in the same area will undermine the ongoing initiative to improve animal health and the economic well-being of the local population. A better approach would be a coordinated or collaborative effort with the Food and Agriculture Organization that augments efforts to enhance the capacity of community animal health workers.

Joint Publication 1, Doctrine for the Armed Forces of the United States, defines military engagement as “the routine contact and interaction between individuals or elements of the Armed Forces of the United States and those of another nation’s armed forces, domestic or foreign civilian authorities or agencies to build trust and confidence, share information, and coordinate mutual activities.”2(pI-15) In the military engagement model, Veterinary Corps officers conduct activities focused on building local animal health capacity in cooperation with partner nation military and civilian veterinary service personnel. Framing an animal health activity as a military engagement allows Veterinary Service personnel to explain the means by which animal health outcomes of improved economic, food, and health security are tied to operational objectives in the irregular warfare environment.

If the partner nation is willing to share its Performance of Veterinary Services report, it can be referenced for planning animal health activities or engagements that extend or augment existing programs that are working to bridge gaps in the national veterinary service system. In the tactical environment, activities and engagements typically focus on human, physical, and financial resources through the transfer of knowledge and sharing of best practices with professional and paraprofessional veterinary personnel.

Activities and engagements that target animal health systems in the partner nation seek to improve economic, food, and health security of individuals and local communities. The outputs and outcomes of these activities can be linked to US defense, diplomatic, and development objectives at the strategic, operational, and tactical levels. Vignette 17-2 illustrates an example of an animal health activity that targets outcomes to mitigate communicable disease risks in remote villages in Uganda, supporting broader US strategic objectives to combat pandemic threats.

Vignette 17-2. One Health Team Combats Animal-To-Human Disease Transmission

LUWERO DISTRICT, Uganda - Living on a planet with more than seven billion people and countless more animals, viruses have many options to invade—and they’re not picky. Viruses often jump from animals to humans, causing many diseases ranging from avian flu to Lyme disease, West Nile virus to severe acute respiratory syndrome (SARS).

The US Agency for International Development (USAID) estimates that more than 60 percent of emerging infectious diseases in humans are transmitted from animals in a process called zoonoses. Though some diseases transmit from livestock, many more—at least 74 percent—come from wildlife, which is most likely a result of human encroachment into animals’ habitats. Making matters worse, some diseases, such as anthrax, can be harvested for bio-terrorism.

With the opportunity to make a difference in this fight, human and animal healthcare experts from Combined Joint Task Force-Horn of Africa (CJTF-HOA) Surgeon Cell, 411th Civil Affairs Battalion (CA Bn), the Uganda People’s Defense Force (UPDF), and their civilian counterparts recently launched a program called One Health in Luwero district, Uganda.

Traditionally, One Health recognizes the impact of zoonoses and how the health of humans, animals and ecosystems, like nations, are interconnected. Overall, One Health is a whole-of-government program coordinated by the Ugandan government, the UPDF and USAID.

“One Health is a good concept we need to advance,” said Maj. (Dr.) Godwin B. Bagyenzi, director of medical research for the UPDF. Previously, medical professionals, veterinarians, environmental specialists and wildlife scientists worked separately, he said, “but because the high percent of diseases challenging mankind are emitting from animals, we need to work together.”

US Army Maj. Thamus J. Morgan, a veterinarian with the 411th CA Bn., which is supporting CJTF-HOA, said everyone should be concerned about preventing disease in Uganda, including Americans.

“I can leave here, get on a plane, and be back in the United States within 19 hours,” said Morgan. “That’s a very long time to pass on a virus. If we can stop an outbreak here, then we are going to prevent a whole lot of other people from dying.”

To combat such threats, One Health uses a mix of classroom instruction and practical field exercises to prepare others in the fight against infectious diseases. Dozens of Luwero district animal and human healthcare experts, handpicked by local health officials, joined the UPDF and US soldiers every morning to review basic diagnosis of various diseases, treatment plans, and preventive measures. Participants then fanned out across the district to test their newly acquired skills.

“This training has boosted our knowledge about zoonotic diseases,” said Serunkuuma Daniel, a Luwero District vector control officer. “I’m more than happy because the community now has people who are technically aware of diseases, how to prevent them and can do a lot to make sure epidemics are combated before they spread.”

Since inadequate sanitation contributes to the spread of disease, One Health also included a review of human hygiene and water and food sanitation procedures at ranches, farms, households, and medical facilities.

“Probably the greatest success story is the linkage of all diseases to sanitation,” said U.S. Army Col. (Dr.) Richard Birdsong, a physician with the 411th CA Bn. “Safe water, safe food are key to preventing disease.”

Program coordinators chose the Luwero district for One Health because the area has experienced two Ebola outbreaks within the past year. Ebola is a highly contagious, often-fatal virus which is believed to be transmitted to people from animals, although the exact origin, locations, and natural habitat of Ebola remain unknown. The virus can be transmitted from person to person in several ways, including direct contact with the blood or secretions of an infected person or through contact with objects, such as needles, that have been contaminated with infected secretions.

“This is the epicenter or ‘tip of the spear’ of where an outbreak took place last year,” said Morgan, who is from Clinton, Conn. She said the information will be collected, analyzed, and shared with citizens to prevent another outbreak.

“It’s a new culture. Under One Health, we learned we can’t leave out the vets,” said Col. Dr. Samuel Kasule, the UPDF director for public health. “We realize diseases come from the life circle of man, animal and environment.”

Protecting humans often starts by protecting animals, prompting One Health participants to visit several ranches and farms to learn how to identify disease in livestock. For example, one ranch located in the remote Kitendeli area measures six square miles and raises cattle, pigs and poultry.

“Not treating livestock for disease would be disastrous,” said Dr. Kawule Leonard, the Kitendeli ranch veterinarian and production manager. “What we produce on the farms will target humans. Not putting this in to consideration is a very big risk to the market and ultimately humans, who are consuming the products.”

Humphrey Kabugo, a monitoring and evaluation officer for USAID’s Emerging Pandemic Threats Program, said he was pleased with One Health’s accomplishments in addressing the interconnectedness of human and animal life.

“Individuals are much more prepared to work together from different disciplines to respond to outbreaks so that the impact on human life, animal life and the environment is reduced,” said Kabugo.

The partnership is working, said Kabugo, “and the best is yet to come.”

News article by Petty Officer First Class Thomas Ouellette. Reproduced from http://www.hoa.africom.mil/Story/7769/one-health-team-combats-animaltohuman-disease-transmission and the Defense Video and Imagery Distribution System. Accessed October 13, 2017.

Sustained and coordinated activities and engagements conducted within the framework of existing country programs in collaboration with interagency and international partners maximize the efficiency of invested resources and reduce redundancy. For example, a local animal health project that intends to increase animal-source protein production and consumption, secure livelihoods of livestock owners, and mitigate the risk of zoonotic disease will directly benefit local populations, supporting a tactical military objective in counterinsurgency operations. This same animal health activity can meet the common objectives of interagency diplomatic and development partners through pooling of common resources, expertise, and logistics.

Vignette 17-3 illustrates interagency collaboration to meet common US objectives of food and economic security in Sulu, Philippines.

Vignette 17-3. Armed Forces of the Philippines, Joint Special Operations Task Force-Philippines, and US Department of Agriculture Participate in Sulu Agricultural Seminar

JOLO, Philippines - More than 100 faculty members and students from Mindanao State University, Sulu, Philippines, participated on June 1 in a historic Veterinary/Agricultural Seminar at the Sulu Area Coordination Center.

Hosted by Sulu’s provincial government, the seminar, which was the first of its kind in conflict-affected Sulu province, featured Philip Shull, a foreign service agricultural counselor from the US Department of Agriculture and veterinarians from the Armed Forces of the Philippines and Joint Special Operations Task Force-Philippines.

Shull said he hopes the seminar will help Sulu barangays develop a closer relationship with the Philippine government and draw attention to the value of the resources at the US Embassy for agricultural advice and support programs.

“We hope they see the US as a positive partner with the Philippine government and a positive force in the lives and communities of the Filipino people,” Shull said. “And we are hopeful that in the future we will be able to do regular outreach seminars like this and bring in experts who can convey information that is critical and will have a quick and direct impact on their lives, their livelihood, and their families.”

Also in attendance were Sulu Governor Abdusakur Tan and members of the Philippine Department of Agriculture, the Philippines Bureau of Fisheries and Aquatic Resources, and the Sulu Area Coordination Center.

The US Army veterinarian assigned to JSOTF-P said the goal of the seminar was to engage the local government in partnership with the US Embassy and the AFP and eventually help facilitate this kind of civic assistance with increasingly greater local government participation and sponsorship.

“The presence of the USDA team was critical because it helped marry provincial-level assets with their national-level counterparts,” said another JSOTF-P team member. “These relationships will help Sulu coordinate future seminars and subject matter information exchanges, enhancing the knowledge and capacity of the local farmers of Sulu.”

In addition to giving practical advice on farming techniques, the speakers used samples, pamphlets and handouts to increase awareness of common livestock diseases and toxic plants in southern Mindanao and introduce new uses for familiar agricultural products, including home remedies for common illnesses.

“We appreciate and welcome so many groups coming together sharing their thoughts, resources, and enthusiasm for agriculture,” said Fazlur Abdullah, Sulu ACC director. “The mission of the governor is to enhance, develop and improve our natural resources. Opening up to the outside world, floating ideas, doing community outreach will help us help ourselves and instill confidence in our people. Our goal is food sufficiency. We should be producing our own food.”

Abdullah said he hopes these seminars will be conducted in the future “soon and often.”

News article by Petty Officer 1st Class Cassandra Thompson. Reproduced from https://www.dvidshub.net/news/72716/afp-jsotf-p-and-usda-participate-sulu-agricultural-seminar. Defense Video and Imagery Distribution System. Accessed October 13, 2017.

Animal Health Surveillance Capacity

The DoD participates in US interagency efforts to build global health surveillance capacity.[50] DoD global health surveillance capacity-building efforts are primarily conducted to protect the health of the force; however, partner nation surveillance system improvements have a broader impact on global public health. Force health protection efforts to prevent zoonotic diseases require strengthening and integration of animal health and human health surveillance systems. The surveillance capacity that targets zoonotic disease will also impact the partner nation’s veterinary services capacity to deal with economically important transboundary animal diseases, supporting efforts to alleviate economic and food insecurity. Building animal health surveillance capacity for identification of and response to zoonotic diseases can be expanded to nonzoonotic transboundary animal diseases and support the economic development activities of stability operations or enhance livelihoods to influence local populations in support of counterinsurgency operations.

DoD overseas laboratories and defense agencies play an important role in building partner nation surveillance capacity.[50] Efficiently functioning national veterinary services are necessary for access to global markets that trade animal-source products. DoD animal health activities conducted in the tactical environment often focus on building local capacity in the delivery of veterinary services. In the strategic environment, DoD animal health activities and engagements may focus on enhancing animal health surveillance systems. In the technical authority and capability domain of the Performance of Veterinary Services framework, the DoD has the capacity to conduct animal health activities and engagements that target veterinary laboratory diagnostic services, laboratory quality assurance, and epidemiologic surveillance and early detection. Enhancing these partner nation veterinary services capabilities supports the US National Security Strategy global health and food security initiatives.[51]

For example, in 2006, mortality in Afghan poultry significantly increased, and H5N1 avian influenza was suspected. The threat of H5N1 avian influenza was considered a risk to force health and public health. Although H5N1 avian influenza poses a serious health risk to individuals who have close contact with dead or dying poultry, the greater threat was to the economic and food security of Afghans who depend on poultry as a protein source and for supplemental income. The US Embassy in Afghanistan, with concurrence from the World Health Organization, the Food and Agriculture Organization, and the Afghanistan Ministry of Agriculture, requested diagnostic support from the DoD.

In response, Navy Medical Research Unit 3 dispatched a Veterinary Corps comparative medicine specialist (Lieutenant Colonel Samuel Yingst) with a portable real-time polymerase chain reaction diagnostic capability to provide technical assistance. H5-type avian influenza was identified using what is believed to be the first polymerase chain reaction assay conducted in Afghanistan. Although the pathogenicity was suggestive of H5N1, Afghanistan Ministry of Agriculture officials decided to wait for reference laboratory confirmation before acting. Samples were sent to the World Organization for Animal Health and the Food and Agriculture Organization reference laboratory in Padova, Italy. Two weeks later, the Navy Medical Research Unit 3 diagnostic results were confirmed and containment efforts began. Over 30,000 poultry were culled in the effort to contain the disease, but the total number of poultry lost to the outbreak was never well enumerated (personal knowledge, Lieutenant Colonel Samuel Yingst, chapter author and then Deputy Head of Virology at Naval Medical Research Unit 3, dispatched to Afghanistan, 2006–2008, now retired).

The outcome of this activity was confidence in the technical capability of Navy Medical Research Unit 3 and an illustration of the importance of in-country rapid diagnostic capabilities for control of animal diseases. Afghan Ministry of Agriculture, Irrigation, and Livestock requested that Navy Medical Research Unit 3 provide long-term technical support to establish polymerase chain reaction diagnostic capacity within Afghanistan’s central veterinary diagnostic and research laboratory in collaboration with the Food and Agriculture Organization.

Such support was established before a second H5N1 avian influenza outbreak in February 2007. The geographical pattern of the outbreak was similar to the previous year, but because of early identification and response, fewer than 15,000 poultry were culled to contain the outbreak (personal knowledge, Lieutenant Colonel Samuel Yingst, chapter author and Deputy Head of Virology at Navy Medical Research Unit 3, dispatched to Afghanistan, 2006–2008, now retired).

The Navy Medical Research Unit 3 capacity-building effort is an example of a force health protection initiative that had an impact on economic and food security for the Afghan people. The polymerase chain reaction capability established in the Afghanistan central veterinary diagnostic and research laboratory was expanded for rapid diagnosis of nonzoonotic transboundary animal diseases such as Newcastle disease and mycoplasma in poultry, as well as foot and mouth disease in hoofstock and peste des petits ruminants in small ruminants, putting Afghanistan on a pathway to meet international standards and open global markets to Afghan animal-source products.

SELECTION, TRAINING, AND EDUCATION CONSIDERATIONS

As noted earlier in this chapter, Veterinary Corps authorizations in the US Special Operations Command, US Army Civil Affairs and Psychological Operations Command, and the conventionally aligned Civil Affairs Brigade account for approximately 10% of the DoD Veterinary Corps officer authorizations (Colonel [Retired] Bob Walters, Director, Department of Defense Veterinary Service Activity, 2009–2015, personal communication with Paul Hollier, chapter author, August 25, 2014). Veterinary Corps officers assigned to Special Operations and Civil Affairs units are utilized in unconventional ways, are selected based on experience and personality, and receive additional professional skills through on-the-job training or specialized training events.

Selection Criteria and Value

It is commonly believed that medical personnel who have successfully completed an early career assignment in a Special Operations unit are more likely to be successful in other Special Operations medical staff officer positions. This observation led to the development of the S1 skill identifier, Army Medical Department Special Operations Officer (Exhibit 17-2).

The S1 skill identifier does not outline a particular set of skills or competence; rather, it recognizes that certain experiences and personality traits are better suited to support Special Operations and Civil Affairs units during rapidly evolving missions in irregular warfare. Special Operations and Civil Affairs veterinary personnel have been described as practical, reliable, self-sufficient, and slightly peculiar. These traits may serve as predictors of a successful assignment, but, ultimately, selection for more senior assignments in Special Operations and Civil Affairs is judged by a veterinary officer’s ability to fit in with the operators they support.

In addition to soft skills and personality traits, Veterinary Corps personnel assigned to Special Operations and Civil Affairs require expertise and competency in canine operational medicine and global veterinary medicine. These skills and competencies are not part of the veterinary professional education system or the general Veterinary Corps officer education and training life cycle. Therefore, Veterinary Corps officers who are assigned to support irregular warfare operations must acquire additional skills and competencies through on-the-job training or specialized military courses in these fields.

Canine Operational Medicine

Canine operational medicine refers to the team approach to military working dog health and performance throughout the deployment cycle, leveraging principles of veterinary preventive medicine, veterinary occupational health, veterinary operational planning, and case management of canine casualties from point of injury to return to duty.

The American College of Occupational and Environmental Medicine states that occupational and environmental medicine physicians enhance the health of workers through preventive medicine, clinical care, disability management, research, and education.[52] These same competencies are essential parts of an integrated health support package that maintains health and readiness and extends the range of multipurpose canines. In order to provide realistic and accurate guidance on management of ill or injured canines to Special Operations units, veterinary personnel must have a comprehensive understanding of the working requirements, environmental hazards, capabilities, and limitations of the tactical canine team. In addition to a solid foundation of veterinary medical skills, Special Operations veterinarians apply operational medicine principles, including combat medicine, battlefield care, and medical evacuation, to the canine populations they support.

EXHIBIT 17-2.

S1 SKILL IDENTIFIER: ARMY MEDICAL DEPARTMENT SPECIAL OPERATIONS OFFICER

The S1 skill identifier was established to identify personnel who have one of the following qualifications:

1. Served 12 months in an active duty capacity in any Army Medical Department (AMEDD) area of concentration with a Special Operations Forces (SOF)-designated unit.

2. Participated in an SOF-designated unit deployment or mission for 4 consecutive months.

3. Qualified in Special Forces, Civil Affairs, or psychological operations through formal schooling.

4. For US Army Reserve AMEDD officers, completed a cumulative 24 months of assignment in an SOF-designated unit.

____________

Reproduced from Fiscal year 2011 officer military occupational classification and structure (MOCS) personnel reclassification actions, MILPER Message Number 10-123. Published May 3, 2010.

Maintaining operational readiness of multipurpose canines requires effective case management and a broad understanding of relevant veterinary specialties and available resources to decrease return to duty time and training distractions. An understanding of the operational environment and the physiologic limits of multipurpose canines are also essential. Tactical canine programs are unique, and the normal limits of multipurpose canines sometimes extend beyond the ranges acceptable in companion animal medicine.

The tolerance of individual multipurpose canines to environmental extremes can vary, however, and the operational environment offers additional clinical challenges. Veterinary personnel must therefore understand not only qualities of the working dog population, but also an individual canine’s response to desert, tropical, maritime, mountain, and airborne operational environments. As noted earlier in this chapter, the effects of high altitude, cold weather, extreme heat, and salt water exposure have the ability to affect—either limit or possibly enhance—the operational effectiveness of tactical canine teams.15,19,53 Other unique aspects of canine care include toxicity of ingested explosive materials that military working dogs are trained to detect, the effect of environmental noise and vibration from rotary or fixed-winged transport, and acoustic problems associated with blast overpressure. The delayed access to veterinary care for ballistic injuries in the combat environment is also a unique treatment challenge for military working dog populations.[14]

Human occupational hazards receive extensive research in military medicine; however, this is not the case in military veterinary medicine. Depsite the lack of evidence, a Special Operations veterinarian is required to advise tactical canine program personnel on prevention and management of occupational hazards inherent—or perceived—in extreme operating environments. Therefore, Special Operations veterinarians must stay current in medical literature and have the flexibility to merge evidence-based medicine with empirical practices rapidly adapted from lessons learned on the battlefield.

The Veterinary Support to Tactical Canine Programs course is an initiative in the Special Operations veterinary community to aggregate and deliver canine operational medicine competencies in a scenario-based training environment. Graduates of the program course are able to perform the following tasks:

- conduct a train-the-trainer course in canine tactical combat casualty care;

- develop low-cost and realistic training aids out of commonly available materials;

- conduct realistic scenario-based training for canine handlers and human medical personnel;

- manage care of a critically wounded canine casualty from point of injury through return to duty;

- manage a combined mass casualty event with multiple human and canine casualties;

- conduct a site survey and develop a comprehensive veterinary support plan for a canine training event;

- understand the occupational hazards of military working dogs and utilize evidence-based practice to recommend prevention and treatment guidelines;

- communicate risk to canine handlers, program leadership, and other veterinary personnel; and

- develop a culmination training exercise for veterinarians, canine handlers, and human medical providers, pulling together all the principles of canine operational medicine

(personal knowledge, Colonel Janice Baker, chapter author, Course Developer and Director of the Veterinary Support to Tactical Canine Programs Course, 2011–2017).

The competencies gained in the Veterinary Support to Tactical Canine Programs course, along with on-the-job training and mentoring from senior special operations veterinarians, are essential to providing comprehensive care packages and performance enhancement for multipurpose canines in the irregular warfare environment.

Global Veterinary Medicine

As previously discussed, in population-centric irregular warfare, animal health systems serve as targets for capacity-building activities and engagements intended to impact economic, food, and health security. Veterinary Corps officers have animal health and public health expertise relevant to global animal health, but additional expertise is required to operationalize these skills to impact security and stability objectives in the irregular warfare environment.

The American Veterinary Medical Association Council on Education has established competencies for veterinary professionals to practice in the United States. Army Veterinary Corps personnel who are trained in the United States have validated clinical skills that enable them to apply for state licensure and practice clinical medicine.[54] Although some are relevant in the global animal health environment, these clinical skills are primarily focused on the delivery of veterinary care to sick animals. To plan activities and engagements that build global animal health capacity, a broader understanding of global animal health systems is required.

The World Organization for Animal Health has identified competencies for international veterinary graduates required for a global network of national veterinary service systems.[55] These globally focused competencies include clinical competence as well as preventive medicine, public health, and regulatory competence. The World Organization for Animal Health developed these competencies to ensure graduates of international veterinary training programs can function in the global animal health environment; however, these competencies do not completely prepare a Veterinary Corps officer to plan and deliver capacity-building activities in cooperation with the partner nation to enhance components of the national veterinary service system.

Conducting animal health activities and engagements in support of stability operations and other operations in the irregular warfare environment requires Veterinary Corps officers to identify partner nation counterparts and the systems in which they operate, evaluate those systems, and design and implement activities with intended outputs and outcomes that support military goals and objectives. Acknowledging gaps in the veterinary professional and military education systems, the Army Veterinary Service, in collaboration with the University of Georgia, developed two 40-hour courses to supplement the Veterinary Corps officer training and education life cycle.

First in the series is the Veterinary Support to Stability Operations Assessment and Production Systems course. This course focuses on expanding students’ understanding of international animal production systems and assessment methodologies. A graduate of the course is expected to be able to master the following objectives:

- explain the importance of smallholder animal health in basic agricultural production and marketing systems for poultry, small ruminants, and large ruminants in developing nations;

- utilize participatory assessment methodologies in a simulated environment to describe and differentiate “reality,” “perceived reality,” and “observed reality,” as well as conducting a site survey to identify potential problems;

- apply basic field epidemiology study designs and appropriate statistical tests, and explain how they can be used contextually;

- summarize the legalities and limitations of working with foreign governments, other US federal agencies, and nongovernmental organizations in stability operations;

- explain assessment findings to host nation government officials, host nation village community members, and military audiences using appropriate formats for different audiences;

- develop and communicate civil information within current operating systems used by the US government, the DoD, and nongovernmental organizations; and

- convey national security relevance of veterinary support to stability operations activities to global interagency partners

(personal knowledge, Lieutenant Colonel Paul Hollier, chapter author, Course Developer and Director of the Veterinary Support to Stability Operations Courses, 2009–2013).

Second in the series is the Veterinary Support to Stability Operations Global Veterinary Medicine course. This course focuses on expanding students’ understanding of the global animal health environment and project planning methodologies. A graduate of the course will master these objectives:

- describe how globalization has provided economic opportunities for agriculture in developing nations and how animal health is key to this success;

- articulate the difference between active and passive surveillance and how these systems are used and explain the application of surveillance in national and international public health, as well as its role in agricultural trade policy;

- demonstrate an understanding of how political history, national cultures, and educational systems differ from country to country and can impact efforts;

- develop a concept of operation using the program action logic model and demonstrate how this tool can be used to identify and plan projects and programs that will synergize with existing national, intergovernmental, and nongovernmental organization efforts;

- conduct training in field necropsy, sample collection, and basic laboratory testing for effective diagnostics in resource-poor settings; and

- explain pertinent clinicopathologic and diagnostic features of selected transboundary diseases

(personal knowledge, Lieutenant Colonel Paul Hollier, chapter author, Course Developer and Director of the Veterinary Support to Stability Operations Courses, 2009–2013).

Completing the course series provides the Veterinary Corps officer a basic level of competence to operate in and design and implement capacity-building activities in the global animal health environment. Some Veterinary Corps officers also take advantage of the veterinary preventive medicine track of the Army Medical Department’s Long-Term Health and Education Training program to develop more specialized competence in global veterinary medicine. These skills are important to Veterinary Corps officers operating in the irregular warfare environment, as well as to the future of the veterinary profession in a globalized world.

SUMMARY

The DoD’s 2012 publication Sustaining US Global Leadership: Priorities for 21st Century Defense[56] outlines a transition period for the US military as it withdraws from over a decade of sustained operation in Afghanistan and Iraq. Its guidance deemphasizes large stability operations as they were conducted in Iraq and Afghanistan; however, the competencies developed in these conflicts in risk communication, canine operational medicine, and global veterinary medicine have enduring relevance, even if military strategies shift away from nation-building in certain theaters. The Army Veterinary Service will continue to operationalize professional skills, abilities, and competencies to protect animal health and promote public health in a way that meets the objectives of military commanders. Veterinary expertise is in short supply globally, and the DoD can leverage a pool of highly trained experts to meet national security goals and objectives.

The US Army Veterinary Corps continues to expand its relevance in the DoD by leveraging skills and expanding capabilities that are unique to the veterinary community.[6] The DoD is encountering increased global challenges with emerging diseases, food supply shortages, bioterrorism, natural disasters, land transition, famine, and poverty. To meet these challenges, The Army Veterinary Service is adapting its functional capability to support the irregular warrior and operations in the irregular warfare environment. The Army Veterinary Service is also faced with the opportunity to lead cross-disciplinary efforts to build sustainable animal health and public health capacity in support of US, partner nation, and coalition forces security strategies.

Acknowledgments

Special thanks to Dr Todd Helmus and the RAND Arroyo Center for their support and comprehensive review of this chapter. Thanks also to Dr Corrie Brown, Lieutenant Colonel Joel Vernetti, and Major Gerry Dolan for expert peer review and to Lieutenant Colonel Alicia Wilma, Master Sergeant Sandra Reeves, and Master Sergeant (Retired) Andy Lacy for their contributions to various sections of this chapter.

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ACRONYMS AND ABBREVIATIONS

A

AAALAC: Association for Assessment and Accreditation of Laboratory Animal Care

AAFES: Army and Air Force Exchange Service

AAT: animal-assisted therapy

AC: hydrogen cyanide

ACGME: Accreditation Council of Graduate Medical Education

AChE: acetylcholinesterase

ACLAM: American College of Laboratory Animal Medicine

ACUP: animal care and use program

ACURO: Animal Care and Use Review Office

ACVP: American College of Veterinary Pathologists

ADA: Americans with Disabilities Act

ADPAC: Animal Disease Prevention and Control

AE: aeromedical evacuation

AEF: American Expeditionary Forces

AEP: auditory evoked potential

AFB: Air Force base

AFHSC: Armed Forces Health Surveillance Center

AFMIS: Army Food Management Information System

AFOTSG: Consultant to the Air Force Surgeon General

AFRIMS: Armed Forces Research Institute of Medical Sciences

AFRRI: Armed Forces Radiobiology Research Institute

AI: avian influenza

AIS: alveolar interstitial syndrome

AIT: advanced individual training

ALFOODACT: All Food Activities Program

ALP: alkaline phosphatase

AMC: Army Medical Center

AMEDD: Army Medical Department

AMEDD C&S: AMEDD Center and School

AMM: Army Medical Museum

AMSA: Army Medical Surveillance Activity

ANA: Afghan National Army

AOC: area of concentration

APHC: Army Public Health Center

APIE: assessment, planning, implementation, and evaluation

APHIS: Animal and Plant Health Inspection Service

ARS: acute radiation syndrome

ARVN: Army of the Republic of Vietnam

ASDR&E: Assistant Secretary of Defense, Research and Engineering

ASF: African swine fever

ATPase: adenosine triphosphatase

AVFSI: Army veterinary food safety instructor

AVMA: American Veterinary Medical Association

AVT: Army veterinary technician

AWA: Animal Welfare Act

AWR: animal welfare regulation

B

BAF: Bagram Air Field

BAI: Bureau of Animal Industry

BAMC: Brook Army Medical Center

BEST: Battlefield Excellence through Superior Training

BPRP: biological personnel reliability program

BRD: Biological Research Database

BSAT: biological select agent or toxin

BSE: bovine spongiform encephalopathy

BSL: biosafety level

BUMED: Bureau of Medicine & Surgery

C

CA: civic action

CA Bn: Civil Affairs Battalion

CANA: Convulsive Antidote, Nerve Agent

CASEVAC: casualty evacuation

CBI: China-Burma-India

CBRN: chemical, biological, radiological, and nuclear

CCC: Civilian Conservation Corps

CCMD: combatant command

CDC: Centers for Disease Control and Prevention

CDV: canine distemper virus

CENTCOM: Central Command

CFD: Combat Feeding Directorate

CFR: US Code of Federal Regulations

CG: phosgene

CIS: Clinical Investigations Site

CHPPM: Center for Health Promotion and Preventive Medicine

CJD: Creuztfeldt-Jakob disease

CJTF-HOA: Combined Joint Task Force-Horn of Africa

CK: cyanogen chloride

CNS: central nervous system

CONUS: continental United States

COSC: combat and operational stress control

CPEAP: Caisson Platoon Equine-Assisted Program

CPG: clinical practice guideline

CPV: canine parvovirus

CSF: cerebral spinal fluid

CSF: classical swine fever

CTT: combat trauma training

CVL: canine visceral leishmaniasis

CWD: contract working dog

CWS: Chemical Warfare Service

CX: phosgene oxime

D

DA: Department of the Army

DARPA: Defense Advanced Research Projects Agency

DCI: Department of Clinical Investigation

DCPA: Defense Civil Preparedness Agency

DD: Defense Department

DE: directed energy

DCE: Dog Center Europe

DeCA: Defense Commissary Agency

DENCAP: dental civil action program

DFA: direct fluorescent antibody

DHA: Defense Health Agency

DHHQ: Defense Health Headquarters

DLA: Defense Logistics Agency

DLA-TS: Defense Logistics Agency-Troop Support

DMP: destination monitoring program

DNA: deoxyribonucleic acid

DNBI: disease and nonbattle injury

DoD: Department of Defense

DODDC: DoD Dog Center

DoD FADL: Department of Defense Food Analysis and Diagnostic Laboratory

DoDI: Department of Defense Instruction

DODVPR: DoD Veterinary Pathology Residency

DOTML-PF: doctrine, organization, training, materiel, leadership and education, personnel, or facilities

DODMWDVS: Department of Defense MWD Veterinary Service

DODVSA: DoD Veterinary Services Activity

dRIT: direct rapid immunohistochemical test

DRSI: Disease Reporting System–Internet

DSCP: Defense Supply Center Philadelphia

DTRA: Defense Threat Reduction Agency

DU: depleted uranium

DVM: doctor of veterinary medicine

E

EAC: echelon above corps

EAMC: Eisenhower Army Medical Center

EC: European Commission

EEEV: eastern equine encephalitis virus

EHR: electronic health record

ELISA: enzyme-linked immunosorbent assay

EM: erythema migrans

EPW: enemy prisoner of war

ESR: erythrocyte sedimentation rate

ETT: endotracheal tube

EU: European Union

EUCOM: European Command

EVD: Ebola virus disease

F

FADL: Food Analysis and Diagnostic Laboratory

FASS: Federation of Animal Science Societies

FAVN: fluorescent antibody virus neutralization test

FAWD: food and water defense

FDA: Food and Drug Administration

FEMA: Federal Emergency Management Agency

FEST: field epidemiology survey team

FHA: foreign humanitarian assistance

FM: field manual

FMD: foot and mouth disease

FMDV: FMD virus

FOB: Forward Operating Base

FPLT: food procurement and laboratory team

FSCT: food safety communication team

FSHTX: Fort Sam Houston, Texas

FSO: food safety officer

FSR: first strike ration

FST: forward surgical team

FWRA: food and water risk assessment

FYGVE: First-Year Graduate Veterinary Education

G

GA: tabun

GAO: Government Accountability Office

GB: sarin

GD: soman

GEIS: Global Emerging Infectious Surveillance and Response System

GI: gastrointestinal

GLP: Good Laboratory Practices

GME: graduate medical education

H

HAC: House Appropriations Committee

HC: hexachloroethane

HD: sulfur mustard

HHA: higher headquarters assessment

HHS: Health and Human Services

HPAI: highly pathogenic avian influenza

HPSP: Health Professions Scholarship Program

HQDA EXORD: Headquarters, Department of the Army Executive Order

HRCoE: Health Readiness Center of Excellence

I

IACUC: Institutional Animal Care and Use Committee

IDVT: independent duty veterinary technician

IFA: immunofluorescent antibody test

IFOR: implementation force

IFVA: installation food vulnerability assessment

IG: Inspector General

IgG: immunoglobulin G

IgM: immunoglobulin M

IPAT: integrated process action team

IRB: institutional review board

ISO/IEC: Organization for Standardization/International Electrotechnical Commission

ISP: installation support plan

ISR: Institute of Surgical Research

IV: intravenously

IWDBA: International Working Dog Breeding Association

J

JAT: Joint Analysis Team

JCCoE: Joint Culinary Center of Excellence

JCIDS: Joint Capabilities Integration Development System

JDVC: Japan District Veterinary Command

JPC: Joint Pathology Center

JPMRC: joint patient movement requirements center

JSIVA: joint staff integrated vulnerability assessment

JSOMTC: Joint Special Operations Medical Training Center

K

K9: canine

KFOR: Kosovo Protection Forces

KSA: Kingdom of Saudi Arabia

L

L: lewisite

LAM: laboratory animal medicine

LAMRAC: Laboratory Animal Medicine Residency Advisory Committee

LPS: lipopolysaccharide

LS: Department of Laboratory Sciences

LTHET: Long-Term Health Education Training

M

MAMC: Madigan Army Medical Center

MARCENT: US Marine Corps Forces Central Command

MAT: microscopic agglutination test

MCFMT: Marine Corps food management team

MCM: medical countermeasure

MDVM: medical detachment, veterinary medicine

MDVS: medical detachment, veterinary service

MDVSS: medical detachment, veterinary service support

MEDCAP: medical civil action program

MEDDAC: Medical Department activity

MEDCOM: Medical Command

MEDEVAC: medical evacuation

MIL-STD: military standard

MILVANs: military-owned demountable containers

MK: mark

MMP: Marine Mammal Program

MMS: Marine Mammals System

MOA: memorandum of agreement

MOCS: military occupational classification and structure

MOS: military occupational specialty

MPH: Master of Public Health

MRE: Meal, Ready to Eat

MRMC: Medical Research and Material Command

MTF: medical task force

MWA: military working animal

MWD: military working dog

MWR: moral, welfare, and recreation

N

NAMRU: Naval Medical Research Unit

NCO: noncommissioned officer

NEO: noncombatant evacuation operation

NFMT: Navy food management team

NIAID: National Institute of Allergy and Infectious Diseases

NMCSD: Naval Medical Center San Diego

NMRC: Naval Medical Research Center

NPLA: neutralizing peroxidase-linked assay

NPO: nonprofit organization

NRC: Nuclear Regulatory Commission

NSF: National Science Foundation

NSRDEC: Natick Soldier Research, Development, and Engineering Center

O

OCONUS: outside the continental United States

OCT: optical computer tomography scan

ODA: operational detachment alpha

OEF: Operation Enduring Freedom

OIC: officer in charge

OIE: World Organization for Animal Health

OIF: Operation Enduring Freedom

OPCON: operational control

OSD: Office of the Secretary of Defense

Osp: outer surface lipoprotein

OTSG: Office of the Surgeon General

OUA: Operation United Assistance

OVI: Onderstepoort Veterinary Institute

OWS: Old World screwworm

P

PAPR: powered air-purifying respirator

PCR: polymerase chain reaction

P-CS: Philadelphia Consumer Safety

PDF: Panamanian Defense Forces

PEP: postexposure prophylaxis

PFIB: perfluoroisobutylene

PHC: Public Health Command

PHD: doctor of philosophy

PHS: Public Health Service

PI: principal investigator

PMR: patient movement request

PMRC: patient movement requirement center

PNMC: Portsmouth Naval Medical Center

PPE: personal protective equipment

PROFIS: Professional Filler System

PTSD: posttraumatic stress disorder

RAB: Rabies Advisory Board

R

RBC: red blood cell

RBT: rose bengal test

R&D: research and development

RDT&E: research, development, test, and evaluation

RMES: Reportable Medical Events System

RMSF: Rocky Mountain spotted fever

RNA: ribonucleic acid

ROTC: Reserve Officers’ Training Corps

ROVR: Remote Online Veterinary Record

S

SAMMC: San Antonio Military Medical Center

SARS: severe acute respiratory syndrome

SCUD: tactical ballistic missile

SDTC: Service Dog Training Center

SFOR: stabilization force

SOF: Special Operations Forces

SSGT: staff sergeant

S&T: science and technology

SWA: Southwest Asia

T

TAD: transboundary animal disease

TAMC: Tripler Army Medical Center

TAML: Theater Area Medical Laboratory

TBD: tick-borne disease

TBI: traumatic brain injury

TC: Thomas Carlyle

TCCC: Tactical Casualty Combat Care

TFF: Task Force Falcon

TO&E: table of organization and equipment

TPMRC: theater patient movement requirement center

TSA: Transportation Security Administration

TSRL: Triservice Research Laboratory

U

UGR-A: unitized group ration-A

UGR-E: unitized group ration express

UGR-H&S: unitized group ration-heat and serve

UK: United Kingdom

UPDF: Uganda People’s Defense Force

USAF: US Air Force

USAFSAM: US Air Force School of Aerospace Medicine

USAID: US Agency for International Development

USAISR: US Army Institute of Surgical Research

USAMC-AFRIMS: US Army Medical Component Armed Forces Research Institute of Medical Sciences

USAMEDCOM: US Army Medical Command

USAMRICD: US Army Medical Research Institute of Chemical Defense

USAMRIID: US Army Medical Research Institute of Infectious Diseases

USAMRMC: US Army Medical Research and Materiel Command

USAMRU-E: US Army Medical Research Unit-Europe

USAMRU-G: US Army Medical Research Unit-Georgia

USAMRU-K: US Army Medical Research Unit-Kenya

USAPHC: US Army Public Health Command

USAR: US Army Reserve

USARIEM: US Army Research Institute of Environmental Medicine

USDA: US Department of Agriculture

USFJ: US Forces Japan

USMC: US Marine Corps

USNORTHCOM: US Northern Command

USSOCOM: US Special Operations Command

USUHS: Uniformed Services University of Health Sciences

V

VBD: vector-borne disease

VBS: veterinary biomedical scientist

VC: Veterinary Corps

VCO: Veterinary Corps officer

VCPR: veterinarian-client-patient relationship

VEE: Venezuelan equine encephalitis

VEEV: Venezuelan equine encephalitis virus

VES: veterinary equipment set

VETAC: veterinary activity center

VETCAP: veterinary civil action program

VETCEN: veterinary center

VETCOM: Veterinary Command

VFI: veterinary food inspector

VMD: Veterinary Medicine Division

VMSB: Veterinary Medical Standardization Board

VMST: veterinary medical and surgical team

VS: Veterinary Services

VSSA: Veterinary Service Support Area

VSST: veterinary service support teams

VTF: veterinary treatment facility

W

WBAMC: William Beaumont Army Medical Center

WBC: white blood cell count

WCC: Warrior Canine Connection

WEEV: western equine encephalitis virus

WHO: World Health Organization

WNV: West Nile virus

WP-AFLR: Wright-Patterson Air Force Research Laboratory

WRAIR: Walter Reed Army Institute of Research

WRNMMC: Walter Reed National Military Medical Center

WTB: Warrior Transition Battalion

INDEX

A

AAA. See Animal-assisted activity

AAALAC International. See Association for Assessment and Accreditation of Laboratory Animal Care International

Aabel, Colonel Bernard, 28

AAFES. See Army and Air Force Exchange Service

AAT. See Animal-assisted therapy

Abbot, Major William L., 24

Aberdeen Proving Grounds, 96

“Above and Beyond” Award, 136–137

Accreditation Council of Graduate Medical Education, 415

Accreditation program, 370–371

ACGME. See Accreditation Council of Graduate Medical Education

ACLAM. See American College of Laboratory Animal Medicine

Activity animals, 146–148

ACUP. See Animal care and use program

Acute radiation syndrome, 448

ACVP. See American College of Veterinary Pathologists

Adams, Colonel Timothy K., 62

ADPACs. See Animal Disease Prevention and Control

Advance Trauma Life Support, 416

Advanced individual training, 128–129

Advanced Marine Biological Systems Program, 177

AEF. See American Expeditionary Forces

Afghanistan

health service support, 489–490

operations, 57–62, 98–102, 354–355, 358–359

AFMIS. See Army Food Management Information System

African swine fever, 318–322

AFRRI. See Armed Forces Radiobiological Research Institute

Agency for International Development, 33, 69

Agnew, Dr. Robert Vans, 11

Ahle, Lieutenant Colonel Neil, 59

Air Force Veterinary Corps

disestablishment of, 39

establishment of, 23

AIS. See Alveolar interstitial syndrome

AIT. See Advanced individual training

Al Qaeda, 57

ALFOODACT. See All Food Activities Program

Alkaline phosphatase, 193

All Food Activities Program, 242, 246–247

Allenby, General Sir Edmund, 212

Alveolar interstitial syndrome, 192

Alves, Colonel Derron A., 70

AMEDDC&S. See Army Medical Department Center and School

Amen, Sergeant First Class Tom, 67

American Association for Laboratory Accreditation, 272

American College of Laboratory Animal Medicine, 384, 389–391

American College of Veterinary Behaviorists, 103

American College of Veterinary Pathologists, 429, 431–433

American Expeditionary Forces, 213–214

American Red Cross, 44

American Revolutionary War

military equine procurement and care, 208–209

Veterinary Services support, 4–5

American Theater Wing Incorporated program, 86

American Veterinary Medical Association, 7, 20, 69–70, 124, 126

American Veterinary Service, 11

Americans with Disabilities Act, 145–146

AMSA. See Army Medical Surveillance Activity

Anderson, Major Lynn, 144

Animal and Plant Health Inspection Service, 370, 375

Animal-assisted activity, 146–165

Animal-assisted therapy, 143–144, 146–165

Animal bite program, 136

Animal bond programs. See Human-animal bond programs

Animal care

“Above and Beyond” Award, 136–137

animal bite program, 136

clinical credentialing program, 130–133

evolution of military-provided pet care services, 124–126

expansion of Veterinary Corps mission, 13–15

financing of veterinary care for privately owned pets, 126–127

horse stable facilities, 135

maintenance of privately owned animal health records, 127–128

military veterinary treatment facilities policy, 126

pet fairs, 137

pet visitations to hospitals, 137

rabies control, 136, 356–357

reorganization of veterinary treatment facilities, 134–135

special types of military animal care services and programs, 135–137

standardization of military pet care, 130–134

stray animal facilities, 136

training for military pet care providers, 128–130

vaccination clinics, 137

Veterinary Medical Standardization Board, 133–134

visits to schools and daycare centers, 137

Animal care and use program, 392, 394–407

Animal Care Specialists, 115, 128–129

Animal Disease Prevention and Control, 124, 125

Animal diseases

African swine fever, 318–322

babesiosis, 56, 311–314

classical swine fever, 318–322

distemper, 30, 303–305

ehrlichiosis, 311–314

foot and mouth disease, 322–325

heartworm disease, 308–311

highly pathogenic avian influenza, 60, 325–328, 374, 376

in military animals, 278, 303–316

New World Screwworm, 316–318

Old World Screwworm, 316–318

parvovirus, 305–308

rabies, 26, 35, 42–43, 53–54, 61, 346–362

Staphylococcus aureus, 314–316

tick-borne disease, 311–314

transboundary diseases, 316–328

vaccination clinics, 137

Animal health capacity building, 499–504

Animal health care

activity animals, 146–148

animals and, 143–145

assistance animals, 145–146

service animals, 145–146

therapy animals, 146–148

Animal health records

electronic, 371–372

maintenance of, 127–128

Animal health surveillance, 503–504

Animal Welfare Act, 386–387

Animal welfare regulations, 387

Antarctic Treaty, 243

Anthrax

clinical findings, 280–281

control of, 282

diagnostic approaches, 281

geographic distribution, 280

incidence of, 280

military importance of, 279

pathogen, 279

pathogenesis, 280–281

prevention, 282

therapy for, 281–282

transmission of, 279

vaccination for, 50

Antibiological warfare program, 22

APHC. See Army Public Health Center

APHIS. See Animal and Plant Health Inspection Service

APIE. See Assessment, Planning, Implementation, and Evaluation System

Appert, Nicolas, 232

Aristide, Jean-Bertrand, 53

Armed Forces Health Surveillance Center, 373–374

Armed Forces Institute of Pathology, 27, 432, 435

Armed Forces Radiobiological Research Institute, 391–393, 398, 447

Army and Air Force Exchange Service, 44, 245–246

Army Dog Association, Inc., 93

Army Dog Training Center, 93

Army Food Management Information System, 237–238

Army Institute of Pathology, 429, 431

Army Materiel Command, 257

Army Medical Department Center and School, 28

Army Medical Department Schools, 28

Army Medical Department Special Operations Officer, 504

Army Medical Museum, 20, 27, 429–430

Army Medical School, 12

Army Medical Service Meat and Dairy Hygiene School, 28

Army Medical Surveillance Activity, 373

Army of the Republic of Vietnam, 29–30

Army Public Health Center, 233, 371, 475

Army Public Health Command, 106–107

Army Remount Service, 20

Army Reorganization Act of 1901, 9

Army Veterinary Corps. See US Army Veterinary Corps

Army veterinary food safety instructors, 240

Army veterinary laboratory service, 268–272

Army Veterinary School Laboratory, 20

Army Veterinary Service

American Revolutionary War to pre-Civil War, 4–5

animal care mission, 13–15

assignment changes during World War II, 19–20

casualties during World War I, 15

Civil War to Spanish-American War, 5–8

Cold War, 26–29

consideration for reserve corps, 10–11

consolidation of, 39

Ebola virus protection involvement, 66–70

expanded mission of, 12–14

expansion of, 11–12

First-Year Graduate Veterinary Education, 105–106

food inspection mission, 13

food inspection responsibilities, 16

impact of non-DoD missions, 70–71

Korean War, 24–26

mission changes during World War II, 17–18

Persian Gulf War, 46–51

post-Persian Gulf War, 46–65

post-World War I services, 15–17

pre-Persian Gulf War, 42–46

proposed Congressional phase-out, 38–39

reassessment of mission after Vietnam War, 37

64F training, 102, 107

Spanish-American War to pre-World War I, 8–11

training changes during World War II, 18–19

Veterinary Reserve, 11–12

Vietnam War, 29–42

World War I to pre-World War II, 11–17

World War II to pre-Korean War, 17–24

zoonotic disease protection and control mission, 13

ARVN. See Army of the Republic of Vietnam

Ash, Colonel James Earle, 430, 431

Assessment, Planning, Implementation, and Evaluation System, 157–158

Assistance animals, 145–146

Association for Assessment and Accreditation of Laboratory Animal Care International, 178, 183, 384, 385, 387

AVFSIs. See Army veterinary food safety instructors

Avian influenza, 60, 325–328, 374, 376

AVImark, 128

AVMA. See American Veterinary Medical Association

AWRs. See Animal welfare regulations

B

B-rations, 51

Babesiosis, 56, 311–314

Bacteriology research, 475

BAI. See Bureau of Animal Industry

Barron, Charlie N., 435

Battlefield Excellence through Superior Training Practices Act, 389

Beattie, Dr. Robert, 390

Beckman, Mary Jo, 166

Beef. See also Meat inspection

bovine spongiform encephalopathy, 43–44

Creuztfeldt-Jakob Disease, 43–44

hormone testing of, 43

Behavioral Medicine Section, 104–105

Behavioral research, 409–410

Behavioral services, 102–105

Bin Laden, Osama, 57

Biodefense and biomedical research, 436–443, 476–477

Biological attack training, 50

Biological Defense Research Program, 65

Biological Research Database, 388–389

Biomedical science. See Veterinary biomedical science

Biosecurity, 397

Biosensor Research Program, 32, 96–97

Bioterrorism Act of 2002, 256

Birds

highly pathogenic avian influenza, 60, 325–328, 374, 376

World War II service, 22

Bishop, Maurice, 42

Blackmore, Staff Sergeant Robert W., III, 61

Blake, Captain Jack P., 36

Blue Star Milk Company, 45

Bonding programs. See Human-animal bond programs

Bosnia operations, 55–57

Bottlenose dolphins

advanced medical technologies, 184

aging research, 183

data and tissue collection and management, 188–189

deployment support, 188

disease prevention research, 184

diseases, 191–200

fatty liver disease, 197–198

fleet support, 181

gastritis, 199–200

healthcare research furthering marine mammal understanding, 183–186

history and background of Marine Mammal Program, 176–179

iron overload, 197

metabolic conditions, 184

metabolic syndrome, 197–198

mine countermeasures operations, 181

nephrolithiasis, 198–199

nutrition oversight, 187–188

operational systems, 180–181

physical examinations and health monitoring, 186–187

physiology of, 180

pneumonia research, 183–184

preventive medicine focus for marine mammal health, 186–191

research, 183–186

respiratory disease, 191–193

sanitation oversight, 187–188

Bovine spongiform encephalopathy, 43–44

BRD. See Biological Research Database

Brooke Army Medical Center, 28, 144

Brown, Dr. Paul W., 166

Brucellosis, 282–285

BSE. See Bovine spongiform encephalopathy

Bureau of Animal Industry, 8, 9–10

Burghardt, Dr. Walter, 103

Burns, Major Kenneth F., 23

Bush, George H.W., 49, 52

C

Caisson Platoon, 220

Caisson Platoon Equine-Assisted Programs, 166–170

California sea lions

advanced medical technologies, 184

aging research, 183

cataracts, 196–197

data and tissue collection and management, 188–189

deployment support, 188

diseases, 191–200

fleet support, 183

force protection operations, 182

gastritis, 199–200

healthcare research furthering marine mammal understanding, 183–186

history and background of Marine Mammal Program, 176–179

lens luxations, 196–197

nutrition oversight, 187–188

object recovery operations, 182–183

ocular disease, 193–197

operational systems, 182–183

otariid keratitis, 195

physical examinations and health monitoring, 186–187

physiology of, 182

preventive medicine focus for marine mammal health, 186–191

research, 183–186

sanitation oversight, 187–188

Callahan, Major Thomas J., 42

Camp Shelby, Mississippi, 63

CANA. See Convulsant Antidote Nerve Agent

Canine distemper, 30, 303–305

Canine ehrlichiosis, 34–35

Canine operational medicine, 504–505

Canine programs, tactical, 490–499

Canine visceral leishmaniasis, 287–292

CARVER plus Shock method, 248

Castle, Staff Sergeant Sandra M., 61

Catanzaro, Lieutenant Colonel Thomas, 144

Cataracts

in California sea lions, 196–197

Cates, Brigadier General Michael, 179

Cattle

bovine spongiform encephalopathy, 43–44

Creuztfeldt-Jakob Disease, 43–44

hormone testing of, 43

vaccination campaign in Sudan cattle camps, 488

CBI. See China-Burma-India Theater

CCC. See Civilian Conservation Corps

CDC. See Centers for Disease Control and Prevention

Centennial Time Capsule, 2

Center for Health Promotion and Preventive Medicine, 44, 106

Centers for Disease Control and Prevention, 67, 69, 232

Chemical attack training, 50

Chemical defense, 443–447, 476

Chicago General Supply Depot, 16

China-Burma-India Theater, 215–216

Cholera, 35–36

CHPPM. See Center for Health Promotion and Preventive Medicine

Chumley, Major Perry, 144

Chyla, Warrant Officer Roman I., 56

Civic actions

Afghanistan, 62

Vietnam, 30, 35–36

Civil support

Coalition Joint Civil-Military Operations Task Force-Kabul, 62

Kosovo operations, 57

US Northern Command, 374–375

Civil War

military equine procurement and care, 209–211

military working dogs’ service, 84

post-war military equine procurement and care, 211–212

pre-war Veterinary Services support, 4–5

Veterinary Services support, 5–8

Civilian Conservation Corps, 16

CJD. See Creuztfeldt-Jakob Disease

Classical swine fever, 318–322

Clinical credentialing program, 130–133

Clinical practice guidelines, 100, 115

Clinton, Bill, 373

Coalition Joint Civil-Military Operations Task Force-Kabul, 62

Cold War

military working dogs’ service, 87–88

Veterinary Service support, 26–29

Cole, Dr. Bill, 390

Colonial America

military working dogs’ service, 84

Combat and Operational Stress Control

animal-assisted therapy programs in theater, 161–162

background of dogs program, 161

deployments with therapy teams, 162–164

determining resources, 162–163

establishing relationships, 162–163

evaluating benefits, 163–164

post-deployment programs, 164–165

standardized procedures, 163

Combat casualty care, 451–452, 491–494

Combat Feeding Directorate, 248–249

Combat trauma training, 416–417

Combined Laboratory Animal Medicine Program, 391

Companion animals, 146, 147

Computerized tomography scans, 190

Contract working dogs, 112

Convulsant Antidote Nerve Agent, 50, 446

COSC. See Combat and Operational Stress Control

Cotton, Dr. Chas E., 11

Counterinsurgency operations

food safety, 249–254

Cox, Second Lieutenant James C., 15

CPEAP. See Caisson Platoon Equine-Assisted Programs

CPGs. See Clinical practice guidelines

Craig, Colonel Dan, 103

Credentialing program, 130–133, 370–371

Creuztfeldt-Jakob Disease, 43–44

CTT. See Combat trauma training

Custer, Lieutenant Colonel George A., 7, 143

Cutaneous leishmaniasis, 440

CWDs. See Contract working dogs

Cyanide, 446

D

Dairy inspection

expansion of Veterinary Corps mission, 13

training of inspectors, 15

Dakin, Lieutenant Colonel Paul, 58

Dalgaard, Dr. Daniel, 67

DARPA. See Defense Advanced Research Projects Agency

Davis, Major Charles Louis, 429, 430–432

Dayton Peace Plan, 55

DCI. See Department of Clinical Investigation

DCPA. See Defense Civil Preparedness Agency

de Tienne, First Lieutenant Thais, 23

DeCA. See Defense Commissary Agency

Defense Advanced Research Projects Agency, 385

Defense Civil Preparedness Agency, 375

Defense Commissary Agency, 245

Defense Health Agency, 69–70

Defense Industrial Supply Center, 246

Defense Logistics Agency-Troop Support, 238, 246–247

Defense Logistics Agency-Troop Support-Europe & Africa, 247

Defense Logistics Agency-Troop Support-Pacific, 247

Defense Logistics Agency-Troop Support-Philadelphia-Quality Assurance, 247

Defense Personnel Support Center, 246

Defense Supply Center Philadelphia, 246

Defense Threat Reduction Agency, 257

Delta Society, 144, 146

Denny, Major Steve, 67

Dental Civil Action Program, 36

Department of Clinical Investigation, 415–416

Depleted uranium, 449–450

Depression Era, 16

Desert Mounted Corps, 212

Destination monitoring program, 235–236

DHA. See Defense Health Agency

Dinges, Tim, 64

Directed energy medical research, 478, 479

Disease and nonbattle injuries, 277

Disease Reporting System-Internet, 233

Distemper, 30, 303–305

Diving research, 414

DLA-TS. See Defense Logistics Agency-Troop Support

DMP. See Destination monitoring program

DNBI. See Disease and nonbattle injuries

DoD Dog Center, 95, 97

DoD Military Working Dog Veterinary Service, 114, 118

DoD Veterinary Pathology Residency, 429, 432–434

DoD Veterinary Service Activity, 43–44, 114

DODDC. See DoD Dog Center

Dodge, General Grenville, 10

Dodge Commission Report, 10

DODMWDVS. See DoD Military Working Dog Veterinary Service

DODVPR. See DoD Veterinary Pathology Residency

DODVSA. See DoD Veterinary Service Activity

Dog Center Europe, 27, 101, 116, 118

Dogs. See also Military working dogs

“Above and Beyond” Award, 136–137

animal-assisted activity and therapy programs, 148–161

animal bite program, 136

animals used in healthcare settings, 145–148

babesiosis, 56, 311–314

clinical credentialing program, 130–133

evolution of military-provided services, 124–126

financing of veterinary care for privately owned pets, 126–127

leishmaniasis, 287–292

leptospirosis outbreaks and control, 27, 30, 35, 292–294

maintenance of privately owned animal health records, 127–128

military veterinary treatment facilities policy, 126

pet fairs, 137

pet visitations to hospitals, 137

rabies, 26, 35, 42–43, 53–54, 61, 346–362

reorganization of veterinary treatment facilities, 134–135

standardization of military pet care, 130–134

stray animal facilities, 136

stray dog control, 23, 56, 358–359

training for military pet care providers, 128–130

tropical canine pancytopenia, 34–35

vaccination clinics, 137

Veterinary Medical Standardization Board, 133–134

visits to schools and daycare centers, 137

Wounded Warrior service dogs, 149–156

Dogs for Defense, Inc., 92

Dogs for Defense program, 86, 92

Dolphins. See Bottlenose dolphins

DRSI. See Disease Reporting System-Internet

Duke, Specialist 4 Douglas O., 36

Dutton, Sergeant William C., 21

Dwight D. Eisenhower Army Medical Center, 144, 156–161

E

Earthquake response, 63–65

Eastern equine encephalitis virus, 285–287

Ebola Companion Animal Response Plan Working Group, 69–70

Ebola virus disease

Marburg, Germany outbreaks, 66

research, 65, 66, 439

Reston, Virginia outbreak, 67–69

Texas case, 70

West Africa outbreak, 69–70

Edgewood Arsenal, 96

Education and training. See Veterinary medical training

EHR. See Electronic health records

Ehrlichiosis, 311–314

Eisenhower, General Dwight D., 143

Electronic health records, 371–372

Elia, Lieutenant Colonel Charles V.L., 217

Emergency response activities

food safety, 254–255

Veterinary Corps participation, 375–376

Emotional support animals, 146, 147

Enemy prisoner of war camps

Persian Gulf War, 49, 50–51

Enlisted animal care specialists, 128–129

Enrollment Act, 6

Environmental health monitoring, 191

Environmental toxicology, 412–413

EPW. See Enemy prisoner of war camps

Equine encephalitides, 285–287, 375–376

Equines. See also Horses

equine-assisted therapy programs, 165–170

military equine programs, 208–223

Equipment Committee, 133

Erythrocyte sedimentation rate, 193

Europe

European Command Dog Training Center, 27, 94

European Theater military working dogs procurement and care, 93–94

Veterinary Service support during Cold War, 26–29

European Commission

beef import ban, 43

Euthanasia, 358–359, 361, 400

Evacuation. See Medical evacuation

EVD. See Ebola virus disease

Everett, Major Bethany A., 61

F

FADL. See Food Analysis and Diagnostic Laboratory

Family-owned animals

“Above and Beyond” Award, 136–137

animal bite program, 136

clinical credentialing program, 130–133

evolution of military-provided pet care services, 124–126

financing of veterinary care for privately owned pets, 126–127

horse stable facilities, 135

maintenance of privately owned animal health records, 127–128

military veterinary treatment facilities policy, 126

pet fairs, 137

pet visitations to hospitals, 137

rabies control, 136, 356–357

reorganization of veterinary treatment facilities, 134–135

special types of military animal care services and programs, 135–137

standardization of military pet care, 130–134

stray animal facilities, 136

training for military pet care providers, 128–130

vaccination clinics, 137

Veterinary Medical Standardization Board, 133–134

visits to schools and daycare centers, 137

Farriers

role from American Revolutionary War to Civil War, 4–5, 209–210

Fatty liver disease

in bottlenose dolphins, 197

FAWD. See Food and water defense teams

FDA. See Food and Drug Administration

Federal Emergency Management Agency, 375

Federal Fair Housing Amendments Act of 1988, 148

Federal Meat Inspection Act of 1906, 10

Federation of Animal Science Societies, 385

Feldman, William H., 431

FEMA. See Federal Emergency Management Agency

Ferguson, Major James A., 34

FEST. See Field epidemiology survey teams

FHA. See Foreign Humanitarian Assistance

Field epidemiology survey teams, 33–34

First In-First Out policy, 49

First strike rations, 238

First-Year Graduate Veterinary Education, 105–106, 129–130

Fischer, Sergeant Kenneth, 120–121

Fleet support

bottlenose dolphins, 181

California sea lions, 183

Fletcher, Colonel David, 58

“Flying Artillery,” 220–221

Food Analysis and Diagnostic Laboratory, 235, 268–269, 270–271

Food and Agriculture Organization, 500

Food and Drug Administration, 26, 233, 246

Food and water defense teams, 257

Food and Water Risk Assessments, 55, 61, 258–261

Food defense

goals of, 255–256

initiatives, 256–261

risk assessment matrix, 260

in Saudi Arabia, 55

training, 261–262

World War II program, 22

Food inspection. See also Food safety

in Bosnia, 56

Civilian Conservation Corps responsibilities, 16

during Cold War, 26, 27

establishment of Chicago school for inspectors, 15

establishment of system principles, 15

expansion of Veterinary Corps mission, 13

hormone testing of beef, 43

investigation of Boston meat inspectors, 37–38

in Kosovo, 57

Military Food Inspection Technician Program, 41–42

origination of, 10

during Panama invasion, 45, 46

during Persian Gulf War, 51

proposed Congressional phase-out of Veterinary Corps involvement, 38–39

reassessment of role after Vietnam War, 37

in Saudi Arabia, 55

transfer of responsibility to USDA and Department of Commerce, 38

Veterinary Food Inspection Detachment, 24

during Vietnam War, 30–31

Food laboratory program, 242–243

Food safety. See also Food defense; Food inspection

Army and Air Force Exchange Service, 245–246

Army Food Management Information System, 237–238

beginnings of food preservation, 232

CARVER plus Shock method, 248

certification program, 234–235

commercial food protection audits, 234–235

counterinsurgency operations, 249–254

Defense Commissary Agency, 245

Defense Logistics Agency, 246–247

destination monitoring program, 235–236

emergency response activities, 254–255

food analysis, 268–270

food-borne illnesses, 232–233

food regulations development, 232

installation support plans, 233–234

Joint Culinary Center of Excellence, 247–248

Marine Corps food management team, 241

military mission, 233

military sanitation inspections, 236

National Science Foundation programs, 243–244

Navy food management team, 240–241

operational rations programs, 238–240

prime vendor destination audits, 240

salvage operations for subsistence, 236–237

ship-rider program, 241–242

surveillance food laboratory program, 242–243

United States Army Natick Soldier Research, Development, and Engineer Center, 248–249

Food safety communication team, 252–253

Food Safety Laboratory, 269–270

Food safety officers, 235

Food security, 55

Foot and mouth disease, 56, 322–325

Force Protection Dog program, 357–358

Foreign Animal Disease Threat Interagency Working Group, 69–70

Foreign Humanitarian Assistance, 261

Formulary Committee, 133

Forward Operating Base Salerno, Afghanistan, 61

483rd Medical Detachment, 49–51

Fournier, Colonel John S., 55

Foxtrots

research support, 102, 107

veterinary medical training, 130

FSOs. See Food safety officers

FSR. See First strike rations

Ft Bragg Fever, 27

Ft Knox Military Law Enforcement Command, 144

FWRAs. See Food and Water Risk Assessments

FYGVE. See First-Year Graduate Veterinary Education

G

GAO. See Government Accountability Office

Garner, Colonel Floris M., 435

Gastritis

in marine mammals, 199–200

GEIS. See Global Emerging Infectious Surveillance and Response System

Geisbert, Dr. Tom, 67

General Supply Depot, 13

Gibson, Bill, 67

Gibson, Merle, 67

Giles, Lieutenant Colonel James T., III, 121

Glanders, 6, 7

Global animal health environment, 500

Global Emerging Infectious Surveillance and Response System, 373

Global veterinary medicine, 505–507

Gochenour, Colonel William S., Jr., 27

Going, Samuel G., 7

Goodman, Sergeant Robert, 94

Goodwin, Sergeant Robert D., 24–25

Gorgas, Surgeon General William C., 11

Government Accountability Office, 37, 389

Graduate veterinary education, 105–106

The Gray Book, 436

Grenada invasion, 42–43

Griffin, Major Gerald E., 11

Group rations, 238–239

Guide dogs, 146, 147

Guigni, Staff Sergeant Blas, 164

H

Haines, Major Mark, 67

Haiti operations, 53–54

“Half Section,” 220–221

Hanfelt, Colonel Margery, 63

Hankinson, Sergeant William, 93

Hazardous Food and Nonprescription Drug Recall Program, 242

HCPs. See Health care providers

Health Care Operations, 49

Health care providers, 112–113, 114, 116

Health exams, 371–372

Health Professions Scholarship Program, 39

Health Readiness Center of Excellence, 28

Health records

electronic, 371–372

maintenance of, 127–128

Health service support, 489–490

Health Services Command, 53

Hearing dogs, 146, 147

Heartworm disease, 308–311

HHA. See Higher headquarters assessment

Higher headquarters assessment, 257

Highly pathogenic avian influenza, 60, 325–328, 374, 376

Hippotherapy, 221

Hog cholera, 35–36, 318–322

Holland, Lieutenant Colonel Daniel E., 56, 62, 101

Honadel, Colonel Thomas E., 55

Honore, Lieutenant General Russell, 62

Honsinger, Dr. John, 7

Hooks (Sessions), Jean E., 41

Horses

American Revolutionary War to Mexican War procurement and care, 208–209

American Revolutionary War to pre-Civil War service, 4–5

caisson horses, 220

Caisson Platoon Equine-Assisted Programs, 166–170

Civil War procurement and care, 209–211

Civil War to Spanish-American War service, 5–8

current military use of, 219–221

equine-assisted therapy programs, 165–170

equine encephalitides, 285–287, 375–376

first veterinary hospital, 14

hippotherapy programs, 221

horse-drawn field artillery, 220–221

Korean War procurement and care, 217–218

miniature horses as service animals, 146, 147

mobile veterinary hospitals, 14–15

Morale, Welfare, and Recreation program, 221

number of deaths during Civil War, 6–7

Operation Enduring Freedom procurement and care, 219

Panama invasion service, 46

post-Civil War to Spanish-American War procurement and care, 211–212

role of veterinary officers in equine health, 221–222

Spanish-American War to pre-World War I service, 8

spread of glanders, 7

stables for, 135

Venezuelan Equine Encephalitis vaccination, 39–40

Vietnam War procurement and care, 218–219

World War I procurement and care, 212–214

World War II procurement and care, 214–217

World War II service, 21

House Appropriations Committee, 37, 38–39

HPSP. See Health Professions Scholarship Program

Hubbard, Dr. Gene, 452

Huck, Colonel Leslie G., 54, 55

Human-animal bond programs

animal-assisted activity and therapy programs, 148–161

animals and military healthcare, 143–145

animals and the military, 143

animals used in healthcare settings, 145–148

Combat and Operational Stress Control dogs programs, 161–165

equine-assisted therapy programs, 165–170

Hummer, Colonel Robert, 390

Hurricane Katrina, 62–63

Husbandry, 396

Hussein, Saddam, 46, 51, 58

Huxsoll, Colonel David, 67

I

IACUC. See Institutional Animal Care and Use Committee

IFOR. See Implementation Force

IFVAs. See Installation food vulnerability assessments

Imes, Dr. George, 452–453

Implementation Force, 55–56

Independent duty veterinary technicians, 491

Indian Wars

Veterinary Services support, 4–5

Individual rations, 238

Infectious disease research, 410–412

Influenza, avian, 60, 325–328, 374, 376

Inspector General, 386–388

Installation food vulnerability assessments, 233, 257

Installation Management Command, 257

Installation support plans, 233–234

Institute of Surgical Research, 451–452

Institutional Animal Care and Use Committee, 386–388, 394, 402

International Electrotechnical Commission, 271

International Organization for Standardization/International Electrotechnical Commission, 271

International Working Dog Breeding Association, 103–104

Ionizing radiation, 449

Iraq operations, 58–59, 98–102, 356–359

Iraqi Veterinary Syndicate, 60–61

Iron overload

in bottlenose dolphins, 197

Irregular warfare environments, 488–507

ISO/IEC. See International Organization for Standardization/International Electrotechnical Commission

ISP. See Installation support plans

ISR. See Institute of Surgical Research

IWDBA. See International Working Dog Breeding Association

J

Jaax, Colonel Jerry, 67

Jaax, Colonel Nancy, 67

Jahrling, Dr. Peter, 67

Japan

earthquake response, 63–65

Japan District Veterinary Command, 63–65

Japanese Veterinary Service, 23

JDVC. See Japan District Veterinary Command

Jennings, Lieutenant General Hal B., 96

Jennings, Robert, Sr., 5

Johnson, Colonel Clifford I., 53

Johnson, Dr. Carl, 67

Joint Biological Agent Identification and Diagnostic assays, 270

Joint Culinary Center of Excellence, 247–248

Joint Medical Work Station, 251

Joint Pathology Center, 432–433

Joint patient movement requirement center, 116

Joint staff integrated vulnerability assessment, 257

Joint Task Force Katrina, 62–63

Jones, Dr. Thomas Carlyle, 430–432

Jorgensen, Brigadier General Robert R., 42

JPMRC. See Joint patient movement requirement center

JSIVA. See Joint staff integrated vulnerability assessment

K

K-9 Corps, 86. See also Military working dogs

Kelser, Brigadier General Raymond A., 16–17, 18, 23, 28–29, 431

Kennedy, John F., 30

Keogh, Captain Myles, 7, 211

KFOR. See Kosovo Protection Forces

Khan, Staff Sergeant Raffique, 61

King, Colonel Robin K., 56

King Khalid Military City, 49

Kingdom of Saudi Arabia, 46–51, 54–55

Klages, Sergeant Curtis, 67

Korean War

military equine procurement and care, 217–218

military working dogs procurement, 93–94

military working dogs’ service, 87–88

military working dogs veterinary care, 94

pre-war Veterinary Service support, 17–24

Veterinary Service support, 24–26

Kosovo operations, 57

Kosovo Protection Forces, 57

KSA. See Kingdom of Saudi Arabia

Kugel, First Lieutenant Gerald D., 30

Kules, Ryan, 169

Kuwait operations, 46–51

L

Laboratories

accreditation, 271–272

Army veterinary laboratory service, 268–272

Department of Defense laboratory network, 373–374

DoD medical research laboratories, 474–480

Food Analysis and Diagnostic Laboratory, 268–269, 270–271

Food Safety Laboratory, 269–270

Public Health Command Region-Europe, Department of Laboratory Services, 271

surveillance food laboratory program, 242–243

Veterinary Service support, 32–33

Laboratory animal medicine

animal care and use in the DoD, 394–400

animal health monitoring, 402–403

animal usage regulation, 385–389

budget and resource projection, 403

clinical investigation sites, 415–416

combat trauma training, 416–417

disaster planning and emergency preparedness, 403–404

diving research, 414

DoD animal care and use programs and components for program success, 400–407

environmental toxicology, 412–413

field research and field studies, 413

independent and collaborative research, 408–409

infectious disease research, 410–412

neurologic and behavioral studies, 409–410

occupational health and safety, 405–406

overseas research sites, 414–415

personnel management, 403

personnel training and qualifications, 406–407

purpose and oversight of activities, 384–385

radiobiology research, 413–414

research model selection, 407

research support to investigators, 407–415

roles and goals, 384

scope of, 384

security, 404–405

technical veterinary support, 407–408

training military laboratory animal veterinarians, 389–394

LaGodna, Lieutenant Colonel Martin M., 56

LAM. See Laboratory animal medicine

Lancaster, Sergeant Steve, 42

Lausier, Staff Sergeant Travis, 64

Lee, General Robert E., 211

Leishmaniasis, 287–292, 440, 454

Lens luxations

in California sea lions, 196–197

Leptospirosis, 27, 30, 35, 292–294

Levinson, Dr. Boris, 144

Lewis, Doreen H., 41

Linnehan, Captain Richard, 179

Lipscomb, Lieutenant Colonel Thomas P., 435

Loetscher, Corporal Hans, 55

Lombardi, Specialist Thomas D., 55

Long-Term Health Education Training program, 103, 390

Lopez, Specialist 4 Ronald G., 31

Louisiana Maneuvers, 214

LTHET. See Long-Term Health Education Training

Lytle, Major George A., 15

M

Mad cow disease, 43–44

Maghuin-Rogister, Dr. G., 43

Magnuson, Warren G., 39

Mange treatment, 14–15

Marburg, Germany

Ebola virus outbreaks, 66

Marburg virus, 452

Marine Corps

food management team, 241

use of equines, 218–220

Marine Mammal Program

development of advanced clinical technology, 190

education and training, 191

environmental health monitoring, 191

evolution of program, 176–177

evolving roles of animals in program, 177–179

healthcare research furthering marine mammal understanding, 183–186

history and background of, 176–179

marine mammal diseases, 191–200

military objectives and missions of, 180–186

preventive medicine focus for marine mammal health, 186–191

roles of military veterinarians, 179

Marine Mammals System, 176

MARS Task Force, 216

Mascots, 146, 147, 356–357

Master of Public Health, 391

Materiel Development & Readiness Command, 66

MAXIMUS, 39

McClellan, Captain George B., 5, 209–210

McClellan Saddle, 5

McConnell, Dr. Gene, 452–453

McCormick, Dr. Joe, 67

McCulley, Dr. Robert M., 452

McKinley, William, 10

MCMs. See Medical counter-measures

McNamara, Dr. Tracey, 438–439

McNeil, Thomas J., 55

MDVMs. See Medical Detachments, Veterinary Medicine

MDVS. See Medical Detachments, Veterinary Service

MDVSS. See Medical Detachments, Veterinary Service Support

Meals, ready-to-eat, 42, 50–51, 238–239

Meat and Dairy Hygiene School, 28, 38

Meat inspection

in Bosnia, 56

establishment of Chicago school for inspectors, 15

expansion of Veterinary Corps mission, 13

hormone testing of beef, 43

investigation of Boston inspectors, 37–38

origination of, 10

proposed Congressional phase-out of Veterinary Corps involvement, 38–39

transfer of responsibility to USDA and Department of Commerce, 38

Meat Inspection Act of 1906, 232

MEDCAP. See Medical Civic Action Program

MEDCOM. See US Army Medical Command

MEDDACs. See Medical Department Activities

MEDEVAC. See Medical evacuation

Medical Civic Action Program, 36

Medical counter-measures, 471–472, 476–477

Medical Department Activities, 53

Medical Detachment, 483rd, 49–51

Medical Detachments, Veterinary Medicine, 98, 100

Medical Detachments, Veterinary Service, 98

Medical Detachments, Veterinary Service Support, 98, 100, 112–114

Medical Enlisted Reserve Corps, 13

Medical evacuation

military working dogs, 112–121

tactical evacuation care, 492–494, 497–499

Medical Field Service School, 16, 28

Medical record software program, 128

Medical Research and Material Command, 65–66, 437

Medical Task Force 5, 42–43

Medical training. See Veterinary medical training

Merrill’s Marauders, 215–216

Metabolic syndrome

in bottlenose dolphins, 197–198

Meuse-Argonne offensive, 15

Mexican-American War

military equine procurement and care, 208–209

Veterinary Services support, 4–5

Mickelsen, Captain Clayton H., 22, 27

Military Assistance Advisory Group, 29

Military Assistance Group Vietnam, 29, 30

Military Dog Center, 95

Military equine programs

current military use of equines, 219–221

historical use of equines in warfare, 208–219

role of veterinary officers in equine health, 221–222

Military Food Inspection Technician Program, 41–42

Military occupational specialties, 19–20, 128–129

Military Police Corps, 87–88

Military sanitation inspections, 236

Military Sealift Command, 241

Military Working Dog Center, 95

Military working dogs

babesiosis, 56, 311–314

canine operational medicine, 504–505

casualty continuum of care, 112–118

Civil War service, 84

Cold War service, 87–88

distemper, 30, 303–305

ehrlichiosis, 311–314

European Command Dog Training Center, 27

European Theater procurement and care, 93–94

evacuation procedures, 31

food issues, 31

gas protection suit and mask, 85

heartworm disease, 308–311

injury rehabilitation, 120–121

Korean War procurement and care, 93–94

Korean War service, 24–26, 87–88

leishmaniasis, 287–292

medical evacuation, 112–121

Panama invasion service, 45–46

parvovirus, 305–308

Persian Gulf War service, 47–48

Persian Gulf War veterinary care, 98

pre-Persian Gulf War procurement, 97

procurement, 92–102

rabies, 26, 35, 42–43, 53–54, 61, 346–362

research, breeding and training programs during Vietnam War era, 95–97

service in Colonial America, 84

Staphylococcus aureus, 314–316

tactical canine programs, 490–499

transmissible canine pancytopenia, 34–35

veterinary care, 92–102

Vietnam War procurement and care, 94–96

Vietnam War service, 29–36, 88–89

World War I service, 84–85

World War II procurement and care, 92–93

World War II service, 20–21, 85–87

Miller, Lieutenant Colonel Everett, 12

Mine countermeasures operations, 181

Miniature horses, 146, 147

Ministries of Agriculture, 500

Misawa, Japan earthquake, 63–65

Mittemeyer, Lieutenant General Bernhard T., 432

MMP. See Marine Mammal Program

MMS. See Marine Mammals System

Mobile Veterinary Section, 14–15

Mobilization Center Shelby, 63

Morale, Welfare, and Recreation, 221

MOREs, 51

MOSs. See Military occupational specialties

Mountain Warfare Training Center, 220

MRE. See Meals, ready-to-eat

MRMC. See Medical Research and Material Command

Mules

in China-Burma-India Theater, 215–216

Civil War service, 6

equine-assisted therapy programs, 165–170

military equine programs, 208–223

number of deaths during Civil War, 6–7

World War I service, 214

World War II service, 215–217

Multinational Peacekeeping Force, 48

Munson Army Health Center, 144

Murnane, Brigadier General Thomas G., 35

Murphy, Dr. Fred, 67

MWDs. See Military working dogs

MWR. See Morale, Welfare, and Recreation

N

NAFs. See Nonappropriated funds

Najera, Captain Cecilia, 161, 163

NAMRU-3. See Naval Medical Research Unit No. 3

Natick Soldier Research, Development, and Engineer Center, 248–249

Nation-building actions

Afghanistan, 62

Vietnam, 30, 35–36

National Cooperative Rabies Management Program, 353

National Defense Act of 1916, 11, 13

National Defense Appropriations Act for Fiscal Year 2013, 389

National Defense Authorization Act, 41, 389

National Institute of Allergy and Infectious Diseases, 439, 441

National Intrepid Center of Excellence, 149, 151

National Research Council, 385

National Science Foundation, 243–244

National Strategy for Countering Biologic Threats, 488

National Tissue Repository, 435–436

National Veterinary Accreditation Program, 370–371

Naval Medical Research Unit No. 3, 60, 478

Navy food management team, 240–241

NEO. See Noncombatant evacuation operation

Nephrolithiasis

in bottlenose dolphins, 198–199

Nerve agents, 445

Neurologic research, 409–410

New Orleans, Louisiana

Hurricane Katrina, 62–63

New World Screwworm, 316–318

Newcastle disease, 40

NIAID. See National Institute of Allergy and Infectious Diseases

Nonappropriated funds, 126–127

Noncombatant evacuation operation, 54

Nonprofit organizations, 150, 151

Noriega, Manuel, 44, 45

North American Riding for the Handicapped Association Horses for Heroes, 170

NPOs. See Nonprofit organizations

Nuclear attack training, 50

NVAP. See National Veterinary Accreditation Program

O

Obama, Barack, 69

Occupational therapists, 152

Occupational Therapy, 144, 161

Ocular disease

in California sea lions, 193–197

ODAs. See Operational detachments alpha

Office of the Secretary of Defense, 37, 38–39

Officer Personnel Act of 1947, 23, 46

“Old Guard” Caisson Platoon, 220

Old World Screwworm, 316–318

Oliver, Animal Technician 5 Frank, 93

Onderstepoort Veterinary Institute, 452–453

One Health concept, 369–370, 501–503

One Health conference, 372–373

One Medicine concept, 126, 190, 369

Operation Continue Hope, 52–53

Operation Desert Shield, 46–51, 98

Operation Desert Storm, 46–51, 98

Operation Enduring Freedom, 57–58, 98–102, 219

Operation Green Cross, 43

Operation Iraqi Freedom, 58–59, 98–102

Operation Joint Endeavor, 55–57

Operation Joint Forge, 56

Operation Joint Guard, 56

Operation Joint Guardian, 57

Operation Just Cause, 44–46

Operation MAD DOG, 53–54

Operation Noah’s Ark, 54–55

Operation Pacific Passage, 64

Operation Promote Liberty, 46

Operation Provide Comfort, 51–52

Operation Restore Hope, 52–53, 99

Operation Tomodachi, 63–65

Operation United Assistance, 69–70

Operation Uphold Democracy, 53–54

Operation Urgent Fury, 42–43

Operational detachments alpha, 219

Operational rations programs, 238–240

OSD. See Office of the Secretary of Defense

Osler, Sir William, 369

Osteen, Colonel Wilson, 390

Otariid keratitis, 195

Overman Act, 11, 12

P

Panama invasion, 44–46

PAPR. See Powered air-purifying respirator

Paranoid schizophrenia

animal-assisted therapy, 160

Parasitology research, 475

Parker, Colonel Gerald, 65, 66

Parry, George F., 6, 211

Parvovirus, 305–308

Pasteur, Louis, 232

PATH. See Professional Association of Therapeutic Horsemanship International

Pathology. See Veterinary pathology

Patient movement requests, 116

Patient movement requirement center, 116

Pawling Army Air Force Convalescent Center, 144

Paz, Lieutenant Robert, 44

PCR laboratory, 60, 435

Pence, Larry, 166

Pershing, General John J., 16

Persian Gulf War

military working dogs veterinary care, 98

pre-war military working dogs procurement, 97

pre-war Veterinary Services support, 42–46

Veterinary Services support, 46–51

Pet care

“Above and Beyond” Award, 136–137

animal bite program, 136

clinical credentialing program, 130–133

evolution of military-provided services, 124–126

financing of veterinary care for privately owned pets, 126–127

horse stable facilities, 135

maintenance of privately owned animal health records, 127–128

military veterinary treatment facilities policy, 126

pet fairs, 137

pet visitations to hospitals, 137

rabies control, 136, 356–357

reorganization of veterinary treatment facilities, 134–135

special types of military animal care services and programs, 135–137

standardization of military pet care, 130–134

stray animal facilities, 136

training for military pet care providers, 128–130

vaccination clinics, 137

Veterinary Medical Standardization Board, 133–134

visits to schools and daycare centers, 137

Pet fairs, 137

Pet Partners, 144, 146

Peters, Colonel C.J., 67

Pham, Nina, 70

PHC. See Public Health Command

Philadelphia Quartermaster Depot, 246

PHS. See Public Health Service

Physiology research, 477–478

Pigeons

World War II service, 22

Plague, 298–300

Pletcher, Dr. John, 434, 452–453

Plummer, Dr. Alexander, 212

PMRC. See Patient movement requirement center

PMRs. See Patient movement requests

Pneumonia

marine mammal research, 183–184

Police dogs, 89

Polymerase chain reaction laboratory, 60, 435

Poppe, Major John L., 43, 52

Porter, Clyde, 86

Positron emission tomography scans, 190

Post-traumatic stress disorder

animal-assisted therapy, 146–161

complementary interventions, 149

Wounded Warrior service dog training programs, 149–156

Poultry

highly pathogenic avian influenza, 60, 325–328, 374, 376

Newcastle disease, 40

Powell, Major Nate, 67

Powered air-purifying respirator, 398

Preventive medicine

Prime vendor destination audits, 240

Prisoner of war camps

Persian Gulf War, 49

Privately-owned animals

“Above and Beyond” Award, 136–137

animal bite program, 136

clinical credentialing program, 130–133

evolution of military-provided pet care services, 124–126

financing of veterinary care for privately owned pets, 126–127

horse stable facilities, 135

maintenance of privately owned animal health records, 127–128

military veterinary treatment facilities policy, 126

pet fairs, 137

pet visitations to hospitals, 137

rabies control, 136, 356–357

reorganization of veterinary treatment facilities, 134–135

special types of military animal care services and programs, 135–137

standardization of military pet care, 130–134

stray animal facilities, 136

training for military pet care providers, 128–130

vaccination clinics, 137

Veterinary Medical Standardization Board, 133–134

visits to schools and daycare centers, 137

Professional Association of Therapeutic Horsemanship International, 170

Professional Filler System, 100

PROFIS. See Professional Filler System

Progressive Era, 9

Protocol Committee, 134

Pruitt, Colonel Basil A., Jr., 452

Public Health Center, 233, 371

Public Health Command, 106–107, 136–137

Public Health Command Region-Europe, 269, 271

Public Health Service, 385, 391

Pulmonary choking agents, 445–446

Puppy parents, 150–151

Pure Food and Drug Act, 232

Pyridostigmine bromide tablets, 50

Q

Q fever, 301–303

Quarantine, 396

Quartermaster Corps, 8–9, 15, 86, 87

R

Rabies

in an operational environment, 353–359

animal management after bites, 350–351

animal vaccination, 351–352

clinical review, 349–351

control in future contingency operations, 362

control program, 136

diagnosis in animals, 350

difficulties posed by certain animal populations, 355–358

epidemiology, 347–349

etiology, 347–349

euthanasia programs, 358–359, 361

Haiti immunization campaign, 53–54

human postexposure treatment, 351, 361–362

human preexposure vaccination, 361

human vaccination, 352

internationally supported control programs, 359–362

Korean War outbreak, 26

mass parenteral vaccination, 360

military animal bite reports, 352–353

number of bite reports in Afghan theater of operations, 355

number of bite reports in Iraq theater of operations, 356–357

oral vaccination, 360

outbreak in Afghanistan, 61

outbreak in Grenada, 42–43

population management, 360–361

prevention and control, 351–353

rabies-free definition and areas, 348

signs of rabies in animals, 349–350

stray animal control in Afghanistan and Iraq, 358–359

surveillance, 353, 359–360

transmission process and conditions, 348–349

US military’s involvement, 346–347

Vietnam War outbreak, 35

virus variants and distribution, 347–348

Rabies Advisory Board, 57

Rabstein, Dr. Melvin, 390

Radiation defense, 447–451

Radiobiology research, 413–414

Radiography, 193

Ralyea, Chief Warrant Officer 3 Robert D., 55

Ramsey, Brigadier General Frank A., 42, 94

Rations programs, 238–240

Recreational animals, 146, 147, 159

Recreational therapists, 152

Recreational therapy, 159

Registry of Veterinary Pathology, 20, 434

Rehabilitation Act of 1973, 148

Remote Online Veterinary Record, 128

Reportable Medical Events System, 233

Reserve Corps

consideration for, 10–11

food inspection responsibilities, 16

number of members during post-World War I period, 16

Reserve Officers’ Training Corps, 16

Resident/facility animals, 146, 147

Respiratory disease

in dolphins, 191–193

Reston, Virginia

Ebola virus outbreak, 67–69

Revolutionary War

military equine procurement and care, 208–209

Veterinary Services support, 4–5

Reynolds, First Sergeant Bradley, 63

Rhee, Syngman, 26

Rick, Captain Joanne Marie, 41

Ridgway, Dr. Sam, 176, 177, 178, 179

Riordan, Lieutenant John J., 214

Risk assessment matrix, 260

RMES. See Reportable Medical Events System

Roberts, Colonel Clifford, 394

Robertson, First Lieutenant Helen M., 23

Rolfe, Colonel David, 103, 133

ROTC. See Reserve Officers’ Training Corps

ROVR. See Remote Online Veterinary Record

Royal Veterinary School of Lyon, 4

Rozmiarek, Dr. Harry, 390

Russell, Major General Phillip, 67

S

Saddles, 5

Sanitation inspections, 236

Saudi Arabia operations, 46–51, 54–55

Saunders, Leon Z., 435

Schillreff, Captain Theresa, 164

Schuylkill Arsenal, 246

Schwabe, Dr. Calvin, 190, 369

Schwarzkopf, General Norman, 66

Schwarzkopf, Olaf, 211

Screwworm, 316–318

SCUD missiles, 50

SDTC. See Service Dog Training Center

Sea lions. See California sea lions

Second Harvest, 51

Secretary of Defense, 388–389

Seeing Eye Inc., 97

Sentry Dog School, 95

Service animals, 145–146

Service dog instructors, 151–152

Service Dog Training Center, 144

Service dogs, 146, 147, 149–156

SFHSC. See Armed Forces Health Surveillance Center

SFOR. See Stabilization Force

Shanks, Specialist 4 Richard S., 32

Sheldon, Elisha, 209

Sheridan, General Philip, 8

Ship-rider program, 241–242

Sinclair, Upton, 10, 232

64F training, 102, 107

Social dogs, 146, 147

Social workers, 152

Soldiers and Horses-Helping Soldiers, Now and in the Future, 170

Somalia operations, 52–53, 99

South East Asia Treaty Organization Medical Laboratory, 33

Space and Naval Warfare Systems Center Pacific, 176, 180

Spanish-American War

military equine procurement and care, 211–212

pre-war Veterinary Service support, 5–8

Veterinary Service support, 8–11

Special Forces

tactical canine programs, 490–499

Veterinary Service support, 32–33

Stability operations

Afghanistan, 62

Vietnam, 30, 35–36

Stabilization Force, 56–57

Stamp, Colonel Gary, 103

Staphylococcus aureus, 314–316

Steele, Major Keith, 69

Stein, Dr. Charles A., 7, 211

Stevenson, Colonel Timothy H., 7

Stray animal facilities, 136

Stray dog control, 23, 56, 358–359

Sudan

vaccination campaign in cattle camps, 488

Super Dog Program, 32, 97

Surveillance food laboratory program, 242–243

Survival rations, 239

Swimmer defense system, 177–178

Swine fever, 318–322

T

T-rations, 51

Tables of Organization and Equipment, 14

Tables of Organization for the Veterinary Service, 14

Tactical canine programs

airborne and air assault operations, 497

canine emergency planning, 497–499

care under fire, 492

combat casualty care, 491–494

enroute care, 499

extreme cold hazards, 495–496

extreme heat hazards, 494–495

maritime environments, 496

operational hazards, 494–497

tactical evacuation care, 492–494, 497–499

tactical field care, 492–494

teams, 490–491

use of human medical resources, 499

Tactical field care, 492–494

Tangos, 128–129

Task Force Falcon, 57

Task Force Medical Falcon, 57

Task Force Phoenix, 144–145

Taubenberger, Jeffrey K., 435

Taylor, Captain Rodney F., 32

Taylor, Lieutenant Colonel Brett, 394

TBI. See Traumatic brain injury

TCP. See Tropical canine pancytopenia

TFF. See Task Force Falcon

Theater Area Medical Laboratory, 453–455

Theater patient movement requirement center, 116

Therapy animals, 146–148

THREATCON levels, 49–50

Thurmond, Strom, 39

Tick-borne disease, 311–314

Timed Get Up and Go Test, 168

Total Army Personnel Command, 49

Toxicology research, 479–480

TPMRC. See Theater patient movement requirement center

TRAC2ES3. See Transportation Command Regulating and Command and Control Evacuation System

Training. See Veterinary medical training

Transboundary animal diseases, 316–328

Transportation Command Regulating and Command and Control Evacuation System, 116

Traumatic brain injury, 149

Treacy, MJ, 8

Trichinosis, 56

Tripler Army Medical Center, 144, 148–149

Tropical canine pancytopenia, 34–35

Tsunami response, 63–65

U

Ultrasonography, 192

Uniformed Service University of the Health Sciences, 391, 480

Uniformed Services University of the Health Sciences, 385

United Nations Food and Agriculture Organization, 500

United Nations Operation in Somalia, 52

United Nations Peace Keepers, 52

United States Army Natick Soldier Research, Development, and Engineer Center, 248–249

Unitized group ration-heat and serve, 238–239

UNOSOM I, 52

Uranium, 449–450

US Agency for International Development, 33, 69

US Air Force

Air Force Veterinary Corps, 23, 39

behavioral services, 102–105

military dog procurement responsibilities, 95, 97, 98

US Animal Health Association, 436

US Army Combined Arms Combat Development Command, 96

US Army Dog Training Detachment, Europe, 27, 94

US Army Europe Medical Laboratory, 27

US Army Meat and Dairy Hygiene School, 28, 38

US Army Medical Command, 53

US Army Medical Department, 469

US Army Medical Research and Development Command, 66

US Army Medical Research and Material Command, 65–66

US Army Medical Research Institute of Chemical Defense, 443–444

US Army Medical Research Institute of Infectious Diseases, 65–68, 70, 391–395, 438–439

US Army Service Dog Training Center, 144

US Army Training and Doctrine Command, 96

US Army Veterinary Command, 53, 106, 125, 130–132

US Army Veterinary Corps

animal care mission, 13–15

assignment changes during World War II, 19–20

behavioral services, 102–105

casualties during World War I, 15

Centennial Time Capsule plaque, 2

Cold War, 26–29

consideration for Reserve Corps, 10–11

consolidation of, 39

evolution of military-provided pet care services, 124–126

expansion of, 11–12

financing of veterinary care for privately owned pets, 126–127

food inspection mission, 13

food inspection responsibilities, 16

irregular warfare environment support, 488–507

Korean War, 24–26

maintenance of privately owned animal health records, 127–128

mission changes during World War II, 17–18

National Veterinary Accreditation Program, 370–371

participation in interagency and emergency response, 375–376

Persian Gulf War, 46–51

post-Persian Gulf War, 46–65

post-World War I services, 15–17

pre-Persian Gulf War, 42–46

proposed Congressional phase-out, 38–39

reorganization of veterinary treatment facilities, 134–135

Special Forces support, 32–33

special types of military animal care services and programs, 135–137

specialty training, 102–106

standardization of military pet care, 130–134

training changes during World War II, 18–19

training for military pet care providers, 128–130

Vietnam War, 29–42

World War I to pre-World War II, 11–17

World War II to pre-Korean War, 17–24

zoonotic disease protection and control mission, 13

US Army Veterinary Service

American Revolutionary War to pre-Civil War, 4–5

animal care mission, 13–15

assignment changes during World War II, 19–20

casualties during World War I, 15

Civil War to Spanish-American War, 5–8

Cold War, 26–29

consideration for reserve corps, 10–11

consolidation of, 39

Ebola virus protection involvement, 66–70

expanded mission of, 12–14

expansion of, 11–12

First-Year Graduate Veterinary Education, 105–106, 129–130

food inspection mission, 13

food inspection responsibilities, 16

impact of non-DoD missions, 70–71

Korean War, 24–26

mission changes during World War II, 17–18

Persian Gulf War, 46–51

post-Persian Gulf War, 46–65

post-World War I services, 15–17

pre-Persian Gulf War, 42–46

proposed Congressional phase-out, 38–39

reassessment of mission after Vietnam War, 37

64F training, 102, 107

Spanish-American War to pre-World War I, 8–11

training changes during World War II, 18–19

Veterinary Reserve, 11–12

Vietnam War, 29–42

World War I to pre-World War II, 11–17

World War II to pre-Korean War, 17–24

zoonotic disease protection and control mission, 13

US Department of Agriculture

ban on meat imports from Europe, 44

Bureau of Animal Industry, 8, 9

food inspection responsibilities, 16, 38

meat inspection origination, 10

National Veterinary Accreditation Program, 370–371

Veterinary Service Activity, 43–44

US Department of Commerce

food inspection responsibility, 38

US Department of Defense

animal care and use, 394–400

animal care and use programs and components for program success, 400–407

animal usage regulation, 385–389

DoD Dog Center, 95, 97

DoD Military Working Dog Veterinary Service, 114, 118

DoD Veterinary Pathology Residency, 429, 432–434

DoD Veterinary Service Activity, 43–44, 114, 118

Food Analysis and Diagnostic Laboratory, 268–269, 270–271

Inspector General, 386–388

laboratory network, 373–374

Secretary of Defense, 388–389

US Forces Japan, 64

US Government Accountability Office, 37

US Marine Corps

food management team, 241

use of equines, 218–220

US Naval Medical Research Unit No. 3, 60

US Navy

food management team, 240–241

Marine Mammal Program, 176–200

US Northern Command

civil support, 374–375

US Veterinary Medical Association, 7

USAF. See US Air Force

USAMRIID, US Army Medical Research Institute of Infectious Diseases

USDA. See US Department of Agriculture

USFJ. See US Forces Japan

V

Vaccination clinics, 137

Van Dyke, Major Donald, 179

VBDs. See Vector-borne diseases

VCO. See Veterinary Corps Officers

VCPR. See Veterinarian-Client-Patient relationship

Vector-borne diseases, 372–373

Venezuelan equine encephalitis, 39–40, 285–287, 375–376

VES. See Veterinary equipment set

Vesicants, 445

VETAC. See Veterinary activity

VETCAP. See Veterinary Civil Action Program

VETCENs. See Veterinary centers

VETCOM. See Veterinary Command

Veterinarian-Client-Patient relationship, 126

Veterinarians. See also Veterinary Corps Officers

early insignia, 9

officer status during Spanish-American War, 9

pay during Spanish-American War, 9

retirement benefits establishment, 10

veterinary surgeons, 4–8

Veterinary accreditation, 370–371

Veterinary activity, 114, 118, 134–135

Veterinary behaviorists, 102–103

Veterinary biomedical science

animal modeling, 473–474

bacteriology, 475

bench research, 474

biological warfare defense research, 476–477

chemical warfare defense research, 476

collaborative medical research, 478

directed energy medical research, 478, 479

DoD medical research laboratories, 474–480

DoD policy, 472

mission process, 470–472

parasitology, 475

physiology research, 477–478

program and product management, 472

scientists, 469–473

scientists’ skill set, 469–470

scope of duties, 470

special missions, 472–473

toxicology research, 479–480

virology, 475–476

Veterinary centers, 114, 118, 134–135

Veterinary Civil Action Program, 36, 57, 62, 274

Veterinary College of London, 4

Veterinary Command, 53, 106, 125, 130–132

Veterinary Corps. See US Army Veterinary Corps

Veterinary Corps Officers

behavioral services, 102–105

clinical credentialing program, 130–133

consolidation of functions, 39

First-Year Graduate Veterinary Education, 105–106, 129–130

impact of non-DoD missions, 70–71

long-term health education, 102

number of officers during post-World War I period, 16

rank of Veterinary Corps Chief, 46

shifting personnel changes, 41–42

64F training, 102, 107

Special Forces support, 32–33

specialty training, 102–106

standardizing pay, 40–41

training for new Army Veterinary Corps Officers, 129–130

training for specialized Veterinary Corps Officers, 130

Veterinary electronic health records, 371–372

Veterinary Electronic Medical Record system, 128

Veterinary equipment set, 242–243

Veterinary Food Inspection Detachment, 24

Veterinary food inspectors, 234, 236, 245

Veterinary Laboratory Course, 16

Veterinary Laboratory Europe, 272

Veterinary laboratory service, 268–272

Veterinary medical and surgical teams, 112, 114

Veterinary Medical Association, 7

Veterinary Medical Division, 67–68

Veterinary Medical Standardization Board

current committee activities, 134

Equipment Committee, 133

Formulary Committee, 133

Protocol Committee, 134

Veterinary medical training

Army enlisted animal care specialists, 128–129

canine operational medicine, 504–505

Chicago General Supply Depot, 16

early veterinary education, 5

First-Year Graduate Veterinary Education, 105–106, 129–130

improved training 1917-1918, 12–14

late 1800’s-early 1900’s, 7–8

Medical Field Service School, 16

military laboratory animal veterinarians, 389–394

for military pet care providers, 128–130

new Army Veterinary Corps Officers, 129–130

Reserve Officers’ Training Corps, 16

skill identifier, 504

for specialized Army Veterinary Corps Officers, 130

Veterinary Laboratory Course, 16

during World War II, 18–19

Veterinary pathology

biodefense and biomedical research, 436–443

chemical defense, 443–447

combat casualty care, 451–452

diagnostics, 429–436

field operations, 452–455

history of, 428, 429–432

radiation defense, 447–451

Veterinary Reserve, 11–12

Veterinary Service

American Revolutionary War to pre-Civil War, 4–5

animal care mission, 13–15

assignment changes during World War II, 19–20

casualties during World War I, 15

Civil War to Spanish-American War, 5–8

Cold War, 26–29

consideration for reserve corps, 10–11

consolidation of, 39

Ebola virus protection involvement, 66–70

expanded mission of, 12–14

expansion of, 11–12

First-Year Graduate Veterinary Education, 105–106, 129–130

food inspection mission, 13

food inspection responsibilities, 16

impact of non-DoD missions, 70–71

Korean War, 24–26

mission changes during World War II, 17–18

Persian Gulf War, 46–51

post-Persian Gulf War, 46–65

post-World War I services, 15–17

pre-Persian Gulf War, 42–46

proposed Congressional phase-out, 38–39

reassessment of mission after Vietnam War, 37

64F training, 102, 107

Spanish-American War to pre-World War I, 8–11

training changes during World War II, 18–19

Veterinary Reserve, 11–12

Vietnam War, 29–42

World War I to pre-World War II, 11–17

World War II to pre-Korean War, 17–24

zoonotic disease protection and control mission, 13

Veterinary Service Activity, 43–44

Veterinary Service Approved Sources, 20

Veterinary Service Support Areas, 53

Veterinary service support teams, 112, 114

Veterinary treatment facilities

establishment of, 26–27

in Japan, 64

in Panama, 45–46

pet care policy, 125–126

reorganization of, 134–135

VFI. See Veterinary food inspectors

VFID. See Veterinary Food Inspection Detachment

Vietnam War

civic action, 30, 35–36

establishing a US veterinary presence, 29–31

initiating a veterinary animal care system, 31–32

military equine procurement and care, 218–219

military working dogs procurement, 94–95

military working dogs research, breeding and training programs, 95–97

military working dogs’ service, 88–89

military working dogs veterinary care, 95–96

Newcastle eradication campaign, 40

post-war problems, 36–39

shifting personnel changes, 41–42

studying and preventing zoonotic disease, 33–35

supporting Special Forces and laboratories, 32–33

Venezuelan Equine Encephalitis control, 39–40

veterinary pay standardization, 40–41

Veterinary Service losses, 36

Vietnamese National Institute of Bacteriology, 33

Virchow, Rudolf, 369

Virology research, 475–476

VMD. See Veterinary Medical Division

VMSB. See Veterinary Medical Standardization Board

VMST. See Veterinary medical and surgical teams

Vogelsang, Colonel Robert L., III, 55

VSSAs. See Veterinary Service Support Areas

VSSTs. See Veterinary service support teams

VTFs. See Veterinary treatment facilities

W

Wade, Colonel John V., 66

Walker, Colonel Clifford, 130

Walter Reed Army Institute of Research, 33–34, 96, 439–440

Walter Reed National Military Medical Center, 144, 149–154, 166, 169

Walters, Colonel Robert E., 56

War Dog Program, 86, 92

War of 1812, 4

Warrior Canine Connection, 149, 150, 151

Warrior trainers, 152

Warrior Transition Battalion, 154, 160–161

Washington, General George, 4, 209

Water plant inspection, 59

Watson, Captain William T., 32

WCC. See Warrior Canine Connection

Weeks, Staff Sergeant John R., 31

Weir, Lieutenant Colonel Robert D., 55

West Africa

Ebola virus disease outbreak, 69–70

West Nile virus, 439

Western equine encephalitis virus, 285–287

White blood cell counts, 193

Whitmer, Colonel Deborah, 473

Whitney, Dr. Robert, 390

WHO. See World Health Organization

Wiggins, First Lieutenant Roger N., 29, 30

Willis, Major General John M., 28

Wilson, Charles Erwin, 28

Wilson, Woodrow, 11

Woodward, Dr. Joseph J., 429–430

Woollen, Major Neal, 43, 69

Woolverton, Mary, 166

World Health Organization, 69, 348, 358

World Trade Organization, 500

World War I

military equine procurement and care, 212–214

military working dogs’ service, 84–85

pre-war Veterinary Service support, 8–11

Veterinary Service support, 11–17

World War II

military equine procurement and care, 214–217

military working dogs procurement, 92

military working dogs’ service, 85–87

military working dogs veterinary care, 92–93

pre-war Veterinary Service support, 11–17

Veterinary Service support, 17–24

Wounded Warrior service dogs

benefits of training programs, 154–156

continuity of instruction, 153

costs of program, 151

early socialization and training of puppies, 150

fostering of puppies, 150–151

government relationships with NPOs supporting program, 151

group training, 154

instructor teaching and instruction guidelines, 152–153

military treatment center and supporting programs, 149–150

one-on-one training, 153

purpose-breeding dogs used in programs, 150

service dog instructors, 151–152

staff roles and responsibilities, 151–152

team training, 154

training of low-arousal dogs, 153

training session instruction overview, 153–154

WRAIR. See Walter Reed Army Institute of Research

WTB. See Warrior Transition Battalion

Y

Yeager, Major Arthur, 161

Young, Brigadier General Elmer W., 216

Yount, Rick, 149

Z

Zalewski, Colonel Tami, 62

Zoonotic diseases

anthrax, 50, 279–282

brucellosis, 282–285

equine encephalitides, 285–287, 375–376

global surveillance and control, 369–376

leishmaniasis, 287–292

leptospirosis, 292–294

Lyme disease, 294–298

military importance of, 278–279

plague, 298–300

Q fever, 301–303

in service members, 277

study and prevention during Vietnam War, 33–35

surveillance, 373–374

Veterinary Corps protection and control mission, 13