VAZIANI, Georgia –
As part of its mission to promote force health protection through the identification and mitigation of medical threats, the U.S. Army Medical Research Directorate-Georgia (USAMRD-G), has supported joint training exercises in Georgia since 2019. Such training exercises are crucial for building upon collaboration and service interoperability while replicating a combat training environment.
Agile Spirit 2023 (AS23) is a biennial, multi-national exercise hosted by the Georgian Defense Forces (GDF) and co-led by the United States involving 22 NATO and Allied countries and over 3,600 military personnel (>1,100 U.S. service members) occurring from 21 August to 2 September 2023. USAMRD-G personnel supported AS23 via respiratory, enteric, and vector surveillance. Supporting personnel include Dr. Nino Mitaishvili (respiratory), Dr. Maia Nozadze (enteric), Dr. Giorgi Kirkitadze (vector), Capt. Matthew Burrows (vector), and Mr. Andrew Sydenstricker (vector). Respiratory and enteric efforts represent the second year USAMRD-G supported a multi-national exercise within Georgia (previously Noble Partner 2022), and the fourth year of vector surveillance support. Georgian and U.S. medical personnel received surveillance data from patient specimens regarding circulating pathogens among exercise participants. The respiratory, enteric, and vector surveillance findings were compiled into a weekly report provided to exercise support and Senior Stakeholders.
Significant findings:
Respiratory: SARS-CoV-2 was detected in 66% of respiratory samples and was the leading cause of detectable DNBI for the exercise.
Enteric: one enteric specimen was detected for enteroaggregative E. coli, enterotoxigenic E. coli, and Shiga toxin-producing E. coli (3x co-infection).Vector: 601 Rhipicephalus annulatus ticks (1 adult, 600 larvae); 2087 mosquitoes including primary West Nile vectors (Culex pipiens and Culex tritaeniorynchus), and 63 Sandflies, Phlebotomus perfiliewi , a vector of visceral leishmaniasis and sandfly fever virus. Tick and sandfly species was determined by morphology and molecular barcoding; mosquito species was determined by morphology; sandfly species was determined by molecular barcoding.
Surveillance support for multi-national exercises is an evolving activity at USAMRD-G. Each year, unit personnel expand and improve this effort, funded by the Global Emerging Infections Surveillance (GEIS) program. USAMRD-G personnel worked closely with Georgian providers to collect from ill exercise personnel (respiratory/enteric). This effort was enabled by an agreement developed in 2022 to support infectious disease surveillance within the Georgian Defense Forces, including multi-national military exercises.
Burrows and Kirkitadze were critical in providing vector surveillance feedback to senior GDF Medical Department leadership and the AS23 Health Team. The team conducted eight tick collection attempts and 42 individual mosquito/sandfly collection periods. Capt. Burrows and Team observed tick, mosquito, and sand fly activity in the training areas readily used by service members. All three of these arthropod vectors are known for their public health importance in the transmission of multiple diseases such as tick-borne encephalitis, Lyme, Crimean-Congo hemorrhagic fever, West Nile, and leishmaniasis, among others. Febrile and vector-borne infections can lead to lost duty days or, even worse, chronic health effects. Therefore, it is highly recommended that service members practice proper wear of the military uniform and application of insect repellent (such as 20-33% DEET).
“For the typical Soldier arriving at these training exercises, it’s likely that vector-borne disease is an afterthought, Burrows said. "Therefore, our goal in supporting this exercise was to inform the AS23 health teams, providers, and exercise leadership of the existing health threats and how best to prevent them so they can communicate this down to their Soldiers.”
Collectively, USAMRD-G’s AS23 surveillance findings were highly impactful for informing respiratory, enteric, and vector-borne threat assessment and decision-making during the exercise and will provide important future context for future military exercises in Georgia and the Eastern European area of responsibility.