Since the re-emergence of Plasmodium vivax in the Republic of Korea (ROK), 32,197 cases of vivax malaria have been reported .The aim of this study was to review the notification records of malaria to the Korean Centres for Disease Control and Prevention to investigate its transmission during the period 2013-2014.Reporting of malaria cases confirmed by microscopic examination is mandatory in the ROK.In this study, all available records of malaria cases and collected malaria vectors from eight locations in Gangwon Province, Gyeonggi Province, and Incheon Metropolitan City during 2013-2014 were reviewed.During the study period, 943 malaria cases were recorded.The number of cases reported in 2013 decreased by 30.6% (385 cases) compared with that in 2012 (555 cases); however, it increased by 44.9% in 2014 (558 cases) compared with that in 2013.This change may be due to the increased malaria vector density.Anopheles sinensis sensu lato increased at most collection sites in 2014 compared with that in 2013.In addition, the annual mean temperature and precipitation were slightly increased in 2014 compared with those in 2013.An increase in the number of malaria cases in a short period requires the attention of the officer in charge in order to treat the disease.More-intensive surveillance is needed in high-risk areas to identify the factors that affect the incidence of malaria in the ROK.

New formulations of camouflage face paint (CFP), one with 30% N,N-diethyl-3-methylbenzamide (DEET) and the other without DEET, were evaluated for soldier-user acceptability during a military field-training exercise in the Republic of Korea. Soldiers testing the CFP formulations were members of one of four U.S. Army infantry companies (A, B, C, or D). The formulations were evaluated while soldiers participated in simulated combat exercises for 5 days during hot, humid summer weather in Korea. Results showed that soldiers found both of the new formulations easier to apply (91.3% of respondents who used CFP without DEET and 87.9% of respondents who used CFP with DEET) and remove (82.6% without DEET and 81.2% with DEET) than the previous standard military-issue CFP. Soldier acceptability was higher for the new CFP formulation with 30% DEET (70.5%) than for the formulation without 30% DEET (52.9%). Soldiers recommended it more frequently (70.5%) than the formulation without 30% DEET (50.0%). The new CFP formulation with 30% DEET was rated more often (79.5%) as either good or excellent than the new formulation without 30% DEET (67.4%). Soldiers reported that the CFP formulation with 30% DEET more successfully camouflaged the face (92.7%) than the formulation without 30% DEET (80.0%).

Identifying viral isolates from field-collected mosquitoes can be difficult and time-consuming, particularly in regions of the world where numerous closely related viruses are co-circulating (e.g., the Amazon Basin region of Peru). The use of molecular techniques may provide rapid and efficient methods for identifying these viruses in the laboratory. Therefore, we determined the complete nucleotide sequence of two South American eastern equine encephalomyelitis viruses (EEEVs): one member from the Peru-Brazil (Lineage II) clade and one member from the Argentina-Panama (Lineage III) clade. In addition, we determined the nucleotide sequence for the nonstructural P3 protein (nsP3) and envelope 2 (E2) protein genes of 36 additional isolates of EEEV from mosquitoes captured in Peru between 1996 and 2001. The 38 isolates were evenly distributed between lineages II and III virus groupings. However, analysis of the nsP3 gene for lineage III strongly suggested that the 19 isolates from this lineage could be divided into two sub-clades, designated as lineages III and IIIA. Compared with North American EEEV (lineage I, GA97 strain), we found that the length of the nsP3 gene was shorter in the strains isolated from South America. A total of 60 nucleotides was deleted in lineage II, 69 in lineage III, and 72 in lineage IIIA. On the basis of the sequences we determined for South American EEEVs and those for other viruses detected in the same area, we developed a series of primers for characterizing these viruses.

Hantaan (HTN) virus, the etiologic agent of clinically severe hemorrhagic fever with renal syndrome (HFRS), was first isolated in 1976 from lung tissue of a striped-field mouse (Apodemus agrarius) captured in Songnae-ri, Gyeonggi Province, Republic of Korea. Found primarily in mountainous areas, the Korean field mouse (A. peninsulae) is the second-most dominant field rodent species found throughout Korea. A new hantavirus, designated Soochong (SOO), was isolated in Vero E6 cells from four A. peninsulae captured in August 1997 at Mt. Gyebang in Hongcheon-gun, Mt. Gachil, Inje-gun, Gangwon Province, and in September 1998 at Mt. Deogyu, Muju-gun, Jeollabuk Province. The entire S, M, and L genomic segments of SOO virus, amplified by RT-PCR from lung tissues of seropositive A. peninsulae and from virus-infected Vero E6 cells, diverged from HTN virus (strain 76-118) by 15.6%, 22.8%, and 21.7% at the nucleotide level and 3.5%, 9.5%, and 4.6% at the amino acid level, respectively. Phylogenetic analyses of the nucleotide and deduced amino acid sequences, using the maximum parsimony and neighbor-joining methods, indicated that SOO virus was distinct from A. agrarius-borne HTN virus. SOO virus shared a common ancestry with Amur virus from Far East Russia, as well as with H5 and B78 hantaviruses, previously isolated from HFRS patients in China. Cross-focus-reduction neutralizating antibody tests showed that SOO virus, which is the first hantavirus isolated in cell culture from A. peninsulae, could be classified as a new hantavirus serotype.

Mosquito surveillance was conducted near the Korean Demilitarized Zone (Paju County, Gyeonggi Province) from April to October, 1999, where malaria cases were reported. Adult mosquito surveillance, using black light and CDC UV light traps, was conducted at five and two sites, respectively. Weekly larval collections were made at five rice paddies located adjacent to the adult collection sites. Anopheles sinensis was the most abundant mosquito of 11 species collected throughout the surveillance period in 1999, comprising 47 - 48% of the total number of mosquitoes collected at cow sheds and residence. At all five sites surveyed by CDC UV light traps, anophelines appeared early in the year (May 3) and were most abundant in the cow sheds followed by the hillside forest, residence, stream/river bank, and were least abundant in rice fields. The population density of the larvae and the adults of An. sinensis increased steadily in June and reached their peaks during the second week of July (mean 112 females/trap/night). The parity rates were higher in July and September, when populations were highest. The probabilities of daily survival of An. sinensis were 0.804 in June to 0.895 in July. Cross-correlation showed a significant relationship between the number of adult anopheline mosquitoes and the number of larvae collected on the previous day, the same day, and also three and seven days later, which may be useful for determining treatment thresholds.

Since Venezuelan equine encephalitis virus (VEEV) was isolated in Peru in 1942, >70 isolates have been obtained from mosquitoes, humans, and sylvatic mammals primarily in the Amazon region. To investigate genetic relationships among the Peru VEEV isolates and between the Peru isolates and other VEEV strains, a fragment of the PE2 gene was amplified and analyzed by single-stranded conformation polymorphism. Representatives of seven genotypes underwent sequencing and phylogenetic analysis. The results identified four VEE complex lineages that cocirculate in the Amazon region: subtypes ID (Panama and Colombia/Venezuela genotypes), IIIC, and a new, proposed subtype IIID, which was isolated from a febrile human, mosquitoes, and spiny rats. Both ID lineages and the IIID subtype are associated with febrile human illness. Most of the subtype ID isolates belonged to the Panama genotype, but the Colombia/Venezuela genotype, which is phylogenetically related to epizootic strains, also continues to circulate in the Amazon basin.

This study was conducted as part of a field ecology study of arboviral activity in the Amazon Basin, Peru, to determine the taxonomy, frequency, seasonal, and vertical distributions of potential mosquito vectors. In addition, the relative efficiency of human-landing collections and dry ice-baited Centers for Disease Control (CDC)-type light traps was determined for collecting mosquitoes. A total of 70 species of mosquitoes from 14 genera were collected from June 1996 through December 1997 at a forested site near Puerto Almendras, approximate to20 km west-southwest of Iquitos, Peru. Three species [Psorophora (Janthinosoma) albigenu (Peryassu), Ochlerotatus (Ochlerotatus) fulvus (Wiedemann), and Ochlerotatus (Ochlerotatus) serratus (Theobald)] accounted for 70% of all mosquitoes captured in human-landing collections. Overall, biting activity occurred throughout the 24-h cycle but was higher during the daytime, primarily because of large populations of two day-biting species, Ps. albigenu and Oc. serratus. Oc. fulvus was active throughout the 24-h cycle but was more frequently collected during the evening: Oc: fulvus, Ps. albigenu, Culex (Melanoconion) pedroi Sirivanakarn & Belkin, and a mixture of Culex (Melanoconion.) vomerifer Komp, and Culex (Melanoconion) gnomatos Sallum, Huchings & Ferreira, accounted for 73% of the mosquitoes captured during darkness by human collectors. In general, Ochlerotatus spp. and Psorophora spp. were more commonly captured in human-landing collections, whereas most Culex spp. were more frequently collected in the dry ice-baited CDC-type light traps. In general, mosquito populations were lowest from June through August when river levels were at their lowest. Two large population peaks occurred in November-December and in February-March as a result of "flood water" mosquito populations (e.g., Ps. albigenu). These data provide a better understanding of the taxonomy, population density, and seasonal distribution of potential mosquito vectors within the Amazon Basin region and allow for the development of appropriate vector and disease prevention strategies.

Malaria reemerged in the Republic of Korea (ROK) in 1993. While limited numbers of U.S. soldiers in high-risk areas use chloroquine/primaquine chemoprophylaxis to prevent malaria, control of mosquito larvae through larviciding also can be used to reduce the risk of malaria transmission. In order to estimate the cost of larviciding, accurate estimates of the spatial extent of mosquito larval habitats are necessary. The purpose of this study was to determine whether an accurate estimate of the area covered by mosquito larval habitats can be obtained using Landsat 7 Enhanced Thematic Mapper+ (ETM+) and/or IKONOS data for the Korean test site.To estimate the area covered by larval habitats near Camp Greaves [Paekyeon-Ri, near Tongil-Chon (village)] in the ROK, an IKONOS and a Landsat 7 ETM+ image were classified using a parallelepiped classification. In a comparison with rice paddy field sites, 24 (92%) of the sites were classified correctly on the IKONOS image and 17 (65%) were classified correctly on the Landsat image. Comparing the classifications on a pixel-by-pixel basis, the agreement between the two classifications was 79%. Part of the disagreement was due to the difference in resolution of the two images. In spite of local differences, the two classifications produced similar area estimates.Although either Landsat or IKONOS could be used in Korea for a reasonable estimate of habitat area, only IKONOS can resolve small irrigation ponds. While ponds represent a small portion of the total larval habitat, they are an important source for mosquito breeding during the late rice-growing season in the ROK since they contain higher larval densities. High-resolution imagery, such as IKONOS, would be necessary for planning and implementing treatment of these smaller habitats. (C) 2003 Elsevier Inc. All rights reserved.

Vector-borne diseases are a potential public health threat to U.S. Forces Korea (USFK). Ehrlichia and Anaplasma spp., transmitted by ticks, are only two of several diseases that may affect military readiness and operations. Rodents were collected at selected U.S. military installations and training sites in the Republic of Korea. DNA was extracted from spleen tissues and assayed by PCR methods for Ehrlichia and Anaplasma species. From rodents and mustelids collected during 1999 and 2000, a total of 196 Apodemus agrarius (striped field mouse), 2 Mustela sibirica (weasel), and 1 Cricetulus triton nestor (Korean greater long-tailed hamster) were assayed for Ehrlichia and Anaplasma species-specific DNA fragments. Rodent surveillance indicated a very high prevalence of Ehrlichia and Anaplasma spp. at selected training sites. Ehrlichia/Anaplasma DNA were identified from spleen tissue from 157 Apodemus agrarius, 1 Mustela sibirica, and 1 Cricetulus riton nestor. Species-specific DNA fragments of E. canis (45), E. ewingii (16), A. phagocytophila (5), and A. platys (62) were amplified by PCR techniques. Seventy-one striped field mice had single infections, while 24 had mixed infections of 2 (17 specimens), 3 (7 specimens), or 4 (1 specimen) pathogens. The striped field mouse plays a role as a reservoir for latent infections of various Ehrlichia or Anaplasma species.

As part of an evaluation of the ecology of arthropod-borne diseases in the Republic of Korea (ROK), we examined 8,765 mosquitoes captured in Paju County, Gyonggi Province, ROK, for the presence of viruses. Mosquitoes were captured in propane lantern/human-baited Shannon traps, Mosquito Magnet traps, or American Biophysics Corporation (East Greenwich, RI) miniature light traps with or without supplemental octenol bait and/or dry ice. Mosquitoes were identified to species, placed in pools of up to 40 mosquitoes each, and tested on Vero cells for the presence of virus. A total of 15 virus isolations were made from 293 pools of mosquitoes. Viruses were identified by reverse transcriptase-polymerase chain reaction and sequencing and consisted of 14 isolations of Japanese encephalitis (JE) virus and one isolation of Getah (GET) virus. All JE isolates were from Culex tritaeniorhynchus Giles, and the isolate of GET was from Aedes vexans (Meigen). The minimum field infection rate for JE in Cx. tritaeniorhynchus was 3.3 per 1,000, whereas the GET virus infection rate for Ae. vexans was 0.2 per 1,000. Isolation of JE and GET indicated that both viruses were actively circulating in northern Gyonggi Province, ROK. The lack of human cases of JE among the Korean population probably is because of an effective government-mandated vaccination program. The reason for no cases among >10,000 United States military and others that reside or train nearby is unknown, but may be related to personnel protection measures (permethrin-impregnated uniforms and use of deet repellent), adult mosquito control, mosquito selection of nonhuman hosts (unpublished data), and the low symptomatic to asymptomatic ratio of disease in adults.

BACKGROUND: Uterine arteriovenous malformation is a lesion that can cause recurrent pregnancy loss. Very few successful pregnancies have been reported after selective embolization of an arteriovenous malformation.CASE: A 42-year-old gravida 6 para 0 with a history of four first-trimester spontaneous abortions was found to have a uterine arteriovenous malformation by hysterosalpingogram, which was confirmed by magnetic resonance angiography. She underwent selective transcatheter embolization of the arteriovenous malformation. A twin gestation was later conceived via in vitro fertilization. The twins were delivered by cesarean at term.CONCLUSION: Uterine arteriovenous malformation can be successfully treated with selective embolization, with good obstetric outcome. (C) 2003 by The American College of Obstetricians and Gynecologists.

Hemorrhagic fever with renal syndrome has been described among the U.S. and the U.N. troops assigned to the Republic of Korea since the Korean War. However, this appears to be the first case in which infection was acquired during garrison duty in an urban environment.

The larval habitats of malaria vectors near the Demilitarized Zone of the Republic of Korea (ROK) were sampled from June through September 2000 to determine larval abundance and to identify environmental factors associated with high larval density. Six primary habitats were identified: rice fields, irrigation ditches, drainage ditches, stream pools, irrigation pools, and marshes. Most habitats harbored similar densities of larvae until August and September, when population densities in rice fields declined and those in irrigation pools increased. The primary vector in the ROK, Anopheles sinensis, occurred in water with a wide range of values for environmental factors, including pH, total dissolved solids, percent of surface covered with floating vegetation, and nitrate and phosphate concentrations. No environmental factor or combination of factors were found that were predictive of high larval densities. This study suggests that larval Anopheles are capable of developing in a wide range of stagnant, freshwater habitats in northern Kyunggi Province, ROK.

As part of an on-going malaria surveillance effort conducted by the U.S. Forces Korea, Republic of Korea (ROK), a total of 28,286 anopheline mosquitoes was tested for the presence of Plasmodium vivax circumsporozoite (CS) protein. Mosquitoes were collected (using a variety of light and baited traps) from 29 locations throughout the ROK (the majority were collected near the de-militarized zone), identified to species, and tested by enzyme-linked immunosorbent assay for the presence of P. vivax 210 and P. vivax 247 CS protein. Recent evidence suggests that characters used to separate Anopheles sinensis Wiedemann from An. lesteri Baisas & Hu are unreliable; therefore, the data have been analyzed by grouping these two species. A total of 25,365 Anopheles sinensis/lesteri, 2,890 An. yatsushiroensis Miyazaki, and 31 An. sineroides Yamada was tested. Of these, one pool of 10 An. sinensis/lesteri collected on 9 September 1999 at Camp Howze and one pool of nine An. sinensis/ lesteri collected on 13 September 1999 at Camp Bonifas were positive for P. vivax 247.

BACKGROUND:Uterine artery embolization is increasingly used as an alternative to myomectomy, hysterectomy, and medical treatment for the management of symptomatic leiomyomata.CASE:A woman with an 18-week-size fibroid uterus who underwent uterine artery embolization developed a 3-cm, exquisitely tender, hypopigmented, necrotic-appearing area on the right labium minus. Spontaneous resolution occurred over 4 weeks.CONCLUSION:Labial necrosis is a possible complication of uterine artery embolization and may be successfully managed with conservative therapy.

A cost-comparison of two methods for the control of malaria in the Republic of Korea was performed. The cost of larviciding with methoprene granules was estimated at $93.48/hectare. The annual cost of providing chemoprophylaxis was estimated at $37.53/person. Remote sensing and geographic information systems were used to obtain estimates of the size of vector larval habitats around two U.S. Army camps, allowing an estimate of the cost of larviciding around each of the camps. This estimate was compared to the cost of providing chloroquine and primaquine chemoprophylaxis for the camp populations. Costs on each of the camps differed by the size of the larval habitats and the size of the at-risk population. These tools allow extrapolation of larval surveillance data to a regional scale while simultaneously providing site-specific cost analysis, thus reducing the cost and labor associated with vector surveillance over large areas.

A checklist of the mosquito fauna encountered during arboviral studies in Iquitos, Peru, is presented. A total of 16 genera, 30 subgenera, and 96 species were identified, including 24 species reported from Peru for the 1st time. Notations on the taxonomy and biology for 28 species are also provided.

Mosquitoes collected in the Amazon Basin, near Iquitos, Peru, were evaluated for their susceptibility to epizootic (IAB and IC) and enzootic (ID and IE) strains of Venezuelan equine encephalomyelitis (VEE) virus. After feeding on hamsters with a viremia of approximately 10(8) plaque-forming units of virus per milliliter, Culex (Melanoconion) gnomatus Sallum, Huchings, & Ferreira, Culex (Melanoconion) vomerifer Komp, and Aedes fulvus (Wiedemann) were highly susceptible to infection with all four subtypes of VEE virus (infection rates > or = 87%). Likewise, Psorophora albigenu (Peryassu) and a combination of Mansonia indubitans Dyar & Shannon and Mansonia titillans (Walker) were moderately susceptible to all four strains of VEE virus (infection rates > or = 50%). Although Psorophora cingulata (Fabricius) and Coquillettidia venezuelensis (Theobald) were susceptible to infection with each of the VEE strains, these two species were not efficient transmitters of any of the VEE strains, even after intrathoracic inoculation, indicating the presence of a salivary gland barrier in these species. In contrast to the other species tested, both Culex (Melanoconion) pedroi Sirivanakarn & Belkin and Culex (Culex) coronator Dyar & Knab were nearly refractory to each of the strains of VEE virus tested. Although many of the mosquito species found in this region were competent laboratory vectors of VEE virus, additional studies on biting behavior, mosquito population densities, and vertebrate reservoir hosts of VEE virus are needed to incriminate the principal vector species.

Repellent efficacy of N,N-diethyl-3-methyl-benzamide (deet), the piperidine, 1-[3-cyclohexen-1-ylcarbonyl]-2-methylpiperidine (AI3-37220), and a 1:1 ratio of deet + AI3-37220 were evaluated topically (0.25 mg/cm2 applied in ethanol solution) on human volunteers against the mosquito Aedes communis (DeGeer) and the black fly Simulium venustum Say. The average repellency of all three formulations was > 95% at 4 h. For both mosquitoes and black flies, deet alone provided < 90% protection at 6 h, whereas AI3-37220 provided > 95% protection. Although repellent treatments were not significantly different overall, the contrasts between AI3-3720 versus deet were significant at 6 and 8 h. The 95% confidence interval on percent repellency at 6 h ranged from 90.1 to 98.9% for AI3-37220 versus 64.3 to 82.2% for deet, and at 8 h ranged 76.1 to 88.5% for AI3-37220 versus 47.8 to 64.0% for deet. Similarly, the confidence interval for protection against black flies at 6 h by (AI3-37220 ranged from 86.3 to 99.5% and did not overlap with the confidence interval provided by deet alone (51.2 to 78.8%). There was no evidence of synergistic repellency from a combination of the two compounds; i.e., protection from combined compounds was no better than either repellent used alone.

Four repellents, N,N-diethyl-3-methyl-benzamide (deet), 2-hydroxy-methyl-cyclohexyl acetic acid lactone (CIC-4), and 2 piperidines (1-[3-cyclohexen-1-ylcarbonyl] piperidine [AI3-35765] and 1-[3-cyclohexen-1-ylcarbonyl]-2-methylpiperidine [AI3-37220]) were evaluated alone and in combination against Aedes aegypti, Anopheles stephensi, and Culex quinquefasciatus using a modified in vitro test system. This method was a valuable tool for comparing effective concentrations of the new compounds. Because of the controlled conditions of the test, it was possible to use the results of assays that had been conducted over a 5-year period and to perform the many replications necessary to evaluate combinations of compounds. The new candidate repellents were generally as effective as deet. Although speculative at this time, there was some evidence of synergistic interaction. Repellent combinations of CIC-4/AI3-37220/AI3-35767, deet/AI3-35765, and deet/AI3-37220/AI3-35765 against An. stephensi and CIC-4/AI3-35765, deet/AI3-37220/AI3-35765, AI3-37220/AI3-35765, and CIC-4/AI3-37220 against Ae. aegypti were more effective than the component compounds alone.