TABLE OF CONTENTS

Common Mechanical Vectors:

Cockroaches
............
.. 2
Musca Domestica .
2-3

Shoo Fly, Dont

Infect Me!
Mechanical Vectors of
Bacterial GI Diseases
By: Liz Melton
March 9th, 2012

Musca Sorbens

.. 3
Musca Chrysoma
..
3-4
Fly Life Stages
.
4-5

Mechanical Transmission Process....

. 5-6

Mechanically Transmitted GI Diseases:

Salmonella

... 6-7
Typhoid

. 7
Bacillary Dysentery (Shigellosis).
.. 7-8

Summarized Scenarios:
Role of Cockroaches and Flies as Mechanical Vectors in Egypt
. 8
Role of Cockroaches as Mechanical Vectors in Thailand
... 8
Role of House Flies in Cholera Transmission in India
. 9

Recent Research:
The housefly (Musca domestica) as a carrier of pathogenic
microorganisms in a hospital environment
9
Reduction of transmission of shigellosis by control of houseflies
. 10

Political Ties and Wartime Relevance:

PATH & WaterAid America
.. 10
Armed Forces Pest Management Board TECHNICAL GUIDE NO. 30 Filth
Flies
Significance, Surveillance and Control in Contingency Operations
. 11
AFPMB: Disease Vector Ecology Profile for Somalia..
.11-12

References:

Reference List ..
..
13-14

INTRODUCTION
Civil strife, diminished immune status, food shortages, antibiotic
resistance, and utterly unsanitary living conditions taint all settlements
undergoing humanitarian crises. Such catastrophes yield irreparable
harm to innocent bystanders, reducing everyday routine to disarray
and disorganization. Refugee camps are characterized by chaos.
Internationally displaced persons are forced to inhabit incredibly close
quarters; in many cases, this equates to: defecating sans any form of
privacy, consuming meals and water of the poorest quality, and failure
to bathe in overcrowded, filthy locations. Most unsettling then, is
looming potential for rapid and virulent spread of disease via
mechanical transmission: a form of indirect transmission in which the
infectious agent does not undergo physiologic changes inside the
vector1.
This background delineates modes of bacterial gastrointestinal
disease transmission in humanitarian crisis communities. To combat
mechanical disease transmission, this paper first distinguishes features
of mechanical vectors that supply distinct connection to areas of

humanitarian crisis. Owing to feeding and reproductive behaviors,

several mechanical vectors such as cockroaches, houseflies, filth flies,
and blow flies become exceedingly prevalent in disaster zones.
Publications hailing from Egypt, Thailand, India, and Somalia provide
concrete examples of fly and cockroach infectivity in humantarian
crises-esque scenarios. Documented spread of pathogens by way of
cockroaches and flies near latrines, open-air markets, military bases,
village animal pens and trash dumps, and hospitals are also examined
within this piece. Finally, a discussion of political influence and
wartime repercussions may instigate further research on intervention
strategies for control of mechanical vectors of GI bacterial disease.

Common Mechanical Vectors

Common Cockroach
Common cockroaches are typified by their 5-73mm length and
dual wing structure2. All cockroaches have a flattened appearance,
and are yellowish brown in color. What differentiates cockroaches from
other beetles or land-bound insects is their incredible agility.
Moreover, they exhibit endophagic behavior, feeding on garbage and
feces indoors3. These arthropods are most active at night, scurrying in
and out of latrines and other warm, man-made structures. Often, they
breed outdoors, and opt to reside in colony form4.
Due to the fact that refugee camps have little to no shelter
denying cockroach entry into makeshift tents, and the propensity for

organic waste and feces to be proximal to sleeping individuals, it is

clear how mechanical transmission is not only possible, but probable5.
Unfortunately, cockroaches are responsible for transmitting numerous
bacterial GI diseases including: many forms of diarrheal diseases,
typhoid fever, and dysentery along with a host of other viruses and
diseases2.

Musca domestica (Common Housefly)

Distributed worldwide, Musca domestica, the common housefly,
is marked by its 6-7 mm length, grey color, and four dark longitudinal
stripes along its thorax2. It has been proven that high density of flies is
correlated with crowded human populations in unsanitary conditions.
This habitat is a near-exact portrayal of humanitarian crisis sites. What
makes the housefly so intrinsically linked to mechanical transmission of
bacterial GI diseases in humanitarian crises is the dependency of its
life cycle on unsanitary settings4. Although house flies do not
physically lay eggs directly in latrines, landing and feeding on
uncovered human and animal excrement as well as domestic organic
waste is essential to house fly survival. What is more, houseflies are
associated with the spread of infantile diarrhea, shigellosis diarrhea,
cholera, other forms of dysentery, and typhoid fever2,6.

Musca sorbens (Filth fly)

Similar to Musca domestica, Musca sorbens, common name filth

fly, is characterized by a grey color, and usually grows to a size of 6
mm in length2. Unlike houseflies, however, filth flies are detected by
two dark stripes on the thorax, and normally reside in tropical
locations. Musca sorbens flies possess a wing-span of around 15 mm,
and, like most other flies, filth flies breed and engorge in human feces
around settlements7. Filth flies are unique in that they also feed on eye
secretions, especially those of children2. As a result, Musca sorbens is
implicated in the transmission of the eye disease trachoma. In the
context of humanitarian crises, diarrheal diseases are the most
commonly transmitted pathogens from filth flies.

Chrysomya (Blowfly)
A compact body 10mm in length, and a shiny blue or green color
set Chrysomya, otherwise known as blow flies, apart from other flies2.
Blow flies are distributed worldwide, and also possess a strong
preference for breeding in open latrines, decomposing meat or fish,
garbage, and animal excrement. Recent research demonstrates that
blow flies are most active in refugee camps, simple pit latrines, market
places, defecation holes sans lids7. Luckily, blow flies display
contrasting behavior from cockroaches, and do not enter houses.
Nonetheless, Chrysomya density rises as the number of simple pit
latrines in a camp increases7an imminent threat to regions in the

vicinity of humanitarian crises. These flies are linked to intestinal

worm eggs, diarrheal disease, and dysentery transmission.

Fly Life Stages:

Four discrete phases can be identified in fly genesis. Eggs give
way to maggots/larvae, which eventually pupate, emerging as adults
within weeks3. Per the World Health Organization, female flies seldom
lay greater than 150 eggs in one sitting, which takes place only up to
five times within her lifetime8. In general, eggs are deposited on an
assortment of spots, namely: decayed, fermenting, rotting, moist
organic material of animal or vegetable origin, and heaps of animal or
human feces2. Choice of egg-laying venue is dependent on its
moisture, texture, and freshness. Following about an 8-48 hour
incubation period, eggs hatch into maggot form3.
Conveniently, larvae thrive on organic matter and animal/human
excrement. Larvae are recognized by their slender, white, legless,
maggot-like exterior, and grow after burrowing far into breeding
material. Reaching pupa maturity takes anywhere from three days to
as long as several weeks3. Maggot development is contingent on
temperature, fly species, and the type, quantity, and quality of food8
(high in fecal and waste-contaminated areas of humanitarian crisis).
Two to ten days subsequent to formation of a puparium, the capsulelike case containing the fly-to-be, the adult fly emerges2. Spreading its

wings, and pushing to the surface, the body of the adult fly dries and
hardens.
Adult flies can subsist for one to two months prior to death,
conditional on the species and living conditions. On account of their
mouthpart design, flies only consume food in a liquid, or readily soluble
state. Solid food is wetted with saliva, and sucked up along with water,
a vital component to a flys livelihood. Flies cannot exist over 48 hours
without drinking water3. A flys diet habitually consists of: milk, sugar,
syrup, blood, meat broth, and any materials found in human
settlements ingested at least two to three times a day7.

Mechanical Transmission Process:

Fly breeding mechanisms and filthy feeding habits of
cockroaches mentioned above are precisely what make flies and
cockroaches efficient mechanical vectors and transmitters of bacterial
GI diseases. Three hundred fifty fly species in twenty-nine families
have been potentially associated with the spread of food-borne
diseases4. According to Clinical Microbiology Reviews, over fifty
species of synanthropic flies have been reported to be associated with
unsanitary conditions, and are involved in dissemination of human
pathogens in the environment, and twenty-one of these species have
been involved in transmission of human gastrointestinal diseases. A
flys configuration and flying patterns are inherently conducive to
mechanical transmission. Individual flies have been known to migrate

up to twenty miles, with unsanitary sites as targets. Sucking

mouthparts, sticky footpads, sticky substances on appendages, body
and leg hair, and electrostatic charge on exoskeletons effectively
render flies super transmitters of disease2,4.
In particular, districts subjected to humanitarian crises are prime
breeding and feeding grounds for these infective arthropods. Waste
incurred via food preparation, handling, vending, and serving waste in
public places is considered hazardous2,7. More disturbingly, feces
enhance transmission of infectious agents much greater than that of
any other substrate or medium, a major concern in humanitarian
crises. Ample animal manure and human excrement, garbage, animal
bedding, and decaying organic matter can be found scattered all over
refugee camps, and pose pending danger of mechanical disease
transmission7.

Mechanically Transmitted GI Diseases

Salmonellosis:
Salmonellosis is attributed to infection with the bacteria
Salmonella. Salmonella infects the GI tract, and is frequently spread
by mechanical vectors affiliated with humanitarian crisis settings.
Infecteds will present with diarrhea, fever, and abdominal cramps 12 to
72 hours after infection. A sustained fever of approximately 40 C, and
feelings of weakness, headache, loss of appetite, or materialization of

a rash of flat, rose-colored spots are other symptoms of Salmonellosis.

Antibiotics are the suggested treatment for Salmonellosis9.
Salmonellosis persists only 4 to 7 days, though, in some
individuals, severity of diarrhea may prompt patient hospitalization.
Salmonella bacteria is capable of spreading from the GI tract to the
portal system, triggering infection of other body sites, and leading to
eventual death without immediate antibiotic treatment. Furthermore,
some patients complain of joint and urination pain, as well as eye
irritationwhat is deemed Reiter's syndrome. This form of the disease
may continue for months or years, bringing about chronic arthritis.
Infants, the elderly, and immuno-compromised persons are more liable
to this degree of illness. All three age/status groups are regularly
observed in refugee populations, making Salmonellosis outbreaks
grave concerns in humanitarian crises7.

Typhoid fever:
Typhoid fever, caused by the bacterium Salmonella typhi is
classified as a life-threatening illness. In the developing world, this
disease is fairly common, about 21.5 million persons are afflicted with
typhoid fever each year10. Salmonella Typhi lives only in humans.
Infected individuals harbor bacteria in their GI tract and bloodstream,
and both silent carriers and ill persons shed bacterial residue in stool.
Fecal-oral transmission is a method of contracting typhoid fever, a
logical explanation for enormous prevalence of typhoid where

handwashing and clean water is limited7,11. Additionally, houseflies and

cockroaches are known to be wonderful mechanical vectors of typhoid
fever2, and, coincidentally reside in areas at high risk of endemicity.
Typhoid fever is treated and prevented by oral antibiotics10, which are
expensive, and rarely imported in the bulk required by humanitarian
crises settings.

Bacillary Dysentery (Shigella):

As with most bacterial GI diseases, bacillary dysentery invokes
bloody diarrhea, fever, and stomach cramps a day or two after
exposure to the Shigella bacterium. Shigellosis symptoms remain for 5
to 7 days on average; in spite of this, children younger than two years
of age may experience violent seizures12. To make matters worse,
infection by the strain Shigella flexneri, causes post-infectious, and
possibly chronic, arthritis. As aforementioned, chrysomya, houseflies,
and cockroaches all mechanically transmit Shigella bacteria2.
Antibiotic treatment destroys Shigella bacteria, so ampicillin,
trimethoprim/sulfamethoxazole, ceftriaxone, or, among adults,
ciprofloxacin will alleviate symptoms12. Regrettably, Shigella bacteria
have become resistant to antibiotics, requiring multiple treatments at
oncea near impossibility to administer in humanitarian crises7.

Summarized Scenarios
The role of cockroaches and flies in mechanical
transmission of medical important parasites:

METHODS:
1) Surveyed residential areas in Khaldyia Village, Egypt 2009 2010
45 cockroaches collected in control, 178 total collected
Flies from human feces also observed
2) Parasites isolated/identified from defecation areas in and around
houses
RESULTS:
-Cockroaches trapped in the toilets of:
houses with pit latrines: 98 parasites/ml
houses with water system: 31 parasites/ml
-Pathogens isolated from external and internal surface of 98% of test
cockroaches
(Adapted from: Gehad T. El-Sherbini, Eman T. El-Sherbini. The role of
cockroaches and flies in mechanical transmission of medical important
parasites. Journal of Entomology and Nematology. 2011;3(7):98-104.)4

The majority of cockroaches from the samutprakarn

province of Thailand are carriers of parasitic organisms:
METHODS:
920 cockroaches were obtained Samutprakarn province of
Thailand
o 18 open-air shopping markets in 5 districts
1 subdistrict of this province
o captured during feeding time in natural habitat
wet smear and modified acid-fast bacilli staining
identified parasites from the external surface or
cuticle of the cockroaches
RESULTS:

-498/920 (54.1%) of the cockroaches harbored parasitic organisms

**Results elucidate that markets giving refuge to cockroaches cultivate
colonies that carry several pathogens activating transmission of illness
such as diarrhea or bowel disorder.
(Adapted from: Pennapa Chamavit, Panupong Sahaisook, Nunthawadee
Niamnuy. The majority of cockroaches from the samutprakarn province
of Thailand are carriers of parasitic organisms. EXCLI Journal. 2011;
(10):218-222.)5

Vector potential of houseflies (Musca domestica) in the

transmission of Vibrio cholerae in India:
METHODS:
1) Small village 15 km away from Delhi city outbreak of diarrhea
2) 150 houseflies captured with sterilized nets from animal pens, yards
or houses
3) Collect stool samples from 50 patients within 24 hrs of illness,
before anti-microbial
o all subjects of lower socioeconomic status
o all exhibiting signs of gastroenteritis
4) Samples were transferred to tubes of high pH (8.4) of alkaline
peptone water suppressing commensal intestinal bacterial growth to
permit uninhibited multiplication of V. cholerae
RESULTS:
-60% fly pools were positive for V. cholerae
**This study bestowed convincing evidence that houseflies acted as
mechanical vectors, and aided in dissemination of V. cholerae biotype
El Tor.
(Adapated from: R. Fotedar. Vector potential of houseflies (Musca
domestica) in the transmission of Vibrio cholerae in India. Acta Tropica.
2001;(78):3134.)6

Recent Research:
The housefly (Musca domestica) as a carrier of pathogenic
microorganisms in a hospital environment:
METHODS:
1) Collect Musca domestica from:
surgical ward (All India Institute of Medical Sciences Hospital)
remote residential area 5 km away as a control
2) A total of 113 flies were collected:

65 from a surgical ward (test)

48 from a residential area (comparison)

RESULTS:
-10 genera of bacteria isolated from the test group, 9 from control
group
-However, the load of bacteria carried by the test group of flies was
significantly more.
**Evidence for houseflies acting as vectors of potentially pathogenic
bacteria in a hospital environment is a frightening, and very real
prospect.
(Adapted from: R. Fotedar, U. Banjeree S. Singh Shriniwas, A Verma.
The housefly (Musca domestica) as a carrier of pathogenic
microorganisms in a hospital environment. Journal of Hospital Infection.
1992;(20):209-215.)13

Reduction of transmission of shigellosis by control of

houseflies (Musca domestica):
Prospective Crossover Intervention Study
METHODS:
1) 2 military field bases several km apart in early summer, 1988
2) Implement and track progress of intensive fly control measures at
one base, keep another as control
RESULTS:
-After 11 weeks, fly counts were 64% lower on the bases exposed
to fly control
-Clinic visits for diarrheal diseases dropped by 42%:
85% for shigellosis (76% for antibodies to Shigella)
57% for antibodies to enterotoxigenic Escherichia coli
**Leads one to believe that control of mechanical vectors is on the
horizon, and is an achievement necessary for reducing the number of
GI diseased individuals in humanitarian crises.
(Adapted from: Dani Cohen, Manfred Green, Colin Block, Raphael
Slepon, Ruhama Ambar, Steven Wasserman, Myron Levine. Reduction
of transmission of shigellosis by control of houseflies (Musca
domestica). The Lancet. 1991;(337).)14

Political Ties and Wartime Relevance

PATH & WaterAid America:
Two leading NGOs, WaterAid America and PATH (Program for
Appropriate Technology in Health) have joined forces in order to
defeat a global killer that entertains little attention on our side of the
continent: diarrheal disease. Both philanthropic organizations aspire to
ameliorate international living conditions which currently foster the
transmission of diarrheal diseases. With a focus primarily on children,
PATH and WaterAid will be conducting extensive research in endemic
communities on the upshot of clean water and sanitation solutions and
dispensation of adequate resources. Thus, surveillance carried out by
NGOs akin to WaterAid and PATH may be an alternative route for
testing exploratory mechanical vector control strategies in
humanitarian crisis locations.
(Adapted from: (May, 2009). Defeating a Global Killer: The Need for
Action on Diarrheal Disease.
www.who.int/entity/pmnch/events/2009/InvitationD
Devent.pdf. [Flyer]. February 13, 2012.)15

Armed Forces Pest Management Board TECHNICAL GUIDE

NO. 30 Filth Flies: Significance, Surveillance and Control in
Contingency Operations:
Historically, arthropods have plagued military operations whether
it be as a result of physical distress induced by spread of infection, or
simply by sustained, non-stop pestering base-side. Evidenced by

journals dating back to World War I, Colonel J.C.G. Ledingham of the

Royal Army Medical Corps, Mesopotamian Expeditionary Force found a
strong correlation between fly density and the incidence of dysentery.
World War II battles, especially that of El Alamein in North Africa, bore
extreme troops loss to to dysentery presumably from flies as well.
Farther down the historical line, flies were proven a monumental
nuisance throughout the Vietnam War, with testimonies regarding one
mess hall in which fly infestation was so heavy it was difficult to eat
without ingesting one or two.
The Persian Gulf War of 1991 posed parallel problems, and fly
infestation finally began to be established as a chief issue in
humanitarian relief operations.
Somalian relief forces encountered brutally insufficient sanitation, and
detailed vast fly infestations within military bases, and refugee
shelters. Realizing that a blend of deficient sanitation, and growing
livestock populations (inevitably initiating a greater garbage and
excrement load), was a recipe for fly and cockroach influx, the Armed
Forces Pest Management launched the creation of Disease Vector
Ecology Profiles, and technical guides to narrow the risk of mechanical
transmission of disease in wartime and humanitarian crises.
(Adapted from: Armed Forces Pest Management Board TECHNICAL
GUIDE NO. 30 Filth Flies: Significance, Surveillance and Control in
Contingency Operations
Published and Distributed by Armed Forces Pest Management Board
Information Services Division Forest Glen Section/Walter Reed Army
Medical Center, Washington, DC 20307-5001, Office of the Deputy

Under Secretary of Defense (Installations and Environment))7

Armed Forces Pest Management Board: Disease Vector

Ecology Profile for Somalia:
Disease Vector Ecology Profiles (DVEPs) single out relevant vectorborne and other militarily significant diseases in countries with an
emphasis on: essential epidemiology, vector bionomics, behavior, and
pesticide resistance. A Somalian example on Fly-Associated
Diseases: ENTERIC DISEASES highlights agents of disease, vector
transmission, and vector bionomics. Generally, profiles are
constructed as compilations of contemporary research on both vector
characteristics and control measures. DVEPs are constantly evolving
owing to swift Third World urban development, civil strife, ecological
change, and invariable growth in the number of countries tormented
by humanitarian crisis.
(Adapted from: (15, September, 1993). Disclosure. Armed Forces Pest
Management Board: Disease Vector Ecology Profile for Somalia, 4th Ed.
Armed Forces Pest Management Board. Retrieved from:
file:///C|/Inetpub/wwwroot/AFPMB/pubs
/dveps/somalia.htm.)11

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Transmission of Human Protozoan Parasites by Insects. Clin. Microbiol.
Rev. 2005;18(1):128.
4. Gehad T. El-Sherbini, Eman T. El-Sherbini. The role of cockroaches
and flies in mechanical transmission of medical important parasites.
Journal of Entomology and Nematology. 2011;3(7):98-104.
5. Pennapa Chamavit, Panupong Sahaisook, Nunthawadee Niamnuy.
The majority of cockroaches from the samutprakarn province of
Thailand are carriers of parasitic organisms. EXCLI Journal. 2011;
(10):218-222.
6. R. Fotedar. Vector potential of houseflies (Musca domestica) in the
transmission of Vibrio cholerae in India. Acta Tropica. 2001;(78):3134.
7. Armed Forces Pest Management Board TECHNICAL GUIDE NO. 30
Filth Flies
Significance, Surveillance and Control in Contingency Operations
Published and Distributed by Armed Forces Pest Management Board
Information Services Division Forest Glen Section/Walter Reed Army
Medical Center, Washington, DC 20307-5001, Office of the Deputy
Under Secretary of Defense (Installations and Environment)
8. Orin S. Levine, Myron M. Levine. Houseflies (Musca domestica) as
Mechanical Vectors of Shigellosis Reviews of Infectious Diseases.
1991;13(4):688-696.

9. Centers for Disease Control and Prevention. Salmonella. What is

Salmonellosis? September 27, 2010.
http://www.cdc.gov/salmonella/general/. February 13, 2012.
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Emerging and Zoonotic Infectious Diseases. Typhoid Fever. October 5,
2010. http://www.cdc.gov/
nczved/divisions/dfbmd/diseases/typhoid_fever/. February 13, 2012.
11. (15, September, 1993). Disclosure. Armed Forces Pest Management
Board: Disease Vector Ecology Profile for Somalia, 4th Ed. Armed Forces
Pest Management Board. Retreived from:
file:///C|/Inetpub/wwwroot/AFPMB/pubs/dveps/
somalia.htm.
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Emerging and Zoonotic Infectious Diseases. Shigellosis. November 16,
2009. http://www.cdc.
gov/nczved/divisions/dfbmd/diseases/shigellosis/. February 13, 2012.
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(Musca domestica) as a carrier of pathogenic microorganisms in a
hospital environment. Journal of Hospital Infection. 1992;(20):209-215.
14. Dani Cohen, Manfred Green, Colin Block, Raphael Slepon, Ruhama
Ambar, Steven Wasserman, Myron Levine. Reduction of transmission of
shigellosis by control of houseflies (Musca domestica). The Lancet.
1991;(337).
15. (May, 2009). Defeating a Global Killer: The Need for Action on
Diarrheal Disease.
www.who.int/entity/pmnch/events/2009/InvitationDDevent.pdf. [Flyer].
February 13, 2012.