S. Selleck Alpelisib troops in Baghdad were at risk of exposure, leading

to a potentially important significant impact on the operation (Ellis et al., 2008). As summarized above, sandlfy fever has always been a problem for immunologically naive soldiers that enter endemic areas when Phlebotomus sandflies are active. Although in most cases the disease is relatively benign, the effects of an outbreak in troops may be devastating because of high attack rates, diagnostic uncertainty and acute morbidity. In most cases, military operations are interrupted and postponed. These types of scenario inevitably impact on military strategies in the theatre of operations. Although sandfly fever is a self-limiting illness, it can be costly ISRIB price to diagnose and to treat when there is a high incidence of clinical disease. Since there is no preventive treatment, sandfly repellents and insecticide spraying are the most effective measures for protecting troops against sandflies. However, insecticide spraying requires knowledge of the habitats of sandflies which is unlikely to be possible if there is no literature about the spread of the flies around the stationed area. There are currently no available approved vaccines

or specific antiviral therapies for these diseases. The development of a broad-spectrum vaccine may be justified for army troops stationed in endemic areas, for people who travel to endemic regions, and of course for populations living in areas where endemicity is documented or is considered an at-risk area. Because of the generally favorable outcome of infections with Sicilian and Naples virus, it Nintedanib (BIBF 1120) is likely that an effective vaccine would fulfill a useful purpose mainly for military personnel, to

reduce the risk of short-term decimation of army forces. For instance, 12 of 23 febrile soldiers among British troops in Afghanistan were diagnosed as being infected by sandfly fever virus, and they were treated with doxycycline since there is no specific treatment for sandfly fever (Bailey et al., 2011). A study on prevention from infection by Toscana virus reported that a combination of recombinant Toscana virus structural proteins N-Gc, used as a vaccine, protected 100% of mice infected with a lethal, neurovirulent strain of Toscana virus (Gori Savellini et al., 2008). Because of the extensive genetic and antigenic diversity observed between Naples and Sicilian virus, a vaccine developed against one of these viruses has little chance of being effective against the other virus. Moreover, whether or not a vaccine developed against Toscana virus would have a induce cross-protection against Naples virus is uncertain and should be experimentally investigated. The concept of a broad-spectrum vaccine would therefore probably have to rely upon the development of at least a triple-virus vaccine. Other than prevention and antiviral therapy, repellents and insecticides are the principal options to reduce the spread of sandfly-borne diseases.