Abstract
BackgroundFort Bragg, a large Army installation with reported high Chlamydia trachomatis (Ct) infection rates, is characterized by a highly mobile population and a surrounding Ct-endemic community. We assessed the rates of Ct incidence and recurrence among the installation’s active component Army personnel and determined the association of soldier transience, sociodemographic factors, and history of sexually transmitted infection (STI) with these rates.MethodsA cohort of soldiers stationed at Fort Bragg during 2005 to mid-2010 was followed for incident and recurrent Ct infection using laboratory-confirmed reportable disease data. Linkage to demographic and administrative data permitted multivariate analysis to determine association of covariates with initial or recurrent infection.ResultsAmong 67,425 soldiers, 2,198 (3.3%) contracted an incident Ct infection (crude incidence, 21.7 per 1,000 person-years). Among soldiers followed for incident infection, 223 (10.6%, crude incidence 110.8 per 1,000 person-years) contracted a recurrent Ct infection. Being female, of lower rank, under 26 years of age, of non-white race, single, or with a high school diploma or less was significantly associated with incident Ct infection. Having breaks in duty or having deployments during follow-up was associated with a lower infection rate. Among women, having prior deployments was associated with a lower rate of both incident and recurrent infection. Specifically associated with recurrent infection in women was age under 21 years or no education beyond high school.ConclusionsThis analysis reaffirms risk factors for Ct infection determined in other studies. In addition, infection risk was lower for more mobile soldiers and tied to the specific location of their regular duty assignment. The findings support the STI prevention efforts at Fort Bragg and the surrounding community, regardless of how often or for how long soldiers have deployed for military operations.
Highlights
Fort Bragg, a large Army installation with reported high Chlamydia trachomatis (Ct) infection rates, is characterized by a highly mobile population and a surrounding Ct-endemic community
Study location and population The location chosen for this study was Fort Bragg, North Carolina (NC), one of the largest military installations in the country, with an active duty population numbering more than 50,000 [7] which is dominated by elite Army units and which consists of an exceptional range of occupational groups assigned there well reflecting the Army as a whole
The final cohort of 67,425 soldiers excluded 113 persons who were deployed throughout the study period, and 4 who were infected at the time they entered into the cohort at the start of the study
Summary
Fort Bragg, a large Army installation with reported high Chlamydia trachomatis (Ct) infection rates, is characterized by a highly mobile population and a surrounding Ct-endemic community. Koizumi and colleagues used mapping with spatial analysis to reveal an ecological correlation between the presence of military bases in specific Virginia counties, and county-level rates of Chlamydia trachomatis (Ct) and gonorrhea (GC); but the area studied is in a part of the tidewater region where population-dense foci might account for higher disease rates without attribution to military subpopulations [4]. While these studies indirectly account for non-permanent residents of given geographic locations, analyses that address the mobility of subpopulations are generally lacking. The present study was conducted to assess Ct incidence and recurrent infection rates in a cohort of active component Army personnel, and determine any association of these rates with soldier transience, in addition to demographic characteristics and STI history
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