Abstract
Infectious diarrhea remains a major risk to deployed military units worldwide in addition to their impact on travelers and populations living in the developing world. This report describes an outbreak of diarrheal illness in the U.S. military’s 130th Maneuver Enhancement Brigade deployed in San Vicente, El Salvador during a training and humanitarian assistance mission. An outbreak investigation team from U.S. Naval Medical Research Unit – Six conducted an epidemiologic survey and environmental assessment, patient interviews, and collected stool samples for analysis in an at risk population of 287 personnel from May 31st to June 3rd, 2011. Personnel (n = 241) completed an epidemiological survey (87% response rate) and 67 (27%) reported diarrhea and/or vomiting during the past two weeks. The median duration of illness was reported to be 3 days (IQR 2–4 days) and abdominal pain was reported among 30 (49%) individuals. Presentation to the medical aid station was sought by (62%) individuals and 9 (15%) had to stop or significantly reduce work for at least one day. Microscopy and PCR analysis of 14 stool samples collected from previously symptomatic patients, Shigella (7), Cryptosporidium (5), and Cyclospora (4) were the most prevalent pathogens detected. Consumption of food from on-base local vendors (RR = 4.01, 95% CI = 1.53–10.5, p-value <0.001) and arriving on base within the past two weeks (RR = 2.79, 95% confidence [CI] = 1.35–5.76, p-value = 0.001) were associated with increased risk of developing diarrheal disease. The risk of infectious diarrhea is great among reserve military personnel during two week training exercises. The consumption of local food, prepared without proper monitoring, is a risk factor for deployed personnel developing diarrheal illness. Additional information is needed to better understand disease risks to personnel conducting humanitarian assistance activities in the Latin America Region.
Highlights
Infectious diarrhea remains a global health problem and a risk to travelers and military personnel deploying to developing regions
Existing epidemiologic data indicates that enterotoxigenic E. coli (ETEC), Campylobacter jejuni, and Shigella spp. ( S. flexneri and S. sonnei) are the most common causes of diarrheal disease among adults and children who live in the developing world as well as among U.S military personnel deployed to these areas [1,2,3]
The peak of diarrheal illnesses occurred on May 27th, with 18 personnel reporting to the medical aid station
Summary
Infectious diarrhea remains a global health problem and a risk to travelers and military personnel deploying to developing regions. In personnel deploying to Iraq or Afghanistan in 2003 to 2004, 78.6% of troops in Iraq and 54.4% of those in Afghanistan experienced diarrhea, with 80% seeking care from their unit medic; eating local food from non-U.S sources was associated with an increased risk of illness [10]. Outpatient medical surveillance of U.S forces during missions conducted in Latin America showed an overall attack rate of 26%, with off-base travel and ice consumption being associated with higher reported disease rates [11]. These studies have demonstrated the risk that diarrheal illness presents to military operations and the risks associated with local food sources
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
