Abstract
The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.
Highlights
Enteric infections pose a significant risk to the 80 to 100 million travelers from industrialized countries visiting developing countries [1] and are leading causes of death among children in these same developing countries, where they claimed between 1.4 and 2.5 million lives in the year 2000 [2]
From the perspective of the United States Department of Defense (DoD), political instabilities in many parts of the world require that U.S military personnel must be ready to deploy to austere environments where the risk of exposure to infectious diseases may be significant and where routine preventive health efforts are often impractical
Enteric disease surveillance was established as a pillar within the AFHSC-Global Emerging Infections Surveillance and Response System (GEIS) system
Summary
Enteric infections pose a significant risk to the 80 to 100 million travelers from industrialized countries visiting developing countries [1] and are leading causes of death among children in these same developing countries, where they claimed between 1.4 and 2.5 million lives in the year 2000 [2]. The DoD Military Infectious Diseases Research Program (MIDRP) has a primary mission of developing vaccine countermeasures to prevent the major infections, including bacterial diarrhea, encountered during deployment Within this sustained research and development program, surveillance and epidemiological research are long-standing components; MIDRP’s support to the overseas laboratories helps assess the pathogen-specific burden of disease and the establishment of field sites for interventional studies in military and host-national pediatric populations. This diverse network could be strengthened with an alternative system that uses standardized case definitions, eligibility criteria, basic demographic and clinical data, and advanced pathogen characterization including antimicrobial resistance testing Such an approach could continue to meet individual laboratory missions while increasing the quality of study design, with the goal of being able to generalize findings across populations and over time. This importance, as well as identified gaps that can be filled, should be met with dedicated programmatic funding allocated to enteric research
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