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Am. J. Trop. Med. Hyg., 52(2), 1995, pp. 188-193
Copyright © 1995 by The American Society of Tropical Medicine and Hygiene

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Diarrheal Disease among Military Personnel During Operation Restore Hope, Somalia, 1992–1993

Trueman W. Sharp, Scott A. Thornton, Mark R. Wallace, Robert F. Defraites, Jose L. Sanchez, Roger A. Batchelor, Patrick J. Rozmajzl, R. Kevin Hanson, Peter Echeverria, Albert Z. Kapikian, Xi J. Xiang, Mary K. Estes AND James P. Burans
Naval Medical Research Institute, Bethesda, Maryland; Naval Medical Center, San Diego, California; Walter Reed Army Institute of Research, Washington, District of Columbia; U.S. Naval Medical Research Unit No. 3, Cairo, Egypt; U.S. Navy Environmental and Preventive Medicine Unit No. 7, Naples, Italy; Navy Environmental and Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; National Institutes of Health, Bethesda, Maryland; Baylor College of Medicine, Houston, Texas

The potential for widespread diarrheal disease was regarded as a substantial threat to U.S. troops participating in the early phases of Operation Restore Hope in Somalia. Outpatient surveillance of 20,859 U.S. troops deployed during the first eight weeks, however, indicated that a mean of only 0.8% (range 0.5–1.2%) of personnel sought care for diarrhea each week, and in three epidemiologic surveys, < 3% of troops reported experiencing a diarrheal illness per week. Despite these low overall attack rates, diarrhea accounted for 16% of 381 hospital admissions and 20% of 245 patients admitted with a temperature ≥ 38.5°C. Sixty-one specimens were obtained from inpatients and 52 were obtained from outpatients. Shigella sp. were isolated from 33%, enterotoxigenic Escherichia coli from 16%, Giardia lamblia from 4%, and rotavirus from 1% of 113 stool samples obtained from inpatient (61) and outpatient (52) troops with diarrhea. Bacterial isolates obtained in Somalia were resistant to doxycycline (78%), ampicillin (54%), and sulfamethoxazole (49%), but uniformly sensitive to ciprofloxacin. With the exception of 10 Shigella sonnei isolates that were linked epidemiologically to one eating facility, bacterial pathogens occurred sporadically and demonstrated a wide variation of serotypes and antibiotic sensitivity patterns. Additionally, three of 11 paired sera collected from persons with nausea, vomiting, and watery diarrhea demonstrated a four-fold or greater increase in titer to Norwalk virus antibody. These data indicate that large outbreaks of diarrheal disease did not occur; however, highly drug-resistant enteric bacteria, and to a lesser extent viral and parasitic pathogens, were important causes of morbidity among U.S. troops in Somalia.




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M. S. RIDDLE, J. W. SANDERS, S. D. PUTNAM, and D. R. TRIBBLE
Incidence, etiology, and impact of diarrhea among long-term travelers (us military and similar populations): a systematic review.
Am J Trop Med Hyg, May 1, 2006; 74(5): 891 - 900.
[Abstract] [Full Text] [PDF]


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Copyright © 1995 by the American Society of Tropical Medicine and Hygiene.