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INCIDENCE, ETIOLOGY, AND IMPACT OF DIARRHEA AMONG DEPLOYED US MILITARY PERSONNEL IN SUPPORT OF OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM

A health assessment survey was collected from US military personnel deployed to the Middle East taking part in the "Rest and Recuperation" program or on temporary assignment to Camp As Sayliyah Doha, Qatar, from January to December 2004. In addition, a concurrent clinic-based observational study was conducted to determine pathogen etiology and potential risk factors. From 28,322 health assessment surveys, overall self-reported incidence of diarrhea was 4.9 cases per 100 person-months. Disease incidence increased with rank and was higher in Iraq compared with Afghanistan. During this period, 109 US military personnel with acute diarrhea and 85 asymptomatic personnel were enrolled in the observational study. Enterotoxigenic E. coli (ETEC) was the predominant pathogen (32%), followed by enteroaggregative E. coli (12%) and Salmonella spp. (6%). These data are consistent with previous reports implicating ETEC as the primary cause of acute diarrhea for military personnel deployed to this region.

Received March 15, 2006. Accepted for publication June 30, 2006.

Acknowledgments: We thank Army Central Command and the Camp As Sayliyah Troop Medical Clinic for assistance with this research project. Furthermore, we thank Dr. Hind Shaheen and Marilou Salamat for laboratory technical assistance. Lastly, we thank Dr. Anne Marie Svennerholm for providing reagents used to detect enterotoxigenic E. coli toxins.

Financial support: This project was funded by the Military Infectious Disease Research Program work unit 6000.RAD1.DE0301.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.

^* Address correspondence to Marshall R. Monteville, NAMRU-3 PSC 452 Box 5000, FPO AE, 09835. E-mail: montevillem{at}namru3.med.navy.mil

Copyright assignment statement: Some of the authors are military service members (or employees of the US Government). This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that "Copyright protection under this title is not available for any work of the United States Government." Title 17 U.S.C. 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person’s official duties.

Authors’ addresses: Marshall R. Monteville, NAMRU-3 PSC 452 Box 5000, FPO AE, 09835, Telephone: 011-202-342-1375 ext. 379, E-mail: montevillem{at}namru3.med.navy.mil. Mark S. Riddle, NAMRU-3 PSC 452 Box 5000, FPO AE, 09835, Telephone: 011-202-342-1375 ext. 451, E-mail: riddlem{at}namru3.med.navy.mil. Usha Baht, ASG QA, ATTN TMC/508, APO AE 09898, Telephone: 009-74-438-4251, E-mail: ubhatuk{at}yahoo.co.uk. Shannon D. Putnam, NAMRU-2, Box 3 Unit 8132, FPO AP 96520, E-mail: putnam{at}namru2.org. Robert W. Frenck, Jr. UCLA Center for Vaccine Research, 1124 W. Carson St., Torrance, CA 90502, Telephone: 310-781-3636, E-mail: rfrenck{at}uclacvr.labiomed.org. Kenneth S. Brooks, ASG QA, ATTN TMC/508, APO AE 09898, E-mail: Kenneth.s.brooks{at}us.army.mil. Manal Moustafa, NAMRU-3 PSC 452 Box 5000, FPO AE, 09835, E-mail: manalm{at}namru3.med.navy.mil. Jaime Bland, ASG QA, ATTN TMC/508, APO AE 09898, Telephone: 009-74-460-8333, E-mail: Jaime.Bland{at}qatar.army.mil. John W. Sanders, NAMRU-3 PSC 452 Box 5000, FPO AE, 09835, E-mail: jwsanders{at}Bethesda.med.navy.mil.

Reprint requests: Marshall R. Monteville, NAMRU-3 PSC 452 Box 5000, FPO AE, 09835. E-mail: montevillem{at}namru3.med.navy.mil.

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