Volume 84, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



To better understand the epidemiology of diarrhea in deployed personnel to the Middle East, a prospective cohort study of travelers' diarrhea (TD) was conducted between May 2004 and January 2005 at the Multinational Force and Observers (MFO) camp in the southern Sinai. A baseline entry questionnaire and stool specimen was provided on study entry, and volunteers were followed every 6 weeks. Of 211 volunteers, 145 (68.7%) completed one or more follow-up visits. In total, 416 follow-up surveys were completed, which described an overall incidence of 25.2 episodes per 100 person months (95% confidence interval = 21.2–30.0). Additionally, stools were collected in 72 of 77 diarrhea-associated clinic visits, with bacterial pathogens most commonly isolated (enterotoxigenic in 30 [42%] samples and in 7 [10%] samples) Despite modern preventive methods, diarrhea is still a common problem for deployed US military personnel in Egypt, frequently resulting in diminished ability to work.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Sanders JW, Putnam SD, Frankart C, Frenck RW, Monteville MR, Riddle MS, Rockabrand DM, Sharp TW, Tribble DR, , 2005. Impact of illness and non-combat injury during Operations Iraqi Freedom and Enduring Freedom (Afghanistan). Am J Trop Med Hyg 73: 713719. [Google Scholar]
  2. Sanders JW, Putnam SD, Gould P, Kolisnyk J, Merced N, Barthel V, Rozmajzl PJ, Shaheen H, Fouad S, Frenck RW, , 2005. Diarrheal illness among deployed U.S. military personnel during Operation Bright Star 2001–Egypt. Diagn Microbiol Infect Dis 52: 8590.[Crossref] [Google Scholar]
  3. Sanders JW, Putnam SD, Riddle MS, Tribble DR, , 2005. Military importance of diarrhea: lessons from the Middle East. Curr Opin Gastroenterol 21: 914. [Google Scholar]
  4. Riddle MS, Sanders JW, Putnam SD, Tribble DR, , 2006. Incidence, etiology, and impact of diarrhea among long-term travelers (US military and similar populations): a systematic review. Am J Trop Med Hyg 74: 891900. [Google Scholar]
  5. Bohnker BK, Thornton S, , 2003. Explosive outbreaks of gastroenteritis in the shipboard environment attributed to Norovirus. Mil Med 168: iv. [Google Scholar]
  6. Riddle MS, Smoak BL, Thornton SA, Bresee JS, Faix DJ, Putnam SD, , 2006. Epidemic infectious gastrointestinal illness aboard U.S. Navy ships deployed to the Middle East during peacetime operations—2000–2001. BMC Gastroenterol 6: 9.[Crossref] [Google Scholar]
  7. Svennerholm AM, Wiklund G, , 1983. Rapid GM1-enzyme-linked immunosorbent assay with visual reading for identification of Escherichia coli heat-labile enterotoxin. J Clin Microbiol 17: 596600. [Google Scholar]
  8. Sanchez J, Holmgren J, Svennerholm AM, , 1990. Recombinant fusion protein for simple detection of Escherichia coli heat-stable enterotoxin by GM1 enzyme-linked immunosorbent assay. J Clin Microbiol 28: 21752177. [Google Scholar]
  9. Jiang X, Wilton N, Zhong WM, Farkas T, Huang PW, Barrett E, Guerrero M, Ruiz-Palacios G, Green KY, Green J, Hale AD, Estes MK, Pickering LK, Matson DO, , 2000. Diagnosis of human caliciviruses by use of enzyme immunoassays. J Infect Dis 181 (Suppl 2): S349S359.[Crossref] [Google Scholar]
  10. Herwaldt BL, de Arroyave KR, Roberts JM, Juranek DD, , 2000. A multiyear prospective study of the risk factors for and incidence of diarrheal illness in a cohort of Peace Corps volunteers in Guatemala. Ann Intern Med 132: 982988.[Crossref] [Google Scholar]
  11. Hoge CW, Shlim DR, Echeverria P, Rajah R, Herrmann JE, Cross JH, , 1996. Epidemiology of diarrhea among expatriate residents living in a highly endemic environment. JAMA 275: 533538.[Crossref] [Google Scholar]
  12. Monteville MR, Riddle MS, Baht U, Putnam SD, Frenck RW, Brooks K, Moustafa M, Bland J, Sanders JW, , 2006. Incidence, etiology, and impact of diarrhea among deployed US military personnel in support of Operation Iraqi Freedom and Operation Enduring Freedom. Am J Trop Med Hyg 75: 762767. [Google Scholar]
  13. Sanders JW, Putnam SD, Riddle MS, Tribble DR, Jobanputra NK, Jones JJ, Scott DA, Frenck RW, , 2004. The epidemiology of self-reported diarrhea in operations Iraqi freedom and enduring freedom. Diagn Microbiol Infect Dis 50: 8993.[Crossref] [Google Scholar]
  14. Putnam SD, Sanders JW, Frenck RW, Monteville M, Riddle MS, Rockabrand DM, Sharp TW, Frankart C, Tribble DR, , 2006. Self-reported description of diarrhea among military populations in operations Iraqi freedom and enduring freedom. J Travel Med 13: 9299.[Crossref] [Google Scholar]
  15. Putnam SD, Frenck RW, Riddle MS, El-Gendy A, Taha NN, Pittner BT, Abu-Elyazeed R, Wierzba TF, Rao MR, Savarino SJ, Clemens JD, , 2003. Antimicrobial susceptibility trends in Campylobacter jejuni and Campylobacter coli isolated from a rural Egyptian pediatric population with diarrhea. Diagn Microbiol Infect Dis 47: 601608.[Crossref] [Google Scholar]
  16. Hyams KC, Malone JD, Bourgeois AL, Hawkins R, Hale TL, Murphy JR, , 1995. Serum antibody to lipopolysaccharide antigens of Shigella species among U.S. military personnel deployed to Saudi Arabia and Kuwait during Operations Desert Shield and Desert Storm. Clin Diagn Lab Immunol 2: 700703. [Google Scholar]
  17. Riddle MS, Sanders JW, Putnam SD, Tribble DR, , 2006. Incidence, etiology, and impact of diarrhea among long-term travelers (US military and similar populations): a systematic review. Am J Trop Med Hyg 74: 891900. [Google Scholar]
  18. Grimes KA, Mohamed JA, Dupont HL, Padda RS, Jiang ZD, Flores J, Belkind-Gerson J, Martinez-Sandoval FG, Okhuysen PC, , 2008. PCR-based assay using occult blood detection cards for detection of diarrheagenic Escherichia coli in specimens from U.S. travelers to Mexico with acute diarrhea. J Clin Microbiol 46: 22272230.[Crossref] [Google Scholar]
  19. Huang DB, Mohamed JA, Nataro JP, DuPont HL, Jiang ZD, Okhuysen PC, , 2007. Virulence characteristics and the molecular epidemiology of enteroaggregative Escherichia coli isolates from travelers to developing countries. J Med Microbiol 56: 13861392.[Crossref] [Google Scholar]
  20. Huang DB, Nataro JP, DuPont HL, Kamat PP, Mhatre AD, Okhuysen PC, Chiang T, , 2006. Enteroaggregative Escherichia coli is a cause of acute diarrheal illness: a meta-analysis. Clin Infect Dis 43: 556563.[Crossref] [Google Scholar]
  21. de Bruin E, Duizer E, Vennema H, Koopmans MP, , 2006. Diagnosis of Norovirus outbreaks by commercial ELISA or RT-PCR. J Virol Methods 137: 259264.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 11 Feb 2010
  • Accepted : 04 Oct 2010
  • Published online : 05 Jan 2011

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error