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

Trueman W. Sharp Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Scott A. Thornton Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Mark R. Wallace Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Robert F. Defraites Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Jose L. Sanchez Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Roger A. Batchelor Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Patrick J. Rozmajzl Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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R. Kevin Hanson Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Peter Echeverria Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Albert Z. Kapikian Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Xi J. Xiang Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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Mary K. Estes Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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James P. Burans Naval Medical Research Institute, Naval Medical Center, Walter Reed Army Institute of Research, U.S. Naval Medical Research Unit No. 3, U.S. Navy Environmental and Preventive Medicine Unit No. 7, Navy Environmental and Preventive Medicine Unit No. 6, Armed Forces Research Institute of Medical Sciences, National Institutes of Health, Baylor College of Medicine, Bethesda, Maryland, Egypt

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DOI:
https://doi.org/10.4269/ajtmh.1995.52.188
Volume/Issue:
Volume 52: Issue 2
Page(s):
188–193
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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.
Copyright:
Copyright © 1995 by The American Society of Tropical Medicine and Hygiene 1995
Published Online:
Feb 1995
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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