• 1.

    Ryan ET, Kain KC, 2000. Health advice and immunizations for travelers. N Engl J Med 342: 17161725.

  • 2.

    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.

    • Search Google Scholar
    • Export Citation
  • 3.

    Cook GC, 2001. Influence of diarrhoeal disease on military and naval campaigns. J R Soc Med 94: 9597.

  • 4.

    Zapor MJ, Moran KA, 2005. Infectious diseases during wartime. Curr Opin Infect Dis 18: 395399.

  • 5.

    Oyofo BA, Soderquist R, Lesmana M, Subekti D, Tjaniadi P, Fryauff DJ, Corwin AL, Richie E, Lebron C, 1999. Norwalk-like virus and bacterial pathogens associated with cases of gastroenteritis onboard a US Navy ship. Am J Trop Med Hyg 61: 904908.

    • Search Google Scholar
    • Export Citation
  • 6.

    Centers for Disease Control and Prevention (CDC), 2002. Outbreak of acute gastroenteritis associated with Norwalk-like viruses among British military personnel-Afghanistan, May 2002. MMWR Morb Mortal Wkly Rep 51: 477479.

    • Search Google Scholar
    • Export Citation
  • 7.

    Anonymous, 2005. Gastroenteritis outbreak among Canadian Forces members: Bosnia-Herzegovina, August 2003. Can Commun Dis Rep 31: 141148.

    • Search Google Scholar
    • Export Citation
  • 8.

    Riddle MS, Tribble DR, Putnam SD, Mostafa M, Brown TR, Letizia A, Armstrong AW, Sanders JW, 2008. Past trends and current status of self-reported incidence and impact of disease and nonbattle injury in military operations in Southwest Asia and the Middle East. Am J Public Health 98: 21992206.

    • Search Google Scholar
    • Export Citation
  • 9.

    Skeehan CD, Tribble DR, Sanders JW, Putnam SD, Armstrong AW, Riddle MS, 2009. Nonbattle injury among deployed troops: an epidemiologic study. Mil Med 174: 12561262.

    • Search Google Scholar
    • Export Citation
  • 10.

    Brown JA, Riddle MS, Putnam SD, Schlett CD, Armstrong AW, Jones JJ, Tribble DR, Sanders JW, 2009. Outcomes of diarrhea management in operations Iraqi Freedom and Enduring Freedom. Travel Med Infect Dis 7: 337343.

    • Search Google Scholar
    • Export Citation
  • 11.

    Bai Y, Dai YC, Li JD, Nie J, Chen Q, Wang H, Rui YY, Zhang YL, Yu SY, 2004. Acute diarrhea during army field exercise in southern China. World J Gastroenterol 10: 127131.

    • Search Google Scholar
    • Export Citation
  • 12.

    Jelastopulu E, Venieri D, Komninou G, Kolokotronis T, Constantinidis TC, Bantias C, 2006. Outbreak of acute gastroenteritis in an air force base in western Greece. BMC Public Health 6: 254.

    • Search Google Scholar
    • Export Citation
  • 13.

    Bailey MS, Gallimore CI, Lines LD, Green AD, Lopman BA, Gay JJ, Brown DW, 2008. Viral gastroenteritis outbreaks in deployed British troops during 2002–7. J R Army Med Corps 154: 156159.

    • Search Google Scholar
    • Export Citation
  • 14.

    Michel R, Garnotel E, Spiegel A, Morillon M, Saliou P, Boutin JP, 2005. Outbreak of typhoid fever in vaccinated members of the French Armed Forces in the Ivory Coast. Eur J Epidemiol 20: 635642.

    • Search Google Scholar
    • Export Citation
  • 15.

    Sauvet F, Lebeau C, Foucher S, Flusain O, Jouanin JC, Debonne JM, 2009. Operational impact of health problems during a four-month military deployment in Ivory Coast. Mil Med 174: 921928.

    • Search Google Scholar
    • Export Citation
  • 16.

    World Health Organization, 2009. Country Profile Djibouti. Available at: http://www.emro.who.int/djibouti/. Accessed February 1, 2010.

  • 17.

    Rogier C, 2008. Republic of Djibouti. Carter R, Parker M, eds. Pocket Guide to Cultural Health Assessment. Fourth edition. St Louis, MO: Mosby Elsevier, 210215.

    • Search Google Scholar
    • Export Citation
  • 18.

    Chaudet H, Pellegrin L, Meynard JB, Texier G, Tournebize O, Queyriaux B, Boutin JP, 2006. Web services based syndromic surveillance for early warning within French Forces. Stud Health Technol Inform 124: 666671.

    • Search Google Scholar
    • Export Citation
  • 19.

    Murray CK, Horvath LL, 2007. An approach to prevention of infectious diseases during military deployments. Clin Infect Dis 44: 424430.

  • 20.

    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.

    • Search Google Scholar
    • Export Citation
  • 21.

    Anonymous, 2008. Système National d'Information Sanitaire - Annuaire Statistique 2007. Direction de l'Épidémiologie et de l'Information Sanitaire. Djibouti: Ministère de la Santé.

    • Search Google Scholar
    • Export Citation
  • 22.

    Anonymous, 2009. Système National d'Information Sanitaire - Annuaire Statistique 2008. Direction de l'Épidémiologie et de l'Information Sanitaire. Djibouti: Ministère de la Santé.

    • Search Google Scholar
    • Export Citation
  • 23.

    Aronson NE, Sanders JW, Moran KA, 2006. In harm's way: infections in deployed American military forces. Clin Infect Dis 43: 10451051.

  • 24.

    Sanders JW, Putnam SD, Riddle MS, Tribble DR, 2005. Military importance of diarrhea: lessons from the Middle East. Curr Opin Gastroenterol 21: 914.

    • Search Google Scholar
    • Export Citation
  • 25.

    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.

    • Search Google Scholar
    • Export Citation
  • 26.

    Morillon M, De Pina JJ, Husser JA, Baudet JM, Bertherat E, Martet G, 1998. Djibouti, history of 2 epidemics of cholera: 1993–1994 [in French]. Bull Soc Pathol Exot 91: 407411.

    • Search Google Scholar
    • Export Citation
  • 27.

    Dray X, Dray-Spira R, Mattera D, Bougere J, Garnotel E, 2002. A cholera epidemic in Dijibouti (May 2000–January 2001) [in French]. Med Trop (Mars) 62: 497502.

    • Search Google Scholar
    • Export Citation
  • 28.

    Richard V, Haus R, Verret C, Molinier S, Hugard L, Nicand E, Spiegel A, Buisson Y, 2006. Impact and forecasting of hepatitis A immunization in French armed forces, 1990–2004 [in French]. Rev Epidemiol Sante Publique 54: 433441.

    • Search Google Scholar
    • Export Citation
  • 29.

    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.

    • Search Google Scholar
    • Export Citation
  • 30.

    Sanchez JL, Gelnett J, Petruccelli BP, Defraites RF, Taylor DN, 1998. Diarrheal disease incidence and morbidity among United States military personnel during short-term missions overseas. Am J Trop Med Hyg 58: 299304.

    • Search Google Scholar
    • Export Citation
  • 31.

    Maslin J, Nicand E, Ambert-Balay K, Fouet C, Kaplon J, Haus R, Pothier P, Kohli E, 2008. Detection and characterization of human caliciviruses associated with sporadic acute diarrhea in adults in Djibouti (Horn of Africa). Am J Trop Med Hyg 78: 522526.

    • Search Google Scholar
    • Export Citation
  • 32.

    Anonymous, 2009. Travellers' Recommendations. Bull Epidemiol Hebdo 23–24, 237–257. Available at: http://www.invs.sante.fr/beh/2009/23_24/index.htm. Accessed February 1, 2010.

    • Search Google Scholar
    • Export Citation
  • 33.

    Shlim DR, 2005. Looking for evidence that personal hygiene precautions prevent traveler's diarrhea. Clin Infect Dis 41: 531535.

 
 
 
 
 
 
 
 

 

 

 

 

Gastrointestinal Illnesses among French Forces Deployed to Djibouti: French Military Health Surveillance, 2005–2009

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  • Direction Interarmées du Service de Santé des Forces Françaises, Djibouti, Djibouti; Département d'Épidémiologie et de Santé Publique Sud, Institut de Médecine Tropicale du Service de Santé des Armées, Marseille, France; Programme des Maladies Infectieuses, Ministère de la Santé, Djibouti, Djibouti; Armed Forces Health Surveillance Center, Silver Spring, Maryland; Laboratoire de Biologie Médicale, Hôpital Médico-Chirurgical Bouffard, Djibouti, Djibouti

Despite an increase in foreign tourism and in the numbers of foreign military personnel deployed to Djibouti, little is known about the risk of gastrointestinal illness in this country in eastern Africa. To assess risk and to describe common features of gastrointestinal illnesses, reports of illness derived from military health surveillance data collected during 2005–2009 among French service members deployed to Djibouti were reviewed. Diarrhea was the most common problem; it had an annual incidence ranging from 260 to 349 cases per 1,000 person-years. The risk was higher among soldiers deployed short-term (four months) than among soldiers deployed long-term (two years). This five-year review of French health surveillance data documents a significant burden of diarrhea among French soldiers in Djibouti. The identification of factors associated with risk may permit efficient targeting of interventions to reduce morbidity from gastrointestinal illness.

Author Notes

*Address correspondence to Lénaïck Ollivier, Direction Interarmées du Service de Santé des Forces Françaises, SP 85002, 00812 Armées, Djibouti, Djibouti. E-mail: lenaickollivier@hotmail.com

Financial support: This study was supported by the French Medical Forces.

Authors' addresses: Lénaïck Ollivier and Olivier Romand, Direction Interarmées du Service de Santé des Forces Françaises, SP 85002, 00812 Armées, Djibouti, Djibouti, E-mails: lenaickollivier@hotmail.com and olivier_romand@intnet.dj. Christophe Decam, Vincent Pommier de Santi, Aïssata Dia, Xavier Deparis, and Jean-Paul Boutin, Institut de Médecine Tropicale du Service de Santé des Armées, Allée du Médecin Colonel Jamot, Parc du Pharo, BP60109, 13262 Marseille Cedex 07, France, E-mails: christophe.2km@netcourrier.com, pommierdesantiv@imtssa.fr, aissdia@orange.fr, xavier.deparis@wanadoo.fr, and jeanpaul.boutin@free.fr. Houssein Y. Darar, Hôpital Général Peltier, Avenue Maréchal Joffre, BP 123, Djibouti, Djibouti, E-mail: yhoussein@yahoo.fr. Remington L. Nevin, Armed Forces Health Surveillance Center, Silver Spring, MD, E-mail: remington.nevin@us.army.mil. Jacques Bougère, HMC Bouffard SP 85024, 00812 Armées, Djibouti, Djibouti, E-mail: jacquesbougere@yahoo.fr.

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