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Hotel Clinic-Based Diarrheal and Respiratory Disease Surveillance in U.S. Service Members Participating in Operation Bright Star in Egypt, 2009

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  • United States Naval Medical Research Unit Number 3, Cairo, Egypt; United States Special Operations Command, MacDill Air Force Base, Florida; Naval Medical Research Center, Silver Spring, Maryland; Navy Environmental Preventive Medicine Unit 6, Joint Base Pearl Harbor Hickam, Hawaii

We conducted clinic-based, influenza-like illness and diarrheal disease surveillance among U.S. service members participating in Operation Bright Star 2009. Epidemiologic data and samples were collected. Nasopharyngeal swab specimens were tested for viruses, and feces was tested for microbiologic, immunologic, and molecular diagnostics. A survey was used to collect self-reported data. From 1,529 surveys, 41% reported diarrheal disease and 25% reported respiratory illness (incidence rate = 62 of 100 versus 37 of 100 person-months; incidence rate ratio = 1.7, 95% confidence interval = 1.5–1.9). Enterotoxigenic Escherichia coli was identified in 74% (69 of 93) of fecal samples. In the influenza-like illness case series, 17% (9 of 52) were positive for influenza A; all were positive for pandemic (pH1N1) 2009 virus. Rates of decreased work performance reported by patients with diarrhea and influenza-like illness were similar (46% versus 48%; P = 0.8). Diarrheal diseases and respiratory illness remain common among deployed military personnel, with important operational impact. Despite an ongoing influenza pandemic, diarrheal disease incidence was higher than that of respiratory illness.

Author Notes

*Address correspondence to Peter J. Sebeny, US Naval Medical Research Center, Infectious Diseases Directorate, 3A34, 503 Robert Grant Ave., Silver Spring, MD 20910-7500. E-mails: Peter.Sebeny@med.navy.mil or sebeny@comcast.net

Financial support: This study was supported by AFHSC, GEIS OPS, work unit # “GS-47”, and the study protocol NAMRU3.2005.0012 (IRB No.181) was supported under work unit number 847705.82000.25GB.E0018.

Authors' addresses: Peter J. Sebeny, Isabelle Nakhla, Manal Moustafa, Hanan El-Mohammady, Rania A. Nada, and Salwa F. Ahmed, U.S. Naval Medical Research Unit #3, E-mails: peter.sebeny@med.navy.mil, isabelle.nakhla.eg@med.navy.mil, manal.moustafa.eg@med.navy.mil, hanan.elmohammady.eg@med.navy.mil, raniaabdelkhalek.eg@med.navy.mil, and salwa.fouad.eg@med.navy.mil. Jody A. Bruton, Angie, LA, E-mail: jodybruton@hotmail.com. Joanne Cline, U.S. Special Operations Command, Office of the Command Surgeon, E-mail: joanne.cline@socom.mil. Douglas Hawk and Guillermo Pimentel, Naval Medical Research Center, Silver Spring, MD, E-mails: douglas.hawk@med.navy.mil and guillermo.pimentel@med.navy.mil. Sylvia Y. N. Young, Navy Environmental Preventive Medicine Unit 6, HI, E-mail: sylvia.young@med.navy.mil.

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