Accession Number:

AD1038600

Title:

Incidence, Etiology and Risk Factors for Travelers Diarrhea during a Hospital Ship-Based Military Humanitarian Mission: Continuing Promise 2011 (Open Access Publishers Version)

Descriptive Note:

Journal Article

Corporate Author:

NAVAL HEALTH RESEARCH CENTER SAN DIEGO CA SAN DIEGO United States

Report Date:

2016-05-12

Pagination or Media Count:

14.0

Abstract:

Travelers diarrhea TD is the most common ailment affecting travelers, including deployed U.S. military. Continuing Promise 2011 was a 5-month humanitarian assistancedisaster response HADR military and non-governmental organization training mission aboard the hospital ship USNS Comfort, which deployed to Central and South America and the Caribbean between April and September 2011. Enhanced TD surveillance was undertaken during this mission for public health purposes. Passive surveillance clinic visits, active surveillance self-reported questionnaires, and stool samples were collected weekly from shipboard personnel. Descriptive statistics and multivariate-logistic regression methods were used to estimate disease burden and risk factor identification. Two polymerase chain reaction methods on frozen stool were used for microbiological identification. TD was the primary complaint for all clinic visits 20 and the leading cause of lost duties days due to bed rest confinement 62 , though underreported, as the active self-reported incidence was 3.5 times higher than the passive clinic-reported incidence. Vomiting p 0.002, feeling lightheaded or weak p 0.005, and being a food handler p 0.017 were associated with increased odds of lost duty days. Thirty-eight percent of self-reported cases reported some amount of performance impact. Based on the epidemiological curve, country of exercise and liberty appeared to be temporally associated with increased risk. From the weekly self-reported questionnaire risk factor analysis, eating off ship in the prior week was strongly associated adjusted odds ratio OR 2.4, p0.001. Consumption of seafood increased risk aOR 1.7, p 0.03, though consumption of ice appeared protective aOR 0.3, p 0.01. Etiology was bacterial 48 , with enterotoxigenic Escherichia coli as the predominant pathogen 35 . Norovirus was identified as a sole pathogen in 12 , though found as a copathogen in an additional 6 .

Subject Categories:

  • Medicine and Medical Research

Distribution Statement:

APPROVED FOR PUBLIC RELEASE