Prospective Cohort Studies of Shigellosis During Military Field Training

Cohen, Dani; Sela, Tamar; Slepon, Raphael; Yavzori, Miri; Ambar, Ruhama; Orr, Nadav; Robin, Guy; Shpielberg, O.; Eldad, Arieh; Green, M.

doi:10.1007/s100960000428

Cited by 23 publications

(22 citation statements)

References 12 publications

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“…Nine studies reported a median probability of 27% (range, 3-56%) that a person with diarrhea would be placed sick-in-quarters (SIQ) or be incapacitated because of the illness. 7,[31][32][33][34][35][36][37][38] Four studies reported the probability of requiring intravenous hydration ranging from 0% to 18%. 31,[37][38][39] Two studies (from the same reference) reported provider estimates of the probability of hospitalization caused by diarrhea among those seeking treatment to be between 10% and 13%.…”

Section: Resultsmentioning

confidence: 99%

Incidence, Etiology, and Impact of Diarrhea Among Long-Term Travelers (Us Military and Similar Populations): A Systematic Review

Riddle

Sanders

Putnam

et al. 2006

The American Journal of Tropical Medicine and Hygiene

163

102

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To determine regional estimates of pathogen-specific prevalence and incidence, as well as, describe morbidity associated with diarrhea among deployed US military and similar populations, a systematic review was conducted for publications between January 1990 to June 2005. Point estimates and confidence intervals of pathogen prevalence and travelers' diarrhea incidence were combined in a random effects model and assessed for heterogeneity. In total, 262 studies were identified for potential inclusion, of which 52 fulfilled inclusion criteria. Overall, 38% were from the Middle East, 29% from Southeast Asia, 27% from Latin America/Caribbean, and 6% from sub-Saharan Africa. Median duration of travel was 1.5 months (interquartile range, 1-3 months). Enterotoxigenic Escherichia coli (ETEC), Campylobacter, and Shigella were identified as causing 38-45% of diarrhea, with regional and population differences. Incidence based on self-report was higher than studies using passive surveillance or clinic-based methods (29 versus 7 versus 6 episodes per 100 person-months, respectively) without regional differences.

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Section: Resultsmentioning

confidence: 99%

Incidence, Etiology, and Impact of Diarrhea Among Long-Term Travelers (Us Military and Similar Populations): A Systematic Review

Riddle

Sanders

Putnam

et al. 2006

The American Journal of Tropical Medicine and Hygiene

163

102

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“…We should enhance the basic clinical and preventive researches on diarrhea to guarantee fighting capacity. Moreover, we detected a relatively high rate of vibrio, especially that of plesiomonas shigelloides which was 16.5%, at the second place [36] . This may be correlated with training at coastal area as water, food, and articles for daily use contain high counts of such pathogens (results not shown).…”

Section: Discussionmentioning

confidence: 90%

Acute diarrhea during army field exercise in southern China

Bai

Dai²,

Li³

et al. 2004

WJG

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AIM: During emergency period, infectious diseases can be a major threat to military forces. During field training in southern China, diarrhea is the main cause of nonbattle injury. To evaluate the causes of and risk factors for diarrhea in emergency period, we collected clinical and epidemiological data from the People's Liberation Army (PLA) during field training in southern China. METHODS:From September 25 to October 2 1997, 2636 military personnel were investigated. Fecal sample cultures for lapactic pathogens were obtained from 103 military personnel with diarrhea. In addition, a questionnaire was administered to 103 cases and 206 controls to evaluate the association between illness and potential risk factors. At the same time, another questionnaire of 1:4 case-case control was administered to 22 severe cases (each severe case paired 4 mild cases). RESULTS:The training troop's diarrhea incidence rate was significantly higher than that of garrison. The diarrhea incidence rate of officers was significantly lower than that of soldiers. A lapactic pathogen was identified in 63.1% (65/103) of the troops with diarrhea. Enterotoxigenic Escherichia coli (35.0%) and plesiomona shigelloides (16.5%) were the most common bacterial pathogens. All bacterial isolates were sensitive to norfloxacin and ceftazidine. However, almost all of them were resistant to sulfamethoxazole, trimethoprim-sulfamethoxazole, oxytetracycline, doxycycline, furazolidone, ampicillin and cloromycetin to a different degree. Risk factors associated with diarrhea included drinking raw water, eating outside, contacting diarrhea patients, lacking sanitation, depression, lacking sleep, which were established by multiple-factor logistic regression analysis. In addition, the unit incidence rate was associated with the density of flies and the average daily boiled water available by regression and discriminate analysis. CONCLUSION:A series of risk factors are associated with the incidence rate of diarrhea. Our results may provide a useful basis for prevention and cure of diarrhea in emergency period of PLA.

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“…A very large range in rotavirus prevalence was found in gastrointestinal cases, from 0.2% in England to 82.4% (children) in Melbourne. Military personnel in Israel experienced gastrointestinal discomfort caused by several types of infections, but many soldiers remained on duty; 15 to 32% of the soldiers were infected with ETEC, up to 20% were infected with Shigella, and 16% were infected with Giardia (35). Cryptosporidium infection in Iran is related to the health status of the individual and ranges from 4 to 7% for healthy persons to 50% for those who were immunodeficient.…”

Section: Carriage and Shedding Of Pathogens In Ill And Asymptomatic Imentioning

confidence: 99%

Outbreaks Where Food Workers Have Been Implicated in the Spread of Foodborne Disease. Part 4. Infective Doses and Pathogen Carriage

Todd

Greig

Bartleson³

et al. 2008

Journal of Food Protection

120

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In this article, the fourth in a series reviewing the role of food workers in foodborne outbreaks, background information on the presence of enteric pathogens in the community, the numbers of organisms required to initiate an infection, and the length of carriage are presented. Although workers have been implicated in outbreaks, they were not always aware of their infections, either because they were in the prodromic phase before symptoms began or because they were asymptomatic carriers. Pathogens of fecal, nose or throat, and skin origin are most likely to be transmitted by the hands, highlighting the need for effective hand hygiene and other barriers to pathogen contamination, such as no bare hand contact with ready-to-eat food. The pathogens most likely to be transmitted by food workers are norovirus, hepatitis A virus, Salmonella, Shigella, and Staphylococcus aureus. However, other pathogens have been implicated in worker-associated outbreaks or have the potential to be implicated. In this study, the likelihood of pathogen involvement in foodborne outbreaks where infected workers have been implicated was examined, based on infectious dose, carriage rate in the community, duration of illness, and length of pathogen excretion. Infectious dose estimates are based on volunteer studies (mostly early experiments) or data from outbreaks. Although there is considerable uncertainty associated with these data, some pathogens appear to be able to infect at doses as low as 1 to 100 units, including viruses, parasites, and some bacteria. Lengthy postsymptomatic shedding periods and excretion by asymptomatic individuals of many enteric pathogens is an important issue for the hygienic management of food workers.

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Prospective Cohort Studies of Shigellosis During Military Field Training

Cited by 23 publications

References 12 publications

Incidence, Etiology, and Impact of Diarrhea Among Long-Term Travelers (Us Military and Similar Populations): A Systematic Review

Incidence, Etiology, and Impact of Diarrhea Among Long-Term Travelers (Us Military and Similar Populations): A Systematic Review

Acute diarrhea during army field exercise in southern China

Outbreaks Where Food Workers Have Been Implicated in the Spread of Foodborne Disease. Part 4. Infective Doses and Pathogen Carriage

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