Acute diarrhea during army field exercise in southern China

Abstract

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.

The 12 Gastrointestinal Pathogens Spectrum of Acute Infectious Diarrhea in a Sentinel Hospital, Shenzhen, China

“…Norovirus infection is responsible for most outbreaks of nonbacterial gastroenteritis (Yan et al, 2003). Shigella sp., V. parahaemolyticus, Salmonella sp., and diarrheagenic Escherichiacoli (DEC) are frequently detected agents associated with acute infectious diarrhea (Huilan et al, 1991; Bai et al, 2004; Qu et al, 2012). C. jejuni is one of the most common causes of gastroenteritis worldwide and its prevalence is particularly high in developed countries (Allos, 2001; Koopmans et al, 2001; Scallan et al, 2011).…”

“…Although these common enteropathogens have been extensively studied in China (Bai et al, 2004; Qu et al, 2012; Li et al, 2014), and the laboratory-based surveillance for acute infectious diarrhea has been established in Shenzhen City since 2007, few comprehensive studies covering a broad range of diarrheal agents have been undertaken. Furthermore, the long-term fluctuation in the frequency of infections with the common gastrointestinal pathogens captured by this surveillance system suggested the etiology of acute infectious diarrhea in this region has changed obviously during the past few years.…”

Plesiomonas shigelloides Revisited

“…O'Ryan et al (87) suggested that the higher incidence of P. shigelloides diarrheal illness in developing countries may also be related to substandard environmental sanitation conditions compared to those of industrialized nations. Support for this concept comes from army field training exercises in China (88), where the lack of personal hygiene and drinking raw water contributed to a high infectivity rate in the military (16.5%). Additionally, another Southeast Asia report described a sizeable reduction in the frequency of stool pathogens among food handlers that occurred after a continuing education program concerning food and personal hygiene was introduced (89).…”

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

“…2 Gastrointestinal diseases have historically resulted in a significant reduction in operational readiness of military personnel, 3,4 and outbreaks of gastrointestinal diseases have continued to afflict military forces despite the provision of safe food and water, education about hygiene, and appropriate waste disposal. [5][6][7][8][9][10][11][12][13] French soldiers have had gastrointestinal diseases while deployed to areas around the world, including Africa. 14,15 In addition to being present in the Djibouti, French soldiers have been stationed for many years in Senegal, the Côte d'Ivoire, the Central African Republic, Gabon, Chad, Mayotte, La Reunion, and until 2008, Cameroon.…”