The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review

Abstract

Background The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed evidence in the medical and public health literature for the military as a disease vector. Methods We searched 3 electronic databases without temporal restrictions. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub-themes. A content analysis was later performed and frequency distributions for each theme were generated. Results Of 6477 studies, 210 met our inclusion criteria and provided evidence, spanning over two centuries (1810–2020), for the military as a pathogen transmitter, within itself or between it and civilians. Biological mechanisms driving transmission included person-to-person transmission, contaminated food and water, vector-borne, and airborne routes. Contaminated food and/or water were the most common biological transmission route. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high-risk behaviours, and occupation-specific freedom of movement. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Selected social mechanisms, such as employment-related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military. Conclusions This study identified features of the military that pose a significant threat to global health, especially to civilian health in countries with substantial military presence or underdeveloped health systems. While biological transmission mechanisms are shared by other social groups, selected social transmission mechanisms are unique to the military. As an increasingly interconnected world faces the challenges of COVID-19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable global public health policies.

A Single Clinical Case of Leptospirosis in a 70-Year-Old Man During the Military Conflict in Ukraine

“…Despite the well-described cases of infectious disease in military personnel around the world, limited work has been focused on transmission of diseases to civilians during military conflicts. In one of the systematic reviews of the literature, which analyzed 210 articles published from 1810 to 2020, only 17% of the works studied the morbidity of the civilian population (Chaufan et al, 2021 ).…”

Effectiveness of the self-regulation educational program in increasing knowledge about COVID-19 in Peruvian soldiers

“…In this scenario, in Peru, military personnel were in charge of ensuring quarantine; in regions with scarce health personnel, such as the Puno region, they were in charge of verifying the use of masks, social distancing, and promoting the adoption of other COVID-19 prevention measures. However, recent research shows the negligent role of the armed forces, both government officials and military personnel, because they could have been vectors of the transmission of COVID-19 ( 4 - 5 ) . Therefore, it is necessary to develop health interventions to promote the adoption of preventive measures in the among them.…”

Efectividad del Programa educativo de autorregulación en incrementar conocimientos sobre COVID-19 en militares

“…En este escenario, en Perú, el personal militar fue el encargado en garantizar la cuarentena; en las regiones que contaban con escaso personal de salud, como la región Puno, se encargó en verificar el uso de mascarillas, el distanciamiento físico y promover la adopción de otras medidas de prevención de la COVID-19. Sin embargo, investigaciones recientes evidencian el negligente rol de las fuerzas armadas, tanto de funcionarios gubernamentales como del personal militar, debido a que podrían haber sido vectores de la trasmisión de la COVID-19 (4)(5) . Por ello, se requiere desarrollar intervenciones sanitarias para promover la adopción de medidas preventivas en los militares.…”