TY - JOUR
T1 - A Multisite Network Assessment of the Epidemiology and Etiology of Acquired Diarrhea among U.S. Military and Western Travelers (Global Travelers’ Diarrhea Study)
T2 - A Principal Role of Norovirus among Travelers with Gastrointestinal Illness
AU - GTD Study Team
AU - Ashbaugh, Hayley R.
AU - Early, June M.
AU - Johnson, Myles E.
AU - Simons, Mark P.
AU - Graf, Paul C.F.
AU - Riddle, Mark S.
AU - Swierczewski, Brett E.
N1 - Funding Information:
Financial support: This study was supported by the Armed Forces Health Surveillance Division (AFHSD) and its Global Emerging Infectious Disease Surveillance (GEIS) section (grant nos P0137_19_SD and P0148_20_SD).
Funding Information:
The GTD study could not have been completed without the dedication of a team of laboratory support personnel and other study staff. Global Travelers? Diarrhea Study team members included the following: Chris Myers, Reza Zeighami, Melissa Anderson, Shannon Putnam, Ramona McCaffrey, Krista Brooks, Melinda Balansay-Ames, Ladaporn Bodhidatta, Prativa Pandey, Paphavee Lertsethtakarn-Ketwallah, Sanjaya Shrestha, Jamal Dejli, Kimberly Edgel, Michael Gregory, Joey Garcia, Andrea McCoy, James Regeimbal, Giselle Soto, Marita Silva, Yeny Tinoco, Faviola Reyes, Maruja Bernal, Rina Meza, Paul Rios, Miguel Cabada, Drake H. Tilley, Maria Luisa Morales, Erick C. Kipkirui, Mary C. Kirui, Cliff O. Philip, Janet N. Ndonye, Nancy C. Kipkemoi, Ronald K. Kirera, Abigael N. Ombogo, Margaret Koech, Elizabeth A. Odundo, Christine Hulseberg, Stacey Bateman, Alex Flynn, Michael Washington, Nabil Latif, and Nino Akhvlediani. This study was supported by the Armed Forces Health Surveillance Division (AFHSD) and its Global Emerging Infectious Disease Surveillance (GEIS) section (grant nos P0137_19_SD and P0148_20_SD).
Publisher Copyright:
Copyright © 2020 by The American Society of Tropical Medicine and Hygiene
PY - 2020/11
Y1 - 2020/11
N2 - U.S. military personnel must be ready to deploy to locations worldwide, including environments with heightened risk of infectious disease. Diarrheal illnesses continue to be among the most significant infectious disease threats to operational capability. To better prevent, detect, and respond to these threats and improve synchronization across the Department of Defense (DoD) overseas laboratory network, a multisite Global Travelers’ Diarrhea protocol was implemented with standardized case definitions and harmonized laboratory methods to identify enteric pathogens. Harmonized laboratory procedures for detection of Norovirus (NoV), enterotoxigenic Escherichia coli (ETEC), enteroaggregative E. coli, Shiga toxin–producing E. coli, enteropathogenic E. coli, Salmonella enterica, Shigella/enteroinvasive E. coli, and Campylobacter jejuni have been implemented at six DoD laboratories with surveillance sites in Egypt, Honduras, Peru, Nepal, Thailand, and Kenya. Samples from individuals traveling from wealthy to poorer countries were collected between June 2012 and May 2018, and of samples with all variables of interest available (n = 410), most participants enrolled were students (46%), tourists (26%), U.S. military personnel (13%), or other unspecified travelers (11%). One or more pathogens were detected in 59% of samples tested. Of samples tested, the most commonly detected pathogens were NoV (24%), ETEC (16%), and C. jejuni (14%), suggesting that NoV plays a larger role in travelers’ diarrhea than has previously been described. Harmonized data collection and methods will ensure identification and characterization of enteric pathogens are consistent across the DoD laboratory network, ultimately resulting in more comparable data for global assessments, preventive measures, and treatment recommendations.
AB - U.S. military personnel must be ready to deploy to locations worldwide, including environments with heightened risk of infectious disease. Diarrheal illnesses continue to be among the most significant infectious disease threats to operational capability. To better prevent, detect, and respond to these threats and improve synchronization across the Department of Defense (DoD) overseas laboratory network, a multisite Global Travelers’ Diarrhea protocol was implemented with standardized case definitions and harmonized laboratory methods to identify enteric pathogens. Harmonized laboratory procedures for detection of Norovirus (NoV), enterotoxigenic Escherichia coli (ETEC), enteroaggregative E. coli, Shiga toxin–producing E. coli, enteropathogenic E. coli, Salmonella enterica, Shigella/enteroinvasive E. coli, and Campylobacter jejuni have been implemented at six DoD laboratories with surveillance sites in Egypt, Honduras, Peru, Nepal, Thailand, and Kenya. Samples from individuals traveling from wealthy to poorer countries were collected between June 2012 and May 2018, and of samples with all variables of interest available (n = 410), most participants enrolled were students (46%), tourists (26%), U.S. military personnel (13%), or other unspecified travelers (11%). One or more pathogens were detected in 59% of samples tested. Of samples tested, the most commonly detected pathogens were NoV (24%), ETEC (16%), and C. jejuni (14%), suggesting that NoV plays a larger role in travelers’ diarrhea than has previously been described. Harmonized data collection and methods will ensure identification and characterization of enteric pathogens are consistent across the DoD laboratory network, ultimately resulting in more comparable data for global assessments, preventive measures, and treatment recommendations.
UR - http://www.scopus.com/inward/record.url?scp=85095861657&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.20-0053
DO - 10.4269/ajtmh.20-0053
M3 - Article
C2 - 32959765
AN - SCOPUS:85095861657
SN - 0002-9637
VL - 103
SP - 1855
EP - 1863
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 5
ER -