Military importance of diarrhea: Lessons from the Middle East

Purpose of review: Historically, diarrhea has been one of the most important diseases encountered during military operations. With more than 140,000 US military personnel currently deployed to the Middle East in support of the global war on terror, it is important for health care providers and planners to be aware of the incidence and potential impact of diarrheal disease in that region. Recent findings: Recently published data from mid-deployment surveys assessing the incidence and clinical impact of diarrhea on troops deployed to Iraq and Afghanistan have been updated and presented along with a review of the recent literature concerning diarrheal pathogens of military concern in the Middle East. Of 4348 volunteers, 76% reported at least one diarrhea episode during their deployment and more than half reported multiple episodes. In 45% of subjects, diarrhea resulted in decreased job performance for a median of 3 days. Diarrhea resulted in 62% of subjects seeking medical care at least once, and 31% required intravenous rehydration. In 17% of subjects, diarrhea resulted in confinement to bed for a median of 2 days, causing an estimated 3.7 days (Poisson 95% CI, 3.4 to 4.0 days) of complete work loss per 100 person-months. Summary: Despite modern preventive medicine efforts, diarrhea rates remain high, and the impact of illness remains a threat to military efficiency. Novel enteric disease research programs designed to decrease the impact of diarrhea on the military mission are needed. The development of enteric vaccines and appropriate treatment regimens remain a top priority.