Quantifying the incidence and burden of postinfectious enteric sequelae

Background: Evidence continues to reveal that travelers' diarrhea (TD) may be associated with several chronic conditions. We quantified the burden of these TD sequelae (TDS) and compared it to post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI), both well-appreciated long-term health outcomes (LTHO) of deployment. Methods: A systematic review of outcome-specific incidence and disability was conducted to estimate years lived with disability (YLDs) allowing for comparisons of disease burden across outcomes. Results: Estimates varied within outcomes across publication year, study design, and data source. YLD estimates showed that although PTSD results in the highest overall disability (1,225 per 100,000), the impact of TDS is similarly elevated with the greatest burden associated with irritable bowel syndrome (627 per 100,000) followed by reactive arthritis (139). Conclusion: Given the significant impact of the acute effects of TD on troop readiness and the growing appreciation for its LTHO, the need for improved primary prevention strategies are evident. Additional study of the pathogen-specific risk of these sequelae and duration and level of disability are needed to further refine our understanding of morbidity and inform evidence-based decisions on policy toward disease mitigation among those put in harm's way.