Diarrheal disease incidence and morbidity among United States personnel during short-term missions overseas

Abstract. Outpatient medical surveillance of U.S. troops was conducted during 11 different overseas missions between 1981 and 1990. In addition, at the end of each of 18 overseas missions during the same period, a sample of troops was queried regarding illnesses and exposures experienced in the preceding time overseas. Diarrhea was among the leading causes of morbidity during all of these short-term missions. Diarrhea incidence rates were found to be highest during summer months, and were higher during missions to Thailand (median 5 25%, range 5 20– 29%), Latin America (median 5 26%, range 5 1–43%), and northeastern Africa and southwest Asia (median 5 19%, range 5, 1–52%). Rates were lowest in troops deployed to the Republic of South Korea (median 5 16%, range 5 8–27%). During April and May 1990, a focused surveillance and questionnaire study was conducted during a five-week, joint U.S.-Thai military training exercise in central Thailand. Among 2,600 U.S. personnel, diarrheal illness was found to be the most common medical problem for troops (estimated cumulative incidence 5 29%). Travel outside of the base of operations and consumption of ice were found to be important risk factors. The 10-year database analyzed for this report is the largest, published summary showing the significant impact of diarrheal diseases on U.S. military forces during short-term deployments to less developed areas. Diarrhea is the most common illness affecting internation-al travelers.1 Annually, 250 million travelers are afflicted b