Copyright © 2015 by The American Society of Tropical Medicine and Hygiene Review Article: Gastrointestinal Infections in Deployed Forces in the Middle East Theater: An Historical 60 Year Perspective

Abstract. Infectious diarrhea has been among the most common maladies of military deployments throughout time. The U.S. military experienced a significant burden from this disease in the middle eastern and north African campaigns of World War II (WWII). This article compares patterns of disease experienced in WWII with the recent military deployments to the same region for Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF). Remark-able similarities in the prevalence and risk factors were noted, which belie the assumed improvements in prevention against these infections. In both campaigns, peaks of diarrhea occurred shortly after arrival of new personnel, which were seasonally associated and were linked to initial lapses in field sanitation and hygiene. It is important to reassess current strategies, especially, in light of emerging evidence of the chronic sequelae of these common infections to include a reemphasis on or reexamination of vaccine development, rapid field diagnostics, treatment algorithms, and antimicrobial prophylaxis. PROLOGUE In 1941, U.S. forces entered World War II (WWII) and joined the allied efforts in the Middle East with the mission to provide logistical support in north Africa and the Persian Corridor. These missions reached peak troop strengths of about 65,000 personnel in 1943. In addition, force totals were augmented by about 25,000 personnel in the Ninth Air Force, which was responsible for missions in Libya, Tunisia