title: Epidemiology of food-borne disease outbreaks in the French armed forces: a review of investigations conducted from 1999 to 2009.
abstract: OBJECTIVE
  Aim of this study was to describe the main characteristics of food-borne disease outbreaks (FBDOs) in the French armed forces from 1999 to 2009.
  
  
  METHODS
  FBDOs are reported to the military epidemiological surveillance system, which concerns all active military personnel. Investigation reports published from 1999 to 2009 were reviewed.
  
  
  RESULTS
  Among the 180 FBDOs reported, 48.3% occurred overseas. The mean reporting rate was 2.4 outbreaks p.100,000 in France and 26.7 p.100,000 overseas, reaching to 39.3 p.100,000 in Africa. Digestive symptoms were predominant among cases. Laboratory analyses on cases were positive in 29.4% of FBDOs. The most frequently isolated agents were shigella (15.4%). Laboratory analyses on food samples were positive in 18.9% of outbreaks, the most frequently isolated agent being Clostridium perfringens (15.7%). Only 7 FBDOs were documented by concordant analyses in both patients and food samples.
  
  
  CONCLUSIONS
  The reporting rate was much higher among military deployed overseas, which can be the consequence of a lack of hygiene due to operational imperatives and the consumption of local food which does not meet safety standards. In operational settings, laboratory evidence may be difficult to obtain and a timely epidemiological investigation in some cases proves valuable to identify the likely vehicle of infection and to guide targeted intervention measures.
authors.affiliation: Centre d'épidémiologie et de santé publique des armées, Hôpital Bégin, Saint Mandé, France. aurelie_marie@hotmail.fr
authors.forename: A
authors.initials: A
authors.lastname: Mayet
authors.forename: G
authors.initials: G
authors.lastname: Manet
authors.forename: C
authors.initials: C
authors.lastname: Decam
authors.forename: D
authors.initials: D
authors.lastname: Morisson
authors.forename: G
authors.initials: G
authors.lastname: Bédubourg
authors.forename: V
authors.initials: V
authors.lastname: Pommier de Santi
authors.forename: J-B
authors.initials: JB
authors.lastname: Meynard
authors.forename: G
authors.initials: G
authors.lastname: Bornert
authors.forename: X
authors.initials: X
authors.lastname: Deparis
authors.forename: R
authors.initials: R
authors.lastname: Migliani
mesh_terms: D003016:Clostridium perfringens / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology*; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008889:Military Personnel; D011159:Population Surveillance; D012189:Retrospective Studies; D012760:Shigella / Q000302:isolation & purification*