Diarrhoea during military deployment:  current concepts and future directions.
OBJECTIVE
Diarrhoea among military travellers deployed globally in conflict and peacekeeping activities remains one of the most important health threats. Here we review recent advances in our understanding of the epidemiology, laboratory identification, treatment and chronic health consequences of this multi-cause infection, and consider the implications for public health management and future research.


RESULTS
The incidence of diarrhoea among deployed military personnel from industrialized countries to lesser developed countries is approximately 30% per month overall, with clinical incidence between 5 and 7% per 100 person-months. The risk appears to be higher early during deployment and is associated with poor hygienic conditions and contaminated food sources. Gaps remain in our understanding of the cause, given the lack of laboratory capability in austere conditions of deployment; however, recent advances in molecular methods of characterization hold promise in improving our detection capabilities. While there have been improvements in understanding of best treatments, more work needs to be done in transforming this knowledge into action and optimizing single-dose antibiotic treatment regimens. Finally, the under-recognized burden of chronic consequences of these infections is gaining awareness and reinforces the need to find effective preventive strategies.


CONCLUSIONS
Our understanding of the epidemiology of diarrhoea is improving but further research is needed to fully account for acute operational-focused health impacts as well as the chronic enduring disease impacts. Improved field diagnostics would be of great value to support these efforts.
Enteric Diseases Research Group, Royal Centre for Defence Medicine, Birmingham, UK. pconnor@doctors.org.uk
Patrick
P
Connor
Chad K
CK
Porter
Brett
B
Swierczewski
Mark S
MS
Riddle
D000208:Acute Disease; D002908:Chronic Disease; D003967:Diarrhea / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008887:Military Medicine / Q000379:methods; D008889:Military Personnel; D014195:Travel