Goal

To provide actionable information to military personnel and related populations by identifying circulating diarrheal pathogens.

Importance of Enteric Surveillance

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Given the current political instabilities in many parts of the world, U.S. military personnel must be ready to deploy to austere environments or underdeveloped regions where the risk of exposure to infectious diseases may be significant and where routine preventive health efforts are often impractical. Throughout history, acute diarrheal illness has played a significant role in the outcomes of military campaigns. Despite advances in environmental health interventions and empiric treatment regimens, the high incidence and burden associated with enteric infections persist. To this day, acute diarrheal illness is a significant health threat for deployed military personnel, resulting in not only significant numbers of lost duty days, but also in increased healthcare utilization, which compromises operational readiness and effectiveness. Surveillance and epidemiologic research increase important knowledge about the pathogen-specific burden of disease. In addition, this research supports the establishment of field sites for interventional studies in military and host-national populations, which helps prevent and mitigate disease in our military and allied troops.

Strategy

The GEIS enterics partner network provides actionable information by conducting studies that:

• Estimate prevalence of common enteric pathogens in U.S. military populations, adult travelers, and military and civilian populations of partner nations
• Evaluate the epidemiologic characteristics of gastrointestinal illness and operational impact
• Monitor antimicrobial susceptibility of common enteric pathogens
• Improve laboratory surveillance capabilities for enterics during military exercises and deployments
• Conduct advanced molecular characterization to identify novel and emerging enteric pathogens

Activities

Surveillance in globally based U.S. military and traveler populations: 

A case-surveillance study among U.S. military and similar civilian populations (e.g., adult Western travelers) is being coordinated across six U.S. military overseas laboratories. This study utilizes standard case-selection and diagnostic testing to characterize enteric disease and its severity in important geographic regions and populations of interest. These data can inform potential geographic threats that may be encountered by deploying military personnel.

Surveillance in Contiguous United States (CONUS)-based U.S. military populations: 

Through the Naval Health Research Center based in San Diego, clinic-based surveillance is conducted in U.S. military recruits to determine the prevalence, incidence, and burden of acute gastroenteritis among operational forces. This activity provides a better understanding of the epidemiology of circulating enteric bacteria and viruses.

Surveillance in host-country military and civilian populations:

Each of the Department of Defense overseas laboratories have established surveillance within host-country military and civilian populations, providing data on the etiology and antibiotic resistance characteristics for the common causes of diarrhea in local populations. These data are shared with local hospitals and appropriate government institutions (e.g., Ministry of Health) to provide timely and accurate information about the endemic and emerging enteric pathogens circulating in their countries.