AFMIC SPECIAL WEEKLY WIRE 1-91B (U)

File: 970613_ww1_91b_91_txt_0001.txt
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[b.2.]




SUBJECT:  AFMIC SPECIAL WEEKLY WIRE 1-91B (U)

1. (U) THIS SPECIAL WEEKLY WIRE REPORTS RECENT U.S. MEDICAL
SURVEILLANCE DATA FROM OPERATION DESERT SHIELD AND DISCUSSES THE
IMPORTANT EPIDEMIOLOGICAL FACTORS ASSOCIATED WITH DISEASE
OCCURRENCE IN U.S. MILITARY PERSONNEL SINCE THE BEGINNING OF THE
DEPLOYMENT. CLINICAL, MEDICAL, TECHNICAL, OPERATIONAL INPUT AND
REVIEW PROVIDED BY AFMIC SURGEON [b.6.]

2.     U.S. MEDICAL SURVEILLANCE REPORTS FOR OPERATION DESERT
SHIELD
INDICATE THAT WEEKLY THEATER OUTPATIENT DISEASE AND NON-BATTLE
INJURY
CDNBI) RATES FROM 11 NOV TO 22 DEC 90 HAVE RANGED FROM 72.9 TO
88.6/1000. THE RATES REPRESENT COVERAGE OF APPROXIMATELY
ONE-QUARTER OF U.S. FORCES IN THE AOR. (DATA WAS RECEIVED FROM
CENTAF
AND NAVCENT/MARCENT DURING THE REPORTING PERIOD.) NINE DIAGNOSTIC
CATEGORIES WERE REPORTED (RATE RANGES PER 1000): HEAT/COLD INJURIES
(0.15 - 0.2); GASTROINTESTINAL (4.9 - 8.5). RESPIRATORY (11.6 -
15.8); DERMATOLOGICAL (7.6 - 10.6); OPHTHALMIC (2.0 - 8.4).
PSYCHIATRIC (1.3 - 2.8); ORTHOPEDIC/SURGICAL INJURIES (6.9 - 14.2);
MEDICAL (2.7 - 4.8); AND MISCELLANEOUS (22.9 - 34.4). THESE CRUDE
RATES CAN BE IMPORTANT FOR MEDICAL PERSONNEL PLANNING DNBI CASUALTY
RATES. INFECTIOUS DISEASE OCCURRENCE HAS CONFORMED TO PREVIOUS
ASSESSMENTS PROVIDED IN AFMIC'S DESERT SHIELD PRODUCTS.
3.     HEAT INJURIES CONSISTENTLY HAVE BEEN LOWER THAN EXPECTED
DURING THE DEPLOYMENT AND CAN BE ATTRIBUTED TO COMMAND EMPHASIS AND
EXCELLENT TROOP DISCIPLINE CONCERNING WORK SCHEDULES AND WATER
CONSUMPTION.
4.     GASTROINTESTINAL (DIARRHEA) RATES WERE HIGHER DURING THE
INITIAL PHASES OF THE DEPLOYMENT. FACTORS IMPLICATED IN FOODBORNE
DISEASE OUTBREAKS INCLUDED USE OF LOCALLY PROCURED FOODS
(PARTICULARLY LETTUCE AND ICE) FROM NON-APPROVED SOURCES, THE LACK
OF
ADEQUATE HANDWASHING FACILITIES, USE OF HOST COUNTRY CONTRACT
FEEDING
FACILITIES, IMPROPER FOOD HANDLING PRACTICES, AND USE OF LOCAL FOOD
ESTABLISHMENTS OR STREET VENDORS. MOST DIARRHEAS ARE OF UNKNOWN
ETIOLOGY, BUT THE MAJORITY OF CASES HAVE HAD SYMPTOMS COMPATIBLE
WITH
TRAVELER'S DIARRHEA. THE MOST COMMON AGENTS ISOLATED (IN DESCENDING
ORDER) HAVE BEEN ENTEROTOXIGENIC ESCHERICHIA COLI (ETEC), SHIGELLA
SPP., AND SALMONELLA SPP. OVER 30 PERCENT OF ALL THREE BACTERIAL
SPECIES ISOLATED DEMONSTRATED SIGNIFICANT RESISTANCE TO
TRIMETHAPRIM/SULFA AND TETRACYCLINES. ALL REPORTED ISOLATES HAVE
BEEN
SENSITIVE TO CIPROFLOXACIN AND NORFLOXACIN. TWO DIARRHEAL DISEASE
OUTBREAKS RECENTLY WERE REPORTED. THE FIRST INVOLVED 23 PERSONNEL
AND
THE IMPLICATED FOOD WAS A CUSTARD FILLED CAKE; STAPHYLOCOCCUS
AUREUS
AND BACILLUS CEREUS WERE ISOLATED FROM THE CAKE. THE SECOND
INVOLVED
79 PERSONNEL, ALL WERE HOSPITALIZED; SALMONELLA GROUP D SPECIES
WERE
ISOLATED FROM 41 OF 48 STOOL CULTURES. THE IMPLICATED FOOD WAS
UNDERCOOKED SCRAMBLED EGGS. NO ADDITIONAL EPIDEMIOLOGIC INFORMATION
ON THE TWO OUTBREAKS WAS PROVIDED. ACUTE DIARRHEAL DISEASES,
PRINCIPALLY OF BACTERIAL ETIOLOGY, WILL CONTINUE TO BE AN IMPORTANT
CAUSE OF MORBIDITY AFFECTING OPERATIONAL READINESS OF MILITARY
PERSONNEL IN THE AOR. ADDITIONALLY, TWO CASES OF HEPATITIS A WERE
DIAGNOSED IN BRITISH TROOPS IN THE AOR. THESE TROOPS HAVE BEEN
EATING
SOME MEALS ON THE LOCAL ECONOMY. THE REPORT DID NOT STATE IF THE
CASES HAD RECEIVED IMMUNE SERUM GLOBULIN.
5.     ACUTE RESPIRATORY ILLNESSES HAVE BEEN COMMON, BUT NOT A
SIGNIFICANT PROBLEM AFFECTING READINESS, AND HAVE BEEN ASSOCIATED
WITH CROWDED LIVING CONDITIONS, DUSTY ENVIRONMENTS, AND LACK OF
ADEQUATE HANDWASHING FACILITIES. INFLUENZA INCIDENCE CAN BE
EXPECTED
TO INCREASE IN WINTER MONTHS.
6.     RELATIVELY HIGH RATES OF DERMATOLOGICAL CASES (HEAT RASH AND
FUNGAL DERMATITIS), MOSTLY OF A MINOR NATURE, ARE ATTRIBUTED TO THE
HOT, HUMID, DIRTY CONDITIONS.
7.     ORTHOPEDIC/SURGICAL CASES MOSTLY HAVE RESULTED FROM INJURIES
TO EXTREMITIES AND EXACERBATION OF EXISTING PROBLEMS, AND HAVE BEEN
A
COMMON (AS HIGH AS 40 PERCENT) CAUSE OF HOSPITAL ADMISSION.
8.     NO SIGNIFICANT UNEXPLAINED FEBRILE ILLNESSES ATTRIBUTABLE TO
SANDFLY, WEST NILE, OR SINDBIS FEVER(S) HAVE BEEN REPORTED. ONE
SEROLOGICALLY CONFIRMED CASE OF WEST NILE FEVER HAS BEEN REPORTED.
A
FEW LEISHMANIASIS CASES HAVE BEEN REPORTED IN SOLDIERS APPARENTLY
STATIONED IN EASTERN SAUDI ARABIA: ONE CONFIRMED CUTANEOUS
LEISHMANIASIS DUE TO LEISHMANIA TROPICA: APPROXIMATELY EIGHT RECENT
PRESUMPTIVE CUTANEOUS CASES; AND ONE CONFIRMED VISCERAL
LEISHMANIASIS
DUE TO L. DONOVANI. ADDITIONAL CLINICAL CASES OF LEISHMANIASIS,
PARTICULARLY CUTANEOUS FORMS, CAN BE EXPECTED DUE TO THE LONG
INCUBATION PERIOD (1 WEEK TO MANY MONTHS) AND LENGTH OF DEPLOYMENT.
SANDFLY FEVER AND CUTANEOUS LEISHMANIASIS ARE FOCALLY ENDEMIC BUT
WIDELY DISTRIBUTED IN THE REGION, WITH YEAR-ROUND TRANSMISSION.
HOWEVER, THE ABSENCE OF SANDFLY FEVER CASES AND FEW CUTANEOUS
LEISHMANIASIS CASES CAN BE ATTRIBUTED TO DEPLOYMENT NEAR THE END OF
THE PEAK TRANSMISSION SEASON (MARCH - SEPTEMBER), UNITS NOT
BIVOUACKING IN ENDEMIC FOCI, VECTOR SURVEILLANCE, AND HIGH
COMPLIANCE
WITH RECOMMENDATIONS FOR REPELLENT USE AND WEAR OF CLOTHING. RISK
FROM SANDFLY FEVER CAND OTHER ARBOVIRAL FEVERS) AND LEISHMANIASIS
WILL BE SIGNIFICANTLY GREATER DURING THE SPRING AND SUMMER OF 1991.
9.     FIELD SANITATION CONTINUES TO IMPROVE AND MANY OF THE
EARLY DEFICIENCIES HAVE BEEN CORRECTED. HOWEVER, GOOD PREVENTIVE
MEDICINE, TROOP DISCIPLINE, DISEASE SURVEILLANCE, AND COMMAND
EMPHASIS AT ALL LEVELS WILL CONTINUE TO BE IMPORTANT FOR LIMITING
THE
INFECTIOUS DISEASE THREAT. [b.6.]?