Preface

Veterans of the Persian Gulf War report a variety of physical and psychological symptoms, some of which remain unexplained. In an effort to determine the extent to which these symptoms may be related to Gulf War service and to develop policies to better deal with health risks in future deployments, the Secretary of Defense designated a special assistant to oversee all Department of Defense (DoD) efforts related to the illnesses of Gulf War veterans. The Office of the Special Assistant for Gulf War Illnesses (OSAGWI) is charged to do everything possible to understand and explain the illnesses, to inform veterans and the public of its progress and findings, and to recommend changes in DoD policies and procedures to minimize such problems in the future.

This literature review, one of eight commissioned by the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, examines the existing scientific literature on what is known about the health effects of infectious diseases that may have affected service members who served in Operations Desert Shield and Desert Storm. The eight RAND reviews are intended to complement efforts by the DoD and other federal agencies as they attempt to understand the full range of health implications of service in that conflict.

The other seven RAND literature reviews deal with chemical and biological warfare agents, depleted uranium, oil well fires, pesticides, pyridostigmine bromide, immunizations, and stress. These represent plausible causes of some of the illnesses Gulf War veterans have reported.

These reviews are intended principally to summarize the scientific literature on the known health effects of given exposures to these risk factors. Where available evidence permits, the other seven reviews also summarize what is known about the range of actual exposures in the Gulf and assess the plausibility of the risk factor at hand as a cause of illness. Statements related to the Gulf War experience should be regarded as suggestive rather than definitive, for more research on health effects and exposures remains to be completed before definitive statements can be made. Recommendations for additional research where appropriate are included.

These reviews are limited to literature published or accepted for publication in peer-reviewed journals, books, government publications, and conference proceedings. Unpublished information was occasionally used, but only to develop hypotheses. This review covers literature published before the spring of 1999 but in some cases includes additional references primarily as a result of the peer-review process.

This work is sponsored by the Office of the Special Assistant and was carried out jointly by RAND Health�s Center for Military Health Policy Research and the Forces and Resources Policy Center of the National Defense Research Institute. The latter is a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the unified commands, and the defense agencies.

Contents