Title
A Multisite Network Assessment of the Epidemiology and Etiology of Acquired Diarrhea among U.S. Military and Western Travelers (Global Travelers’ Diarrhea Study): A Principal Role of Norovirus among Travelers with Gastrointestinal Illness
Date Issued
01 November 2020
Access level
open access
Resource Type
journal article
Author(s)
Ashbaugh H.R.
Early J.M.
Johnson M.E.
Simons M.P.
Riddle M.S.
Swierczewski B.E.
Centro de Investigación de Salud Naval
Publisher(s)
American Society of Tropical Medicine and Hygiene
Abstract
U.S. military personnel must be ready to deploy to locations worldwide, including environments with heightened risk of infectious disease. Diarrheal illnesses continue to be among the most significant infectious disease threats to operational capability. To better prevent, detect, and respond to these threats and improve synchronization across the Department of Defense (DoD) overseas laboratory network, a multisite Global Travelers’ Diarrhea protocol was implemented with standardized case definitions and harmonized laboratory methods to identify enteric pathogens. Harmonized laboratory procedures for detection of Norovirus (NoV), enterotoxigenic Escherichia coli (ETEC), enteroaggregative E. coli, Shiga toxin–producing E. coli, enteropathogenic E. coli, Salmonella enterica, Shigella/enteroinvasive E. coli, and Campylobacter jejuni have been implemented at six DoD laboratories with surveillance sites in Egypt, Honduras, Peru, Nepal, Thailand, and Kenya. Samples from individuals traveling from wealthy to poorer countries were collected between June 2012 and May 2018, and of samples with all variables of interest available (n = 410), most participants enrolled were students (46%), tourists (26%), U.S. military personnel (13%), or other unspecified travelers (11%). One or more pathogens were detected in 59% of samples tested. Of samples tested, the most commonly detected pathogens were NoV (24%), ETEC (16%), and C. jejuni (14%), suggesting that NoV plays a larger role in travelers’ diarrhea than has previously been described. Harmonized data collection and methods will ensure identification and characterization of enteric pathogens are consistent across the DoD laboratory network, ultimately resulting in more comparable data for global assessments, preventive measures, and treatment recommendations.
Start page
1855
End page
1863
Volume
103
Issue
5
Language
English
Scopus EID
2-s2.0-85095861657
PubMed ID
Source
American Journal of Tropical Medicine and Hygiene
ISSN of the container
00029637
Source funding
Armed Forces Health Surveillance Branch
Sources of information: Directorio de Producción Científica Scopus