Enteric Diseases Research Group, Royal Centre for Defence Medicine, Birmingham, UK.
Curr Opin Infect Dis. 2012 Oct;25(5):546-54. doi: 10.1097/QCO.0b013e3283582ebc.
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.
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.
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.
在全球冲突和维和活动中部署的军人旅行者中，腹泻仍然是最重要的健康威胁之一。在这里，我们回顾了对这种多病因感染的流行病学、实验室鉴定、治疗和慢性健康后果的最新认识，并考虑了对公共卫生管理和未来研究的影响。
来自工业化国家向欠发达国家部署的军人旅行者中，腹泻的总发病率约为每月 30%，每 100 人月的临床发病率为 5%至 7%。风险似乎在部署早期更高，与卫生条件差和受污染的食物来源有关。由于部署条件艰苦，实验室能力不足，我们对病因的了解仍存在差距；然而，最近在分子特征描述方法方面的进展有望提高我们的检测能力。虽然人们对最佳治疗方法的理解有所提高，但需要做更多的工作将这方面的知识转化为行动，并优化单剂量抗生素治疗方案。最后，这些感染的慢性后果的认识不足正在引起关注，并加强了寻找有效预防策略的必要性。
我们对腹泻流行病学的认识正在提高，但需要进一步研究，以充分说明急性作战相关的健康影响以及慢性持久疾病的影响。改进现场诊断将对这些努力有很大的价值。
