Faculty of Health, York University, Toronto, Canada.
Independent Scholar, Oakland, USA.
Glob Health Res Policy. 2021 Dec 10;6(1):48. doi: 10.1186/s41256-021-00232-0.
The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed evidence in the medical and public health literature for the military as a disease vector.
We searched 3 electronic databases without temporal restrictions. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub-themes. A content analysis was later performed and frequency distributions for each theme were generated.
Of 6477 studies, 210 met our inclusion criteria and provided evidence, spanning over two centuries (1810-2020), for the military as a pathogen transmitter, within itself or between it and civilians. Biological mechanisms driving transmission included person-to-person transmission, contaminated food and water, vector-borne, and airborne routes. Contaminated food and/or water were the most common biological transmission route. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high-risk behaviours, and occupation-specific freedom of movement. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Selected social mechanisms, such as employment-related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military.
This study identified features of the military that pose a significant threat to global health, especially to civilian health in countries with substantial military presence or underdeveloped health systems. While biological transmission mechanisms are shared by other social groups, selected social transmission mechanisms are unique to the military. As an increasingly interconnected world faces the challenges of COVID-19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable global public health policies.
随着全球化的发展，传染病爆发演变为大流行的风险急剧上升。因此，了解传染病的传播机制对于制定全球公共卫生政策至关重要。本系统评价评估了医学和公共卫生文献中军队作为疾病载体的证据。
我们在没有时间限制的情况下搜索了 3 个电子数据库。两名研究人员使用标准化表格独立提取研究数据。通过团队讨论，根据其传播机制的类型对研究进行分组，并提取直接引语以生成主题和子主题。随后进行内容分析，并为每个主题生成频率分布。
在 6477 项研究中，有 210 项符合我们的纳入标准，并提供了证据，这些证据跨越了两个多世纪（1810-2020 年），表明军队本身或军队与平民之间存在病原体传播者。驱动传播的生物学机制包括人际传播、受污染的食物和水、媒介传播和空气传播途径。受污染的食物和/或水是最常见的生物传播途径。促进传播的社会机制包括拥挤的居住空间、不卫生条件、艰苦的工作、训练条件、缺乏或不充分的疫苗接种计划、军事领导层的压力、对公共卫生建议的遵守不力、承包商管理不善、高风险行为以及特定职业的行动自由。生活条件是最常见的社会传播机制，年轻、低级别军人反复被报告为受影响最严重的群体。一些社会机制，如与就业相关的行动自由，是军队作为一种社会机构所特有的。虽然很少有研究专门研究平民人口，但更多的研究包含了暗示平民可能受到军队中描述的疫情影响的信息。
本研究确定了军队对全球健康构成重大威胁的特征，尤其是对军事存在或卫生系统欠发达的国家的平民健康构成威胁。虽然生物传播机制也存在于其他社会群体中，但一些特定的社会传播机制是军队所特有的。随着一个日益互联的世界面临 COVID-19 和未来传染病的挑战，军队的这些特征可能会加剧当前和类似的挑战，并损害实施成功和公平的全球公共卫生政策的努力。
