Sharp T W, Thornton S A, Wallace M R, Defraites R F, Sanchez J L, Batchelor R A, Rozmajzl P J, Hanson R K, Echeverria P, Kapikian A Z
Naval Medical Research Institute, Bethesda, Maryland.
Am J Trop Med Hyg. 1995 Feb;52(2):188-93. doi: 10.4269/ajtmh.1995.52.188.
The potential for widespread diarrheal disease was regarded as a substantial threat to U.S. troops participating in the early phases of Operation Restore Hope in Somalia. Outpatient surveillance of 20,859 U.S. troops deployed during the first eight weeks, however, indicated that a mean of only 0.8% (range 0.5-1.2%) of personnel sought care for diarrhea each week, and in three epidemiologic surveys, < 3% of troops reported experiencing a diarrheal illness per week. Despite these low overall attack rates, diarrhea accounted for 16% of 381 hospital admissions and 20% of 245 patients admitted with a temperature > or = 38.5 degrees C. Sixty-one specimens were obtained from inpatients and 52 were obtained from outpatients. Shigella sp. were isolated from 33%, enterotoxigenic Escherichia coli from 16%, Giardia lamblia from 4%, and rotavirus from 1% of 113 stool samples obtained from inpatient (61) and outpatient (52) troops with diarrhea. Bacterial isolates obtained in Somalia were resistant to doxycycline (78%), ampicillin (54%), and sulfamethoxazole (49%), but uniformly sensitive to ciprofloxacin. With the exception of 10 Shigella sonnei isolates that were linked epidemiologically to one eating facility, bacterial pathogens occurred sporadically and demonstrated a wide variation of serotypes and antibiotic sensitivity patterns. Additionally, three of 11 paired sera collected from persons with nausea, vomiting, and watery diarrhea demonstrated a four-fold or greater increase in titer to Norwalk virus antibody. These data indicate that large outbreaks of diarrheal disease did not occur; however, highly drug-resistant enteric bacteria, and to a lesser extent viral and parasitic pathogens, were important causes of morbidity among U.S. troops in Somalia.
广泛传播的腹泻病被视为对参与索马里“恢复希望行动”初期阶段的美军构成的重大威胁。然而，对前八周部署的20859名美军进行的门诊监测表明，平均每周只有0.8%（范围为0.5%-1.2%）的人员因腹泻就医，并且在三项流行病学调查中，每周报告有腹泻疾病的部队人员不到3%。尽管总体发病率较低，但腹泻占381例住院病例的16%，以及245例体温≥38.5摄氏度的住院患者的20%。从住院患者中获取了61份样本，从门诊患者中获取了52份样本。从113份来自腹泻住院患者（61例）和门诊患者（52例）的粪便样本中，分别分离出33%的志贺菌属、16%的产肠毒素大肠杆菌、4%的蓝氏贾第鞭毛虫和1%的轮状病毒。在索马里分离出的细菌对多西环素耐药率为78%，对氨苄西林耐药率为54%，对磺胺甲恶唑耐药率为49%，但对环丙沙星均敏感。除了10株宋内志贺菌分离株在流行病学上与一个饮食设施有关联外，细菌病原体呈散发性出现，并且表现出广泛的血清型和抗生素敏感性模式差异。此外，从出现恶心、呕吐和水样腹泻的人员中采集的11份配对血清中有3份显示诺如病毒抗体滴度升高了四倍或更多。这些数据表明腹泻病并未大规模爆发；然而，高度耐药的肠道细菌以及程度较轻的病毒和寄生虫病原体是索马里美军发病的重要原因。
