Diarrhoeal disease: current concepts and future challenges. Diarrhoeal disease--a military perspective

Diarrhoeal disease has always been a major medical problem during military operations. Lost personnel time has been significant, with over 50% of deployed forces being affected and unable to do their jobs for several days. During 'Operation Desert Shield' in Saudi Arabia in 1990, the US military took extensive precautions to prevent diarrhoeal disease. Surveys from 1% of the 200,000 US military personnel in Saudi Arabia indicated that 97% experienced diarrhoea, 22% sought medical care, and 19% were not able to perform their duties while affected. Medical evaluation of 452 individuals with diarrhoea determined a bacterial aetiology in 50% and a clear relationship with consumption of local fruits and raw vegetables. Prophylactic antibiotic administration was not a reasonable proposal and treatment was effective only when susceptibility patterns of local enteric agents were considered. Research efforts must continue for diagnostic tests to indicate which individuals with diarrhoeal disease would benefit from early antibiotic therapy and for development of vaccines effective against the common agents of diarrhoeal disease.