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Enteric Infections (EI) Surveillance

Picture of the digestive system and the etiologic agents that cause acute gastroenteritis or travelers' diarrhea. Learn how enteric infections surveillance aids in protecting U.S. Armed Forces and improves readiness.EI surveillance projects address the prevalence of etiologic agents causing acute gastroenteritis or travelers' diarrhea to protect the force and improve readiness through:

  • Surveillance in the U.S. military, including recruit, shipboard, and deployed populations, and in foreign military and civilian populations
  • Estimation of disease burden and identification of high-risk populations
  • Characterization of changes in pathogen etiology, including understanding drug resistance patterns

Importance of EI Surveillance within the U.S. Military

Modern advances in public health (e.g., improved water, sanitation, and hygiene conditions; development and dissemination of vaccines; and antimicrobials to treat infection) have all led to a decline in infectious diarrhea. However, acute gastroenteritis (AGE) remains a significant threat to travelers, including military personnel.

U.S. military personnel must be ready to deploy to austere environments where the risk of exposure to enteric diseases may be significant. In these environments, routine preventive health efforts are often either impractical or inadequate and enteric diseases can rapidly spread through units. AGE has played a significant role in the outcomes of military campaigns throughout history, and diarrheal illness continues to threaten operational capability through mission degradation and lost man-hours. Studies have shown diarrhea incidence among U.S. troops deployed during Operation Iraqi Freedom and Operation Enduring Freedom outpaces respiratory illness and injury, highlighting the need for improved surveillance to prevent, detect, and respond to EI disease threats.

EI Focus Area Strategy

Pictured GEIS laboratory scientists and the enteric infections surveillance work they do.

  • Provide timely, accurate, and actionable EI surveillance data for decision makers within the DoD and global public health community
  • Estimate prevalence of common enteric pathogens in U.S. military populations, adult travelers, and military and civilian populations of partner nations
  • Proactively assess potential EI threats to U.S. military members by summarizing region specific pathogen etiology and antimicrobial resistance rates within the military, and when unavailable, civilian travelers
  • Provide support for outbreaks of EIs as requested by U.S. government or partners

Pathogens of interest include:

  • Bacteria: Campylobacter species, Salmonella enterica, Shigella species, and diarrheagenic Escherichia coli, including pathotypes Enterotoxigenic E. coli (ETEC), Enteroaggregative E. coli (EAEC), Enterohemorrhagic E. coli (EHEC), and Enteroinvasive E. coli (EIEC), Enteropathogenic E. coli (EPEC)
  • Viruses: Norovirus (NoV) and enteric adenoviruses
  • Parasites: Entamoeba histolytica, Giardia lamblia, Cyclospora cayetanesis, and Cryptosporidium parvum

EI Focus Area Activities

  • EI surveillance focusing on immuno-naïve populations in U.S. military members in all geographic combatant commands, including recruit, shipboard, and deployed populations
  • Standardization of case definitions for enteric diseases, harmonization of laboratory methods for identification of enteric pathogens, and characterization of antimicrobial resistance patterns
  • Advanced characterization and antimicrobial suspectibility testing of endemic and novel pathogens
  • Detection of emerging pathogens in previously tested "pathogen-negative" stool samples

What's New in the EI Focus Area for FY17

The EI focus area provides approximately $4.8 million of funding to support partner projects.

New projects include:

  • Evaluation of laboratory tests for detection of Cryptosporidium species, Entamoeba histolytica and Giardia lamblia to determine prevalence and severity of infection in western travelers and U.S. military deployed to Southeast Asia
  • Improved detection of antimicrobial resistance in enteropathogens by expanding antimicrobial susceptibility testing to foodborne and environmental isolates collected from a region of Peru frequented by western travelers and Peruvian military members
  • Surveillance of AGE within small-platform U.S. Naval Pacific Fleet elements to develop baseline data on AGE incidence and sources in these hard-to-reach U.S. military populations 

Where We're Going

  • Implementing standard operating procedures for multipathogen platform technologies
  • Enhancing harmonized reporting of antimicrobial susceptibilities of bacterial pathogens detected through the Global Travelers' Diarrhea Study
  • Expanding surveillance among U.S. military populations, particularly in military treatment facilities that empirically treat diarrheal illness

See what GEIS is doing to combat antimicrobial resistant infections and sexually transmitted infections, febrile and vector-borne infections, and respiratory infections.

If you are involved with the DoD medical community and are interested in partnering with GEIS, or if you would like more information, please email us.

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AFHSB's health surveillance program supports Defense Department global health engagement efforts

Article
11/30/2017
U.S. Air Force Senior Airman Joshua Douglass, left, an aerospace medical technician, watches as Liberian health care workers properly put on their personal protective equipment as part response by the Defense Department operation to provide logistics, training and engineering support during the Ebola virus outbreak. (U.S. Army photo by Staff Sgt. Terrance D. Rhodes)

Navy Commander Franca R. Jones, chief of the Global Emerging Infections section at the Armed Forces Health Surveillance Branch (AFHSB) discusses how AFHSB's health surveillance program supports the Defense Department global health engagement efforts.

Recommended Content:

Armed Forces Health Surveillance Branch | Global Emerging Infections Surveillance | Antimicrobial Resistance (AMR) Surveillance | Febrile and Vector-Borne Infections (FVBI) Surveillance | Enteric Infections (EI) Surveillance | GEIS Partners | Global Health Engagement
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