Cross-sectional survey of anthrax vaccine coverage and KAP among deployed US military.

The recently refocused effort on anthrax (AVA) vaccination has been the source of much ethical and legal deliberation. However, the factors affecting one's decision to receive any or all of the vaccine doses are poorly understood. Using a self-administered questionnaire, we sought to evaluate AVA coverage among a cross-section of deployed active duty US military personnel and identify factors associated with receipt of the vaccine. A questionnaire was distributed to U.S. military personnel deployed to Iraq, Afghanistan and surrounding areas. Questions solicited demographic information, AVA vaccination status, and agreement to several questions attempting to assess the respondent's knowledge and attitudes regarding anthrax and the AVA vaccine. Of the 1,743 participants, 40.6% reported receiving all AVA vaccine doses. Older age and service in the Army were associated with an increased likelihood of AVA vaccination. Additionally, those who neither agreed nor disagreed with specific questions commonly rejected the AVA vaccine compared to those who agreed or disagreed to the same question. The only factor clearly associated with receipt or rejection of the AVA vaccine was whether the respondent thought that the anthrax vaccine is as safe as other vaccines. The individual decision to receive the AVA vaccine is most likely a multifactorial decision process even in a military population. Targeted educational interventions should be developed to increase AVA coverage and further understand drivers of vaccine receipt.

Infectious gastroenteritis and risk of developing inflammatory bowel disease.

BACKGROUND & AIMS: Infectious gastroenteritis (IGE) is known to exacerbate previously diagnosed inflammatory bowel disease (IBD). However, limited data are available describing a causal link between IGE and incident IBD. METHODS: By using a medical encounter data repository of active duty military personnel, a study was conducted to assess IBD risk in subjects with an antecedent case of IGE. RESULTS: Between 1999 and 2006, there were 3019 incident IBD cases and 11,646 matched controls who were evaluated in a conditional logistic regression model. To control for potential misclassification, IGE episodes within 6 months of IBD diagnosis were excluded as exposures. After adjusting for potential confounders, an episode of IGE increased the risk of IBD (odds ratio, 1.40; 95% confidence interval, 1.19-1.66). The risk was slightly higher for Crohn's disease compared with ulcerative colitis. In addition, there was an approximate 5-fold increase in IBD risk for persons with a previous irritable bowel syndrome diagnosis. CONCLUSIONS: These data support theories that the initiation of IBD is a multifactorial process that might include the disruption of normal gut homeostatic mechanisms. Further studies are warranted to evaluate the pathogen-specific risks, identify susceptible populations, and better understand the pathophysiologic relationship between IGE and IBD.

Acute gastrointestinal infection, respiratory illness, and noncombat injury among US military personnel during Operation Bright Star 2005, in Northern Egypt.

BACKGROUND: In the fall 2005, approximately 7,500 US military personnel participated in an exercise in the Egyptian desert. The epidemiology of disease and noncombat injury among deployed troops is important in the context of assessing current mitigation strategies and the development of future ones. METHODS: To assess the prevalence and impact of diarrhea and enteropathogen distribution, we conducted a case series study. To assess the relative impact of diarrhea compared to respiratory infection and injury, we conducted a post-deployment survey and compared these data to clinic-based syndromic surveillance data. RESULTS: We enrolled 43 patients with acute diarrhea, 21 (49%) having one or more pathogens isolated. Enterotoxigenic Escherichia coli (n= 16), enteroaggregative E coli (n= 3), and Shigella spp. (n= 3) were the most common pathogens identified. Respiratory illness had the highest incidence (73 episodes/100 person-months) compared to diarrhea (35 episodes/100 person-months) and noncombat injury (17 episodes/100 person-months), though noncombat injury more frequently resulted in lost duty days and health-care utilization. CONCLUSIONS: Noncombat injuries and illnesses have had a significant impact on military missions and continue to result in force health protection challenges today. Future studies are needed to test and evaluate countermeasures to mitigate these illnesses and injuries to increase the health of the individuals and optimize mission readiness.

Screening for chlamydial infection: an evidence update for the U.S. Preventive Services Task Force.

BACKGROUND: Chlamydial infection is the most common sexually transmitted bacterial infection in the United States, with an estimated 3 million new cases annually. In 2001, the U.S. Preventive Services Task Force (USPSTF) recommended that clinicians screen all sexually active women at increased risk for infection for Chlamydia trachomatis. PURPOSE: To summarize a systematic evidence review commissioned by the USPSTF in preparation for an update of its 2001 recommendation. DATA SOURCES: English-language articles identified in PubMed between July 2000 and July 2005. Additional articles were identified by bibliographic reviews and discussions with experts. A total of 452 articles were identified. STUDY SELECTION: Explicit inclusion and exclusion criteria were used for each of 3 key questions. For studies of screening in nonpregnant women at increased risk, review was limited to randomized, controlled trials. For other groups, both randomized, controlled studies and nonrandomized, prospective, controlled studies were included. DATA ABSTRACTION: Using standardized forms, staff of the Agency for Healthcare Research and Quality abstracted data on study design, setting, sample, randomization, blinding, results, and harms. DATA SYNTHESIS: Only 1 new study met inclusion criteria. This poor-quality study of the effectiveness of screening for chlamydial infection among nonpregnant women at increased risk found that screening was associated with a lower prevalence of chlamydial infection and fewer reported cases of pelvic inflammatory disease at 1-year follow-up. LIMITATIONS: No new evidence was found on screening in pregnant women, nonpregnant women not at increased risk, or men. CONCLUSIONS: A systematic review found a small amount of new evidence to inform the USPSTF as it updates its recommendations regarding screening for chlamydial infection. There are large gaps in the evidence about screening men to improve health outcomes in women.

Postinfectious irritable bowel syndrome--a meta-analysis.

OBJECTIVES: Irritable bowel syndrome (IBS) is a heterogeneous disorder affecting 12% of the population worldwide. Several studies identify IBS as a sequela of infectious gastroenteritis (IGE) with reported prevalence ranging from 4% to 31% and relative risk from 2.5 to 11.9. This meta-analysis was conducted to explore the differences between reported rates and provide a pooled estimate of risk for postinfectious irritable bowel syndrome (PI-IBS). DATA SOURCES: Electronic databases (MEDLINE, OLDMEDLINE, EMBASE, Cochrane database of clinical trials) and pertinent reference lists (including other review articles). REVIEW METHODS: Data were abstracted from included studies by two independent investigators; study quality, heterogeneity, and publication bias were assessed; sensitivity analysis was performed; and a summative effect estimate was calculated for risk of PI-IBS. RESULTS: Eight studies were included for analysis and all reported elevated risk of IBS following IGE. Median prevalence of IBS in the IGE groups was 9.8% (IQR 4.0-13.3) and 1.2% in control groups (IQR 0.4-1.8) (sign-rank test, p= 0.01). The pooled odds ratio was 7.3 (95% CI, 4.7-11.1) without significant heterogeneity (chi2 heterogeneity statistic, p= 0.41). Subgroup analysis revealed an association between PI-IBS risk and IGE definition used. CONCLUSIONS: This study provides supporting evidence for PI-IBS as a sequela of IGE and a pooled risk estimate revealing a sevenfold increase in the odds of developing IBS following IGE. The results suggest that the long-term benefit of reduced PI-IBS may be gained from primary prevention of IGE.