Gastro Enteritis in a military population deployed in West Africa in the UK Ebola response; was the observed lower disease burden due to handwashing?

BACKGROUND: Travellers' diarrhoea in military populations is reported ranging from 50 to 70 cases per thousand person months. The UK personnel deployed to the Ebola Outbreak in Sierra Leone during the Ebola outbreak adopted standard measures associated with disease prevention. As part of the infection control measures against transmission of Ebola, personnel also rinsed their hands frequently in 0.05% hypochlorite. This was felt to have reduced the incidence of travellers' diarrhoea in the population and an audit was carried out to test this hypothesis. METHODS: Routine data identified diarrhoea and vomiting cases. A questionnaire sought information on traveller's diarrhoea and hand hygiene in Sierra Leone and Afghanistan. RESULTS: The incidence of Gastro Intestinal Disease for the population ranged from 23.9 Per thousand personnel per month to 74.4 per thousand personnel per month (mean 55.1 cases per thousand personnel per month). This included 4 headline outbreaks which accounted for 156 of the total number of 243 cases in the period of the deployment. The mean daily number of hand washes in Sierra Leone as reported in a survey was 17.02 (SD 8.2) and for Afghanistan was 9.06 (6.88). The mean difference was 7.94 (t 0.64 p < 0.0001.) CONCLUSION: The gastro intestinal disease incidence appeared to be at the lower end of the range reported by other groups in an environment with, arguably, a greater risk of infection. Force health protection policies were similar between Sierra Leone and Afghanistan excepting the frequency with which hands were rinsed or washed. We recommend that hand washing stations are placed at every office and communal area and not just at the dining facility in order to minimise the incidence of travellers' diarrhoea on future operations.

A review of 10 years of systematic health surveillance in the Army.

Health and morbidity reporting has been an important feature of the historical assessment of military campaigns from times of antiquity. Most of these reports have concentrated on hospital admission rates and mortality. In 1994 the British Army introduced a primary care health surveillance reporting system called J94. This provided the first opportunity for the systematic capture and analysis of morbidity data that allowed the identification of disease trends and the audit of remedial action. In parallel with the developments made by the military in the field of health surveillance, a number of initiatives in the NHS tried to develop real time surveillance systems with differing degrees of success. This paper reviews the developments made by military and civilian programs, identifies the problems that have been faced, areas where success has been achieved and the issues that will have to be considered as we prepare for the introduction of the next generation of IT based medical information systems into the military.

A malaria outbreak following a British military deployment to Sierra Leone.

OBJECTIVES: To describe a malarial outbreak amongst a British military force deployed to Sierra Leone in May 2000. METHODS: A case-control study was conducted that investigated possible risk or protective factors affecting the population. RESULTS: All bite avoidance measures (use of insecticide-treated bed nets and insecticide-treated clothes and use of thermal fogging/knockdown insecticide sprays) offered some degree of protection, although only use of clothes and nets was significant at the 5% level. Use of 3 or 4 protection measures was significantly protective, as was the cumulative protective effect when using multiple protective measures. CONCLUSION: Professionals giving travel advice must continue to advice travellers that they can significantly improve their levels of malarial protection by using multiple protection measures.