DIARRHEAL-DISEASE AMONG MILITARY-PERSONNEL DURING OPERATION-RESTORE-HOPE, SOMALIA, 1992-1993

The potential for widespread diarrheal disease was regarded as a subst antial threat to U.S. troops participating in the early phases of Oper ation 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 diar rhea each week, and in three epidemiologic surveys, < 3% of troops rep orted experiencing a diarrheal illness per week. Despite these low ove rall attack rates, diarrhea accounted for 16% of 381 hospital admissio ns and 20% of 245 patients admitted with a temperature greater than or equal to 38.5 degrees C. Sixty-one specimens were obtained from inpat ients and 52 were obtained from outpatients. Shigella sp. were isolate d from 33%, enterotoxigenic Escherichia coli from 16%, Giardia lamblia from 4%, and rotavirus from 1% of 113 stool samples obtained from inp atient (61) and outpatient (52) troops with diarrhea. Bacterial isolat es obtained in Somalia were resistant to doxycycline (78%), ampicillin (54%), and sulfamethoxazole (49%), but uniformly sensitive to ciprofl oxacin. With the exception of 10 Shigella sonnei isolates that were li nked epidemiologically to one eating facility, bacterial pathogens occ urred 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 dem onstrated a four-fold or greater increase in titer to Norwalk virus an tibody. 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.