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Schawaller M, Wiemer D, Hagen RM, Frickmann H. Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years. BMJ Mil Health 2023; 169:146-151. [PMID: 33257519 DOI: 10.1136/bmjmilitary-2020-001575] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Military deployments to the tropics are associated with specific infection risks. To add to the available epidemiological information, infectious disease risks in German military personnel returning from predominantly tropical deployments were assessed. METHODS Since 2006, German soldiers returning from predominantly tropical deployments have been offered the opportunity of returnee screenings at the Department of Tropical Medicine and Infectious Diseases of the Bundeswehr Hospital Hamburg. Case files and diagnostic results recorded between 2006 and 2018 were retrospectively assessed to identify deployment-associated infectious disease risks. RESULTS Along with high enteric colonisation rates with apathogenic protozoa and resistant Enterobacteriaceae, direct or indirect proof of infections among the 764 assessed cases comprised Plasmodium spp (n=37), Giardia duodenalis (n=21), Schistosoma spp (n=14), Yersinia enterocolitica (n=5), Strongyloides stercoralis (n=3), Campylobacter jejuni (n=1), Leishmania spp (n=1) and Salmonella enterica (n=1), as well as latent infections with Mycobacterium tuberculosis complex (n=8). The infections were mainly imported from the African region and Eastern Mediterranean region and high proportions of cases lacked typical symptoms. Reported side effect rates of antimalarial chemoprophylaxis for mefloquine (n=121), atovaquone/proguanil (n=49) and doxycycline (n=6) were 36.3%, 19.3% and 11.8%, respectively, while non-compliance rates were 12.9%, 13.0% and 5.9%, respectively. CONCLUSIONS Considerable rates of infections with sometimes atypical or absent symptoms confirm a need for returnee screenings after tropical deployments. High reported side effect rates for mefloquine support its replacement by atovaquone/proguanil or doxycycline for antimalarial chemoprophylaxis.
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Affiliation(s)
- Marius Schawaller
- Department of Tropical Medicine and Infectious Diseases, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - D Wiemer
- Department of Tropical Medicine and Infectious Diseases, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - R M Hagen
- Department of Microbiology and Hospital Hygiene, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - H Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsmedizin Rostock, Rostock, Germany
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2
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Murphy RJ. Communicable diseases in humanitarian operations and disasters. BMJ Mil Health 2022; 168:457-461. [PMID: 32123000 DOI: 10.1136/bmjmilitary-2020-001415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 11/04/2022]
Abstract
Military organisations have battled communicable disease for millennia. They have pioneered disease prevention from the Crusades to the World Wars and continue to do so today. Predeployment vaccinations and chemoprophylaxis are effective in preventing communicable disease, as is reliable vector destruction and bite prevention, especially in the era of multidrug resistant organisms. These measures are unlikely to be fully possible in disasters, but reactive vaccination and efforts to reduce exposure to communicable disease should be a priority. Communicable diseases can be challenging to diagnose-the UK Defence Medical Services have become familiar with tools such as multiplex PCR and mass spectrometry. These have the potential to accurately identify organisms and sensitivity patterns in austere environments. Management of communicable diseases depends on accurate diagnosis and has a largely well-established evidence base but can be limited by a lack of resources and skills in an austere setting, therefore telemedicine can assist diagnosis and treatment of infections by projecting specialist skill. Systems such as EpiNATO2 are useful in monitoring diseases and identifying trends in order to establish control measures. Many of these tools and techniques are effective in austere environments and offer learning opportunities for those providing care in similar settings. Further research is ongoing into diagnostic tools as well as remote management.
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3
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Biselli R, Nisini R, Lista F, Autore A, Lastilla M, De Lorenzo G, Peragallo MS, Stroffolini T, D’Amelio R. A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health. Biomedicines 2022; 10:2050. [PMID: 36009598 PMCID: PMC9405556 DOI: 10.3390/biomedicines10082050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil-military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.
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Affiliation(s)
- Roberto Biselli
- Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Roberto Nisini
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - Florigio Lista
- Dipartimento Scientifico, Policlinico Militare, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Alberto Autore
- Osservatorio Epidemiologico della Difesa, Ispettorato Generale della Sanità Militare, Stato Maggiore della Difesa, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Marco Lastilla
- Istituto di Medicina Aerospaziale, Comando Logistico dell’Aeronautica Militare, Viale Piero Gobetti 2, 00185 Roma, Italy
| | - Giuseppe De Lorenzo
- Comando Generale dell’Arma dei Carabinieri, Dipartimento per l’Organizzazione Sanitaria e Veterinaria, Viale Romania 45, 00197 Roma, Italy
| | - Mario Stefano Peragallo
- Centro Studi e Ricerche di Sanità e Veterinaria, Comando Logistico dell’Esercito, Via S. Stefano Rotondo 4, 00184 Roma, Italy
| | - Tommaso Stroffolini
- Dipartimento di Malattie Infettive e Tropicali, Policlinico Umberto I, 00161 Roma, Italy
| | - Raffaele D’Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
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4
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Davis SI, Biswas JS, White S. Infection Prevention and Control Lead Link Practitioner: a new deployed role piloted on Exercise SAIF SAREEA 3. BMJ Mil Health 2020; 166:411-413. [PMID: 33293376 DOI: 10.1136/bmjmilitary-2020-001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 11/03/2022]
Abstract
Disease non-battle injury has plagued British expeditionary forces through the ages. While in recent years significant mortality has reduced, it has had a large impact on operational effectiveness, at times leading to closure of major medical treatment facilities (MTFs).Infection Prevention and Control (IPC) benefits from a subject matter expert and champion to ensure it remains at the front of people's minds and to be on hand to manage acute and dynamic situations. To mitigate the lack of an IPC Nursing Officer, we piloted a deployed military IPC Lead Link Practitioner (IPC-LL) for the first time on a large-scale overseas exercise (SAIF SAREEA 3). An experienced generalist nurse deploying as the IPC-LL (after specific training) provided pre-deployment IPC education and preparation, deployed IPC advice, undertook mandatory audits and monitored IPC compliance throughout the MTFs on the exercise. Data from 22 IPC audits conducted on the exercise showed that the presence of the IPC-LL improved IPC compliance and standards overall in the MTF where based, compared with others. In addition, a gastroenteritis outbreak occurred and was successfully managed with significant input from the IPC-LL. The IPC-LL was also able to add value by pre-empting potential IPC problems from occurring.There is a small pool of deployable Infection Prevention and Control Nursing Officers, so this new IPC-LL role could help to fill the capability gap. The IPC-LL could be the dedicated person focusing on IPC elements, reducing the IPC risk within the deployed field hospital setting where deployed experts are not available.
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Affiliation(s)
- Siobhan I Davis
- Infection Prevention and Control, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - J S Biswas
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - S White
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Milne G. Predeployment Collective Training under lockdown: lessons learnt from the COVID-19 pandemic. BMJ Mil Health 2020; 169:e82-e85. [PMID: 33214221 DOI: 10.1136/bmjmilitary-2020-001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 11/03/2022]
Abstract
Completing meaningful and high-fidelity Collective Training during the COVID-19 pandemic presents an entirely new set of challenges to both the Chain of Command and supporting medical assets. Under Project PHOENIX, the Field Army will gradually phase the return of Collective Training, starting with Deployed Operation Force Generation. This article describes the personal experiences and challenges faced by 1st Battalion Coldstream Guards Battle Group and the Mission Training and Mobilisation Centre to enable the Operation SHADER 11 Mission Rehearsal Exercise, the first Collective Training the Field Army completed during the national lockdown.
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Affiliation(s)
- Grant Milne
- Regimental Medical Officer, 1st Battalion Coldstream Guards, Victoria Barracks, Windsor, UK
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6
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Falconer Hall T, Ross DA. Can the UK win back its collective memory of epidemics? BMJ Mil Health 2020; 167:73-74. [PMID: 32999085 DOI: 10.1136/bmjmilitary-2020-001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 11/03/2022]
Affiliation(s)
| | - D A Ross
- Parkes Professor of Preventive Medicine, Army Medical Services, Camberley, UK
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7
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Biswas JS, Lentaigne J, Burns DS, Osborne JC, Simpson AJ, Hutley EJ, Hill NE, Bailey MS. Undifferentiated febrile illnesses in South Sudan: a case series from Operation TRENTON from June to August 2017. BMJ Mil Health 2020; 167:358-361. [PMID: 32094218 DOI: 10.1136/jramc-2019-001238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/03/2022]
Abstract
Undifferentiated febrile illnesses present diagnostic and treatment challenges in the Firm Base, let alone in the deployed austere environment. We report a series of 14 cases from Operation TRENTON in South Sudan in 2017 that coincided with the rainy season, increased insect numbers and a Relief in Place. The majority of patients had headaches, myalgia, arthralgia and back pain, as well as leucopenia and thrombocytopenia. No diagnoses could be made in theatre, despite a sophisticated deployed laboratory being available, and further testing in the UK, including next-generation sequencing, was unable to establish an aetiology. Such illnesses are very likely to present in tropical environments, where increasing numbers of military personnel are being deployed, and clinicians must be aware of the non-specific presentation and treatment, as well as the availability of Military Infection Reachback services to assist in the management of these cases.
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Affiliation(s)
- Jason S Biswas
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK .,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Lentaigne
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - D S Burns
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - J C Osborne
- Rare and Imported Pathogens Laboratory, Public Health England Porton, Salisbury, UK
| | - A J Simpson
- Rare and Imported Pathogens Laboratory, Public Health England Porton, Salisbury, UK
| | - E J Hutley
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
| | - N E Hill
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - M S Bailey
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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8
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Gentile G, Fréchard G, Dia A, Buzens A, Vives R, Jego M, Pommier de Santi V, Simon F. Incidence of acute respiratory tract infections (2006-2015) and influenza (2006-2013) among French armed forces. Med Mal Infect 2019; 50:689-695. [PMID: 31759689 DOI: 10.1016/j.medmal.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/21/2018] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We aimed to assess the incidence of respiratory tract infections in military settings between 2006 and 2015. PATIENTS AND METHODS We performed a retrospective epidemiological study of the entire military population from 2006 to 2015. Comprehensive data was collected from all medical centers, operational medical units, naval services, and army training hospitals and provided by the epidemiological surveillance of the armies. RESULTS The annual average population of the study was 331,394 soldiers. For acute respiratory tract infections (2006-2015), 22,818 cases were reported in metropolitan France, 3,211 cases in French overseas territories, 1,595 cases in the French Navy, and 1,318 cases in external military operations for a total of 28,942 cases. For influenza (2006-2013), 934 cases were reported in metropolitan France, 101 cases in French overseas territories, and 23 cases in external operations, for a total of 1,058 cases. The mean incidence rate of acute respiratory tract infections expressed as case number per 1,000 person-years (PY) was 8.7 PY (95% CI [8.6-8.8]) with an exceptional increased incidence rate in 2009 (25.9 PY, 95% CI [25.4-26.4]). The mean incidence rate of influenza was 0.35 PY (95% CI [0.33-0.37]) with a peak incidence rate of 1.9 PY in 2009. CONCLUSION Acute respiratory tract infections are at the forefront of infectious episodes in the French armies. Although not necessarily severe, current prevention measures are not enough to reduce the incidence threshold of these infections and need to be improved.
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Affiliation(s)
- G Gentile
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France; Inserm 1106, Institut des neurosciences des systèmes, Aix Marseille université, 13885 Marseille, France; Comité pédagogique, hôpital d'instruction des Armées Laveran, 13384 Marseille, France.
| | - G Fréchard
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France
| | - A Dia
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - A Buzens
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - R Vives
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - M Jego
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France; Centre d'études et de recherche sur les services de santé et qualité de vie (CERESS), Aix Marseille université, 13385 Marseille, France
| | - V Pommier de Santi
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - F Simon
- Comité pédagogique, hôpital d'instruction des Armées Laveran, 13384 Marseille, France; Department of infectious diseases and tropical medicine, Laveran military teaching hospital, 13384 Marseille, France
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9
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Riley MR. Romaine Amiel: a French surgeon in the British Army during the Napoleonic Wars. J ROY ARMY MED CORPS 2019; 165:457-458. [PMID: 30992339 DOI: 10.1136/jramc-2019-001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mark Robert Riley
- Academic Clinical Fellow, Academic Department of Military General Practice, Birmingham, UK
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10
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Herron JBT, Alexander Thomas Dunbar J. The British Army's contribution to tropical medicine. Clin Med (Lond) 2018; 18:380-383. [PMID: 30287430 PMCID: PMC6334121 DOI: 10.7861/clinmedicine.18-5-380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Infectious disease has burdened European armies since the Crusades. Beginning in the 18th century, therefore, the British Army has instituted novel methods for the diagnosis, prevention and treatment of tropical diseases. Many of the diseases that are humanity's biggest killers were characterised by medical officers and the acceptance of germ theory heralded a golden era of discovery and development. Luminaries of tropical medicine including Bruce, Wright, Leishman and Ross firmly established the British Army's expertise in this area. These innovations led to the prevention of many deaths of both military personnel and civilians. British Army doctors were instrumental in establishing many of the teaching facilities that we now consider to be global leaders in tropical medicine. The impact of the Army in this field has certainly been significant in the past and its contribution continues to this day.
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11
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Burns DS, Riley MR, Mason A, Bailey MS. UK Role 4 military infectious diseases and tropical medicine cases in 2005-2013. J ROY ARMY MED CORPS 2017; 164:77-82. [PMID: 29279320 DOI: 10.1136/jramc-2017-000815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Infectious diseases are a frequent cause of morbidity among British troops. The aim of this paper is to describe the spectrum of infectious diseases seen when UK service personnel are evacuated for definitive care to the Role 4 Medical Treatment Facility based at Birmingham Heartlands Hospital. METHOD A retrospective analysis of all military patients presenting with infectious diseases and treated at Birmingham Heartlands Hospital between 14 April 2005 and 31 December 2013 was undertaken. RESULTS During this period, 502 patients were identified. Infections originated in 49 countries, most commonly Afghanistan (46% cases), the UK (10% cases) and Belize (9% of cases). The most common presentations were dermatological conditions, gastroenterological illnesses and undifferentiated fevers. CONCLUSION UK service personnel in significant numbers continue to suffer a wide range of infectious diseases, acquired throughout the globe, which often require specialist tertiary infection services to diagnose and manage. Future prospective data collection is recommended to identify trends, which in turn will inform military training needs and future research priorities in the Defence Medical Services (DMS) and allows development of appropriate policies and clinical guidelines for management of DMS personnel with infectious diseases.
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Affiliation(s)
- Daniel S Burns
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK.,Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - M R Riley
- Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - A Mason
- Army Medical Directorate, Former Army Staff College, Camberley, UK
| | - M S Bailey
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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12
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Charles Dickens, trachoma, and blindness in pre-Victorian England. Surv Ophthalmol 2017; 63:275-280. [PMID: 29056503 DOI: 10.1016/j.survophthal.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/03/2017] [Accepted: 10/09/2017] [Indexed: 11/22/2022]
Abstract
In the early 1820s, a Yorkshire boarding school was devastated by an outbreak of blinding ophthalmia. The cause of the epidemic was-in all likelihood-trachoma, then known as Egyptian ophthalmia. The headmaster of the Yorkshire school, William Shaw, was sued for gross negligence by 2 families whose sons went blind during the outbreak. The epidemic and trial would play a role in creating one of the literature's most notorious fictional characters. Eighteen years after the trial, Charles Dickens modeled the vile schoolmaster Wackford Squeers in Nicholas Nickleby after Shaw, whose reputation and career would later be ruined by his thinly disguised portrayal in the novel. The original boarding school epidemic took place while London's first eye hospital was moving to Lower Moorfields, an institution that 17 years earlier was established primarily to cope with Egyptian ophthalmia. We explore trachoma's wide-ranging impact on pre-Victorian England, from inspiring an enduring literary villain to the creation of a renowned eye hospital.
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13
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Newman ENC, Johnstone P, Bridge H, Wright D, Jameson L, Bosworth A, Hatch R, Hayward-Karlsson J, Osborne J, Bailey MS, Green A, Ross D, Brooks T, Hewson R. Seroconversion for infectious pathogens among UK military personnel deployed to Afghanistan, 2008-2011. Emerg Infect Dis 2016; 20:2015-22. [PMID: 25418685 PMCID: PMC4257834 DOI: 10.3201/eid2012.131830] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Military personnel are at high risk of contracting vector-borne and zoonotic infections, particularly during overseas deployments, when they may be exposed to endemic or emerging infections not prevalent in their native countries. We conducted seroprevalence testing of 467 UK military personnel deployed to Helmand Province, Afghanistan, during 2008-2011 and found that up to 3.1% showed seroconversion for infection with Rickettsia spp., Coxiella burnetii, sandfly fever virus, or hantavirus; none showed seroconversion for infection with Crimean-Congo hemorrhagic fever virus. Most seroconversions occurred in personnel who did not report illness, except for those with hantavirus (70% symptomatic). These results indicate that many exposures to infectious pathogens, and potentially infections resulting from those exposures, may go unreported. Our findings reinforce the need for continued surveillance of military personnel and for education of health care providers to help recognize and prevent illnesses and transmission of pathogens during and after overseas deployments.
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14
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Osborne LG, Brown M, Bailey MS. Enteric fever in a British soldier from Sierra Leone. J ROY ARMY MED CORPS 2015; 162:226-8. [PMID: 26243802 DOI: 10.1136/jramc-2015-000470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/02/2015] [Indexed: 11/03/2022]
Abstract
Enteric fever (typhoid and paratyphoid) remains a threat to British troops overseas and causes significant morbidity and mortality. We report the case of a soldier who developed typhoid despite appropriate vaccination and field hygiene measures, which began 23 days after returning from a deployment in Sierra Leone. The incubation period was longer than average, symptoms started 2 days after stopping doxycycline for malaria chemoprophylaxis and initial blood cultures were negative. The Salmonella enterica serovar Typhi eventually isolated was resistant to amoxicillin, co-amoxiclav, co-trimoxazole and nalidixic acid and had reduced susceptibility to ciprofloxacin. He was successfully treated with ceftriaxone followed by azithromycin, but 1 month later he remained fatigued and unable to work. The clinical and laboratory features of enteric fever are non-specific and the diagnosis should be considered in troops returning from an endemic area with a febrile illness. Multiple blood cultures and referral to a specialist unit may be required.
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Affiliation(s)
- Lucy G Osborne
- Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK Army Medical Directorate, Camberley, UK
| | - M Brown
- Hospital for Tropical Diseases, University College London Hospital Trust, London, UK
| | - M S Bailey
- Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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15
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Bailey MS, Beaton K, Bowley D, Eardley W, Hunt P, Johnson S, Round J, Tarmey NT, Williams A. Bending the curve: force health protection during the insertion phase of the Ebola outbreak response. J ROY ARMY MED CORPS 2015; 162:191-7. [PMID: 26036821 DOI: 10.1136/jramc-2014-000375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/05/2015] [Indexed: 11/03/2022]
Abstract
After >10 years of enduring operations in Iraq and Afghanistan, Defence Strategic Direction is returning to a contingency posture. As the first post-Afghanistan operation, in September 2014, a UK Joint Inter-Agency Task Force deployed to Sierra Leone in response to the Ebola virus disease (EVD) epidemic in West Africa. The aims were expanding treatment capacity, assisting with training and supporting host nation resilience. The insertion phase of this deployment created a unique set of challenges for force health protection. In addition to the considerable risk of tropical disease and trauma, deployed personnel faced the risks of working in an EVD epidemic. This report explores how deployed medical assets overcame the difficulties of mounting a short-notice contingent operation in a region of the world with inherent major climatic and health challenges.
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Affiliation(s)
- Mark S Bailey
- Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - K Beaton
- Headquarters 2nd Medical Brigade, York, UK
| | - D Bowley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - W Eardley
- Department of Orthopaedics, James Cook University Hospital, Middlesbrough, UK Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - P Hunt
- Emergency Department, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - S Johnson
- Garrison Medical Centre, Catterick Garrison, North Yorkshire, UK
| | - J Round
- Anaesthetics & Critical Care, James Cook University Hospital, Middlesbrough, UK
| | - N T Tarmey
- Academic Department of Critical Care, Queen Alexandra Hospital, Portsmouth, UK
| | - A Williams
- Department of Cardiology, Royal Gwent Hospital, Newport, United Kingdom
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Vassallo D. A short history of Camp Bastion Hospital: part 2-Bastion's catalytic role in advancing combat casualty care. J ROY ARMY MED CORPS 2015; 161:160-6. [PMID: 25896811 DOI: 10.1136/jramc-2015-000437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Michel R, Demoncheaux JP, Créach MA, Rapp C, Simon F, Haus-Cheymol R, Migliani R. Prevention of infectious diseases during military deployments: a review of the French armed forces strategy. Travel Med Infect Dis 2014; 12:330-40. [PMID: 25052855 DOI: 10.1016/j.tmaid.2014.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 06/24/2014] [Accepted: 07/02/2014] [Indexed: 11/18/2022]
Abstract
Military personnel in operations have always paid a high toll to infections. In the 21st century some of these diseases still cause outbreaks with significant morbidity and impact on deployments. The new configuration of the French Armed Forces requires the permanent preparedness of deployable units. During deployments, soldiers are at least exposed to the infectious diseases that are observed in travellers, but with a potentially severe impact for the combatting strengths and a risk for cancelation or failure of the operational durability. The most common disabling infections during military deployments are faeco-oral transmitted diseases including diarrhoea. Preventing infectious diseases during deployments is of great concern and the French medical service has established a strategy based on different components; risk assessment and preparation, immunizations, protective measures and chemoprophylaxis, health education, health surveillance, outbreak investigations and medical tracking. In this review, the authors present the context of deployment of the French Armed Forces, the main health risks they are exposed to and develop the key points of the force health protection strategy, focused on infections related to military deployments.
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Affiliation(s)
- R Michel
- Centre d'épidémiologie et de santé publique des armées, Marseille, France; Ecole du Val-de-Grace, Paris, France.
| | - J P Demoncheaux
- Centre médical des armées de Nîmes-Orange-Laudun, Antenne vétérinaire de Nîmes, France
| | - M A Créach
- Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - C Rapp
- Hôpital d'instruction des armées Bégin, Saint Mandé, France; Ecole du Val-de-Grace, Paris, France
| | - F Simon
- Ecole du Val-de-Grace, Paris, France; Hôpital d'instruction des armées Laveran, Marseille, France
| | - R Haus-Cheymol
- Direction centrale du Service de santé des armées, Vincennes, France
| | - R Migliani
- Ecole du Val-de-Grace, Paris, France; Direction centrale du Service de santé des armées, Vincennes, France
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Rapp C, Aoun O, Ficko C, Andriamanantena D, Flateau C. Infectious diseases related aeromedical evacuation of French soldiers in a level 4 military treatment facility: A ten year retrospective analysis. Travel Med Infect Dis 2014; 12:355-9. [DOI: 10.1016/j.tmaid.2014.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/27/2014] [Accepted: 03/05/2014] [Indexed: 11/25/2022]
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Burns DS, Bailey MS. Undifferentiated febrile illnesses in military personnel. J ROY ARMY MED CORPS 2013; 159:200-5. [DOI: 10.1136/jramc-2013-000118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dufty NE, Bailey MS. UK Role 4 Military Infection Services: past, present and future. J ROY ARMY MED CORPS 2013; 159:141-3. [DOI: 10.1136/jramc-2013-000088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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