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Deployment and Travel Related Infections

United States military combat, humanitarian assistance and other activities in developing countries expose forward deployed troops to infectious diseases that can significantly and negatively affect operations.  Travel medicine has become an increasingly important discipline in the civilian and military sectors with the rapid growth in international travel, particularly to the developing world.  The IDCRP has focused efforts on describing the epidemiology of deployment and travel related infections, evaluating pre-travel health care and developing novel methodologies for identifying enteropathogens and pathogens associated with febrile disease. Efforts have also focused on developing effective treatment strategies for travelers’ diarrhea in deployed troops.  Most recently, DoD encountered several emerging infectious disease threats relating to deployment health, including the spread of chikungunya virus within South/Central America and Florida with expected expansion into the eastern US, and the Ebola epidemic in West Africa leading to a large-scale deployment of troops into the region as part of Operation United Assistance.  IDCRP launched several initiatives through ongoing protocols as well as new studies aimed at providing valuable epidemiologic and outcome data related to these infections.

Key Studies

IDCRP-037: Deployment and Travel Related Infectious Disease Risk Assessment, Outcomes, and Prevention Strategies Among Department of Defense Beneficiaries (TravMil)

IDCRP-065: A Randomized, Double-Blind, Clinical Trial Evaluating the Equivalency of Three Single Dose Regimens with Loperamide for Treatment of Ambulatory Watery Travelers' Diarrhea, and Azithromycin with and without Loperamide for Treatment of Ambulatory Dysentery/Febrile Diarrhea (TrEAT Travelers’ Diarrhea)

IDCRP-076: Development of multiplex PCR assay using stool smears obtained on filter paper cards for detection of pathogens associated with travelers’ diarrhea

IDCRP-080: A randomized, double-blind, placebo-controlled study evaluating rifaximin for the prevention of travelers’ diarrhea in TravMil deployment population (Prevent TD)

Military Impact

  1. Multisite TravMil clinical research network (expand to 6 sites FY15); capacity to support DoD infectious disease surveillance efforts  and serve as a platform for licensed and investigational product research trials 
  2. Generate evidence base  to refine Deployment clinical practice guidelines for treatment of acute infectious diarrhea
  3. Generate evidence to evaluate rifaximin chemoprophylaxis of acute infectious diarrhea in deployed military
  4. Targeted surveillance for febrile illnesses among deployed personnel
  5. Advance molecular diagnostic platform for diarrhea using self-collected stool filter cards for application in forward settings 
  6. Evaluate clinical impact from long-term sequelae from traveler's diarrhea

Partners and Collaborators

The IDCRP is a key partner with other military programs such as the Armed Forces Health Surveillance Center - Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) network, the military research and development commands including Walter Reed Army Institute of Research (WRAIR) and Naval Medical Research Center (NMRC), and laboratories outside the continental US) by filling a unique niche of conducting clinical and translational research. The Navy Bureau of Medicine and Surgery’s (BUMED) Wounded, Ill, and Injured (WII) project also funds the TrEAT Travelers’ Diarrhea study.

Publications

Murray CK, Yun HC, Markelz AE, et al. Operation United Assistance: Infectious Disease Threats to Deployed Military Personnel. Military Medicine 180(6):626-651.

Lalani T, Maguire JD, Grant EM, et al. Epidemiology and self-treatment of travelers’ diarrhea in a large, prospective cohort of Department of Defense beneficiaries. Journal of Travel Medicine.

Lalani T, Tisdale MD, Maguire JD, Wongsrichanalai C, Riddle MS, Tribble DR. Detection of enteropathogens associated with travelers' diarrhea using a multiplex Luminex-based assay performed on stool samples smeared on Whatman FTA Elute cards. Diagn Microbiol Infect Dis. 2015 May 27.

TravMil Executive Summary - Deployment

TravMil Executive Summary - Non-Deployment

Presentations

Lalani T, Tribble D, Maguire JD, Grant E, Fraser J, Johnson M, Ganesan A, Burgess T, Hickey PW. Pre-travel health care for pediatric travelers: Experience from the TravMil Cohort. Poster presentation. American Society of Tropical Medicine and Hygiene, 2-7 November 2014, New Orleans, LA.

Tisdale M.  PCR detection of travelers’ diarrhea pathogens: Overview of preliminary testing and future development. ASTMH 2014. Oral presentation. American Society of Tropical Medicine and Hygiene, 2-7 November 2014, New Orleans, LA. (Presented)

Lalani T, Johnson M, Grant E, Tribble D, Maguire JD, Fraser J, Ganesan A, Burgess T, KronmannK. Travel related vaccination coverage rates in a cohort of Department of Defense beneficiaries seeking pre-travel health care. Poster presentation. American Society of Tropical Medicine and Hygiene, 2-7 November 2014, New Orleans, LA. (Presented)

St.Clair K, Lalani T, Grant E, Johnson M, Tribble D, Maguire JD, Fraser J, Burgess T, Riddle M, Maves R, Deiss R, Coyne P, Ganesan A. Utilization of pre-travel clinic for administration of routine vaccinations in adults: a lost opportunity? Poster presentation. Infectious Disease Society of America ID Week, 8-12 October 2014, Philadelphia, PA. (Presented)

Hulseberg C, Koech M, Odundo E, Swierczewski B, Danboise B, Tisdale M, Lalani T, Tribble D, Fraser J, Connor P, Riddle M. Etiologies of acute diarrhea pathogens in British Military training population in Kenya. Poster presentation. Vaccines for Enteric Diseases, 8-10 July 2015, Edinburgh, UK.

Lindholm DA, Grant EM, Myers T, PhD; Kalyani Telu K, Fairchok M, Ganesan A, Johnson MD, Kunz A, Tribble DR, Lalani T, Yun H. Traveler Demographics, Characteristics of Travel, Personal Protective Measure Use, Mosquito Exposure, and Chikungunya Seroconversion during the Outbreak in the Americas. Poster presentation. ID Week, A Joint Meeting of IDSA, SHEA, HIVMA, and PIDS, 7-11 October 2015, San Diego, CA.

Lalani T, Johnson MD, Ganesan A, Yun H, Fraser J, Grant E, Burgess T, Tribble D, Deiss RG. Comparing the use of personal protective measures for mosquito-avoidance during travel to regions with dengue or chikungunya activity, and regions endemic for Plasmodium falciparum malaria. Poster presentation. American Society of Tropical Medicine and Hygiene, 25-29 October 2015, Philadelphia, PA.

Lalani T, Riddle M, Johnson MD, Ganesan A, Yun H, Fraser J, Grant E, Burgess T, Tribble D. Effectiveness of Loperamide Monotherapy for Self-Treatment of Moderate or Severe Acute Watery Diarrhea. Oral presentation. American Society of Tropical Medicine and Hygiene, 25-29 October 2015, Philadelphia, PA.

Simons MP, Soto G, Reyes F, Reynolds N, Fraser J, Aviles R, Wolken D, Tribble D, Gutierrez R, and Riddle M. Prevalence of Acute Gastroenteritis among U.S. Military Personnel Deployed to Honduras during 2014-2015. Poster presentation. American Society of Tropical Medicine and Hygiene, 25-29 October 2015, Philadelphia, PA.