Infectious diseases during the European Union training mission Mali (EUTM MLI) – a four-year experience

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Abstract

Background

The European Union Training Mission Mali (EUTM MLI) is a multinational military training deployment to the Western African tropical nation of Mali. Based on routinely collected disease and non-battle injury surveillance data, this study quantifies the true impact of infectious diseases for this tropical mission and potential seasonal variations in infectious disease threats.

Methods

Categorized health events during the EUTM MLI mission and associated lost working days were reported using the EpiNATO-2 report. Infection-related health events were descriptively analyzed for a 4-year period from the 12th week in 2013 to the 13th week in 2017. Aggregated EpiNATO-2 data collected from all missions other than EUTM MLI were used as a comparator.

Results

Among the infectious diseases reported by EUTM MLI, non-severe upper respiratory infections and gastrointestinal diseases dominated quantitatively, accounting for 1.65 and 1.42 consultations per 100 person-weeks, respectively. The number of recorded infectious disease-associated lost working days during the whole study interval was 723. Seasonal changes in disease frequency were detectable. More gastrointestinal infections were seen in the rainy season, and more respiratory infections occurred in the dry season; these were associated with peaks of more than 2.5 consultations per 100 person-weeks for both categories.

Conclusions

Despite initial concerns focused on tropical infectious diseases during this mission in tropical Mali, upper respiratory tract and gastrointestinal infections predominate. The relatively low number of reported lost working days may indicate that these infections are at the milder end of the spectrum of infectious diseases despite a likely reporting bias.

Electronic supplementary material

The online version of this article (10.1186/s40779-018-0166-5) contains supplementary material, which is available to authorized users.

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Most cited references 26

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Latitudinal Variations in Seasonal Activity of Influenza and Respiratory Syncytial Virus (RSV): A Global Comparative Review

Kimberly Bloom-Feshbach, Wladimir J Alonso, Vivek Charu … (2013)

Background There is limited information on influenza and respiratory syncytial virus (RSV) seasonal patterns in tropical areas, although there is renewed interest in understanding the seasonal drivers of respiratory viruses. Methods We review geographic variations in seasonality of laboratory-confirmed influenza and RSV epidemics in 137 global locations based on literature review and electronic sources. We assessed peak timing and epidemic duration and explored their association with geography and study settings. We fitted time series model to weekly national data available from the WHO influenza surveillance system (FluNet) to further characterize seasonal parameters. Results Influenza and RSV activity consistently peaked during winter months in temperate locales, while there was greater diversity in the tropics. Several temperate locations experienced semi-annual influenza activity with peaks occurring in winter and summer. Semi-annual activity was relatively common in tropical areas of Southeast Asia for both viruses. Biennial cycles of RSV activity were identified in Northern Europe. Both viruses exhibited weak latitudinal gradients in the timing of epidemics by hemisphere, with peak timing occurring later in the calendar year with increasing latitude (P<0.03). Time series model applied to influenza data from 85 countries confirmed the presence of latitudinal gradients in timing, duration, seasonal amplitude, and between-year variability of epidemics. Overall, 80% of tropical locations experienced distinct RSV seasons lasting 6 months or less, while the percentage was 50% for influenza. Conclusion Our review combining literature and electronic data sources suggests that a large fraction of tropical locations experience focused seasons of respiratory virus activity in individual years. Information on seasonal patterns remains limited in large undersampled regions, included Africa and Central America. Future studies should attempt to link the observed latitudinal gradients in seasonality of viral epidemics with climatic and population factors, and explore regional differences in disease transmission dynamics and attack rates.

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An explanation for the seasonality of acute upper respiratory tract viral infections.

R. ECCLES (2002)

Despite a great increase in our understanding of the molecular biology of the viruses associated with acute upper respiratory tract viral infections (URTIs) there is a remarkable lack of knowledge and ideas about why URTI should exhibit a seasonal incidence. Most publications in this area either acknowledge a complete lack of any explanation for the seasonality of URTI or put forward an explanation relating to an increased "crowding" of susceptible persons in winter. This review will discuss some of the ideas concerning the seasonality of URTI and put forward a new hypothesis for discussion, namely that seasonal exposure to cold air causes an increase in the incidence of URTI due to cooling of the nasal airway. The hypothesis is supported by literature reports demonstrating that inhalation of cold air causes cooling of the nasal epithelium, and that this reduction in nasal temperature is sufficient to inhibit respiratory defences against infection such as mucociliary clearance and the phagocytic activity of leukocytes. A case is also made to suggest that warming of the nasal airway during fever and nasal congestion may help to resolve a current URTI.

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Acute and potentially life-threatening tropical diseases in western travelers--a GeoSentinel multicenter study, 1996-2011.

O Freedman, Mogens Jensenius, Eli Schwartz … (2013)

We performed a descriptive analysis of acute and potentially life-threatening tropical diseases among 82,825 ill western travelers reported to GeoSentinel from June of 1996 to August of 2011. We identified 3,655 patients (4.4%) with a total of 3,666 diagnoses representing 13 diseases, including falciparum malaria (76.9%), enteric fever (18.1%), and leptospirosis (2.4%). Ninety-one percent of the patients had fever; the median time from travel to presentation was 16 days. Thirteen (0.4%) patients died: 10 with falciparum malaria, 2 with melioidosis, and 1 with severe dengue. Falciparum malaria was mainly acquired in West Africa, and enteric fever was largely contracted on the Indian subcontinent; leptospirosis, scrub typhus, and murine typhus were principally acquired in Southeast Asia. Western physicians seeing febrile and recently returned travelers from the tropics need to consider a wide profile of potentially life-threatening tropical illnesses, with a specific focus on the most likely diseases described in our large case series.

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Author and article information

Contributors

Hagen Frickmann:

ORCID: http://orcid.org/0000-0002-8967-9528

Frickmann@bnitm.de

Journal

Journal ID (nlm-ta): Mil Med Res

Journal ID (iso-abbrev): Mil Med Res

Title: Military Medical Research

Publisher: BioMed Central (London )

ISSN (Print): 2095-7467

ISSN (Electronic): 2054-9369

Publication date (Electronic): 31 May 2018

Publication date PMC-release: 31 May 2018

Publication date Collection: 2018

Volume: 5

Electronic Location Identifier: 19

Affiliations

[1 ]ISNI 0000 0000 8715 7852, GRID grid.452235.7, Department of Microbiology and Hospital Hygiene, , Bundeswehr Hospital Hamburg, ; Bernhard Nocht Str. 74, 20359 Hamburg, Germany

[2 ]ISNI 0000000121858338, GRID grid.10493.3f, Institute for Medical Microbiology, Virology and Hygiene, , University Medicine Rostock, ; Schillingallee 70, 18057 Rostock, Germany

[3 ]Department of Preventive Medicine, Bundeswehr Medical Academy, Neuherbergstraße 11, 80937 Munich, Germany

[4 ]NATO Center of Excellence for Military Medicine (MilMedCOE), Deployment Health Surveillance Capability (DHSC), Dachauer Str. 128, 80637 Munich, Germany

[5 ]ISNI 0000 0004 1936 973X, GRID grid.5252.0, Institute of Medical Information Processing, Biometry and Epidemiology, , LMU Munich, ; Marchionini-Str. 15, 81377 Munich, Germany

Author information

Hagen Frickmann http://orcid.org/0000-0002-8967-9528

Article

Publisher ID: 166

DOI: 10.1186/s40779-018-0166-5

PMC ID: 5977544

PubMed ID: 29848381

SO-VID: b7d06d92-2417-42f0-b20e-ac193f3b1c8f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 24 October 2017

Date accepted : 15 May 2018

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Keywords: tropical deployment,infectious diseases,tropical medicine,gastrointestinal infections,upper respiratory tract infections,mali

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Keywords: tropical deployment, infectious diseases, tropical medicine, gastrointestinal infections, upper respiratory tract infections, mali

Infectious diseases during the European Union training mission Mali (EUTM MLI) – a four-year experience

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China Tropical Medicine

Most cited references 26

Latitudinal Variations in Seasonal Activity of Influenza and Respiratory Syncytial Virus (RSV): A Global Comparative Review

An explanation for the seasonality of acute upper respiratory tract viral infections.

Acute and potentially life-threatening tropical diseases in western travelers--a GeoSentinel multicenter study, 1996-2011.

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