EI surveillance projects address the prevalence of etiologic agents causing acute gastroenteritis or travelers' diarrhea to protect the force and improve readiness through:

• Surveillance in the U.S. military, including recruit, shipboard, and deployed populations, and in foreign military and civilian populations
• Estimation of disease burden and identification of high-risk populations
• Characterization of changes in pathogen etiology, including understanding drug resistance patterns

Importance of EI Surveillance within the U.S. Military

Modern advances in public health (e.g., improved water, sanitation, and hygiene conditions; development and dissemination of vaccines; and antimicrobials to treat infection) have all led to a decline in infectious diarrhea. However, acute gastroenteritis (AGE) remains a significant threat to travelers, including military personnel.

U.S. military personnel must be ready to deploy to austere environments where the risk of exposure to enteric diseases may be significant. In these environments, routine preventive health efforts are often either impractical or inadequate and enteric diseases can rapidly spread through units. AGE has played a significant role in the outcomes of military campaigns throughout history, and diarrheal illness continues to threaten operational capability through mission degradation and lost man-hours. Studies have shown diarrhea incidence among U.S. troops deployed during Operation Iraqi Freedom and Operation Enduring Freedom outpaces respiratory illness and injury, highlighting the need for improved surveillance to prevent, detect, and respond to EI disease threats.

EI Focus Area Strategy

• Provide timely, accurate, and actionable EI surveillance data for decision makers within the DOD and global public health community
• Estimate prevalence of common enteric pathogens in U.S. military populations, adult travelers, and military and civilian populations of partner nations
• Proactively assess potential EI threats to U.S. military members by summarizing region specific pathogen etiology and antimicrobial resistance rates within the military, and when unavailable, civilian travelers
• Provide support for outbreaks of EIs as requested by U.S. government or partners

Pathogens of interest include:

• Bacteria: Campylobacter species, Salmonella enterica, Shigella species, and diarrheagenic Escherichia coli, including pathotypes Enterotoxigenic E. coli (ETEC), Enteroaggregative E. coli (EAEC), Enterohemorrhagic E. coli (EHEC), and Enteroinvasive E. coli (EIEC), Enteropathogenic E. coli (EPEC)
• Viruses: Norovirus (NoV) and enteric adenoviruses
• Parasites: Entamoeba histolytica, Giardia lamblia, Cyclospora cayetanesis, and Cryptosporidium parvum

EI Focus Area Activities

• EI surveillance focusing on immuno-naïve populations in U.S. military members in all geographic combatant commands, including recruit, shipboard, and deployed populations
• Standardization of case definitions for enteric diseases, harmonization of laboratory methods for identification of enteric pathogens, and characterization of antimicrobial resistance patterns
• Advanced characterization and antimicrobial suspectibility testing of endemic and novel pathogens
• Detection of emerging pathogens in previously tested "pathogen-negative" stool samples

What's New in the EI Focus Area for FY20

The EI focus area provides approximately $6 million of funding to support partner projects.

New projects include:

• Surveillance work conducted by the 65th MED BDE examining antimicrobial resistance (AR) in food-source pathogens utilizing MinION technology and comparing these findings to pathogen and resistance trends from human AGE specimens
• AGE surveillance at Camp Lemonnier, Djibouti describing impact of diarrheal illness on Service member performance
• Campylobacter isolates from AGE patients within MTFs sequenced by MRSN to inform AR trends of this pathogen of serious concern

Where We're Going

• Implementing standard operating procedures for multipathogen platform technologies
• Enhancing harmonized reporting of antimicrobial susceptibilities of bacterial pathogens detected through the Global Travelers' Diarrhea Study
• Expanding surveillance among U.S. military populations, particularly in military treatment facilities that empirically treat diarrheal illness

See what GEIS is doing to combat antimicrobial resistant infections and sexually transmitted infections, febrile and vector-borne infections, and respiratory infections.

If you are involved with the DOD medical community and are interested in partnering with GEIS, or if you would like more information, please email us.