Back to Top Skip to main content Skip to sub-navigation

Commentary: The Limited Role of Vaccines in the Prevention of Acute Gastroenteritis

Image of Illustration of drug-resistant, Shigella sp. bacteria. This is a medical illustration of drug-resistant, Shigella sp. bacteria, presented in the Centers for Disease Control and Prevention (CDC) publication entitled, Antibiotic Resistance Threats in the United States, 2019 (Content provider: CDC/Antibiotic Resistance Coordination and Strategy Unit; Photo credit: CDC/Stephanie Rossow).

Recommended Content:

Medical Surveillance Monthly Report

Acute gastroenteritis is associated with sudden onset of disturbances in gastrointestinal function such as nausea, vomiting, diarrhea (sometimes bloody), abdominal cramps, and fever. The illness typically lasts less than 2 weeks and is most commonly associated with an infectious etiology. Treatment with antibiotics and anti-motility agents may be indicated depending upon the causative infectious agent and the severity of symptoms. Acute gastroenteritis is very common and is estimated to cause 179 million cases, over 470,000 hospitalizations, and over 5,000 deaths among U.S. residents each year.1 People usually acquire the infectious agents (bacteria, viruses, or protozoa) via the ingestion of contaminated food or water or direct person-to-person contact. Although developed nations have reduced the risks of exposure to gastrointestinal pathogens by building infrastructures of sanitary systems for water distribution and sewage disposal, transmission via contaminated food and water remains common.

In military populations, the threat of gastroenteritis is enhanced when personnel are serving in field settings as part of training, deployment, or in theaters of combat. The efforts of military preventive medicine and environmental health assets focus on minimizing the risks of food-borne and waterborne disease not only in the peacetime settings of congregate housing and field training but also in the austere settings of combat. Although such preventive measures are effective, they do not prevent all gastrointestinal illness.

Immunizations provide a powerful class of defense against infectious diseases. Although vaccines protecting against at least 30 different infectious diseases have been approved by the U.S. Food and Drug Administration (FDA) on the basis of evidence of safety and effectiveness, only 2 of those vaccines (cholera, rotavirus) offer the prospect of an immunological defense against a specific cause of gastroenteritis.2

The FDA-approved cholera vaccine is a live, orally administered vaccine that offers protection against the Vibrio cholerae O1 strain, a bacterium capable of causing gastroenteritis at the more severe end of the spectrum (i.e., cholera).3 Cholera vaccine is not a routinely administered vaccine, and no country or territory currently requires vaccination against cholera as a condition of entry for visitors. The Advisory Committee for Immunization Practices and the Centers for Disease Control and Prevention recommend cholera vaccine for individuals 18–64 years of age who reside in an area with endemic cholera or who will travel to an area that is experiencing a cholera outbreak or that has a high risk of cholera because of a humanitarian crisis.3 There are also 3 other oral vaccines for cholera that are not approved for use in the U.S. These vaccines are killed vaccines and they require 2 doses at least a week apart for full protection.3

Rotavirus-caused gastroenteritis affects nearly all children by the time they reach the age of 5 in both developed and underdeveloped regions around the world.4 The live, oral vaccine must be given in 2 or 3 doses, depending upon the brand of vaccine used. The first dose should be administered before 14 weeks and 6 days of age and the last dose by 8 months and 0 days of age. The vaccine is not indicated for adults.5

The better-recognized bacterial species associated with gastroenteritis are members of the genera Escherichia, Salmonella, Shigella, Campylobacter, Clostridium, Staphylococcus, Bacillus, Yersinia, and Vibrio. Except for V. cholerae, there are no vaccines for any of these bacteria. Protozoan causes of gastroenteritis are less commonly identified than the bacterial and viral causes, but there are no vaccines for the more common protozoans (i.e., Giardia, Cryptosporidium, and Cyclospora). There are numerous viral causes of gastroenteritis, but the best known are the caliciviruses (including noroviruses), astroviruses, and rotaviruses. Except for the rotavirus vaccine, there are no FDA-approved vaccines to protect against the viral causes of acute gastroenteritis. It has been estimated that noroviruses are the cause of about one-third of all cases of gastroenteritis in the U.S., so an efficacious norovirus vaccine has been the subject of much research to date.6 The quest for a norovirus vaccine or vaccines has proven especially challenging because of the relatively short period of immunity following a clinically significant infection, the heterogeneity of strains of norovirus, and the inability to culture the virus in the laboratory.6 Despite these challenges, several norovirus vaccine candidates are currently being evaluated in human clinical trials, including a study of a bivalent vaccine in military recruits.7

The incidence rates of most types of acute infectious gastroenteritis are not susceptible to reduction by vaccines. The prevention of gastroenteritis (and other diseases) spread through fecal contamination of water, food, or fomites depends upon diligent implementation of the wide spectrum of measures that constitute sanitation, hygiene, environmental health, food safety, and disease surveillance. Responsibilities in these areas fall to government agencies, suppliers of food and water, educators, public health authorities, healthcare providers, parents, and individuals.

A current review of required immunizations for Department of Defense personnel by Combatant Command is available at https://health.mil/Military-Health-Topics/Health-Readiness/Immunization-Healthcare/Vaccine-Recommendations/Vaccine-Recommendations-by-AOR.

Author affiliations: GDIT contracted to the Armed Forces Health Surveillance Branch, Defense Health Agency, Silver Spring, MD (Dr. O'Donnell); Immunization Healthcare Branch, Public Health Division, Defense Health Agency, Falls Church, VA (Col Rans).

REFERENCES

1. Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM. Foodborne illness acquired in the United States—unspecified agents. Emerg Infect Dis. 2011;17(1):16–22.

2. U.S. Food and Drug Administration. Vaccines licensed for use in the United States. https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states. Accessed 21 February 2020.

3. Centers for Disease Control and Prevention. Cholera–Vibrio cholerae infection. Vaccines. https://www.cdc.gov/cholera/vaccines.html. Accessed 21 February 2020.

4. Dormitzer PR. Rotaviruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:1854–1864.

5. Centers for Disease Control and Prevention. Rotavirus vaccination: information for health care professionals. https://www.cdc.gov/vaccines/vpd/rotavirus/hcp/index.html. Accessed 3 January 2020.

6. O’Ryan M, Vidal R, del Canto F, Salazar JC, Montero D. Vaccines for viral and bacterial pathogens causing acute gastroenteritis: Part I: Overview, vaccines for enteric viruses and Vibrio cholerae. Hum Vaccin Immunother. 2015;11(3):584–600.

7. Mattison CP, Cardemil CV, Hall AJ. Progress on norovirus vaccine research: public health considerations and future directions. Expert Rev Vaccines. 2018;17(9):773–784.

You also may be interested in...

Exertional Heat Illness at Fort Benning, GA: Unique Insights from the Army Heat Center

Article
4/1/2022
Navy Petty Officer 3rd Class Ryan Adams is being used as an example victim for cooling a heat casualty at the bi-annual hot weather standard operating procedure training aboard Marine Corps Base Camp Lejeune, N.C., Aug. 24. Adams is demonstrating the "burrito" method used to cool a heat related injury victim. Photo by Pfc. Joshua Grant.

Exertional heat illness (hereafter referred to as heat illness) spans a spectrum from relatively mild conditions such as heat cramps and heat exhaustion, to more serious and potentially life-threatening conditions such as heat injury and exertional heat stroke (hereafter heat stroke).

Recommended Content:

Medical Surveillance Monthly Report

Exertional Hyponatremia, Active Component, U.S. Armed Forces, 2006–2021

Article
4/1/2022
Marine Corps Cpl. Luis Alicea drinks water after a combat conditioning exercise at Naval Air Station Joint Reserve Base New Orleans, May 20, 2019. Photo By: Marine Corps Lance Cpl. Jose Gonzalez.

Exertional (or exercise-associated) hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 mEq/L) that develops during or up to 24 hours following prolonged physical activity. Acute hyponatremia creates an osmotic imbalance between fluids outside and inside of cells.

Recommended Content:

Medical Surveillance Monthly Report

Exertional Rhabdomyolysis, Active Component, U.S. Armed Forces, 2017–2021

Article
4/1/2022
The Embry-Riddle Army ROTC Ranger Challenge team heads out on the 12-mile road march after completing the timed obstacle course event of the 6th Brigade Army ROTC Ranger Challenge January 14, 2022 at Fort Benning, Ga. The Titan Brigade’s Ranger Challenge took place at Fort Benning, Ga. January 13-15, 2022. Photo by Capt. Stephanie Snyder

Exertional rhabdomyolysis is a potentially serious condition that requires a vigilant and aggressive approach. Some service members who experience exertional rhabdomyolysis may be at risk for recurrences, which may limit their military effectiveness and potentially predispose them to serious injury.

Recommended Content:

Medical Surveillance Monthly Report

Heat Illness, Active Component, U.S. Armed Forces, 2021

Article
4/1/2022
Airmen participate in the 13th Annual Fallen Defender Ruck March at Joint Base San Antonio, Nov. 6, 2020. The event honors 186 fallen security forces, security police and air police members who have made the ultimate sacrifice. Photo By: Sarayuth Pinthong, Air Force.

From 2020 to 2021, the rate of incident heat stroke was relatively stable while the rate of heat exhaustion increased slightly

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Medical Separation from Service Among Incident Cases of Osteoarthritis and Spondylosis, Active Component, U.S. Armed Forces, 2016–2020

Article
3/1/2022
Marines hike to the next training location during Exercise Baccarat in Aveyron, Occitanie, France, Oct.16, 2021. Exercise Baccarat is a three-week joint exercise with Marines and the French Foreign Legion that challenges forces with physical and tactical training. Photo By: Marine Corps Lance Cpl. Jennifer Reyes

Osteoarthritis (OA) is the most common adult joint disease and predominantly involves the weight-bearing joints. This condition, including spondylosis (OA of the spine), results in significant disability and resource utilization and is a leading cause of medical separation from military service.

Recommended Content:

Medical Surveillance Monthly Report

Brief report: Using syndromic surveillance to monitor MIS-C associated with COVID-19 in Military Health System beneficiaries

Article
3/1/2022
Air Force 1st Lt. Anthony Albina, a critical care nurse assigned to Joint Base Andrews, Md., checks a patient’s breathing and heart rate during an intubation procedure while supporting COVID-19 response operations in Cleveland, Jan. 20, 2022.

SARS CoV-2 and the illness it causes, COVID-19, have exacted a heavy toll on the global community. Most of the identified disease has been in the elderly and adults. The goal of this analysis was to ascertain if user-built ESSENCE queries applied to records of outpatient MHS health care encounters are capable of detecting MIS-C cases that have not been identified or reported by local public health departments.

Recommended Content:

Medical Surveillance Monthly Report

Obesity prevalence among active component service members prior to and during the COVID-19 pandemic, January 2018–July 2021

Article
3/1/2022
Maintaining a healthy weight is important for military members to stay fit to fight. The body mass index is a tool that can be used to determine if an individual is at an appropriate weight for their height. A person’s index is determined by their weight in kilograms divided by the square of height in meters. (U.S. Air Force photo illustration by Airman 1st Class Destinee Sweeney)

This study examined monthly prevalence of obesity and exercise in active component U.S. military members prior to and during the COVID-19 pandemic. These results suggest that the COVID-19 pandemic had a small effect on the trend of obesity in the active component U.S. military and that obesity prevalence continues to increase.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Refractive Surgery Trends at Tri-Service Refractive Surgery Centers and the Impact of the COVID-19 Pandemic, Fiscal Years 2000–2020

Article
3/1/2022
Cadet Saverio Macrina, U.S. Military Academy West Point, receives corneal cross-linking procedure at Fort Belvoir Community Hospital, Va., Nov. 21, 2016. (DoD photo by Reese Brown)

Since the official introduction of laser refractive surgery into clinical practice throughout the Military Health System (MHS) in fiscal year 2000, these techniques have been heavily implemented in the tri-service community to better equip and improve the readiness of the U.S. military force.

Recommended Content:

Medical Surveillance Monthly Report

Update: Malaria, U.S. Armed Forces, 2021

Article
3/1/2022
Mosquitos – like this one, collected as part of a military study in North Carolina – were used during USAMRDC’s initial RTS,S vaccine studies nearly 40 years ago. (Photo courtesy: AFC Kimberly Barrera)

Malaria infection remains an important health threat to U.S. service members who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. In 2021, a total of 20 service members were diagnosed with or reported to have malaria.

Recommended Content:

Medical Surveillance Monthly Report

A new approach to categorization of ocular injury among U.S. Armed Forces

Article
2/1/2022
Air Force and Space Force Surgeon General Lt. Gen. Dorothy Hogg receives an eye exam from Air Force Reserve Maj. Leslie Wilderson at Joint Base Anacostia-Bolling, Washington, D.C., March 26, 2021. Photo By: Air Force Staff Sgt. Kayla White

Ocular injuries present an ongoing threat to readiness and retention of service members. This report describes a new approach to categorizing ocular injury using Military Health System data, the application of an algorithm to a dataset, and the verification of the results using an audit of clinical data.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Health care burden attributable to osteoarthritis and spondylosis, active component, U.S. Armed Forces, 2016–2020

Article
2/1/2022
Air Force security forces trainees climb a hill during a 3-mile ruck march to commemorate National Police Week at Joint Base San Antonio, May 13, 2019. Photo By: Sarayuth Pinthong, Air Force

This snapshot summarizes the total numbers of inpatient and outpatient encounters with an OA or spondylosis diagnosis in the first diagnostic position and the total numbers of unique individuals affected by these conditions during the same 5-year surveillance period.

Recommended Content:

Medical Surveillance Monthly Report

Diagnosis of hepatitis C infection and cascade of care in the active component, U.S. Armed Forces, 2020

Article
2/1/2022
Navy Petty Officer 2nd Class Cecil Dorse, left, and Navy Petty Officer 3rd Class Janet Rosas test blood samples aboard the Military Sealift Command hospital ship USNS Comfort while the ship is in New York City in support of the nation’s COVID-19 response, April 6, 2020. Photo By: Navy Petty Officer 2nd Class Sara Eshleman

Hepatitis C virus (HCV) infection rates are rising in the U.S. despite widely available tools to identify and effectively treat nearly all of these cases. This cross-sectional study aimed to use laboratory data to evaluate the prevalence of HCV diagnoses among active component U.S. military service members.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Lengths of Hospital Stays for Service Members Diagnosed with Sepsis, Active Component, U.S. Armed Forces, 2011–2020

Article
1/1/2022
The (left to right) Senior Airman Austin Shrewsbury, 88th Diagnostics and Therapeutic Squadron medical laboratory technician, works with student, Airman 1st Class Taylor Altman, 88th Diagnostics and Therapeutic Squadron medical laboratory technician, to identify bacteria of patient’s cultures inside the microbiology laboratory at Wright-Patterson Air Force Base medical center June 30, 2017.

Sepsis is a serious and life-threatening organ dysfunction caused by a dysregulated host response to infection. In the U.S., sepsis is a leading cause of in-hospital mortality and 1 of the most expensive conditions treated in U.S. hospitals.

Recommended Content:

Medical Surveillance Monthly Report

Description of a COVID-19 Beta Variant Outbreak, Joint Base Lewis-McChord, WA, February–March 2021

Article
1/1/2022
U.S. Army Soldiers from 1-17th Infantry Battalion, 2nd Stryker Brigade, 2nd Infantry Division, clear an objective during the training exercise Bayonet Focus 19-02 at Yakima Training Center, Wash., May 6, 2019. Bayonet Focus is a training exercise designed to assess Soldiers’ ability to preform tasks and complete objectives under conditions experienced during combat situations. (U.S. Army photo by Spc. Angel Ruszkiewicz)

This report describes an outbreak of SARS-CoV-2, the causative agent of COVID-19, that peaked during 21–26 February 2021 and was tied to a single military training event. A total of 143 laboratory-confirmed cases were identified.

Recommended Content:

Medical Surveillance Monthly Report

COVID-19 and Depressive Symptoms Among Active Component U.S. Service Members, January 2019–July 2021

Article
1/1/2022
With the holiday season upon us, the cold, dark days that winter brings, and the social distancing and movement restrictions brought about by COVID-19, it’s not uncommon for people to feel depressed. (Photo by Erin Bolling)

This study examined the rates of depressive symptoms in active component U.S. service members prior to and during the COVID-19 pandemic and evaluated whether SARS-CoV-2 test results (positive or negative) were associated with self-reported depressive symptoms.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 12
Refine your search
Last Updated: September 14, 2020

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.