scientific data on long-term adverse health outcomes related to the infectious diseases it selected for study.

The final step in the committee’s evaluation process was to weigh the evidence on the infectious diseases and their long-term adverse health outcomes and to develop conclusions about the strength of the evidence. The conclusions are assigned to categories of association, which range from sufficient evidence of a causal relationship to insufficient or inadequate evidence of an association.

This report includes discussion of acute diseases with potential long-term adverse health outcomes caused by known pathogens. The committee acknowledges that there might be clinically important pathogens that cannot be detected with available cultivation techniques (Relman 2002). Because the extent to which such pathogens might contribute to acute illnesses in military personnel is unknown, it is not possible to define a relationship between them and an acute illness or long-term adverse health outcome.


Chapter 2 lays out the committee’s process for selecting the infectious diseases to study and reviewing and evaluating the evidence on them. Chapter 3 presents, in tabular format, the endemic infectious diseases of southwest and south-central Asia that are known to have long-term adverse health outcomes. Chapter 4 summarizes the body of literature on infectious diseases that have been diagnosed in military personnel serving in the Gulf War, OIF, and OEF. The committee’s comprehensive evaluations of selected infectious diseases are presented in Chapter 5, which also contains the committee’s conclusions. The final chapter, Chapter 6, presents information about diseases and agents of special concern to veterans of the Gulf War, OIF, and OEF that have an infectious component or have been implicated as a cause of “Gulf War illness”.


DOD (Department of Defense). 2006. US Department of Defense Official Website. [Online]. Available: [accessed March 2006].

Hyams KC, Hanson K, Wignall FS, Escamilla J, Oldfield EC, 3rd. 1995. The impact of infectious diseases on the health of US troops deployed to the Persian Gulf during operations Desert Shield and Desert Storm. Clinical Infectious Diseases 20(6):1497-1504.

Hyams KC, Riddle J, Trump DH, Graham JT. 2001. Endemic infectious diseases and biological warfare during the Gulf War: A decade of analysis and final concerns. American Journal of Tropical Medicine and Hygiene 65(5):664-670.

IOM (Institute of Medicine). 2000. Gulf War and Health, Volume 1: Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines. Washington, DC: National Academy Press.

IOM. 2003. Gulf War and Health, Volume 2: Insecticides and Solvents. Washington, DC: The National Academies Press.

IOM. 2004. Gulf War and Health: Updated Literature Review of Sarin. Washington, DC: The National Academies Press.

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