INDEX
A
Acinetobacter baumannii, 3, 29
clinical manifestations of active TB, 141–142
coinfection with TB and HIV, 142
primary TB vs reactivation TB, 140
relapse, 144
sufficient evidence of a causal relationship involving, 4, 142, 144
sufficient evidence of an association involving, 5
treatment, 142
Acute Al Eskan disease, 182
Acute Campylobacter infection, 103–104
diagnosis during and after, 104
Guillain-Barré syndrome, 104–105
long-term adverse health outcomes, 104–107
treatment, 104
uveitis, 107
Acute flaccid paralysis (AFP), 151, 154
Acute idiopathic acute eosinophilic pneumonia, 183
Acute inflammatory demyelinating polyneuropathy (AIDP), 105, 127–128
Acute malaria, 125
Acute motor axonal neuropathy (AMAN), 105
Acute nontyphoidal Salmonella infection, 109
diagnosis, 109
Salmonella bacteremia, 109
Salmonella gastroenteritis, 109
treatment, 109
atypical presentations, 131
Coxiella burnetii hepatitis, 130–131
Coxiella burnetii pneumonia, 130
treatment for, and related long-term toxicity, 131
Acute respiratory distress syndrome (ARDS), 83
Acute Shigella infection, 111
diagnosis, 111
treatment, 111
Acute West Nile fever, 151
Adverse health outcomes. See Long-term adverse health outcomes
AFP. See Acute flaccid paralysis
AIDP. See Acute inflammatory demyelinating polyneuropathy
AIDS, 190.
See also Coinfections with HIV
Al Eskan disease, 28–29, 181–183
description of acute illness, 182
long-term adverse health outcomes, 182
pathogenesis, 182
treatment, 183
AMAN. See Acute motor axonal neuropathy
Amnesia, limited or suggestive evidence of an association involving, 6
Ankylosing spondylitis, 110–111
Anopheles mosquito, 124
Anthrax, 194
Antimicrobial susceptibility, 65
ARDS. See Acute respiratory distress syndrome
Armed Forces Institute of Pathology, 85, 182
Army Medical Surveillance Activity, 61, 82
Arthritis
in chronic brucellosis, 116
sufficient evidence of an association involving, 5, 116
Attributions to military service in southwest and south-central Asia, 24–26
B
charge to the Committee on Gulf War and Health:Infectious Diseases, 13, 15–16
identifying infectious diseases to study, 13–14
Bacterial diseases, 2, 21–22, 25–26, 36–44
antibiotic-resistant or common nosocomial infections, 44
endemic to southwest and south-central Asia that have long-term adverse health outcomes, 36–44
more prevalent in southwest and south-central Asia than in the US, 36–41
not more prevalent in southwest and south-central Asia than in the US, 42–44
of special concern to US troops or veterans, 41
against which all military personnel were immunized and vaccines are highly or fully protective, 41
against which all military personnel were immunized and vaccines are partly protective, 42
BAMC. See Brooke Army Medical Center
Benign intracranial hypertension, 131
coinfection, 115
diagnosis in US troops serving in the Gulf War, OEF, or OIF, 84–85
limited or suggestive evidence of an association involving, 6, 117
long-term adverse health outcomes, 115–118
sufficient evidence of an association involving, 5, 116–117
transmission and endemicity, 113–114
treatment for, and related long-term toxicity, 115
BW. See Biologic-warfare agents
C
Campylobacter infection, 1, 3, 103–107
endemicity in southwest and south-central Asia, 103
limited or suggestive evidence of an association involving, 6, 107
transmission, 103
Cardiovascular system infections
in chronic brucellosis, 117
sufficient evidence of an association involving, 5, 117
Centers for Disease Control and Prevention (CDC), 61, 110
Chicken pox (varicella), diagnosis in US troops serving in the Gulf War, OEF, or OIF, 85
Choroiditis, multifocal, 6, 117
arthritis, 116
cardiovascular system infections, 117
diagnosis, 115
genitourinary tract manifestations, 117
hepatic involvement, 116
neurologic involvement, 116–117
ophthalmologic involvement, 117
other symptoms, 118
respiratory system infections, 118
Chronic hepatitis, sufficient evidence of an association involving, 5, 134
Chronic osteomyelitis, 187
Chronic sequelae of Coxiella burnetii infection, 132–135
chronic hepatitis, 134
endocarditis, 133
osteomyelitis, 134
post-Q fever fatigue syndrome, 134–135
vascular infection, 134
CL. See Cutaneous leishmaniasis
pulmonary, 141
tuberculosis pleurisy, 142
Coinfections with brucellosis, 115
Coinfections with HIV
active tuberculosis, 142
leishmaniasis, 122
malaria, 126
nontyphoidal Salmonella infection, 109–110
Plasmodium spp., 126
Combat Support Hospital, 187
Committee on Gulf War and Health:
Infectious Diseases, 1
charge to, 13
Complications, of acute Q fever, 132
inadequate or insufficient evidence to determine whether an association exists, 6
limited or suggestive evidence of an association, 6
limited or suggestive evidence of no association, 7
sufficient evidence of a causal relationship, 4
sufficient evidence of an association, 5–6
Coxiella burnetii infections
chronic sequelae of, 1, 132–135
limited or suggestive evidence of an association involving, 6, 135
pneumonia, 130
sufficient evidence of a causal relationship involving, 4, 134
sufficient evidence of an association involving, 5, 133–134
Cutaneous leishmaniasis (CL), 118
D
Deafness, limited or suggestive evidence of an association involving, 6, 117
Demyelinating meningovascular syndromes, limited or suggestive evidence of an association involving, 6, 117
Demyelinating polyneuropathy
acute inflammatory, 105, 127–128
limited or suggestive evidence of an association involving, 6, 128
Department of Defense (DOD), 7, 61, 88, 91, 145
Deployment Health Support, 15
medical databases, 28, 91–93, 191
policies on tuberculin skin testing, 7
policy regarding predeployment and postdeployment serum collection, 7, 93–94
Serum Repository, 93
Department of Veterans Affairs (VA), 1, 11, 19, 61, 155, 187
Occupational and Environmental Health Strategic Healthcare Group, 15
Depression, limited or suggestive evidence of an association involving, 6
Desert Storm pneumonitis, 181
Detection, of tuberculosis transmission, 136
Development
Diagnosis
acute Campylobacter infection, 104
acute nontyphoidal Salmonella infection, 109
acute Shigella infection, 111
chronic brucellosis, 115
latent tuberculosis infection, 136
leishmaniasis, 121
Q fever, 131
Diarrheal diseases, 1, 62–73, 103–112
Campylobacter infection, 103–107
diagnosis in US troops serving in the Gulf War, OEF, or OIF, 62–73
enteric infections in the Gulf War, 62–69
gastroenteritis in OEF and OIF, 69–73
nontyphoidal Salmonella infection, 108–110
Diseases, unreported, 25
Diseases and etiologic agents considered by the Committee for evaluation, 21–24
fungal diseases, 22
protozoan diseases, 23
viral diseases, 23
Diseases and etiologic agents of special interest to Gulf War, OEF, and OIF veterans, 181–194
bacterial diseases, 41
biologic-warfare agents, 193–194
idiopathic acute eosinophilic pneumonia, 183–184
sexually transmitted diseases, 57–58
wound and nosocomial infections, 184–185
Diseases excluded from in-depth study
Escherichia coli, 28
reasons for, 28
sand fly fever, 28
DOD. See Department of Defense
E
ELISA. See Enzyme-linked immunosorbent assay testing
Encephalitis
St. Louis, 149
West Nile, 151
Endemicity in southwest and south-central Asia, 2, 15, 25–26, 120
Campylobacter infection, 103
nontyphoidal Salmonella infection, 109
Q fever, 130
Shigella infection, 111
tuberculosis, 137
West Nile virus infection, 150
Endocarditis, 117
sequelae of Coxiella burnetii infection, 133
sufficient evidence of an association involving, 5, 133
Enteric Disease Research Program (US Navy), 69
Enteric infections in the Gulf War, 62–69
among shipboard military personnel, 68–69
Enterotoxigenic Escherichia coli (ETEC), 2
Enzyme-linked immunosorbent assay (ELISA) testing, 67, 84, 114–115, 131
Epidemiologic investigations
among ground troops in the Gulf War, 66
of gastroenteritis in OEF and OIF, 69–71
Episcleritis, limited or suggestive evidence of an association involving, 6, 117
Escherichia coli
pathogenic, 13
reasons for excluding from in-depth study, 28
ETEC. See Enterotoxigenic Escherichia coli
Etiology. See Diseases and etiologic agents
Exclusions. See Diseases excluded from in-depth study
F
Fatigue and inattention, limited or suggestive evidence of an association involving, 6
FDA. See Food and Drug Administration
First Marine Expeditionary Force, 72
Focal neurologic deficits, West Nile virus-positive patients with, 154
Food and Drug Administration (FDA), 85, 136, 187
Fungal diseases, 22
G
Gastroenteritis in OEF and OIF, 69–73
epidemiologic investigations, 69–71
GBS. See Guillain-Barré syndrome
Genitourinary tract manifestations, in chronic brucellosis, 117
Giardia lamblia, 68
Glomerulonephritis, immune-complex, 5
Ground troops in the Gulf War
with enteric infections, 62–68
with mild acute respiratory disease, 74–75
Guillain-Barré syndrome (GBS), 127–128
in acute Campylobacter infection, 104–105
limited or suggestive evidence of an association involving, 6, 117, 128
sufficient evidence of an association involving, 5, 105
instance of leishmaniasis, 78–80
malaria in, 82
nosocomial infections in, 85
Q fever contracted during, 89
severe acute respiratory disease in, 76
West Nile fever in, 84
Gulf War and Health series, 4, 11, 101
"Gulf War Illness" (GWI), 13
H
Helminthic diseases, 2, 22–23, 25
endemic to southwest and south-central Asia that have long-term adverse health outcomes, 53–55
Hematologic complications
of infection with Plasmodium spp., 126
sufficient evidence of a causal relationship involving, 4, 126
Hemolytic uremic syndrome (HUS), 112
sufficient evidence of an association involving, 5, 112
Hemoptysis, 141
Hepatic abnormalities
in chronic brucellosis, 116
sufficient evidence of an association involving, 5, 116
Hepatitis. See Chronic hepatitis
HIV. See Coinfections with HIV
HUS. See Hemolytic uremic syndrome
I
IAEP. See Idiopathic acute eosinophilic pneumonia
IARC. See International Agency for Research on Cancer
ICD. See International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
Idiopathic acute eosinophilic pneumonia (IAEP), 28–29, 183–184
acute, 183
long-term adverse health outcomes, 183–184
pathogenesis, 184
treatment, 184
Immune-complex glomerulonephritis, sufficient evidence of an association involving, 5, 128
Immunofluorescence assay (IFA), 131–132
Inadequate or insufficient evidence to determine whether an association exists, 6, 31
Infectious diseases diagnosed in US troops who served in the Gulf War, OEF, or OIF, 61–94
chicken pox (varicella), 85
and Department of Defense Medical Databases, 91–93
and Department of Defense policy regarding predeployment and postdeployment serum collection, 93–94
meningococcal disease, 85
viral hepatitis, 90
Infectious diseases endemic to southwest and south-central Asia that have long-term adverse health outcomes, 20–24, 35–60
sexually transmitted diseases, 56–58
Infectious diseases identified for study, 13–14, 19–29
direct attribution to military service in southwest and south-central Asia, 24–26
diseases and agents of special interest to Gulf War, OEF, and OIF veterans, 28–29
endemic to southwest and south-central Asia that have long-term adverse health outcomes, 20–24
for strength of association with long-term adverse health outcomes, 27–28
timing of appearance of long-term adverse health outcomes, 27
Infectious diseases to be studied for strength of association with long-term adverse health outcomes, 27–28
diagnosis in US troops serving in the Gulf War, OEF, or OIF, 78–84
West Nile fever, 84
Institute of Medicine (IOM), 1, 4, 11, 13, 28, 30, 91, 101
International Agency for Research on Cancer (IARC), 4, 30
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), 91–93, 141
IOM. See Institute of Medicine
K
Kuwait, Iraqi invasion of, 9
L
Laboratory analysis
among ground troops in the Gulf War, 62–65
of enteric infections in the Gulf War, 62–65
of gastroenteritis in OEF and OIF, 71–73
Landstuhl Regional Medical Center (LRMC), 86–88, 186
Late manifestations of active tuberculosis, 142–144
extrapulmonary tuberculosis, 143–144
pulmonary tuberculosis, 143
relapse of active TB, 144
spinal tuberculosis and long-term neurologic disability, 144
tuberculosis meningitis and long-term neurologic disability, 143–144
Latent tuberculosis infection (LTBI), 7, 137, 142, 145
diagnosis, 136
Leishmaniasis, 3, 13, 78–82, 118–123
coinfection with HIV, 122
diagnosis, 121
endemicity in southwest and south-central Asia, 120
treatment for, and related long-term toxicity, 121–122
Levels of association between select diseases and long-term adverse health outcomes, 101–155
West Nile virus infection, 149–155
Limited or suggestive evidence of an association, 6, 31
involving amnesia, 6
involving Campylobacter infection, 6, 107
involving Coxiella burnetii infections, 6, 135
involving demyelinating meningovascular syndromes, 6, 117
involving demyelinating polyneuropathy, 6, 128
involving depression, 6
involving episcleritis, 6, 117
involving fatigue and inattention, 6
involving Guillain-Barré syndrome, 6, 117, 128
involving multifocal choroiditis, 6, 117
involving myelitis-radiculoneuritis, 6, 117
involving neurologic and neuropsychiatric complications, 6, 128
involving nummular keratitis, 6, 117
involving optic neuritis, 6, 117
involving Plasmodium falciparum infections, 6, 128
involving Plasmodium vivax infections, 6, 128
involving post-Q fever fatigue syndrome, 6, 135
involving sensorineural hearing loss, 6, 117
Limited or suggestive evidence of no association, 7, 31
Literature
amassing, 29
review and evaluation of, 3–4, 29–30
selection of, 29
Long-term adverse health outcomes, 24
of acute Campylobacter infection, 104–107
of Al Eskan disease, 182
definition, 2
of infection with West Nile virus, 152–154
of nontyphoidal Salmonella infection, 110
of Shigella infection, 111–112
of visceral leishmaniasis, 122–123
Long-term neurologic disability
in patients with West Nile neurologic disease, 154
in spinal tuberculosis, 144
Long-term toxicity. See Treatments with related long-term toxicity
LRMC. See Landstuhl Regional Medical Center
LTBI. See Latent tuberculosis infection
M
Malaria (infection by Plasmodium spp), 1, 3, 82–84, 123–129
acute, 125
coinfection with HIV, 126
endemicity in southwest and south-central Asia, 124–125
in the Gulf War, 82
long-term adverse health outcomes, 126–129
relapse and recrudescence, 128–129
sufficient evidence of a causal relationship involving, 4, 126, 128–129
transmission, 124
treatment for, and related long-term toxicity, 125–126
Meningitis
sufficient evidence of an association involving, 5, 117
tuberculosis and long-term neurologic disability, 143–144
West Nile, 151
Meningococcal disease, diagnosis in US troops serving in the Gulf War, OEF, or OIF, 85
Meningoencephalitis, 152
sufficient evidence of an association involving, 5, 117
categories of strength of association, 30–31
development of conclusions, 3–4
identifying the infectious diseases to study, 19–29
identifying the pathogens to study, 2–3
reasons for excluding two diseases from in-depth study, 28
review and evaluation of the literature, 29–30
MFS. See Miller-Fisher syndrome
Mild acute respiratory disease in the Gulf War, 73–76
among shipboard military personnel, 76
Miller-Fisher syndrome (MFS), 105
Multiple drug-resistant Mycobacterium tuberculosis infection, anticipating, 149
Mycobacterium tuberculosis infection, 1, 7
anticipating multiple drug-resistant, 149
sufficient evidence of a causal relationship involving, 4, 142
and "Gulf War Illness," 191–193
Myelitis-radiculoneuritis, limited or suggestive evidence of an association involving, 6, 117
N
National Academy of Sciences (NAS), 1
National Library of Medicine, 29
National Naval Medical Center, 186
National Reference Center for Rickettsial Diseases (France), 132
Neurologic and neuropsychiatric complications. See also Long-term neurologic disability
of chronic brucellosis, 116–117
of infection with Plasmodium spp., 127–128
limited or suggestive evidence of an association involving, 6, 128
sufficient evidence of an association involving, 5, 117
NGT. See Nuclear gene tracking
Nontyphoidal Salmonella infection, 1, 108–110
acute illness, 109
coinfection with nontyphoidal Salmonellae and HIV, 109–110
endemicity in southwest and south-central Asia, 109
long-term adverse health outcomes, 110
sufficient evidence of an association involving, 5, 110
transmission, 108
Norovirus (NV), 71
among ground troops in the Gulf War, 67
Nosocomial infections, 85–88, 184–185
antibiotic-resistant or common, 44
diagnosis in US troops serving in the Gulf War, OEF, or OIF, 85–88
Nuclear gene tracking (NGT), 192–193
Nummular keratitis, limited or suggestive evidence of an association involving, 6, 117
NV. See Norovirus
O
ODSh. See Operation Desert Shield
ODSt. See Operation Desert Storm
OEF. See Operation Enduring Freedom
OIF. See Operation Iraqi Freedom
Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), 1–3, 11, 19, 35, 61, 78, 86–88, 90, 103
Brooke Army Medical Center, 86–87
Landstuhl Regional Medical Center, 87–88
nosocomial infections in, 86–88
Q fever contracted during, 89–90
Walter Reed Army Medical Center, 87–88
West Nile fever in, 84
Ophthalmologic complications
of chronic brucellosis, 117
of infection with Plasmodium spp., 126–127
sufficient evidence of a causal relationship involving, 4, 127
Optic neuritis, limited or suggestive evidence of an association involving, 6, 117
Orchioepididymitis, sufficient evidence of an association involving, 5, 117
Osteomyelitis, 189
chronic, 187
sequelae of Coxiella burnetii infection, 134
sufficient evidence of a causal relationship involving, 4, 134
P
Papilledema, limited or suggestive evidence of an association involving, 6, 117
Pathogenesis
of Al Eskan disease, 182
of idiopathic acute eosinophilic pneumonia, 184
Pathogens, identified for study, 2–3
Persian Gulf War. See Gulf War
Persian Gulf War Veterans Act, 1, 11–12, 24
PFTs. See Pulmonary function tests
PKLD. See Post-kala-azar dermal leishmaniasis
Plasmodium falciparum infections
limited or suggestive evidence of an association involving, 6, 128
sufficient evidence of an association involving, 5, 129
Plasmodium malariae infections, sufficient evidence of an association involving, 5, 128
Plasmodium vivax infections, limited or suggestive evidence of an association involving, 6, 128
Pleurisy, 141
Post-kala-azar dermal leishmaniasis (PKDL), sufficient evidence of an association involving, 5, 123
Post-Q fever fatigue syndrome
limited or suggestive evidence of an association involving, 6, 135
sequelae of Coxiella burnetii infection, 134–135
Potential relationships between tuberculosis and military service, 144–149
anticipating multiple drug-resistant Mycobacterium tuberculosis infection, 149
Pre-existing conditions, 27
Prevalence in southwest and south-central Asia, 2
sexually transmitted diseases, 56–57
Primary infections, 3
Primary TB, vs reactivation TB, 140
endemic to southwest and south-central Asia that have long-term adverse health outcomes, 50–52
PubMed, 29
Pulmonary function tests (PFTs), 143
Pulmonary TB, 141
late manifestations of, 143
Pyothorax, 143
Q
Q fever (infection by Coxiella burnetii), 3, 88–90, 129–135
diagnosis in US troops serving in the Gulf War, OEF, or OIF, 88–90, 131
endemicity in southwest and south-central Asia, 130
long-term adverse health outcomes, 132–135
transmission of Coxiella burnetii, 129–130
R
ReA. See Reactive arthritis
Reactivation TB, vs primary TB, 140
Reactive arthritis (ReA), 110–112
in acute Campylobacter infection, 106–107
sufficient evidence of an association involving, 5, 107, 110, 112
Regional experiences in non-Americans, with wound and nosocomial infections, 188–190
Reiter's syndrome, 106
Relapse and recrudescence, of malaria, 128–129
Renal complications
of infection with Plasmodium spp., 128
sufficient evidence of a causal relationship involving, 4
Resistance in the World: Anti-TB Drug Prevalence and Trends, 149
Respiratory system infections
in chronic brucellosis, 118
diagnosis in US troops serving in the Gulf War, OEF, or OIF, 73–78
S
Salmonella infection, 3, 108–110.
See also Nontyphoidal Salmonella infection
acute illness, 109
bacteremia, 109
endemicity in southwest and south-central Asia, 109
gastroenteritis, 109
long-term adverse health outcomes, 110
transmission, 108
Sand fly fever, 13
reasons for excluding from in-depth study, 28
Sensorineural hearing loss, limited or suggestive evidence of an association involving, 6, 117
Serum agglutination test (SAT), 114
Severe acute respiratory disease in the Gulf War, 76
Sexually transmitted diseases, 56–58
Shigella infection, 1, 3, 13, 71, 110–112
acute illness, 111
among ground troops in the Gulf War, 66–67
endemicity in southwest and south-central Asia, 111
long-term adverse health outcomes, 111–112
sufficient evidence of an association involving, 5, 112
transmission, 110
Shipboard military personnel
enteric infections in the Gulf War among, 68–69
mild acute respiratory disease in the Gulf War among, 76
Southwest and south-central Asia.
See also Endemicity in southwest and south-central Asia;
Prevalence in southwest and south-central Asia
map of, 20
Special interest diseases. See Diseases and agents of special interest to Gulf War, OEF, and OIF veterans
Spinal tuberculosis, and long-term neurologic disability, 144
Spondylitis, 116
sufficient evidence of an association involving, 5, 116
St. Louis encephalitis virus, 149, 154
Strength of association categories, 30–31
inadequate or insufficient evidence to determine whether an association exists, 6, 31
limited or suggestive evidence of an association, 6, 31
limited or suggestive evidence of no association, 7, 31
sufficient evidence of a causal relationship, 4, 30
sufficient evidence of an association, 5–6, 31
Strength of the evidence, assessing, 4
Subacute infections, 27
involving active TB, 4, 142, 144
involving Coxiella burnetii infections, 4, 134
involving hematologic complications, 4, 126
involving malarial infection, 4, 126, 128–129
involving Mycobacterium tuberculosis infection, 4, 142
involving ophthalmologic complications, 4, 127
involving osteomyelitis, 4, 134
involving renal complications, 4
Sufficient evidence of an association, 5–6, 31
involving active TB, 5
involving arthritis and spondylitis, 5, 116
involving brucellosis, 5, 116–117
involving cardiovascular system infections, 5, 117
involving chronic hepatitis, 5, 134
involving Coxiella burnetii infections, 5, 133–134
involving endocarditis, 5, 133
involving Guillain-Barré syndrome, 5, 105
involving hemolytic uremic syndrome, 5, 112
involving hepatic abnormalities, 5, 116
involving immune-complex glomerulonephritis, 5, 128
involving meningitis and meningoencephalitis, 5, 117
involving neurologic and neuropsychiatric complications, 5, 117
involving nontyphoidal Salmonella infection, 5, 110
involving orchioepididymitis, 5, 117
involving Plasmodium falciparum infections, 5, 129
involving Plasmodium malariae infections, 5, 128
involving post-kala-azar dermal leishmaniasis, 5, 123
involving reactive arthritis, 5, 107, 110, 112
involving respiratory system infections, 5, 118
involving Shigella infection, 5, 112
involving vascular infection, 5, 134
involving visceral leishmaniasis, 5, 123
involving West Nile virus infection, 6, 154
T
TB. See Tuberculosis
Timing of appearance of long-term adverse health outcomes, 27
Toxicity. See Treatments with related long-term toxicity
Transmission
of Campylobacter infection, 103
of malaria, 124
of nontyphoidal Salmonella infection, 108
of Shigella infection, 110
of West Nile virus infection, 150
Treatments
of active TB, 142
of acute Campylobacter infection, 104
of acute nontyphoidal Salmonella infection, 109
of acute Shigella infection, 111
of Al Eskan disease, 183
of idiopathic acute eosinophilic pneumonia, 184
of latent tuberculosis infection, 140
of West Nile virus infection, 152
Treatments with related long-term toxicity
of acute Q fever, 131
of brucellosis, 115
Tuberculin skin testing (TSTs)
Department of Defense policies on, 7
Tuberculosis meningitis, and long-term neurologic disability, 143–144
Tuberculosis pleurisy, 142
Tuberculosis (TB), 1, 3, 135–149
diagnosis in US troops serving in the Gulf War, OEF and OIF, 90–91
endemicity in southwest and south-central Asia, 137
potential relationships with military service, 144–149
risk of progression from latent tuberculosis infection to active tuberculosis, 137–140
treatment for latent tuberculosis infection to prevent active tuberculosis, 140
U
Unreported diseases, 25
US Navy Forward Laboratory, 83
US Senate Committee on Veterans Affairs, Special Investigation Unit on Persian Gulf War Illness, 192
US troops
living conditions of, 61
personal hygiene among, 66
USNS Comfort, 186
Uveitis
in acute Campylobacter infection, 107
limited or suggestive evidence of an association involving, 6, 107
sufficient evidence of an association involving, 5, 117
V
VA. See Department of Veterans Affairs
Varicella, 85
Vascular infection
sequelae of Coxiella burnetii infection, 134
sufficient evidence of an association involving, 5, 134
Veterans Programs Enhancement Act, 1, 11–12, 24
Viral diseases, 2, 23, 25–26, 45–49
endemic to southwest and south-central Asia that have long-term adverse health outcomes, 45–49
more prevalent in southwest and south-central Asia than in the US, 45–46
potentially more prevalent among troops in southwest and south-central Asia than in the US population, 46–49
Viral hepatitis, diagnosis in US troops serving in the Gulf War, OEF, or OIF, 90
Visceral leishmaniasis (VL), 78, 118
sufficient evidence of an association involving, 5, 123
Viscerotropic leishmaniasis (VTL), 78
in the Gulf War, 79
VL. See Visceral leishmaniasis
VTL. See Viscerotropic leishmaniasis
W
Walter Reed Army Institute of Research, 15
Walter Reed Army Medical Center (WRAMC), 78, 80, 87–88, 186–187
West Nile encephalitis (WNE), 151
West Nile meningitis (WNM), 151
West Nile neurologic disease (WNND), 150–151, 153
West Nile virus (WNV) infection, 1, 3, 84, 149–155
acute, 151
endemicity in southwest and south-central Asia, 150
in the Gulf War, 84
long-term adverse health outcomes, 152–154
in OEF and OIF, 84
sufficient evidence of an association involving, 6, 154
transmission, 150
treatment, 152
WHO. See World Health Organization
WNE. See West Nile encephalitis
WNM. See West Nile meningitis
WNND. See West Nile neurologic disease
WNV. See West Nile virus infection
World Health Organization (WHO), 30, 149
concerns regarding Acinetobacter baumannii, 185–186
regional experiences in non-Americans, 188–190
Wounded-to-killed ratios, 184
WRAMC. See Walter Reed Army Medical Center
Z