Etiologic Agent


Various fungi

Nosocomial infection

Acinetobacter baumannii and other pathogens

Sexually transmitted diseases (STDs)

Haemophilus ducreyi, herpes simplex virus, HIV, human papillomavirus, HTLV, chancroid, Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis, and others

Wound-associated bacterial infection

Acinetobacter baumannii, Staphylococcus aureus, and other pathogens

NOTE: The term infection refers to a primary infection that leads to disease.

SOURCE: CDC 2005; Heymann 2004; Mandell et al. 2005.

BOX 2.1

The Four Diseases Specified in PL 105-277 and PL 105-368


Sand fly fever

Pathogenic Escherichia coli infection


Though present in southwest or south-central Asia, some of the diseases on the committee’s preliminary list do not have long-term adverse health outcomes. The committee’s next step was to identify infectious diseases endemic in southwest and south-central Asia that have potential long-term adverse health outcomes, including secondary diseases or conditions (sequelae) caused by primary diseases, reactivation or recrudescence of diseases, and delayed presentation of diseases. Only diseases with known or possible long-term adverse health outcomes were selected from Table 2.1 for further evaluation.

The process began with the development of consensus on the meaning of long-term adverse health outcomes. Such health outcomes, the committee agreed, should have one or more of the following characteristics:

  • Substantial interruption of normal physical and mental functioning occurring outside the timeframe of acute infection.

  • Organ dysfunction or damage with a persistent effect.

  • Reproductive effects in military personnel, including birth defects in offspring of military personnel.

A long-term adverse health outcome may be reversible. The committee also considered the potential for secondary transmission of the pathogen.

The application of these criteria to the infectious diseases listed in Table 2.1 generated the infectious diseases contained in Box 2.2: infectious diseases that are endemic to southwest and south-central Asia and have long-term adverse health outcomes.

Direct Attribution to Military Service in Southwest and South-Central Asia

The committee examined the likelihood that the candidate infections would have occurred specifically during military deployment to southwest and south-central Asia during the

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