three operations in question. The risk of contracting a disease in the theater of operations must have been equal to or greater than the risk of contracting it in the United States. Moreover, given the natural history of the disease or infection, it must have been diagnosed in US troops in appropriate temporal relationship to deployment.

Chapter 4 comprises a review of infectious diseases that have been reported in US troops in close temporal relationship to the operations under study. On the basis of that review, the committee determined that many of the diseases in Box 2.2 have never been reported in US military personnel in close temporal relationship to deployment to southwest or south-central Asia during the Gulf War, OEF, or OIF. Nevertheless, it is impossible to prove that US troops did not contract any of the unreported diseases during deployment. Thus, the committee summarizes the acute and long-term characteristics of these unreported diseases in tabular form in Chapter 3 and excludes them from further analysis.

BOX 2.2

Infectious Diseases That Are Endemic in Southwest and South-Central Asia and Have Long-Term Adverse Health Outcomes

Type of Etiologic Agent

Bacterium

Virus

Protozoan

Helminth

More prevalent in southwest or south-central Asia than in the United States

Anaplasmosis

Anthrax

Boutonneuse fever

Brucellosis

Campylobacter infection

Chancroid

Cholera

E. coli gastroenteritis

Ehrlichiosis

Enteric fever

Helicobacter infection

Leptospirosis

Lymphogranuloma venereum

Melioidosis

Plague

Q fever

Rat bite fever

Relapsing fever

Salmonellosis (nontyphoid)

Shigellosis

Syphilis

Tuberculosis

Typhus group (louse-borne and murine)

Yaws

Yersinia enterocolitica infection

Potentially more prevalent among troops in war theater than among US adult population

Gonorrhea

Trichomoniasis

More prevalent in southwest or south-central Asia than in the United States

Crimean-Congo hemorrhagic fever

Dengue fever

Dengue hemorrhagic fever

Dengue shock syndrome

Hepatitis A

Hepatitis B

Hepatitis C

Rift Valley fever

Sand fly fever

Sindbis

Potentially more prevalent among troops in war theater than among US adult population

Adenovirus infection

Avian influenza

Hantaviral hemorrhagic fever with renal syndrome

Hantavirus pulmonary syndrome

Influenza

Viral enteritis

West Nile fever

More prevalent in southwest or south-central Asia than in the United States

Amebiasis

Cryptosporidiosis

Cyclosporiasis

Giardiasis

Isosporiasis

Leishmaniasis

Malaria

Microsporidiosis

Toxoplasmosis

More prevalent in southwest or south-central Asia than in the United States

Ascariasis

Cysticercosis

Echinococcosis

Enterobiasis

Filariasis

Hookworm disease

Onchocerciasis

Schistosomiasis

Strongyloidiasis



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