Directorate for Information, Operations, and Reports, 1985). Table 2-8 shows the types of infectious diseases that have accounted for the greatest morbidity among American soldiers.

The relative importance to deployed forces of any particular infectious disease depends on a number of environmental factors and operational circumstances, including, principally, the geographic area of deployment, the time of year, the mission and composition of the force, and the intensity of the conflict. For example, military operations generally result in large numbers of susceptible individuals living in close proximity, circumstances that can facilitate the transmission of respiratory diseases. Under field conditions, food and water sanitation services may be rudimentary and subject to disruptions, opportunities to exercise good personal hygiene are diminished, and there may be exposure to the bites of infected arthropod vectors of both human and zoonotic diseases. In addition, warfare usually creates some degree of social disruption, which can produce refugee populations that are frequently subject to epidemics of infectious disease. Troops may be at added risk of infection to the extent that they become involved in the supervision and care of the refugees. Because troops are frequently living under relatively primitive field conditions, there is also the potential for accidental transmission of previously unknown zoonotic diseases. The return of

TABLE 2-8 Infectious Diseases Causing High Morbidity in U.S. Forces in Past Conflicts: World War II, Korea, Vietnam, and Operation Desert Storm

Disease Category

Conflict

Acute respiratory diseases and influenza

All

Acute diarrheal diseases

All

Malaria

WWII, Korea, Vietnam

Hepatitis

WWII, Korea, Vietnam

Sexually transmitted diseases

WWII, Korea, Vietnam

Arthropod-borne diseasesa

WWII, Vietnam

Rickettsial diseasesb

WWII, Vietnam

Leptospirosis

WWII, Vietnam

Leishmaniasis

WWII, Desert Storm

Schistosomiasis

WWIIc

NOTE: WWII=World War II.

a Especially dengue fever, sandfly fever, hemorrhagic fevers, and encephalitides.

b Principally scrub typhus, whose distribution is limited to parts of Asia and northern Australia.

c Principally in engineer bridge-building units in Luzon, Philippines.

SOURCE: L. J. Legters, Department of Preventive Medicine, Division of Tropical Public Health, Uniformed Services University of the Health Sciences, Bethesda, Maryland.



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