During WWII, British military units were stationed in the Gulf region and based
on this experience documented the nature of endemic infectious diseases. Thus,
the U.S. command was concerned about diseases, including shigellosis, malaria,
sandfly fever, and cutaneous leishmaniasis.6,65,90,187 For example, cutaneous
leishmaniasis, known locally as the Baghdad boil, is endemic to that area; 80
to 90 percent of people in some parts of Southwest Asia have scars from
previous attacks.187 During WWII, rates of sandfly fever were 3 to 10 percent
of all troops in the Middle East, and in some units it exceeded 50 percent.187
Infectious diseases during the Gulf War,
however, were not a major cause of sickness or lost work time.90 During the
Gulf War, only one death due to infectious disease (meningococcal meningitis)
Experts attribute the lack of a problem with infectious diseases during the
Gulf War to a comprehensive infrastructure of medical care and preventive
medicine efforts.90,185,271,273,293 DOD took measures to minimize infectious
disease risk, including strict monitoring of drinking water purity, inspecting
food sources and supplies, maintaining field camp sanitation, and
instituting an insect vector control program. U.S. service members received
booster doses of routine vaccinations, including typhoid, meningococcus and,
during the fall, influenza. Immune gamma globulin was used to prevent Hepatitis
A, and the small number of troops who entered Iraq near the Euphrates River
valley received drug prophylaxis for malaria.
Most of the combat troops were isolated in barren desert locations, distant
from rivers, oases, and urban areas. Additionally, maximum troop deployment
occurred during the cooler winter months, which provided the least favorable
conditions for the transmission of insect-borne diseases.90,185 Indeed, the
majority of the 12 individuals who developed viscerotropic leishmaniasis had
been deployed to urban areas.145
Short-term diarrhea was a common symptom among troops in-theater. Most cases
were mild, traveler's-type diarrhea that resolved spontaneously without
antibiotics after a few days.64,90 Gastroenteritis among outpatients decreased
percent per week early in the deployment to less than 0.5 percent per week
after U.S. medical command tightened control of food sources-especially
imposing a ban on locally-grown fresh fruits and vegetables. The most common
organisms identified in service members with diarrhea severe enough to warrant
cultures were Shigella sonnei and Escherichia coli. DOD reports no
confirmed cases in-theater of food-borne, diarrheal diseases, such as
cholera, typhoid fever, or giardiasis.90
DOD medical personnel evaluated U.S. service members for several diseases
transmitted by insects, including leishmaniasis, sandfly fever, malaria,
dengue, Sindbis, West Nile fever, Rift Valley fever, and Congo-Crimean
hemorrhagic fever.90,293 As noted, sandfly fever had been a major concern, but
no cases were seen during the Gulf War. DOD reports detecting seven cases of
malaria and one case of West Nile fever, a mosquito-borne viral illness. No
rickettsial illnesses and no cases of other arthropod-borne
viral illnesses were identified.
Viscerotropic leishmaniasis (VL) and cutaneous leishmaniasis (CL) are the only
endemic infectious diseases demonstrated to cause chronic morbidity among a
number of Gulf War service members. These diseases are transmitted through the
bites of sand flies; person-to-person infection does not occur. Thirty-two
cases of leishmaniasis were diagnosed among U.S. troops, consisting of 12 cases
of VL and 20 cases of CL.145,277 CL causes a characteristic ulcerative or
nodular skin rash that can persist for more
than a year without treatment. And, while VL can be difficult to confirm, it is
not considered to be a cause of widespread illness in Gulf War veterans. All
veterans diagnosed with VL, except one, have experienced the signs
characteristic of the disease.90,146,293
It is unlikely that veterans in the Registry or CCEP who have unexplained
illnesses are suffering from VL. The incidence of VL during the Gulf War and
the five years since has been low (12 of 697,000), and other sandfly-borne
infectious diseases in the troops have been absent.90,278 Additionally,
individuals with unexplained illnesses also lack signs and symptoms
characteristic of VL. VL can sometimes occur following a prolonged incubation
period (more than 18 to 24 months); there is also a risk of activation of
latent infections in immunosuppressed persons.65,90,146 To date, DOD and VA
report that delayed onset of VL has not occurred.
From August 1990 through July 1991, the U.S. Army deployed approximately
347,000 individuals to the Gulf region. Based on information from U.S. Army
field hospitals, the only infectious diseases that caused 30 or more each of
approximately 14,000 admissions were pneumonia, intestinal infections,
inflammation of the testes and/or epididymus, chicken pox, and kidney
What do we conclude about the risks of infectious diseases to Gulf War
Based on a review of the rates and types of the diseases diagnosed during and
after the Gulf War, the Committee concludes it is unlikely that infectious
diseases endemic to the Gulf region are responsible for long term health
effects in Gulf War veterans, except in a small, known number of individuals.
join the discussion .
analyzing the major theories .
five interviews .
the veterans .
a closer look .
examining the media's role .
a guide to the site .
comparing gulf veterans' health with other veterans .
tapes & transcripts .
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