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Enteric disease on Operation HERRICK
  1. Patrick Connor1,2,
  2. E Hutley1,2,
  3. H E Mulcahy3 and
  4. M S Riddle4
  1. 1Military Enteric Disease Group, Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2MDHU Frimley Park Hospital, Frimley, Surrey, UK
  3. 3Department of Gastroenterology, St Vincent's University Hospital, Dublin, Ireland
  4. 4Department of Enteric Diseases, Infectious Diseases Division, Naval Medical Research Center, Silver Spring, Maryland, USA
  1. Correspondence to Col Patrick Connor, Military Enteric Disease Group, Department of Military Medicine, Birmingham Research Park, Vincent Drive, Birmingham, B15 2SQ, UK; pconnor{at}


Background It is increasingly recognised that diarrhoeal disease is an important contributor to disease non-battle injury (DNBI) rates on operations. Current data collection methods (J97/EPINATO) rely on self-presentation of patients to medical care, which is likely to under-record the true incidence of diarrhoea in theatre. Along with this, the data recording itself is less than adequate, with acknowledged issues in classification of diarrhoeal disease within J97/EPINATO categories.

Methods Two post-tour diarrhoeal disease questionnaire surveillance exercises were carried out at the end of Operation HERRICK 6 (H6) and 10 (H10), respectively.

Results Crude diarrhoeal disease attack rates were similar across the two surveillance periods with approximately 40% of troops questioned reporting at least one diarrhoeal illness episode. The severity of illness increased from H6 to H10 as measured by disease-related symptomatology and days ill and/or off work. Mission burden was substantial and increased in H10 compared with H6.

Conclusions Diarrhoeal disease is a significant cause of DNBI on operations. Current data collection methodologies underestimate its incidence and true operational burden.


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