Source: US Army
¶ I ran across a ProMed posting earlier this week and it still has me thinking about the impact of military deployments on disease transmission. According to the post, Afghanistan’s Ministry of Public Health reported 710 of 779 H1N1 cases to date have been among military personnel – 320 cases among American and Italian troops and 390 within the Afghan National Army. Additionally, the Ministry estimates up to 22 percent of the Afghan population could be infected with H1N1. On November 1st, the government declared a health emergency, closing schools, universities, and public restrooms for three weeks. World Health Organization representative Peter Graaff added, “The population is poor. Many live in poor hygienic circumstances, and there is a large amount of malnutrition. The mortality rate in Mexico, where H1N1 affected poor people, was considerably higher than in the U.S. or Western Europe.”
¶ Good point. Malnutrition has always been a major risk factor for disease transmission, allowing diseases that would normally be considered of minor public health importance to take a foothold in a population and become major issues. Lack of food security also contributes to the consumption of poorer quality food, increasing the potential for outbreaks of foodborne illness in an already compromised group.
¶ The general Afghan population might have increased susceptibility to H1N1 and potentially have increased severity of disease. If there is a high prevalence of H1N1 in the local population, then military units are subsequently at higher risk for exposure.
¶ So, what is my point in mentioning this? I have been considering the affects transportation and rapid military deployments have upon disease exposure, and risk of introduction to home populations. A sort of military ‘globalization’ effect, if you will.
¶ Throughout history, disease and wound infection have had major impacts on militaries – I would argue that the majority of casualties were probably due to these factors, prior to the development of vaccines and antimicrobials. Military units, by definition, congregate together in groups based upon their operational unit size. Close quarters also contributes to disease transmission. I guess I’ve been thinking of the unique dynamic presented by a situation where a local population with high prevalence of a certain contagious disease regularly comes into contact with indigenous and foreign military units – especially since in Afghanistan, the various military units try to have regular, direct contact with local individuals. The complex dynamics of disease transmission fascinates me.
Source: US Army
¶ Individuals within the military groups live in close contact with each other, yet also have members transferred to other regions, as well as new, susceptible individuals added to the group as replacements, transfers, etc, – potentially allowing for the disease to make large geographical leaps into distant populations. And finally, when the unit re-deploys back to its home location, there is the possibility of introducing disease into this population as well.
¶ This complex dynamic also makes me consider the different influences a regular military unit might have on disease transmission to a home population compared to a reserve or national guard unit. Members of a reserve or national guard unit return to their civilian jobs upon return, thereby re-entering and re-integrating into the general home population, while a regular military unit still maintains its unit cohesion and close contact, even upon return. Even though members of the regular military unit have contact with the home population, they remain more segregated from it than reserve or national guard members. Therefore, would a reserve or national guard unit pose more of a disease transmission risk to the home population upon their return?
¶ Just some thoughts and questions that came to mind upon reading the report.
