Wed, Aug 09, 2017 - Page 8 News List

Medical matters of national defense

By King Chwan-chuen 金傳春

A recent outbreak of meningococcal disease at an army base in northern Taiwan has resulted in the death of a soldier.

Due to the fatality, the Centers for Disease Control (CDC) has taken preventive measures, providing antibiotics and monitoring the situation.

Outbreaks of infectious disease in the military are always taken extremely seriously by public health professionals around the world.

The most notable case was the 1918 influenza A (H1N1) pandemic, commonly known as the Spanish flu.

From September to November 1918, as World War I raged and the US military was locked in a bitter military campaign, a novel influenza virus began to rapidly spread among military personnel. Influenza-associated pneumonia sickened 20 to 40 percent of US Army and Navy personnel.

The rapidly accumulating number of influenza cases and high fatality rate severely crippled the US military’s combat ability. By the end of the war, influenza and pneumonia had killed more US soldiers and sailors during the pandemic than those who had died on the battlefield.

For this reason, the US military places a strong emphasis on monitoring of infectious diseases.

In addition, the transmission, prevention and control measures of influenza have to be viewed from a global perspective.

Throughout history, infectious diseases have often been accompanied by wars, such as typhus, which plagued Napoleon’s armies, or typhoid fever, which hampered the US Army during the 1898 Spanish-American War.

Fortunately, by 1918, due to the advent of modern bacteriology, antibiotics and the development of vaccines for cholera, typhoid, yellow fever, trench fever and other infectious diseases — previously commonplace among militaries — had become fairly rare.

For this reason, the commander of the US forces during World War I did not expect that a novel influenza virus with a higher transmission rate and greater virulence would quickly affect his troops.

In other words, the military needs to train officers how to prevent and defend against the emergence of infectious diseases.

Unfortunately, soldiers are a high-risk group for an outbreak of an emerging infectious disease due to the high population density of military bases, the close proximity in which military personnel train and live, the intensity of field operations, the pressure of combat and the frequent lack of sleep.

In addition to influenza, military garrisons have previously been the vector of acute respiratory infections, adenoviral conjunctivitis, food and water-borne infectious diseases and arthropod-borne infectious diseases.

Academics at the National Defense Medical College in Japan have carried out research on infectious diseases in the military.

They found that new military recruits were more likely to catch respiratory infections from multiple sources, viral hepatitis or even rubella (German measles) while on leave.

Interaction between the military and outside communities will often result in a subsequent wave of transmission.

During the 2003 SARS outbreak, although only a single military guard was infected, epidemiological specialists investigating the source of the infection still ran into a myriad of problems.

This is why military medical colleges in Taiwan must cultivate their own specialists trained in infectious disease epidemiology and preventive measures in order to meet the specialist public health needs of the military and any urgent needs during an epidemic.

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