National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

GULF WAR and HEALTH

Volume 5
INFECTIOUS DISEASES

Abigail E. Mitchell, Laura B. Sivitz, Robert E. Black, Editors

Committee on Gulf War and Health: Infectious Diseases

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

THE NATIONAL ACADEMIES PRESS

500 Fifth Street, NW Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract V101(93)P-2155 between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-10: 0-309-10106-9 (Book)

International Standard Book Number-13: 978-0-309-10106-6 (Book)

International Standard Book Number-10: 0-309-65706-7 (PDF)

International Standard Book Number-13: 978-0-309-65706-8 (PDF)

Library of Congress Control Number: 2006934962

Additional copies of this report are available from the

National Academies Press,

500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu.

Copyright 2007 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do”

—Gothe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

COMMITTEE ON GULF WAR AND HEALTH: INFECTIOUS DISEASES

ROBERT E. BLACK, MD, MPH, Edgar Berman Professor and Chair,

Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD

MARTIN J. BLASER, MD, Frederick H. King Professor of Internal Medicine, Chair of the Department of Medicine, and Professor of Microbiology,

New York University School of Medicine, New York

RICHARD D. CLOVER, MD, Dean and Professor,

School of Public Health and Information Sciences, University of Louisville, KY

MYRON S. COHEN, MD, J. Herbert Bate Distinguished Professor of Medicine and Microbiology,

Immunology and Public Health, University of North Carolina School of Medicine, Chapel Hill

JERROLD J. ELLNER, MD, Professor and Chair of the New Jersey Medical School at the University of Medicine and Dentistry of New Jersey,

Newark

JEANNE MARRAZZO, MD, MPH, Associate Professor,

Department of Medicine, University of Washington School of Medicine, Seattle

MEGAN MURRAY, MD, ScD, MPH, Assistant Professor of Epidemiology,

Harvard University, School of Public Health, Boston, MA

EDWARD C. OLDFIELD III, MD, Director,

Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk

RANDALL R. REVES, MD, MSc, Professor,

Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver

EDWARD T. RYAN, MD, Director,

Tropical and Geographic Medicine Center, Massachusetts General Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, MA

STEN H. VERMUND, MD, PhD, Amos Christie Chair and Director,

Vanderbilt University Institute for Global Health, and Professor of Pediatrics, Medicine, Preventive Medicine, and Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN

DAWN M. WESSON, PhD, Associate Professor,

Tulane School of Public Health and Tropical Medicine, New Orleans, LA

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

STAFF

ABIGAIL E. MITCHELL, PhD, Senior Program Officer

LAURA B. SIVITZ, MSJ, Senior Program Associate

DEEPALI M. PATEL, Senior Program Associate

MICHAEL J. SCHNEIDER, MPH, Senior Program Associate

PETER JAMES, Research Associate

DAMIKA WEBB, Research Assistant

DAVID J. TOLLERUD, Program Assistant

RENEE WLODARCZYK, Program Assistant

NORMAN GROSSBLATT, Senior Editor

ROSE MARIE MARTINEZ, ScD, Director, Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

REVIEWERS

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report:


Lawrence R. Ash, Professor Emeritus, Department of Epidemiology, University of California, Los Angeles School of Public Health

Michele Barry, Tropical Medicine and International Health Programs, Yale University School of Medicine

Herbert DuPont, School of Public Health, University of Texas Health Science Center at Houston and St. Luke’s Episcopal Hospital

Robert Edelman, Travelers’ Health Clinic, University of Maryland

David Hill, National Travel Health Network and Centre, Hospital for Tropical Diseases, London

Richard T. Johnson, Department of Neurology, The Johns Hopkins Hospital

Arthur Reingold, Division of Epidemiology, University of California, Berkeley

Philip K. Russell, Professor Emeritus, Johns Hopkins School of Public Health

Mark Wallace, Independent Infectious Diseases Consultant and United States Navy, Retired


Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by George Rutherford, Institute of Global Health, University of California, San Francisco, and Elaine L. Larson, School of Nursing, Columbia University. Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

PREFACE

Infectious diseases have been a problem for military personnel throughout history. The consequences in previous conflicts have ranged from frequent illnesses disrupting daily activities and readiness to widespread deaths. Preventive measures, early diagnosis, and treatment greatly limit the exposures and acute illnesses of troops today in comparison with those in armies of the past, but infections and consequent acute illnesses still occur. In addition, long-term adverse health outcomes of some pathogens are increasingly recognized.

The deployment of about 700,000 US troops to the Persian Gulf region in the Gulf War of 1991 potentially exposed them to pathogens that they had not encountered at home. After returning from that short campaign, some veterans reported symptoms and expressed the concern that they may have been exposed to biologic, chemical, or physical agents during their service in the Persian Gulf. In response to those concerns, the US Department of Veterans Affairs (VA) commissioned the Institute of Medicine (IOM) to review the scientific evidence on possible long-term adverse health outcomes of exposure to specific biologic, chemical, and physical agents and to draw conclusions on the strength of that evidence with regard to delayed and chronic illnesses of the veterans.

The authorizing legislation for the work of IOM included several infectious diseases endemic in the Persian Gulf region. In the charge to our committee, VA asked that we not limit consideration to those diseases but rather include all infectious exposures that had been documented in troops and consider their possible long-term adverse health outcomes. It further requested that the time and geographic dimensions of the committee’s work be widened to include military personnel deployed as part of Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in the Persian Gulf region. OEF began in 2001, and OIF in 2003; they continued as this report went to press. The number of military personnel involved in the more recent conflicts now exceeds that in the 1991 Gulf War. Furthermore, they have remained for much longer periods on the average than in the Gulf War, and many have been deployed for more than one tour in this region. Thus, the potential for exposure to endemic pathogens is greater in these troops than in those deployed to the Gulf War. Because the possible exposures are relatively recent, there has been only a short time to observe long-term adverse health outcomes. The committee needed to rely on observations from the Gulf War, information on infectious diseases in OEF and OIF, and evidence in the scientific literature to allow conclusions to be drawn on possible long-term adverse health outcomes. With further time to observe the possible consequences of infectious exposures, the knowledge base will increase. Given the continuing presence of troops in the areas and the variable nature of infectious diseases, the exposures may change.

Valuable contributions were made to this study by a number of people who shared their expertise on infectious diseases. On behalf of the committee, I thank several of them—K. Craig Hyams, MD, MPH, chief consultant, Occupational and Environmental Health Strategic Healthcare Group, VA; Michael Kilpatrick, MD, deputy director, Deployment Health Support, Department of Defense (DOD); and Alan Magill, MD, science director, Walter Reed Army Institute of Research, for presenting information on infectious diseases that have been diagnosed in military personnel during the Gulf War, OIF, and OEF and Richard Reithinger, PhD,

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

infectious diseases consultant, for presenting information on infectious diseases that are endemic in southwest and south-central Asia to the committee at its May 26, 2005 meeting. I also thank William Winkenwerder, Jr., MD, MBA, assistant secretary for defense for health affairs, and his staff at DOD’s Deployment Health Support for expeditiously providing information to the committee on DOD health-related policies. Finally, the committee is grateful for the insight provided by representatives of veteran service organizations, veterans, and others who spoke with the committee or sent in written testimony.

I am grateful for the great expertise the committee members brought to bear on this subject. Furthermore, the report would not have been successfully completed without the diligent and expert contributions of the IOM staff, led by Abigail Mitchell and including Laura Sivitz, Deepali Patel, Michael Schneider, Peter James, Damika Webb, David Tollerud, and Renee Wlodarczyk.

Robert E. Black, MD, MPH, Chair

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×

CONTENTS

 

 

Summary

 

1

   

 Methodology

 

1

   

 Identifying the Pathogens to Study

 

2

   

 Development of Conclusions

 

3

   

 Summary of Conclusions

 

4

   

 Sufficient Evidence of a Causal Relationship

 

4

   

 Sufficient Evidence of an Association

 

5

   

 Limited or Suggestive Evidence of an Association

 

6

   

 Inadequate or Insufficient Evidence to Determine Whether an Association Exists

 

6

   

 Limited or Suggestive Evidence of No Association

 

7

   

 Department of Defense Policies on Tuberculin Skin Testing and Predeployment and Postdeployment Serum Collection

 

7

1

 

Introduction

 

9

   

 Identifying the Infectious Diseases to Study

 

13

   

 The Committee’s Approach to Its Charge

 

15

   

 Organization of the Report

 

16

   

 References

 

16

2

 

Methodology

 

19

   

 Identifying the Infectious Diseases to Study

 

19

   

 Geographic Boundaries

 

19

   

 Infectious Diseases Endemic to Southwest and South-Central Asia That Have Long-Term Adverse Health Outcomes

 

20

   

 Direct Attribution to Military Service in Southwest and South-Central Asia

 

24

   

 Timing of Appearance of Long-Term Adverse Health Outcomes

 

27

   

 The Infectious Diseases to Be Studied for Strength of Association with Long-Term Adverse Health Outcomes

 

27

   

 Comments on Diseases and Agents of Special Interest to Gulf War, OEF, and OIF Veterans

 

28

   

 Review and Evaluation of the Literature

 

29

   

 Selection of the Literature

 

29

   

 Amassing the Literature

 

29

   

 Reviewing the Literature

 

29

   

 Categories of Strength of Association

 

30

   

 Origin and Evolution of the Categories

 

30

   

 Sufficient Evidence of a Causal Relationship

 

30

   

 Sufficient Evidence of an Association

 

31

   

 Limited or Suggestive Evidence of an Association

 

31

   

 Inadequate or Insufficient Evidence to Determine Whether an Association Exists

 

31

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
   

 Limited or Suggestive Evidence of No Association

 

31

   

 References

 

31

3

 

Infectious Diseases Endemic to Southwest and South-Central Asia That Have Long-Term Adverse Health Outcomes

 

35

   

 References

 

60

4

 

Infectious Diseases Diagnosed in US Troops Who Served in the Persian Gulf War, Operation Enduring Freedom, or Operation Iraqi Freedom

 

61

   

 Diarrheal Disease

 

62

   

 Enteric Infections in the Gulf War

 

62

   

 Gastroenteritis in Operation Enduring Freedom and Operation Iraqi Freedom

 

69

   

 Respiratory Disease

 

74

   

 Mild Acute Respiratory Disease in the Gulf War

 

74

   

 Severe Acute Respiratory Disease in the Gulf War

 

76

   

 Respiratory Disease in Operation Enduring Freedom and Operation Iraqi Freedom

 

76

   

 Insect-Borne Diseases

 

78

   

 Leishmaniasis

 

78

   

 Malaria

 

82

   

 West Nile Fever

 

84

   

 Brucellosis

 

84

   

 Chicken Pox (Varicella)

 

85

   

 Meningococcal Disease

 

85

   

 Nosocomial Infections

 

85

   

 Gulf War

 

85

   

 Operation Enduring Freedom and Operation Iraqi Freedom

 

86

   

 Q Fever

 

88

   

 Q Fever Contracted During the Gulf War

 

89

   

 Q Fever Contracted During Operation Enduring Freedom and Operation Iraqi Freedom

 

89

   

 Viral Hepatitis

 

90

   

 Tuberculosis

 

90

   

 Department of Defense Medical Databases

 

91

   

 Department of Defense Policy Regarding Predeployment and Postdeployment Serum Collection

 

93

   

 References

 

94

5

 

Levels of Association Between Select Diseases and Long-Term Adverse Health Outcomes

 

101

   

 Diarrheal Diseases: Campylobacter, Non-typhoid Salmonella, and Shigella Infections

 

103

   

 Campylobacter Infection

 

103

   

 Nontyphoidal Salmonella Infection

 

108

   

 Shigella Infection

 

110

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
   

 Brucellosis

 

112

   

 Transmission and Endemicity of Brucellosis

 

113

   

 Acute Brucellosis

 

114

   

 Treatments for Brucellosis and Related Long-Term Toxicity

 

115

   

 Coinfection

 

115

   

 Long-Term Adverse Health Outcomes of Brucellosis

 

115

   

 Leishmaniasis

 

118

   

 Transmission of Leishmaniasis

 

119

   

 Endemicity in Southwest and South-Central Asia

 

120

   

 Acute Leishmaniasis

 

120

   

 Diagnosis of Leishmaniasis

 

121

   

 Treatments for Leishmaniasis and Related Long-Term Toxicity

 

121

   

 Coinfection by Leishmania Parasite and Human Immunodeficiency Virus

 

122

   

 Long-Term Adverse Health Outcomes of Leishmaniasis

 

122

   

 Malaria

 

123

   

 Transmission of Malaria

 

124

   

 Endemicity in Southwest and South-Central Asia

 

124

   

 Acute Malaria

 

125

   

 Treatments for Malaria and Related Long-Term Toxicity

 

125

   

 Coinfection with Plasmodium Spp. and Human Immunodeficiency Virus

 

126

   

 Long-Term Adverse Health Outcomes of Infection with Plasmodium Spp

 

126

   

 Q Fever (Infection by Coxiella burnetii)

 

129

   

 Transmission of Coxiella burnetii

 

129

   

 Endemicity in Southwest and South-Central Asia

 

130

   

 Acute Q Fever

 

130

   

 Diagnosing Q Fever

 

131

   

 Coinfection with Coxiella burnetii and Human Immunodeficiency Virus

 

131

   

 Long-Term Adverse Health Outcomes of Q Fever

 

132

   

 Tuberculosis

 

135

   

 Transmission of Tuberculosis

 

135

   

 Endemicity in Southwest and South-Central Asia

 

137

   

 Risk of Progression from Latent Tuberculosis Infection to Active Tuberculosis

 

137

   

 Treatment for Latent Tuberculosis Infection to Prevent Active Tuberculosis

 

140

   

 Active Tuberculosis

 

140

   

 Late Manifestations of Active Tuberculosis

 

142

   

 Potential Relationships Between Tuberculosis and Military Service

 

144

   

 West Nile Virus Infection

 

149

   

 Transmission of West Nile Virus Infection

 

150

   

 Endemicity in Southwest and South-Central Asia

 

150

   

 Acute West Nile Fever

 

151

   

 Diagnosis of West Nile Fever

 

151

   

 Treatment of West Nile Virus Infection

 

152

   

 Long-Term Adverse Health Outcomes of Infection with West Nile Virus

 

152

   

 Recommendation

 

155

   

 References

 

155

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R10
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Gulf War and Health: Volume 5: Infectious Diseases. Washington, DC: The National Academies Press. doi: 10.17226/11765.
×
Page R14
Next: Summary »
Gulf War and Health: Volume 5: Infectious Diseases Get This Book
×
Buy Hardback | $49.00 Buy Ebook | $39.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Infectious diseases have been a problem for military personnel throughout history. The consequences in previous conflicts have ranged from frequent illnesses disrupting daily activities and readiness to widespread deaths. Preventive measures, early diagnosis, and treatment greatly limit the exposures and acute illnesses of troops today in comparison with those in armies of the past, but infections and consequent acute illnesses still occur.

Thousands of US veterans of the Persian Gulf War have reported an array of unexplained illnesses since the war ended in 1991. Many veterans have believed that the illnesses were associated with their military service in southwest Asia during the war. This volume of Gulf War and Health evaluates the scientific literature on chemical, biologic, and physical agents to which military personnel in the gulf were potentially exposed and possible long-term adverse health outcomes.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!