Infection is the final battle: the double-edged sword of military response

Reviewed by: Cynthia T. Nguyen, PharmD, University of Chicago Medicine

Military personnel and service members may inadvertently be carriers of pathogens, causing infections among close contacts at home or abroad. Zemke and colleagues refer to this act of mitigating one problem while creating another a ‘double-edged sword.’

This was a systematic review of 67 publications describing the transportation of infectious pathogens into or out of deployment areas by military personnel. Among these studies, 21 articles described the transportation of bacterial pathogens (e.g., A. baumaniiP. aeruginosa), 23 parasitic pathogens (e.g., LeishmaniaPlasmodium), and 23 viral pathogens (e.g., hepatitis B, influenza). For example, one study described 1285 cases of Acinetobacter colonization after evacuation from Iraq and Afghanistan in 2009, including at least 170 cases of infection.

The majority of articles in the review did not report rates of secondary transmission. However, there were a few examples, including the transmission of Vibrio cholerae by Nepalese peacekeepers into the Artibonite River Valley in Haiti resulting in a massive cholera outbreak in 2010, affecting 697,000 people and causing 8,500 deaths. The large collection of cases in this review underscores the need for targeted pre- and post- screening and education of service members, military vaccination programs, and basic sanitation practices to prevent future outbreaks. Still, each pathogen and population likely requires individualized prevention and containment strategies.


Zemke JN, Sanchez JL, Pang J, Gray GC. The Double-Edged Sword of Military Response to Societal Disruptions: A Systematic Review of the Evidence for Military Personnel as Pathogen Transmitters. J Infect Dis. 2019 Nov 6;220(12):1873-1884. doi: 10.1093/infdis/jiz400. 

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