Course of an ARTIs and GI over three years span, 2017–2019

Surveillance using outbreak markers for Canadian Armed Forces (CAF) deployed operations, 2017–2019

This infographic depicts the outbreak markers for Canadian Armed Forces (CAF) deployed operations between 2017 and 2019.

Three CAF overseas Operations

Canadian Armed Forces (CAF) operations vary by mission purpose, location, and number of personnel. To help troops stay healthy on deployments, the Disease and Injury Surveillance System is used to meet health surveillance requirements in theatre.

Outbreak markers

Gastrointestinal (GI) infections

Acute respiratory tract infections (ARTIs)

Average CAF denominator per week

Eastern Europe Training Army

- Op UNIFIER ~ 201 (99–254)

- Op REASSURANCE ~ 405 (97–540)

Middle East Combat Air Force

- Op IMPACT ~ 277 (190–629)

GI infections and ARTIs - rates per 100 person-years over a three year period

ARTI rates were over three times more common than the rates of GI infections.

21.1 GI infection rates

65.0 ARTIs rates

13.3 GI infection rates

13.8 ARTIs rates

42.2 GI infection rates

54.6 ARTIs rates

Lost duty days by GI infections and ARTIs over a three year period

Overall, ARTIs took a higher toll on lost duty days than GI infections.

58.6% GI infections

41.4% ARTIs rates

22.8% GI infections

77.2% ARTIs rates

41.8% GI infections

58.2% ARTIs rates

Three years of results 2017–2019

The trend in ARTI rates observed for all three operations are comparable to the influenza seasonal patterns in the northern hemisphere (Sep to Apr).

Three year averaged weekly ARTI rates per Operation

Within each Operation, ARTIs were over three times more common than the number of GI infections over the three-year period. When looking at trends over the three year period time combined, an increase in the ARTI rates was observed for all three operations comparable to the influenza seasonal patterns in the northern hemisphere (Sep to Apr). 4.0% was the maximum percentage of CAF personnel affected by ARTIs in a given week in Eastern Europe. ARTIs did not increase above 3.0% in the Middle East. Influenza like-illness cases are rarely tested on deployment; therefore variations within the seasonal pattern cannot be attributed to a dominant type of virus. In Op Unifier, there was a substantial increase in the number of cases in the later part of the influenza season as well.

GI infection outbreaks by year, month and Operation

Among the GI infection outbreaks in Eastern Europe, 4.0% was the highest percentage of CAF personnel affected during a one week period. While Op Unifier had three GI outbreaks during the three year period, Op Reassurance had one outbreak. There was no outbreak identified in Op Impact (Middle East). Less than 2% of CAF personnel were affected by a GI infection in a given week at Op Impact. No pattern was identified between deployment rotation and the increase in the rates of any outbreak marker, contrary to what has been historically reported among US deployed personnel.

GI infections and to a greater extent ARTIs continue to play an important role in CAF deployed troops in both training and combat settings. Both of these conditions contribute to lost duty days, which has the ability to impact operational readiness.

Disease and Injury Surveillance System (DISS) and Canadian Forces Task Planning and Operations

Valbuena L, Strauss B, Lu D, Theriault F.

Directorate Force Health Protection, Canadian Forces Health Services, Ottawa, Canada

luisa.valbuena@forces.gc.ca