NAMRU-3 Supports Force Health Protection in the Horn of Africa

Lt. Cmdr. Peter Sebeny briefs NAMRU-3 surveillance team members in Camp Lemonnier, Djibouti.

By Lt. Cmdr. Peter Sebeny, U.S. Naval Medical Research Unit 3, research clinician

Camp Lemonnier, established in Djibouti in 2002, is the only fixed U.S. base under the Africa Command (AFRICOM) and is also home of the U.S. Combined Joint Task Force-Horn of Africa (CJTF-HOA).

Originally focused on counter-terrorism operations, the camp’s mission has now expanded to include strengthening partnerships and contributing to stability in East Africa.  This serves as part of a comprehensive approach to increase African partner nations’ capacity to maintain stable environments for their populations.

With the growing presence of U.S. personnel in Africa, there is a need to better understand infectious disease threats in the region, which can be challenging since little surveillance data and public health capacity exists.  Improved surveillance and laboratory diagnostics are the cornerstones to gaining a better understanding.

In order to provide those cornerstones, the U.S. Naval Medical Research Unit 3 (NAMRU-3) initiated a diarrheal surveillance project at Camp Lemonnier’s expeditionary medical facility (EMF) in 2007 with plans to expand the surveillance to include other illnesses, including influenza-like illness and acute febrile illnesses such as malaria. As part of our surveillance project, eligible patients may fill out a questionnaire with demographics, vaccination history, hospitalization information and antibiotic use. Our research activities are aimed at detecting health threats among deployed military personnel and are executed in accordance with the NAMRU-3 Military Infectious Disease and Operational Health Surveillance Network.

The importance of a surveillance system is that it can identify new disease trends or infectious disease outbreaks. For example during the early period of the 2009 H1N1 influenza pandemic, the EMF, with direct support from NAMRU-3, utilized the existing surveillance system to identify an outbreak of seasonal influenza A (H2N2).  That surveillance also identified the first confirmed pH1N1/2009 influenza cases in the Horn of Africa among U.S. service members.

 Ongoing surveillance has also been important in identifying the most common causes of acute gastroenteritis in the region, including Enterotoxigenic E. coli and norovirus.  Recent findings from this surveillance were presented by NAMRU-3 at the European Command and AFRICOM Science and Technology Conference in June 2011.

I believe establishing better local laboratory capabilities in Djibouti will be important for current surveillance efforts as well as the ability to conduct more advanced studies to understand the causes, burden and impact of gastroenteritis, one of the most common illnesses in deployed populations.

It is through efforts such as these that NAMRU-3 has built valuable professional relationships with the EMF and the CJTF-HOA staff and continues to play an important role in force health protection in Africa.

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