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DoD Reports on Pneumonia Investigation

By Donna Miles
American Forces Press Service

WASHINGTON, Sept. 10, 2003 – Cigarette smoking appears to be a contributing factor in a spate of pneumonia cases in which 19 service members within the U.S. Central Command region contracted severe cases of the disease. Two of them died.

Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, emphasized to reporters here Sept. 9 that "we do not have an epidemic," and that pneumonia rates are no higher among service members deployed to the theater than among other healthy people in the same age group.

Between March 1 and Aug. 31, about 100 active-duty service members deployed to Southwest Asia have developed pneumonia. Of the 19 cases of severe pneumonia -- meaning that the pneumonia entered both lungs and was severe enough that patients required ventilators or respirators -- two of the patients became ill in March, two in April, one in May, six in June, four in July, and two in August. Thirteen of the cases occurred in Iraq, and six were in other Central Command countries, including Kuwait, Qatar, Uzbekistan, and Djibouti. All but one of the patients were male.

Winkenwerder reported the Defense Department's investigation into these cases is helping eliminate several possible causes. It shows no evidence of severe acute respiratory syndrome, known as SARS, associated with the pneumonia, and appears to rule out the possibility that the disease is spread person-to- person.

The investigation also shows no indication that anthrax or smallpox vaccines increase the risk of pneumonia, according to Col. Robert DeFraites from the Army Surgeon General's Office, who is spearheading the investigation.

Among the group with severe pneumonia, four had bacterial pneumonia. However, in nine of the cases of severe pneumonia experienced by service members who deployed to the theater -- and in all but one of the 10 cases involving elevated levels of a particular type of white blood cell called eosinophils -- the patients had recently taken up smoking.

DeFraites said the chemicals in cigarette smoke, compounded by hot temperatures and dehydration, could potentially increase the body's susceptibility to pneumonia. DeFraites said two soldiers experienced severe pneumonia in 1997 while training in similar conditions at the Army's National Training Center in Barstow, Calif.

He said the Defense Department will continue to work with the Centers for Disease Control and the services to explore any link between tobacco use and the pneumonia. "We are investigating this further," he said.

Meanwhile, DeFraites said the DoD investigation is "well advanced," and that epidemiological consultation teams are about to wrap up their work in Iraq and the U.S. military hospital in Landstuhl, Germany. The teams will resume their work in the United States.

A scientist from the Centers for Disease Control and Prevention joined the consultative team at the Walter Reed Army Institute of Research and Prevention, where all information from the Germany and Iraq teams is being gathered, analyzed and evaluated.

DoD also has engaged the expertise of several members of the Armed Forces Epidemiological Board, an advisory committee of eminent civilian scientists and physicians that is providing consultation assistance.

CDC's associate director for epidemiological science and a member of the Armed Forces Epidemiological Board, Dr. Stephen Ostroff, also is involved in the investigative review. "I have a high degree of confidence in the depth of the investigation being done to get the bottom of this and get some answers," he said.

The investigation will include ongoing medical surveillance of the service members who have recovered from the disease, particularly those who experienced severe pneumonia. DeFraites said all have recovered from their symptoms and have been released from the hospital. One returned to duty in Southwest Asia, and the others are on duty at their home stations or on convalescent leave.

DeFraites said the Defense Department is committed to finding the answers to the pneumonia cases. "The investigation remains ongoing and we will keep an open mind to any and all possibilities," he said.

"Although we don't have all the answers we'd like to at this point," Winkenwerder concluded, "we are making good progress and our work will continue."

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