A cumulative total of 124 days off duty was reported for the whole 5-month study period. Among the 240 cases reported, only 196 patients provided stool samples (81.7%), the remainder

failed to return samples. Pathogenic agents were identified in 78 stool samples (39.8%), 7 of which had dual infections. Enteric viruses were the most common pathogens identified (28.1%), alone or in coinfection (Table 1). Norovirus was found in 14.3% of the samples, three times in coinfection with respectively Salmonella spp, Shigella spp, and Ankylostomiasis. Rotavirus was found in 10.2% of the samples, three times in coinfection with Shigella spp and once in coinfection with astrovirus. In January 2008, an outbreak was observed (second peak, Figure 3) where rotaviruses represented 29.5% (13/44)

of tested stools. Among the 240 cases of diarrhea, 70 were excluded from case-crossover Talazoparib clinical trial analysis: 34 due to a diarrheal episode occurring before a minimum of 10 days of stay in N’Djamena, 25 due to a diarrheic episode occurring in the 10 days following a previous diarrheic episode, and 12 due to missing data for one of these two criteria. The case-crossover analysis included 170 diarrheic episodes (170 case–control pairs). By univariate analysis, the significant risk factors for acute diarrhea were (1) ice in drinks, (2) presence of a diarrheal case in the close circle, (3) eating at local restaurants, and (4) eating in a field kitchen (Table 2). Always

eating at the mess was protective. No interaction see more was observed between the presence of diarrhea in the close circle and places to eat, thus ruling out a group effect due to C-X-C chemokine receptor type 7 (CXCR-7) a food-borne disease outbreak. The conditional multivariate logistic regression analysis confirmed that the presence of diarrhea in the close circle was a risk factor for acute diarrhea (Table 2), while always eating at the mess conferred a protective effect. Moreover, sometimes eating in a temporary encampment was also protective (Table 2). Our study is the first to evaluate etiology and risk of TD in Chad. We observed substantial implication of viruses and a high risk of person-to-person transmission for diarrhea among French forces deployed to Chad. Enteric viruses were the most frequently observed pathogens (28.1%), ahead of bacteria (12.8%) in stool samples. However, no pathogen was identified in 60% of stool samples. This rate is slightly higher than that in others’ studies reporting rates of around 50% of no pathogen identification in TD.8–10 This difference may be partly explained by the fact that our study failed to identify the most frequent pathogens usually involved in TD, namely enterotoxigenic E coli and enteroaggregative E coli.8–11 This is undoubtedly related to the fact that the local French field laboratory in N’Djamena did not perform analyses for E coli for want of suitable technical facilities.