Morbidity and mortality caused by rickettsioses have had a major influence on military activities and public health for 12000 years. The threat posed by the rickettsioses is reviewed, focusing on the impact and epidemiology of those that have adversely influenced wartime operations and the current challenges posed by these diseases. With their uneven worldwide distribution, the discovery of drug-refractory strains of Orientia tsut-sugamushi, the increased threat of their use in acts of bioterrorism, frequent deployment of troops to regions of endemicity, and exposures due to increased humanitarian missions, these diseases continue to be a threat to military personnel in the field. Effective strategies to reduce the impact of these diseases include development of effective vaccines, enhanced surveillance, and development of new safe, effective, and odorless repellants. The continuation of a proven, highly productive military infectious disease research program is essential for providing solutions to these daunting tasks. World and military histories are replete with examples of infectious diseases that changed the course of nations. Rickettsial diseases are widely distributed throughout the world. They are generally incapacitating , sometimes fatal, but frequently unrecognized illnesses that cause fevers in susceptible populations. When recognized, they are often easily treated, but the unusual conditions created by war, military operations, or civil unrest often delay or prevent appropriate treatment. Rickettsial diseases are notoriously difficult to diagnose because they share symptoms with many other febrile diseases with similar epidemiology. Thus, the reported historical numbers of cases of infections with rickettsiae are probably not very accurate and are known to be severely underreported. Strategies to ameliorate the military and public health impact of rick-ettsial and other infectious diseases include medical training and ongoing global surveillance, improved recognition of clinical disease, and the development of novel detection systems, treatments, and approaches to prevention. Our purpose is to review the epidemiology of the rickettsioses, to describe the impact of those rickettsial diseases that have adversely influenced past military deployments and operations, and to outline the current challenges posed by this family of diseases to present military operations and international public health.
Kelly, D. J., Richards, A. L., Temenak, J., Strickman, D., & Dasch, G. A. (2002). The Past and Present Threat of Rickettsial Diseases to Military Medicine and International Public Health. Clinical Infectious Diseases, 34(Supplement_4), S145–S169. https://doi.org/10.1086/339908