VIII. AREAS REQUIRING FURTHER INVESTIGATION OR RESEARCH
Detailed information about the physical, chemical, and biological properties of particles that might cause the adverse health effects as observed in some Gulf War veterans is limited. Information about the mechanisms of toxicity and the synergistic effect of multiple compounds present in association with particulate matter is also limited. In general, there is not a clear relationship between the individual toxic components of airborne particulate matter and adverse health symptoms or indicators, such as respiratory and cardiovascular ailments. Nor are there toxicological evidence suggesting plausible biological mechanisms to explain the toxic effects attributed to particulate matter in epidemiological studies, or to determine how the populations at risk are exposed to these components. The USACHPPM, however, continues its collaborative efforts with the NOAA/Air Resources Laboratory to reconstruct daily particulate matter levels for Operation Desert Shield/Storm Kuwait Theater of Operations. This effort will provide additional information on particulate matter exposure levels of the KTO in relation to daily troop unit locations.
It should also be noted that the limitations in the data and the need for additional research noted above are not unique to the Gulf War setting or population, rather, they apply more generally to our knowledge of particulate matter exposures.
IX. LESSONS LEARNED
The primary symptoms of infectious disease among Gulf War participants were generally mild acute diarrhea and some forms of respiratory distress, which was expected, based on experiences from previous US deployments. Because of the unavoidable crowding during rapid mobilization for war and the inevitable exposure to infectious disease pathogensespecially in tropical and developing countriesdiarrhea and respiratory disease will remain a problem for US personnel until effective preventive measures are developed.
The US military should therefore continue to support an aggressive program of preventive medicine, which is guided during deployments by continuous disease surveillance and on-site laboratory analyses. In addition, the military should maintain an infectious diseases research program to develop new vaccines, improved medical treatments, and more accurate and rapid diagnostic tests.
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