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Fukuda K, Nisenbaum R, Stewart G, et al. Chronic Multisymptom Illness Affecting Air Force Veterans of the Gulf War. JAMA. 1998;280(11):981–988. doi:10.1001/jama.280.11.981
From the Divisions of Viral and Rickettsial Diseases (Drs Fukuda, Noah, Mawle, and Reeves) and Parasitic Diseases (Dr Herwaldt), National Center for Infectious Diseases, the Division of Environmental Hazards and Health Effects, National Center for Environmental Health (Dr Barrett), and the Epidemic Intelligence Service, Epidemiology Program Office (Drs Robin and Washko), Centers for Disease Control and Prevention, Atlanta, Ga; Klemm Analysis Group, Atlanta, Ga (Dr Nisenbaum); and Abt Associates Inc, Cambridge, Mass (Mss Stewart and Randall and Dr Thompson).
Context.— Gulf War (GW) veterans report nonspecific symptoms significantly more
often than their nondeployed peers. However, no specific disorder has been
identified, and the etiologic basis and clinical significance of their symptoms
Objectives.— To organize symptoms reported by US Air Force GW veterans into a case
definition, to characterize clinical features, and to evaluate risk factors.
Design.— Cross-sectional population survey of individual characteristics and
symptoms and clinical evaluation (including a structured interview, the Medical
Outcomes Study Short Form 36, psychiatric screening, physical examination,
clinical laboratory tests, and serologic assays for antibodies against viruses,
rickettsia, parasites, and bacteria) conducted in 1995.
Participants and Setting.— The cross-sectional questionnaire survey included 3723 currently active
volunteers, irrespective of health status or GW participation, from 4 air
force populations.The cross-sectional clinical evaluation included 158 GW
veterans from one unit, irrespective of health status.
Main Outcome Measures.— Symptom-based case definition; case prevalence rate for GW veterans
and nondeployed personnel; clinical and laboratory findings among veterans
who met the case definition.
Results.— We defined a case as having 1 or more chronic symptoms from at least
2 of 3 categories (fatigue, mood-cognition, and musculoskeletal). The prevalence
of mild-to-moderate and severe cases was 39% and 6%, respectively, among 1155
GW veterans compared with 14% and 0.7% among 2520 nondeployed personnel. Illness
was not associated with time or place of deployment or with duties during
the war. Fifty-nine clinically evaluated GW veterans (37%) were noncases,
86 (54%) mild-to-moderate cases, and 13 (8%) severe cases. Although no physical
examination, laboratory, or serologic findings identified cases, veterans
who met the case definition had significantly diminished functioning and well-being.
Conclusions.— Among currently active members of 4 Air Force populations, a chronic
multisymptom condition was significantly associated with deployment to the
GW. The condition was not associated with specific GW exposures and also affected
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