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Keiji Fukuda, MD, MPH; Rosane Nisenbaum, PhD; Geraldine Stewart, MA; William W. Thompson, PhD; Laura Robin, DO, MPH; Rita M. Washko, MD; Donald L. Noah, DVM, MPH; Drue H. Barrett, PhD, MS; Bonnie Randall, MCP; Barbara L. Herwaldt, MD, MPH; Alison C. Mawle, PhD; William C. Reeves, MD, MSPH

JAMA. 1998;280:981-988.

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 remain unclear.

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 nondeployed personnel.

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).

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RELATED LETTER

Chronic Multisystem Illness Among Gulf War Veterans
Robert W. Haley, Stephen C. Hunt, Ralph D. Richardson, Claudia S. Miller, Nicholas A. Ashford, William C. Reeves, Keiji Fukuda, Rosane Nisenbaum, and William W. Thompson
JAMA. 1999;282(4):327-329.
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Illness Among Gulf War Veterans: Risk Factors, Realities, and Future Research
Joyce C. Lashof and Joseph S. Cassells
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