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Outbreak chart

Click here for a list of the Navy's most widespread outbreaks in the past four years.

In the fight against illness, the place sailors like most is where they are most at risk: in port.

Many of the viruses and bacteria that sweep through the fleet are picked up ashore, both in the U.S. and abroad, and then spread back onboard ship, where close quarters allow these microscopic stowaways to thrive.

A month after Haiti suffered a devastating earthquake in 2010, five Marines and soldiers involved in the relief effort near Port-au-Prince were diagnosed with malaria, a parasitic disease that can be fatal if untreated. All were treated and recovered.

This is just one of the 90 infectious outbreaks the Navy and Marine Corps have suffered in the last five years. With flu season underway, Navy Times sought reports on the most recent outbreaks to assess the biggest threats sailors face and who is most susceptible. The data show that the flu consistently causes the most outbreaks, racking up hundreds aboard big decks. Obtained via an open records request, the data do not include sexually transmitted diseases, which the Navy tallies separately.

"The disadvantage of being on a ship … is certain illnesses can spread rapidly when you're in an enclosed environment," said Capt. (Dr.) Robert Lipsitz, the preventive medicine officer at the Bureau of Medicine and Surgery. "When you're at sea, there's no other place to go."

Impact of a virus

One new and highly contagious threat, for instance, was an influenza pandemic spreading through Asia and North America four years ago that struck a deployed strike group.

Not long after departing Singapore, crew members on the aircraft carrier Ronald Reagan began reporting to sick bay with symptoms of the influenza virus H1N1, aka swine flu. They had fevers and chills, sore throats and severe headaches. In the carrier's close confines, the highly communicable virus had spread to 222 sailors within three weeks.

A common strain of stomach flu sickened 23 sailors on the attack sub Cheyenne in early February, after the deployed sub left Subic Bay, Philippines. Nearly a fourth of the crew "had varying degrees of nausea, vomiting, cramps and diarrhea," a report said.

Port visits — especially ones to developing countries such as Malaysia, where sanitary conditions may be lacking — are a common cause of contagions.

Ships can be incubators for illness. Viruses can spread between people in close quarters, transferred by a sneeze or an unclean surface. But the biggest vulnerability is to airborne bacteria that can roam the ship through spaces and ventilation ducts.

"A bacteria that can travel through the ventilatory system and hang out ambiently in the air and have no problem is a big threat," Lipsitz said. "Viruses are a little less risky because they take person-to-person [transmission]. You have to be exposed within a 3-foot or 6-foot radius to someone."

One of the gravest of these is tuberculosis, a life-threatening illness spread when an infected person coughs, sneezes or even speaks, releasing bacteria that can linger in the air for hours. The Navy's last tuberculosis case was in September, but it has not had an outbreak of the highly contagious disease in at least five years.

The noro threat

Other illnesses are a constant threat. Take norovirus — the fleet's foremost foe. This highly transmissible strain of the stomach flu has racked up the highest tally of sickened sailors in the last five years. The virus causes vomiting and diarrhea. In the last six months, the Navy has suffereda norovirus outbreak every two weeks, these records show.

Norovirus, Lipsitz said, is "very hard to eradicate when it's in the environment because it can persist on hard surfaces for a long time and you need certain types of cleaners to kill it."

Contaminated food is the most common cause of the virus. Navy investigators believe this was behind many outbreaks, such as the 2010 outbreak on the amphibious assault ship Bonhomme Richard that sickened 174 sailors after their Kuala Lumpur, Malaysia, port visit.

Restaurants in foreign countries can be a bigger issue. Sailors aboard the carrier Abraham Lincoln began reporting to medical not long after the ship left Bahrain last May. They had nausea and vomiting from moderate to severe. Some were having trouble keeping down water, while others had fevers as high as 103.7 degrees. Several had more than 10 diarrhea episodes. A lab analysis found E.coli bacteria in stool samples.

"The common denominator of the group was dining at Macaroni Grill," a Navy report observed. The outbreak sickened 26.

Illnesses routinely strike training commands, most notably Recruit Training Command Great Lakes, Ill. Not only norovirus, but strep throat and conjunctivitis are common there. Recruits come from all over the country and the world, sleep and eat in close quarters and are under stress — all factors that make Great Lakes an especially susceptible target.

But the Navy has seen gains there, too. Season after season, recruits have suffered from a respiratory flu that induces everything from fever to rash to pneumonia. Last year, the Navy began vaccinating recruits against this illness, known as adenovirus, Lipsitz said.

Port precautions

Your greatest susceptibility to picking up an unusual disease is in port, especially in foreign countries. Here are some tips for staying healthy from the Navy's preventive medicine expert:

• Mind your food. Assess a restaurant's cleanliness before eating there. In less developed countries, avoid street vendors and be aware that food that is not fully cooked may carry harmful bacteria, said Lipsitz, who added, "Stay away from buffets — buffets are notoriously hazardous." Drink bottled water.

• Wash your hands. Use soap and water to scrub your hands often, especially before and after meals. You can also use alcohol-based sanitizer. This simple practice will remove most harmful germs, according to the Centers for Disease Control and Prevention.

• Look both ways! The single largest cause of injury abroad is not illness; it's traffic accidents. "That common stuff happens more abroad, especially if people are looking the wrong way when they're crossing the street or driving standards are different in different parts of the world," Lipsitz said.

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