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Medical Surveillance Monthly Report

thumbnail image of several MSMRsThe Medical Surveillance Monthly Report (MSMR), a peer-reviewed journal launched in 1995, is the AFHSB's flagship publication. The MSMR provides monthly evidence-based estimates of the incidence, distribution, impact, and trends of health-related conditions among service members. Additionally, the MSMR focuses one issue per year on the absolute and relative morbidity burden attributable to various illnesses and injuries among service members and beneficiaries. You may request an electronic subscription online or via email

Would you like to be published in the MSMRAuthors are welcome to submit their manuscripts to the MSMR. >>See Instructions for Authors

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Here, you can download the current and past issues of the MSMR. Inquiries regarding content or material to be considered for publication should be directed to the MSMR Editor.

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Citing the MSMR

When citing MSMR articles, please use the following formats:

Author Names Listed with the Article

Collier DA, Bayles MK, Barrett, JP. Acute gastroenteritis outbreak at the Armed Forces Retirement Home, Washington, DC, January 2011. MSMR. 2011;18(6):11-14.

No Author Name Listed (April 2007 to current)

Armed Forces Health Surveillance Branch. Mental disorders and mental health problems, active component, U.S. Armed Forces, January 2000 – December 2009. MSMR. 2010;17(11):6-13.

No Author Name Listed (Before April 2007)

Army Medical Surveillance Activity. Overhydration and hyponatremia among active duty soldiers, 1997-1999. MSMR. 2000;6(3):9-11.


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Acute Flaccid Myelitis Case Reporting

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1/29/2019
Acute Flaccid Myelitis Case Reporting

This case highlights important clinical characteristics of acute flaccid myelitis and emphasizes the importance of including AFM in the differential diagnosis when evaluating active duty service members and Military Health System beneficiaries presenting with paralysis.

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Cardiovascular disease-related medical evacuations

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1/29/2019
Cardiovascular disease-related medical evacuations

This descriptive analysis summarizes the demographic characteristics, counts, rates and temporal trends for Cardiovascular disease-related medical evacuations from the CENTCOM area of responsibility. In addition, the percentage of those evacuated who had received pre-deployment diagnoses indicating cardiovascular risk is summarized. Responses to questions regarding health status and physician referrals on the DD2795 are also summarized.

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Cardiovascular Disease-related Medical Evacuations, Active and Reserve Components, U.S. Armed Forces, 1 October 2001–31 December 2017

Article
1/1/2019
Cardiovascular Diagnoses

From 1 October 2001 through 31 December 2017, a total of 697 medical evacuations of service members from the U.S. Central Command (CENTCOM) area of responsibility were followed by at least one medical encounter in a fixed medical facility outside the operational theater with a diagnosis of a cardiovascular disease (CVD). The vast majority of those (n=660; 94.7%) evacuated were males. More than a third of CVD-related evacuations (n=278, 39.9%) occurred in service members 45 years of age or older; slightly more than half (n=369; 52.9%) occurred in reserve or guard members. The most common CVD risk factors which had been diagnosed among evacuated service members prior to their deployment were hypertension (n=236; 33.9%) and hyperlipidemia (n=241; 34.9%). Much lower percentages had been previously diagnosed with obesity (n=74, 10.6%) or diabetes (n=21, 3.0%). More than 1 in 4 service members with a CVD-related medical evacuation had been diagnosed with more than one risk factor (n=182, 26.1%). Both limitations to the data available and strategies to reduce CVD morbidity in theater are discussed.31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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Acute Flaccid Myelitis: Case Report

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1/1/2019
Acute Flaccid Myelitis

In August 2018, the U.S. Centers for Disease Control and Prevention (CDC) noted an increased number of reports of patients in the U.S. having symptoms clinically compatible with acute flaccid myelitis (AFM). AFM is characterized by rapid onset of flaccid weakness in one or more limbs and distinct abnormalities of the spinal cord gray matter on magnetic resonance imaging (MRI). Clinical and laboratory data suggest that AFM is associated with an antecedent viral infection. AFM may be difficult to differentiate from other causes of paralysis and, given that it is rare, has the potential to be overlooked. This case highlights important clinical characteristics of AFM and emphasizes the importance of including AFM in the differential diagnosis when evaluating active duty service members and Military Health System (MHS) beneficiaries presenting with paralysis.31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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Non-alcoholic Fatty Liver Disease (NAFLD), Active Component, U.S. Armed Forces, 2000–2017

Article
1/1/2019
Non-alcoholic fatty liver disease

During 2002–2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). In both sexes, overall rates of other disorders of adrenal gland and Cushing’s syndrome were lower than for adrenal insufficiency but higher than for hyperaldosteronism, adrenogenital disorders, and adrenomedullary hyperfunction. Crude overall rates of adrenal gland disorders among females tended to be higher than those of males, with female:male rate ratios ranging from 2.1 for adrenal insufficiency to 5.5 for androgenital disorders and Cushing’s syndrome. The highest overall rates of adrenal insufficiency for males and females were among non-Hispanic white service members. Among females, rates of Cushing’s syndrome and other disorders of adrenal gland were 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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Historical Perspective: Leptospirosis Outbreaks Affecting Military Forces

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1/1/2019
Acute Flaccid Myelitis

Leptospirosis is a widespread and highly prevalent bacterial zoonotic disease that is caused by pathogenic spirochetes of the genus Leptospira. It is transmitted to humans primarily through contact of abraded skin or mucous membranes with water or wet soil that has been contaminated with infected animal urine. Many wild and domestic animals are susceptible to infection by pathogenic Leptospira bacteria including rats, dogs, cattle, goats, sheep, and swine. Once chronically infected, a carrier animal can shed Leptospira bacteria in urine for long periods of time and Leptospira bacteria can survive in water or soil for weeks to months.higher among non-Hispanic white service members compared with those in other race/ethnicity groups. In both sexes, the annual rates of adrenal insufficiency and other disorders of adrenal gland increased slightly during the 16-year period.31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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Incidence and Prevalence of the Metabolic Syndrome Using ICD-9 and ICD-10 Diagnostic Codes, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018
Metabolic Syndrome

This report uses ICD-9 and ICD-10 codes (277.7 and E88.81, respectively) for the metabolic syndrome (MetS) to summarize trends in the incidence and prevalence of this condition among active component members of the U.S. Armed Forces between 2002 and 2017. During this period, the crude overall incidence rate of MetS was 7.5 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, overall incidence rates were highest among Asian/Pacific Islanders, Air Force members, and warrant officers and were lowest among those of other/unknown race/ethnicity, Marine Corps members, and junior enlisted personnel and officers. During 2002–2017, the annual incidence rates of MetS peaked in 2009 at 11.6 cases per 100,000 p-yrs and decreased to 5.9 cases per 100,000 p-yrs in 2017. Annual prevalence rates of MetS increased steadily during the first 11 years of the surveillance period reaching a high of 38.9 per 100,000 active component service members in 2012, after which rates declined slightly to 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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Thyroid Disorders, Active Component, U.S. Armed Forces, 2008–2017

Article
12/1/2018
Thyroid scan

This analysis describes the incidence and prevalence of five thyroid disorders (goiter, thyrotoxicosis, primary/not otherwise specified [NOS] hypothyroidism, thyroiditis, and other disorders of the thyroid) among active component service members between 2008 and 2017. During the 10-year surveillance period, the most common incident thyroid disorder among male and female service members was primary/NOS hypothyroidism and the least common were thyroiditis and other disorders of thyroid. Primary/NOS hypothyroidism was diagnosed among 8,641 females (incidence rate: 43.7 per 10,000 person-years [p-yrs]) and 11,656 males (incidence rate: 10.2 per 10,000 p-yrs). Overall incidence rates of all thyroid disorders were 3 to 5 times higher among females compared to males. Among both males and females, incidence of primary/NOS hypothyroidism was higher among non-Hispanic white service members compared with service members in other race/ethnicity groups. The incidence of most thyroid disorders remained stable or decreased during the surveillance period. Overall, the prevalence of most thyroid disorders increased during the first part of the surveillance period and then either decreased or leveled off.31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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Adrenal Gland Disorders, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018
Adrenal Glands

During 2002–2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). In both sexes, overall rates of other disorders of adrenal gland and Cushing’s syndrome were lower than for adrenal insufficiency but higher than for hyperaldosteronism, adrenogenital disorders, and adrenomedullary hyperfunction. Crude overall rates of adrenal gland disorders among females tended to be higher than those of males, with female:male rate ratios ranging from 2.1 for adrenal insufficiency to 5.5 for androgenital disorders and Cushing’s syndrome. The highest overall rates of adrenal insufficiency for males and females were among non-Hispanic white service members. Among females, rates of Cushing’s syndrome and other disorders of adrenal gland were 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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Rabies

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11/20/2018
Rabies

Although Germany is rabies-free for terrestrial land mammals, rabies exposure remains a concern for U.S. military personnel assigned there because of personal and military travel and deployments to rabies endemic countries. Deployments have become much more variable both in location and duration. Deployments have increasingly focused on enhancing partnerships and peacekeeping.

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Cold Weather Injuries

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11/20/2018
Cold Weather Injuries

This update summarizes the frequencies, incidence rates, and correlates of risk of cold injuries among members of both active and reserve components of the U.S. Armed Forces during the past 5 years.

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Malaria

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11/20/2018
Malaria

This report describes a cluster of 11 soldiers with vivax malaria among U.S. military personnel who trained at Dagmar North training area, near the demilitarized zone (DMZ), in the Republic of Korea (ROK) in 2015.

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DoD Flu VE

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10/26/2018
DoD Flu VE

Each season, several entities within the(DoD) perform surveillance for influenza among beneficiaries and utilize these data to perform VE analyses to estimate how well the seasonal vaccine protects against medically-attended influenza.

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Pelvic Inflammatory Disease

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10/26/2018
Pelvic Inflammatory Disease

The purpose of this study was to update previous MSMR analyses of the incidence of acute Pelvic inflammatory disease (PID) among U.S. active component women using a 21-year surveillance period from 1996 through 2016. A secondary objective was to report on the proportion of service women with previously diagnosed PID who were subsequently diagnosed with infertility or ectopic pregnancy.

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Psychiatric Medical Evaluations

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10/26/2018
Psychiatric Medical Evaluations

This study evaluated incidence of pre-deployment family problem diagnoses and psychiatric medical evacuations among a population of active component service members without a history of previous mental health diagnoses, who deployed to the U.S. Central Command Area of Responsibility for the first time between 1 January 2002 and 31 December 2014.

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