The Epidemiology and Analysis section performs comprehensive surveillance and analyses of health-related information among military service members and military-associated populations. The E&A section also provides oversight and direction to the Armed Forces Health Surveillance Division satellites located at Aberdeen Proving Ground, Md.; Dayton, Ohio; and Portsmouth, VA. The satellites have direct interaction with the U.S. military services public health and epidemiology centers, and provide coordinated support and reports for AFHSD and the military services.

E&A leverages two major health surveillance tools maintained by AFHSD's Data Management and Technical Support section to help its staff of epidemiologists, preventive medicine physicians, and data analysts provide timely analyses and reports of actionable health information:

• Defense Medical Surveillance System
• Department of Defense Serum Repository

The use of these tools allows E&A to provide health surveillance products to DOD policymakers, military commanders, health care providers, public health officers, and researchers.

E&A's main lines of effort are:

• Providing epidemiologic consults, studies, and analyses in support of ad hoc requests
• Preparing periodic and recurring Analytical Reports to monitor trends over time of diseases, illnesses, and injuries affecting military and associated populations
• Publishing the Medical Surveillance Monthly Report
• Developing and distributing Standardized Health Surveillance Case Definitions and methodologies uniquely used by DOD public health practitioners
• Conducting health surveillance and epidemiology training for preventive medicine residents - Read the AFHSD Annual Report to learn about the program
• Managing updates and publication of the Armed Forces Reportable Medical Events Guidelines and Case Definitions used by DOD medical providers, public health officers and laboratories

DMSS Data and DODSR Serum Requests

The E&A section receives requests for DMSS data and DODSR serum specimens from numerous DOD health surveillance professionals and researchers by email. The types of requests made to AFHSD include: operational public health practice, research support, and clinical support. To request operational public health or surveillance data, please fill out this form. For clinical data requests, please use this form. If you are requesting data for a research study, please submit the study protocol. Each request is evaluated for factors such as military relevance, status as research versus public health practice, scientific integrity, and feasibility.

To make a request for data, analysis or serum, the requester must meet certain criteria including:

• A requester must be a military service member or government employee working for a U.S. military organization.
• For research studies, there must be at least one military principal investigator.
• The study/ analysis must address a military-relevant topic.

Specimens contained in the DODSR are available to researchers and other investigators within the DOD for a fee. However, this fee is waived for investigators requesting fewer than 100 specimens.  At a minimum study protocols should provide clear objectives and hypotheses. Protocols should include a title page with the PI’s contact information, background/literature review section, military relevance and benefit to the military/MHS population, methods for determining the population, exposures, and outcomes, sample size calculations, methods for statistical analysis, serologic assays to be performed (if applicable), measures to protect privacy, and direction on where to send the final data sets and serum samples. The protocol must clearly:

1. Identify the study population of interest.
2. Define the specific inclusion and exclusion criteria.
3. Define the matching criteria for cases and controls (if applicable).
4. Specify the requirements for serum sample selection (if applicable).
5. Provide sufficient details on all required variables, their categorization, and handling of time-varying covariates.

The study protocol should be submitted to the AFHSD prior to submission to the military Institutional Review Board/Human Use Committee so that the AFHSD can determine if the request can be supported. Please note general restrictions that pertain to the amount of serum that can be requested for research purposes:

• AFHSD receives the remaining serum from the periodic, mandatory HIV screening and pre- and post-deployment testing requirements for service members. Generally, a service member will have a specimen available every 1-2 years. There is typically 2-4mL of serum in each parent tube.
• A maximum amount of 4 aliquoted specimens may be requested from the same individual, and only one 0.5mL aliquot will be provided from any available time point (i.e., parent tube).
• Once an aliquoted specimen is released for a study, that parent specimen cannot typically be requested by the same researchers for future studies.
• Investigators are encouraged to review the published information about the DODSR before submitting their study protocol to AFHSD:

1. Perdue CL, Eick-Cost AA, Rubertone MV. A Brief Description of the Operation of the DoD Serum Repository. Mil Med. 2015;180(10 Suppl):10-12. doi:10.7205/MILMED-D-14-00739
2. Pavlin JA, Welch RA. Ethics, Human Use, and the Department of Defense Serum Repository. Mil Med. 2015;180(10 Suppl):49-56. doi:10.7205/MILMED-D-14-00725
3. Baird CP. Maximizing the Utility of the Serum Repository With Current Technologies and Recommendations to Meet Future Needs: Report of the Technical Panel. Mil Med. 2015;180(10 Suppl):25-33. doi:10.7205/MILMED-D-15-00065
4. Perdue CL, Cost AA, Rubertone MV, Lindler LE, Ludwig SL. Description and utilization of the United States department of defense serum repository: a review of published studies, 1985-2012. PLoS One. 2015;10(2):e0114857. Published 2015 Feb 27. doi:10.1371/journal.pone.0114857

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