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AFHSB's health surveillance program supports Defense Department global health engagement efforts

U.S. Air Force Senior Airman Joshua Douglass, left, an aerospace medical technician, watches as Liberian health care workers properly put on their personal protective equipment as part response by the Defense Department operation to provide logistics, training and engineering support during the Ebola virus outbreak. (U.S. Army photo by Staff Sgt. Terrance D. Rhodes) U.S. Air Force Senior Airman Joshua Douglass, left, an aerospace medical technician, watches as Liberian health care workers properly put on their personal protective equipment as part response by the Defense Department operation to provide logistics, training and engineering support during the Ebola virus outbreak. (U.S. Army photo by Staff Sgt. Terrance D. Rhodes)

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Armed Forces Health Surveillance Division | Global Emerging Infections Surveillance | Antimicrobial Resistance (AMR) Surveillance | Febrile and Vector-Borne Infections (FVBI) Surveillance | Enteric Infections (EI) Surveillance | GEIS Partners | Global Health Engagement

Both the U.S. Armed Forces’ operational posture and the emergence and spread of infectious diseases relevant to military operations have evolved in recent decades. Worldwide, people are more mobile and interconnected than ever before. At the same time, land use in the developing world is changing in such a way that long-dormant pathogens have the opportunity to re-emerge and become health problems for a significant proportion of the population again. These conditions threaten not only the health of populations, but also the security and stability of nations around the world.

The Defense Department has long recognized the link between global health and security, and its global health engagement efforts address the intersection of these concerns. Defense Department health agencies are primarily focused on protecting the health of the force and medical readiness, but their global health engagement efforts also address other security priorities for the U.S. government such as helping partner nations build health capacity, combatting global health threats (e.g., emerging infectious diseases and antibiotic-resistant bacteria), and supporting U.S. government humanitarian assistance and disaster relief initiatives.

The Global Emerging Infections Surveillance (GEIS) section of the Armed Forces Health Surveillance Branch (AFHSB) supports global health engagement by leveraging a network of Defense Department laboratory partners that are positioned in critical locations globally and work with partner nations to combat infectious disease threats. Defense Department laboratories around the world execute coordinated, integrated surveillance efforts to detect and respond to febrile and vector-borne infections, respiratory infections, antimicrobial-resistant and sexually transmitted infections, and enteric infections regardless of the source. These efforts are conducted in more than 70 countries and serve to protect the health of a highly mobile force by informing risk assessments and countermeasure development, providing support to outbreak response efforts when they arise, and supporting operational access and freedom of movement in high-threat areas.

In support of the Defense Health Agency’s combat support efforts, the GEIS network’s ultimate goal is early, accurate detection of emerging infectious disease and rapid communication regarding those that potentially threaten the health of U.S. forces so that preventive measures can be taken to enable operational readiness and mitigate the risk of mission failure. Surveillance efforts are conducted in partnership with partner nation ministries of health and defense, thereby improving their health capacity by enabling rapid identification and response to infectious disease threats to their population and strengthening relationships with key U.S. partners. In this way, the GEIS program supports the U.S. geographic combatant commands (GCCs) in their areas of responsibility, advancing their campaign plans, lines of efforts, and end states. Additionally, by providing direct technical support to GCC-led international scientific coalitions and strategic engagement efforts, GEIS enhances Defense Department global health engagements and advances information sharing with partner nations. These activities ultimately better inform force health protection decision making at the GCCs and enable global health security for partner nations and U.S. government assets abroad.

Throughout December, in celebration of the Global Health Engagement Month, AFHSB will showcase some of the surveillance efforts conducted by GEIS’s laboratory partners around the world. These stories are available on DHA’s Global Health Engagement Spotlight page.

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Risk Factors for Tinea Pedis Infections (Athlete’s Foot) among U.S. Armed Forces

Infographic
6/19/2017
Athlete’s foot is a chronic fungal infection of the feet and toes that is common among military service members. Risk factors for infection include: •	High-intensity training •	Heavy sweating •	Protracted shoe/boot wearing •	Less frequent sock changes During field training exercises or deployment, service members may be exposed to additional risk factors for athlete’s foot including hot and humid ambient weather, poor skin hygiene, and close-quarter living. The condition’s most common clinical presentation is infection in the space between the toes. If left untreated this pattern of infection may cause… •	Softening and breaking down of skin resulting from prolonged exposure to moisture (maceration) •	Reddening of skin caused by congestion of the capillaries in the lower layers of the skin (erythema) •	Fissures of the skin These changes in the skin increase the risk of cellulitis, a serious bacterial infection of the skin capable of spreading to other parts of the body. Read this brief report “Tinea Pedis, Active Component, U.S. Armed Forces, 2000 – 2016,” which summarizes the impact of the condition among U.S. active component service members. Access the report in MSMR Vol. 24 No. 5 – May 2017 at Health.mil/MSMR.  Background graphic of the infographic is a pair of feet diagnosed with athlete’s foot but instead of showing breakage of skin we see the leg and foot of a military service member walking through water.

This infographic documents the risk factors for tinea pedis infections (athlete’s foot).

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Armed Forces Health Surveillance Division

Tinea Pedis (Athlete’s Foot) U.S. Armed Forces, 2000-2016

Infographic
6/19/2017
Athlete’s foot is a common problem among military service members. Known by the medical term, Tinea Pedis, the condition causes a chronic fungal infection of the feet and toes. It is the most common dermatophyte infection among adults. Up to 25% of the global population is affected by tinea pedis at any given time. Findings: During the 17-year surveillance period there were a total of 193,432 medical encounters for tinea pedis. Of these total encounters, 91% were ambulatory visits. Of 459 hospitalization records that contained diagnoses of athlete’s foot during the surveillance period, a total of 275 (59.9%) had a primary diagnosis of cellulitis or abscess of the foot or leg during the incident tinea pedis hospitalization. Where this information displays two feet are seen. The pie chart shows in an orange pie slice the 59.9% or 275 military service members that had a primary diagnosis of cellulitis or abscess of the foot or leg during the incident tinea pedis hospitalization. The rest of the pie chart shows in purple the 184 other hospitalization records. Background of the pie chart shows a foot.  High Risks for tinea pedis infections: •	Males – overall incident rate 17.4% higher than females •	Service members younger than 20 years of age •	Black, non-Hispanic and Hispanic service members •	Junior enlisted service members Given these costs, prevention efforts such as training and education about foot and skin health warrant continual emphasis, especially during initial entry training and in preparation for field exercises and deployments to warm locations. Learn more at Health.mil/MSMR Top of image shows foot with tinea pedis (athlete’s foot).

This infographic summarizes the counts, rates, trends and demographic characteristics of diagnoses of tinea pedis among U.S. active component service members during 2000 -2016.

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Armed Forces Health Surveillance Division

Healthcare Burdens Attributable to Various Mental Disorders, U.S. Armed Forces 2016

Infographic
5/25/2017
Did you know…? In 2016, mood disorders and substance abuse accounted for 25.9% of all hospital days. Together, four mental disorders – mood, substance abuse disorders, adjustment, and anxiety – and two maternal conditions – pregnancy complications and delivery – accounted for 53.6% of all hospital bed days. And 12.4% of all hospital bed days were attributable to injuries and poisonings. Here are the mental disorders that affected U.S. Armed Forces in 2016: Pie Chart titled Bed days for mental disorders in 2016: •	Mood Disorder (46,920 bed days) – the orange pie slice. •	Substance Abuse Disorders (44,746 bed days) – the blue pie slice. •	Adjustment Disorder (30,017 bed days) – the purple pie slice. •	Anxiety Disorder (20,458 bed days) – the gray pie slice. •	Psychotic Disorder (6,532 bed days) – the light blue pie slice. •	All other mental disorders (3,233 bed days) – the violet pie slice. •	Personality disorder (2,393 bed days) – the forest green pie slice. •	Somatoform (552 bed days) – the lime green pie slice. •	Tobacco dependence (2 bed days) – the white pie slice. Bar graph shows percentage and cumulative percentage distribution, burden “conditions” that accounted for the most hospital bed days, active component, U.S. Armed Forces 2016.  % of total bed days (bars) for mood disorder, substance abuse disorders, adjustment disorder, pregnancy complications; delivery; anxiety disorder; head/neck injuries, all other digestive diseases, other complications NOS; other back problems, all other signs and symptoms; leg injuries, all other maternal conditions; all other neurologic conditions; all other musculoskeletal diseases; all other skin diseases;  back and abdomen; appendicitis; all other infectious and parasitic diseases; all other cardiovascular diseases; all other mental disorders; all other respiratory diseases; arm/shoulder injuries; poisoning, drugs; foot/ankle injuries; other gastroenteritis and colitis; personality disorder; lower respiratory infections; all other genitourinary diseases; all other malignant neoplasms; cerebrovascular disease.  See more details on this bar graph in the Medical Surveillance Monthly Report (MSMR) April 2017 Vol. 24 No. 4 report, page 4. This annual summary for 2016 was based on the use of ICD-10 codes exclusively. Read more on this analysis at Health.mil/MSMR. #LetsTalkAboutIt Background of graphic is a soldier sitting on the floor in a dark room.

This infographic documents the mental disorders that affected U.S. Armed Forces in 2016.

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Armed Forces Health Surveillance Division

Erectile Dysfunction among Male Active Component Service members

Infographic
5/25/2017
Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. ED can result from a problem with any of the above: •	Hormones •	Emotions •	Nerves •	Muscles •	Blood vessels These factors are required for an erection include. Picture is a brain (left) and a male figure (right) showing the heart and main arteries of the body. The top three most common ED diagnoses are: 1.	Psychosexual dysfunction 2.	Hypoactive sexual desire disorder 3.	Male orgasmic disorder Image shows a couple outside together during sunset. House displays in background. Causes of ED (Shows cut out of male body highlighting areas of the body where causes happen) •	Unrealistic sexual expectations •	Depression/ Anxiety/ Stress or other mental health issues •	High blood pressure •	Diabetes •	Obesity •	Injuries that affect the pelvic area or spinal cord •	Low testosterone •	Aging, Substance Abuse Demographics: •	Incidence rate of erectile dysfunction are higher among black, non-Hispanic servicemen when compared to other race/ethnicity groups. •	Black non-Hispanic service members have higher incidence rates of several conditions known to be risk factors for erectile dysfunction, including hypertension, obesity and diabetes. •	Separated, divorced and widowed servicemen had a higher incidence rate of ED than servicemen never married. •	Servicemen never deployed had the highest crude incidence rate of erectile dysfunction. Get the facts •	Erectile dysfunction is the most common sexual complaint reported by men to healthcare providers •	Among male service members nearly half of erectile dysfunction cases related predominantly or exclusively to psychological factors. •	Incidence rates of psychogenic erectile dysfunction are greater than organic erectile dysfunction for service members. •	Organic erectile dysfunction can result from physical factors such as obesity, smoking, diabetes, cardiovascular disease or medication use. •	Highest incidence rates were observed in those aged 60 years or older. •	Those 40 years or older are most commonly diagnosed with erectile dysfunction. Effective against erectile dysfunction •	Regular exercise  ( Shows soldier running) •	Psychological counseling (Shows two soldiers engaging in mental health counseling. They are seating on a couch).  •	Quit smoking ( shows lit cigarette)  •	Stop substance abuse ( Shows to shot glasses filled with alcohol) •	Nutritional supplements ( Shows open pill bottle of supplements) •	Surgical treatment ( Shows surgical instruments) Talk to your partner Although Erectile Dysfunction (ED) is a difficult issue for sex partners to discuss, talking openly can often be the best way to resolve stress and discover underlying causes. If you are experiencing erectile dysfunction, explore treatment options with your doctor. Learn more about ED by reading ‘Erectile Dysfunction Among Male Active Component Service Members, U.S. Armed Forces, 2004 – 2013.’ Medical Surveillance Monthly Report (MSMR) Vol. 21 No. 9 – September 2014 at www.Health.mil/MSMRArchives. Follow us on Twitter at AFHSBPAGE. #MensHealth

Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. This infographic provides details on the ways ED impacts male active component services members of the U.S. Armed Forces.

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Armed Forces Health Surveillance Division | Men's Health

Medical encounters, by condition, U.S. Armed Forces 2016

Infographic
5/25/2017
This infographic documents the three burden of disease related conditions that accounted for the most medical encounters among the active component of the U.S. Armed Forces in 2016. LONG FORM: In 2016, the three burden of disease related conditions accounted for the most medical encounters were: •	Other back problems •	All other musculoskeletal diseases •	Knee injuries Altogether they accounted for 25.1% of all illness-and injury-related medical encounters overall. More Findings The top nine conditions that accounted for the most medical encounters accounted for 53.1% of all illness-and-injury –related medical encounters overall. In general, the conditions that accounted for the most medical encounters were predominantly musculoskeletal disorders such as the back) injuries to the knee, arm, shoulder, foot or ankle, and mental disorders like anxiety and adjustment conditions. View more findings at www.Health.mil/MSMR    Graphic details This graphic displays the musculoskeletal of a male service member’s body to show the bones of the back and knees.

This infographic documents the three burden of disease related conditions that accounted for the most medical encounters among the active component of the U.S. Armed Forces in 2016.

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Accidental Drownings Among U.S. Service Members

Infographic
5/25/2017
Military members are at risk for unintentional drownings during training, occupational activities and off-duty recreation. Increase your awareness today to lower your risks: Drowning prevention: Water-related recreational activities in or near water can be potentially dangerous – particularly for non-swimmers and weak swimmers – in hazardous conditions and settings (e.g., storms, currents, riptides), and when safety measures are not observed. Military members are at risk for unintentional drownings during training, occupational activities and off-duty recreation. Here are four ways you can prevent unintentional drowning: •	Wear life jackets. •	Take swim lessons to become a stronger swimmer. •	Swim with a buddy; never swim alone. •	Be knowledgeable of water environments you are in. Increase your awareness and lower your risks by reading the Medical Surveillance Monthly Report (MSMR) Vol. 22 No. 6 – June 2015 report “Update: Accidental drownings, active component, U.S. Armed Forces, 2005 – 2014 at www.Health.mil/MSMR  #SwimSafe Follow us on Twitter for more information at AFHSBPAGE. Also check out hashtag #SwimSafe. Source: Defense Health Agency, Armed Forces Health Surveillance Branch. Graphic shows: •	Man swimming in pool •	Mom with three children swimming in pool. •	Woman swimming in pool

Military members are at risk for unintentional drownings during training, occupational activities and off-duty recreation. This infographic provides swim safety information to help increase awareness and lower the risks of accidental drownings among service members.

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Absolute and Relative Morbidity Burdens Attributable to various illnesses and injuries: Non-service member beneficiaries of the Military Health System, 2016

Infographic
5/18/2017
Individuals who are eligible for care through the Military Health System (MHS) are known as beneficiaries. MHS beneficiaries include family members of active component service members, the National Guard and Reserve service members, retirees and eligible family members of retirees. In 2016, there were approximately 9.4 million beneficiaries eligible for health care in the MHS. Findings: •	In 2016, a total of 6,589,843 non-service member beneficiaries of the MHS had 86,486,080 medical encounters. •	On average, each individual who accessed care from the MHS had 13.1 medical encounters over the course of the year. •	The top three morbidity-related categories accounted for 34.5% of all medical encounters. Top Three Morbidity-Related Categories Pie Chart •	Injuries and poisonings (10.5%) – pie slice shown in the color of lavender.  •	Signs, symptoms, and ill-defined conditions (11.9%) – pie slice shown in green. •	Musculoskeletal diseases (12.2%) - pie slice shown in dark blue. •	Orange of pie chart indicates the other morbidity related categories (make up approximately 65.4% of the pie chart). Signs, symptoms, and ill-defined conditions, injuries and poisonings, and disorders of the sense organs were the illness/injury categories that affected the most individuals (44.9%, 34.7%, and 30.3% of all beneficiaries who received any care, respectively). Learn more at Health.mil/MSMR Other images seen on graphic:  Father and baby daughter at medical appointment with a family doctor from the MHS.

Individuals who are eligible for care through the Military Health System (MHS) are known as MHS beneficiaries. This graphic provides information on the absolute and relative morbidity burdens attributable to various illnesses and injuries among non-service member beneficiaries of the MHS in 2016.

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Armed Forces Health Surveillance Division

Absolute and Relative Morbidity Burdens Attributable to Various illnesses and Injuries, Active Component, U.S. Armed Forces, 2016

Infographic
5/18/2017
everal classification systems and morbidity measures have been developed to quantify absolute and relative morbidity burdens attributable to various illnesses and injuries among the active component of the U.S. Armed Forces in 2016. They determine to a large extent the conclusions that may be drawn regarding the relative “importance” of various conditions – and, in turn, the resources that may be indicated to prevent or minimize their impacts. This annual summary provides: •	142 categories based on a modified version of the classification system developed for the Global Burden of Disease (GBD) study. •	25 burden of disease-related conditions for all illness-and injury-specific diagnoses (as defined by the ICD-10). Findings: •	In 2016, 550,213 service members received medical care for injury/poisoning, more than any other morbidity related category. •	Injury/poisoning accounted for more medical encounters (n= 2,755,387) than any other morbidity category – that is 24.8% of all medical encounters overall. •	Together, injury/poisoning and mental disorders accounted for 56.2% of all hospital bed days and 41.8% of all medical encounters. Medical Encounters Pie Chart Display: •	There were a total of 11,113,506 medical encounters overall (whole pie chart or 100%) •	A total of 2,755,387 for the injury/poisoning category or 24.793% for injury/poisoning ( purple slice of pie chart that is labeled Injury/poisoning) •	A total of 1,895,156 categorized as mental disorders or 17.053% for mental disorders ( lime green slice of pie chart that is labeled mental disorders) •	Together, injury/poisoning and mental disorders accounted  for 41.8 of all medical encounters •	All other medical encounters is approximately 58.2% (dark green slice of the pie chart that is labeled all other medical encounters). For more findings, view the full MSMR report at Health.mil/AFHSB Images included on graphic: DHA logo, Military vehicle and helicopter propellers.

Several classification systems and morbidity measures have been developed to quantify absolute and relative morbidity burdens attributable to various illnesses and injuries among the active component of the U.S. Armed Forces. This graphic highlights findings about the active component of the U.S. Armed Forces in 2016.

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Armed Forces Health Surveillance Division

Ambulatory visits, Active Component, U.S. Armed Forces, 2016

Infographic
5/18/2017
This infographic documents the frequencies, rates, trends and characteristics of ambulatory healthcare visits of active component members of the U.S. Army, Navy, Air Force, and Marine Corps during 2016. Findings •	During 2016, there were 19,158,557 reported ambulatory visits of active component service members. •	On average each service member had approximately 15 ambulatory encounters during the year. •	In 2016, four major diagnostic categories accounted for 72.6% of all illness-and injury-related ambulatory visits among active component service members. Pie Chart •	Signs, Symptoms, and ill-defined conditions (8.8%) – pie slice is blue;  military woman with illness seen. •	Disorders of the nervous system and sense organs (10.8%) – pie slice shows many getting his eye examined by a doctor. •	Mental Disorders (16.8%) –  pie slice is green; shows man sitting on the floor who is seeking mental health treatment. •	Musculoskeletal system/connective tissue disorders (36.3%) – pie slice is red; physician is treating patient for musculoskeletal system/ connective tissue disorders. The 2016 number of visits for musculoskeletal disorders (n= 4,198,896) is the highest annual count in the past 13 years. Learn about the largest percentage increases and decreases in ambulatory visits during 2012-2016 at www.Health.mil/MSMR.  Other images seen on graphic: transparent background shows entrance to an Emergency Center.

This infographic documents the frequencies, rates, trends and characteristics of ambulatory healthcare visits of active component members of the U.S. Army, Navy, Air Force, and Marine Corps during 2016.

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Armed Forces Health Surveillance Division

DoD Global, Laboratory-Based Influenza Surveillance Program, 2014- 2015 Season

Infographic
4/17/2017
The DoD Global, Laboratory-Based, Influenza Surveillance Program is a DoD-wide, year-round program that tests respiratory specimens from DoD beneficiaries presenting to military treatment facilities with influenza-like illness (ILI). ILI is defined as an illness characterized by a fever 100.5 degrees F or greater and cough or sore throat within 72 hours of seeking treatment. Sentinel sites submit 6-10 specimens per week from beneficiaries presenting with ILI. Each specimen is tested via reverse transcription-polymerase chain reaction (RT-PCR) and viral culture. The 2014-2015 influenza season was dominated by influenza A (H3N2) at the beginning; however by Week 10, identifications of influenza B viruses were more numerous than for influenza A. Out of a total of 6,432 specimens, 32.7% were positive for influenza. Additionally 19.6% of specimens were positive for other respiratory pathogens while 47.7% specimens were negative. The molecular characterization of specimens showed that the majority of influenza A (H3N2) viruses circulating had drifted from the vaccine strain by December 2014. This finding was in agreement with the Centers for Disease Control and Prevention and World Health Organization observations during the 2014-2015 influenza season. For more information visit Health.mil/AFHSB

The DoD Global, Laboratory-Based, Influenza Surveillance Program is a DoD-wide, year-round program that tests respiratory specimens from DoD beneficiaries presenting to military treatment facilities with influenza-like illness (ILI).

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Armed Forces Health Surveillance Division

Zika Virus Infections in Military Health System Beneficiaries

Infographic
4/17/2017
The introduction and rapid spread of the Zika virus (ZIKV), a Flavivrus of the Flaviviridae family, across the Western Hemisphere have posed a risk of infection to Military Health System (MHS) beneficiaries. This report documents: •	The impact of ZIKV transmission on MHS beneficiaries. •	ZIKV spread to nearly 50 countries and territories within a 17-month period. •	Among affected service members, the Army reported the most Zika cases. •	There have been 156 confirmed cases of Zika in MHS beneficiaries. •	A majority of cases reported exposure in Puerto Rico (n=91, 58.3%). Geographic regions of potential exposure to Zika cases in MHS beneficiaries between 01 Jan – 30 Nov 2016 included: •	Puerto Rico ( 91 cases) •	Caribbean ( 41 cases) •	Central America & Mexico (15 cases) •	South America (6 cases) •	Asia ( 3 cases) •	Unknown (3) •	U.S. Florida (1 case) Cases in Service Members Between 01 Jan – 30 Nov 2016 were: •	Army (48 cases) •	Coast Guard (29 cases) •	Air Force (16 cases) •	Navy (10 cases) •	Marine Corps (7 cases) Although most ZIKV infections are asymptomatic or have a relatively mild illness, the gravity of pregnancy and neurologic issues linked to infection remains a significant impetus for the continued surveillance of ZIKV in the MHS population. For more Zika surveillance and information on signs and symptoms, visit Health.mil/AFHSB

The introduction and rapid spread of the Zika virus (ZIKV), a Flavivrus of the Flaviviridae family, across the Western Hemisphere have posed a risk of infection to Military Health System (MHS) beneficiaries.

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Armed Forces Health Surveillance Division | Zika Virus | In the Spotlight

Findings from The Department of Defense Global, Laboratory-Based Influenza Surveillance Program, 2015-2016 Influenza Season

Infographic
4/17/2017
The Department of Defense (DoD) Global, Laboratory-Based, Influenza Surveillance Program monitors the circulation of influenza viruses throughout each influenza season. Each season runs from the beginning of October through end of the next September. During the 2015 – 2016 influenza season, a total of 4,591 specimens were tested from 80 locations. The predominant influenza strain was A (H1N1) pdm09. Additionally peak influenza activity occurred during weeks 7 – 13 (14 February – 2 April 2016). Of those submitted for routine surveillance, 1,182 (25.7%) tested positive for other respiratory pathogens, 377 (8.2%) tested positive for influenza B, 755 (16.5%) tested positive for influenza A, and 2,277 (49.6%) tested negative. For more information on the 2015-2016 influenza season and how to identify influenza-like illness (ILI), read the Medical Surveillance Monthly Report (MSMR) at Health.mil/AFHSB.

The Department of Defense (DoD) Global, Laboratory-Based, Influenza Surveillance Program monitors the circulation of influenza viruses throughout each influenza season. Each season runs from the beginning of October through end of the next September.

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Armed Forces Health Surveillance Division

New and Improved Defense Medical Epidemiology Database

Infographic
4/4/2017
The new and improved Defense Medical Epidemiology Database (DMED), known as DMED 5.0, is now only available online.  DMED provides timely and efficient access to data of active component personnel and medical event data.  It contains a subset of data from the Defense Medical Surveillance System (DMSS), offering remote access to tri-service epidemiologic data. Moreover, it protects privacy using only de-identified data and updates monthly.  The new DMED features an enhanced user interface, query data using ICD-9 and ICD-10 diagnostic codes granting authorized users to search multiple databases simultaneously. These users are U.S. military personnel (DoD-CaC users) or Federal partners and civilian collaborators in military medical research and operations. Authorized U.S. military personnel with access to DMED include medical providers, epidemiologists, medical researchers, safety officers, and medical operations and clinical support staff. Sign up for a new account at www.health.mil/dmed

The new and improved Defense Medical Epidemiology Database (DMED), known as DMED 5.0, is now only available online. DMED provides timely and efficient access to data of active component personnel and medical event data.

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Armed Forces Health Surveillance Division | Defense Medical Epidemiology Database

Update: Exertional Hyponatremia U.S. Armed Forces, 2001-2016

Infographic
4/4/2017
Exertional Hyponatremia occurs during or up to 24 hours after prolonged physical activity. It is defined by a serum, plasma or blood sodium concentration below 135 millequivalents per liter. This infographic provides an update on Exertional Hyponatremia among U.S. Armed Forces, information on service members at high risk. Exertional hyponatremia can result from loss of sodium and/or potassium as well as relative excess of body water. There were 1,519 incident diagnoses of exertional hyponatremia among active component service members from 2001 through 2016. 86.8 percent were diagnosed and treated without having to be hospitalized. 2016 represented a decrease of 23.3 percent from 2015. In 2016, there were 85 incident diagnoses of exertional hyponatremia among active component service members and 77.6 percent of exertional hyponatremia cases affected males.  The annual rate was higher among females. Service members age 40 and over were most affected by exertional hyponatremia. High risk service members of exertional hyponatremia were: •	Females •	Service members aged 19 years or younger •	White, non-Hispanic and Asian/ Pacific Islander service members •	Recruit Trainees •	Marine Corps members Learn more at www.Health.mil/MSMR

Exertional Hyponatremia occurs during or up to 24 hours after prolonged physical activity. It is defined by a serum, plasma or blood sodium concentration below 135 millequivalents per liter. This infographic provides an update on Exertional Hyponatremia among U.S. Armed Forces, information on service members at high risk. Exertional hyponatremia can result from loss of sodium and/or potassium as well as relative excess of body water.

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Armed Forces Health Surveillance Division | Physical Fitness

Minority Health Heat Illness Active Component U.S. Armed Forces, 2016

Infographic
4/4/2017
Heat illness refers to a spectrum of disorders that occur when the body is unable to dissipate heat absorbed from the external environment and the heat generated by internal metabolic processes. As heat illness progresses, failure of one or more body systems can occur. This report summarizes reportable medical events of heat illnesses, heat-related hospitalizations and ambulatory visits among minority active component members (Black, non-Hispanic, Hispanic, and Asian/Pacific Islanders) during 2016. In 2016, incidence rates of heat stroke were highest among Asian/ Pacific Islanders than any other ethnicity. Crude incidence rate of “other heat illnesses” was higher among females than males.  Heat Incidence cases: •	Black, non-Hispanic heat illness incidence cases – 64 for heatstroke and 389 for other heat illnesses •	Hispanic heat illness incidence cases—  63 for heatstroke and 320 for other heat illnesses •	Asian/ Pacific Islander heat illness incidence cases – 32 for heatstroke and for  117 other heat illnesses Incidence rates: •	Black, non-Hispanic incidence rates – 0.30 for heatstroke and 1.84 for other heat illnesses •	Hispanic incidence rates – 0.33 for heatstroke and 1.67 for other heat illnesses •	Asian/Pacific Islander – 0.62 for heatstroke and 2.26 for other heat illnesses Of all military members, the youngest and most inexperienced marines and soldiers – particularly those training at installations in the south eastern U.S. – are at highest risk of heat illnesses including heat stroke, exertional hyponatremia, and exertional rhabdomyolysis. Learn more at www.Health.mil/MSMR

Heat illness refers to a spectrum of disorders that occur when the body is unable to dissipate heat absorbed from the external environment and the heat generated by internal metabolic processes. As heat illness progresses, failure of one or more body systems can occur. This report summarizes reportable medical events of heat illnesses, heat-related hospitalizations and ambulatory visits among minority active component members (Black, non-Hispanic, Hispanic, and Asian/Pacific Islanders) during 2016.

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Armed Forces Health Surveillance Division | Summer Safety
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