Skip to main content

Military Health System

Outbreak of Cyclosporiasis in a U.S. Air Force Training Population, Joint Base San Antonio–Lackland, TX, 2018

Image of Cyclosporiasis. Cyclosporiasis

Recommended Content:

Medical Surveillance Monthly Report

Abstract

Diarrheal illnesses have an enormous impact on military operations in the deployed and training environments. While bacteria and viruses are the usual causes of gastrointestinal disease outbreaks, 2 Joint Base San Antonio–Lackland, TX, training populations experienced an outbreak of diarrheal illness caused by the parasite Cyclospora cayetanensis in June and July 2018. Cases were identified from outpatient medical records and responses to patient questionnaires. A confirmed case was defined by diarrhea and laboratory confirmation, and patients without a positive lab were classified as suspected cases. In cluster 1, 46 suspected and 7 confirmed cases occurred among technical training students who reported symptom onset from 12 June to 21 June. In cluster 2, 18 suspected and 14 confirmed cases in basic military training trainees reported symptom onset from 29 June to 8 July. Numerous lessons from cluster 1 were applied to cluster 2. Crucial lessons learned during this cyclosporiasis outbreak included the importance of maintaining clinical suspicion for cyclosporiasis in persistent gastrointestinal illness and obtaining confirmatory laboratory testing for expedited diagnosis and treatment.

What Are the New Findings?

Diarrheal disease due to the protozoan Cyclospora cayetanensis had not been previously reported among American military trainees in the U.S. This report describes the life cycle of the protozoan and highlights the difficult nature of source finding and the importance of clinical suspicion for cyclosporiasis in persistent gastrointestinal illness.

What Is the Impact on Readiness and Force Health Protection?

Up to 60% of deployed U.S. troops have reported episodes of diarrhea during their deployment. The main causes of these diarrheal illnesses are bacterial and viral, but C. cayetanensis may cause protracted, relapsing gastroenteritis impacting operational readiness and mission effectiveness. This report shares recommendations for future cyclosporiasis outbreak investigations.

Background

Diarrheal illnesses have an enormous impact on military operations. Historically, up to 60% of deployed U.S. troops have reported episodes of diarrhea during their deployment.1–3 Understandably, diarrheal illness negatively impacts operational readiness and mission effectiveness in deployment locations, as it results in increased health care service use, loss of man-hours, and transient critical shortages.4 However, this negative impact is also readily apparent within the unique environment of military training. Moreover, although the majority of military gastrointestinal outbreaks in both the deployed and training environments have been bacterial (e.g., Escherichia coli) or viral (e.g., norovirus) in origin,5–7 recent outbreaks in the U.S. civilian population as well as an outbreak in military training facilities in El Salvador indicate that the protozoan Cyclospora cayetanensis may also pose a threat.8

C. cayetanensis is a coccidian protozoan parasite that causes protracted, relapsing gastroenteritis known as cyclosporiasis.9 Cyclosporiasis is a waterborne and foodborne illness associated with contaminated water or fresh produce, usually imported. The illness has an average incubation period of 7 days, and symptoms can last up to 6 weeks. Excreted oocysts require 1 to 2 weeks outside the human host to undergo sporulation before becoming infectious9; therefore, person-to-person transmission is unlikely. While the course of illness can be self-limited, treatment with trimethoprimsulfamethoxazole can shorten the duration of illness and oocyte excretion.9

From 2000 through 2016, the Centers for Disease Control and Prevention (CDC) tracked 33 U.S. outbreaks of cyclosporiasis.10 In 2017, CDC received notification of 1,065 laboratory-confirmed cases of cyclosporiasis from 40 states, including cases associated with international travel.11 This report describes an outbreak of diarrheal disease caused by C. cayetanensis among U.S. military technical school students (cluster 1) and basic military trainees (cluster 2) at Joint Base San Antonio–Lackland (JBSA–Lackland), TX, during June and July 2018. These outbreaks were unrelated to the 2 national outbreaks of cyclosporiasis that occurred during the same time period.

Methods

Setting

JBSA–Lackland is the only location for U.S. Air Force basic military training (BMT). Recruits come from all parts of the U.S. and from numerous international locations for 7.5 weeks of BMT. At any given time, there are 5,000 to 8,000 BMT trainees distributed across 6 training squadrons. The squadrons are divided into 40- to 50-member training flights. Members of each flight share a common dormitory room and perform all training activities as a unit. Contact between trainees of differing flights is limited to shared common touch surface areas in the Dining Facilities Administration Center (DFAC), classroom hallways, and stairwells. All meals are eaten in DFACs except for a prepackaged meal upon arrival to JBSA–Lackland and meals during the last week of training, when off-base privileges are granted.

Medical care for trainees is provided at the Reid Health Services Center during regular business hours or at the Family Emergency Center at Wilford Hall Ambulatory Surgical Center after hours. On average, 2 to 3 trainees per day present to Reid Health Services Center with nausea, vomiting, and/or diarrhea.

Case identification

Cases were identified from review of outpatient medical records from Reid Health Services Center and administered questionnaires. In cluster 1 (technical trainees), 2 teams with reported cases were administered an open-ended questionnaire, and in cluster 2 (BMT trainees), the flight with the greatest number of confirmed cases was administered a questionnaire that gathered information about fresh vegetables and fruits known to have been consumed during training.

For the purposes of this outbreak investigation, a confirmed case of cyclosporiasis was defined by the presence of diarrhea with or without vomiting between 12 June and 8 July 2018 accompanied by a positive gastrointestinal pathogen polymerase chain reaction (PCR) for Cyclospora in a stool specimen. Without a positive lab, a case was classified as a suspected case. Bivariate analysis was carried out to determine whether associations existed between food exposures and illness. Statistical analysis was performed using OpenEpi v3.01.12 One-tailed p values <.01 were considered statistically significant.

Results

Two distinct clusters of cyclosporiasis cases occurred between 12 June and 8 July 2018. Cluster 1 (n=53) occurred among technical training students who reported with symptoms from 12 June through 21 June and included 46 suspected and 7 confirmed cases (Figure 1). Five of the suspected cases did not have documented onset dates. Diarrhea was reported by 100% of cluster 1 cases, with 45% reporting vomiting, and 64% reporting nausea (data not shown). Cluster 2 (n=32) occurred among BMT trainees and included 18 suspected and 14 confirmed cases who reported symptom onset between 29 June and 8 July (Figure 2). Of the 18 suspected cases, 5 cases did not have documented onset dates. In this cluster of 32 cases, 100% reported diarrhea, 44% reported vomiting, and 72% reported nausea (data not shown). One additional confirmed BMT case was reported, but it did not occur in the timeframe of either cluster and was not considered in the analysis.

In cluster 1, the first technical student sought medical care on 13 June for diarrhea; 3 additional students followed on 14 June, and 7 followed on 15 June. The earliest report of symptom onset was on 12 June. At this point, a gastrointestinal disease cluster was suspected in 2 technical training squadrons and gastrointestinal pathogen panel PCRs were ordered. One stool sample was returned to the clinic for testing and tested positive for Cyclospora on 19 June. The next positive Cyclospora PCR was reported on 21 June. One suspected case tested positive for Salmonella. Reported symptom onset peaked 14 June and continued through 21 June (Figure 1). In addition to identifying cases in the clinic, investigators conducted mass briefings from 22 June through 28 June, during which questionnaires were administered to members of 2 technical squadrons to elicit information on food and water exposures. However, data obtained from this open-ended questionnaire lacked the specificity needed to examine associations between exposures to potential food sources and illness.

In cluster 2, the first trainee sought medical care on 30 June, and 5 more trainees sought care on 2 July; the earliest report of symptom onset was on 29 June. Gastrointestinal pathogen panel PCRs were already being ordered on all patients with gastrointestinal symptoms visiting the clinic. Three positive Cyclospora PCRs were reported on 3 July, 2 of which belonged to 1 flight. Reported symptom onset peaked on 1 July and continued through 8 July (Figure 2). On 6 July, questionnaires were administered to the trainees in the flight with the most laboratory-confirmed cyclosporiasis cases (n=6). The questionnaire captured information on the fresh food items eaten after arrival at San Antonio, TX. Among the 49 trainees who responded to the BMT questionnaire, 2 additional suspected cases were identified. None of the suspected or confirmed cases from this flight reported departing from the Midwest states that were experiencing a contemporaneous cyclosporiasis outbreak (i.e., IA, IL, MN, and WI). Bivariate analysis of data from the 49 questionnaire respondents demonstrated statistically significant positive associations between confirmed cases and 4 exposures: blueberries (odds ratio [OR]=25.51; p=.001), blackberries (OR=23.11; p=.001), cherry tomatoes (OR=11.25; p=.006), and oranges (OR=11.20; p=.004) (Table 1). No statistically significant associations were identified between other possible food exposures and illness.

Public health investigations were performed at training facilities and DFACs. No DFAC food workers who served confirmed cases reported illness during the outbreak. During inspections of the DFACs, there were no discrepancies noted with respect to Cyclospora. Food vendors that service all DFACs at JBSA–Lackland were questioned, and no concerns other than this outbreak were brought to investigators' attention.

Editorial Comment

During the months of June and July 2018, JBSA–Lackland experienced 2 clusters of cyclosporiasis affecting 2 technical training squadrons and (primarily) 1 BMT flight. Investigations of these clusters did not reveal a specific source of infection; therefore, at the time of the outbreak, there were no known connections to the larger national outbreaks related to Del Monte Fresh Produce vegetable trays or salads from McDonald's restaurants distributed by Fresh Express that were contemporaneously occurring.13,14 At the time of this publication, there were no further confirmed cases of cyclosporiasis in the JBSA–Lackland training population.

Similar to many CDC-reported cyclosporiasis outbreaks, even though there were statistically significant associations with some food items (i.e., blueberries, blackberries, oranges, and cherry tomatoes), a source of the pathogen could not be conclusively determined despite a 2-week food history questionnaire, detailed interviews, and DFAC inspections.10 Potable water and DFAC food from shared sources serve all of the training and permanent populations on JBSA–Lackland. Yet these clusters of cyclosporiasis were restricted to a few specific squadrons and flights. Because of the restricted nature of the outbreak, source exposure was presumed to be most likely through a contaminated batch of produce, and therefore potable water sources were not examined.

Lessons from the investigation response to cluster 1 were implemented in cluster 2. For example, the questionnaire used during cluster 1 did not have enough granularity to determine food associations; therefore, during cluster 2, the investigative team designed a questionnaire based on DFAC menus. Outbreak response also shifted from an early emphasis on treatment to confirmatory testing, providing more accurate case counts and distinction of gastroenteritis due to other potential pathogens (e.g., Salmonella). Lastly, the emphasis on diagnostic testing during cluster 2 resulted in fewer courses of antimicrobial treatment for presumptive diagnoses of cyclosporiasis.

Despite unique opportunities during the investigation of cluster 2 (e.g., control of food and a known cohort), no definitive source of infection was found. The typically long incubation period for cyclosporiasis and delays between symptom onset and diagnosis confirmation represented challenges to identifying the Cyclospora source. In addition, food recall was likely low, even with a comprehensive questionnaire listing fresh food from the DFAC. Even though specific foods were identified, food testing was not feasible because of the short shelf life and immediate use of fresh foods. Moreover, given that Cyclospora has relatively recently emerged in the U.S. (outbreaks have only been reported since the 1990s),10 clinical suspicion of this uncommon parasite as a cause for acute gastrointestinal illness is low. Testing posed another challenge; Cyclospora was not a component of routine ova and parasite testing and had to be requested specifically. Therefore, providers relied on molecular methods in diagnosing cyclosporiasis, and at the onset of the outbreak, the local supplies of testing kits were quickly depleted. Perhaps the most important challenge in determining the source of the outbreak was the low case numbers, which prevented conclusive determination of a source despite observed associations with blueberries, blackberries, cherry tomatoes, and oranges.

The JBSA–Lackland Public Health Flight and Preventive Medicine team collaborated with county, state, and national agencies and shared lessons learned. Perhaps the most crucial lessons learned were the importance of clinical suspicion for cyclosporiasis in persistent gastrointestinal illness and the importance of confirmatory laboratory testing for expedited diagnosis and treatment.

Author affiliations: Trainee Health Surveillance, 559th Medical Group, JBSA–Lackland, TX (Maj Pawlak, Maj Gottfredson); Public Health Flight, 559th Medical Group, JBSA–Lackland, TX (Lt Col Cuomo); 559th Medical Group, JBSA–Lackland, TX (Lt Col White)

Disclaimer: The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its components.

References

  1. Sanders JW, Putnam SD, Gould P, et al. Diarrheal illness among deployed U.S. military personnel during Operation Bright Star 2001—Egypt. Diagn Microbiol Infect Dis. 2005;52(2):85–90.
  2. Sanders JW, Putnam SD, Riddle MS, Tribble DR. Military importance of diarrhea: lessons from the Middle East. Curr Opin Gastroenterol. 2005;21(1):9–14.
  3. Monteville MR, Riddle MS, Baht U, et al. Incidence, etiology, and impact of diarrhea among deployed US military personnel in support of Operation Iraqi Freedom and Operation Enduring Freedom. Am J Trop Med Hyg. 2006;75(4):762–767.
  4. Sanders JW, Putnam SD, Frankart C, et al. Impact of illness and non-combat injury during Operations Iraqi Freedom and Enduring Freedom (Afghanistan). Am J Trop Med Hyg. 2005;73(4):713–719.
  5. Bohnker BK, Thornton S. Explosive outbreaks of gastroenteritis in the shipboard environment attributed to norovirus [Letter to the Editor]. Mil Med. 2003;168(5):iv.
  6. Riddle MS, Smoak BL, Thornton SA, Bresee JS, Faix DJ, Putnam SD. Epidemic infectious gastrointestinal illness aboard U.S. Navy ships deployed to the Middle East during peacetime operations—2000–2001. BMC Gastroenterol. 2006;6(9).
  7. Riddle MS, Sanders JW, Putnam SD, Tribble DR. Incidence, etiology, and impact of diarrhea among long-term travelers (US military and similar populations): a systematic review. Am J Trop Med Hyg. 2006;74(5):891–900.
  8. Kasper MR, Lescano AG, Lucas C, et al. Diarrhea outbreak during U.S. military training in El Salvador. PloS One. 2012;7(7):e40404.
  9. Ortega YR, Sanchez R. Update on Cyclospora cayetanensis, a food-borne and waterborne parasite. Clin Microbiol Rev. 2010;23(1):218–234.
  10. Centers for Disease Control and Prevention. U.S. Foodorne Outbreaks of Cyclosporiasis—2000–2016. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/foodborneoutbreaks.html. Accessed 24 Sept. 2018.
  11. Centers for Disease Control and Prevention. Cyclosporiasis Outbreak Investigations—United States, 2017. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2017/index.html. Accessed 24 Sept. 2018.
  12. Sullivan KM, Dean A, Soe MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Rep. 2009;124(3):471–474.
  13. Centers for Disease Control and Prevention. Multistate Outbreak of Cyclosporiasis Linked to Del Monte Fresh Produce Vegetable Trays—United States, 2018: Final Update. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2018/a-062018/index.html. Accessed 24 Sept. 2018.
  14. Centers for Disease Control and Prevention. Multistate Outbreak of Cyclosporiasis Linked to Fresh Express Salad Mix Sold at McDonald's Restaurants—United States, 2018: Final Update. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2018/b-071318/index.html. Accessed 24 Sept. 2018.

Symptom onset among cases in cluster 1 (technical training students)Symptom onset among cases in cluster 2 (basic military training)Attack rates of confirmed illness based on food exposures in the 49 BMT trainee respondents

You also may be interested in...

Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022
Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

In 2021, the overall numbers and rates of active component service member ambulatory care visits were the highest of any of the last 10 years. Most categories of illness and injury showed modest increases in numbers and rates. The proportions of ambulatory care visits that were accomplished via telehealth encounters fell to under 15% in 2021, compared to 19% in 2020.

Recommended Content:

Medical Surveillance Monthly Report

Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

Article
6/1/2022
Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

The proportions of evacuations out of USCENTCOM that were due to battle injuries declined substantially in 2021. For USCENTCOM, evacuations for mental health disorders were the most common, followed by non-battle injury and poisoning, and signs, symptoms, and ill-defined conditions. For USAFRICOM, evacuations for non-battle injury and poisoning were most common, followed by disorders of the digestive system and mental health disorders.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

Article
6/1/2022
Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021

Article
5/1/2022
iStock—The castor bean tick (Ixoedes ricinus). Credit: Erik Karits

Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021. Tick-borne encephalitis (TBE) is a viral infection of the central nervous system that is transmitted by the bite of infected ticks, mostly found in wooded habitats in parts of Europe and Asia

Recommended Content:

Medical Surveillance Monthly Report

Evaluation of ICD-10-CM-based Case Definitions of Ambulatory Encounters for COVID-19 Among Department of Defense Health Care Beneficiaries

Article
5/1/2022
SEATTLE, WA, UNITED STATES 04.05.2020 U.S. Army Maj. Neil Alcaria is screened at the Seattle Event Center in Wash., April 5. Soldiers from Fort Carson, Colo., and Joint Base Lewis-McChord, Wash. have established an Army field hospital center at the center in support of the Department of Defense COVID-19 response. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army photo by Cpl. Rachel Thicklin)

This is the first evaluation of ICD-10-CM-based cased definitions for COVID-19 surveillance among DOD health care beneficiaries. The 3 case definitions ranged from highly specific to a lower specificity, but improved balance between sensitivity and specificity.

Recommended Content:

Medical Surveillance Monthly Report

Update: Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2013–2021

Article
5/1/2022
This illustration depicts a 3D computer-generated image of a number of drug-resistant Neisseria gonorrhoeae bacteria. CDC/James Archer

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2013–2021. In general, compared to their respective counterparts, younger service members, non-Hispanic Black service members, those who were single and other/unknown marital status, and enlisted service members had higher incidence rates of STIs.

Recommended Content:

Medical Surveillance Monthly Report

The Association Between Two Bogus Items, Demographics, and Military Characteristics in a 2019 Cross-sectional Survey of U.S. Army Soldiers

Article
5/1/2022
NIANTIC, CT, UNITED STATES 06.16.2022 U.S. Army Staff Sgt. John Young, an information technology specialist assigned to Joint Forces Headquarters, Connecticut Army National Guard, works on a computer at Camp Nett, Niantic, Connecticut, June 16, 2022. Young provided threat intelligence to cyber analysts that were part of his "Blue Team" during Cyber Yankee, a cyber training exercise meant to simulate a real world environment to train mission essential tasks for cyber professionals. (U.S. Army photo by Sgt. Matthew Lucibello)

Data from surveys may be used to make public health decisions at both the installation and the Department of the Army level. This study demonstrates that a vast majority of soldiers were likely sufficiently engaged and answered both bogus items correctly. Future surveys should continue to investigate careless responding to ensure data quality in military populations.

Recommended Content:

Medical Surveillance Monthly Report

Exertional Heat Illness at Fort Benning, GA: Unique Insights from the Army Heat Center

Article
4/1/2022
Navy Petty Officer 3rd Class Ryan Adams is being used as an example victim for cooling a heat casualty at the bi-annual hot weather standard operating procedure training aboard Marine Corps Base Camp Lejeune, N.C., Aug. 24. Adams is demonstrating the "burrito" method used to cool a heat related injury victim. Photo by Pfc. Joshua Grant.

Exertional heat illness (hereafter referred to as heat illness) spans a spectrum from relatively mild conditions such as heat cramps and heat exhaustion, to more serious and potentially life-threatening conditions such as heat injury and exertional heat stroke (hereafter heat stroke).

Recommended Content:

Medical Surveillance Monthly Report

Exertional Hyponatremia, Active Component, U.S. Armed Forces, 2006–2021

Article
4/1/2022
Marine Corps Cpl. Luis Alicea drinks water after a combat conditioning exercise at Naval Air Station Joint Reserve Base New Orleans, May 20, 2019. Photo By: Marine Corps Lance Cpl. Jose Gonzalez.

Exertional (or exercise-associated) hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 mEq/L) that develops during or up to 24 hours following prolonged physical activity. Acute hyponatremia creates an osmotic imbalance between fluids outside and inside of cells.

Recommended Content:

Medical Surveillance Monthly Report

Exertional Rhabdomyolysis, Active Component, U.S. Armed Forces, 2017–2021

Article
4/1/2022
The Embry-Riddle Army ROTC Ranger Challenge team heads out on the 12-mile road march after completing the timed obstacle course event of the 6th Brigade Army ROTC Ranger Challenge January 14, 2022 at Fort Benning, Ga. The Titan Brigade’s Ranger Challenge took place at Fort Benning, Ga. January 13-15, 2022. Photo by Capt. Stephanie Snyder

Exertional rhabdomyolysis is a potentially serious condition that requires a vigilant and aggressive approach. Some service members who experience exertional rhabdomyolysis may be at risk for recurrences, which may limit their military effectiveness and potentially predispose them to serious injury.

Recommended Content:

Medical Surveillance Monthly Report

Heat Illness, Active Component, U.S. Armed Forces, 2021

Article
4/1/2022
Airmen participate in the 13th Annual Fallen Defender Ruck March at Joint Base San Antonio, Nov. 6, 2020. The event honors 186 fallen security forces, security police and air police members who have made the ultimate sacrifice. Photo By: Sarayuth Pinthong, Air Force.

From 2020 to 2021, the rate of incident heat stroke was relatively stable while the rate of heat exhaustion increased slightly

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Medical Separation from Service Among Incident Cases of Osteoarthritis and Spondylosis, Active Component, U.S. Armed Forces, 2016–2020

Article
3/1/2022
Marines hike to the next training location during Exercise Baccarat in Aveyron, Occitanie, France, Oct.16, 2021. Exercise Baccarat is a three-week joint exercise with Marines and the French Foreign Legion that challenges forces with physical and tactical training. Photo By: Marine Corps Lance Cpl. Jennifer Reyes

Osteoarthritis (OA) is the most common adult joint disease and predominantly involves the weight-bearing joints. This condition, including spondylosis (OA of the spine), results in significant disability and resource utilization and is a leading cause of medical separation from military service.

Recommended Content:

Medical Surveillance Monthly Report

Obesity prevalence among active component service members prior to and during the COVID-19 pandemic, January 2018–July 2021

Article
3/1/2022
Maintaining a healthy weight is important for military members to stay fit to fight. The body mass index is a tool that can be used to determine if an individual is at an appropriate weight for their height. A person’s index is determined by their weight in kilograms divided by the square of height in meters. (U.S. Air Force photo illustration by Airman 1st Class Destinee Sweeney)

This study examined monthly prevalence of obesity and exercise in active component U.S. military members prior to and during the COVID-19 pandemic. These results suggest that the COVID-19 pandemic had a small effect on the trend of obesity in the active component U.S. military and that obesity prevalence continues to increase.

Recommended Content:

Medical Surveillance Monthly Report

Brief report: Using syndromic surveillance to monitor MIS-C associated with COVID-19 in Military Health System beneficiaries

Article
3/1/2022
Air Force 1st Lt. Anthony Albina, a critical care nurse assigned to Joint Base Andrews, Md., checks a patient’s breathing and heart rate during an intubation procedure while supporting COVID-19 response operations in Cleveland, Jan. 20, 2022.

SARS CoV-2 and the illness it causes, COVID-19, have exacted a heavy toll on the global community. Most of the identified disease has been in the elderly and adults. The goal of this analysis was to ascertain if user-built ESSENCE queries applied to records of outpatient MHS health care encounters are capable of detecting MIS-C cases that have not been identified or reported by local public health departments.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Refractive Surgery Trends at Tri-Service Refractive Surgery Centers and the Impact of the COVID-19 Pandemic, Fiscal Years 2000–2020

Article
3/1/2022
Cadet Saverio Macrina, U.S. Military Academy West Point, receives corneal cross-linking procedure at Fort Belvoir Community Hospital, Va., Nov. 21, 2016. (DoD photo by Reese Brown)

Since the official introduction of laser refractive surgery into clinical practice throughout the Military Health System (MHS) in fiscal year 2000, these techniques have been heavily implemented in the tri-service community to better equip and improve the readiness of the U.S. military force.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 16 - 30 Page 2 of 13
Refine your search
Last Updated: November 02, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery