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Early Detection Support for Troops During COVID-19

Woman in lab wearing mask and testing samples Lt. Cmdr. Danett Bishop, from Hawthorn Woods, Illinois, tests respiratory samples in the biological safety lab of amphibious assault ship USS America (LHA 6). (U.S. Navy photo by Mass Communication Specialist Seaman Jonathan Berlier)

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Armed Forces Health Surveillance Division | Coronavirus

The quick spread of Coronavirus Disease 2019 has caused many health organizations including the Defense Health Agency’s Armed Forces Health Surveillance Division to innovate, using resources readily available in their arsenal.  

One example of this innovation lies within AFHSD’s Global Emerging Infections Surveillance (GEIS) program. The team funded the production of Research Use Only testing kits and sent them to GEIS laboratory partners located across the globe; targeting countries with high totals of positive COVID-19 cases. Navy mobile laboratories embedded on military ships, such as the USS Theodore Roosevelt received these kits. Military commanders then used the kits as respiratory surveillance tools on their sailors and Marines.

The Department of Defense funds the GEIS’s network of 16 medical research laboratories. This funding allowed the teams to quickly reach out to their partners and use their capabilities, such as the quick production of research assays, to support our forces. Assays are an investigative procedure in laboratory medicine that assess or measure the presence, amount, or activity of a military-relevant pathogen—in this case, the current coronavirus. This assay is similar to those created by the U.S. Centers for Disease Control and Prevention.

Two soldiers looking at computers
Hospital Corpsman 1st Class Ernesto Santa Ana, right, and Hospital Corpsman 2nd Class Maria F. Potts-Szoke work in Naval Medical Research Center's mobile laboratory aboard USS Theodore Roosevelt (CVN 71). (U.S. Navy/MCSN Kaylianna Genier)

“By rapidly distributing the RUO assays to our global partners and to three Navy mobile laboratories on shipboard settings, we were able to provide a much needed testing capability for this emerging pathogen in an operational environment,” explained U.S. Public Health Service Cmdr. (Dr.) Mark Scheckelhoff, who leads the respiratory infections focus area for GEIS. This assay supports surveillance studies only and not the clinical management of cases.

“The ability to procure and distribute the CDC RUO assay outside of a clinical laboratory setting provided a rapid and reliable source of COVID-19 testing and detection materials that were distributed to all of our network laboratories and allowed rapid implementation of testing activities,” said Scheckelhoff.

“As the COVID-19 cases began to increase around the world, military commanders in an operational environment had these RUO resources to conduct respiratory surveillance for COVID-19 exposure,” said Sean Friendly, chief of administration & operations at the AFHSD.

One recent example involved the Marine Corps Recruit Depot at Parris Island in South Carolina.  

"Our partner, the Naval Health Research Center laboratory was able to use their surveillance capabilities to provide the assistance to detect the first cases,” said Friendly.  He recounts a report from Dr. Chris Myers at NHRC in San Diego, California; the lab collected samples from the recruit population of Parris Island. GEIS-funded respiratory surveillance projects at NHRC provided the capability and personnel to test the recruits and quickly identify COVID-19.   

GEIS has worked with the NHRC for several years and supported ongoing surveillance of respiratory diseases among recruits and trainees. This network of health partners continues to grow and evolve as GEIS coordinates with NHRC as well as other network partners. The network’s ability to integrate the priorities identified by the Combatant Commands into its mission creates an agile organization ready to respond to needs as they occur.

Since 1997, GEIS has funded key laboratory/epidemiological work across the DoD. It has also coordinated crucial infectious disease surveillance projects that could impact military operations. GEIS uses key DoD medical research laboratories—such as the U.S. Army Medical Research Institute for Infectious Diseases, the Navy Medical Research Center, and the Walter Reed Army Institute of Research’s global lab enterprise in Maryland; and the Air Force School of Aerospace Medicine in Dayton, Ohio — to establish an integrated network that studies the impact of infectious diseases and respond to outbreaks and epidemics.

“In lay terms, GEIS’s projects and activities have allowed DoD to maintain world-wide critical surveillance capabilities that continue to provide crucial support during events of public health concern like the COVID-19 pandemic,” stated Navy Capt. Guillermo Pimentel, GEIS chief.

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The incidence rates of active tuberculosis (TB) disease in the general U.S. population and the U.S. military have declined over the past two decades, with foreign birth remaining one of the strongest correlates of risk. Recently, there have been several atypical and asymptomatic presentations of active and suspected TB cases among the population of trainees at Joint base San Antonio – Lackland, TX. Between 1 January 2010 and 31 December 2016, a total of 14 U.S. and international military personnel in training at JBSA – Lackland were hospitalized for suspected pulmonary TB. The variety of atypical presentations and their resulting diagnostic and public health challenges promoted this retrospective review of all hospitalized cases. This case series raises concerns about the increasing reliance on molecular tests for rapid diagnosis of active TB, especially in patients with minimal to no pulmonary symptoms. Findings •	The incidence rate in the training population was 1.89 per 100,000 population •	5 of 14 U.S. and international military personnel were diagnosed with active TB disease •	All were male, aged 19 – 29 years •	Only one TB case had pulmonary symptoms, but these were not suggestive of TB •	8 of 14 trainees were asymptomatic at the time of hospital admission, and tuberculin skin test and interferon gamma release assay results were highly variable Chart displays with descriptions and diagnoses of trainees hospitalized for suspected active tuberculosis, Joint Base San Antonio  – Lackland, TX, 2010 – 2016 (N=14). Access the report in MSMR Vol. 24 No. 8 August 2017 at Health.mil/MSMR  Images featured on infographic: •	Human lungs •	Image of TB

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