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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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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 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

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Zika Virus Infections in Military Health System Beneficiaries

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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

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

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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.

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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

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

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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

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Routine Screening for Antibodies to Human Immunodeficiency Virus

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The Human immunodeficiency virus type 1 (HIV-1) is the cause of Acquired immune deficiency syndrome (AIDS) and has had major impacts on the health of populations and on healthcare systems worldwide. This infographic provides an update on routine screening for antibodies to HIV among civilian applicants for the U.S. military service and U.S. Armed Forces during a January 2011 - June 2016 surveillance period.  Since October 1985, the U.S. military has conducted routine screening for antibodies to HIV-1 to enable adequate and timely medical evaluations, treatment and counseling; to prevent unwitting transmission; and protect the battlefield blood supply. From January 2015 through June 2016, 463,132 civilian applicants for U.S. military service were tested. 124 were identified as HIV antibody positive. During 2015, one was detected with antibodies to HIV per 3,267 screening tests. Annual seroprevalences peaked in 2015, up 29% from 2014. The seroprevalences were much higher among males than females and among black, non-Hispanics than other race/ethnicity groups. Seroprevalences decreased by approximately 26% among male applicants, dropped to zero among female applicants, and decreased by 43% among black, non-Hispanic applicants.  As for the active component of the U.S. Army, 548,974 soldiers were tested from January 2015 through June 2016. 120 were identified as HIV antibody positive. During 2015, one was detected with antibodies to HIV per 5,265 screening tests. Of the 515 active component soldiers diagnosed with HIV infections since 2011, a total of 291 (57%) were still in military service in 2016. Annual seroprevalences for male active component Army members greatly exceed those of females.  Among active and reserve component service members, seroprevalences continue to be higher among Army and Navy members and males than their respective counterparts. Service members who are infected with HIV receive clinical assessments, treatments, and counseling; they may remain in service as long as they are capable of performing their military duties. Learn more at Health.mil/AFHSB

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