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Surveillance Snapshot: Illness and Injury Burdens, Recruit Trainees, Active Component, U.S. Armed Forces, 2019

Image of A Marine Corps Staff Sgt inspects a platoon. (U.S. Marine Corps Lance Cpl. Zachary Beatty). A Marine Corps Staff Sgt inspects a platoon. (U.S. Marine Corps Lance Cpl. Zachary Beatty)

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

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Female Infertility, Active Component Service Women, U.S. Armed Forces, 2013–2018

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As in prior years, mental health disorders, pregnancy-related conditions, and injury/poisoning accounted for the majority (59.8%) of all hospitalizations among active component service members in 2018. However, the hospitalization rate for all causes was the lowest rate in the past 10 years.

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Norovirus Outbreak in Army Service Members, Camp Arifjan, Kuwait, May 2018

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Norovirus are a group of related, single-stranded RNA, nonenveloped viruses that cause acute gastroenteritis in humans. (Photo Courtesy: CDC/Charles D. Humphrey

As in prior years, mental health disorders, pregnancy-related conditions, and injury/poisoning accounted for the majority (59.8%) of all hospitalizations among active component service members in 2018. However, the hospitalization rate for all causes was the lowest rate in the past 10 years.

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Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2018

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5/1/2019
A U.S. naval officer listens through his stethoscope to hear his patient’s lungs at Camp Schwab in Okinawa, Japan in 2018. (Photo courtesy of U.S. Marine Corps) photo by Lance Cpl. Cameron Parks)

In 2018, mental health disorders accounted for the largest proportions of the morbidity and healthcare burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 years, musculoskeletal diseases accounted for the most morbidity and healthcare burdens, and among adults aged 65 years or older, cardiovascular diseases accounted for the most.

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Medical evacuations out of the U.S. Central Command, active and reserve components, U.S. Armed Forces, 2018

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Airmen from the 19th Medical Group litter-carry a simulated patient onto a C-130J during an aeromedical evacuation training mission at Little Rock Air Force Base in 2019. (Photo Courtesy of U.S. Air Force)

The number of medical evacuations for battle injuries has decreased considerably since 2014. Most medical evacuations in 2018 were attributed to mental health disorders, followed by non-battle injury/poisoning; signs, symptoms, and ill-defined conditions; musculoskeletal disorders; and digestive system disorders.

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Hospitalizations, active component, U.S. Armed Forces, 2018

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U.S. Navy sailors graduate from boot camp at Recruit Training Command (RTC) in 2018. (Photo courtesy of U.S. Navy)

As in prior years, mental health disorders, pregnancy-related conditions, and injury/poisoning accounted for the majority (59.8%) of all hospitalizations among active component service members in 2018. However, the hospitalization rate for all causes was the lowest rate in the past 10 years.

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Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2018

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A senior airman of 366th Medical Support Squadron pediatric clinic checks vitals of the child of its service member at Mountain Home Air Force Base in Idaho. (Photo courtesy of U.S. Air Force)

In 2018, mental health disorders accounted for the largest proportions of the morbidity and healthcare burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 years, musculoskeletal diseases accounted for the most morbidity and health care burdens, and among adults aged 65 years or older, cardiovascular diseases accounted for the most.

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Surveillance Snapshot: Illness and Injury Burdens, Reserve Component, U.S. Armed Forces, 2018

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U.S. Navy sailors graduate from boot camp at Recruit Training Command (RTC) in 2018. (Photo courtesy of U.S. Navy)

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Surveillance Snapshot: Illness and Injury Burdens, Recruit Trainees, Active Component, U.S. Armed Forces, 2018

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5/1/2019
U.S. Navy sailors graduate from boot camp at Recruit Training Command (RTC) in 2018. (Photo courtesy of U.S. Navy)

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Morbidity burdens attributable to various illnesses and injuries, deployed active and reserve component service members, U.S. Armed Forces, 2018

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5/1/2019
A U.S. naval officer listens through his stethoscope to hear his patient’s lungs at Camp Schwab in Okinawa, Japan in 2018. (Photo courtesy of U.S. Marine Corps) photo by Lance Cpl. Cameron Parks)

Among service members deployed during 2018, injury/poisoning, musculoskeletal diseases, and signs/symptoms accounted for more than half of the total health care burden while deployed. Compared to the distribution of major burden of disease categories documented in garrison, a relatively greater proportion of in-theater medical encounters due to respiratory infections, skin diseases, infectious/parasitic diseases, and digestive diseases was documented.

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Ambulatory visits, active component, U.S. Armed Forces, 2018

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5/1/2019
A U.S. naval officer listens through his stethoscope to hear his patient’s lungs at Camp Schwab in Okinawa, Japan in 2018. (Photo courtesy of U.S. Marine Corps) photo by Lance Cpl. Cameron Parks)

Musculoskeletal disorders and mental health disorders accounted for more than half (52.6%) of all illness- and injury-related ambulatory encounters among active component service members in 2018. Since 2014, the number of ambulatory visits for mental health disorders has decreased, while the numbers of ambulatory visits for musculoskeletal system/connective tissue disorders, nervous system and sense organ disorders, and respiratory system disorders have increased.

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Modeling Lyme Disease Host Animal Habitat Suitability, West Point, New York

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4/1/2019
A deer basks in the morning sun at Joint Base San Antonio-Fort Sam Houston, Texas.  (Photo Courtesy: U.S. Air Force)

As the most frequently reported vector-borne disease among active component U.S. service members, with an incidence rate of 16 cases per 100,000 person-years in 2011, Lyme disease poses both a challenge to health care providers in the Military Health System and a threat to military readiness. Spread through the bite of an infected blacklegged tick, infection with the bacterial cause of Lyme disease can have lasting effects that may lead to medical discharge from the military. The U.S. Military Academy at West Point is situated in a highly endemic area in New York State. To identify probable areas where West Point cadets as well as active duty service members stationed at West Point and their families might contract Lyme disease, this study used Geographic Information System mapping methods and remote sensing data to replicate an established spatial model to identify the likely habitat of a key host animal—the white-tailed deer.

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Incidence, Timing, and Seasonal Patterns of Heat Illnesses During U.S. Army Basic Combat Training, 2014–2018

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4/1/2019
U.S. Marines participate in morning physical training during a field exercise at Marine Corps Base Camp Pendleton, California. (Photo Courtesy: U.S. Marine Corps)

Risk factors for heat illnesses (HIs) among new soldiers include exercise intensity, environmental conditions at the time of exercise, a high body mass index, and conducting initial entry training during hot and humid weather when recruits are not yet acclimated to physical exertion in heat. This study used data from the Defense Health Agency’s–Weather-Related Injury Repository to calculate rates and to describe the incidence, timing, and geographic distribution of HIs among soldiers during U.S. Army basic combat training (BCT). From 2014 through 2018, HI events occurred in 1,210 trainees during BCT, resulting in an overall rate of 3.6 per 10,000 BCT person-weeks (p-wks) (95% CI: 3.4–3.8). HI rates (cases per 10,000 BCT p-wks) varied among the 4 Army BCT sites: Fort Benning, GA (6.8); Fort Jackson, SC (4.4); Fort Sill, OK (1.8); and Fort Leonard Wood, MO (1.7). Although the highest rates ofHIs occurred at Fort Benning, recruits in all geographic areas were at risk. The highest rates of HI occurred during the peak training months of June through Sept., and over half of all HI cases affected soldiers during the first 3 weeks of BCT. Prevention of HI among BCT soldiers requires relevant training of both recruits and cadre as well as the implementation of effective preventive measures.

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Update: Exertional Hyponatremia, Active Component, U.S. Armed Forces, 2003–2018

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4/1/2019
Drink water the day before and during physical activity or if heat is going to become a factor. (Photo Courtesy: U.S. Air Force)

From 2003 through 2018, there were 1,579 incident diagnoses of exertional hyponatremia among active component service members, for a crude overall incidence rate of 7.2 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, females, those less than 20 years old, and recruit trainees had higher overall incidence rates of exertional hyponatremia diagnoses. The overall incidence rate during the 16-year period was highest in the Marine Corps, intermediate in the Army and Air Force, and lowest in the Navy. Overall rates during the surveillance period were highest among Asian/Pacific Islander and non-Hispanic white service members and lowest among non-Hispanic black service members. Between 2003 and 2018, crude annual incidence rates of exertional hyponatremia peaked in 2010 (12.7 per 100,000 p-yrs) and then decreased to 5.3 cases per 100,000 p-yrs in 2013 before increasing in 2014 and 2015. The crude annual rate in 2018 (6.3 per 100,000 p-yrs) represented a decrease of 26.5% from 2015. Service members and their supervisors must be knowledgeable of the dangers of excessive water consumption and the prescribed limits for water intake during prolonged physical activity (e.g., field training exercises, personal fitness training, and recreational activities) in hot, humid weather.

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Update: Exertional Rhabdomyolysis, Active Component, U.S. Armed Forces, 2014–2018

Article
4/1/2019
U.S. Marines sprint uphill during a field training exercise at Marine Corps Air Station Miramar, California. to maintain contact with an aviation combat element, teaching and sustaining their proficiency in setting up and maintaining communication equipment.  (Photo Courtesy: U.S. Marine Corps)

Among active component service members in 2018, there were 545 incident diagnoses of rhabdomyolysis likely due to exertional rhabdomyolysis, for an unadjusted incidence rate of 42.0 cases per 100,000 person-years. Subgroup-specific rates in 2018 were highest among males, those less than 20 years old, Asian/Pacific Islander service members, Marine Corps and Army members, and those in combat-specific or “other/unknown” occupations. During 2014–2018, crude rates of exertional rhabdomyolysis increased steadily from 2014 through 2016 after which rates declined slightly in 2017 before increasing again in 2018. Compared to service members in other race/ethnicity groups, the overall rate of exertional rhabdomyolysis was highest among non-Hispanic blacks in every year except 2018. Overall and annual rates were highest among Marine Corps members, intermediate among those in the Army, and lowest among those in the Air Force and Navy. Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat/recruit training or major ground combat units of the Army or the Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain or swelling, limited range of motion, or the excretion of dark urine (possibly due to myoglobinuria) after strenuous physical activity, particularly in hot, humid weather.

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Last Updated: July 30, 2020
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