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How the military stays ready during disease outbreaks

Headshot of Dr. Sanchez Dr. Toti Sanchez is a senior scientist and deputy chief at Armed Forces Health Surveillance Branch

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Armed Forces Health Surveillance Branch | Coronavirus

A Q & A with Dr. Jose L. (Toti) Sanchez, Senior Scientist & Deputy Chief, AFHSB


What is your focus area?

A major component of my work is to ensure that major health surveillance program plans and initiatives are current and reflect alignment with the Defense Health Agency’s Strategic Plan. Under the guidance of AFHSB’s Chief, I also help to build strong scientific and collaborative relationships within the Public Health Directorate.

How do you monitor disease outbreaks?

I spend a significant amount of time monitoring the many peer-reviewed, governmental and international association reports. I also analyze the disease outbreak reports and coordinate data gathering and report generation from AFHSB’s Global Emerging Infections Surveillance, Epidemiology and Analysis), and Integrated Biosurveillance  sections.

In my role as Senior Scientist at AFHSB, I serve on the Infectious Disease Clinical Research Program Operational Steering Committee, a “think-tank” committee of experts who provide guidance on military-relevant research efforts in support of the U.S. military’s force health protection needs. I also work as an instructor at the Uniformed Services University of the Health Sciences. I ensure students and residents in public health learn the basic skills of outbreak investigation, associated surveillance, and research initiatives.

How do you support AFHSB's response to COVID-19?

The COVID-19 pandemic has placed an immense workload on our AFHSB staff to produce analyses and reports for DHA leadership, senior DoD officials, the Secretary of Defense, and respond to questions from Congressional officials. In my role as Deputy Chief, AFHSB, I ensure that reports, documents and COVID-19 related policy reviews are accurate and produced in a timely fashion from AFHSB’s three sections. Since February 2020, I’ve reviewed and provided input to nearly 70 executive summaries , several information and position papers, and at least 20 weekly surveillance summaries addressing COVID-19 issues.

Where have you traveled in this role?

My travel is mainly limited to the National Capital Region. I’ve participated in tabletop drills such as an interagency simulation for Crimson Contagion, a response to a severe influenza pandemic. I’ve also served as a representative to the Defense Health Board to evaluate health surveillance matters such as COVID-19 and respiratory infections in support of DHA’s Combat Support Agency mission.

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5 Major Categories of Abdominal Hernia

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An abdominal hernia is an abnormal protrusion of an organ or tissue through a defect in the abdominal wall. This infographic provides information on incident diagnoses of the five types of abdominal hernia that were documented in health records of 72,404 active component service members from 1 January 2005 through 31 December 2014.  A total of 87,480 incident diagnoses of the five types of abdominal hernia were documented in health records of 72,404 active component service members. Here are highlights of the findings from this study: •	The give types of abdominal hernia categories used in this analysis were: inguinal, umbilical ventral/ incisional, femoral and “other.” •	 During the 10-year interval, incidence rates for most of the five types of hernia trended downward but increased for umbilical hernias in both males and females and ventral/ incisional hernias among females. •	Overall incidence rate of inguinal hernias among males was six times the rate among females. •	Incidence rates of femoral, ventral/ incisional and umbilical hernias were higher among females than males. •	For most types of hernia incidence rates tend to be higher among older age groups.  Abdominal hernias are diagnosed most frequently in the inguinal, umbilical, and femoral regions, but another category of relatively common hernias of the anterior abdominal wall includes ventral and incisional hernias. Health records contained documentation for 35,624 surgical procedures whose description corresponded to the types of hernia diagnoses in U.S. military service members. Learn more about the findings of the study at Health.mil/MSMR

An abdominal hernia is an abnormal protrusion of an organ or tissue through a defect in the abdominal wall. This infographic provides information on incident diagnoses of the five types of abdominal hernia that were documented in health records of 72,404 active component service members from 1 January 2005 through 31 December 2014.

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Chlamydia Trachomatis Infections

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This report characterizes the rates of Chlamydia Trachomatis (CT) during the pre-deployment, deployment, and post-deployment phases for active component members of the U.S. Army, Navy, Air Force and Marine Corps. The surveillance period was 2008 through 2015.  For incidence rates of laboratory-confirmed Chlamydia Trachomatis diagnoses, by deployment cycle and sex, active component, U.S. Armed Forces, 2008-2015, there were 84,783 cases for men and 54,867 cases for women. The surveillance period findings show: •	Rates of CT were highest during the pre-deployment phase for both sexes •	Males tended to have similar rates of CT across pre-, post-, and non-deployed phases •	Women had substantial rate differences between phases  The results of these analyses underscore the need for better screening and documentation of STIs during deployment to assess the true burden of disease. Learn more about rates of CT among U.S. Armed Forces by visiting Health.mil/MSMR

This report characterizes the rates of Chlamydia Trachomatis (CT) during the pre-deployment, deployment, and post-deployment phases for active component members of the U.S. Army, Navy, Air Force and Marine Corps. The surveillance period was 2008 through 2015.

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Diabetes Mellitus

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3/17/2017
Diabetes Mellitus (DM) is a group of chronic metabolic conditions characterized by high blood glucose levels resulting from a decreased ability to produce and or use insulin. DM-related metabolic abnormalities are associated with damage to various organs and tissues. From 2008 - 2015, a total of 9,092 incident cases of DM were reported among active duty service members. This infographic provides details on the overall incidence rates of type 1 and 2 DM cases per 100,000 person-years. It also provides information about service members at higher risk of diabetes. Here are some key findings from the study: •	Type 1 DM (previously known as “insulin-dependent diabetes”) overall incidence rate was 3.0 cases per 100,000 p-yrs. •	Type 2 DM ( “non-insulin-dependent diabetes) was 74.5 cases per 100,000 p-yrs. And rates doubled within each successive age group.  Service members at higher risk of diabetes are male, black, non-Hispanic, unknown race/ ethnicity, Hispanic and enlisted in the Army and Navy. Learn more by visiting Health.mil/AFHSB

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Leishmaniasis

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Leishmaniasis is a zoonotic disease caused by protozoan parasites of the genus Leishmania that are transmitted to humans by the bites of infected female sand flies. The disease remains a military medical surveillance interest because of deployments to endemic areas of the Middle East. It is also endemic in many other regions including Africa, Mexico, Southern Europe, Asia, and South and Central America. This report provides an update on the frequencies, rates, and demographic characteristics of U.S. service members who were diagnosed/ reported with leishmaniasis while expanding analysis to include information on the location of acquisition of leishmaniasis infection during a 2001-2016 surveillance period. Here are key findings from the surveillance period: •	There were 2,040 incident diagnoses/ reports of leishmaniasis among members of the U.S. Armed Forces. •	Cutaneous Leishmaniasis accounted for 61.0% of total diagnoses/ reports among active duty service members. •	71.1% of the total leishmaniasis case were diagnosed or reported during the 7 months from early autumn to spring (September – March) in the northern hemisphere. •	The majority of cases diagnosed or reported during this 7-month interval were acquired in the Middle East, South/Central America and other or unknown locations.  Learn more information at Health.mil/MSMR

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Global Influenza Summary: March 12, 2017

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March 10 is National Women & Girls HIV/AIDS Awareness Day

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3/3/2017
This graphic shows the results of routine screening for antibodies to Human Immunodeficiency Virus (HIV) among both female civilian applicants for U.S. military service and female service members of the U.S. Armed Forces, active component - Army during  January 2015 through June 2016 surveillance period. 94,763 females out of 463,132 civilian applicants for U.S. military service were tested for antibodies to HIV. Out of 124 civilian applicants that were HIV positive, 10 were female. Throughout the period, seroprevalences were much higher among males than females.  During 2015 – 2016 seroprevalences dropped to zero among female applicants.  As for U.S. Armed Forces active component, 81,963 female service members out of 548,974 were tested for antibodies to HIV. Out of 120 soldiers that were HIV positive 3 were female. Annual seroprevalences for male active component Army members greatly exceed those of females. During the 2015, on average, one new HIV infection was detected among active duty army soldiers per 5,265 screening tests.  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. Of 515 active component soldiers diagnosed with HIV infections since 2011, a total of 291 (57%) were still in the military. Get tested and learn more by reading the Medical Surveillance Monthly Report at Health.Mil/MSMR.

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Counts, Rates, & Trends of Incedent Diagnoses of Melanoma

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3/3/2017
Melanoma is a leading cause of cancer death. This graphic shows facts from an analysis for counts, rates, and trends of incident diagnoses of Melanoma among active component military members conducted during a 10-year surveillance period from 2005 through 2014.   Although melanoma is more common among males in the general U.S. population, in this analysis, females had a higher crude rate of malignant melanoma compared to males. From 2005 – 2014, there were 1,571 malignant melanoma cancers diagnosed in the U.S. Armed Forces. Here are other key facts from the analysis: •	Among male service members, malignant melanoma was one of the most frequent cancer diagnoses after testicular cancer. •	Among females, malignant melanoma was the 2nd most frequent cancer diagnoses after breast cancer. •	White, non-Hispanic service members had a much higher crude rate of malignant melanoma relative to their counterparts in other race/ ethnicity groups. •	In general, the strongest demographic correlate of increased risk of cancer diagnosis was older age. To learn more information, visit Health.mil/AFHSB

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Cold injuries among active duty U.S. service members drop to lowest level since winter 2011–2012

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U.S. service members often perform duties in cold weather climates where they may be exposed to frigid conditions and possible injury.

Cold injuries among active duty U.S. service members drop to the lowest level since winter 2011-2012, according to a study published in Defense Health Agency’s Armed Forces Health Surveillance Branch (AFHSB) peer-reviewed journal, the Medical Surveillance Monthly Report.

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Human Physiologic responses to cold exposure preserve core body temperature, but those responses may not be sufficient to prevent hypothermia if heat loss is prolonged. This infographic offers helpful information on preserving core body temperature to counter the threat from cold environments. Physiologic responses include: •	Constriction of the peripheral (superficial) vascular system – may result in non-freezing injuries or hasten the onset of actual freezing of tissues (frostbite) •	Minimizing loss of body heat •	Protecting superficial tissues Protection includes:	 •	Nutrition •	Shelter •	Physical Activity •	Protective Clothing Learn more about preserving core body temperature by reading the Medical Surveillance Monthly Report at www.Health.mil/AFHSB

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Rift Valley Fever Virus Ecology

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This infographic describes Rift Valley Fever (RVF) virus ecology and how RVF infects livestock and humans.   •	First the enzootic cycle begins. It is maintained via transfer from parent mosquito to offspring. This is a local, low-level transfer of disease to livestock and happens during periods of average rainfall. •	Next, high rainfall and flooding enable Aedes mosquito breeding environments to flourish. This is followed by epizootic outbreaks, which cause abortion storms in animals, with > 90% mortality in newborns and 10-20% mortality in adults. Secondary vectors, including other mosquito genera such as Culex, can pass on the virus to humans and animals.  Spillover to humans includes exposure to blood and tissue of infected livestock and occurs during slaughter or birthing activities. Humans can also be infected with RVF via bites of infected mosquitos.

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