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DHA recognizes 25 years of AFHSB's health surveillance journal

Medical technicians wearing masks and entering information on a computer Georgia Army National Guardsman Pfc. Loran Jones, a combat medic with the Marietta-based 248th Medical Company, 265th Chemical Battalion, updates patient medical records at Wellstar Atlanta Medical Center in Atlanta, Ga. In May, the Georgia National Guard strategically deployed medical support teams to hospitals to augment medical staff. (Photo by Spc. Isaiah Matthews.)

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Armed Forces Health Surveillance Division | Medical Surveillance Monthly Report

This year, the Armed Forces Health Surveillance Branch (AFHSB) celebrated the 25th anniversary of its peer-reviewed journal, the Medical Surveillance Monthly Report (MSMR). The MSMR offers readers evidence-based estimates of the health-related conditions and trends prevalent among U.S. military members and their associated populations.

“MSMR surveillance information and the published explanations of such information facilitate military leaders’ understanding of the public health measures that help to preserve the health and readiness of our armed forces,” said Dr. Francis O’Donnell, MSMR editor. Established in 1995, the MSMR was created as a flagship publication and public health authority within the Army Medical Surveillance Activity (AMSA), the forerunner of the AFHSB, a part of the Public Health Directorate at the Defense Health Agency.

“The 25 years of reports in the MSMR have dealt with a myriad of illnesses, injuries, and health threats that have challenged our military members. The rich historical record preserved in MSMR archives helps in assessments of the military importance of current health threats and in the development of policies to prevent or mitigate their medical and military operational impacts,” said Dr. John Brundage former editor and co-founder of the report.

Many studies in the MSMR are based on summaries of medical administrative data that are routinely provided to AFHSB and integrated into the Defense Medical Surveillance System (DMSS) for health surveillance purposes. The DMSS is an active database of health-related information on service members who have served in the military since 1990. It contains billions of records including medical encounters such as hospitalizations, outpatient visits, immunizations, reportable medical events, health risk appraisals, and deployment health assessments; demographic characteristics; and military experiences like deployments, assignments, and casualty information.

According to Brundage, Dr. Mark Rubertone, chief of AFHSB’s Data Management & Technical Support section, played an essential role in the production of the MSMR from its inception. Rubertone led the collection and assembly of military health surveillance-related data (initially, in the AMSA and then the Defense Medical Surveillance System) in the 1990s that allowed for a new method of statistical and epidemiologic analyses by military health surveillance professionals. “There would not have been a MSMR without the vision, dedication, and relentless efforts of Doctor Mark Rubertone,” credits Brundage.

“It has been a real pleasure witnessing the MSMR’s evolution to a peer-reviewed journal.  My association with the MSMR remains one of the efforts I am most proud of during my service in the DoD," stated Rubertone, as he expressed congratulations to the current and past MSMR staff on 25 years of tireless, comprehensive health surveillance reporting. This point-of-view was strongly supported by Dr. Jose “Toti” Sanchez, deputy chief, AFHSB, who since his early days at the Walter Reed Army Institute of Research in the early 1990’s saw the potential and relevance of this publication in providing a unique military-relevant perspective to the major public health problems faced by the U.S. military.

The MSMR is published on a monthly basis and is available online only in a downloadable PDF format. To subscribe to the MSMR, visit https://health.mil/msmr.

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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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New and Improved Defense Medical Epidemiology Database

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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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Minority Health Heat Illness Active Component U.S. Armed Forces, 2016

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Heat illness refers to a spectrum of disorders that occur when the body is unable to dissipate heat absorbed from the external environment and the heat generated by internal metabolic processes. As heat illness progresses, failure of one or more body systems can occur. This report summarizes reportable medical events of heat illnesses, heat-related hospitalizations and ambulatory visits among minority active component members (Black, non-Hispanic, Hispanic, and Asian/Pacific Islanders) during 2016. In 2016, incidence rates of heat stroke were highest among Asian/ Pacific Islanders than any other ethnicity. Crude incidence rate of “other heat illnesses” was higher among females than males.  Heat Incidence cases: •	Black, non-Hispanic heat illness incidence cases – 64 for heatstroke and 389 for other heat illnesses •	Hispanic heat illness incidence cases—  63 for heatstroke and 320 for other heat illnesses •	Asian/ Pacific Islander heat illness incidence cases – 32 for heatstroke and for  117 other heat illnesses Incidence rates: •	Black, non-Hispanic incidence rates – 0.30 for heatstroke and 1.84 for other heat illnesses •	Hispanic incidence rates – 0.33 for heatstroke and 1.67 for other heat illnesses •	Asian/Pacific Islander – 0.62 for heatstroke and 2.26 for other heat illnesses Of all military members, the youngest and most inexperienced marines and soldiers – particularly those training at installations in the south eastern U.S. – are at highest risk of heat illnesses including heat stroke, exertional hyponatremia, and exertional rhabdomyolysis. Learn more at www.Health.mil/MSMR

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Heat Illnesses by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet

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This fact sheet provides details on heat illnesses by location during a five-year surveillance period from 2012 through 2016. 11,967 heat-related illnesses were diagnosed at more than 250 military installations and geographic locations worldwide. Three Army Installations accounted for close to one-third of all heat illnesses during the period.

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Demographic and Military Traits of Service Members Diagnosed as Traumatic Brain Injury Cases

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This fact sheet provides details on the demographic and military traits of service members diagnosed as traumatic brain injury (TBI) cases during a 16-year surveillance period from 2001 through 2016, a total of 276,858 active component service members received first-time diagnoses of TBI - a structural alteration of the brain or physiological disruption of brain function caused by an external force.

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Rhabdomyolysis by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet

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This fact sheet provides details on Rhabdomyolysis by location for active component, U.S. Armed Forces during a five-year surveillance period from 2012 through 2016. The medical treatment facilities at nine installations diagnosed at least 50 cases each and, together approximately half (49.9%) of all diagnosed cases.

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2016 marks first year of zero combat amputations since the start of the Afghan, Iraq wars

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An analysis by the Medical Surveillance Monthly Report recently reported 2016 marks the first year without combat amputations since the wars in Afghanistan and Iraq began. U.S. Armed Forces are at risk for traumatic amputations of limbs during combat deployments and other work hazards. (DoD photo)

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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

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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

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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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Diabetes Mellitus

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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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