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Description of a COVID-19 Beta Variant Outbreak, Joint Base Lewis-McChord, WA, February–March 2021

Image of U.S. Army Soldiers from 1-17th Infantry Battalion, 2nd Stryker Brigade, 2nd Infantry Division, clear an objective during the training exercise Bayonet Focus 19-02 at Yakima Training Center, Wash., May 6, 2019. Bayonet Focus is a training exercise designed to assess Soldiers’ ability to preform tasks and complete objectives under conditions experienced during combat situations. (U.S. Army photo by Spc. Angel Ruszkiewicz). U.S. Army Soldiers from 1-17th Infantry Battalion, 2nd Stryker Brigade, 2nd Infantry Division, clear an objective during the training exercise Bayonet Focus 19-02 at Yakima Training Center, Wash., May 6, 2019. Bayonet Focus is a training exercise designed to assess Soldiers’ ability to preform tasks and complete objectives under conditions experienced during combat situations. (U.S. Army photo by Spc. Angel Ruszkiewicz)

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Abstract

An outbreak of SARS CoV-2 infection occurred in an infantry battalion from Joint Base Lewis-McChord following participation in a field training exercise in the vicinity of Yakima, WA in February of 2021. Extreme weather during the exercise disrupted planned COVID-19 mitigation measures and caused 110 soldiers to be sheltered in a small aircraft hangar for several nights. The probable index case reported to sick call with symptoms compatible with COVID-19, but the soldier was not diagnosed with COVID-19, was returned to duty, and was allowed to remain in the enclosed hangar for 3 additional days. In total, 143 individuals with epidemiologic ties to the field training exercise tested positive for SARS-CoV-2 during the outbreak. Nine samples sent for sequencing were determined to be the SARS-CoV-2 Beta variant. This report illustrates important lessons learned whose implementation in the future will enable better protection of service members from COVID-19 and similar health risks associated with training.

What are the new findings?

COVID-19 is a threat to military exercises because of the virus's ability to cause illness in a large number of soldiers. Results of this investigation demonstrate the potential impact of a COVID-19 outbreak in land-based military congregate living settings, especially those with shared sleeping spaces.

What is the impact on readiness and force health protection?

In addition to immunization, pre-deployment screening, basic hygiene measures such as sufficient sleeping space, and ready access to appropriate clinical assessment and diagnostic testing can be important parts of mitigating the risk of a potential COVID-19 outbreak in military training settings.

Background

This report describes an outbreak of SARS-CoV-2, the causative agent of COVID-19, that peaked during Feb. 21–26, 2021 and was tied to a single military training event. A total of 143 laboratory-confirmed cases were identified. Nine samples collected within the first several days of the outbreak (Feb. 20–23, 2021) were sent for sequencing upon noting an increase in the baseline SARS-CoV-2 positivity rate among individuals in a congregate setting. All 9 samples were determined to be the SARS-CoV-2 variant B.1351, referred to by the World Health Organization naming scheme as the Beta variant.

The first case of SARS-CoV-2 infection known to be caused by the Beta variant (501Y.V2/B.1.351 lineage) was reported in South Africa on Dec. 18, 2020.1 The Beta variant was first reported in the U.S. in South Carolina on Jan. 28, 2021.2 By March 23, 2021, the Washington State Department of Health had reported 8 cases while the Centers for Disease Control (CDC) had reported 219 cases of Beta variant in 27 jurisdictions nationally.3,4 Similar to the Alpha (B.1.1.7) variant first reported in December 2020, the Beta variant has been linked to higher viral load and increased transmissibility compared to other SARS-CoV-2 variants that were identified at the time.5 Other known attributes of the variant include moderate reduction in neutralization by monoclonal antibody therapeutics, convalescent sera, and post-vaccination sera.6 Additionally, clinical trial data have also shown a decreased efficacy of some coronavirus disease 2019 (COVID-19) vaccines primarily due to antigenic changes in the SARS-CoV-2 spike protein.7,8 To date, there is no evidence suggesting that the Beta variant is associated with an increase in disease severity.9,10

This report aims to describe the setting, timeline, and characteristics of an outbreak of COVID-19 Beta variant among an infantry battalion from Joint Base Lewis-McChord (JBLM), WA following participation in a field training exercise at a local Army training center in Yakima, WA in February 2021.

Methods

Population and setting

During Feb. 4–19, 2021, an Infantry Battalion (herein Battalion A) of a Brigade (herein Brigade X) from JBLM conducted a tactical field training exercise at an Army training center in Yakima, WA. Brigade X is an infantry unit comprised of 8 battalions; battalions typically consist of about 1,000 soldiers distributed among 4 to 6 companies. Neither symptom-based nor laboratory-based COVID-19 screening of the soldier participants was performed prior to deployment. Soldiers of Battalion A conducted platoon- and company-level training in groups of approximately 40 or 275 personnel at a time rotating through different training iterations to maximize physical distance between soldiers as much as practically possible. Hand washing stations were placed near all tactical operations centers, latrines, and designated dining areas. Use of face covering was mandated by policy and enforced by leadership. Despite COVID-19 mitigation measures that were integrated in the planning of the field training exercise, extreme environmental conditions and logistical difficulties made these measures difficult to execute and maintain.

On Feb. 12, 2021, the training center experienced extreme weather with temperatures reaching 13 °F (-10 °C) with roughly 2 inches (5 cm) of snow and wind gusts up to 14 mph. Because of these conditions, 110 soldiers (an infantry company of 103 soldiers and a group of 7 medics from a separate supporting company) were moved into a relatively small aircraft hangar on the night of Feb. 12, 2021, for protection from freezing temperatures; this was the sleeping arrangement for the remainder of the field training exercise. The aircraft hangar was approximately 75 ft (23 m) x 85 ft (26m) or 6,375 square feet (592 square meters) in size (Figures 1, 2). The hangar had no mechanical heating or ventilation system and the windows were kept closed to keep the heat in. Furthermore, because of limited space, many soldiers slept on the ground in their military issued 5-component modular sleep systems with roughly 2 feet of space between soldiers. Based on minimum acceptable sleeping space allowance of 72 square feet of floor space per person,11 the aircraft hangar had a maximum capacity of 88 personnel (6,375/72=88.5). By housing 110 soldiers in this space, the unit's use of the hangar exceeded recommended public health capacity by 22 soldiers.

The unit returned earlier than planned to JBLM on Feb. 18–19, 2021, using buses within which recommended physical distancing could not be achieved. Shortly after returning to JBLM, a small number of soldiers began reporting symptoms of COVID-19. On Feb. 20, 2021, the Battalion physician assistant was notified of what was later identified as the index case of this outbreak; the case had tested positive for SARS-CoV-2 earlier the same day. The affected soldier reported initial symptoms of fever (101.6 °F, 38.7 °C) and chills that started on Feb. 16, 2021. This soldier was evaluated by medics in the field on the day of his symptom onset but was not suspected as having COVID-19. The soldier was rehydrated and was promptly returned to duty where he resumed normal training activities for the next 3 days among other soldiers, including sleeping in the enclosed hangar. When the presence of an outbreak was confirmed, representative respiratory samples were collected and sent for sequencing; these samples were from cases that were among the first diagnosed and most highly connected to other cases.

Case identification

All cases identified (service members and beneficiaries) were diagnosed using PCR testing through Madigan Army Medical Center's laboratory. Case interview and contact tracing were performed for all individuals with laboratory-confirmed COVID-19 infection by the unit medical section with assistance from JBLM Department of Public Health. Close contact was defined using CDC's criteria of being within 6 feet of someone with laboratory-confirmed SARS-CoV-2 infection for a cumulative total of 15 minutes or more over a 24-hour period during the window of high-risk viral transmission (2 days prior to symptom onset or if asymptomatic, prior to a positive test, until completion of the isolation period). Contact tracing included civilian close contacts. Genome sequencing for variants was completed on an Illumina MiSeq (Illumina, San Diego, CA) at U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID).

Results

Outbreak investigation

The index case described above was the first symptomatic soldier from the hangar to test positive for COVID-19. Identification of this case triggered immediate contact tracing by the Battalion medical section which resulted in 21 individuals being quarantined for close contact with the index case. On Feb. 21, 2021, the day after the first laboratory-confirmed case was reported, 2 additional individuals tested positive for SARS-CoV-2 COVID-19 (Figure 3). Although these 2 individuals were not identified as close contacts by the index case as they worked in different sections, they were found to have slept in the same enclosed hangar during the field training exercise. The identification of these cases triggered the quarantine and testing of 7 additional soldiers. By the end of the day on Feb. 21, a total of 18 individuals had tested positive for COVID-19 from Battalion A. Contact tracing for the first 3 positive cases revealed a total of 28 individuals (including civilians and beneficiaries) as close contacts who were subsequently quarantined and tested. By 24 February 2021, 46 individuals from the infantry company had tested positive for COVID-19. At this point the remainder of the company was placed into quarantine and tested.

Following several iterations of contact tracing, the total number of positive cases from this company reached 87. Forty-two additional positive cases were identified in the support company to which the medical detachment belonged. These 2 companies accounted for 129 (90.8%) of the 142 positive cases in Battalion A from Feb. 21 to March 4, 2021. An additional 19 cases were identified as part of this outbreak that were not part of the battalion, but were linked epidemiologically. As above, 9 samples from the outbreak were sent for sequencing, all of which were determined to be SARS-CoV-2 Beta variant.

The distribution of daily counts of positive tests for SARS-CoV-2 infection among soldiers in each of the battalions represents an outbreak from Feb. 14, 2021 to March 5, 2021 (Figure 3). Cases from Battalion A caused a sudden and dramatic increase of daily COVID-19 cases in Brigade X beginning Feb. 21, 2021 and ending Feb. 26, 2021, clearly marking the beginning and end of the peak outbreak period. The index case was not included in the peak outbreak period as this soldier tested positive on Feb. 20. Of note, it is likely that many of the cases identified in the first few days of the outbreak may have become infected earlier. Battalion A accounted for 92.3% (132/143) of the cases during this period, and the daily average of COVID-19 cases during the peak outbreak period was 24. Comparatively, the daily average of COVID-19 cases during the 7 days preceding the outbreak (Feb. 14–20, 2021, the pre-outbreak period) was less than 1. In the late-outbreak period (Feb. 27–March 5, 2021), the average daily COVID-19 case count decreased to 2, a 91.7% decrease compared to the peak outbreak period.

The distribution of COVID-19 cases before, during, and after the peak period of the outbreak reflect the age distribution of the infantry units involved, the concentration of cases in Battalion A, and the high proportion of infected soldiers who were asymptomatic but were identified through methodical contact tracing (Table). In total, 164 individuals from the study cohort sample tested positive for SARS-CoV-2 from Feb. 14 through March 5, 2021. The field training exercise (FTX) was held from Feb. 9–19, 2021. The majority of samples tested were collected in the days immediately following the FTX (dates of collection Feb. 21–26, 2021). The majority of those testing positive were male (92.1%; n=151). The average age was 24, (range=7–43 years) with a majority in aged 20– 29 (71.3%; n=117). The majority were active duty soldiers (99.4%; n=163), with the remaining individual being a young (under 18 years old) family member of an active duty soldier. Battalion A accounted for 144 of the individuals testing positive (87.8%). Among the 154 individuals whose reasons for testing were specified, a majority experienced no symptoms (68.8%; n=106) while a minority did experience symptoms (n=48; 31.2%). No cases reported symptoms as being severe (data not shown). For an additional 10 individuals, no data were available as to whether they experienced symptoms (unspecified) (Table). The most common reason for testing was being identified as a close contact to a positive case only (62.2%; n=102).

During the peak outbreak period, 67.8% (97/143) of COVID-19 cases were asymptomatic close contacts who were tested primarily as the result of contact tracing efforts stemming from the index case (Table). Conversely, none of the cases during the pre-outbreak period and one-third (5/15) of the cases in the late-outbreak period were tested due to close contact. Furthermore, just one-quarter (36/143) of peak outbreak cases reported symptoms while two-thirds (4/6) of pre-outbreak cases and a little more than half (8/15) of late outbreak cases reported symptoms. Of note, at the time of this outbreak, COVID-19 vaccine was not widely available. Only 2 medics from the medical detachment were fully vaccinated. Neither of the vaccinated medics who were tested during the outbreak period contracted COVID-19 whereas 4 of the 5 unvaccinated medics tested positive for SARS-CoV-2.

Editorial Comment

This report describes a COVID-19 outbreak tied to a single military training event that affected almost a quarter (23.8%) of soldiers in an infantry battalion. The current findings demonstrate that highly contagious variants could be of particular concern in military congregate living settings, especially those with shared sleeping spaces. Disease severity during the outbreak was generally mild in an otherwise healthy population; however, the results underscore the negative impact (i.e., 24% of a battalion isolated or quarantined) that a COVID-19 outbreak, especially of a highly contagious variant, can have on readiness. Intensive contact tracing, testing, and command-implemented isolation and quarantine contributed to quick extinction of the outbreak. These control efforts resulted from an investigation of the outbreak that featured robust two-way communication between JBLM Public Health and the medical and command assets of the affected units.

In addition, the experience of the 2 vaccinated medics supports the effectiveness of vaccinations in combating COVID-19 transmission.

Military leaders are tasked with optimizing and maintaining combat readiness of their soldiers and the unit. The COVID-19 pandemic presents a unique challenge to leaders in balancing combat readiness against mitigation of SARS-CoV-2 transmission. Although this battalion's leadership took additional steps to ensure COVID-19 mitigation measures were incorporated into every aspect of the field training exercise, this outbreak was not prevented.

Three key issues appear to have contributed to this outbreak. First, the unit did not include pre-deployment COVID-19 screening as part of operational plans. Symptom-based or temperature-based screening might have mitigated viral transmission risk by identifying soldiers displaying symptoms of COVID-19 who needed to be tested and isolated prior to deployment. Furthermore, lab-based screening might have identified asymptomatic spreaders and potentially prevented this outbreak. As a result of this outbreak, the leadership of the training base has implemented a screening protocol for members of units undergoing training activities.

However, it should be noted that the apparent index case did not develop symptoms until the 13th day of the exercise, so pre-exercise screening might not have been helpful in detecting his infection.

Second, the unit's contingency plan for extreme weather conditions did not incorporate adequate COVID-19 mitigation measures in indoor settings. Overcrowded indoor sleeping arrangements coupled with poor ventilation permitted conditions for widespread transmission of a highly contagious variant of COVID-19. This was potentially exacerbated by transport back to JBLM on buses where large numbers of soldiers in a shared air space could also promote disease transmission. Given the exigency of protecting the soldiers from severe weather conditions, the local public health authority was not consulted about these decisions made prior to the recognition of the first COVID case in the unit.

Third, despite the index case presenting to the platoon aid station with report of chills and a fever on Feb. 16, 2021, 4 days before laboratory-confirmed diagnosis of SARS-CoV-2 infection, this soldier was not evaluated for COVID-19 or placed in isolation. Instead, the soldier was returned to duty. This misstep could have been averted through the use of an effective screening protocol that triggered isolation and testing for anyone presenting with symptoms consistent with COVID-19. Early removal and testing of the index case might have significantly reduced the number of positive cases in this outbreak.

This study has some limitations that should be considered in light of the findings. The lack of access to COVID-19 testing at YTC may have led to delayed diagnoses in some cases. In addition, the absence of a licensed independent medical provider at the training event may have also led to delayed diagnosis. The scope of practice for medics assigned to this exercise included provision of OTC medications for sick-call and ordering quarantine/isolation for possible communicable disease, although no such determination (isolation) was made for the index case.

This study describes the characteristics of a Beta variant outbreak which may not be fully applicable to other more current or emerging SARS-CoV-2 variants. This study also describes the characteristics of an outbreak in a predominantly unvaccinated population which is no longer applicable to the current predominantly vaccinated military force.

The findings of this study can inform mitigation efforts in military units in a deployed or field training environment and are particularly applicable in the setting of the Delta variant as the predominant cause of COVID-19. Like Beta, Delta is highly contagious, suggesting the need for continued vigilance among medical personnel and leaders at all levels during deployment and training events. Similarly, the planning considerations that might have mitigated or prevented the outbreak described in this report could be valuable for medical and command elements preparing for training or deployment events.

Author Affiliations: Madigan Army Medical Center, Department of Public Health, JBLM, WA (LTC Mease, MAJ Yun, CPT Egbert, LTC Yassin, COL Faestel, CPT Moyer, COL Terrio); Department of Chemistry and Life Science, United States Military Academy, West Point, NY (MAJ Bateman).

Acknowledgements: The authors thank MAJ Jeremy McGuffey for his assistance in collecting details of the field training exercise which made this work possible. The authors also thank LTC Kurt Jerke for his laboratory expertise and input.

Funding: All work described herein was performed as part of paid regular duties as part of employment by the U.S. Government.

Conflicts of Interest: None.

Disclaimer: The views expressed herein are those of the authors and do not necessarily represent the views of the U.S. Army, Department of Defense, or U.S. Government.

References

1. Tracking SARS-CoV-2 variants. Accessed Jan. 28, 2022. https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

2. Chappell B. South Carolina Reports 1st Known U.S. Cases Of Variant From South Africa. NPR. Published Jan. 28, 2021. Accessed Sept. 17, 2021. https://www.npr.org/sections/coronavirus-live-updates/2021/01/28/961609976/south-carolina-reports-1st-known-u-s-cases-of-variant-from-south-africa

3. CDC. COVID Data Tracker. Centers for Disease Control and Prevention. Published March 28, 2020. Accessed Sept. 17, 2021. https://covid.cdc.gov/covid-data-tracker

4. WA DOH. SARS-CoV-2 Sequencing and Variants in Washington State. Accessed April 15, 2021. https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/420-316-SequencingAndVariantsReport.pdf

5. Pearson CAB, Russell TW, Davis NG, et al. Estimates of severity and transmissibility of novel SARS-CoV-2 variant 501Y.V2 in South Africa. CMMID Repository. Published Jan. 11, 2021. Accessed Sept. 17, 2021. https://cmmid.github.io/topics/covid19/sa-novel-variant.html

6. CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published Feb. 11, 2020. Accessed Sept. 17, 2021. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html

7. Madhi SA, Baillie V, Cutland CL, et al. Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the BETA Variant. New Engl J Med. 2021;384(20):1885–1898. 

8. Mahase E. Covid-19: Novavax vaccine efficacy is 86% against UK variant and 60% against South African variant. BMJ. 2021;372:n296. 

9. What you need to know about the 501Y.V2 (BETA) South African Variant of SARS-CoV-2. Ask a Scientist. Published Jan. 19, 2021. Accessed Sept. 17, 2021. https://www.thermofisher.com/blog/ask-a-scientist/what-you-need-to-know-about-the-501y-v2-b-1-351-south-african-variant-of-sars-cov-2/

10. CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published Feb. 11, 2020. Accessed Sept. 17, 2021. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/scientific-brief-emerging-variants.html

11. HQ, Department of the Army, Facility Sanitation Controls and Inspections. March 1, 2019. TB MED 531: 44-45. Accessed Sept. 17, 2021. https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/ARN16903_tbmed531_FINAL.pdf

FIGURE 1. Exterior of hangar used to house soldiers at an Army training center during a field training exercise

FIGURE 2. Interior of hanger used to house soldiers at an Army training center during a field training exercise

FIGURE 3. Epidemic curve depicting the daily counts of positive tests for SARS-CoV-2 infection among soldiers in each of the battalions in the brigade affected by the outbreak, 14 February–5 March 2021

TABLE. Background characteristics of SARS-CoV-2 positive soldiers by outbreak period, 14 February–5 March 2021

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The Embry-Riddle Army ROTC Ranger Challenge team heads out on the 12-mile road march after completing the timed obstacle course event of the 6th Brigade Army ROTC Ranger Challenge January 14, 2022 at Fort Benning, Ga. The Titan Brigade’s Ranger Challenge took place at Fort Benning, Ga. January 13-15, 2022. Photo by Capt. Stephanie Snyder

Exertional rhabdomyolysis is a potentially serious condition that requires a vigilant and aggressive approach. Some service members who experience exertional rhabdomyolysis may be at risk for recurrences, which may limit their military effectiveness and potentially predispose them to serious injury.

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Heat Illness, Active Component, U.S. Armed Forces, 2021

Article
4/1/2022
Airmen participate in the 13th Annual Fallen Defender Ruck March at Joint Base San Antonio, Nov. 6, 2020. The event honors 186 fallen security forces, security police and air police members who have made the ultimate sacrifice. Photo By: Sarayuth Pinthong, Air Force.

From 2020 to 2021, the rate of incident heat stroke was relatively stable while the rate of heat exhaustion increased slightly

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Medical Surveillance Monthly Report

Brief report: Using syndromic surveillance to monitor MIS-C associated with COVID-19 in Military Health System beneficiaries

Article
3/1/2022
Air Force 1st Lt. Anthony Albina, a critical care nurse assigned to Joint Base Andrews, Md., checks a patient’s breathing and heart rate during an intubation procedure while supporting COVID-19 response operations in Cleveland, Jan. 20, 2022.

SARS CoV-2 and the illness it causes, COVID-19, have exacted a heavy toll on the global community. Most of the identified disease has been in the elderly and adults. The goal of this analysis was to ascertain if user-built ESSENCE queries applied to records of outpatient MHS health care encounters are capable of detecting MIS-C cases that have not been identified or reported by local public health departments.

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Surveillance Snapshot: Medical Separation from Service Among Incident Cases of Osteoarthritis and Spondylosis, Active Component, U.S. Armed Forces, 2016–2020

Article
3/1/2022
Marines hike to the next training location during Exercise Baccarat in Aveyron, Occitanie, France, Oct.16, 2021. Exercise Baccarat is a three-week joint exercise with Marines and the French Foreign Legion that challenges forces with physical and tactical training. Photo By: Marine Corps Lance Cpl. Jennifer Reyes

Osteoarthritis (OA) is the most common adult joint disease and predominantly involves the weight-bearing joints. This condition, including spondylosis (OA of the spine), results in significant disability and resource utilization and is a leading cause of medical separation from military service.

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Obesity prevalence among active component service members prior to and during the COVID-19 pandemic, January 2018–July 2021

Article
3/1/2022
Maintaining a healthy weight is important for military members to stay fit to fight. The body mass index is a tool that can be used to determine if an individual is at an appropriate weight for their height. A person’s index is determined by their weight in kilograms divided by the square of height in meters. (U.S. Air Force photo illustration by Airman 1st Class Destinee Sweeney)

This study examined monthly prevalence of obesity and exercise in active component U.S. military members prior to and during the COVID-19 pandemic. These results suggest that the COVID-19 pandemic had a small effect on the trend of obesity in the active component U.S. military and that obesity prevalence continues to increase.

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Brief Report: Refractive Surgery Trends at Tri-Service Refractive Surgery Centers and the Impact of the COVID-19 Pandemic, Fiscal Years 2000–2020

Article
3/1/2022
Cadet Saverio Macrina, U.S. Military Academy West Point, receives corneal cross-linking procedure at Fort Belvoir Community Hospital, Va., Nov. 21, 2016. (DoD photo by Reese Brown)

Since the official introduction of laser refractive surgery into clinical practice throughout the Military Health System (MHS) in fiscal year 2000, these techniques have been heavily implemented in the tri-service community to better equip and improve the readiness of the U.S. military force.

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Update: Malaria, U.S. Armed Forces, 2021

Article
3/1/2022
Mosquitos – like this one, collected as part of a military study in North Carolina – were used during USAMRDC’s initial RTS,S vaccine studies nearly 40 years ago. (Photo courtesy: AFC Kimberly Barrera)

Malaria infection remains an important health threat to U.S. service members who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. In 2021, a total of 20 service members were diagnosed with or reported to have malaria.

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Surveillance snapshot: Health care burden attributable to osteoarthritis and spondylosis, active component, U.S. Armed Forces, 2016–2020

Article
2/1/2022
Air Force security forces trainees climb a hill during a 3-mile ruck march to commemorate National Police Week at Joint Base San Antonio, May 13, 2019. Photo By: Sarayuth Pinthong, Air Force

This snapshot summarizes the total numbers of inpatient and outpatient encounters with an OA or spondylosis diagnosis in the first diagnostic position and the total numbers of unique individuals affected by these conditions during the same 5-year surveillance period.

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A new approach to categorization of ocular injury among U.S. Armed Forces

Article
2/1/2022
Air Force and Space Force Surgeon General Lt. Gen. Dorothy Hogg receives an eye exam from Air Force Reserve Maj. Leslie Wilderson at Joint Base Anacostia-Bolling, Washington, D.C., March 26, 2021. Photo By: Air Force Staff Sgt. Kayla White

Ocular injuries present an ongoing threat to readiness and retention of service members. This report describes a new approach to categorizing ocular injury using Military Health System data, the application of an algorithm to a dataset, and the verification of the results using an audit of clinical data.

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Diagnosis of hepatitis C infection and cascade of care in the active component, U.S. Armed Forces, 2020

Article
2/1/2022
Navy Petty Officer 2nd Class Cecil Dorse, left, and Navy Petty Officer 3rd Class Janet Rosas test blood samples aboard the Military Sealift Command hospital ship USNS Comfort while the ship is in New York City in support of the nation’s COVID-19 response, April 6, 2020. Photo By: Navy Petty Officer 2nd Class Sara Eshleman

Hepatitis C virus (HCV) infection rates are rising in the U.S. despite widely available tools to identify and effectively treat nearly all of these cases. This cross-sectional study aimed to use laboratory data to evaluate the prevalence of HCV diagnoses among active component U.S. military service members.

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Surveillance Snapshot: Lengths of Hospital Stays for Service Members Diagnosed with Sepsis, Active Component, U.S. Armed Forces, 2011–2020

Article
1/1/2022
The (left to right) Senior Airman Austin Shrewsbury, 88th Diagnostics and Therapeutic Squadron medical laboratory technician, works with student, Airman 1st Class Taylor Altman, 88th Diagnostics and Therapeutic Squadron medical laboratory technician, to identify bacteria of patient’s cultures inside the microbiology laboratory at Wright-Patterson Air Force Base medical center June 30, 2017.

Sepsis is a serious and life-threatening organ dysfunction caused by a dysregulated host response to infection. In the U.S., sepsis is a leading cause of in-hospital mortality and 1 of the most expensive conditions treated in U.S. hospitals.

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COVID-19 and Depressive Symptoms Among Active Component U.S. Service Members, January 2019–July 2021

Article
1/1/2022
With the holiday season upon us, the cold, dark days that winter brings, and the social distancing and movement restrictions brought about by COVID-19, it’s not uncommon for people to feel depressed. (Photo by Erin Bolling)

This study examined the rates of depressive symptoms in active component U.S. service members prior to and during the COVID-19 pandemic and evaluated whether SARS-CoV-2 test results (positive or negative) were associated with self-reported depressive symptoms.

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Update: Osteoarthritis and Spondylosis, Active Component, U.S. Armed Forces, 2016–2020

Article
12/1/2021
Osteoarthritis (OA) knee . film x-ray AP ( anterior - posterior ) and lateral view of knee show narrow joint space, osteophyte ( spur ), subchondral sclerosis, knee joint inflammation. Photo by: iStockPhoto

Osteoarthritis (OA), the most com­mon adult joint disease, is primarily a degenerative disorder of the entire joint organ, including the subchondral bone, synovium, and periarticular structures (e.g., tendons, ligaments, bursae). Spondylosis, often referred to as OA of the spine, is characterized by degenerative changes in the vertebral discs, joints, and vertebral bodies.

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Last Updated: April 21, 2022

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