Skip to main content

Military Health System

Important Notice about Pharmacy Operations

Change Healthcare Cyberattack Impact on MHS Pharmacy Operations. Read the statement to learn more. 

Surveillance Snapshot: Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021

Image of Cover 4. iStock—The castor bean tick (Ixoedes ricinus). Credit: Erik Karits

Tick-borne encephalitis (TBE) is a viral infection of the central nervous system that is transmitted by the bite of infected ticks, mostly found in wooded habitats in parts of Europe and Asia.1 In Germany, the rate of 0.5 confirmed cases per 100,000 people in 2019 was the third highest of the 25 European countries reporting data on TBE.1 TBE has been of historical military significance because there are a large number of U.S. service members stationed in Germany, with an estimate of about 35,000 active duty members as of September 2021.2 In the Department of Defense (DOD) reportable medical event guidelines, TBE is a notifiable event listed under arboviral diseases.3

In August 2021, the U.S. Food and Drug Administration (FDA) approved a TBE vaccine (“TICOVAC”) for U.S. travelers visiting or living in endemic areas.4 In February 2022, the U.S. Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend Pfizer’s TICOVAC vaccine for use in U.S. populations who travel or move to endemic areas and will have extensive exposure to ticks based on their planned outdoor activities, including many service members serving in these locations.5

A 2019 MSMR report described the cases of TBE occurring among U.S. military service members and other beneficiaries between 2006 and 2018.6 This snapshot updates these results through the end of 2021 using confirmed and probable medical event reports of TBE cases contained in the U.S. military’s Disease Reporting System internet, with a focus on the past 10-year surveillance period.

The reported TBE cases between 2012 and 2018 have been previously described,6 consisting of 1 active component service member in 2012, 4 in 2017, and 3 other beneficiaries in 2018 (Figure). In 2019, there was 1 probable case reported in a 45 year-old male Army active component service member, and in 2020 there was 1 confirmed case in a 38 year-old male Army active component service member. In 2021, there were 2 cases reported: 1 probable case in a 6 year-old female Army dependent, and 1 probable case in a 34 year-old Army active component service member. All cases reported between 2019 and 2021 occurred in Germany in the months of June and July. Case comments were available for 2 of the 4 cases; both indicated that tick exposure likely occurred from living or exercising in a wooded area. None of the cases had a prior history of TBE vaccination.

The number of TBE cases per 5-year period among military health system beneficiaries grew from 1 in 2012–2016 to 11 in 2017–2021. Although the total number of cases is small, the increase in recent years provides information that should be considered when contemplating use of the FDA-approved vaccine for U.S. service members and beneficiaries who live or participate in extensive outdoor activities in a TBE-endemic area.

References

1. European Centre for Disease Prevention and Control. Tick-borne Encephalitis – Annual Epidemiologic report for 2019. Accessed 1 April 2022. https://www.ecdc.europa.eu/en/publications-data/tick-borne-encephalitis-annual-epidemiological-report-2019

2. Defense Manpower Data Center. Number of Military and DoD Appropriated Fund (APF) Civilian Personnel Permanently Assigned By Duty Location and Service/Component. September 30, 2021. Accessed 24 March 2022. https://dwp.dmdc.osd.mil/dwp/app/dod-data-reports/workforce-reports

3. Armed Forces Health Surveillance Branch. Armed Forces Reportable Medical Events, Guidelines and Case Definitions. January 2020. Accessed 2 April 2022. https://health.mil/Reference-Center/Publications/2020/01/01/Armed-Forces-Reportable-Medical-Events-Guidelines

4. Pfizer Press Release. U.S. FDA Approves TICOVAC, Pfizer’s Tick-Borne Encephalitis (TBE) Vaccine. 13 August 2021. Accessed 1 April 2022. https://www.pfizer.com/news/press-release/press-release-detail/us-fda-approves-ticovactm-pfizers-tick-borne-encephalitis

5. Pfizer Press Release. CDC Advisory Committee on Immunization Practices Votes to Recommend TICOVAC, Pfizer’s Tick-Borne Encephalitis (TBE) Vaccine, For Those at Risk of Virus Exposure. 23 February 2022. Accessed 1 April 2022. https://www.pfizer.com/news/press-release/press-release-detail/cdc-advisory-committee-immunization-practices-votes

6. Mancuso JD, Bazaco S, Stahlman S, Clausen SS, Cost AA. Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006–2018. MSMR. 2019;26(11):4–10.

FIGURE. Confirmed or probable TBE cases among U.S. military service members and other beneficiaries, 2012–2021

 

 

You also may be interested in...

Article
Apr 1, 2019

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

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 ...

Article
Apr 1, 2019

Update: Heat Illness, Active Component, U.S. Armed Forces, 2018

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

In 2018, there were 578 incident diagnoses of heat stroke and 2,214 incident diagnoses of heat exhaustion among active component service members. The overall crude incidence rates of heat stroke and heat exhaustion diagnoses were 0.45 cases and 1.71 cases per 1,000 person-years, respectively. In 2018, subgroup-specific rates of incident heat stroke ...

Article
Apr 1, 2019

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

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 ...

Article
Apr 1, 2019

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

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 ...

Article
Apr 1, 2019

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

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, ...

Article
Mar 1, 2019

Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2010–2018

Anopheles merus

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2010–2018. Infections with chlamydia were the most common, followed in decreasing order of frequency by infections with genital human papillomavirus (HPV), gonorrhea, genital herpes ...

Article
Mar 1, 2019

Brief Report: Male Infertility, Active Component, U.S. Armed Forces, 2013–2017

Sperm is the male reproductive cell  Photo: iStock

Infertility, defined as the inability to achieve a successful pregnancy after 1 year or more of unprotected sexual intercourse or therapeutic donor insemination, affects approximately 15% of all couples. Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male. A male factor contributes in part ...

Article
Mar 1, 2019

Vasectomy and Vasectomy Reversals, Active Component, U.S. Armed Forces, 2000–2017

Sperm is the male reproductive cell  Photo: iStock

During 2000–2017, a total of 170,878 active component service members underwent a first-occurring vasectomy, for a crude overall incidence rate of 8.6 cases per 1,000 person-years (p-yrs). Among the men who underwent incident vasectomy, 2.2% had another vasectomy performed during the surveillance period. Compared to their respective counterparts, the ...

Article
Mar 1, 2019

Testosterone Replacement Therapy Use Among Active Component Service Men, 2017

Image of Marines carrying a wooden log for physical fitness. Click to open a larger version of the image.

This analysis summarizes the prevalence of testosterone replacement therapy (TRT) during 2017 among active component service men by demographic and military characteristics. This analysis also determines the percentage of those receiving TRT in 2017 who had an indication for receiving TRT using the 2018 American Urological Association (AUA) clinical ...

Article
Feb 1, 2019

Update: Malaria, U.S. Armed Forces, 2018

Anopheles merus

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 2018, a total of 58 service members were diagnosed with or reported to have malaria. This represents a 65.7% increase from ...

Article
Feb 1, 2019

Re-evaluation of the MSMR Case Definition for Incident Cases of Malaria

Anopheles merus

The MSMR has been publishing the results of surveillance studies of malaria since 1995. The standard MSMR case definition uses Medical Event Reports and records of hospitalizations in counting cases of malaria. This report summarizes the performance of the standard MSMR case definition in estimating incident cases of malaria from 2015 through 2017. ...

Article
Feb 1, 2019

Outbreak of Acute Respiratory Illness Associated with Adenovirus Type 4 at the U.S. Naval Academy, 2016

Malaria case definition

Human adenoviruses (HAdVs) are known to cause respiratory illness outbreaks at basic military training (BMT) sites. HAdV type-4 and -7 vaccines are routinely administered at enlisted BMT sites, but not at military academies. During Aug.–Sept. 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory ...

Article
Feb 1, 2019

Update: Incidence of Glaucoma Diagnoses, Active Component, U.S. Armed Forces, 2013–2017

Glaucoma

Glaucoma is an eye disease that involves progressive optic nerve damage and vision loss, leading to blindness if undetected or untreated. This report describes an analysis using the Defense Medical Surveillance System to identify all active component service members with an incident diagnosis of glaucoma during the period between 2013 and 2017. The ...

Article
Dec 1, 2018

Adrenal Gland Disorders, Active Component, U.S. Armed Forces, 2002–2017

During 2002–2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). ...

Article
Dec 1, 2018

Incidence and Prevalence of the Metabolic Syndrome Using ICD-9 and ICD-10 Diagnostic Codes, Active Component, U.S. Armed Forces, 2002–2017

This report uses ICD-9 and ICD-10 codes (277.7 and E88.81, respectively) for the metabolic syndrome (MetS) to summarize trends in the incidence and prevalence of this condition among active component members of the U.S. Armed Forces between 2002 and 2017. During this period, the crude overall incidence rate of MetS was 7.5 cases per 100,000 person ...

Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery