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Shanks G.D.,Australian Army Malaria Research Institute | Brundage J.F.,Armed Forces Health Surveillance Center
Emerging Infectious Diseases | Year: 2012

Of the unexplained characteristics of the 1918-19 influenza pandemic, the extreme mortality rate among young adults (W-shaped mortality curve) is the foremost. Lack of a coherent explanation of this and other epidemiologic and clinical manifestations of the pandemic contributes to uncertainty in preparing for future pandemics. Contemporaneous records suggest that immunopathologic responses were a critical determinant of the high mortality rate among young adults and other high-risk subgroups. Historical records and findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918 (e.g., A/H3Nx 1890 pandemic strain) were likely to have dysregulated, pathologic cellular immune responses to infections with the A/H1N1 1918 pandemic strain. The immunopathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia. The extreme mortality rate associated with the 1918-19 pandemic is unlikely to recur naturally. However, T-cell-mediated immunopathologic effects should be carefully monitored in developing and using universal influenza vaccines.

Webber B.J.,Uniformed Services University of the Health Sciences | Seguin P.G.,U.S. Air force | Burnett D.G.,Uniformed Services University of the Health Sciences | Clark L.L.,Armed Forces Health Surveillance Center | And 2 more authors.
JAMA - Journal of the American Medical Association | Year: 2012

Context: Autopsies of US service members killed in the Korean and Vietnam wars demonstrated that atherosclerotic changes in the coronary arteries can appear early in the second and third decades of life, long before ischemic heart disease becomes clinically apparent. Objective: To estimate the current prevalence of coronary and aortic atherosclerosis in the US armed forces. Design, Setting, and Participants: Cross-sectional study of all US service members who died of combat or unintentional injuries in support of Operations Enduring Freedom and Iraqi Freedom/New Dawn between October 2001 and August 2011 and whose cardiovascular autopsy reports were available at the time of data collection in January 2012. Prevalence of atherosclerosis was analyzed by various demographic characteristics and medical history. Classifications of coronary atherosclerosis severity were determined prior to data analysis and designed to provide consistency with previous military studies: minimal (fatty streaking only), moderate (10%-49% luminal narrowing of ≥1 vessel), and severe (≥50% narrowing of ≥1 vessel). Main Outcome Measures: Prevalence of coronary and aortic atherosclerosis in the US armed forces and by age, sex, self-reported race/ethnicity, education, occupation, service branch and component, military rank, body mass index at military entrance, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnoses of cardiovascular risk factors. Results: Of the 3832 service members included in the analysis, the mean age was 25.9 years (range, 18-59 years) and 98.3% were male. The prevalence of any coronary atherosclerosis was 8.5% (95% CI, 7.6%-9.4%); severe coronary atherosclerosis was present in 2.3% (95% CI, 1.8%-2.7%), moderate in 4.7% (95% CI, 4.0%-5.3%), and minimal in 1.5% (95% CI, 1.1%-1.9%). Service members with atherosclerosis were significantly older (mean [SD] age, 30.5 [8.1] years) than those without (mean [SD] age, 25.3 [5.6] years; P<.001). Comparing atherosclerosis prevalence among with those with no cardiovascular risk factor diagnoses (11.1% [95% CI, 10.1%-12.1%]), there was a greater prevalence among those with a diagnosis of dyslipidemia (50.0% [95% CI, 30.3%-69.7%]; age-adjusted prevalence ratio [PR], 2.09 [95% CI, 1.43-3.06]), hypertension (43.6% [95% CI, 27.3%-59.9%]; age-adjusted PR, 1.88 [95% CI, 1.34-2.65]), or obesity (22.3% [95% CI, 15.9%-28.7%]; age-adjusted PR, 1.47 [95% CI, 1.10-1.96]), but smoking (14.1% [95% CI, 8.0%-20.2%]) was not significantly associated with a higher prevalence of atherosclerosis (age-adjusted PR, 1.12 [95% CI, 0.73-1.74]). Conclusion Among deployed US service members who died of combat or unintentional injuries and received autopsies, the prevalence of atherosclerosis varied by age and cardiovascular risk factors. ©2012 American Medical Association. All rights reserved.

From May 19 to May 21, 2010, the Armed Forced Health Surveillance Center and the Uniformed Services University cosponsored an educational symposium and workshop on the assessment of potentially hazardous environmental exposures among military populations. Symposium participants reviewed and analyzed historical exposure events, from herbicides in Vietnam to the 1991 Gulf War oil well fires and World Trade Center dust exposure in 2001, using the framework that the Institute of Medicine developed for addressing environmental exposures and their possible impact on military populations. Historical exposures were critically assessed in terms of methods used to identify and define harmful exposures, to prevent or limit exposures, and to define the health risks to exposed people. The lessons learned were then used during small group discussions to deliberate on the current scientific approach for dealing with hazardous environmental exposures. This article summarizes the major conclusions and proceedings of the symposium and provides suggestions to improve the U.S. military's current strategy on identifying and assessing potentially hazardous environmental exposures.

Human papillomavirus (HPV) is the most common sexually transmitted infection among U.S. military members. The most frequent clinical manifestation of HPV is genital warts (GW). This investigation examined the annual incidence of diagnoses of GW among U.S. service members before and after the availability of the quadrivalent HPV (HPV4) vaccine in 2006. Incidence rates of GW diagnoses markedly declined among female service members in the HPV4 vaccine-eligible age range from 2007 (following introduction of the HPV4 vaccine) through 2010. In contrast, among women 25 years and older and men of all age groups, annual rates of GW diagnoses remained relatively low and stable from 2000 through 2010. The higher rates of diagnoses of GWs among female than male service members reflect the effects of routine periodic gynecologic screening. Slight increases in the incidence of GW diagnoses among men between 2010 and 2012 may in part reflect the repeal of the U.S. military's "Don't Ask Don't Tell" policy.

Defraites R.F.,Armed Forces Health Surveillance Center
BMC Public Health | Year: 2011

Since its establishment in February 2008, the Armed Forces Health Surveillance Center (AFHSC) has embarked on a number of initiatives and projects in collaboration with a variety of agencies in the Department of Defense (DoD), other organizations within the federal government, and non-governmental partners. In 2009, the outbreak of pandemic H1N1 influenza attracted the major focus of the center, although notable advances were accomplished in other areas of interest, such as deployment health, mental health and traumatic brain injury surveillance. © 2011 DeFraites; licensee BioMed Central Ltd.

Shanks G.D.,Australian Army Malaria Institute | Brundage J.F.,Armed Forces Health Surveillance Center
American Journal of Epidemiology | Year: 2014

Until the mid-20th century, mortality rates were often very high during measles epidemics, particularly among previously isolated populations (e.g., islanders), refugees/internees who were forcibly crowded into camps, and military recruits. Searching for insights regarding measles mortality rates, we reviewed historical records of measles epidemics on the Polynesian island of Rotuma (in 1911), in Boer War concentration camps (in 1900-1902), and in US Army mobilization camps during the First World War (in 1917-1918). Records classified measles deaths by date and clinical causes; by demographic characteristics, family relationships (for Rotuma islanders and Boer camp internees), and prior residences; and by camp (for Boer internees and US Army recruits). During the Rotuman and Boer War epidemics, measles-related mortality rates were high (up to 40%); however, mortality rates differed more than 10-fold across camps/districts, even though conditions were similar. During measles epidemics, most deaths among camp internees/military recruits were due to secondary bacterial pneumonias; in contrast, most deaths among Rotuman islanders were due to gastrointestinal complications. The clinical expressions, courses, and outcomes of measles during first-contact epidemics differ from those during camp epidemics. The degree of isolation from respiratory pathogens other than measles may significantly determine measles-related mortality risk. © The Author 2013.

Lindler L.E.,Armed Forces Health Surveillance Center
Military Medicine | Year: 2015

Military service members come in contact with a wide range of hazardous substances especially during deployment. The identification of service member’s with potential exposures to infectious diseases and environmental toxic substances has been a problem for the U.S. military almost since the formation of the services and continues to be an issue today. In June and July of 2013, the Armed Forces Health Surveillance Center sponsored two meetings to address the need by the Department of Defense to perform retrospective exposure analysis that would support military force health protection efforts. The first meeting included medical professionals who were familiar with health problems that followed potential environmental or infectious disease exposures but that the military health system was unprepared to address. The second group was composed of technical experts who were asked to suggest potential material and nonmaterial solutions to address the needs of the military public health community. This supplement to Military Medicine includes the outcome of these two meetings, descriptions of some of the Department of Defense biorepositories including the large serum repository housed at Armed Forces Health Surveillance Center and discussion of additional topics related to the establishment and use of biorepositories that would support public health practice in the 21st century. © 2015 Association of Military Surgeons of the U.S. All rights reserved.

Lindler L.E.,Armed Forces Health Surveillance Center
Military Medicine | Year: 2015

Significant advances have been made in the molecular analyses of the human physiological state. In general, these techniques have been termed “omics” because of their requirements for sophisticated analyses of large datasets. Application of these new omics technologies has led to advances in medical practice related to public health as well as a new field termed personalized medicine. The Department of Defense (DoD) consistently needs the ability to identify people who have been exposed to environmental hazards during deployments and in their day-to-day jobs. The department currently has a biorepository of sera collected from military service members and has used that repository to study potential environmental exposures (toxins and infectious diseases) since 1987. The DoD Serum Repository is also linked to service member health records, making it a very powerful tool for studies related to force health protection and public health practice. However, this repository does not contain a reliable source of nucleic acid. Accordingly, to take advantage of modern molecular omics technologies, the DoD should establish an enhanced biospecimen repository that can support future questions related to force health protection. This article briefly discusses the various omics techniques, and how they can be used for analyses to supportmedical practice and public health. © 2015 Association of Military Surgeons of the U.S. All rights reserved.

Multi-drug resistant Neisseria gonorrhoeae (GC) threatens the successful treatment of gonorrhea. This report presents preliminary findings with regard to the prevalence of laboratory-confirmed GC and the extent of drug-resistance among sample populations in five countries. Between October 2010 and January 2013, 1,694 subjects (54% male; 45% female; 1% unknown) were enrolled and screened for the presence of laboratory-confirmed GC in the United States, Djibouti, Ghana, Kenya, and Peru. Overall, 108 (6%) of enrolled subjects tested positive for GC. Antimicrobial susceptibility testing results were available for 66 GC isolates. Resistance to at least three antibiotics was observed at each overseas site. All isolates tested in Ghana (n=6) were resistant to ciprofloxacin, penicillin, and tetracycline. In Djibouti, preliminary results suggested resistance to penicillin, tetracycline, ciprofloxacin, cefepime, and ceftriaxone. The small sample size and missing data prevent comparative analysis and limit the generalizability of these preliminary findings.

News Article | March 29, 2016

Diffusion tensor imaging (DTI), a type of MRI, may be able to predict functional post-deployment outcomes for veterans who sustained mild traumatic brain injury (MTBI), or concussion, during combat, according to a new study published in the journal Radiology. MTBI is a public health problem of increasingly-recognized importance, particularly among military veterans. Recently, there has been a dramatic rise in the incidence of combat-related MTBI. More than 300,000 U.S. service members were diagnosed with MTBI between 2000 and 2015, according to the Armed Forces Health Surveillance Center. Current assessment of MTBI remains challenging due to the difficulties in establishing the diagnosis, predicting outcomes and separating the effects of MTBI from other conditions like post-traumatic stress disorder (PTSD). DTI uses measurements of water movement in the brain to detect abnormalities, particularly in white matter. Previous studies have linked DTI metrics to neurocognitive function and short-term functional outcomes in groups of patients. The desire to uncover possible long-term effects spurred Jeffrey B. Ware, M.D., from the Philadelphia VA Medical Center in Philadelphia, Pa., to evaluate combat veterans using this technique. Dr. Ware and colleagues used brain MRI and DTI to study 57 military veterans who had a clinical diagnosis of MTBI upon return from deployment. The average length of time between injury and post-deployment evaluation was 3.8 years with an average follow-up duration of 1.4 years. "All conventional MR images were interpreted as normal," Dr. Ware said. "We retrospectively analyzed the data from the DTI sequence to derive measures of white matter integrity, which we compared to clinical measures and subsequent outcome measures 6 months to 2.5 years after the initial evaluation." The results showed significant associations between initial post-deployment DTI measurements and neurobehavioral symptoms, timing of injury, and subsequent functional outcomes. The measurements also correlated with greater healthcare utilization among veterans with MTBI. Following initial post-deployment evaluation, 34 of the study participants returned to work. Veterans who did not return to work displayed significantly lower fractional anisotropy (FA) and higher diffusivity in a specific brain region, the left internal capsule. These measures imply less structural integrity in that area of the brain. As this region is known to contain important fibers providing motor stimulation to the typically dominant right side of the body, the results may provide a correlation between impairments in fine motor functioning and inability to return to work. "Our findings suggest that differences in white matter microstructure may partially account for the variance in functional outcomes among this population. In particular, loss of white matter integrity has a direct, measurable effect," Dr. Ware said. "It was illuminating to see the association between measures of white matter integrity and important outcomes occurring months to years down the road in our study population."

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