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Medical Surveillance Monthly Report

thumbnail image of several MSMRsThe Medical Surveillance Monthly Report (MSMR), a peer-reviewed journal launched in 1995, is the AFHSB's flagship publication. The MSMR provides monthly evidence-based estimates of the incidence, distribution, impact, and trends of health-related conditions among service members. Additionally, the MSMR focuses one issue per year on the absolute and relative morbidity burden attributable to various illnesses and injuries among service members and beneficiaries. You may request an electronic subscription online or via email

Would you like to be published in the MSMRAuthors are welcome to submit their manuscripts to the MSMR. >>See Instructions for Authors

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Download the MSMR

Here, you can download the current and past issues of the MSMR. Inquiries regarding content or material to be considered for publication should be directed to the MSMR Editor.

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Citing the MSMR

When citing MSMR articles, please use the following formats:

Author Names Listed with the Article

Collier DA, Bayles MK, Barrett, JP. Acute gastroenteritis outbreak at the Armed Forces Retirement Home, Washington, DC, January 2011. MSMR. 2011;18(6):11-14.

No Author Name Listed (April 2007 to current)

Armed Forces Health Surveillance Branch. Mental disorders and mental health problems, active component, U.S. Armed Forces, January 2000 – December 2009. MSMR. 2010;17(11):6-13.

No Author Name Listed (Before April 2007)

Army Medical Surveillance Activity. Overhydration and hyponatremia among active duty soldiers, 1997-1999. MSMR. 2000;6(3):9-11.


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Testosterone Replacement Therapy

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3/20/2019
Testosterone Replacement Therapy

With the increasing number of testosterone deficiency diagnoses and potential health risks associated with initiation of TRT, it is important to understand the epidemiology of which U.S. service men are receiving TRT and whether these individuals have an indication for receiving treatment.

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Vasectomy

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3/20/2019
Vasectomy

There are few published studies of vasectomy and vasectomy reversal among the U.S. military population. To address these gaps, the current analysis describes the overall and annual incidence rates of vasectomy among active component service men during 2000–2017 by demographic and military characteristics and by type of surgical vas isolation procedure used. In addition, the median age at incident vasectomy and the time between incident vasectomy and first vasectomy reversal are described.

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Male Infertility

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3/20/2019
Male Infertility

The current report updates and expands on the findings of the previous MSMR analysis of infertility among active component service men. Specifically, the current report summarizes the frequencies, rates, temporal trends, types of infertility, and demographic and military characteristics of infertility among active component service men during 2013–2017.

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Malaria

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3/1/2019
Malaria

Since 1999, the Medical Surveillance Monthly Report has published regular updates on the incidence of malaria among U.S. service members. The MSMR’s focus on malaria reflects both historical lessons learned about this mosquito-borne disease and the continuing threat that it poses to military operations and service members’ health.

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Adenovirus

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3/1/2019
Adenovirus

During August–September 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak.

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Glaucoma

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3/1/2019
Glaucoma

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.

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

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3/1/2019
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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 overall rates of vasectomy were highest among service men aged 30–39 years, non-Hispanic whites, married men, and those in pilot/air crew occupations. Male Air Force members had the highest overall incidence of vasectomy and men in the Marine Corps, the lowest. Crude annual vasectomy rates among service men increased slightly between 2000 and 2017. The largest increases in rates over the 18-year period occurred among service men aged 35–49 years and among men working as pilots/air crew. Among those who underwent vasectomy, 1.8% also had at least 1 vasectomy reversal during the surveillance period. The likelihood of vasectomy reversal decreased with advancing age. Non-Hispanic black and Hispanic service men were more likely than those of other race/ethnicity groups to undergo vasectomy reversals.

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

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3/1/2019
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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 or whole to about 50% of cases of infertility. However, determining the true prevalence of male infertility remains elusive, as most estimates are derived from couples seeking assistive reproductive technology in tertiary care or referral centers, population-based surveys, or high-risk occupational cohorts, all of which are likely to underestimate the prevalence of the condition in the general U.S. population.

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Testosterone Replacement Therapy Use Among Active Component Service Men, 2017

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3/1/2019
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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 practice guidelines. In 2017, 5,093 of 1,076,633 active component service men filled a prescription for TRT, for a period prevalence of 4.7 per 1,000 male service members. After adjustment for covariates, the prevalence of TRT use remained highest among Army members, senior enlisted members, warrant officers, non-Hispanic whites, American Indians/Alaska Natives, those in combat arms occupations, healthcare workers, those who were married, and those with other/unknown marital status. Among active component male service members who received TRT in 2017, only 44.5% met the 2018 AUA clinical practice guidelines for receiving TRT.

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

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3/1/2019
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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 simplex virus (HSV), and syphilis. Compared to men, women had higher rates of all STIs except for syphilis. In general, compared to their respective counterparts, younger service members, non-Hispanic blacks, soldiers, and enlisted members had higher incidence rates of STIs. During the latter half of the surveillance period, the incidence of chlamydia and gonorrhea increased among both male and female service members. Rates of syphilis increased for male service members but remained relatively stable among female service members. In contrast, the incidence of genital HPV and HSV decreased among both male and female service members. Similarities to and differences from the findings of the last MSMR update on STIs are discussed.

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

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2/1/2019
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 analysis identified 37,718 incident cases of glaucoma and an overall incidence rate of 5.9 cases per 1,000 person-years (p-yrs). The majority of cases (97.6%) were diagnosed at an early stage as borderline glaucoma; of these borderline cases, 2.2% progressed to open-angle glaucoma during the study period. No incident cases of absolute glaucoma, or total blindness, were identified. Rates of glaucoma were higher among non-Hispanic black (11.0 per 1,000 p-yrs), Asian/Pacific Islander (9.5), and Hispanic (6.9) service members, compared with non-Hispanic white (4.0) service members. Rates among female service members (6.6 per 1,000 p-yrs) were higher than those among male service members (5.8). Between 2013 and 2017, incidence rates of glaucoma diagnoses increased by 75.4% among all service members.

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

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2/1/2019
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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 August–September 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak. During 22 August–11 September 2016, 652 clinic visits for ARI were identified using electronic health records. HAdV-4 was confirmed by real-time polymerase chain reaction assay in 18 out of 33 patient specimens collected and 1 additional HAdV case was detected from hospital records. Two HAdV-4 positive patients were treated for pneumonia including 1 hospitalized patient. Molecular analysis of 4 HAdV-4 isolates identified genome type 4a1, which is considered vaccine-preventable. Understanding the impact of HAdV in congregate settings other than enlisted BMT sites is necessary to inform discussions regarding future HAdV vaccine strategy.

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

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2/1/2019
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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 the 35 cases identi­fied in 2017. The relatively low numbers of cases during 2012–2018 mainly reflect decreases in cases acquired in Afghanistan, a reduction due largely to the progressive withdrawal of U.S. forces from that country. The percentage of cases of malaria caused by unspecified agents (63.8%; n=37) in 2018 was the highest during any given year of the surveillance period. The percent­age of cases identified as having been caused by Plasmodium vivax (10.3%; n=6) in 2018 was the lowest observed during the 10-year surveillance period. The percentage of malaria cases attributed to P. falciparum (25.9 %) in 2018 was similar to that observed in 2017 (25.7%), although the number of cases increased. Malaria was diagnosed at or reported from 31 different medical facilities in the U.S., Afghanistan, Italy, Germany, Djibouti, and Korea. Pro­viders of medical care to military members should be knowledgeable of and vigilant for clinical manifestations of malaria outside of endemic areas.

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

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2/1/2019
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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. Also explored was the potential surveillance value of including outpatient encounters with diagnoses of malaria or positive laboratory tests for malaria in the case definition. The study corroborated the relative accuracy of the MSMR case definition in estimating malaria incidence and provided the basis for updating the case definition in 2019 to include positive laboratory tests for malaria antigen within 30 days of an outpatient diagnosis.

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Non-alcoholic fatty liver disease

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1/29/2019
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At the time of this report, there were no published studies of non-alcoholic fatty liver disease (NAFLD) incidence over time among active component U.S. military personnel. Examining the incidence rates of NAFLD and their temporal trends among active component U.S. military members can provide insights into the future burden of NAFLD on the MHS.

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