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Armed Forces Health Surveillance Branch

Health Surveillance, Analysis and Insight for Action

Armed Forces Health Surveillance Branch is the central epidemiology health resource for the US Military and Public Health

The Armed Forces Health Surveillance Branch (AFHSB) is the central epidemiologic resource for the U.S. Armed Forces, conducting medical surveillance to protect those who serve our nation in uniform and allies who are critical to our national security interests. Explore our website to learn about the critical role AFHSB plays in force health protection.

AFHSB provides timely, relevant, actionable and comprehensive health surveillance information to promote, maintain, and enhance the health of military and military-associated populations.

AFHSB critical functions are:

  • Acquire, analyze, interpret, disseminate information, and recommend evidence-based policy
  • Develop, refine, and improve standardized health surveillance methods
  • Serve as the focal point for sharing health surveillance products expertise and information
  • Coordinate a global program of military-relevant infectious disease surveillance

Explore our health surveillance resources to learn how to utilize our data applications, systems and the ways our health information analysis supports worldwide disease surveillance and public health activities to improve the U.S. military's Force Health Protection (FHP) program.

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Medical Surveillance Monthly Report

Medical Surveillance Monthly Report MSMR Online SubscriptionThe Medical Surveillance Monthly Report (MSMR) is AFHSB's flagship publication. The monthly peer-reviewed journal provides 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.

 View Current Report  View Archived Reports

Health Surveillance Explorer

The Health Surveillance Explorer (HSE) is a dynamic CAC-enabled mapping application that allows the Geo­graphic Combatant Commands (GCCs) to identify global health threats and disease outbreaks in near-real time. It provides timely, relevant and actionable health surveillance information to military leaders around the globe. The HSE makes it more efficient and effective to assemble surveillance data.

Launch HSE

Proposal Management Information System

Launch Proposal Management Information SystemThe Proposal Management Information System (ProMIS) program is a web-based application used to facilitate program management at the AFHSB's Global Emerging Infections Surveillance (GEIS) section. Investigators in the GEIS partner network submit proposals for funding consideration and GEIS operations staff monitors the progress of those projects.

Go to ProMIS

Defense Medical Epidemiology Database

DMED ButtonThe Defense Medical Epidemiology Database (DMED) provides worldwide access to de-identified data contained in the Defense Medical Surveillance System (DMSS). Through this user-friendly interface, authorized users can create customized queries of disease and injury rates in active duty populations.

Go to DMED

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Mid-season influenza vaccine effectiveness estimates for the 2016 – 2017 influenza season

Infographic
8/28/2017
The Department of Defense (DoD) conducts year-round influenza surveillance for military healthcare beneficiaries and select civilian populations. Data from routine respiratory surveillance are used to estimate mid-season influenza vaccine effectiveness (VE) and these findings are shared at the Food and Drug Administration’s advisory committee meeting on U.S. influenza vaccine strain selection. DoD VE estimates from the Defense Health Agency’s Armed Forces Health Surveillance Branch (AFHSB) and Naval Health Research Center (NHRC) are presented in this report. Findings •	For all influenza types: VE was 42% as found by AFHSB-Air Force Satellite Cell, similar to NHRC’s overall VE of 45% •	Influenza A (H3N2) VE was 42% by AFHSB-AF estimation and VE was 46% as estimated by NHRC •	VE for Influenza B was slightly higher at 53% as estimated by AFHSB-AF •	AFHSB analysis found that VE against influenza A was 3% and VE against influenza A (H3N2) was 33% Table showing the mid-season influenza effectiveness estimates, 2016 –2017 displays. The mid-season influenza VE estimates indicated that vaccination reduced the odds of medically attended influenza infection by approximately 45% among DoD dependents and civilians. Access the full report in MSMR Vol. 24 No. 8 August 2017 at Health.mil/MSMR  Three photos display on this infographic: 1.	An elderly woman receiving a flu show from a female service member 2.	Female service member receives a flu shot 3.	Male physician hold a flu shot

This infographic documents Department of Defense mid-season influenza vaccine effectiveness estimates from the Defense Health Agency’s Armed Forces Health Surveillance Branch and Naval Health Research Center for the 2016 – 2017 influenza season.

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Armed Forces Health Surveillance Branch | Influenza Summary and Reports

Tdap vaccination coverage during pregnancy, active component service women, 2006 – 2014

Infographic
8/14/2017
Pertussis, commonly known as “whooping cough,” is a vaccine-preventable illness more common and more severe in children than in adults. Infections during the first few months of life can be particularly severe, with almost all deaths from pertussis occurring in infants less than 6 months of age. A vaccinated mother’s antibodies against pertussis protect the baby during pregnancy until it can receive the vaccine at two months of age. Approximately 400 probable and 50 confirmed cases occur annually among service members and other adult beneficiaries of the Military Health System. In 2012, the Advisory Committee on Immunization Practices recommended Tdap for every pregnancy to reduce the burden of pertussis in infants. This surveillance study assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014. FINDINGS: •	There were records of a total of 137,133 live birth deliveries to service women •	Only 1%  – 3% of service women received a Tdap vaccine during pregnancy from 2006  – 2011 •	Tdap vaccination coverage increased substantially  – 8% in 2012 to 54% in 2014 •	Navy women had the highest  annual proportion of vaccine coverage at 65% in 2014 •	First deliveries had the highest vaccination coverage at 57% in 2014 •	Fourth or subsequent deliveries had the lowest coverage at 41% in 2014 More education and attention by military physicians and pregnant service women about the benefits of Tdap vaccination are needed to bring coverage closer to 100%. Learn more in MSMR Vol. 22 No. 5 May 2015 at Health.mil/MSMR  Images on graphic: •	Baby icon to depict live birth deliveries •	Pie charts showing the findings in visual form •	Line graph showing the percent vaccinated among Navy, Marine Corps, Army, Air Force and Coast Guard The line graph shows the annual percentages of active component service women with a live birth delivery who received a Tdap vaccine during pregnancy, by year of delivery and service, 2011– 2014.

This infographic documents findings from a surveillance study that assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014.

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Armed Forces Health Surveillance Branch | Tetanus-Diphtheria-Pertussis | Women's Health

Surveillance Snapshot Norovirus Outbreaks among Military Forces, 2008 – 2016

Infographic
8/8/2017
Norovirus (NoV) is a highly contagious virus and a leading cause of gastroenteritis among military populations. There are many different strains of norovirus and immunity to one strain does not protect against another. Why Norovirus Strains Are Leading Causes of Acute Gastrointestinal Illness Outbreaks •	Multiple transmission routes include person-to-person direct contact, contaminated food and water, clothes or utensils that carry infection  •	Resistant to extreme temperatures and standard cleaning solutions •	No lasting immunity This report summarizes the NoV outbreaks in military forces in both garrison and deployed settings during 2008 – 2016. Table from this MSMR article displays and includes month/year of outbreak onset, setting, estimated attack rate (EAR)/ no. of NoV cases, and description. Access the report in MSMR Vol. 24 No.7 July 2017 at Health.mil/MSMR

Norovirus (NoV) is a highly contagious virus and a leading cause of gastroenteritis among military populations. There are many different strains of norovirus and immunity to one strain does not protect against another. This report summarizes the NoV outbreaks in military forces in both garrison and deployed settings during 2008 – 2016.

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Armed Forces Health Surveillance Branch

Skin and Soft Tissue Infections Active Component, U.S. Armed Forces, 2013 – 2016

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7/24/2017
Skin and soft tissue infections (SSTIs) are common in both military and non-military populations. Due to the nature of the military training environment, risk factors associated with SSTIs such as crowding, infrequent hand washing/ bathing, skin abrasions and trauma, and environmental contamination favor the acquisition and transmission of Staphylococcus spp. and Streptococcus spp. These pathogens are the major causative agents of SSTIs and lead to outbreaks of disease.

This report documents the incident cases of skin and soft tissue infections among active component U.S. military member during a 4-year surveillance period.

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Armed Forces Health Surveillance Branch

Age-Period-Cohort Analysis of Colorectal Cancer Service Members Aged 20-59 Years Active Component U.S. Armed Forces, 1997 – 2016

Infographic
7/24/2017
Among cancers affecting both men and women, colorectal cancer is the third most common cancer and the second leading cause of death from cancer in the U.S. This report documents the time-varying elements of age, period, and birth cohort effects in the epidemiology of colorectal cancer among members of the active component.

This report documents the time-varying elements of age, period, and birth cohort effects in the epidemiology of colorectal cancer among members of the active component.

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Armed Forces Health Surveillance Branch

Heat Illness Prevention: Use the Buddy System to Stay Cool and Safe

Infographic
7/20/2017
Did you know that exposure to heat and heat-related illnesses can cause a spectrum of disorders that includes minor conditions such as heat cramps to the more severe condition known as heat stroke? To protect U.S. service members, it is important for commanders, small unit leaders, training cadre, and supporting medical personnel to encourage the use of the buddy system to prevent these conditions – especially during training at recruit centers and installations. The buddy system pairs service members to stay motivated and hold each other accountable of their physical limits during training exercises. Protecting Service Members from Heat Illness •	Do not exercise when sick. Intense workouts can increase susceptibility to illness, including infection and diarrhea. •	Dump heat by taking a cold shower or ice slush immersion before a workout. •	Wear a cooling vest to keep skin cool and dry in the heat. Learn more about heat illness prevention at Health.mil/AFHSB Stay cool. Stay hydrated. Stay informed. #BeatTheHeat Source: Dr. Francis G. O’Connor, a professor and chair of Military and Emergency Medicine and associate director for the Consortium on Health and Military Performance at the Uniformed Services University of the Health Sciences.

This infographic documents the use of the buddy system to prevent heat-related illnesses.

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Armed Forces Health Surveillance Branch | Summer Safety

Preventable and Treatable: Know the Signs of Heat Exhaustion

Infographic
7/20/2017
Warmer temperatures and strenuous physical activity put service members at higher risk of heat illnesses. It is important for commanders, small unit leaders, training cadre, and supporting medical personnel – particularly at recruit training centers and installations with large combat troop populations – to educate service members about the risks early signs and symptoms, and preventive treatment measures related to heat illnesses. Signs of Dehydration •	Light-headed/ Dizzy/ Headache •	Fever •	Lack of sweat •	Dark yellow urine •	Thirst Under the signs of dehydration section an image of a man experiencing these early signs and symptoms of heat illnesses. Staying Hydrated •	Hydrate with water and eat rich foods with water before, during, and after exercise. •	Decrease the intensity of the physical activity. Under the staying hydrated section graphics of a water bottle, glass of water, runner and cyclist appear. Signs of Heat Stroke •	Fatigue •	Combative •	Confused •	Muscle cramps Under the signs of heat stroke section, a man experiencing these symptoms of heat stroke displays. Effective Ways to Cool Off a Heat Stroke Victim •	Make an “ice burrito” by wrapping the victim in cold sheets, ice packs, and wet towels •	Immerse victim in cold water Images of ice and a man under a shower appear.  Ways to Treat Heat Exhaustion •	Use a rectal thermostat to read core body temperatures to diagnose and treat heat stroke •	Provide IV fluid replacement •	Spray with cool mist Image of rectal thermostat, man in a hospital bed with an IV and a man being sprayed with cool mist appear. Learn more about heat illness by reading MSMR Vol. 24 No. 3 – March 2017 at Health.mil/MSMR Source: Dr. Francis FG. O’Connor, a professor and chair of Military and Emergency Medicine and associate director for the Consortium on Health and Military Performance at the Uniformed Services University of the Health Sciences.

This infographic documents the risks, early signs and symptoms, and preventive treatment measures related to heat illnesses.

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Armed Forces Health Surveillance Branch | Summer Safety

Exertional heat injuries pose annual threat to U.S. service members

Article
7/20/2017
Two U.S. service members perform duties in warm weather where they may be exposed to extreme heat conditions and a higher risk of heat illness.

Exertional heat injuries pose annual threat to U.S. service members, according to a study published in Defense Health Agency’s Armed Forces Health Surveillance Branch (AFHSB) peer-reviewed journal, the Medical Surveillance Monthly Report.

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Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report | Summer Safety

Incidence of Escherichia Coli Intestinal Infections Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
7/11/2017
Escherichia coli bacteria normally live in the lower intestines of healthy people and animals. Most varieties of E. coli are harmless, but certain types of E. coli are among the most frequent bacterial causes of diarrhea. This report summarizes the counts, rates, and trends of E. coli gastrointestinal infections in active component service members over the past 10 years. Findings: •	During 2007 – 2016, there were 290 incident cases of E. coli infection among active duty service members •	The overall incidence rate was 2.3 cases per 100,000 person-years (p-yrs) •	Annual incidence rates peaked at 4.7 cases per 100,000 p-yrs. in 2016 •	Cases were shown to peak during warmer months Overall rates were higher for: •	Persons aged 50 years or older •	Persons aged 25-29 years •	Females at twice the rate of males •	Non-Hispanic white service members •	Air Force members •	Service members in healthcare occupations Two graphs appear on infographic: One graph shows the annual numbers of incident cases and incidence rates of E. coli infection, active component, U.S. Armed Forces, 2007 – 2016. The second graph shows the cumulative number of incident cases of E. coli infection by calendar month, active component, U.S. Armed Forces, 2007 – 2016. Access the report in MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR

This report summarizes the counts, rates, and trends of Escherichia coli gastrointestinal infections in active component service members over the past 10 years.

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Armed Forces Health Surveillance Branch

Estimate of the Incidence of Norovirus Infections Active Component, U.S. Armed Forces, 2007 - 2016

Infographic
7/11/2017
The norovirus (NoV) is a highly infective and easily transmitted pathogen that imposes a significant public health burden across geographic regions as the causative pathogen for approximately 18% of all diarrhea cases worldwide. This report estimates the incidence of NoV diagnoses among active component service members during a 10-year surveillance period using medical record documentation of diagnoses of NoV infection and of positive laboratory tests for the virus. Findings During the 10-year surveillance period, there were 709 incident cases of NoV infection among active duty service members. •	The overall incidence rate was 5.7 cases per 100,000 person-years (p-yrs) •	Annual incidence rates ranged from a low of 2.5 cases per 100,000 p-yrs in 2008 to a high 11.2 cases per 100,000 p-yrs in 2010 •	Higher numbers of diagnosed cases were reported during November-March Graph depicting the above information displays. Overall rates were highest in: •	Female service members •	Persons Aged 24 years or younger •	Army members •	Junior enlisted •	Recruits Comparing the results of this analysis to modeled estimates of the underreported incidence of the NoV infections demonstrated the limited utility of using only medical encounter diagnoses, reportable events, and laboratory data to report on NoV incidence. Access the report in MSMR Vol. 24 No. 6 June 2017 at Health.mil/MSMR

This report estimates the incidence of norovirus diagnoses among active component service members during a 10-year surveillance period.

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Armed Forces Health Surveillance Branch

Incidence of Nontyphoidal Salmonella Intestinal Infections Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
7/11/2017
The term nontyphoidal salmonellae (NTS) refers to gram-negative bacteria of the genus Salmonella except for the specific strains S. typhi and S. paratyphi. NTS are a leading cause of foodborne illness in the U.S. and of acute gastrointestinal illness among members of the active component of the U.S. Armed Forces. This report summarizes the counts, rates, and trends of nontyphoidal Salmonella infections in active component service members during a 10-year surveillance period. Findings  •	During 2007 – 2016, there were 1,536 incident cases of nontyphoidal Salmonella infection among active duty service members •	The overall incidence rate was 12.4 cases per 100,000 person-years (p-yrs) •	In 2016, the annual incidence rates peaked at 15.9 cases p-yrs •	Cases were shown to peak during the summer months Graph displays highlighting findings above for annual numbers of incident cases and incidence rates of nontyphoidal salmonellosis, active, component, U.S. Armed Forces, 2007 – 2016.  Overall rates were higher in: •	 Females •	Persons Aged 25-29 years •	Aged 50 years or older Access the report in the MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR

This report summarizes the counts, rates, and trends of nontyphoidal Salmonella infections in active component service members during a 10-year surveillance period.

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Armed Forces Health Surveillance Branch

Viral Hepatitis A, Active Component, U.S. Armed Forces, 2007 - 2016

Infographic
6/19/2017
Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). An estimated 1.4 million cases are reported worldwide each year. HAV is highly contagious and is a concern of the U.S. military as widespread outbreaks can occur due to contaminated food or water and spread by unsanitary food and water handling practices. This report estimates the frequencies, incidence rates, trends, and correlates of risk of hepatitis A among active component service members of the U.S. military during 2007 – 2016. Findings: During the 10-year surveillance period, there were 237 incident diagnoses of acute hepatitis A. The overall incidence rate was 1.88 cases per 100,000 person-years (p-yrs.). In 2012, rates peaked at 2.94 per 100,000 p-yrs. Rates dipped to 1.41 per 100,000 p-yrs. in 2015 and increased to 2.22 per 100,000 p-yrs in 2016. The graph shows the incident cases and incidence rates of acute Hepatitis A, by gender, active component, U.S. Armed Forces, 2007 – 2016. The bars on the graph show the number of individuals diagnosed and the lines show incidence rates per 100,000 p-yrs. See on page 3 FIGURE 1. Incident cases and incidence rates of acute hepatitis A, by gender, active component, U.S. Armed Forces, 2007–2016 of the  May 2017 MSMR Vol. 24 No. 5. Key chart includes: pink bar for number of female service members, blue bar for number of male service members, solid yellow line for incidence rate, and dash line for U.S. population rate. Source: www.cdc.gov/hepatitis/statistics/2014surveillance/index.htm#tabs-1170596-1  High Risks of Hepatitis A •	Youngest age group of service members •	Service members who work in healthcare occupations •	Air Force and Navy members •	Unknown race/ethnicity and non-Hispanic black service members HAV vaccines in current use are highly effective. Learn more at Health.mil/MSMRArchives  Small figure of male is seen on graphic with a circle highlighting his liver.

This infographic documents the frequencies, incidence rates, trends, and correlates of risk of hepatitis A among active component service members of the U.S. military during 2007-2016.

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Armed Forces Health Surveillance Branch

Surveillance Snapshot: Respiratory Infections Resulting in Hospitalizations, U.S. Air Force Recruits, October 2010 – February 2017

Infographic
6/19/2017
A number of vaccine and non-vaccine interventions have been used to reduce the historically high burden of respiratory infections during military training. This snapshot displays the trend in hospitalizations for respiratory infections, stratified by major pathogens, and associated hospital days for all recruits in U.S. Air Force Basic Military Training at Joint Base San Antonio Lackland, TX. Preventive measures: •	Hand Hygiene •	“Head-to-toe” sleeping arrangements •	Liberal use of respiratory face masks •	Isolation of febrile trainees •	Stringent gas mask cleaning protocol •	Universal provision of seasonal influenza vaccine during non-summer months Interventions: •	Year-round adenovirus vaccine (Ad4 and Ad7) was reintroduced November 2011 •	Group A streptococcus chemoprophylaxis transitioned from oral penicillin to intramuscular benzathine penicillin January 2012 Surveillance Findings: •	No recruits have been hospitalized due to adenovirus or group A streptococcus since the respective interventions were implemented. •	The adenovirus vaccine and benzathine penicillin chemoprophylaxis decrease the likelihood of severe respiratory disease outbreaks •	Downward trend in respiratory infection hospitalizations Bar graph shows the number of hospitalized for respiratory infection  per 1 million training days as well as lost training days per 1 million training days (line graph) from October 2010 to February 2017. Color coding on chart: •	Orange for Adenovirus •	Gray is for Group A streptococcus •	Yellow is for Influenza •	Blue is for Other/ Unknown •	Red is for Lost Training Days Learn more at Health.mil/MSMR where you can find the surveillance snap shot from MSMR Vol. 24 No. 4 – May 2017. In background of infographic can see human body highlight the respiratory system.

This infographic displays the trend in hospitalizations for respiratory infections, stratified by major pathogens, and associated hospital days for all recruits in U.S. Air Force Basic Military Training at Joint Base San Antonio Lackland, TX.

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Armed Forces Health Surveillance Branch

Risk Factors for Tinea Pedis Infections (Athlete’s Foot) among U.S. Armed Forces

Infographic
6/19/2017
Athlete’s foot is a chronic fungal infection of the feet and toes that is common among military service members. Risk factors for infection include: •	High-intensity training •	Heavy sweating •	Protracted shoe/boot wearing •	Less frequent sock changes During field training exercises or deployment, service members may be exposed to additional risk factors for athlete’s foot including hot and humid ambient weather, poor skin hygiene, and close-quarter living. The condition’s most common clinical presentation is infection in the space between the toes. If left untreated this pattern of infection may cause… •	Softening and breaking down of skin resulting from prolonged exposure to moisture (maceration) •	Reddening of skin caused by congestion of the capillaries in the lower layers of the skin (erythema) •	Fissures of the skin These changes in the skin increase the risk of cellulitis, a serious bacterial infection of the skin capable of spreading to other parts of the body. Read this brief report “Tinea Pedis, Active Component, U.S. Armed Forces, 2000 – 2016,” which summarizes the impact of the condition among U.S. active component service members. Access the report in MSMR Vol. 24 No. 5 – May 2017 at Health.mil/MSMR.  Background graphic of the infographic is a pair of feet diagnosed with athlete’s foot but instead of showing breakage of skin we see the leg and foot of a military service member walking through water.

This infographic documents the risk factors for tinea pedis infections (athlete’s foot).

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Armed Forces Health Surveillance Branch

Tinea Pedis (Athlete’s Foot) U.S. Armed Forces, 2000-2016

Infographic
6/19/2017
Athlete’s foot is a common problem among military service members. Known by the medical term, Tinea Pedis, the condition causes a chronic fungal infection of the feet and toes. It is the most common dermatophyte infection among adults. Up to 25% of the global population is affected by tinea pedis at any given time. Findings: During the 17-year surveillance period there were a total of 193,432 medical encounters for tinea pedis. Of these total encounters, 91% were ambulatory visits. Of 459 hospitalization records that contained diagnoses of athlete’s foot during the surveillance period, a total of 275 (59.9%) had a primary diagnosis of cellulitis or abscess of the foot or leg during the incident tinea pedis hospitalization. Where this information displays two feet are seen. The pie chart shows in an orange pie slice the 59.9% or 275 military service members that had a primary diagnosis of cellulitis or abscess of the foot or leg during the incident tinea pedis hospitalization. The rest of the pie chart shows in purple the 184 other hospitalization records. Background of the pie chart shows a foot.  High Risks for tinea pedis infections: •	Males – overall incident rate 17.4% higher than females •	Service members younger than 20 years of age •	Black, non-Hispanic and Hispanic service members •	Junior enlisted service members Given these costs, prevention efforts such as training and education about foot and skin health warrant continual emphasis, especially during initial entry training and in preparation for field exercises and deployments to warm locations. Learn more at Health.mil/MSMR Top of image shows foot with tinea pedis (athlete’s foot).

This infographic summarizes the counts, rates, trends and demographic characteristics of diagnoses of tinea pedis among U.S. active component service members during 2000 -2016.

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Armed Forces Health Surveillance Branch
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