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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

Launch Proposal Management Information SystemThe Proposal Management Information Solution (ProMIS) program is a web-based application used to track surveillance projects funded by AFHSB's Global Emerging Infections Surveillance (GEIS) Operations section. Investigators in the GEIS partner network submit proposals for funding through the system, and GEIS Operations monitors the progress of those projects.

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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.

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Armed Forces Reportable Medical Events Guidelines and Case Definitions

Publication
7/17/2017

A reportable event may represent an inherent, significant threat to public health and military operation. These events have the potential to affect large numbers of people, to be widely transmitted within a population, to have severe/life threatening clinical manifestations, and to disrupt military training and deployment. Timely, accurate reporting ...

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Armed Forces Reportable Medical Events Guidelines and Case Definitions Memo

Policy

The Armed Forces Reportable Medical Events Guidelines and Case Definitions (RME Guidelines) standardize reporting and tracking of disease and other conditions of public health and military importance. Timely reporting permits earlier recognition of public health events and interventions to protect the health of the force.

Zika in the Americas: July 12, 2017

Report
7/12/2017

This is a biosurveillance summary of Zika in the Americas as of July 12, 2017. As of 1300 on 12 JUL 2017, there have been 175 (+1) confirmed Zika virus (ZIKV) disease cases (see table) since the first case was reported in JAN 2016.

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

Infographic
7/11/2017
Campylobacter species, predominantly C. jejuni, are now among the leading causes of bacterial infections of the intestines in the U.S. and around the world. Infections cause fever, diarrhea, and abdominal pain. The bacterium is acquired by ingesting contaminated food or water. Among active component service members, Campylobacter infections have steadily increased since 2007 as noted in this report of the incidence of diagnoses during a 10-year surveillance period. Findings During the 10-year surveillance period, there were 1,753 diagnosed cases of Campylobacter intestinal infection among active component service members. The overall incidence rate was 14.1 cases per 100,000 person-years (p-yrs). Annual incidence rates steadily increased from 7.6 per 100,000 p-yrs in 2007 to 22.1 cases per 100,000 p-yrs. in 2016. More cases were diagnosed in the warmer months of the year. Overall Rates Were Higher In •	Females •	Persons aged 45 years or older •	Air Force and Army members •	Officers and those in military healthcare occupations Annual numbers of incident cases (bar graph) and incidence rates (line graph) of ’Campylobacter infection, active component, U.S. Armed Forces, 2007 – 2016’ is displayed. Second bar graph titled ‘Cumulative numbers of incident cases of Campylobacter infection, by calendar month, active component, U.S. Armed Forces, 2007 -2016’ displays. Access the report in MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR Background of infographic shows intestines.

This infographic documents the incidence of diagnoses for Campylobacter Intestinal Infections among active component service members.

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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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Most frequent diagnoses: Hospitalizations, Males, Active Component, U.S. Armed Forces

Infographic
7/11/2017
Did you know…? In 2016, alcohol dependence (n= 1,656) was the second most frequent diagnosis among males discharged from the hospital. The most frequent diagnosis was adjustment disorder (n=3,768). The third most frequent diagnosis was major depressive disorder [single episode, unspecified] (n= 1,308), followed by acute appendicitis (n=1,091) and post-traumatic stress disorder (PTSD) (n=832). Two charts display on infographic: First chart is the ‘Most frequent diagnoses during hospitalizations, males, active component, U.S. Armed Forces 2016. Information below: Mental disorders (ICD-10: F01-F99) – 12,571 •	Adjustment disorders: 3,768 / 30.0 % of all hospitalizations of males •	Alcohol dependence: 1,656 / 12.2 % of all hospitalizations of males •	Major depressive disorder, single episode, unspecified: 1,308 / 10.4% •	Post-traumatic stress disorder (PTSD): 832/ 6.6% •	Major depressive disorder, recurrent severe without psychotic features: 638/ 5.1% Second chart is the ‘Most frequent diagnoses during ambulatory visits for diagnoses of mental disorders, males, active component, U.S. Armed Forces, 2016 Mental disorders (ICD-10: F01-F99) 1,452,655 •	Adjustment disorder: 282,610 / 19.5% of all ambulatory visits for males •	Post-traumatic stress disorder (PTSD): 238,061/16.4% of all ambulatory visits for males •	Alcohol dependence: 219,260/ 15.1% of all ambulatory visits for males •	Anxiety disorder, unspecified: 98,861/ 6.8%  of all ambulatory visits for males •	Alcohol abuse: 69,581 / 4.8% all ambulatory visits for males Learn more about healthcare burdens attributable to various diseases and injuries by reading April 2017 – Volume 24/4 of the Medical Surveillance Monthly Report (MSMR) at Health.mil/MSMRArchives. #MensHealth Graphic shows soldier’s commitment to sobriety.

This infographic documents alcohol dependence hospitalizations and ambulatory visits among males, active component, U.S. Armed Forces in 2016.

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Incidence of Shigella Intestinal Infections Active Component

Infographic
7/11/2017
This report summarizes the counts, rates, and trends of Shigella infections in active component service members over the past 10 years. Findings •	During 2007 – 2016, there were 428 incident cases of Shigella infection among active duty service members. •	The overall incidence rate 3.4 cases per 100,000 person-years (p-yrs) •	 In 2015, the annual incidence rate peaked at 6.4 cases per 100,000 p-yrs – twice the rate in 2014 •	This peak was followed by a decrease to 3.4 cases per 100,000 p-yrs in 2016 Overall rates were highest in: •	Females •	Non-Hispanic black service member •	Persons aged 35-29 years •	Army members •	Service members in military healthcare occupations Diarrhea caused by bacteria of the Shigella genus is a major cause of morbidity and mortality worldwide. Shigella organisms can survive passage through the stomach because they are more resistant to acid than other bacteria. Shigella transmission can occur directly via person-to-person contact or indirectly through contaminated food, water or fomites (e.g., clothing bedding). The increasing antimicrobial resistance of Shigella species is a major problem in the treatment of Shigella gastroenteritis both in the United States and globally. Frequent and thorough hand washing with soap and water is an effective way to stop the spread of this and other enteric pathogens. Access the report in MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR Graphic features images of Shigella bacteria, human stomach, Earth, and hands. Additional images are clothing, contaminated food and water as common sources for Shigella transmission.

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

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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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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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H7N9: July 6, 2017

Report
7/6/2017

This is a biosurveillance summary of Avian Influenza A (H7N9) Surveillance #77: July 6, 2017, as reported by the Armed Forces Health Surveillance Branch. As of 6 JUL, the total influenza A (H7N9) human case count since the fifth seasonal epidemic of H7N9 began on 1 OCT 2016 is 919 (+13) cases with at least 269 deaths. Read more:

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H7N9: June 21, 2017

Report
6/21/2017

This is a biosurveillance summary of Avian Influenza A (H7N9) Surveillance #77: June 21, 2017, as reported by the Armed Forces Health Surveillance Branch. As of 21 JUN, the total influenza A (H7N9) human case count since the fifth seasonal epidemic of H7N9 began on 1 OCT 2016 is 906 (+17) cases with at least 269 (+30) deaths. Read more:

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Viral Hepatitis C, U.S. Military Service Members and Beneficiaries, 2008 – 2016

Infographic
6/21/2017
Findings – U.S. Armed Forces •	From 2008 to 2016, there were 342 acute and 1,491 chronic incident cases of HCV infection among active component members •	Annual incidence rates of chronic HCV infection diagnoses decreased 57.4% over the surveillance period •	92% of service members diagnosed with acute HCV infection were subsequently diagnosed with chronic HCV •	Rates of diagnoses of acute HCV infection remained relatively stable during the nine-year surveillance period. Service members at risk of acute HCV infection •	Aged 19 years or younger and enlisted •	Served in the Navy and Army for 2 years or less •	Had never been deployed Service members at risk of chronic HCV infection •	Aged 40 years or older and enlisted •	Served in the Army and Navy for  less than 2 years Findings – MHS non-service member beneficiaries •	There were 2,541 acute and 21,418 chronic HCV cases among non-service member beneficiaries •	Annual numbers of incident diagnoses of both acute and chronic HCV infections decreased 76.9% and 21.3%, respectively during the surveillance period. Non-service member beneficiaries at risk of chronic HCV infection •	Other race/ethnicity groups •	Born before 1965 U.S. Armed Forces bar graph shows annual numbers of incident cases and annual incidence rates of acute and chronic HCV infections for 2008-2016 and incidence rate per 100,000 p=yrs (lines).  Second bar graph is the count of HCV cases among MHS beneficiaries, by HCV infection type, 2008-2016 , showing  number of cases for total no. chronic and total no. acute. Access the report in MSMR Vol. 24 No. 5 – May 2017 at Health.mil/MSMR  On graphic is an image of a man’s Silhouette with his liver highlighted.

This infographic documents numbers and incidence rates of acute and chronic HCV infections among service members and beneficiaries of the Military Health System (MHS).

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Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2016

Infographic
6/19/2017
Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

This infographic documents healthcare burdens attributable to cardiovascular diseases among active component, U.S. Armed Forces in 2016.

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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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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
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