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Immunization research supports warrior care, force readiness

Navy Petty Officer 3rd Class Brett Friebel prepares a flu shot for a patient at Naval Branch Health Clinic Mayport’s immunizations clinic. (U.S. Navy photo by Jacob Sippel) Navy Petty Officer 3rd Class Brett Friebel prepares a flu shot for a patient at Naval Branch Health Clinic Mayport’s immunizations clinic. (U.S. Navy photo by Jacob Sippel)

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FALLS CHURCH, Va. — Vaccinations have played a prominent role in U.S. military history. George Washington ordered smallpox vaccine for his soldiers during the Revolutionary War. Nearly 90 percent of the deaths of soldiers during that time were caused by disease, with smallpox being one of the most prominent. It was said that more American soldiers died of smallpox than from battlefield injuries, and Washington’s plan to defeat smallpox played an important role in the ultimate victory of his army.

Vaccination remains a vital tool for U.S. forces. The Defense Health Agency’s (DHA) Immunization Healthcare Branch (IHB) is a premier, responsive, patient-centered organization that promotes excellence in immunization health care for service members and beneficiaries. IHB also supports Force Health Protection and Readiness by developing and promoting programs, services and research that enhance immunization effectiveness, safety and acceptability. With the ever-present threat of disease to service members abroad and within the U.S., providing evidence-based solutions that improve immunization health care is imperative.

“Given that the DoD mandates many vaccines as part of our force health protection and readiness requirements, we have a duty to ensure the vaccines we develop are not only safe, but also effective for our troops,” said Dr. Bruce McClenathan, regional medical director for IHB at Fort Bragg, North Carolina. “In addition, we seek to eliminate any unnecessary immunizations, as well as reducing the costs.”

 “Within the history of the DoD, research and vaccines have been critical to our military members," said Dr. Limone Collins, an allergy and immunology physician and chief of the Vaccine Safety and Evaluation Section at the IHB Headquarters in Falls Church, Virginia. “Other than clean water and sewage, vaccines have done more to improve public health - not just within the DoD - but nationally. Vaccines have played a critical role in providing protection for us.”

Although U.S. military physicians and researchers have collaborated in the development of vaccines for influenza, rubella and typhoid fever, Collins emphasized our armed forces have had a long history of involvement with vaccines against infectious diseases. “For more than 200 years, our military has been actively engaged in vaccine research, and made many contributions to the development of products for use in disease prevention and control,” he said.

During World War I, Army Surgeon General William Gorgas convened a series of commissions to gather the best civilian and military input for ongoing and recurring infectious disease problems. In 1918, a pneumonia commission was formed, and in 1941 the Army established the Board for the Investigation and Control of Influenza and Other Epidemic Diseases in the Army, which was renamed the Armed Forces Epidemiological Board (AFEB) in 1949.

IHB will continue to conduct research and provide valuable input regarding immunization effectiveness and safety to enhance force health protection and readiness. IHB researchers will ensure that vaccines are safe, effective and properly utilized to protect service members. With the advancement of research techniques, we are now able to conduct clinical studies dedicated to understanding diversity in immune responses to certain vaccines when they are delivered to large populations,” said McClenathan. “These studies hold enormous potential for improving the quality of care, and reducing the possibility of adverse events following immunization.”

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Percentages of each Service’s cold weather injuries, 2016 – 2017 cold season

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Did you know when all cold weather injuries were considered, not just the numbers of individuals affected, frostbite was the most common type of cold weather injury, comprising 53% (n=177) of all cold weather injuries among active component service members in 2016 – 2017? •	In the Air Force and Army respectively, 60.9% and 58.9% of all cold weather injuries were frostbite, whereas the proportions in the Marine Corps (42.9%) and Navy (25.0%) were much lower. •	For the Navy, the 2016-2017 number and rate of frostbite injuries in active component service members were the lowest of the past 5 years. •	The number of immersion injury cases in 2016 – 2017 in the Marine Corps was the lowest of the 5-year surveillance period. Bar graph: Percentages of each Service’s cold weather injuries that were frostbite, 2016 – 2017 cold season •	Air Force (60.9%) •	Army (58.9%) •	Marine Corps (42.9%) •	Navy (25.0%) For all active component service members during the 2016 – 2017, the proportions of non-frostbite cold weather injuries were as follows: •	19.5% hypothermia •	17.7% immersion injuries •	9.9% Other & unspecified cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

This infographic documents the percentages of each service’s cold weather injuries, U.S. Armed Forces for the 2016 – 2017 cold season.

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Cold weather injuries by military location, U.S. Armed Forces, July 2012 – June 2017

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From July 2016 through June 2017, a total of 24 military locations had at least 30 incident cold weather injuries (one per person, per year) among active and reserve component service members.  The locations with the highest 5-year counts of incident injuries were: •	Fort Wainwright, AK (175) •	Bavaria (Grafenwoehr/Vilseck), Germany (110) •	Marine Corps Recruit Depot Parris Island/ Beaufort, SC (102) •	Fort Benning, GA (99) •	Fort Carson, CO (88) •	Marine Corps Base Quantico, VA (86) •	Fort Bragg, NC (78) Map displays the information above. 2016 – 2017 cold season During the 2016 – 2017 cold season, the numbers of incident cases of cold weather injuries were higher than the counts for the previous 2015-2016 cold season at seven of the 24 locations. The most noteworthy increase was found at the Army’s Fort Wainwright, where there were 48 total cases diagnosed in 2016 – 2017 , compared to just 16 during the 2015 – 2016 cold season. Bar chart shows annual number of cold weather injuries (cold season 2016 – 2017) and median number of cold weather injuries (cold seasons 2012 – 2016) at military locations with at least 30 cold weather injuries during the surveillance period, active component, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR Image in background includes  service members out in the snow.

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2016 – 2017 Cold Season, Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces

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or the 2016 – 2017 cold season, the number of active component service members with cold weather injuries was the lowest of the last 18 cold seasons since the Medical Surveillance Monthly Report (MSMR) began reporting such data in the 1999-2000 cold season. Findings •	The overall incidence rate for cold weather injuries for all active component service members in 2016 – 2017 was 15% lower than the rate for the 2015 – 2016 cold season. •	The 2016 – 2017 rate was the lowest of the entire five year surveillance period. •	In the 2016 – 2017 cold season, the Army’s incidence rate of 41.0 per 100,000 person-years for active component soldiers was 18% lower than the Army’s lowest previous rate in 2012 – 2013. •	In the Navy, Air Force, and Marine Corps, the active component rate for 2016 – 2017 was only slightly higher than their lowest rates during the 2012—2017 surveillance period. Pie chart 1 (left side of infographic): Cold Weather Injuries, By Service, Active Component, 2016 – 2017 data •	Army 57.6% (n=189) •	Marine Corps 21.0% (n=69) •	Air Force - 13.1% (n=43) •	Navy – 8.2% (n=27) •	The sharp decline in the Army rate during the 2016 – 2017 cold season drove the overall decline for all services combined. Pie chart 2 (right side of infographic): Percentage distribution by service of cold weather injuries among reserve component service members during cold season 2016 – 2017  •	Army 72.9% (n=43) •	Marine Corps 13.5% (n=8) •	Air Force 13.5% (n=8) •	Navy (n= 0) •	For the 2016 – 2017 cold season, the overall rate of cold weather injuries for the reserve component and the rates for each of the services except the Air Force were lower than in any of the previous four seasons. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR

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Cold and flu season usually runs from October to March, and peaks between December and February. Young children, adults 65 years and older, pregnant women, and people with chronic medical conditions have a higher risk for complications. Military Health System experts encourage everyone to take steps to prevent these viral illnesses from spreading. (U.S. Army photo by photo by Rachel Larue)

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Maintenance key to medical device precision, accuracy

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MSMR Vol. 25 No. 1 - January 2018

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