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Cutting-edge interactive disease surveillance maps support Combatant Commands

This image shows Middle East respiratory syndrome coronavirus particle envelope proteins immunolabeled with rabbit HCoV-EMC/2012 primary antibody and goat anti-rabbit 10-nanometer gold particles. (National Institute of Allergy and Infectious Disease photo) This image shows Middle East respiratory syndrome coronavirus particle envelope proteins immunolabeled with rabbit HCoV-EMC/2012 primary antibody and goat anti-rabbit 10-nanometer gold particles. (National Institute of Allergy and Infectious Disease photo)

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Armed Forces Health Surveillance Branch | Integrated Biosurveillance | Global Emerging Infections Surveillance | Combat Support

As an organization that receives countless streams of data and information, the staff at the Armed Forces Health Surveillance Branch (AFHSB) knows quite a bit about the global threats posed by known and emerging infectious diseases of military relevance. Today, AFHSB’s Integrated Biosurveillance (IB) Section is taking revolutionary steps to produce even more relevant, user-driven health surveillance products that enable its customers, especially the U.S. Combatant Commands, to focus on what they need to know to provide a medically ready military force in peace and wartime.

Interactive surveillance maps created by the Armed Forces Health Surveillance Branch show the global threats posed by endemic and emerging infectious diseases that help Combatant Commands provide a medically ready military force.Interactive surveillance maps created by the Armed Forces Health Surveillance Branch show the global threats posed by endemic and emerging infectious diseases that help Combatant Commands provide a medically ready military force.

 

AFHSB recently released new, web-based interactive disease surveillance maps that allow Combatant Commanders to zoom to an area of interest, click on individual points, and extract exactly what they need to know about a particular disease event. The accompanying text can contain relevant links, sources, and images in their native, high resolution format. With the click of a button, an analyst can instantly upload data from his or her terminal in Washington, D.C., for a decision-maker stationed in Germany, with information that is specifically tailored for that organization’s needs.

As part of the Defense Health Agency’s role as a combat support agency, “it is vital for AFHSB to provide timely health surveillance information to the Combatant Commands with the appropriate flexibility and agility required to support Force Health Protection decisions,” said Mr. Juan Ubiera, chief of the IB section. “These dynamic products provide Department of Defense leaders with a large amount of information in a manner that supports both rapid operational decisions and a deeper understanding of what's going on.”

AFHSB’s latest product in this gallery is The Avian Influenza Epidemic. This product leverages data from near real-time disease reporting systems along with geocoding capabilities to present an emerging picture of the avian influenza A (AI) virus subtypes currently affecting avian populations globally. An overlay of the global flight paths of the wild birds that carry AI viruses enables the viewer to connect outbreaks of particular AI subtypes to the migratory routes that may have facilitated their introduction. This product also depicts human cases of infection with novel and variant influenza A viruses, conveying Defense Department relevance of these occurrences through an in-house designed infographic, all within a dynamic environment.

This new release joins other products in the IB interactive gallery such as The MERS-CoV Epidemic, an interactive surveillance product that guides the user through the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in a new and captivating format. Users will also find surveillance products on the 2014 Ebola outbreak in West Africa and the emergence of the Chikungunya virus in the Americas.

To create these visualizations, AFHSB is implementing leading-edge, commercial-off-the-shelf tools designed by Esri, a geospatial service provider. Our analysts are able to standardize and edit data directly from their desktops; with a few keystrokes, the data are sent to the cloud, instantly updating our products with the latest information. This represents a major leap forward from AFHSB’s current email-based distribution system.

“This type of product and [the] attractive and easy to read visuals are very useful for the education of leadership and others in our division on the importance of avian influenza,” Dr. Jennifer Steele, the Infectious Disease Subject Matter Expert for U.S. European Command after previewing The Avian Influenza Epidemic product. “The maps and graphics help explain why [avian influenza] elsewhere in the world and in other species is important from a human health and operational perspective.” 

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Update: Exertional Rhabdomyolysis Active Component, U.S. Armed Forces, 2012 – 2016

Infographic
4/4/2017
Rhabdomyolysis is characterized by the rapid breakdown of overworked intracellular muscle, skeletal muscle cells and the release of toxic fibers into the bloodstream. It is a significant threat to U.S. military members during physical exertion, particularly under heat stress. This report summarizes numbers, rates, trends, risk factors and locations of occurrences for exertional heat injuries, including exertional rhabdomyolysis for 2012-2016. In 2016, there were 525 incident diagnoses of rhabdomyolysis between 2013 and 2016 rates increased 46.2 percent – 69.7 percent of cases occurred during May through September. Risk factors for exertional rhabdomyolysis include being male, younger than 20 years of age, black, non-Hispanic, low level of physical fitness, prior heat injury and exertion during warmer months. Additional information about the causes and prevention of exertional rhabdomyolysis can be found in the MSMR at www.Health.mil/MSMR

Rhabdomyolysis is characterized by the rapid breakdown of overworked intracellular muscle, skeletal muscle cells and the release of toxic fibers into the bloodstream. It is a significant threat to U.S. military members during physical exertion, particularly under heat stress. This report summarizes numbers, rates, trends, risk factors and locations of occurrences for exertional heat injuries, including exertional rhabdomyolysis for 2012-2016.

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Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

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4/4/2017
Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

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Minority Health Heat Illness Active Component U.S. Armed Forces, 2016

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4/4/2017
Heat illness refers to a spectrum of disorders that occur when the body is unable to dissipate heat absorbed from the external environment and the heat generated by internal metabolic processes. As heat illness progresses, failure of one or more body systems can occur. This report summarizes reportable medical events of heat illnesses, heat-related hospitalizations and ambulatory visits among minority active component members (Black, non-Hispanic, Hispanic, and Asian/Pacific Islanders) during 2016. In 2016, incidence rates of heat stroke were highest among Asian/ Pacific Islanders than any other ethnicity. Crude incidence rate of “other heat illnesses” was higher among females than males.  Heat Incidence cases: •	Black, non-Hispanic heat illness incidence cases – 64 for heatstroke and 389 for other heat illnesses •	Hispanic heat illness incidence cases—  63 for heatstroke and 320 for other heat illnesses •	Asian/ Pacific Islander heat illness incidence cases – 32 for heatstroke and for  117 other heat illnesses Incidence rates: •	Black, non-Hispanic incidence rates – 0.30 for heatstroke and 1.84 for other heat illnesses •	Hispanic incidence rates – 0.33 for heatstroke and 1.67 for other heat illnesses •	Asian/Pacific Islander – 0.62 for heatstroke and 2.26 for other heat illnesses Of all military members, the youngest and most inexperienced marines and soldiers – particularly those training at installations in the south eastern U.S. – are at highest risk of heat illnesses including heat stroke, exertional hyponatremia, and exertional rhabdomyolysis. Learn more at www.Health.mil/MSMR

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New and Improved Defense Medical Epidemiology Database

Infographic
4/4/2017
The new and improved Defense Medical Epidemiology Database (DMED), known as DMED 5.0, is now only available online.  DMED provides timely and efficient access to data of active component personnel and medical event data.  It contains a subset of data from the Defense Medical Surveillance System (DMSS), offering remote access to tri-service epidemiologic data. Moreover, it protects privacy using only de-identified data and updates monthly.  The new DMED features an enhanced user interface, query data using ICD-9 and ICD-10 diagnostic codes granting authorized users to search multiple databases simultaneously. These users are U.S. military personnel (DoD-CaC users) or Federal partners and civilian collaborators in military medical research and operations. Authorized U.S. military personnel with access to DMED include medical providers, epidemiologists, medical researchers, safety officers, and medical operations and clinical support staff. Sign up for a new account at www.health.mil/dmed

The new and improved Defense Medical Epidemiology Database (DMED), known as DMED 5.0, is now only available online. DMED provides timely and efficient access to data of active component personnel and medical event data.

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Update: Exertional Hyponatremia U.S. Armed Forces, 2001-2016

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4/4/2017
Exertional Hyponatremia occurs during or up to 24 hours after prolonged physical activity. It is defined by a serum, plasma or blood sodium concentration below 135 millequivalents per liter. This infographic provides an update on Exertional Hyponatremia among U.S. Armed Forces, information on service members at high risk. Exertional hyponatremia can result from loss of sodium and/or potassium as well as relative excess of body water. There were 1,519 incident diagnoses of exertional hyponatremia among active component service members from 2001 through 2016. 86.8 percent were diagnosed and treated without having to be hospitalized. 2016 represented a decrease of 23.3 percent from 2015. In 2016, there were 85 incident diagnoses of exertional hyponatremia among active component service members and 77.6 percent of exertional hyponatremia cases affected males.  The annual rate was higher among females. Service members age 40 and over were most affected by exertional hyponatremia. High risk service members of exertional hyponatremia were: •	Females •	Service members aged 19 years or younger •	White, non-Hispanic and Asian/ Pacific Islander service members •	Recruit Trainees •	Marine Corps members Learn more at www.Health.mil/MSMR

Exertional Hyponatremia occurs during or up to 24 hours after prolonged physical activity. It is defined by a serum, plasma or blood sodium concentration below 135 millequivalents per liter. This infographic provides an update on Exertional Hyponatremia among U.S. Armed Forces, information on service members at high risk. Exertional hyponatremia can result from loss of sodium and/or potassium as well as relative excess of body water.

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Update: Heat Illness Active Component U.S. Armed Forces, 2016

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4/4/2017
Heat illness refers to a spectrum of disorders that occur when the body is unable to dissipate heat absorbed from the external environment and the heat generated by internal metabolic processes. As heat illness progresses, failure of one or more body systems can occur. This infographic provides an update on heat illness among active component U.S. Armed Forces during 2016. There were 401 incident cases of heat stroke and 2,135 incident cases of other heat illness among active component service members. The annual incidence rate of cases of heat stroke in 2016 was slightly lower than the rate in 2015. There were fewer heat-stroke-related ambulatory visits and more reportable events in 2016 than in 2015. ‘Other heat illness’ was slightly higher in 2016 than in 2015. High risk of heat stroke in 2016 included males, service members aged 19 years or younger, Asian/Pacific Islanders, Recruit Trainees, Combat-specific occupations, Marine Corps and Army members. To learn more about the significant threat of heat illnesses to both the health of U.S. military members and the effectiveness of military operations, visit www.Health.mil/MSMR

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Global Influenza Summary: April 2, 2017

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Rhabdomyolysis by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet

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This fact sheet provides details on Rhabdomyolysis by location for active component, U.S. Armed Forces during a five-year surveillance period from 2012 through 2016. The medical treatment facilities at nine installations diagnosed at least 50 cases each and, together approximately half (49.9%) of all diagnosed cases.

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Demographic and Military Traits of Service Members Diagnosed as Traumatic Brain Injury Cases

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This fact sheet provides details on the demographic and military traits of service members diagnosed as traumatic brain injury (TBI) cases during a 16-year surveillance period from 2001 through 2016, a total of 276,858 active component service members received first-time diagnoses of TBI - a structural alteration of the brain or physiological disruption of brain function caused by an external force.

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Heat Illnesses by Location, Active Component, U.S. Armed Forces, 2012-2016 Fact Sheet

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This fact sheet provides details on heat illnesses by location during a five-year surveillance period from 2012 through 2016. 11,967 heat-related illnesses were diagnosed at more than 250 military installations and geographic locations worldwide. Three Army Installations accounted for close to one-third of all heat illnesses during the period.

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H7N9: March 29, 2017

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This is a biosurveillance summary of Avian Influenza A (H7N9) Surveillance #72: March 29, 2017, as reported by the Armed Forces Health Surveillance Branch. As of 29 MAR, the total of influenza A (H7N9) human case count since the fifth seasonal epidemic or “wave” of H7N9 which began on 1 OCT 2016 is 656 (-15) cases with 122 (-10) deaths. Read more:

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2016 marks first year of zero combat amputations since the start of the Afghan, Iraq wars

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3/28/2017
An analysis by the Medical Surveillance Monthly Report recently reported 2016 marks the first year without combat amputations since the wars in Afghanistan and Iraq began. U.S. Armed Forces are at risk for traumatic amputations of limbs during combat deployments and other work hazards. (DoD photo)

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Global Influenza Summary: March 26, 2017

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Routine Screening for HIV Antibodies Among Male Civilian Applicants

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3/24/2017
This graphic shows the results of routine screening for antibodies to Human Immunodeficiency Virus (HIV) among both male civilian applicants for U.S. military service and male service members of the U.S. Armed Forces, active component - Army during  January 2015 through June 2016 surveillance period. 368,369 males out of 463,132 civilian applicants for U.S. military service were tested for antibodies to HIV. Out of 124 civilian applicants that were HIV positive, 114 were male. Throughout the period, seroprevalences were much higher among males than females.  As for U.S. Armed Forces active component, 467,011 male service members out of 548,974 were tested for antibodies to HIV. Out of 120 soldiers that were HIV positive 117 were male. Annual seroprevalences for male active component Army members greatly exceed those of females. During the 2015, on average, one new HIV infection was detected among active duty army soldiers per 5,265 screening tests.  HIV-1 is the cause of Acquired Immune Deficiency Syndrome (AIDS) and has had major impacts on the health of populations and on healthcare systems worldwide. Of 515 active component soldiers diagnosed with HIV infections since 2011, a total of 291 (57%) were still in the military. Get tested and learn more by reading the Medical Surveillance Monthly Report at Health.Mil/MSMR.

Since October 1985, the U.S. military has conducted routine screening for antibodies to Human immunodeficiency virus type 1 (HIV-1) to enable adequate, timely medical evaluations, treatment and counseling, and protect the battlefield blood supply. This infographic provides information on routine screening for antibodies to HIV among male civilian applicants of the U.S. Military Service and U.S. Armed Forces, January 2011 – June 2016.

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Acetaminophen Overdoses

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3/24/2017
Acetaminophen Overdoses, Active Component, U.S. Armed Forces, 2006 – 2015 Acetaminophen is a drug commonly used to relieve pain and fever. Generally, it is safe and effective when used as directed. This infographic provides information on acetaminophen overdoses among active component members of the U.S. Armed Forces. The surveillance period was 2006 through 2015. During that time 2,588 cases of acetaminophen overdose were identified in active component military members.   Rates of acetaminophen overdose declined during this 10-year surveillance period, from 2.2 cases per 10,000 person-years (p-yrs.) in 2006 to 1.2 cases per 10,000 p-yrs. in 2015. A relatively small percentage of overdose cases receive diagnoses indicating subsequent hepatotoxicity.   The dangers of acetaminophen are too much, too often. Acetaminophen overdose can cause serious adverse events (i.e. liver damage). Self-medicating chronic pain can lead to poisoning. In the United States more than 100,000 calls annually to poison control centers involve acetaminophen – 1/3 of the calls are intentional overdose. Here are other key findings: •	Rates of overdose were almost 3 times higher for females than male service members. •	Annual rates of acetaminophen overdose for male service members have declined every year since 2007. •	Crude rates of acetaminophen overdose were higher among black, non-Hispanic service members than other race/ ethnicity groups. •	Among the services, members of the Army had the highest rates of overdose. •	Service members younger than 25 years of age are at high risk.  Don’t let the over the counter access fool you. Know the signs and symptoms of acetaminophen abuse and unintentional overdose. Learn more at Health.mil/AFHSB

Acetaminophen is a drug commonly used to relieve pain and fever. Generally, it is safe and effective when used as directed. This infographic provides information on acetaminophen overdoses among active component members of the U.S. Armed Forces. The surveillance period was 2006 through 2015.

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