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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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Zika in the Americas: March 22, 2017

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3/22/2017

This is a biosurveillance summary of Zika in the Americas as of March 22, 2017. Weekly incidence among Military Health System (MHS) beneficiaries has decreased significantly since its peak during the week ending 30 JUL 2016. As of 1300 on 22 MAR, there have been 170 (+1) confirmed Zika virus (ZIKV).

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What is Rhabdomyolysis?

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3/21/2017
Although regular exercise is good for the body, too much physical activity can do more harm than good. Rhabdomyolysis is the rapid breakdown of overworked muscle cells, following the release of toxic fibers into the bloodstream, causing many complications during physical exertion. This infographic provides information about the symptoms of Rhabdomyolysis, prevention and treatment.  How to avoid: •	Thoughtfully plan out your exercise routines •	Drink adequate amounts of fluid •	Minimize your workout time in extreme heat conditions How to treat: •	IV fluids/ fluid replacement •	Urinary Alkalization •	Blood transfusion  Symptoms of Rhabdomyolysis •	Difficulty in arm motion / trouble lifting objects •	Muscle weakness, muscle swelling and leg fatigue •	Fever, confusion, loss of consciousness •	Nausea and vomiting •	Dark colored urine or lack of urine  Learn more at Health.mil/MSMR

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Routine Screening for Antibodies to Human Immunodeficiency Virus

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3/17/2017
The Human immunodeficiency virus type 1 (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. This infographic provides an update on routine screening for antibodies to HIV among civilian applicants for the U.S. military service and U.S. Armed Forces during a January 2011 - June 2016 surveillance period.  Since October 1985, the U.S. military has conducted routine screening for antibodies to HIV-1 to enable adequate and timely medical evaluations, treatment and counseling; to prevent unwitting transmission; and protect the battlefield blood supply. From January 2015 through June 2016, 463,132 civilian applicants for U.S. military service were tested. 124 were identified as HIV antibody positive. During 2015, one was detected with antibodies to HIV per 3,267 screening tests. Annual seroprevalences peaked in 2015, up 29% from 2014. The seroprevalences were much higher among males than females and among black, non-Hispanics than other race/ethnicity groups. Seroprevalences decreased by approximately 26% among male applicants, dropped to zero among female applicants, and decreased by 43% among black, non-Hispanic applicants.  As for the active component of the U.S. Army, 548,974 soldiers were tested from January 2015 through June 2016. 120 were identified as HIV antibody positive. During 2015, one was detected with antibodies to HIV per 5,265 screening tests. Of the 515 active component soldiers diagnosed with HIV infections since 2011, a total of 291 (57%) were still in military service in 2016. Annual seroprevalences for male active component Army members greatly exceed those of females.  Among active and reserve component service members, seroprevalences continue to be higher among Army and Navy members and males than their respective counterparts. Service members who are infected with HIV receive clinical assessments, treatments, and counseling; they may remain in service as long as they are capable of performing their military duties. Learn more at Health.mil/AFHSB

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Chlamydia Trachomatis Infections

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3/17/2017
This report characterizes the rates of Chlamydia Trachomatis (CT) during the pre-deployment, deployment, and post-deployment phases for active component members of the U.S. Army, Navy, Air Force and Marine Corps. The surveillance period was 2008 through 2015.  For incidence rates of laboratory-confirmed Chlamydia Trachomatis diagnoses, by deployment cycle and sex, active component, U.S. Armed Forces, 2008-2015, there were 84,783 cases for men and 54,867 cases for women. The surveillance period findings show: •	Rates of CT were highest during the pre-deployment phase for both sexes •	Males tended to have similar rates of CT across pre-, post-, and non-deployed phases •	Women had substantial rate differences between phases  The results of these analyses underscore the need for better screening and documentation of STIs during deployment to assess the true burden of disease. Learn more about rates of CT among U.S. Armed Forces by visiting Health.mil/MSMR

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5 Major Categories of Abdominal Hernia

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3/17/2017
An abdominal hernia is an abnormal protrusion of an organ or tissue through a defect in the abdominal wall. This infographic provides information on incident diagnoses of the five types of abdominal hernia that were documented in health records of 72,404 active component service members from 1 January 2005 through 31 December 2014.  A total of 87,480 incident diagnoses of the five types of abdominal hernia were documented in health records of 72,404 active component service members. Here are highlights of the findings from this study: •	The give types of abdominal hernia categories used in this analysis were: inguinal, umbilical ventral/ incisional, femoral and “other.” •	 During the 10-year interval, incidence rates for most of the five types of hernia trended downward but increased for umbilical hernias in both males and females and ventral/ incisional hernias among females. •	Overall incidence rate of inguinal hernias among males was six times the rate among females. •	Incidence rates of femoral, ventral/ incisional and umbilical hernias were higher among females than males. •	For most types of hernia incidence rates tend to be higher among older age groups.  Abdominal hernias are diagnosed most frequently in the inguinal, umbilical, and femoral regions, but another category of relatively common hernias of the anterior abdominal wall includes ventral and incisional hernias. Health records contained documentation for 35,624 surgical procedures whose description corresponded to the types of hernia diagnoses in U.S. military service members. Learn more about the findings of the study at Health.mil/MSMR

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Diabetes Mellitus

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3/17/2017
Diabetes Mellitus (DM) is a group of chronic metabolic conditions characterized by high blood glucose levels resulting from a decreased ability to produce and or use insulin. DM-related metabolic abnormalities are associated with damage to various organs and tissues. From 2008 - 2015, a total of 9,092 incident cases of DM were reported among active duty service members. This infographic provides details on the overall incidence rates of type 1 and 2 DM cases per 100,000 person-years. It also provides information about service members at higher risk of diabetes. Here are some key findings from the study: •	Type 1 DM (previously known as “insulin-dependent diabetes”) overall incidence rate was 3.0 cases per 100,000 p-yrs. •	Type 2 DM ( “non-insulin-dependent diabetes) was 74.5 cases per 100,000 p-yrs. And rates doubled within each successive age group.  Service members at higher risk of diabetes are male, black, non-Hispanic, unknown race/ ethnicity, Hispanic and enlisted in the Army and Navy. Learn more by visiting Health.mil/AFHSB

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Leishmaniasis

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3/17/2017
Leishmaniasis is a zoonotic disease caused by protozoan parasites of the genus Leishmania that are transmitted to humans by the bites of infected female sand flies. The disease remains a military medical surveillance interest because of deployments to endemic areas of the Middle East. It is also endemic in many other regions including Africa, Mexico, Southern Europe, Asia, and South and Central America. This report provides an update on the frequencies, rates, and demographic characteristics of U.S. service members who were diagnosed/ reported with leishmaniasis while expanding analysis to include information on the location of acquisition of leishmaniasis infection during a 2001-2016 surveillance period. Here are key findings from the surveillance period: •	There were 2,040 incident diagnoses/ reports of leishmaniasis among members of the U.S. Armed Forces. •	Cutaneous Leishmaniasis accounted for 61.0% of total diagnoses/ reports among active duty service members. •	71.1% of the total leishmaniasis case were diagnosed or reported during the 7 months from early autumn to spring (September – March) in the northern hemisphere. •	The majority of cases diagnosed or reported during this 7-month interval were acquired in the Middle East, South/Central America and other or unknown locations.  Learn more information at Health.mil/MSMR

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Obstructive Sleep Apnea Diagnosis Treatment Guide Active Duty U.S. Military

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3/13/2017
This infographic provides information on Obstructive sleep apnea (OSA) diagnosis and treatment of active duty U.S. Armed Forces to help primary care providers screen high-risk individuals and encourage patients to explore OSA treatment options for managing this burden of disease. The data comes from an analysis of sleep apnea conducted from 2004 through 2016.  With appropriate diagnosis and treatment of OSA, this growing health concern for military populations can be effectively managed. OSA symptoms include snoring, gasping for breath during sleep, headaches, insomnia and daytime fatigue. During the surveillance period, OSA were highest in those aged 40 years or older, male non-Hispanic  black, obese, army service members, married, had more than one prior deployment or had completed 18 years or more of service.  The incidence rate among individuals aged 40 years or older was more than 3-fold higher in 2015 compared to 2004. Individuals serving 18 or more years had a 3-fold higher incidence rate of OSA in 2015, compared to 2004. The 12-year incidence rate in service members serving 18 years or more was more than 2-fold higher than those with 11-17 years of service.  Improved screening, referral, and treatment have been recommended for individuals who may suffer from post-traumatic stress disorder (PTSD) and depression, in which OSA-associated fatigue and poor sleep quality can exacerbate symptoms.  Additionally, the STOP-BANG questionnaire for sleep apnea may help primary care providers to screen high-risk individuals and identify those whose symptoms warrant further evaluation. Individuals who suffer from OSA have increased rates of cardiovascular disease, chronic fatigue, motor vehicle accidents, cognitive impairment, and post-traumatic stress disorder.  Learn more about OSA and treatment options for managing this burden of disease by visiting Health.Mil/AFHSB

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Obstructive Sleep Apnea Rates by Service, U.S. Armed Forces

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3/13/2017
This infographic documents an increase in the incidence of Obstructive sleep apnea (OSA) diagnoses and associated attrition among U.S. service members over a 12-year surveillance period from 2004-2015. It also examines time to separation from military service after an incident of OSA diagnosis. Here are key facts about the OSA incidence rates by service: •	Rates of OSA were lowest in young service members, white non-Hispanics, Marines, air crew, and in those with less than five-years of service or no prior deployments. •	The category of pilots/ air crew consistently had the lowest OSA incidence rates, compared to all other occupations •	The annual incidence rates for the Army rose steadily from 2008 to 2015 and were higher during this period than the rates of the other services  The high percentage of cases diagnosed prior to separation from service is a concern because OSA as a large health and economic burden for the armed services is a treatable and partially preventable disease. For more information on OSA, appropriate screening and prevention strategies to improve both individual health and mission performance, visit Health.mil/AFHSB

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Global Influenza Summary: March 5, 2017

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March 10 is National Women & Girls HIV/AIDS Awareness Day

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3/3/2017
This graphic shows the results of routine screening for antibodies to Human Immunodeficiency Virus (HIV) among both female civilian applicants for U.S. military service and female service members of the U.S. Armed Forces, active component - Army during  January 2015 through June 2016 surveillance period. 94,763 females 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, 10 were female. Throughout the period, seroprevalences were much higher among males than females.  During 2015 – 2016 seroprevalences dropped to zero among female applicants.  As for U.S. Armed Forces active component, 81,963 female service members out of 548,974 were tested for antibodies to HIV. Out of 120 soldiers that were HIV positive 3 were female. 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.

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Counts, Rates, & Trends of Incedent Diagnoses of Melanoma

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3/3/2017
Melanoma is a leading cause of cancer death. This graphic shows facts from an analysis for counts, rates, and trends of incident diagnoses of Melanoma among active component military members conducted during a 10-year surveillance period from 2005 through 2014.   Although melanoma is more common among males in the general U.S. population, in this analysis, females had a higher crude rate of malignant melanoma compared to males. From 2005 – 2014, there were 1,571 malignant melanoma cancers diagnosed in the U.S. Armed Forces. Here are other key facts from the analysis: •	Among male service members, malignant melanoma was one of the most frequent cancer diagnoses after testicular cancer. •	Among females, malignant melanoma was the 2nd most frequent cancer diagnoses after breast cancer. •	White, non-Hispanic service members had a much higher crude rate of malignant melanoma relative to their counterparts in other race/ ethnicity groups. •	In general, the strongest demographic correlate of increased risk of cancer diagnosis was older age. To learn more information, visit Health.mil/AFHSB

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