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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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Five cold seasons: July 2012-June 2017, Active reserve component service members who were diagnosed with a cold weather injury

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Did you know during the 5-year surveillance period, the 2,717 service members who were affected by any cold weather injury included 2,307 from the active component and 410 from the reserve component. Overall, Army members comprised the majority (61.6%) of all cold injuries affecting active and reserve component service members. Of all affected reserve component members, 71.7% (n=294) were members of the Army. Cold weather injuries During Basic Training Of all active component service members who were diagnosed with a cold weather injury (n= 2,307), 230 (10.0% of the total) were affected during basic training. Additionally, during the surveillance period, 60 service members who were diagnosed with cold weather injuries during basic training (2.6% of the total) were hospitalized, and most (93.3%) of the hospitalized cases were members of either the Army (n=32) or Marine Corps (n=24). Cold weather injuries during basic training pie chart: The Army (n=122) and Marine Corps (n=99) comprised 96.1% of all basic trainees who were diagnosed with a cold weather injury. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness Image of service member tracking in the snow is the infographic background graphic.

This infographic provides information on active and reserve component service members who were affected by any cold weather injury during the July 2012 – June 2017 cold seasons.

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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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Incidence rates of cold weather injuries: Non-Hispanic black service members, five cold weather seasons, July 2012 – June 2017

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1/18/2018
Did you know for all of the services, overall rates of cold weather injuries were higher among non-Hispanic black service members than among those of other race/ethnicity groups? •	Rates of cold weather injuries among non-Hispanic black service members were two-times as high as those among non-Hispanic white or other race/ethnicity groups.  •	The rates of frostbite among non-Hispanic black service members were three-times those of the other race/ethnicity groups. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to www.Health.mil/MSMR  #ColdReadiness Image of non-Hispanic black service member in the snow displays.

This infographic documents incidence rates of cold weather injuries among non-Hispanic black service members during the July 2012 – June 2017 cold weather seasons.

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Guarding the health of service members

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1/9/2018
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Contraception among active component service women, U.S. Armed Forces, 2012 – 2016

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1/5/2018
Because the majority of women serving in the Armed Forces are of childbearing age, and women’s military career opportunities have expanded into combat roles, contraceptive health care is an increasingly important public health issue. The lack of available, population-based descriptive information on contraceptive use among U.S. service women has generated questions and concerns about ready access to these medical products. This infographic summarizes the annual prevalence of permanent sterilization, as well as use of long – and short-acting reversible contraceptives (LARCs and SARCs, respectively), contraceptive counseling services, and use of emergency contraception from 2012 through 2016, among active component service women. FINDINGS •	2012 through 2016, Sterilization decreased from 4.2% to 3.6% LARC use increased from 17.2% to 21.7%; SARC use decreased from 38.5% to 30.4%. •	Emergency contraception use increased from 0.4% to 1.9%. •	Among deployed women, the average annual prevalence of permanent sterilization was 4.2%. •	For deployed women, LARC use was 17.9% SARC use was 28.0%. •	Emergency contraception use among deployed women was 0.4%. •	262,907 (76.2%) women of childbearing potential (WOCBP) used either a LARC or a SARC at some time during the surveillance period. •	The vast majority of service women have utilized at least one form of contraception, and women are selecting LARCs in greater numbers with each passing year. The bar graph displays information on the annual prevalence of contraceptive utilization, by type, service women of child-bearing potential, active component, U.S. Armed Forces, 2012– 2016. Graphic displayed: contraception option. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

This infographic summarizes the annual prevalence of permanent sterilization, as well as use of long – and short-acting reversible contraceptives (LARCs and SARCs, respectively), contraceptive counseling services, and use of emergency contraception from 2012 through 2016, among active component service women.

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Gestational diabetes among pregnant service members, active component, U.S. Armed Forces 2012 – 2016

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Gestational diabetes is an abnormal increase in blood sugar levels that can adversely affect the health of both a pregnant woman and her baby. During 2012 – 2016, 4,017 (6.3%) of active component female service members who had live births were affected by gestational diabetes. Women aged 25-34 and 35-49 years had consistently higher annual prevalences of gestational diabetes than younger females. The percentage of pregnant service members affected by gestational diabetes was more than twice as high for obese women as for non-obese women (12.4% vs. 5.5%). The percentage of live births affected by gestational diabetes increased with increasing age and was highest among Asians/Pacific Islanders. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Complications and Care Related to Pregnancy, Labor and Delivery among Active Component Service Women U.S. Armed Forces, 2012 – 2016

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1/5/2018
Maternal complications and delivery outcomes are important components of the overall health and well-being of reproductive-age service women. This analysis provides an update on pregnancy complications and characterizes the counts, rates, and trends of several specific pregnancy complications. FINDINGS •	55,601 U.S. service women whose pregnancies resulted in 63,879 live births had 657,060 medical encounters •	For all age groups, percentages of live births affected by preterm labor decreased, but during 2012 – 2016, the percentages of pregnant service members diagnosed with obesity increased. •	The percentage of pregnant service members affected by gestational diabetes was more than twice as high for obese women, compared with non-obese women (12.4% vs. 5.5%). Bar graph shows the number of medical encounters with a primary (first-listed) diagnosis of any pregnancy-related complication or indication for care decreased each year between 2012 and 2016. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR  Background image: New born being provided medical attention by nurse. Secondary image: babies of diverse background on a blanket.

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Live births among female service members, active component, U.S. Armed Forces, 2012 – 2016

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12/21/2017
Did you know…?  •	From 2012 – 2016, there were 63,879 live births to women of childbearing potential in the active component. The overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). The live birth rate decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. The decrease was primarily driven by declining rates among women in their 20s. Overall, live birth rates were highest among women who were: •	30-34 years old •	Army members •	In healthcare occupations •	Married Of the total 63,879 live birth deliveries: •	24.7% were cesarean •	75.3% were vaginal Pie chart depicting this information displays. United States map displays showing the highest numbers of deliveries during the surveillance period reported by military hospitals at: •	Naval Medical Center Portsmouth, VA (7.4%) •	Naval Medical Center San Diego, CA (6.1%) •	The Carl R. Darnall Army Medical Center, TX (4.1%) •	Womack Army Medical Center, NC (3.8%) •	Tripler Army Medical Center, HI (3.7%) Live birth rates were broadly similar among the race/ethnicity groups, although the overall rate was slightly higher among American Indians/ Alaska Natives. Access the full report in the November 2017 MSMR (Vol. 24, No.11). Go to: www.Health.mil/MSMR

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Pregnancies and live births among female service members

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12/21/2017
Women have been able to serve officially in the U.S. military since 1901. Both the number of women serving in the active component and their occupational roles have steadily increased and expanded. Currently, almost one in seven active component service members are female and more than 95% of military occupational specialties are open to women. This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented. FINDINGS •	In 2016, WOCBP comprised the vast majority of active component service women. •	202,849 women served in the active component of the Army, Navy, Air Force, or Marine Corps. 197,947 (97.6%) were WOCBP. Pie chart displays depicting this information. •	In 2016, 13.1% of all WOCBP had at least one pregnancy-related event. Pie chat displays depicting this information. Female stick figures display to show visual of the largest proportions of WOCBP. Breakdown of WOCBP by service: •	Army (32.9%) •	Air Force (30.0%) •	Navy (29.7%) •	Marine Corps (7.5%) Pie chart displays to visually depict breakdown of WOCBP by service. The largest proportions of WOCBP were: •	In a communications / intelligence occupation (32.3%) •	Junior enlisted rank (46.5%) •	Non-Hispanic white (43.4%) •	20 – 24 years old (34.3%) Live births: •	There were 63,879 live births during the surveillance period. •	Overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). This rate of live births decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. Line graph displays this information. Rates of live births were highest among: •	Women who were 30 – 34 years old •	Enlisted or junior officer rank •	Army •	In healthcare / intelligence occupations •	Married Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Pregnancies among female service members, Active component, U.S. Armed Forces, 2012 – 2016

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With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. Between 2012 – 2016, 344,536 unique women of childbearing potential (WOCBP) served at least 1 day in the military, and of those, 132,466 spend at least 1 day as a recruit trainee. Of the 224,718 WOCBP who served at any time in 2016, 13.1% had at least one pregnancy-related event during that year. A “pregnancy-related event,” refers to a health care encounter (visit) for which the record contains a diagnosis code for either pregnancy or a positive pregnancy test. In 2016, the highest prevalence of pregnancy-related events was among service women 30-34 years of age (16.8%) and among senior enlisted women (13.7%). Pie chart displays depicting the information. The annual prevalence of pregnancy-related events decreased slightly, from 14.2% in 2012 to 13.1% in 2016. Line plot graph displays this information. FINDINGS •	Prevalence of pregnancy-related events was approximately evenly distributed among the race/ethnicity categories and military occupation groups. •	A slightly higher percentage of WOCBP in the Army (14.5%) had pregnancy-related events compared to WOCBP in the other services. •	A higher percentage of women who were married (21.4%) had a pregnancy-related event, compared with those in the single (5.7%) or “other” (8.8) categories. •	Only 0.2% of women who served during a recruit training period in any given year had a pregnancy-related event. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to www.Health.mil/MSMR.  Graphic on infographic shows a pregnant service member.

With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. This infographic documents pregnancies among female service members, active component, U.S. Armed Forces from 2012 – 2016.

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