Skip to main content

Military Health System

Norovirus Outbreak in Army Service Members, Camp Arifjan, Kuwait, May 2018

Image of Norovirus are a group of related, single-stranded RNA, nonenveloped viruses that cause acute gastroenteritis in humans. (Photo Courtesy: CDC/Charles D. Humphrey. Norovirus are a group of related, single-stranded RNA, nonenveloped viruses that cause acute gastroenteritis in humans. (CDC photo by Charles D. Humphrey)

Recommended Content:

Medical Surveillance Monthly Report

Abstract

In May 2018, an outbreak of gastrointestinal illnesses due to norovirus occurred at Camp Arifjan, Kuwait. The outbreak lasted 14 days, and a total of 91 cases, of which 8 were laboratory confirmed and 83 were suspected, were identified. Because the cases occurred among a population of several thousand service members transiting through a crowded, congregate setting of open bays of up to 250 beds, shared bathrooms and showers, and large dining facilities, the risk of hundreds or thousands of cases was significant. The responsible preventive medicine authorities promptly recognized the potential threat and organized and monitored the comprehensive response that limited the spread of the illness and the duration of the outbreak. This report summarizes findings of the field investigation and the preventive medicine response conducted from 18 May–3 June 2018 at Camp Arifjan.

What Are the New Findings?

Introduction of norovirus disease into a crowded, congregate setting of transient service members precipitated an outbreak of at least 91 recognized cases in a vulnerable population of thousands. Prompt actions to halt air traffic in and out of the base, to isolate and quarantine infected persons, and to restrict movement to separate the well from the sick aborted the outbreak.

What Is the Impact on Readiness and Force Health Protection?

Norovirus is the leading cause of gastrointestinal illnesses in military settings. The contagiousness of the virus and the short incubation period can result in high case counts in concentrated military populations whose mission readiness may be impaired by widespread illness and necessary control measures. Recognition of this illness should prompt rapid and vigorous countermeasures.

Background

Norovirus is the leading cause of acute gastrointestinal (GI) illness outbreaks in military settings.1–7 Norovirus can be transmitted through person-to-person direct contact and exposure to contaminated food, water, aerosols, and fomites.7–9 Additionally, the virus is resistant to extreme temperatures and many standard disinfection methods.9 Following a short incubation period of 24–72 hours, symptoms, lasting 1 to 3 days, may include diarrhea, vomiting, nausea, and stomach pain. Patients recovering from a norovirus infection may shed the virus in their stool for up to 14 days, increasing the risk of secondary infection.7–9

Setting

Camp Arifjan, Kuwait, is the largest U.S. military base in the U.S. Central Command (USCENTCOM) and, at the time of the reported outbreak, accommodated over 10,000 service members from all branches of the U.S. military and the North Atlantic Treaty Organization as well as Department of Defense (DOD) civilians and contractors. Camp Arifjan's gateway serves as the hub for U.S. military and DOD personnel traveling throughout the Southwest Asian Theater. On a daily basis, a minimum of 1,000 personnel are transiting through Camp Arifjan's gateway to return to the U.S. or to travel to other points within the USCENTCOM, making the area highly susceptible to the spread of infectious disease. At the time of the outbreak described in this report, there were approximately 14,000 service members at Camp Arifjan, of which about 3,000–4,000 were in transit and 10,000 were permanently assigned there.

For transient personnel awaiting transportation, separate housing and bathrooms are located within the gateway area; however, transients' movements throughout the rest of Camp Arifjan are not restricted. Dining, laundry, recreation, and transportation facilities are shared between the transient and permanent populations. Housing comprises concrete buildings with beds located in open bays that can accommodate up to 250 people. Latrine and shower facilities are in separate trailers but are also used by those who work within the gateway area. Of the 35 buildings within the gateway, 5 are reserved for latrine/showers, 7 function as administrative offices for the gateway transportation and postal services, 7 serve as offices for the theater engineer brigade, and 16 operate as transient barracks.

Outbreak timeline

On 18 May at approximately 0800 hours, the 75th Combat Support Hospital emergency department (ED) evaluated a male active duty patient who presented with symptoms of nausea, vomiting, and diarrhea. This patient had traveled from a classified country to Ali Al Salem Air Base and then to Camp Arifjan en route to redeploy to the U.S. The patient and his unit had slept outside while at Ali Al Salem and were there for less than 8 hours before traveling via bus to Camp Arifjan. During the 2-hour bus drive from Ali Al Salem to Camp Arifjan, with an estimated 30 other personnel on the bus, the patient vomited and soiled himself multiple times. Upon arriving in Camp Arifjan, the patient was transported by his unit directly from the bus to the ED. In the ED, after the patient was assessed and treated, a stool specimen was collected for clinical testing, and he was released to his unit into the transient barracks in building D2 at the gateway (Figure 1).

The 223rd Medical Detachment (Preventive Medicine [PM]) and the theater PM physician at the medical brigade were immediately notified of the patient, and an aliquot of the stool specimen was transferred to the PM laboratory for surveillance testing via the BioFire® FilmArray® GI panel. Norovirus, enteropathogenic Escherichia coli, and enteroaggregative E. coli were all detected in the stool specimen. The 223rd Medical Detachment microbiologist immediately notified the public health nurse stationed with the 75th Combat Support Hospital. Twenty minutes after receiving the results of the GI test, the detachment commander and the PM physician decided that the index patient was to be immediately readmitted to the hospital. Two hours after being initially discharged, the patient was readmitted to the hospital and put into isolation.

On 20 May, 2 additional cases presented with nausea, vomiting, and diarrhea. One case tested positive for norovirus on the FilmArray® GI panel. This case was housed at the gateway in building B4. When interviewed, he reported that 1 of the soldiers who lived in building D2 was also sick. The other case could not produce a stool specimen for testing. Social media postings seen by the PM staff reported anecdotally that other soldiers were sick during this time, but no other soldiers presented to the hospital with GI symptoms, resulting in several days without patients.

On 23 May, an Army unit departed Kuwait and arrived at North Fort Hood, TX, the next day. The soldiers in the unit were not symptomatic upon their departure; however, during the course of the flight, a total of 21 soldiers exhibited symptoms consistent with norovirus, and 1 case was later laboratory confirmed. These 21 cases were not counted in the total case count from Camp Arifjan. All symptomatic soldiers were seen, treated, and released to quarters per the chief of PM at Carl R. Darnall Army Medical Center in Fort Hood.

On 24 May, 3 patients presented with norovirus symptoms at the ED at Camp Arifjan; all patients were confirmed positive for norovirus with the BioFire® FilmArray®. On 25 May, a medic arrived at 0500 to the ED to request Imodium® for soldiers in his unit who were sick and were scheduled to redeploy home that day. Throughout the day, 12 patients presented to the ED and clinic with symptoms consistent with norovirus illness, and an outbreak was officially declared by the medical brigade commander, who notified the installation commander of Camp Arifjan. Based upon the recommendation of the theater PM physician, the command authorities and the Air Force agreed to halt flights coming in and out of Camp Arifjan. The flight leaving for Fort Hood mentioned above had departed Camp Arifjan before flights were halted; however, no other flights departed Camp Arifjan until the outbreak had resolved, and Fort Hood reported this incident and response to the Disease Reporting System internet on 30 May. All new cases presenting with symptoms consistent with norovirus were assumed to be part of this outbreak unless proven otherwise. Over the course of 14 days, a total of 91 cases experienced symptoms of nausea, vomiting, diarrhea, and/or abdominal pain while at Camp Arifjan.

Methods

All cases were symptomatically identified. The BioFire® system was used for presumptive testing during the outbreaks in theater. Testing via the BioFire® system was suspended once norovirus was identified in the first 8 cases and thus determined to be the cause of the outbreak. BioFire® testing began again at the end of the outbreak to separate those patients without norovirus to preclude them from the quarantine area in an effort to prevent them from acquiring a nosocomial illness.

For the epidemiologic investigation described here, a confirmed case of norovirus was defined as a patient at Camp Arifjan from 18–31 May who experienced nausea, vomiting, diarrhea, or abdominal cramps and whose stool specimen tested positive for norovirus via polymerase chain reaction using the FilmArray® GI Panel for norovirus. A suspected case was defined as a patient having any of the same symptoms as a confirmed case but whose stool sample was not tested. After the index case, individuals who had experienced symptoms outside of Camp Arifjan, including the aforementioned soldiers who traveled to Fort Hood, were not included in the overall case count.

Results

From 18–31 May 2018, a total of 91 cases (8 confirmed and 83 suspected) of norovirus were found in Camp Arifjan, Kuwait (Figure 2). Two symptomatic cases (1 confirmed and 1 suspected) did not have a recorded onset date.

The most common symptoms reported by patients were diarrhea, vomiting, nausea (Table). Most cases were among men (84%) and among junior enlisted (48%) and senior enlisted (35%) personnel (Table). Six cases (6%) had been previously deployed in neighboring countries and had been in Kuwait for fewer than 4 days before their illness onset date. Twelve cases (13%) belonged to 1 unit, which had the highest concentration of cases in any single unit. Attack rates by unit were not available.

Confirmed and suspect cases were symptomatic for 1 day on average (range: 1–4 days). The index case and the last known case were both hospitalized, primarily for isolation purposes. The last hospitalized case was moved from the barracks to the hospital to allow the barracks to be cleaned and opened to house other service members again.

Countermeasures

On 18 May, PM made initial recommendations to the gateway staff to limit the number of new service members placed in building D2. The staff refused because of overcrowding and the need to place service members in beds. However, in the effort to reduce the spread of infection, signs were placed that evening by the 223rd Detachment team on building D2 and the closest men's bathroom. It was later ascertained through patient interviews that the precautions on these signs were generally ignored.

On the evening of 18 May, PM specialists were sent to observe cleaning contractors while latrines were being disinfected and to oversee the cleaning dilution used. The cleaning contractors were directly observed using toilet water to mop and clean the bathroom sinks. On 19 May, PM notified the base contracting officers about the unsanitary cleaning practices and the potential of an upcoming norovirus outbreak, emphasizing how improper cleaning practices exacerbate the spread of disease. No changes were made to the cleaning schedule to disinfect those sinks until after the outbreak had started.

Daily briefings were held to keep all health care providers, medics, and cleaning teams informed. These briefings provided information to help facilitate the plan for the next 12–24 hours, including a reminder of the cleaning protocols and updates on the status of housing, food, the cleaning of latrines, and the numbers of service members who were quarantined, cleared, or with active symptoms.

On 25 May, at the recommendation of the theater PM physician, all flights departing Kuwait were halted and a 72-hour quarantine at the gateway was initiated. An incident commander worked closely with base stakeholders to ensure infection control measures were implemented while medical care, security, food, and other accommodations were provided for the more than 1,200 personnel housed in the quarantine area, which included the 30 buildings shown in Figure 1. Building D2 was designated the isolation building for all newly identified sick cases. That building was chosen to isolate symptomatic patients because the index case originally slept there and all service members residing in that building had potentially been exposed. The building was also chosen because it was closest to the latrine that had already been used by several confirmed cases.

The same day, the theater PM physician recommended a tiered approach to isolation and quarantine in an effort to control the spread of disease by placing all service members into 4 groups. Group 1 consisted of symptomatic cases who were isolated in building D2. Group 2 comprised those recovering from GI illness who were isolated in another building for an additional 24 hours after symptoms resolved. Group 3 included exposed service members who had not exhibited any symptoms but were being contained in the D and E blocks during the length of the incubation period (72 hours). Group 4 was composed of others in the general population who never exhibited symptoms and were not knowingly exposed to the ill population. Groups 1–3 remained inside the quarantine area, and most were released by 29 May. Service members in group 4 were free to move throughout Camp Arifjan but were restricted from entering the quarantine area. Barricade tape sectioned off the approximately 300 yard perimeter, and military police secured the perimeter to prevent service members from entering or leaving the quarantine zone.

On 28 May, survey forms (Figure 3) were developed to expedite the screening process for medically clearing service members. Providers and medics were recruited from the quarantined units to assist with administering the survey in the quarantined area. The form was designed to be cut in half so that service members could keep a copy and use it as their ticket to leave the quarantined area and move freely within Camp Arifjan if they had been medically cleared to do so. Two health care providers, 20 medics, and 1 public health nurse administered the surveys to the service members who were billeted in the quarantine buildings. Two PM technicians were assigned to each row of quarantined buildings. PM technicians and the public health nurse instructed cleaning teams in each building on the mixing of bleach solution and proper cleaning procedures, according to guidelines from the Centers for Disease Control and Prevention. All personnel were medically evaluated and all buildings were sanitized by 2300 on May 28. At 2400 that evening, the quarantine area was reduced to building D2, where sick personnel remained, and to specified bathrooms.

Editorial Comment

The operational impact of the outbreak at Camp Arifjan was dramatic. Not only was there a surge in illness among service members in transit, the definitive steps taken to preclude the spread of the contagious virus elsewhere resulted in the shutdown of a key USCENTCOM transit station for about 10 days. The unique setting and circumstances of this outbreak highlight several public health gaps faced by deployed service members and those providing health care in this environment. Because no outbreak investigation standard operating procedure (SOP) was in place before this outbreak, the investigation and response were implemented de novo. The absence of an SOP for handling outbreaks is an acknowledged gap across many military treatment facilities, both within the U.S. and in deployed operations.10 The lack of an SOP delayed the initiation of an outbreak investigation by PM and nursing teams. The outbreak highlighted that cleaning staff were not initially using proper techniques to disinfect the latrines, which may have contributed to additional cases. The size of the outbreak and the concomitant tasks of identifying, finding, treating, and responding to the high number of cases overwhelmed the PM staff and directly impacted the delay in reporting details of this outbreak according to DOD policy until the outbreak was nearly over. An approved theater outbreak response plan is needed in order to help mitigate and prevent future outbreaks in theater. Such a plan should be centrally drafted at the level of the medical brigade, not by each unit or location. A general response plan should be encouraged for each location, but the PM assets and expertise required to manage an outbreak may not always be available at each location.

The physicians at the 75th Combat Support Hospital who evaluated and treated the index patient released him to return to his billeting. However, in a deployed environment, a significant consideration is to protect the force by removing patients who are potentially infectious from the general population. Although the theater PM physician and 223rd PM commander were able to identify and readmit the index case within 2 hours of his ED discharge, it is unknown how many others the index case may have exposed during this time, especially given the poor cleaning procedures being utilized during that period. A theater outbreak response plan must include specifics for protecting the health of other service members when one of them is ill and may be highly infectious.

Laboratory capabilities are limited throughout the theater. For most diseases requiring laboratory support, specimens are sent to Landstuhl Regional Medical Center for processing, which can cause a significant delay in diagnosis and treatment. However, for this outbreak, the use of the BioFire® system allowed for immediate testing of specimens in Camp Arifjan. As a result of this outbreak, the theater medical command learned the value of the rapid nucleic acid detection system and acquired additional systems for hospitals and traveling PM teams throughout the theater.

PM assets of the medical brigade, namely the theater PM physician and the commander of the PM detachment, advised the medical brigade commander to recommend to the installation commander the 3 major actions that resulted in control of the norovirus outbreak. Those actions were 1) the halting of flights in and out of Camp Arifjan; 2) the isolation of infected, symptomatic patients and the quarantine of recovering and exposed service members; and 3) the restriction of movement of service members to prevent spread of infection to others outside the quarantine area.

At the time of the Camp Arifjan outbreak, an additional outbreak thought to be due to norovirus occurred in a classified country, where 13 soldiers were identified with symptoms consistent with norovirus. On 27 May, a PM surveillance laboratory team and the theater PM physician were forward deployed to determine the root cause of that outbreak. A link between the 2 outbreaks could not be proven.

Given the number of service members located at Camp Arifjan at the time and the high attack rate of norovirus, the case count could have been in the thousands. Despite the successful response, this outbreak highlighted the need for a theater outbreak response plan, which should include details on responding to infectious patients in the deployed environment and frequent education and review of proper cleaning techniques and personal hygiene. This outbreak also demonstrated the importance of inclusion of the medical brigade PM teams for any outbreak investigations in theater. The epidemic curve suggests this was a point source epidemic, originating from the index case and then further spreading via person-to-person contact and contaminated environmental surfaces, including latrines. Because of the efforts of the public health teams, the outbreak response was successful in limiting the breadth and duration of the outbreak.

Author Affiliations: Army Satellite of Armed Forces Health Surveillance Branch, Defense Health Agency (Ms. Kebisek, Dr. Ambrose); 223rd Medical Detachment, Preventive Medicine (MAJ Richards); 223rd Medical Detachment, Microbiology (MAJ Hourihan); 75th Combat Support Hospital Detachment, Public Health Nursing (CPT Buckelew); Theater Preventive Medicine Physician, TF 1st MED (COL Finder)

References

  1. Armed Forces Health Surveillance Branch. Gastrointestinal infections, active component, U.S. Armed Forces, 2002–2012. MSMR. 2013;20(10):7–11.
  2. Armed Forces Health Surveillance Branch. Surveillance snapshot: Norovirus outbreaks among military forces, 2008–2016. MSMR. 2017;24(7):30.
  3. Armed Forces Health Surveillance Branch. Historical perspective: Norovirus gastroenteritis outbreaks in military forces. MSMR. 2011;18(11):7–8.Darling ND, Poss DE, Brooks KM, et al.
  4. Brief report: Laboratory characterization of noroviruses identified in specimens from Military Health System beneficiaries during an outbreak in Germany, 2016–2017. MSMR. 2017;24(7):2–29.
  5. Kasper MR, Lescano AG, Lucas C, et al. Diarrhea outbreak during U.S. military training in El Salvador. PLoS ONE. 2012;7(7).
  6. Putnam SD, Sanders JW, Frenck RW, et al. Self-reported description of diarrhea among military populations in Operations Iraqi Freedom and Enduring Freedom. J Travel Med. 2006;13(2):92–99.
  7. Riddle MS, Martin GJ, Murray CK, et al. Management of acute diarrheal illness during redeployment: a deployment health guideline and expert panel report. Mil Med. 2017;182(9):34–52.
  8. Centers for Disease Control and Prevention. Updated norovirus outbreak management and disease prevention guidelines. MMWR Recomm Rep. 2011;4(60):1–18.
  9. Centers for Disease Control and Prevention. Norovirus. https://www.cdc.gov/norovirus/about/index.html. Accessed 3 June 2019.
  10. Ambrose J, Kebisek J, Gibson K, White D. Gaps in reportable medical event surveillance across the Department of Defense and recommended tools to improve surveillance practices. MSMR. 2019. In press.
Layout of gateway area, where the majority of initial cases resided

Daily case count for confirmed and suspected norovirus cases, Camp Arifjan, May 2018Demographics of, and symptoms reported by, cases at Camp Arifjan, Kuwait

You also may be interested in...

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Healthcare Workers, August 2017–April 2022

Article
10/1/2022
Carl R. Darnall Army Medical Center, Fort Hood, Texas, Capt Claireisa Spencer prepares to administer a flu vaccine to a Fort Hood Army Exchange customer during CRDAMC’s celebration of National Influenza Vaccination Week.

Immunization Among U.S. Armed Forces Healthcare Workers

Recommended Content:

Medical Surveillance Monthly Report

Viral hepatitis C, active component, U.S. Armed Forces, 2011–2020

Article
10/1/2022
The Armed Services Blood Program (ASBP) is the official blood program of the U.S. military. It is a joint operation that collects, tests, stores, transports and distributes blood products to military locations around the world, wherever and whenever it’s needed most.

This study reports updated numbers and incidence rates of hepatitis C virus (HCV) infection among active component members of the U.S. military using a revised case definition during a 10-year surveillance period between 2011 and 2020.

Recommended Content:

Medical Surveillance Monthly Report

Update: Contraception Among Active Component Service Women, U.S. Armed Forces, 2017–2021

Article
10/1/2022
JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas (Oct. 20, 2021) -- Brooke Army Medical Center now offers female service members a walk-in clinic for contraception on Wednesdays from noon to 2 p.m. in the Adolescent and Young Adult Medicine Clinic at the CPT Jennifer M. Moreno Clinic.

This report 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 contraceptives from 2017 through 2021 among active component U.S. service women.

Recommended Content:

Medical Surveillance Monthly Report

MSMR Vol. 29 No. 10 - October 2022

Report
10/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

Letter to the Editor: Clarification of Hepatitis C Virus Screening with Case Definitions and Prevalence Among Trainees

Article
9/1/2022
ALBANY, Ga. (May 11, 2022) - Hospital Corpsman 2nd Class Leeanna Grzemski, a lab technician at Naval Branch Health Clinic Albany, takes a blood sample. Grzemski, a native of Weatherford, Texas, says, “Best part of my job is meeting and interacting with our patients.” (U.S. Navy photo by Deidre Smith, Naval Hospital Jacksonville/Released).

We read with interest the brief report regarding the prevalence of Hepatitis C Virus (HCV) infection in basic military trainee blood donors by Kasper and colleagues in the November 2021 issue of the Medical Surveillance Monthly Report (MSMR),1 an update of a previous similar report

Recommended Content:

Medical Surveillance Monthly Report

Update: Routine Screening for Antibodies to Human Immunodeficiency Virus, U.S. Armed Forces, Active and Reserve Components, January 2017–June 2022

Article
9/1/2022
NAVAL MEDICAL CENTER CAMP LEJEUNE, North Carolina - As the leading petty officer for Naval Medical Center Camp Lejeune's Community Health Clinic, HM2 Kameron Jacobs is part of the first satellite team to treat service members living with HIV.

This report provides an update through June 2022 of routine screening results for antibodies to the human immunodeficiency virus (HIV) among members of the active and reserve components of the U.S. Armed Forces. During the full 5 and 1/2-year surveillance period, the HIV seropositivity rates for active component service members were 0.21 positives per 1,000 members of the Army, 0.24 for the Navy, 0.16 for the Marine Corps, and 0.14 for the Air Force.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Menstrual Suppression Among U.S. Female Service Members in the Millennium Cohort Study

Article
9/1/2022
U.S. Marine Corps Lance Cpl. Bobby Brodeur, a Gilford, New Hampshire, native and machine gunner with 3rd Battalion, 6th Marine Regiment, 2d Marine Division, conducts gun drills at Camp Lejeune, North Carolina, Oct. 13, 2022. Brodeur is currently serving as a machine gunner with 3/6 and is one of three female infantry Marines in Kilo Co. She has demonstrated an unwavering commitment to 3/6 through her high physical fitness scores and leading by example within the platoon. (U.S. Marine Corps photo by Lance Cpl. Megan Ozaki)

Menstrual suppression allows for the control or complete suppression of menstrual periods through hormonal contraceptive methods. In addition to preventing pregnancy, suppression can alleviate medical conditions and symptoms associated with menstruation such as iron deficiency anemia,1 eliminate logistical hygiene-related challenges, and improve quality of life.

Recommended Content:

Medical Surveillance Monthly Report

Evaluation of the MSMR Surveillance Case Definition for Incident Cases of Hepatitis C

Article
9/1/2022
U.S. Marine Corps Lance Cpl. Angel Alvarado, a combat graphics specialist, donates blood for the Armed Services Blood Program (ASBP).

The validity of military hepatitis C virus (HCV) surveillance data is uncertain due to the potential for misclassification introduced when using administrative databases for surveillance purposes. The objectives of this study were to assess the validity of the surveillance case definition used by the Medical Surveillance Monthly Report (MSMR) for HCV, the over and underestimation of cases from surveillance data, and the true burden of HCV disease in the U.S. military.

Recommended Content:

Medical Surveillance Monthly Report

MSMR Vol. 29 No. 09 - September 2022

Report
9/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

Musculoskeletal Injuries During U.S. Air Force Special Warfare Training Assessment and Selection, Fiscal Years 2019–2021.

Article
8/1/2022
U.S. Air Force Capt. Hopkins, 351st Special Warfare Training Squadron, Instructor Flight commander and Chief Combat Rescue Officer (CRO) instructor, conducts a military free fall equipment jump from a DHC-4 Caribou aircraft in Coolidge, Arizona, July 17, 2021. Hopkins is recognized as the 2020 USAF Special Warfare Instructor Company Grade Officer of the Year for his outstanding achievement from January 1 to December 31, 2020.

Musculoskeletal (MSK) injuries are costly and the leading cause of medical visits and disability in the U.S. military.1,2 Within training envi­ronments, MSK injuries may lead to a loss of training, deferment to a future class, or voluntary disenrollment from a training pipeline, all of which are impediments to maintaining full levels of manpower and resources for the Department of Defense.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Pain and Post-Traumatic Stress Disorder Screening Outcomes Among Military Personnel Injured During Combat Deployment.

Article
8/1/2022
U.S. Air Force Airman 1st Class Miranda Lugo, right, 18th Operational Medical Readiness Squadron mental health technician and Guardian Wingman trainer, and Maj. Joanna Ho, left, 18th OMRS director of psychological health, discuss the suicide prevention training program, Guardian Wingman, at Kadena Air Base, Japan, Aug. 20, 2021. Guardian Wingman aims to promote wingman culture and early help-seeking behavior. (U.S. Air Force photo by Airman 1st Class Anna Nolte)

The post-9/11 U.S. military conflicts in Iraq and Afghanistan lasted over a decade and yielded the most combat casualties since the Vietnam War. While patient survivability increased to the high­est level in history, a changing epidemiology of combat injuries emerged whereby focus shifted to addressing an array of long-term sequelae, including physical, psychologi­cal, and neurological issues.

Recommended Content:

Medical Surveillance Monthly Report

Prevalence and Distribution of Refractive Errors Among Members of the U.S. Armed Forces and the U.S. Coast Guard, 2019.

Article
8/1/2022
Ophthamologist Air Force Maj. Thuy Tran evaluates a patient during an eye exam. (U.S. Air Force photo by Tech. Sgt. John Hughel)

During calendar year 2019, the estimated prevalence of myopia, hyperopia, and astigmatism were 17.5%, 2.1%, and 11.2% in the active component of the U.S. Armed Forces and 10.1%, 1.2%, and 6.1% of the U.S. Coast Guard, respectively.

Recommended Content:

Medical Surveillance Monthly Report

MSMR Vol. 29 No. 08 - August 2022

Report
8/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Medical Surveillance Monthly Report

Establishment of SARS-CoV-2 Genomic Surveillance Within the Military Health System During 1 March–31 December 2020.

Article
7/1/2022
Dr. Peter Larson loads an Oxford Nanopore MinION sequencer in support of COVID-19 sequencing assay development at the U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland. (Photo by John Braun Jr., USAMRIID.)

This report describes SARS-CoV-2 genomic surveillance conducted by the Department of Defense (DOD) Global Emerging Infections Surveillance Branch and the Next-Generation Sequencing and Bioinformatics Consortium (NGSBC) in response to the COVID-19 pandemic. Samples and sequence data were from SARS-CoV-2 infections occurring among Military Health System (MHS) beneficiaries from 1 March to 31 December 2020.

Recommended Content:

Medical Surveillance Monthly Report

Suicide Behavior Among Heterosexual, Lesbian/Gay, and Bisexual Active Component Service Members in the U.S. Armed Forces.

Article
7/1/2022
  The DOD’s theme for National Suicide Prevention Month is “Connect to Protect: Support is Within Reach.” Deployments, COVID-19 restrictions, and the upcoming winter season are all stressors and potential causes for depression that could lead to suicidal ideations. Options are available to individuals who are having thoughts of suicide and those around them (Photo by Kirk Frady, Regional Health Command Europe).

Lesbian, gay, and bisexual (LGB) individuals are at a particularly high risk for suicidal behavior in the general population of the United States. This study aims to determine if there are differences in the frequency of lifetime suicide ideation and suicide attempts between heterosexual, lesbian/gay, and bisexual service members in the active component of the U.S. Armed Forces. Self-reported data from the 2015 Department of Defense Health-Related Behaviors Survey were used in the analysis.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 14
Refine your search
Last Updated: November 02, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery