Back to Top Skip to main content Skip to sub-navigation

Surveillance Snapshot: Incidence of Rickettsial Diseases Among Active and Reserve Component Service Members, U.S. Armed Forces, 2010–2018

Dorsal view of a female American dog tick, Dermacentor variabilis. Credit: CDC/Gary O. Maupin Dorsal view of a female American dog tick, Dermacentor variabilis. Credit: CDC/Gary O. Maupin

Recommended Content:

Medical Surveillance Monthly Report

Rickettsial diseases are vector-borne, bacterial infections that cause acute febrile illness throughout the world. Because symptoms of rickettsial diseases are often non-specific in nature and overlap with other febrile diseases with similar epidemiology, their diagnosis is challenging. The diagnostic difficulties likely contribute to the historical underreporting of cases of these diseases.

In 2018, the MSMR published a report on the surveillance of vector-borne disease in active and reserve component service members that included estimates of incident cases of rickettsial and related diseases during the surveillance period from 2010 through 2016.1 The analysis for this snapshot used similar methodology but restricted the analysis to rickettsial diseases and extended the surveillance period through 2018. A “confirmed” case was defined as an individual identified through a reportable medical event (RME) report of a rickettsial or related disease that was described as “confirmed” by having met specific laboratory and/or epidemiologic criteria.2 A “possible” case was defined by a record of hospitalization with a diagnosis for a rickettsial disease (Table 1) in any diagnostic position. A “suspected” case was defined by either an RME of a rickettsial disease without laboratory or epidemiologic confirmation or a record of an outpatient medical encounter with a diagnosis of a rickettsial disease in the first or second diagnostic position. An individual could be counted once per lifetime for each type of rickettsial disease. Individuals diagnosed as a case before the start of the surveillance period were excluded. Confirmed cases were prioritized over possible and suspected cases, respectively (Table 2).

These data indicate that a continued multidisciplinary focus on preventive measures to counter the threat of these diseases is warranted. Most important are effective vector control and adherence to personal protective measures.

 

REFERENCES

1. O'Donnell FL, Stahlman S, Fan M. Surveillance for vector-borne diseases among active and reserve component service members, U.S. Armed Forces, 2010–2016. MSMR. 2018;25(2):8–15.

2. Defense Health Agency. Armed Forces Health Surveillance Branch. Armed Forces Reportable Medical Events. Guidelines and Case Definitions, 2017. https://health.mil/reference-Center/Publications/2017/07/17/Armed-Forces-Reportable-Medical-Events-Guidelines. Accessed 17 July 2019.

ICD-9 and ICD-10 diagnostic codes used for classification of possible and suspected cases of rickettsiala and related diseases

Numbers of confirmed, possible, and suspected cases of rickettsial and related diseases, U.S. Armed Forces, 2010–2018

You also may be interested in...

Update: Heat Illness, Active Component, U.S. Armed Forces, 2018

Article
4/1/2019
Drink water the day before and during physical activity or if heat is going to become a factor. (Photo Courtesy: U.S. Air Force)

In 2018, there were 578 incident diagnoses of heat stroke and 2,214 incident diagnoses of heat exhaustion among active component service members. The overall crude incidence rates of heat stroke and heat exhaustion diagnoses were 0.45 cases and 1.71 cases per 1,000 person-years, respectively. In 2018, subgroup-specific rates of incident heat stroke diagnoses were highest among males and service members less than 20 years old, Asian/Pacific Islanders, Marine Corps and Army members, recruit trainees, and those in combat-specific occupations. Subgroup-specific incidence rates of heat exhaustion diagnoses in 2018 were notably higher among service members less than 20 years old, Asian/Pacific Islanders, Army and Marine Corps members, recruit trainees, and service members in combat-specific occupations. During 2014–2018, a total of 325 heat illnesses were documented among service members in Iraq and Afghanistan; 8.6% (n=28) were diagnosed as heat stroke. Commanders, small unit leaders, training cadre, and supporting medical personnel must ensure that the military members whom they supervise and support are informed about the risks, preventive countermeasures, early signs and symptoms, and first-responder actions related to heat illnesses.

Recommended Content:

Medical Surveillance Monthly Report

Update: Exertional Hyponatremia, Active Component, U.S. Armed Forces, 2003–2018

Article
4/1/2019
Drink water the day before and during physical activity or if heat is going to become a factor. (Photo Courtesy: U.S. Air Force)

From 2003 through 2018, there were 1,579 incident diagnoses of exertional hyponatremia among active component service members, for a crude overall incidence rate of 7.2 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, females, those less than 20 years old, and recruit trainees had higher overall incidence rates of exertional hyponatremia diagnoses. The overall incidence rate during the 16-year period was highest in the Marine Corps, intermediate in the Army and Air Force, and lowest in the Navy. Overall rates during the surveillance period were highest among Asian/Pacific Islander and non-Hispanic white service members and lowest among non-Hispanic black service members. Between 2003 and 2018, crude annual incidence rates of exertional hyponatremia peaked in 2010 (12.7 per 100,000 p-yrs) and then decreased to 5.3 cases per 100,000 p-yrs in 2013 before increasing in 2014 and 2015. The crude annual rate in 2018 (6.3 per 100,000 p-yrs) represented a decrease of 26.5% from 2015. Service members and their supervisors must be knowledgeable of the dangers of excessive water consumption and the prescribed limits for water intake during prolonged physical activity (e.g., field training exercises, personal fitness training, and recreational activities) in hot, humid weather.

Recommended Content:

Medical Surveillance Monthly Report

Modeling Lyme Disease Host Animal Habitat Suitability, West Point, New York

Article
4/1/2019
A deer basks in the morning sun at Joint Base San Antonio-Fort Sam Houston, Texas.  (Photo Courtesy: U.S. Air Force)

As the most frequently reported vector-borne disease among active component U.S. service members, with an incidence rate of 16 cases per 100,000 person-years in 2011, Lyme disease poses both a challenge to healthcare providers in the Military Health System and a threat to military readiness. Spread through the bite of an infected blacklegged tick, infection with the bacterial cause of Lyme disease can have lasting effects that may lead to medical discharge from the military. The U.S. Military Academy at West Point is situated in a highly endemic area in New York State. To identify probable areas where West Point cadets as well as active duty service members stationed at West Point and their families might contract Lyme disease, this study used Geographic Information System mapping methods and remote sensing data to replicate an established spatial model to identify the likely habitat of a key host animal—the white-tailed deer.

Recommended Content:

Medical Surveillance Monthly Report

Incidence, Timing, and Seasonal Patterns of Heat Illnesses During U.S. Army Basic Combat Training, 2014–2018

Article
4/1/2019
U.S. Marines participate in morning physical training during a field exercise at Marine Corps Base Camp Pendleton, California. (Photo Courtesy: U.S. Marine Corps)

Risk factors for heat illnesses (HIs) among new soldiers include exercise intensity, environmental conditions at the time of exercise, a high body mass index, and conducting initial entry training during hot and humid weather when recruits are not yet acclimated to physical exertion in heat. This study used data from the Defense Health Agency’s–Weather-Related Injury Repository to calculate rates and to describe the incidence, timing, and geographic distribution of HIs among soldiers during U.S. Army basic combat training (BCT). From 2014 through 2018, HI events occurred in 1,210 trainees during BCT, resulting in an overall rate of 3.6 per 10,000 BCT person-weeks (p-wks) (95% CI: 3.4–3.8). HI rates (cases per 10,000 BCT p-wks) varied among the 4 Army BCT sites: Fort Benning, GA (6.8); Fort Jackson, SC (4.4); Fort Sill, OK (1.8); and Fort Leonard Wood, MO (1.7). Although the highest rates ofHIs occurred at Fort Benning, recruits in all geographic areas were at risk. The highest rates of HI occurred during the peak training months of June through September, and over half of all HI cases affected soldiers during the first 3 weeks of BCT. Prevention of HI among BCT soldiers requires relevant training of both recruits and cadre as well as the implementation of effective preventive measures.

Recommended Content:

Medical Surveillance Monthly Report

Sexually Transmitted Infections

Infographic
3/20/2019
Sexually Transmitted Infections

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2010–2018.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Division | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Vasectomy

Infographic
3/20/2019
Vasectomy

There are few published studies of vasectomy and vasectomy reversal among the U.S. military population. To address these gaps, the current analysis describes the overall and annual incidence rates of vasectomy among active component service men during 2000–2017 by demographic and military characteristics and by type of surgical vas isolation procedure used. In addition, the median age at incident vasectomy and the time between incident vasectomy and first vasectomy reversal are described.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Testosterone Replacement Therapy

Infographic
3/20/2019
Testosterone Replacement Therapy

With the increasing number of testosterone deficiency diagnoses and potential health risks associated with initiation of TRT, it is important to understand the epidemiology of which U.S. service men are receiving TRT and whether these individuals have an indication for receiving treatment.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Division | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Male Infertility

Infographic
3/20/2019
Male Infertility

The current report updates and expands on the findings of the previous MSMR analysis of infertility among active component service men. Specifically, the current report summarizes the frequencies, rates, temporal trends, types of infertility, and demographic and military characteristics of infertility among active component service men during 2013–2017.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Division | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Adenovirus

Infographic
3/1/2019
Adenovirus

During August–September 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Malaria

Infographic
3/1/2019
Malaria

Since 1999, the Medical Surveillance Monthly Report has published regular updates on the incidence of malaria among U.S. service members. The MSMR’s focus on malaria reflects both historical lessons learned about this mosquito-borne disease and the continuing threat that it poses to military operations and service members’ health.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Division | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Glaucoma

Infographic
3/1/2019
Glaucoma

This report describes an analysis using the Defense Medical Surveillance System to identify all active component service members with an incident diagnosis of glaucoma during the period between 2013 and 2017.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report | Public Health

Brief Report: Male Infertility, Active Component, U.S. Armed Forces, 2013–2017

Article
3/1/2019
Sperm is the male reproductive cell  Photo: iStock

Infertility, defined as the inability to achieve a successful pregnancy after 1 year or more of unprotected sexual intercourse or therapeutic donor insemination, affects approximately 15% of all couples. Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male. A male factor contributes in part or whole to about 50% of cases of infertility. However, determining the true prevalence of male infertility remains elusive, as most estimates are derived from couples seeking assistive reproductive technology in tertiary care or referral centers, population-based surveys, or high-risk occupational cohorts, all of which are likely to underestimate the prevalence of the condition in the general U.S. population.

Recommended Content:

Medical Surveillance Monthly Report

Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2010–2018

Article
3/1/2019
Anopheles merus

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2010–2018. Infections with chlamydia were the most common, followed in decreasing order of frequency by infections with genital human papillomavirus (HPV), gonorrhea, genital herpes simplex virus (HSV), and syphilis. Compared to men, women had higher rates of all STIs except for syphilis. In general, compared to their respective counterparts, younger service members, non-Hispanic blacks, soldiers, and enlisted members had higher incidence rates of STIs. During the latter half of the surveillance period, the incidence of chlamydia and gonorrhea increased among both male and female service members. Rates of syphilis increased for male service members but remained relatively stable among female service members. In contrast, the incidence of genital HPV and HSV decreased among both male and female service members. Similarities to and differences from the findings of the last MSMR update on STIs are discussed.

Recommended Content:

Medical Surveillance Monthly Report

Vasectomy and Vasectomy Reversals, Active Component, U.S. Armed Forces, 2000–2017

Article
3/1/2019
Sperm is the male reproductive cell  Photo: iStock

During 2000–2017, a total of 170,878 active component service members underwent a first-occurring vasectomy, for a crude overall incidence rate of 8.6 cases per 1,000 person-years (p-yrs). Among the men who underwent incident vasectomy, 2.2% had another vasectomy performed during the surveillance period. Compared to their respective counterparts, the overall rates of vasectomy were highest among service men aged 30–39 years, non-Hispanic whites, married men, and those in pilot/air crew occupations. Male Air Force members had the highest overall incidence of vasectomy and men in the Marine Corps, the lowest. Crude annual vasectomy rates among service men increased slightly between 2000 and 2017. The largest increases in rates over the 18-year period occurred among service men aged 35–49 years and among men working as pilots/air crew. Among those who underwent vasectomy, 1.8% also had at least 1 vasectomy reversal during the surveillance period. The likelihood of vasectomy reversal decreased with advancing age. Non-Hispanic black and Hispanic service men were more likely than those of other race/ethnicity groups to undergo vasectomy reversals.

Recommended Content:

Medical Surveillance Monthly Report

Testosterone Replacement Therapy Use Among Active Component Service Men, 2017

Article
3/1/2019
Image of Marines carrying a wooden log for physical fitness. Click to open a larger version of the image.

This analysis summarizes the prevalence of testosterone replacement therapy (TRT) during 2017 among active component service men by demographic and military characteristics. This analysis also determines the percentage of those receiving TRT in 2017 who had an indication for receiving TRT using the 2018 American Urological Association (AUA) clinical practice guidelines. In 2017, 5,093 of 1,076,633 active component service men filled a prescription for TRT, for a period prevalence of 4.7 per 1,000 male service members. After adjustment for covariates, the prevalence of TRT use remained highest among Army members, senior enlisted members, warrant officers, non-Hispanic whites, American Indians/Alaska Natives, those in combat arms occupations, healthcare workers, those who were married, and those with other/unknown marital status. Among active component male service members who received TRT in 2017, only 44.5% met the 2018 AUA clinical practice guidelines for receiving TRT.

Recommended Content:

Medical Surveillance Monthly Report
<< < ... 6 7 8 9 10  ... > >> 
Showing results 136 - 150 Page 10 of 14

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.