Back to Top Skip to main content

Update: Gallbladder Disease and Cholecystectomies, Active Component, U.S. Armed Forces, 2014–2018

Hansen's disease nerve A team of US military medical professionals participate in a cholecystectomy aboard the USNS Comfort in Colon, Honduras, Dec. 10, 2018. The ship’s medical personnel provided care for 5,475 patients including 159 surgeries, 3,338 medical patients, 1, 426 optometry patients and 711 dental patients. (U.S. Army photo by Maria Pinel)

Recommended Content:

Medical Surveillance Monthly Report

ABSTRACT

The term gallbladder disease refers to a variety of conditions of the gallbladder and the biliary tract. The more common of these conditions are cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder), and these conditions often are treated with cholecystectomy (gallbladder removal). During the 2014–2018 surveillance period, 8,008 active component service members were identified as incident cases of gallbladder disease. The crude overall incidence rate of gallbladder disease was 1.2 per 1,000 person-years; the crude annual rate decreased very slightly during the period. A total of 6,470 active component service members underwent incident cholecystectomies. Almost all (97.4%) were performed laparoscopically, and the majority were performed in outpatient settings (65.2%). The number of hospital bed days per open cholecystectomy far exceeded those per laparoscopic cholecystectomy. However, the number of hospital bed days per open cholecystectomy markedly decreased throughout the period. Gallbladder disease and cholecystectomies were more common among service members who were female, American Indian/Alaska Native or Hispanic, older, in the Air Force, and in healthcare occupations. Clinicians should continue to advocate for lifestyle changes, such as maintaining a healthy weight and a diet low in fat and cholesterol, that could prevent gallbladder disease. Similarly, continued Department of Defense-wide initiatives to promote healthy lifestyles could also help prevent gallbladder disease and maintain the health of the force.

WHAT ARE THE NEW FINDINGS?    

Annual rates of gallbladder disease in active component service members during the 2014–2018 period declined slightly compared to the 2004–2013 period, when rates increased. About 1,601 new cases of gallbladder disease and 1,294 cholecystectomies occurred annually during the surveillance period. Over 97% of cholecystectomies were performed via laparoscopy, a technique that reduces the duration of recovery compared to an open surgical approach.

WHAT IS THE IMPACT ON READINESS AND FORCE HEALTH PROTECTION?

Gallbladder disease and cholecystectomy are not rare, affecting approximately 1 out of every 1,000 service members per year. Their availability for duty and deployability are adversely impacted during the evaluation, surgical treatment, and convalescence associated with gallbladder disease. Risk factors for such disease that are susceptible to modification include excess body weight, a diet with a high fat or cholesterol content, diabetes, and certain medications.

BACKGROUND

The gallbladder is a small (3-inch long), hollow, pear-shaped organ located in the upper right section of the abdomen, just under the right lobe of the liver. The gallbladder stores bile produced by the liver and releases it into the small intestine after a meal to help dissolve fat. Gallbladder disease, including cholelithiasis (gallstones), is common in the U.S. and often results in cholecystitis (inflammation of the gallbladder). Cholecystitis can result in severe pain in the upper right or center abdomen, pain that spreads in the right shoulder or back, tenderness over the abdomen when touched, nausea, vomiting, or fever, particularly after a large or fatty meal. Although these symptoms may be avoided by reducing the amount of fatty and highly processed foods as well as whole milk dairy products consumed, gallbladder removal (cholecystectomy) is recommended when symptoms become frequent, recurrent, or more severe. Gallbladder removal is typically achieved with the minimally invasive laparoscopic technique, which involves inserting a camera and dissection tools through several small incisions in the abdominal wall.1 Open cholecystectomy, which requires a 4- to 6-inch incision1 and longer hospitalization and convalescence periods, is only used if the laparoscopic method is not possible or cannot be completed safely because the gallbladder is severely inflamed, infected, or scarred from other operations.

Gallbladder disease is related to nonmodifiable risk factors, such as being female, being older than 40 years of age, having a family history of gallbladder disease, and being of American Indian or Hispanic descent,2–8 as well as modifiable risk factors, such as being overweight or obese, rapid fluctuations in body weight, a high-fat or high-cholesterol diet, diabetes, and certain medications.2–8 Pregnancy and parity have also been shown to be associated with an increased risk of gallstone formation.2,7,8

It is estimated that over 20 million people in the U.S. have gallstones, and symptoms caused by gallstones are a primary gastrointestinal cause for hospital admissions and healthcare utilization.3,7,9 Furthermore, over 500,000 laparoscopic cholecystectomies are performed annually in the U.S., making it one of the most common abdominal surgeries performed, costing roughly $6.5 billion per year.7,10

A previous MSMR report showed very slight increases in the crude annual incidence rates of gallbladder disease and cholecystectomies among active component members of the U.S. Armed Forces from 2004 through 2013.11 Although outcomes related to laparoscopic cholecystectomy are generally good, an increase in the rates of gallbladder disease could negatively impact the readiness of the force. This report updates the counts and rates of newly diagnosed gallbladder disease and cholecystectomies among U.S. active component service members during 2014–2018.

METHODS

The surveillance period was 01 January 2014 through 31 December 2018. The surveillance population included all active component service members of the Army, Navy, Air Force, and Marine Corps who served at any time during the surveillance period. For the purposes of this report, “gallbladder disease” included not only cholelithiasis and cholecystitis, but also other or unspecified disorders of the gallbladder and other or unspecified disorders of the biliary tract (Table 1). An incident (first-ever) case of gallbladder disease was defined as an inpatient encounter with a case-defining International Classification of Diseases (ICD) code in the primary diagnostic position or 2 outpatient encounters with a relevant ICD code in the primary diagnostic position (Table 1). An individual was considered a case once per lifetime. The type of gallbladder disease was categorized based on the diagnosis specified in the primary diagnostic position for the incident encounter. A prevalent case was defined in the same manner as an incident case, but it occurred before the start of the surveillance period. Individuals with 1 encounter before the start of the surveillance period and 1 after were classified as prevalent cases. Person-time was censored at the incident event and prevalent cases were removed from the study population. Those with diagnoses in non-primary positions were also excluded.

A case of cholecystectomy was defined as an inpatient encounter with a procedure code (PR code) for cholecystectomy in any position or an outpatient encounter with a Current Procedural Terminology (CPT) code for cholecystectomy in any position (Table 1). An individual was considered a case of cholecystectomy only once per lifetime; cholecystectomies were analyzed separately from gallbladder disease cases. For each incident case of cholecystectomy, if an individual had records of multiple procedures performed, inpatient encounters were preferentially selected over outpatient encounters and open cholecystectomies were prioritized over laparoscopic cholecystectomies.

Among the incident gallbladder disease cases that were identified during the surveillance period, the number and percentage of cases with a cholecystectomy encounter whose date was on or after their incident gallbladder disease diagnosis were identified. The average time between incident gallbladder disease diagnosis and first subsequent cholecystectomy encounter was calculated. Similarly, for all individuals with an incident cholecystectomy identified during the surveillance period, the number and percentage of cases with gallbladder disease diagnoses (made in any diagnostic position) during an encounter on or before the date of their incident cholecystectomy were identified. The average time between incident cholecystectomy and first gallbladder disease diagnosis was calculated.

Finally, a burden analysis was performed to identify the morbidity and healthcare burden of gallbladder disease and cholecystectomy during the surveillance period. For this analysis, all inpatient and outpatient encounters with a diagnosis of gallbladder disease in the primary diagnostic position during the study period were included. No more than 1 encounter per person per day was counted. If there were multiple encounters on the same day, inpatient encounters were prioritized over outpatient encounters. The total number of encounters, hospital bed days, and individuals affected were calculated according to standard MSMR burden methodology.12

RESULTS

Gallbladder disease

During the 5-year surveillance period, 8,008 incident diagnoses of gallbladder disease were documented on inpatient or outpatient medical records of active component service members (Table 2). The crude overall rate of incident gallbladder disease diagnoses was 1.2 per 1,000 person-years (p-yrs). A majority of the cases were diagnosed as cholelithiasis (65.8%); cholecystitis was reported among 14.6% of cases, and other/unspecified disorders of the gallbladder/biliary tract were reported among 19.6% (data not shown). Crude annual incidence rates of all gallbladder disease diagnoses (total) decreased very slightly during the surveillance period from 1.3 per 1,000 p-yrs in 2014 to 1.1 per 1,000 p-yrs in 2018 (Figure 1).

Compared to their respective counterparts, service members who were female, American Indian/Alaska Native or Hispanic, in the Air Force or Army, and in healthcare occupations had higher overall incidence rates of gallbladder disease (Table 2). Overall incidence rates increased approximately linearly with increasing age (Table 2).

Cholecystectomy

From 2014 through 2018, a total of 6,470 active component service members underwent cholecystectomies (Table 2). The overall incidence rate of cholecystectomy was 1.0 per 1,000 p-yrs. Slightly more than three-fifths of all the procedures were performed in the outpatient setting (n=4,220; 65.2%), and the vast majority were performed laparoscopically (n=6,300; 97.4%) (data not shown). There was a small decrease in the annual rate of total cholecystectomy procedures during the surveillance period from 1.1 per 1,000 p-yrs in 2014 to 0.87 per 1,000 p-yrs in 2018, with slight decreases observed in the rates of inpatient and outpatient cholecystectomies as well as open and laparoscopic cholecystectomies (Figure 2).

On average, there were 0.7 hospital bed days per laparoscopic cholecystectomy and 4.8 bed days per open cholecystectomy (data not shown). The number of hospital bed days per laparoscopic cholecystectomy remained under 1 bed day during each year of the surveillance period and was stable throughout the surveillance period (Figure 3). Bed days per open cholecystectomy decreased each year from a high of 6.6 bed days in 2014 to a low of 2.3 bed days in 2018.

Relationship between gallbladder disease diagnoses and cholecystectomy

Of the 8,008 individuals who were identified as incident cases of gallbladder disease, 5,720 (71.4%) were also identified as having a cholecystectomy performed following their first-ever case-defining encounter. Among the gallbladder disease cases who had cholecystectomies, 23.3% had their first-ever gallbladder encounter on record on the same day as the cholecystectomy. The average interval between first-ever gallbladder disease diagnosis and surgery was 44 days (data not shown).

Among the 6,470 service members who were identified as having undergone cholecystectomy, 98.7% (n=6,388) had at least 1 gallbladder disease-related encounter before their cholecystectomy (data not shown). Among the cholecystectomy cases, the average number of days between their first-ever gallbladder disease encounter and cholecystectomy was slightly more than 4 months (123 days).

EDITORIAL COMMENT

The annual rates of gallbladder disease declined very slightly between 2014 and 2018. Gallbladder disease was newly diagnosed in approximately 1,600 active component service members on average each year between 2014 and 2018. A total of 6,470 incident cholecystectomies were performed during this period.

A previously published MSMR report documented a slight overall increase in the annual rates;11 however, data toward the end of the surveillance period may have indicated the beginning of the slight decline documented in this report. It is possible that the increase shown in that 2014 report tracked with the increase in obesity rates,11 as obesity is a known risk factor for gallbladder disease. Indeed, the Millennium Cohort study, MSMR analyses, and the recently published Department of Defense (DoD) Health of the Force have shown that the prevalence of obesity among service members, while still lower than the prevalence among the general U.S. population, has been increasing.13–15 However, the current analysis cannot clarify the reasons for the decreases seen. It should be noted, though, that the increases and decreases documented in both reports represent very slight changes that may not be clinically or epidemiologically meaningful.

Consistent with studies of the prevalence of gallbladder disease in the U.S. and elsewhere, the overall rates of gallbladder disease were highest among females, American Indians/Alaska Natives or Hispanics, and those in the oldest age groups. As indicated in the previous MSMR report, the higher overall rates among those in the Air Force and healthcare occupations may be because those groups have comparatively higher proportions of females and older individuals.11

In line with the slightly declining trend observed in the crude annual rates of gallbladder disease, the rates of both inpatient and outpatient and open and laparoscopic cholecystectomies also decreased slightly. Laparoscopic cholecystectomies performed in the outpatient setting continue to be the standard of care.1 The number of hospital bed days per laparoscopic cholecystectomy stayed under 1 bed day throughout the surveillance period. The number of bed days per open cholecystectomy in particular has shown a steep and steady decline throughout the 5-year surveillance period.

The mean number of days between the incident gallbladder disease encounter and cholecystectomy among service members with gallbladder disease was 44 days (range = 0 days–4.8 years), which suggests that clinicians and affected individuals are not waiting long before gallbladder removal. This may be related to a variety of factors, including surgical options with a very short recovery period, access to free health care, and the military’s need to maintain a fit and ready force. On the other hand, the mean number of days between incident gallbladder disease encounter and cholecystectomy among all those who had a cholecystectomy (123 days; range = 0 days–18.7 years) increased slightly from the previous MSMR report (82 days; range = 0 days–14.8 years).

The number of cholecystectomy cases exceeded the number of incident gallbladder disease cases who underwent cholecystectomy because some individuals did not have gallbladder disease case-qualifying encounters (e.g., the individual had only 1 outpatient encounter or had a case-defining diagnosis reported in a non-primary diagnostic position) and were not counted in this report. Furthermore, other gallbladder encounters may have occurred before entrance into military service, before the surveillance period, or in healthcare settings outside the Military Health System (MHS).

Interpretation of the findings in this report should be done with consideration of some limitations. This report likely underestimates the rates of cholecystectomy after a gallbladder disease diagnosis, as some service members may have left military service or were lost to follow-up before surgery. Moreover, the surveillance period may have ended before some of the cases that were identified later in the period underwent surgery. Another limitation of the current analysis is related to the implementation of MHS GENESIS, the new electronic health record for the MHS. For 2017–2018, medical data from sites that were using MHS GENESIS are not available in the Defense Medical Surveillance System. These sites include Naval Hospital Oak Harbor, Naval Hospital Bremerton, Air Force Medical Services Fairchild, and Madigan Army Medical Center. Therefore, medical encounter and person-time data for individuals seeking care at any of these facilities during 2017–2018 were not included in the analysis.

Although the rates of gallbladder disease and cholecystectomies declined slightly among all active component service members during the study period, gallbladder disease and cholecystectomies are not rare and the rates are higher among those with identified risk factors for gallstone formation. Clinicians should continue to advocate for lifestyle changes, such as maintaining a healthy weight and a diet low in fat and cholesterol, that could prevent gallbladder disease. Similarly, continued DoD-wide initiatives to promote healthy lifestyles could also help prevent gallbladder disease and maintain the health of the force.

 

REFERENCES

1. Johns Hopkins University. Cholecystectomy. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/cholecystectomy_92,P07689/. Accessed 19 June 2019.

2. Mayo Clinic. Diseases and conditions: gallstones. http://www.mayoclinic.org/diseases-conditions/gallstones/basics/definition/con-20020461. Accessed 19 June 2019.

3. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172–187.

4. Nakeeb A, Comuzzie AG, Martin L, et al. Gallstones: genetics versus environment. Ann Surg. 2002;235(6):842–849.

5. Arevalo JA, Wollitzer AO, Corporon MB, Larios M, Huante D, Ortiz MT. Ethnic variability in cholelithiasis—an autopsy study. West J Med. 1987;147;44–47.

6. Miquel JF, Covarrubias C, Villaroel L, et al. Genetic epidemiology of cholesterol cholelithiasis among Chilean Hispanics, Amerindians, and Maoris. Gastroenterol. 1998;115(4):937–946.

7. Figueiredo JC, Haiman C, Porcel J, et al. Sex and ethnic/racial-specific risk factors for gallbladder disease. BMC Gastroenterol. 2017;17(1):153.

8. Grodstein F, Colditz GA, Hunter DJ, Manson JE, Willett WC, Stampfer MJ. A prospective study of symptomatic gallstones in women; relation with oral contraceptives and other risk factors. Obstet Gynecol. 1994;84(2):207–214.

9. Afdhal NH, Zakko SF. Gallstones: epidemiology, risk factors and prevention. UpToDate. https://www.uptodate.com/contents/gallstones-epidemiology-risk-factors-and-prevention?search=cholelithiasis&topicRef=654&source=see_link. Accessed 19 June 2019.

10. Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost analysis and supply utilization of laparoscopic cholecystectomy. Minim Invasive Surg. 2018;Dec:7838103.

11. Armed Forces Health Surveillance Branch. Gallbladder disease and cholecystectomies, active component, U.S. Armed Forces, 2004–2013. MSMR. 2014;21(6):8–11.

12. Armed Forces Health Surveillance Branch. Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2018. MSMR. 2019;26(5):2–10.

13. Clark LL, Stephen TB. Update: Diagnosis of overweight and obesity, active component, U.S. Armed Forces, 2011–2015. MSMR. 2016;23(9):9–13.

14. Rush T, LeardMann CA, Crum-Cianflone NF. Obesity and associated adverse health outcomes among US military members and veterans: findings from the Millennium Cohort Study. Obesity. 2016;24(7):1582–1589.

15. Armed Forces Health Surveillance Branch. DoD Health of the Force 2018. Falls Church, VA: Defense Health Agency; 2019.

Incidence rates of gallbladder disease diagnoses by type, active component, U.S. Armed Forces, 2014–2018

Incidence rates of cholecystectomy by type, active component, U.S. Armed Forces, 2014–2018

Ratio of bed days per cholecystectomy by year and type, active component, U.S. Armed Forces, 2014–2018

Gallbladder disease case-defining ICD-9/ICD-10 codes and cholecystectomy PR codes

Demographic and military characteristics of service members with gallbladder disease and cholecystectomies, active component, U.S. Armed Forces, 2014–2018

You also may be interested in...

Rhabdomyolysis

Infographic
4/13/2018
Rhabdomyolysis

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Hyponatremia

Infographic
4/13/2018
Exertional, or exercise-associated, hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 milliequivalents/liter) that develops during or up to 24 hours following prolonged physical activity.

Exertional, or exercise-associated, hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 milliequivalents/liter) that develops during or up to 24 hours following prolonged physical activity.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Cardiovascular Diseases

Infographic
4/4/2018
At the time of entry into military service, many members of the U.S. Armed Forces are young, physically active, and in good physical health. However, following entry, many service members develop or are discovered to have risk factors for cardiovascular disease (CVD). This report documents the incidence and prevalence of select risk factors for CVD among active component (AC) service members and provides estimates of the incidence rates of major categories of cardiovascular diseases themselves.

At the time of entry into military service, many members of the U.S. Armed Forces are young, physically active, and in good physical health. However, following entry, many service members develop or are discovered to have risk factors for cardiovascular disease (CVD). This report documents the incidence and prevalence of select risk factors for CVD among active component (AC) service members and provides estimates of the incidence rates of major categories of cardiovascular diseases themselves.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Mental Health Problems

Infographic
4/4/2018
This report summarizes the numbers, natures, and rates of incident mental health disorder diagnoses as well as mental health problems among active component U.S. service members during 2007–2016.

This report summarizes the numbers, natures, and rates of incident mental health disorder diagnoses as well as mental health problems among active component U.S. service members during 2007–2016.

Recommended Content:

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

Surveillance for Vector-Borne Diseases, Active and Reserve Component Service Members, U.S. Armed Forces, 2010 – 2016

Infographic
2/14/2018
Within the U.S. Armed Forces considerable effort has been applied to the prevention and treatment of vector-borne diseases. A key component of that effort has been the surveillance of vector-borne diseases to inform the steps needed to identify where and when threats exist and to evaluate the impact of preventive measures. This report summarizes available health records information about the occurrence of vector-borne infectious diseases among members of the U.S. Armed Forces, during a recent 7-year surveillance period. For the 7-surveillance period, there were 1,436 confirmed cases of vector-borne diseases, 536 possible cases, and 8,667 suspected cases among service members of the active and reserve components. •	“Confirmed” case = confirmed reportable medical event. •	“Possible” case = hospitalization with a diagnosis for a vector-borne disease. •	“Suspected” case = either a non-confirmed reportable medical event or an outpatient medical encounter with a diagnosis of a vector-borne disease. Lyme disease (n=721) and malaria (n=346) were the most common diagnoses among confirmed and possible cases. •	In 2015, the annual numbers of confirmed case of Lyme disease were the fewest reported during the surveillance period. •	Diagnoses of Chikungunya (CHIK) and Zika (ZIKV) were elevated in the years following their respective entries into the Western Hemisphere: CHIK (2014 and 2015); ZIKV (2016). The available data reinforce the need for continued emphasis on the multidisciplinary preventive measures necessary to counter the ever-present threat of vector-borne disease. Access the full report in the February 2018 MSMR (Vol. 25, No. 2). Go to www.Health.mil/MSMR  Background graphic shows service member in the field and insects which spread vector borne diseases.

This infographic summarizes available health records information about the occurrence of vector-borne infectious diseases among members of the U.S. Armed Forces, during a recent 7-year surveillance period (2010 – 2016).

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report | Preventing Mosquito-Borne Illnesses | Chikungunya | Malaria | Zika Virus

Malaria U.S. Armed Forces, 2017

Infographic
2/14/2018
Since 1999, the Medical Surveillance Monthly Report (MSMR) has published periodic updates on the incidence of malaria among U.S. service members. Malaria infection remains an important health threat to U.S. service members, who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. This update for 2017 describes the epidemiologic patterns of malaria incidence in active and reserve component service members of the U.S. Armed Forces. Findings •	A total of 32 service members were diagnosed with or reported to have malaria, which is the lowest number of cases in any given year during the 10-year surveillance period. •	Health records documented the performance of laboratory tests for malaria for 22 of the cases. The tests for 17 of the 22 were positive for malaria ( stick figure graphic visually depicts this information). •	In 2017, 75.0% (24 of 32) of malaria cases among U.S. service members were diagnosed during May – October (calendar graphic showing the months visually). •	Of the 32 malaria cases in 2017, more than 1/3 of the infections were considered to have been acquired in Africa. Two bar charts display the following information: •	Bar chart 1: Numbers of malaria cases by Plasmodium species and calendar year of diagnosis/report, active and reserve components, U.S. Armed Forces, 2008 – 2017  •	Bar chart 2: Annual numbers of cases of malaria associated with specific locations of acquisition, active and reserve components, U.S. Armed Forces, 2008 – 2017  The majority of U.S. military members diagnosed with malaria in 2017 were: •	Male (96.9%) •	Active component (81.3%) •	In the Army (75.0%) •	In their 20’s (56.3%) Access the full report in the February 2018 MSMR (Vol. 25 No. 2). Go to www.Health.mil/MSMR  Picture of a mosquito displays on the graphic.

This update for 2017 describes the epidemiologic patterns of malaria incidence in active and reserve component service members of the U.S. Armed Forces.

Recommended Content:

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

Outbreak of Influenza and Rhinovirus co-circulation among unvaccinated recruits, U.S. Coast Guard Training Center Cape May, NJ, 24 July – 21 August 2016

Infographic
2/5/2018
On 29 July 2016, the U.S. Coast Guard Training Center Cape May (TCCM), NJ, identified an increase in febrile respiratory illness (FRI) among recruits who were unvaccinated against seasonal influenza as a result of the annual vaccine’s expiration. This report characterizes the outbreak and containment measures implemented at TCCM during the outbreak period. In 2016, respiratory infections affected more than 250,000 U.S. service members and comprised approximately 22% of medical encounters among military recruit populations – who are highly susceptible to respiratory infections. Seasonal influenza and rhinovirus are two of the leading respiratory pathogens. During the Surveillance Period: 115 recruits reported respiratory infection symptoms. Pie chart 1 shows the following data: •	41 (35.7%) suspected cases •	74 (64.3%) confirmed cases Among confirmed cases, lab specimens tested positive for: •	Influenza A 34 (45.9%) •	Rhinovirus 28 (37.8%) •	Influenza A and rhinovirus co-infection 11 (14.9%) •	Rhinovirus and adenovirus co-infection 1 (1.4%) Data above depicted in pie chart 2. •	24 July – 6 August, Influenza predominated •	7 August – 20 August, Rhinovirus predominated Although the outbreak significantly affected operations at TCCM, a timely and comprehensive response resulted in containment of the outbreak within 5 weeks. Key Factor for Outbreak Control •	Rapid detection through FRI sentinel surveillance •	Quick decision-making •	Streamlined response by using a single chain of command •	Rapid implementation of both nonpharmaceutical and pharmaceutical interventions Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

This report characterizes the outbreak and containment measures implemented at the U.S. Coast Guard Training Center Cape May (TCCM), New Jersey, during a July 24 – August 21, 2016 outbreak period.

Recommended Content:

Health Readiness | Medical Surveillance Monthly Report | Integrated Biosurveillance | Influenza Summary and Reports

Department of Defense Global, Laboratory-based Influenza Surveillance Program’s Influenza vaccine effectiveness estimates and surveillance trends, 2016 – 2017 Influenza Season

Infographic
2/5/2018
Each year, the Department of Defense (DoD) Global, Laboratory-based Influenza Surveillance Program performs surveillance for influenza among service members of the DoD and their dependent family members. In addition to routine surveillance, vaccine effectiveness (VE) studies are performed and results are shared with the Food and Drug Administration, Centers for Disease Control and Prevention, and the World Health Organization for vaccine evaluation. This report documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season VE results. The analysis was performed by the U.S. Air Force School of Aerospace Medicine Epidemiology Laboratory, and the DoD Influenza Surveillance Program staff at Wright-Patterson Air Force Base, OH. FINDINGS: A total of 5,555 specimens were tested from 84 locations: •	2,486 (44.7%) negative •	1,382 (24.9%) influenza A •	1,093 (19.7%) other respiratory pathogens •	443 (8.0%) influenza B •	151 (2.7%) co-infections The predominant influenza strain was A (H3N2), representing 73.8% of all circulating influenza. Pie chart displays this information. Graph showing the numbers and percentages of respiratory specimens positive for influenza viruses, and numbers of influenza viruses identified, by type, by surveillance week, Department of Defense healthcare beneficiaries, 2016 – 2017 influenza season displays. The vaccine effectiveness (VE) for this season was slightly lower than for the 2015 – 2016 season, which had a 63% (95% confidence interval: 53% - 71%) adjusted VE. The adjusted VE for the 2016 – 2017 season was 48% protective against all types of influenza.  Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

This infographic documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season vaccine effectiveness.

Recommended Content:

Health Readiness | Influenza Summary and Reports | Medical Surveillance Monthly Report | Vaccine-Preventable Diseases | Force Health Protection | Global Health Engagement

2018 #ColdReadiness Twitter chat recap: Preventing cold weather injuries for service members and their families

Fact Sheet
2/5/2018

To help protect U.S. armed forces, the Armed Forces Health Surveillance Branch (AFHSB) hosted a live #ColdReadiness Twitter chat on Wednesday, January 24th, 12-1:30 pm EST to discuss what service members and their families need to know about winter safety and preventing cold weather injuries as the temperatures drop. This fact sheet documents highlights from the Twitter chat.

Recommended Content:

Medical Surveillance Monthly Report | Winter Safety | Preventive Health | Health Readiness

Insomnia and motor vehicle accident-related injuries, Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
Insomnia is the most common sleep disorder in adults and its incidence in the U.S. Armed Forces is increasing. A potential consequence of inadequate sleep is increased risk of motor vehicle accidents (MVAs). MVAs are the leading cause of peacetime deaths and a major cause of non-fatal injuries in the U.S. military members. To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia. After adjustment for multiple covariates, during 2007 – 2016, active component service members with insomnia had more than double the rate of MVA-related injuries, compared to service members without insomnia. Findings:  •	Line graph shows the annual rates of motor vehicle accident-related injuries, active component service members with and without diagnoses of insomnia, U.S. Armed Forces, 2007 – 2016  •	Annual rates of MVA-related injuries were highest in the insomnia cohort in 2007 and 2008, and lowest in 2016 •	There were 5,587 cases of MVA-related injuries in the two cohorts during the surveillance period. •	Pie chart displays the following data: 1,738 (31.1%) in the unexposed cohort and 3,849 (68.9%) in the insomnia cohort The highest overall crude rates of MVA-related injuries were seen in service members who were: •	Less than 25 years old •	Junior enlisted rank/grade •	Armor/transport occupation •	 •	With a history of mental health diagnosis •	With a history of alcohol-related disorders Access the full report in the December 2017 (Vol. 24, No. 12). Go to www.Health.mil/MSMR Image displays a motor vehicle accident.

To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia.

Recommended Content:

Armed Forces Health Surveillance Branch | Health Readiness | Medical Surveillance Monthly Report

Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD.

Recommended Content:

Health Readiness | Posttraumatic Stress Disorder | Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report

Exertional heat injuries pose annual threat to U.S. service members

Article
7/20/2017
Two U.S. service members perform duties in warm weather where they may be exposed to extreme heat conditions and a higher risk of heat illness.

Exertional heat injuries pose annual threat to U.S. service members, according to a study published in Defense Health Agency’s Armed Forces Health Surveillance Branch (AFHSB) peer-reviewed journal, the Medical Surveillance Monthly Report.

Recommended Content:

Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report | Summer Safety

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

Fact Sheet
3/30/2017

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

Recommended Content:

Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report

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

Fact Sheet
3/30/2017

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

Recommended Content:

Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report

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

Fact Sheet
3/30/2017

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

Recommended Content:

Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report
<< < ... 6 7 8 9 10  ... > >> 
Showing results 136 - 150 Page 10 of 11

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.