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Surveillance Snapshot: Cervical Cancer Screening Among U.S. Military Service Women in the Millennium Cohort Study, 2003–2015

Lt. Cmdr. Leslye Green, staff obstetrician and gynecologist, Naval Hospital Pensacola (NHP), uses a model to discuss cervical cancer with a patient at NHP. According to the Centers for Disease Control and Prevention (CDC), cervical cancer is highly preventable because screening tests for cervical cancer and vaccines to protect against human papillomavirus (HPV), which is the main cause of cervical cancer, are readily available. Cervical cancer is highly treatable and associated with long survival and good quality of life when it is detected early. (U.S. Navy photo by Mass Communication Specialist 1st Class Brannon Deugan) Lt. Cmdr. Leslye Green, staff obstetrician and gynecologist, Naval Hospital Pensacola (NHP), uses a model to discuss cervical cancer with a patient at NHP. According to the Centers for Disease Control and Prevention (CDC), cervical cancer is highly preventable because screening tests for cervical cancer and vaccines to protect against human papillomavirus (HPV), which is the main cause of cervical cancer, are readily available. Cervical cancer is highly treatable and associated with long survival and good quality of life when it is detected early. (U.S. Navy photo by Mass Communication Specialist 1st Class Brannon Deugan)

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Medical Surveillance Monthly Report

The Millennium Cohort Study is a prospective study that was initiated in 2001 and includes over 200,000 current and prior U.S. military service members.1 Questionnaires are sent to participants approximately every 3 years to collect information on service related experiences as well as mental, physical, and behavioral health. Compliance with contemporary cervical cancer screening recommendations was determined among service women enrolled in the Millennium Cohort Study during 2003–2015. Current cervical cancer screening recommendations call for a Pap smear alone every 3 years in women aged 21–65 years or for a human papillomavirus (HPV) DNA test with or without a Pap test every 5 years for women aged 30–65 years.2 Women were considered eligible for screening in a given year if they were aged 21–62 years on the last day of the year, had served in the active component (i.e., at least 9 months in active component pay and strength rosters) for the concurrent year and 2 years before, had not had a hysterectomy, and had not separated from the military. Women were considered compliant with screening recommendations between 2003–2015 if they had a medical report of a Pap smear in the year of assessment or prior 2 calendar years. Women were also considered compliant with screening recommendations in 2013–2015 if they had HPV DNA testing completed within the previous 5 years.

Overall, among U.S. service women in the Millennium Cohort Study, the compliance rate increased from 61.2% in 2003 to a peak of 83.1% in 2010 then declined to a low of 59.8% in 2015 (Figure). During the first 7 years of the study period, compliance was highest among Air Force personnel. Between 2013 and 2015, compliance was highest among Coast Guard personnel. Compliance was lowest among Navy personnel in all but 1 year (2004) of the 13-year period. Compliance was also consistently higher for service women who had initiated the HPV vaccine than for women who had not (on average 6.3% higher). No differences in compliance were observed by cigarette smoking status, which was used as a surrogate measure of other health behaviors.

Author affiliations: Deployment Health Research Department in the Military Population Health Directorate, Naval Health Research Center, San Diego, CA (Dr. Matsuno, Dr. Porter, Mr. Warner, CAPT Wells); Leidos, San Diego, CA (Dr. Matsuno, Dr. Porter, Mr. Warner).

Disclaimer: One of the authors of this work is a military service member or employee of the U.S. Government. This work was prepared as part of their official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. This report was supported by the Military Operational Medicine Research Program under work unit no. 60002. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

REFERENCES

1. Gray GC, Chesbrough KB, Ryan MA, et al. The Millennium Cohort Study: a 21-year prospective cohort study of 140,000 military personnel. Mil Med. 2002;167(6):483–488.

2. U.S. Preventive Services Task Force. Final recommendation statement. Cervical cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening?ds=1&s=pap. Accessed 9 April 2020.

FIGURE. Cervical screening rates among service women, by branch of service, U.S. Armed Forces, 2003–2015

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

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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.

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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.

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

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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

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

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2/5/2018
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2018 #ColdReadiness Twitter chat recap: Preventing cold weather injuries for service members and their families

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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.

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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.

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