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AFHSB tracks bugs worldwide to protect service members

Group of people in forest gathering samples MAJ Jaree Johnson (far right) and her team conducted field insecticidal resistance surveillance to establish a baseline for potential resistant mosquitoes on Aberdeen Proving Ground in Maryland.

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Armed Forces Health Surveillance Branch | Global Emerging Infections Surveillance | Bug-Borne Illnesses

Ticks, mosquitoes, and other blood-feeding arthropods can transmit dangerous pathogens to U.S. military personnel. The Armed Forces Health Surveillance Branch’s (AFHSB) Global Emerging Infections Surveillance (GEIS) program monitors these ticks and mosquitoes—also called vectors—for disease and the pathogens they carry in order to prevent the spread of diseases to Service members.

“The U.S. military has a long history of battling vector-borne diseases. Protecting our Service members is vital to the Department of Defense labs, host countries, and regional partners who conduct disease surveillance work to understand the threats that may impact military personnel and local populations,” said Navy Capt. Guillermo Pimentel, GEIS chief.

The GEIS Febrile and Vector-borne Infections (FVBI) program focuses on four areas:

  • identifying pathogens that cause fever in humans, like dengue or Zika
  • tracking malaria for mutations that might affect our ability to protect, diagnose, and treat our Service members
  • monitoring the distribution of the mosquitoes, ticks, and sandflies that transmit viruses and bacteria to humans
  • mapping and forecasting risk of these diseases 

The GEIS FVBI program supports vector and vector-borne disease surveillance projects in more than 40 countries around the world.

“We work closely with DoD laboratories and public health organizations in each of the geographic combatant command areas of responsibility,” said U.S. Public Health Service Lt. (Dr.) Brett Forshey, lead of the GEIS FVBI program. “These groups collaborate with other local partners in the region, which is key for extending our ability to conduct surveillance for these vectors and diseases.”

DoD partners within the GEIS network and their collaborators are on the ground gathering information about where mosquitoes, ticks, and sand flies are found in different parts of the world. GEIS partners then rely on extensive laboratory expertise to identify the species of mosquito, tick, or sand fly and determine which viruses, bacteria, and parasites they carry. GEIS partners also coordinate to determine how often mosquitoes resist chemicals commonly used to lower their populations.

One of our key projects is to bring all the mosquito and tick detection data together and use it to better understand the types of risks that exist for our Service members,” said Forshey. “Turning that data into actionable information for our military is a challenge, but one that needs to be addressed in order to provide the best guidance possible for those that might be exposed.”

Another issue is timeliness – transporting samples back to the lab can be time consuming and the information received may not be up-to-date. “We need to develop better processes that will allow us to quickly identify these arthropod vectors and pathogens they carry, to help make decisions to limit diseases and prevent transmission to military populations.

“We need to remember that before the current pandemic, West Nile, chikungunya, and Zika viruses emerged out of obscurity to spread rapidly to many parts of the world. There are surely many other pathogens transmitted by mosquitoes and ticks poised to do the same,” said Forshey. “We are still searching for vaccines and treatments for many of these pathogens. For others, we need to keep an eye on whether the vaccines and treatments still work.”

Pimentel agrees. “Knowing the threats and preventing exposure – including proper wear of insecticide-treated uniforms – is still the best way to keep our Service members healthy.”

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The DoD Global, Laboratory-Based, Influenza Surveillance Program is a DoD-wide, year-round program that tests respiratory specimens from DoD beneficiaries presenting to military treatment facilities with influenza-like illness (ILI). ILI is defined as an illness characterized by a fever 100.5 degrees F or greater and cough or sore throat within 72 hours of seeking treatment. Sentinel sites submit 6-10 specimens per week from beneficiaries presenting with ILI. Each specimen is tested via reverse transcription-polymerase chain reaction (RT-PCR) and viral culture. The 2014-2015 influenza season was dominated by influenza A (H3N2) at the beginning; however by Week 10, identifications of influenza B viruses were more numerous than for influenza A. Out of a total of 6,432 specimens, 32.7% were positive for influenza. Additionally 19.6% of specimens were positive for other respiratory pathogens while 47.7% specimens were negative. The molecular characterization of specimens showed that the majority of influenza A (H3N2) viruses circulating had drifted from the vaccine strain by December 2014. This finding was in agreement with the Centers for Disease Control and Prevention and World Health Organization observations during the 2014-2015 influenza season. For more information visit Health.mil/AFHSB

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The introduction and rapid spread of the Zika virus (ZIKV), a Flavivrus of the Flaviviridae family, across the Western Hemisphere have posed a risk of infection to Military Health System (MHS) beneficiaries. This report documents: •	The impact of ZIKV transmission on MHS beneficiaries. •	ZIKV spread to nearly 50 countries and territories within a 17-month period. •	Among affected service members, the Army reported the most Zika cases. •	There have been 156 confirmed cases of Zika in MHS beneficiaries. •	A majority of cases reported exposure in Puerto Rico (n=91, 58.3%). Geographic regions of potential exposure to Zika cases in MHS beneficiaries between 01 Jan – 30 Nov 2016 included: •	Puerto Rico ( 91 cases) •	Caribbean ( 41 cases) •	Central America & Mexico (15 cases) •	South America (6 cases) •	Asia ( 3 cases) •	Unknown (3) •	U.S. Florida (1 case) Cases in Service Members Between 01 Jan – 30 Nov 2016 were: •	Army (48 cases) •	Coast Guard (29 cases) •	Air Force (16 cases) •	Navy (10 cases) •	Marine Corps (7 cases) Although most ZIKV infections are asymptomatic or have a relatively mild illness, the gravity of pregnancy and neurologic issues linked to infection remains a significant impetus for the continued surveillance of ZIKV in the MHS population. For more Zika surveillance and information on signs and symptoms, visit Health.mil/AFHSB

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Findings from The Department of Defense Global, Laboratory-Based Influenza Surveillance Program, 2015-2016 Influenza Season

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The Department of Defense (DoD) Global, Laboratory-Based, Influenza Surveillance Program monitors the circulation of influenza viruses throughout each influenza season. Each season runs from the beginning of October through end of the next September. During the 2015 – 2016 influenza season, a total of 4,591 specimens were tested from 80 locations. The predominant influenza strain was A (H1N1) pdm09. Additionally peak influenza activity occurred during weeks 7 – 13 (14 February – 2 April 2016). Of those submitted for routine surveillance, 1,182 (25.7%) tested positive for other respiratory pathogens, 377 (8.2%) tested positive for influenza B, 755 (16.5%) tested positive for influenza A, and 2,277 (49.6%) tested negative. For more information on the 2015-2016 influenza season and how to identify influenza-like illness (ILI), read the Medical Surveillance Monthly Report (MSMR) at Health.mil/AFHSB.

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The new and improved Defense Medical Epidemiology Database (DMED), known as DMED 5.0, is now only available online.  DMED provides timely and efficient access to data of active component personnel and medical event data.  It contains a subset of data from the Defense Medical Surveillance System (DMSS), offering remote access to tri-service epidemiologic data. Moreover, it protects privacy using only de-identified data and updates monthly.  The new DMED features an enhanced user interface, query data using ICD-9 and ICD-10 diagnostic codes granting authorized users to search multiple databases simultaneously. These users are U.S. military personnel (DoD-CaC users) or Federal partners and civilian collaborators in military medical research and operations. Authorized U.S. military personnel with access to DMED include medical providers, epidemiologists, medical researchers, safety officers, and medical operations and clinical support staff. Sign up for a new account at www.health.mil/dmed

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Update: Exertional Hyponatremia U.S. Armed Forces, 2001-2016

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Exertional Hyponatremia occurs during or up to 24 hours after prolonged physical activity. It is defined by a serum, plasma or blood sodium concentration below 135 millequivalents per liter. This infographic provides an update on Exertional Hyponatremia among U.S. Armed Forces, information on service members at high risk. Exertional hyponatremia can result from loss of sodium and/or potassium as well as relative excess of body water. There were 1,519 incident diagnoses of exertional hyponatremia among active component service members from 2001 through 2016. 86.8 percent were diagnosed and treated without having to be hospitalized. 2016 represented a decrease of 23.3 percent from 2015. In 2016, there were 85 incident diagnoses of exertional hyponatremia among active component service members and 77.6 percent of exertional hyponatremia cases affected males.  The annual rate was higher among females. Service members age 40 and over were most affected by exertional hyponatremia. High risk service members of exertional hyponatremia were: •	Females •	Service members aged 19 years or younger •	White, non-Hispanic and Asian/ Pacific Islander service members •	Recruit Trainees •	Marine Corps members Learn more at www.Health.mil/MSMR

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