Skip to main content

Military Health System

Update: Incidence of Acute Gastrointestinal Infections and Diarrhea, Active Component, U.S. Armed Forces, 2010–2019

Recommended Content:

Medical Surveillance Monthly Report

WHAT ARE THE NEW FINDINGS?

The crude overall incidence rate of unspecified gastroenteritis/diarrhea among active component service members during 2010– 2019 was more than 75 times the combined overall rates of acute GI infections attributable to the 5 specific pathogens of interest. Annual rates of unspecified gastroenteritis/diarrhea and all pathogen-specific GI infections except Shigella increased over the course of the 10-year period.

WHAT IS THE IMPACT ON READINESS AND FORCE HEALTH PROTECTION?

Unspecified gastroenteritis and diarrheal illnesses remain prevalent among military personnel and can significantly degrade service members’ readiness for duty. Increased diagnostic testing of nonspecific acute GI infections is warranted to further elucidate which GI pathogens are the most prevalent in this population.

ABSTRACT

Laboratory, reportable medical event, and medical encounter data were analyzed to identify incident cases of acute gastrointestinal (GI) infections caused by Campylobacter, nontyphoidal Salmonella, Shigella, Escherichia coli (E. coli), or norovirus as well as cases of unspecified gastroenteritis/diarrhea among U.S. active component service members during 2010–2019. Unspecified gastroenteritis/diarrhea diagnoses accounted for 98.8% of identified incident cases (4,135.1 cases per 100,000 person-years [p-yrs]). Campylobacter was the most frequently identified specific etiology (17.6 cases per 100,000 p-yrs), followed by nontyphoidal Salmonella (12.7 cases per 100,000 p-yrs), norovirus (10.8 cases per 100,000 p-yrs), E. coli (7.5 cases per 100,000 p-yrs) and Shigella (3.2 cases per 100,000 p-yrs). Crude annual rates of norovirus, E. coli, Campylobacter, and Salmonella infections and unspecified gastroenteritis/diarrhea increased between 2010 and 2019 while rates of Shigella infections were relatively stable. Among deployed service members during the 10-year period, only 150 cases of the 5 specific causes of gastroenteritis were identified but a total of 20,377 cases of unspecified gastroenteritis/diarrhea were diagnosed (3,062.9 per 100,000 deployed p-yrs).

BACKGROUND

Acute gastrointestinal (GI) infections and diarrheal disease have been the perennial cause of significant morbidity in military personnel in both deployed and nondeployed settings.1,2 In American military personnel, acute diarrheal illness was the most commonly reported noncombat disease among deployed personnel during Operation Iraqi Freedom and Operation Enduring Freedom.3 More recent analyses of the burden of diarrheal disease among active component U.S. service members estimated that diarrheal diseases accounted for 42,601 healthcare encounters affecting 36,387 service members in 2019.4

Acute GI infections can be caused by many bacterial, viral, or parasitic pathogens; however, studies in military populations have often focused on Campylobacter spp., nontyphoidal Salmonella spp., Shigella spp., norovirus, or Escherichia coli as pathogens responsible for a majority of GI infections.5–7 In 2017, the Medical Surveillance Monthly Report (MSMR) published estimated incidence rates of diagnoses of Campylobacter, nontyphoidal Salmonella, Shigella, norovirus, and E. coli infections among active component service members during 2007–2016.8–11 The current report updates and expands upon these previous analyses by estimating incidence rates of diagnoses of GI infections attributed to the aforementioned 5 pathogens as well as diagnoses of unspecified gastroenteritis/diarrhea among active component service members between 2010 and 2019.

METHODS

The surveillance period was 1 January 2010 through 31 December 2019. The surveillance population consisted of all active component service members of the U.S. Armed Forces who served in the Army, Navy, Air Force, or Marine Corps at any time during the 10-year surveillance period.

Diagnoses of pathogen-specific acute GI infections (Campylobacter, nontyphoidal Salmonella, Shigella, norovirus, or E. coli) and unspecified gastroenteritis/diarrhea were ascertained from records of reports of notifiable medical events and from administrative records of all medical encounters of individuals who received care in fixed (i.e., not deployed or at sea) medical facilities of the Military Health System (MHS) or civilian facilities in the Purchased CareThe TRICARE Health Program is often referred to as purchased care. It is the services we “purchase” through the managed care support contracts.purchased care system. All such records are maintained in the Defense Medical Surveillance System. In addition, acute GI infection cases were ascertained from Navy and Marine Corps Public Health Center records of laboratory identification of GI pathogens in stool or rectal samples tested in laboratories of the MHS.

For surveillance purposes, an incident case of acute GI infection was defined as any one of the following: 1) a laboratoryconfirmed identification of GI infection in a stool or rectal sample, 2) a reportable medical event record of “confirmed” GI infection, 3) a single hospitalization with any of the defining diagnoses for acute GI infections in any diagnostic position, or 4) a single outpatient encounter with any of the defining diagnoses for GI infections in any diagnostic position (Table 1). An incident case of unspecified gastroenteritis/diarrhea was defined as 1 hospitalization or outpatient medical encounter with any of the case defining diagnoses of diarrhea in any diagnostic position (Table 1).

An individual could be considered a case once every 180 days for each of the 5 types of acute GI infections and unspecified gastroenteritis/diarrhea. The incidence date was considered the date of the earliest rectal or fecal sample that was confirmed positive for each acute GI infection, the date documented in a reportable medical event report for each acute GI infection, or the date of the first hospitalization or outpatient medical encounter that included the defining diagnosis of a case of acute GI infection/diarrhea. Incidence rates were calculated as the number of cases per 100,000 person-years (p-yrs).

Cases of acute GI infections and unspecified gastroenteritis/diarrhea occurring during deployments were analyzed separately. These cases were identified from the medical records of deployed service members whose healthcare encounters were documented in the Theater Medical Data Store (TMDS). An incident case during deployment was based on a single medical encounter with a diagnosis recorded in the TMDS that occurred between the start and end dates of a service member’s deployment record.

RESULTS

During 2010–2019, there were 2,241 diagnosed cases of Campylobacter infections, 1,616 of Salmonella infections, 406 of Shigella infections, 952 of E. coli infections, 1,379 of norovirus infections, and 527,357 diagnosed cases of unspecified gastroenteritis among active component service members (Table 2). The crude overall incidence rates per 100,000 p-yrs were 17.6 for Campylobacter infections, 12.7 for Salmonella infections, 3.2 for Shigella infections, 7.5 for E. coli infections and 10.8 for norovirus infections. The crude overall incidence rate of unspecified gastroenteritis/ diarrhea (4,135.1 per 100,000 p-yrs) was more than 75 times the combined overall rates of acute GI infections attributable to the 5 specific pathogens of interest.

Examination of overall incidence rates by demographic characteristics showed that, compared with males, females had higher rates of all 5 types of acute GI infections and unspecified gastroenteritis/ diarrhea (Table 2). Active component service members aged 45 years or older had the highest overall rates of Campylobacter and E. coli infections. Compared with those in older age groups, younger service members had the highest rates of norovirus infection and unspecified gastroenteritis/diarrhea. For Shigella infections, service members between 35 and 39 years old had the highest overall incidence rate. Relative to those in other race/ethnicity groups, non-Hispanic black service members had lower rates of Campylobacter, Salmonella, and norovirus infections but the highest rates of Shigella infections and unspecified gastroenteritis/diarrhea (Table 2). Across the services, members of the Army and Air Force had higher rates of all 5 types of acute GI infections and unspecified gastroenteritis/diarrhea compared with members of the other services. Marine Corps members had the lowest overall rates of Campylobacter, Shigella, and norovirus infections as well as the lowest rate of unspecified gastroenteritis/diarrhea. With the exception of Campylobacter and Shigella infections, recruits had higher overall incidence rates compared with nonrecruits. Service members in healthcare occupations had the highest overall rates of all types of GI infections, except for norovirus, compared with those working in other military occupations.

Over the course of the 10-year surveillance period, crude annual incidence rates of E. coli infections and unspecified gastroenteritis/diarrhea increased by 89.6% and 54.8%, respectively. Crude annual rates of Campylobacter infections increased from 2010 through 2017 (82.6%) and then were relatively stable for the remainder of the surveillance period. Crude annual rates of norovirus infections decreased from 11.1 per 100,000 p-yrs in 2010 to a low of 3.5 per 100,000 p-yrs in 2014, after which rates increased steadily to a peak of 24.5 per 100,000 p-yrs in 2019. Annual rates of Salmonella infections fluctuated between a low of 10.4 per 100,000 p-yrs in 2010 and a high of 16.0 per 100,000 p-yrs in 2016. Annual rates of Shigella infections were relatively stable during the 10-year period and, with the exception of 2015, were consistently lower than the rates of the other types of GI infections (Figure 1).

Between 2010 and 2019, the highest percentages of cases of infection by the bacterial pathogens of interest tended to be diagnosed and/or reported during the warmer months in the Northern Hemisphere (Figures 2a–2d). The most pronounced seasonal patterns were seen for cases of Campylobacter and Salmonella infections; the highest percentages of total Campylobacter cases were diagnosed from May through August (Figure 2a) and the majority of total Salmonella infection cases were diagnosed between June and October (60.6%) (Figure 2b). Unlike cases of infection by these bacterial pathogens, the majority of total norovirus infection cases were diagnosed during November–March (60.8%), with the highest percentage of total cases in March (Figure 2e). The highest percentage of unspecified gastroenteritis/diarrhea cases was diagnosed in March (10.2%); however, the distribution of monthly percentages for unspecified gastroenteritis/diarrhea showed the least variation compared to those of the other 5 types of GI infection (Figure 2f).

During the 10-year surveillance period, there were 11 diagnosed cases of Campylobacter infections, 56 of Salmonella infections, 11 of Shigella infections, 43 of E. coli infections, and 29 of norovirus infections among deployed active component service members (data not shown). The paucity of cases precluded any attempts to identify demographic patterns of infection during deployment. A total of 20,377 cases of unspecified gastroenteritis/diarrhea were diagnosed during the surveillance period among deployed active component service members for a crude overall incidence rate of 3,062.9 per 100,000 deployed p-yrs. Compared to their respective counterparts, females, those aged 50 years or older, non-Hispanic blacks, Air Force members, and commissioned officers had higher overall rates of unspecified gastroenteritis/diarrhea. Deployed active component service members in other/unknown military occupations, communications/intelligence, and healthcare had higher overall rates of unspecified gastroenteritis/diarrhea compared to those working in other occupations (Table 3).

EDITORIAL COMMENT

In the current analysis, the vast majority (98.8%) of cases identified during 2010–2019 represented diagnoses of unspecified gastroenteritis/diarrhea. The crude overall incidence rate of unspecified gastroenteritis/diarrhea was considerably higher than the combined overall rates of GI infections attributable to the 5 pathogens of interest. For acute GI infections with identified bacterial etiologies, the highest incidence rates were for Campylobacter infections, followed by Salmonella, E. coli, and Shigella. Crude annual incidence rates of all pathogen-specific acute GI infections except Shigella increased over the course of the 10-year surveillance period. Rates of norovirus infections rose by the highest percentage overall (119.9%), with the greatest slope of increase occurring between 2014 and 2019. Crude annual rates of unspecified gastroenteritis/diarrhea also increased during this period while rates of Shigella infections were relatively stable.

Comparatively few diagnoses of the pathogen-specific acute GI infections of interest were ascertained from TMDS records of deployed service members’ healthcare encounters during the 10-year study period. While acute diarrheal illness is common in the deployed setting, many cases will not undergo laboratory testing. This can be due to the self-limited nature of the condition, potentially rapid resolution of cases as a result of effective treatment, or limited laboratory capabilities in theater.12

It is important to note that the incidence rates reported here likely underestimate the true burden of acute GI infections and diarrheal disease in this population. To be counted as a case in this analysis, military personnel had to seek medical care and receive a diagnosis of acute GI infection or diarrhea, have a positive laboratory result for 1 of the specified GI pathogens, or be reported as a case in the reportable medical event system. However, many individuals with GI illnesses do not seek medical care for their illnesses. In a recent systematic review of traveler’s diarrhea (TD), incidence rates of TD were higher in studies that relied on self-report rather than on clinical diagnosis or reportable medical events.5 The same review reported that only 38% of individuals reporting diarrheal illnesses sought medical care.5 Another limitation of the current analysis is that many acute GI infections were not attributed to particular pathogens because of the lack of testing to determine specific etiologies. Finally, the laboratory data used in this analysis did not include laboratory tests conducted in the civilian purchased care system, so positive tests in that system are not reflected in this report.

Despite the likely underascertainment of total cases of pathogen-specific acute GI infection, the counts and rates of the types of infections reported here represent findings consistent with earlier MSMR analyses8–11 and the known epidemiology of these pathogens.13 Since no pattern of seasonality was observed for unspecified gastroenteritis/diarrhea, it is unclear whether these cases were predominantly caused by viral or bacterial pathogens. Given that unspecified gastroenteritis and diarrheal illnesses remain prevalent among military personnel and can significantly degrade service members’ readiness for duty, increased diagnostic testing of nonspecific acute GI infections is warranted to further elucidate which GI pathogens are the most prevalent in this population.

Acknowledgments: The authors thank the Navy and Marine Corps Public Health Center, Portsmouth, VA, for providing laboratory data for this analysis.

REFERENCES

1. Connor P, Farthing MJ. Travellers’ diarrhoea: a military problem? J R Army Med Corps. 1999;145(2):95–101.

2. Riddle MS, Savarino SJ, Sanders JW. Gastrointestinal Infections in Deployed Forces in the Middle East Theater: An Historical 60 Year Perspective. Am J Trop Med Hyg. 2015;93(5):912–917.

3. Riddle MS, Tribble DR, Putnam SD, et al. Past trends and current status of self-reported incidence and impact of disease and nonbattle injury in military operations in Southwest Asia and the Middle East. Am J Public Health. 2008;98(12):2199–2206.

4. Armed Forces Health Surveillance Branch. Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2019. MSMR. 2020;27(5):39–49.

5. Olson S, Hall A, Riddle MS, Porter CK. Travelers' diarrhea: update on the incidence, etiology and risk in military and similar populations—1990–2005 versus 2005–2015, does a decade make a difference?. Trop Dis Travel Med Vaccines. 2019;5:1.

6. Brooks KM, Zeighami R, Hansen CJ, McCaffrey RL, Graf PCF, Myers CA. Surveillance for norovirus and enteric bacterial pathogens as etiologies of acute gastroenteritis at U.S. military recruit training centers, 2011-2016. MSMR. 2018;25(8):8–12.

7. Mullaney SB, Hyatt DR, Salman MD, Rao S, McCluskey BJ. Estimate of the annual burden of foodborne illness in nondeployed active duty US Army Service Members: five major pathogens, 2010-2015. Epidemiol Infect. 2019;147:e161.

8. O'Donnell FL, Stahlman S, Oh GT. Incidence of Campylobacter intestinal infections, active component, U.S. Armed Forces, 2007–2016. MSMR. 2017;24(6):2–5.

9. Williams VF, Stahlman S, Oh GT. Incidence of nontyphoidal Salmonella intestinal infections, active component, U.S. Armed Forces, 2007– 2016. MSMR. 2017;24(6):6–10.

10. Williams VF, Stahlman S, Oh GT. Incidence of Shigella intestinal infections, active component, U.S. Armed Forces, 2007–2016. MSMR. 2017;24(6):11–15.

11. Clark LL, Stahlman S, Oh GT. Using records of diagnoses from healthcare encounters and laboratory test results to estimate the incidence of norovirus infections, active component, U.S. Armed Forces, 2007–2016: limitations to this approach. MSMR. 2017;24(6):16–19.

12. Riddle MS, Martin GJ, Murray CK, et al. Management of acute diarrheal illness during deployment: A deployment health guideline and expert panel report. Mil Med. 2017;182(S2):34–52.

13. Graves NS. Acute gastroenteritis. Prim Care Clin Office Pract. 2013;40(3):727–741.

FIGURE 1. Crude annual incidence rates of GI infections, by type of infection, active component, U.S. Armed Forces, 2010–2019

FIGURE 2. Cumulative percentage distributions of diagnoses and reported cases of GI infections and unspecified gastroenteritis/diarrhea, by type of infection and month of clinical presentation or diagnosis, active component, U.S. Armed Forces, 2010–2019

TABLE 1. ICD-9 and ICD-10 diagnostic codes used to identify cases of GI infection and unspecified gastroenteritis/diarrhea

TABLE 2. Incident cases and incidence rates of GI infections by type of infection, active component, U.S. Armed Forces, 2010–2019

TABLE 3. Number of incident cases and incidence rates of unspecified gastroenteritis/diarrhea, active component service members during deployment, 2010–2019

You also may be interested in...

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

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

Outbreak of Acute Respiratory Illness Associated with Adenovirus Type 4 at the U.S. Naval Academy, 2016

Article
2/1/2019
Malaria case definition

Human adenoviruses (HAdVs) are known to cause respiratory illness outbreaks at basic military training (BMT) sites. HAdV type-4 and -7 vaccines are routinely administered at enlisted BMT sites, but not at military academies. 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. During 22 August–11 September 2016, 652 clinic visits for ARI were identified using electronic health records. HAdV-4 was confirmed by real-time polymerase chain reaction assay in 18 out of 33 patient specimens collected and 1 additional HAdV case was detected from hospital records. Two HAdV-4 positive patients were treated for pneumonia including 1 hospitalized patient. Molecular analysis of 4 HAdV-4 isolates identified genome type 4a1, which is considered vaccine-preventable. Understanding the impact of HAdV in congregate settings other than enlisted BMT sites is necessary to inform discussions regarding future HAdV vaccine strategy.

Recommended Content:

Medical Surveillance Monthly Report

Update: Incidence of Glaucoma Diagnoses, Active Component, U.S. Armed Forces, 2013–2017

Article
2/1/2019
Glaucoma

Glaucoma is an eye disease that involves progressive optic nerve damage and vision loss, leading to blindness if undetected or untreated. 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. The analysis identified 37,718 incident cases of glaucoma and an overall incidence rate of 5.9 cases per 1,000 person-years (p-yrs). The majority of cases (97.6%) were diagnosed at an early stage as borderline glaucoma; of these borderline cases, 2.2% progressed to open-angle glaucoma during the study period. No incident cases of absolute glaucoma, or total blindness, were identified. Rates of glaucoma were higher among non-Hispanic black (11.0 per 1,000 p-yrs), Asian/Pacific Islander (9.5), and Hispanic (6.9) service members, compared with non-Hispanic white (4.0) service members. Rates among female service members (6.6 per 1,000 p-yrs) were higher than those among male service members (5.8). Between 2013 and 2017, incidence rates of glaucoma diagnoses increased by 75.4% among all service members.

Recommended Content:

Medical Surveillance Monthly Report

Re-evaluation of the MSMR Case Definition for Incident Cases of Malaria

Article
2/1/2019
Anopheles merus

The MSMR has been publishing the results of surveillance studies of malaria since 1995. The standard MSMR case definition uses Medical Event Reports and records of hospitalizations in counting cases of malaria. This report summarizes the performance of the standard MSMR case definition in estimating incident cases of malaria from 2015 through 2017. Also explored was the potential surveillance value of including outpatient encounters with diagnoses of malaria or positive laboratory tests for malaria in the case definition. The study corroborated the relative accuracy of the MSMR case definition in estimating malaria incidence and provided the basis for updating the case definition in 2019 to include positive laboratory tests for malaria antigen within 30 days of an outpatient diagnosis.

Recommended Content:

Medical Surveillance Monthly Report

Update: Malaria, U.S. Armed Forces, 2018

Article
2/1/2019
Anopheles merus

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. In 2018, a total of 58 service members were diagnosed with or reported to have malaria. This represents a 65.7% increase from the 35 cases identi­fied in 2017. The relatively low numbers of cases during 2012–2018 mainly reflect decreases in cases acquired in Afghanistan, a reduction due largely to the progressive withdrawal of U.S. forces from that country. The percentage of cases of malaria caused by unspecified agents (63.8%; n=37) in 2018 was the highest during any given year of the surveillance period. The percent­age of cases identified as having been caused by Plasmodium vivax (10.3%; n=6) in 2018 was the lowest observed during the 10-year surveillance period. The percentage of malaria cases attributed to P. falciparum (25.9 %) in 2018 was similar to that observed in 2017 (25.7%), although the number of cases increased. Malaria was diagnosed at or reported from 31 different medical facilities in the U.S., Afghanistan, Italy, Germany, Djibouti, and Korea. Pro­viders of medical care to military members should be knowledgeable of and vigilant for clinical manifestations of malaria outside of endemic areas.

Recommended Content:

Medical Surveillance Monthly Report

Thyroid Disorders, Active Component, U.S. Armed Forces, 2008–2017

Article
12/1/2018

This analysis describes the incidence and prevalence of five thyroid disorders (goiter, thyrotoxicosis, primary/not otherwise specified [NOS] hypothyroidism, thyroiditis, and other disorders of the thyroid) among active component service members between 2008 and 2017. During the 10-year surveillance period, the most common incident thyroid disorder among male and female service members was primary/NOS hypothyroidism and the least common were thyroiditis and other disorders of thyroid. Primary/NOS hypothyroidism was diagnosed among 8,641 females (incidence rate: 43.7 per 10,000 person-years [p-yrs]) and 11,656 males (incidence rate: 10.2 per 10,000 p-yrs). Overall incidence rates of all thyroid disorders were 3 to 5 times higher among females compared to males. Among both males and females, incidence of primary/NOS hypothyroidism was higher among non-Hispanic white service members compared with service members in other race/ethnicity groups. The incidence of most thyroid disorders remained stable or decreased during the surveillance period. Overall, the prevalence of most thyroid disorders increased during the first part of the surveillance period and then either decreased or leveled off.31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

Incidence and Prevalence of the Metabolic Syndrome Using ICD-9 and ICD-10 Diagnostic Codes, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018

This report uses ICD-9 and ICD-10 codes (277.7 and E88.81, respectively) for the metabolic syndrome (MetS) to summarize trends in the incidence and prevalence of this condition among active component members of the U.S. Armed Forces between 2002 and 2017. During this period, the crude overall incidence rate of MetS was 7.5 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, overall incidence rates were highest among Asian/Pacific Islanders, Air Force members, and warrant officers and were lowest among those of other/unknown race/ethnicity, Marine Corps members, and junior enlisted personnel and officers. During 2002–2017, the annual incidence rates of MetS peaked in 2009 at 11.6 cases per 100,000 p-yrs and decreased to 5.9 cases per 100,000 p-yrs in 2017. Annual prevalence rates of MetS increased steadily during the first 11 years of the surveillance period reaching a high of 38.9 per 100,000 active component service members in 2012, after which rates declined slightly to 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

Adrenal Gland Disorders, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018

During 2002–2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). In both sexes, overall rates of other disorders of adrenal gland and Cushing’s syndrome were lower than for adrenal insufficiency but higher than for hyperaldosteronism, adrenogenital disorders, and adrenomedullary hyperfunction. Crude overall rates of adrenal gland disorders among females tended to be higher than those of males, with female:male rate ratios ranging from 2.1 for adrenal insufficiency to 5.5 for androgenital disorders and Cushing’s syndrome. The highest overall rates of adrenal insufficiency for males and females were among non-Hispanic white service members. Among females, rates of Cushing’s syndrome and other disorders of adrenal gland were 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

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 | Medical and Dental Preventive Care Fitness | Health Readiness & Combat Support

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 Division | Medical Surveillance Monthly Report

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 Division | 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 Division | Medical Surveillance Monthly Report
<< < ... 11 12 > >> 
Showing results 166 - 180 Page 12 of 12
Refine your search
Last Updated: September 14, 2020
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery