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Armed Forces Health Surveillance Branch

Health Surveillance, Analysis and Insight for Action

Armed Forces Health Surveillance Branch is the central epidemiology health resource for the US Military and Public Health

The Armed Forces Health Surveillance Branch (AFHSB) is the central epidemiologic resource for the U.S. Armed Forces, conducting medical surveillance to protect those who serve our nation in uniform and allies who are critical to our national security interests. Explore our website to learn about the critical role AFHSB plays in force health protection.

AFHSB provides timely, relevant, actionable and comprehensive health surveillance information to promote, maintain, and enhance the health of military and military-associated populations.

AFHSB critical functions are:

  • Acquire, analyze, interpret, disseminate information, and recommend evidence-based policy
  • Develop, refine, and improve standardized health surveillance methods
  • Serve as the focal point for sharing health surveillance products expertise and information
  • Coordinate a global program of military-relevant infectious disease surveillance

Explore our health surveillance resources to learn how to utilize our data applications, systems and the ways our health information analysis supports worldwide disease surveillance and public health activities to improve the U.S. military's Force Health Protection (FHP) program.

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Medical Surveillance Monthly Report

Medical Surveillance Monthly Report MSMR Online SubscriptionThe Medical Surveillance Monthly Report (MSMR) is AFHSB's flagship publication. The monthly peer-reviewed journal provides evidence-based estimates of the incidence, distribution, impact, and trends of health-related conditions among service members. Additionally, the MSMR focuses one issue per year on the absolute and relative morbidity burden attributable to various illnesses and injuries among service members and beneficiaries.

 View Current Report  View Archived Reports

Launch Proposal Management Information SystemThe Proposal Management Information Solution (ProMIS) program is a web-based application used to track surveillance projects funded by AFHSB's Global Emerging Infections Surveillance (GEIS) Operations section. Investigators in the GEIS partner network submit proposals for funding through the system, and GEIS Operations monitors the progress of those projects.

Launch ProMIS

DMED ButtonThe Defense Medical Epidemiology Database (DMED) provides worldwide access to de-identified data contained in the Defense Medical Surveillance System (DMSS). Through this user-friendly interface, authorized users can create customized queries of disease and injury rates in active duty populations.

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H7N9: August 30, 2017

Report
8/30/2017

This is a biosurveillance summary of H7N9: August 30, 2017, as reported by the Armed Forces Health Surveillance Branch. As of 30 August 2017, there have been 1,788 (+4) cases of Avian Influenza A (H7N9) since the first two cases were reported in February 2013. Read more:

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Mid-season influenza vaccine effectiveness estimates for the 2016 – 2017 influenza season

Infographic
8/28/2017
The Department of Defense (DoD) conducts year-round influenza surveillance for military healthcare beneficiaries and select civilian populations. Data from routine respiratory surveillance are used to estimate mid-season influenza vaccine effectiveness (VE) and these findings are shared at the Food and Drug Administration’s advisory committee meeting on U.S. influenza vaccine strain selection. DoD VE estimates from the Defense Health Agency’s Armed Forces Health Surveillance Branch (AFHSB) and Naval Health Research Center (NHRC) are presented in this report. Findings •	For all influenza types: VE was 42% as found by AFHSB-Air Force Satellite Cell, similar to NHRC’s overall VE of 45% •	Influenza A (H3N2) VE was 42% by AFHSB-AF estimation and VE was 46% as estimated by NHRC •	VE for Influenza B was slightly higher at 53% as estimated by AFHSB-AF •	AFHSB analysis found that VE against influenza A was 3% and VE against influenza A (H3N2) was 33% Table showing the mid-season influenza effectiveness estimates, 2016 –2017 displays. The mid-season influenza VE estimates indicated that vaccination reduced the odds of medically attended influenza infection by approximately 45% among DoD dependents and civilians. Access the full report in MSMR Vol. 24 No. 8 August 2017 at Health.mil/MSMR  Three photos display on this infographic: 1.	An elderly woman receiving a flu show from a female service member 2.	Female service member receives a flu shot 3.	Male physician hold a flu shot

This infographic documents Department of Defense mid-season influenza vaccine effectiveness estimates from the Defense Health Agency’s Armed Forces Health Surveillance Branch and Naval Health Research Center for the 2016 – 2017 influenza season.

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Armed Forces Health Surveillance Branch | Influenza Summary and Reports

Military infectious disease surveillance guards service members against illness

Article
8/23/2017
GEIS laboratory partners conduct surveillance of vector-borne diseases that are transmitted to humans, animals, and plants through arthropods such as mosquitoes. A U.S. Air Force Senior Airman sets up a dry ice trap to catch mosquitoes to test for viruses.

Susceptibility to infectious disease has long been a concern of the military, threatening the health and readiness of service members

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Armed Forces Health Surveillance Branch | Global Emerging Infections Surveillance | Febrile and Vector-Borne Infections (FVBI) Surveillance

Zika in the Americas: August 16, 2017

Report
8/16/2017

This is a biosurveillance summary of Zika Virus: August 16, 2017, as reported by the Armed Forces Health Surveillance Branch. As of 16 August 2017, there have been 175 cases Zika virus in Military Health System beneficiaries since January 2016. Read more:

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Tdap vaccination coverage during pregnancy, active component service women, 2006 – 2014

Infographic
8/14/2017
Pertussis, commonly known as “whooping cough,” is a vaccine-preventable illness more common and more severe in children than in adults. Infections during the first few months of life can be particularly severe, with almost all deaths from pertussis occurring in infants less than 6 months of age. A vaccinated mother’s antibodies against pertussis protect the baby during pregnancy until it can receive the vaccine at two months of age. Approximately 400 probable and 50 confirmed cases occur annually among service members and other adult beneficiaries of the Military Health System. In 2012, the Advisory Committee on Immunization Practices recommended Tdap for every pregnancy to reduce the burden of pertussis in infants. This surveillance study assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014. FINDINGS: •	There were records of a total of 137,133 live birth deliveries to service women •	Only 1%  – 3% of service women received a Tdap vaccine during pregnancy from 2006  – 2011 •	Tdap vaccination coverage increased substantially  – 8% in 2012 to 54% in 2014 •	Navy women had the highest  annual proportion of vaccine coverage at 65% in 2014 •	First deliveries had the highest vaccination coverage at 57% in 2014 •	Fourth or subsequent deliveries had the lowest coverage at 41% in 2014 More education and attention by military physicians and pregnant service women about the benefits of Tdap vaccination are needed to bring coverage closer to 100%. Learn more in MSMR Vol. 22 No. 5 May 2015 at Health.mil/MSMR  Images on graphic: •	Baby icon to depict live birth deliveries •	Pie charts showing the findings in visual form •	Line graph showing the percent vaccinated among Navy, Marine Corps, Army, Air Force and Coast Guard The line graph shows the annual percentages of active component service women with a live birth delivery who received a Tdap vaccine during pregnancy, by year of delivery and service, 2011– 2014.

This infographic documents findings from a surveillance study that assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014.

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Surveillance Snapshot Norovirus Outbreaks among Military Forces, 2008 – 2016

Infographic
8/8/2017
Norovirus (NoV) is a highly contagious virus and a leading cause of gastroenteritis among military populations. There are many different strains of norovirus and immunity to one strain does not protect against another. Why Norovirus Strains Are Leading Causes of Acute Gastrointestinal Illness Outbreaks •	Multiple transmission routes include person-to-person direct contact, contaminated food and water, clothes or utensils that carry infection  •	Resistant to extreme temperatures and standard cleaning solutions •	No lasting immunity This report summarizes the NoV outbreaks in military forces in both garrison and deployed settings during 2008 – 2016. Table from this MSMR article displays and includes month/year of outbreak onset, setting, estimated attack rate (EAR)/ no. of NoV cases, and description. Access the report in MSMR Vol. 24 No.7 July 2017 at Health.mil/MSMR

Norovirus (NoV) is a highly contagious virus and a leading cause of gastroenteritis among military populations. There are many different strains of norovirus and immunity to one strain does not protect against another. This report summarizes the NoV outbreaks in military forces in both garrison and deployed settings during 2008 – 2016.

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Armed Forces Health Surveillance Branch

H7N9: August 2, 2017

Report
8/2/2017

This is a biosurveillance summary of Avian Influenza A (H7N9) Surveillance #80: August 2, 2017, as reported by the Armed Forces Health Surveillance Branch. As of 2 AUG, the total influenza A (H7N9) human case count since the fifth seasonal epidemic of H7N9 began on 1 OCT 2016 is 922 (+3) cases with at least 282 (+23) deaths.

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Global Influenza Summary: July 30, 2017

Report
7/30/2017

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Body Site of Skin and Soft Tissue Infections Active Component U.S. Armed Forces, 2013 – 2016

Infographic
7/24/2017
Did you know…? The arm, finger, leg, and toe were the most commonly affected body sites for cases of cellulitis/abscess and carbuncle/furuncle skin and soft tissue infections (SSTIs). The total number of inpatient and outpatient diagnoses for which the body location was specified was 142,214.

This report documents body sites affected by skin and soft tissue infections among active component, U.S. Armed Forces, 2013 – 2016.

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Armed Forces Health Surveillance Branch

Skin and Soft Tissue Infections Active Component, U.S. Armed Forces, 2013 – 2016

Infographic
7/24/2017
Skin and soft tissue infections (SSTIs) are common in both military and non-military populations. Due to the nature of the military training environment, risk factors associated with SSTIs such as crowding, infrequent hand washing/ bathing, skin abrasions and trauma, and environmental contamination favor the acquisition and transmission of Staphylococcus spp. and Streptococcus spp. These pathogens are the major causative agents of SSTIs and lead to outbreaks of disease.

This report documents the incident cases of skin and soft tissue infections among active component U.S. military member during a 4-year surveillance period.

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Armed Forces Health Surveillance Branch

Age-Period-Cohort Analysis of Colorectal Cancer Service Members Aged 20-59 Years Active Component U.S. Armed Forces, 1997 – 2016

Infographic
7/24/2017
Among cancers affecting both men and women, colorectal cancer is the third most common cancer and the second leading cause of death from cancer in the U.S. This report documents the time-varying elements of age, period, and birth cohort effects in the epidemiology of colorectal cancer among members of the active component.

This report documents the time-varying elements of age, period, and birth cohort effects in the epidemiology of colorectal cancer among members of the active component.

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Armed Forces Health Surveillance Branch

Heat Illness Prevention: Use the Buddy System to Stay Cool and Safe

Infographic
7/20/2017
Did you know that exposure to heat and heat-related illnesses can cause a spectrum of disorders that includes minor conditions such as heat cramps to the more severe condition known as heat stroke? To protect U.S. service members, it is important for commanders, small unit leaders, training cadre, and supporting medical personnel to encourage the use of the buddy system to prevent these conditions – especially during training at recruit centers and installations. The buddy system pairs service members to stay motivated and hold each other accountable of their physical limits during training exercises. Protecting Service Members from Heat Illness •	Do not exercise when sick. Intense workouts can increase susceptibility to illness, including infection and diarrhea. •	Dump heat by taking a cold shower or ice slush immersion before a workout. •	Wear a cooling vest to keep skin cool and dry in the heat. Learn more about heat illness prevention at Health.mil/AFHSB Stay cool. Stay hydrated. Stay informed. #BeatTheHeat Source: Dr. Francis G. O’Connor, a professor and chair of Military and Emergency Medicine and associate director for the Consortium on Health and Military Performance at the Uniformed Services University of the Health Sciences.

This infographic documents the use of the buddy system to prevent heat-related illnesses.

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Preventable and Treatable: Know the Signs of Heat Exhaustion

Infographic
7/20/2017
Warmer temperatures and strenuous physical activity put service members at higher risk of heat illnesses. It is important for commanders, small unit leaders, training cadre, and supporting medical personnel – particularly at recruit training centers and installations with large combat troop populations – to educate service members about the risks early signs and symptoms, and preventive treatment measures related to heat illnesses. Signs of Dehydration •	Light-headed/ Dizzy/ Headache •	Fever •	Lack of sweat •	Dark yellow urine •	Thirst Under the signs of dehydration section an image of a man experiencing these early signs and symptoms of heat illnesses. Staying Hydrated •	Hydrate with water and eat rich foods with water before, during, and after exercise. •	Decrease the intensity of the physical activity. Under the staying hydrated section graphics of a water bottle, glass of water, runner and cyclist appear. Signs of Heat Stroke •	Fatigue •	Combative •	Confused •	Muscle cramps Under the signs of heat stroke section, a man experiencing these symptoms of heat stroke displays. Effective Ways to Cool Off a Heat Stroke Victim •	Make an “ice burrito” by wrapping the victim in cold sheets, ice packs, and wet towels •	Immerse victim in cold water Images of ice and a man under a shower appear.  Ways to Treat Heat Exhaustion •	Use a rectal thermostat to read core body temperatures to diagnose and treat heat stroke •	Provide IV fluid replacement •	Spray with cool mist Image of rectal thermostat, man in a hospital bed with an IV and a man being sprayed with cool mist appear. Learn more about heat illness by reading MSMR Vol. 24 No. 3 – March 2017 at Health.mil/MSMR Source: Dr. Francis FG. O’Connor, a professor and chair of Military and Emergency Medicine and associate director for the Consortium on Health and Military Performance at the Uniformed Services University of the Health Sciences.

This infographic documents the risks, early signs and symptoms, and preventive treatment measures related to heat illnesses.

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Armed Forces Health Surveillance Branch | Summer Safety

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.

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Armed Forces Reportable Medical Events Guidelines and Case Definitions

Publication
7/17/2017

A reportable event may represent an inherent, significant threat to public health and military operation. These events have the potential to affect large numbers of people, to be widely transmitted within a population, to have severe/life threatening clinical manifestations, and to disrupt military training and deployment. Timely, accurate reporting ...

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Armed Forces Health Surveillance Branch | AFHSB Reports and Publications
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