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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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Measles, Mumps, Rubella, and Varicella: Among service members and other beneficiaries of the Military Health System, 2010 – 2016

Infographic
11/3/2017
Measles, mumps, rubella, and varicella (MMR/V) are highly communicable infectious diseases whose causative agents are spread through contact with contaminated surfaces or airborne droplets. MMR/V were common in the U.S. before the introduction of licensed vaccines: measles (1963), mumps (1967), rubella (1969), and varicella (1995). Since then, these vaccines have been important components of routine pediatric preventive care. This report highlights the recent trends in MMR/V in both military and civilian populations as well as the importance of primary and booster vaccinations. During 2010 – 2016, there were: • 11 confirmed measles cases – one was in a service member. • 76 confirmed mumps cases – 28 were in service members. • 7 confirmed rubella cases – two were in service members. • 62 confirmed varicella cases among service members. The reporting of cases of varicella in non-military personnel was not mandated until 2017. Individuals at highest risk for MMR/V • Infants • Unvaccinated persons • Inadequately vaccinated persons • Individuals living in communities with low vaccination rates • Persons living in crowded and unsanitary conditions • Those with compromised immune systems Access the full report in MSMR Vol. 24 No. 10 October 2017 for more information at Health.mil/MSMR A picture of service members in communal area displays as well as an image of team work activities.

This infographic highlights the recent trends in Measles, Mumps, Rubella, and Varicella (MMR/V) in both military and civilian populations as well as the importance of primary and booster vaccinations.

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Armed Forces Health Surveillance Branch | Measles-Mumps-Rubella

Five cold seasons: July 2012 – June 2017, Cold injuries during deployments

Infographic
11/3/2017
During the 5-year surveillance period, 105 cold injuries were diagnosed and treated in service members deployed outside of the U.S. Of these 105 cold injuries, 68% occurred in the first two cold seasons. Total no. of cold injuries, by season: • 35 cold injuries during cold season 2012 – 2013 • 36 during 2013 – 2014 • 13 during 2014 – 2015 • 11 during 2015 – 2016 • 10 during 2016 – 2017 The decrease in the number of cases is most likely a byproduct of: • The dramatic decline in the number of service members deployed to Iraq and Afghanistan • Changes in the nature of military operations there Access the full report in MSMR Vol. 24 No. 10 October 2017 at Health.mil/MSMR Pie Chart showing cold injuries during deployments: • 39 Immersion • 33 Frostbite • 17 unspecified • 16 Hypothermia Background image shows service member walking in the snow.

This infographic documents cold injuries during deployments outside of the United States for the July 2012 – June 2017 cold seasons (five-year surveillance period).

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Surveillance Snapshot: Influenza Immunization among U.S. Armed Forces Healthcare Workers, August 2012 – April 2017

Infographic
10/31/2017
Did you know …? During the 2016 – 2017 influenza season, each of the three services attained greater than 94% compliance among healthcare personnel. The U.S. Advisory Committee on Immunization Practices recommends that all healthcare personnel be vaccinated against influenza to protect themselves and their patients. The Joint Commission requires that healthcare organizations have influenza vaccination programs for practitioners and staff, and that they work toward the goal of 90 percent receipt of influenza vaccine. This snapshot of a five-year surveillance period (August 2012 – April 2017) shows that the active component healthcare personnel of the Army, Navy, and Air Force has exceeded the percentage compliance with influenza immunization requirement in each year. • Line graph showing the percentage of healthcare specialists and officers with records of influenza vacation by influenza year (1 August through 30 April) and service, active, U.S. Armed Forces, August 2012 – April 2017 displays. Access the full snapshot in MSMR Vol. 24 No. 10 October 2017 at Health.mil/MSMR There are two photos featured on the infographic: 1. A service member being vaccinated with the flu vaccine displays 2. A photo of vaccine administrators shows.

This snapshot of a five-year surveillance period (August 2012 – April 2017) details influenza immunization compliance among the active component healthcare personnel of the Army, Navy, and Air Force.

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Global Influenza Summary: October 29, 2017

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10/29/2017

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Global Influenza Summary: October 22, 2017

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Global Influenza Summary: October 15, 2017

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Global Influenza Summary: October 8, 2017

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10/8/2017

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Review of the U.S. Military’s Human Immunodeficiency Virus program: A legacy of the progress and a future of promise

Infographic
10/3/2017
HIV infection is a threat of the Department of Defense (DoD) because sexually active service members and their beneficiaries are stationed throughout the U.S. and around the globe, including in areas with high rates of HIV transmission. Fortunately, blood testing and a negative test result for HIV infection are required for entry into military service. All U.S. military service members must undergo testing for HIV infection every 2 years. As a result, the incidence and prevalence of HIV in the DoD remains much lower than in the U.S. civilian population.

This infographic documents the incidence and prevalence of the human immunodeficiency virus (HIV) among service members, active and reserve components, of the U.S. Armed Forces, 1990 – 2017.

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Global Influenza Summary: October 1, 2017

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10/1/2017

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Challenges with diagnosing and investigating suspected active Tuberculosis disease in military trainees

Infographic
9/14/2017
The incidence rates of active tuberculosis (TB) disease in the general U.S. population and the U.S. military have declined over the past two decades, with foreign birth remaining one of the strongest correlates of risk. Recently, there have been several atypical and asymptomatic presentations of active and suspected TB cases among the population of trainees at Joint base San Antonio – Lackland, TX. Between 1 January 2010 and 31 December 2016, a total of 14 U.S. and international military personnel in training at JBSA – Lackland were hospitalized for suspected pulmonary TB. The variety of atypical presentations and their resulting diagnostic and public health challenges promoted this retrospective review of all hospitalized cases. This case series raises concerns about the increasing reliance on molecular tests for rapid diagnosis of active TB, especially in patients with minimal to no pulmonary symptoms. Findings • The incidence rate in the training population was 1.89 per 100,000 population • 5 of 14 U.S. and international military personnel were diagnosed with active TB disease • All were male, aged 19 – 29 years • Only one TB case had pulmonary symptoms, but these were not suggestive of TB • 8 of 14 trainees were asymptomatic at the time of hospital admission, and tuberculin skin test and interferon gamma release assay results were highly variable Chart displays with descriptions and diagnoses of trainees hospitalized for suspected active tuberculosis, Joint Base San Antonio – Lackland, TX, 2010 – 2016 (N=14). Access the report in MSMR Vol. 24 No. 8 August 2017 at Health.mil/MSMR Images featured on infographic: • Human lungs • Image of TB

The incidence rates of active tuberculosis (TB) disease in the general U.S. population and the U.S. military have declined over the past two decades, with foreign birth remaining one of the strongest correlates of risk. This infographic documents findings from several atypical and asymptomatic presentations of active and suspected TB cases among the ...

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Multiple Sclerosis among service members of the active and reserve components of the U.S. Armed Forces and among other beneficiaries of the Military Health System, 2007 – 2016

Infographic
9/14/2017
Multiple sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of the central nervous system, affecting approximately 400,000 people in the U.S. and more than two million people worldwide. The inflammatory demyelination and axonal injury that characterize MS result in significant clinical disability and economic burden. This study makes a useful contribution to the literature on temporal changes in the incidence of MS by sex and race/ ethnicity. A map of the U.S. displays to show a visual about the 400,000 people affected by MS in the country. An image of Earth displays to show a visual about the more than 2 million people worldwide affected by MS. FINDINGS • Between 2007 and 2016, a total of 2,031 active component service members received incident diagnoses of MS • The overall unadjusted incidence rate was 14.9 cases per 100,000 p-yrs • During the surveillance period, unadjusted annual incidence rates of MS decreased by 25.4% • The highest overall incidence rates were observed among service members diagnosed after age 30 with rates peaking among those aged 40 years or older. First line graph shows: annual incidence rates of MS were higher among female service members than male service members and decreased by 42.2% during the 10-year period. Second line graph shows: The higher overall incidence of MS among non-Hispanic blacks was found among females, and to a lesser degree among males. Median age at MS case-defining diagnosis • Age 32 years among active component members • Age 37 years among reserve / guard members • Age 48 years among non-service member beneficiaries Common MS Symptoms • Numbness • Tingling in limbs • Visual Loss • Double Vision • Mother Weakness • Gait Disturbance Images showings these symptoms display. Access the full report in MSMR Vol. 24 No. 3 August 2017 at Health.mil/MSMR

Multiple sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of the central nervous system, affecting approximately 400,000 people in the U.S. and more than two million people worldwide. This infographic documents data on the temporal changes in the incidence of MS by sex and race/ ethnicity.

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Global Influenza Summary: September 3, 2017

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9/3/2017

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H7N9: August 30, 2017

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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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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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