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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.

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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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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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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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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

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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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 Reportable Medical Events Guidelines and Case Definitions Memo

Policy

The Armed Forces Reportable Medical Events Guidelines and Case Definitions (RME Guidelines) standardize reporting and tracking of disease and other conditions of public health and military importance. Timely reporting permits earlier recognition of public health events and interventions to protect the health of the force.

Zika in the Americas: July 12, 2017

Report
7/12/2017

This is a biosurveillance summary of Zika in the Americas as of July 12, 2017. As of 1300 on 12 JUL 2017, there have been 175 (+1) confirmed Zika virus (ZIKV) disease cases (see table) since the first case was reported in JAN 2016.

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Incidence of Escherichia Coli Intestinal Infections Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
7/11/2017
Escherichia coli bacteria normally live in the lower intestines of healthy people and animals. Most varieties of E. coli are harmless, but certain types of E. coli are among the most frequent bacterial causes of diarrhea. This report summarizes the counts, rates, and trends of E. coli gastrointestinal infections in active component service members over the past 10 years. Findings: •	During 2007 – 2016, there were 290 incident cases of E. coli infection among active duty service members •	The overall incidence rate was 2.3 cases per 100,000 person-years (p-yrs) •	Annual incidence rates peaked at 4.7 cases per 100,000 p-yrs. in 2016 •	Cases were shown to peak during warmer months Overall rates were higher for: •	Persons aged 50 years or older •	Persons aged 25-29 years •	Females at twice the rate of males •	Non-Hispanic white service members •	Air Force members •	Service members in healthcare occupations Two graphs appear on infographic: One graph shows the annual numbers of incident cases and incidence rates of E. coli infection, active component, U.S. Armed Forces, 2007 – 2016. The second graph shows the cumulative number of incident cases of E. coli infection by calendar month, active component, U.S. Armed Forces, 2007 – 2016. Access the report in MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR

This report summarizes the counts, rates, and trends of Escherichia coli gastrointestinal infections in active component service members over the past 10 years.

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Armed Forces Health Surveillance Branch

Estimate of the Incidence of Norovirus Infections Active Component, U.S. Armed Forces, 2007 - 2016

Infographic
7/11/2017
The norovirus (NoV) is a highly infective and easily transmitted pathogen that imposes a significant public health burden across geographic regions as the causative pathogen for approximately 18% of all diarrhea cases worldwide. This report estimates the incidence of NoV diagnoses among active component service members during a 10-year surveillance period using medical record documentation of diagnoses of NoV infection and of positive laboratory tests for the virus. Findings During the 10-year surveillance period, there were 709 incident cases of NoV infection among active duty service members. •	The overall incidence rate was 5.7 cases per 100,000 person-years (p-yrs) •	Annual incidence rates ranged from a low of 2.5 cases per 100,000 p-yrs in 2008 to a high 11.2 cases per 100,000 p-yrs in 2010 •	Higher numbers of diagnosed cases were reported during November-March Graph depicting the above information displays. Overall rates were highest in: •	Female service members •	Persons Aged 24 years or younger •	Army members •	Junior enlisted •	Recruits Comparing the results of this analysis to modeled estimates of the underreported incidence of the NoV infections demonstrated the limited utility of using only medical encounter diagnoses, reportable events, and laboratory data to report on NoV incidence. Access the report in MSMR Vol. 24 No. 6 June 2017 at Health.mil/MSMR

This report estimates the incidence of norovirus diagnoses among active component service members during a 10-year surveillance period.

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Incidence of Shigella Intestinal Infections Active Component

Infographic
7/11/2017
This report summarizes the counts, rates, and trends of Shigella infections in active component service members over the past 10 years. Findings •	During 2007 – 2016, there were 428 incident cases of Shigella infection among active duty service members. •	The overall incidence rate 3.4 cases per 100,000 person-years (p-yrs) •	 In 2015, the annual incidence rate peaked at 6.4 cases per 100,000 p-yrs – twice the rate in 2014 •	This peak was followed by a decrease to 3.4 cases per 100,000 p-yrs in 2016 Overall rates were highest in: •	Females •	Non-Hispanic black service member •	Persons aged 35-29 years •	Army members •	Service members in military healthcare occupations Diarrhea caused by bacteria of the Shigella genus is a major cause of morbidity and mortality worldwide. Shigella organisms can survive passage through the stomach because they are more resistant to acid than other bacteria. Shigella transmission can occur directly via person-to-person contact or indirectly through contaminated food, water or fomites (e.g., clothing bedding). The increasing antimicrobial resistance of Shigella species is a major problem in the treatment of Shigella gastroenteritis both in the United States and globally. Frequent and thorough hand washing with soap and water is an effective way to stop the spread of this and other enteric pathogens. Access the report in MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR Graphic features images of Shigella bacteria, human stomach, Earth, and hands. Additional images are clothing, contaminated food and water as common sources for Shigella transmission.

This report summarizes the counts, rates, and trends of Shigella infections in active component service members over the past 10 years.

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Armed Forces Health Surveillance Branch

Incidence of Campylobacter Intestinal Infections Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
7/11/2017
Campylobacter species, predominantly C. jejuni, are now among the leading causes of bacterial infections of the intestines in the U.S. and around the world. Infections cause fever, diarrhea, and abdominal pain. The bacterium is acquired by ingesting contaminated food or water. Among active component service members, Campylobacter infections have steadily increased since 2007 as noted in this report of the incidence of diagnoses during a 10-year surveillance period. Findings During the 10-year surveillance period, there were 1,753 diagnosed cases of Campylobacter intestinal infection among active component service members. The overall incidence rate was 14.1 cases per 100,000 person-years (p-yrs). Annual incidence rates steadily increased from 7.6 per 100,000 p-yrs in 2007 to 22.1 cases per 100,000 p-yrs. in 2016. More cases were diagnosed in the warmer months of the year. Overall Rates Were Higher In •	Females •	Persons aged 45 years or older •	Air Force and Army members •	Officers and those in military healthcare occupations Annual numbers of incident cases (bar graph) and incidence rates (line graph) of ’Campylobacter infection, active component, U.S. Armed Forces, 2007 – 2016’ is displayed. Second bar graph titled ‘Cumulative numbers of incident cases of Campylobacter infection, by calendar month, active component, U.S. Armed Forces, 2007 -2016’ displays. Access the report in MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR Background of infographic shows intestines.

This infographic documents the incidence of diagnoses for Campylobacter Intestinal Infections among active component service members.

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Armed Forces Health Surveillance Branch

Most frequent diagnoses: Hospitalizations, Males, Active Component, U.S. Armed Forces

Infographic
7/11/2017
Did you know…? In 2016, alcohol dependence (n= 1,656) was the second most frequent diagnosis among males discharged from the hospital. The most frequent diagnosis was adjustment disorder (n=3,768). The third most frequent diagnosis was major depressive disorder [single episode, unspecified] (n= 1,308), followed by acute appendicitis (n=1,091) and post-traumatic stress disorder (PTSD) (n=832). Two charts display on infographic: First chart is the ‘Most frequent diagnoses during hospitalizations, males, active component, U.S. Armed Forces 2016. Information below: Mental disorders (ICD-10: F01-F99) – 12,571 •	Adjustment disorders: 3,768 / 30.0 % of all hospitalizations of males •	Alcohol dependence: 1,656 / 12.2 % of all hospitalizations of males •	Major depressive disorder, single episode, unspecified: 1,308 / 10.4% •	Post-traumatic stress disorder (PTSD): 832/ 6.6% •	Major depressive disorder, recurrent severe without psychotic features: 638/ 5.1% Second chart is the ‘Most frequent diagnoses during ambulatory visits for diagnoses of mental disorders, males, active component, U.S. Armed Forces, 2016 Mental disorders (ICD-10: F01-F99) 1,452,655 •	Adjustment disorder: 282,610 / 19.5% of all ambulatory visits for males •	Post-traumatic stress disorder (PTSD): 238,061/16.4% of all ambulatory visits for males •	Alcohol dependence: 219,260/ 15.1% of all ambulatory visits for males •	Anxiety disorder, unspecified: 98,861/ 6.8%  of all ambulatory visits for males •	Alcohol abuse: 69,581 / 4.8% all ambulatory visits for males Learn more about healthcare burdens attributable to various diseases and injuries by reading April 2017 – Volume 24/4 of the Medical Surveillance Monthly Report (MSMR) at Health.mil/MSMRArchives. #MensHealth Graphic shows soldier’s commitment to sobriety.

This infographic documents alcohol dependence hospitalizations and ambulatory visits among males, active component, U.S. Armed Forces in 2016.

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Incidence of Nontyphoidal Salmonella Intestinal Infections Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
7/11/2017
The term nontyphoidal salmonellae (NTS) refers to gram-negative bacteria of the genus Salmonella except for the specific strains S. typhi and S. paratyphi. NTS are a leading cause of foodborne illness in the U.S. and of acute gastrointestinal illness among members of the active component of the U.S. Armed Forces. This report summarizes the counts, rates, and trends of nontyphoidal Salmonella infections in active component service members during a 10-year surveillance period. Findings  •	During 2007 – 2016, there were 1,536 incident cases of nontyphoidal Salmonella infection among active duty service members •	The overall incidence rate was 12.4 cases per 100,000 person-years (p-yrs) •	In 2016, the annual incidence rates peaked at 15.9 cases p-yrs •	Cases were shown to peak during the summer months Graph displays highlighting findings above for annual numbers of incident cases and incidence rates of nontyphoidal salmonellosis, active, component, U.S. Armed Forces, 2007 – 2016.  Overall rates were higher in: •	 Females •	Persons Aged 25-29 years •	Aged 50 years or older Access the report in the MSMR Vol. 24 No. 6 – June 2017 at Health.mil/MSMR

This report summarizes the counts, rates, and trends of nontyphoidal Salmonella infections in active component service members during a 10-year surveillance period.

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H7N9: July 6, 2017

Report
7/6/2017

This is a biosurveillance summary of Avian Influenza A (H7N9) Surveillance #77: July 6, 2017, as reported by the Armed Forces Health Surveillance Branch. As of 6 JUL, the total influenza A (H7N9) human case count since the fifth seasonal epidemic of H7N9 began on 1 OCT 2016 is 919 (+13) cases with at least 269 deaths. Read more:

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