The Armed Forces Health Surveillance Center: enhancing the Military Health System’s public health capabilities

Since its establishment in February 2008, the Armed Forces Health Surveillance Center (AFHSC) has embarked on a number of initiatives and projects in collaboration with a variety of agencies in the Department of Defense (DoD), other organizations within the federal government, and non-governmental partners. In 2009, the outbreak of pandemic H1N1 influenza attracted the major focus of the center, although notable advances were accomplished in other areas of interest, such as deployment health, mental health and traumatic brain injury surveillance

Heat Stroke in Physical Activity and Sport

Exertional heat stroke (EHS) is one of the leading causes of sudden death in sport and physical activity. In American Football alone, there have been 46-documented EHS fatalities in the United States between 1995 and 2010. In 2003, National Collegiate Athletics Association mandated pre-season heat acclimatization guidelines, which successfully decreased the number of heat stroke fatalities in collegiate American football. However, despite the advancement in modern medical care and increased awareness in heat safety, lack of appropriate on-site medical care is still contributing to EHS seen especially at the youth level. It is well established in scientific literature that fatalities as a result of EHS are largely preventable with proper education on the knowledge of recognition, treatment, and prevention of EHS. This document provides a review of the current best medical practices and evidence on the epidemiology, pathophysiology, risk factors, recognition, treatment, prevention, and return to play recommendations for EHS, specifically as they relate to sport and physical activity

Seasonal Influenza Vaccine and Protection against Pandemic (H1N1) 2009-Associated Illness among US Military Personnel

INTRODUCTION: A novel A/H1N1 virus is the cause of the present influenza pandemic; vaccination is a key countermeasure, however, few data assessing prior seasonal vaccine effectiveness (VE) against the pandemic strain of H1N1 (pH1N1) virus are available. MATERIALS AND METHODS: Surveillance of influenza-related medical encounter data of active duty military service members stationed in the United States during the period of April-October 2009 with comparison of pH1N1-confirmed cases and location and date-matched controls. Crude odds ratios (OR) and VE estimates for immunized versus non-immunized were calculated as well as adjusted OR (AOR) controlling for sex, age group, and history of prior influenza vaccination. Separate stratified VE analyses by vaccine type (trivalent inactivated [TIV] or live attenuated [LAIV]), age groups and hospitalization status were also performed. For the period of April 20 to October 15, 2009, a total of 1,205 cases of pH1N1-confirmed cases were reported, 966 (80%) among males and over one-half (58%) under 25 years of age. Overall VE for service members was found to be 45% (95% CI, 33 to 55%). Immunization with prior season's TIV (VE = 44%, 95% CI, 32 to 54%) as well as LAIV (VE = 24%, 95% CI, 6 to 38%) were both found to be associated with protection. Of significance, VE against a severe disease outcome was higher (VE = 62%, 95% CI, 14 to 84%) than against milder outcomes (VE = 42%, 95% CI, 29 to 53%). CONCLUSION: A moderate association with protection against clinically apparent, laboratory-confirmed Pandemic (H1N1) 2009-associated illness was found for immunization with either TIV or LAIV 2008-09 seasonal influenza vaccines. This association with protection was found to be especially apparent for severe disease as compared to milder outcome, as well as in the youngest and older populations. Prior vaccination with seasonal influenza vaccines in 2004-08 was also independently associated with protection

Heat Stroke in Physical Activity and Sport [Spanish Translation]

El golpe de calor por esfuerzo (GCE) es una de las causas principales de muerte súbita durante el deporte y la actividad física. Solamente en el fútbol americano han ocurrido 46 muertes documentadas en los EE.UU. entre 1995 y 2010. En el 2003, la asociación responsable por los deportes universitarios de los EE.UU. estableció pautas obligatorias de aclimatización al calor, las cuales tuvieron como resultado una disminución exitosa en el número de muertes por golpe de calor en ese deporte. Sin embargo, a pesar de los avances en la atención médica moderna y una mayor conciencia sobre medidas de seguridad para el calor, la falta de atención adecuada en el sitio para los pacientes continúa contribuyendo GCE, especialmente a nivel juvenil. Está debidamente establecido en las publicaciones científicas que es posible, en gran medida, prevenir las muertes por GCE en los contextos de deportes organizados, si se brinda una educación apropiada y se dispone de personal médico entendido en el reconocimiento y tratamiento del GCE. En este documento se hace una revisión de las mejores prácticas médicas actuales y de la evidencia sobre la epidemiología, fisiopatología, factores de riesgo, reconocimiento, tratamiento, prevención y recomendaciones sobre el regreso a la práctica deportiva para el GCE, específicamente en lo pertinente al contexto del deporte organizado

International Health Regulations (2005) and the U.S. Department of Defense: building core capacities on a foundation of partnership and trust

A cornerstone of effective global health surveillance programs is the ability to build systems that identify, track and respond to public health threats in a timely manner. These functions are often difficult and require international cooperation given the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by both humans and animals. As part of the U.S. Armed Forces Health Surveillance Center (AFHSC), the Department of Defense’s (DoD) Globa Emerging Infections Surveillance and Response System (AFHSC-GEIS) has developed a global network of surveillance sites over the past decade that engages in a wide spectrum of support activities in collaboration with host country partners. Many of these activities are in direct support of International Health Regulations (IHR[2005]). The network also supports host country military forces around the world, which are equally affected by these threats and are often in a unique position to respond in areas of conflict or during complex emergencies. With IHR(2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats

BMC Res Notes

BackgroundDiarrhea is an important cause of morbidity and mortality worldwide. In Africa and Ghana in particular, it is estimated to contribute directly to 19 and 25% of pediatric mortality among children under 5\uc2\ua0years, respectively.MethodsSurveillance for hospitalized acute diarrheal illness was initiated in November 2010 through October 2012 in a referral hospital in southern Ghana, and a teaching hospital in northern Ghana. Consenting hospitalized patients who met a standardized case definition for acute diarrheal illness provided demographic and epidemiologic data. Stool samples were collected and tested by culture for bacteria and by enzyme immunoassays for a panel of viruses and parasites.ResultsA total of 429 patients were enrolled; 216 (50.3%) were under 5\uc2\ua0years, and 221 (51.5%) were females. Stool samples were received from 153 patients. Culture isolates included Shigella sp., Salmonella spp., Plesiomonas sp. and Vibrio cholerae. Of 147 samples tested for viruses, 41 (27.9%) were positive for rotaviruses, 11 (7.5%) for astroviruses, 10 (6.8%) for noroviruses, and 8 (5.4%) for adenoviruses. Of 116 samples tested for parasitic infections; 4 (3.4%) were positive for Cryptosporidium sp. and 3 (2.6%) for Giardia lamblia. Of the enrolled patients, 78.8% had taken antibiotics prior to sample collection.ConclusionsDiarrheal pathogens were identified across all ages, however, predominantly (81%) in the children under 5\uc2\ua0years of age. This study also detected high antibiotic use which has the potential of increasing antibiotic resistance. The most common enteric pathogen detected (49.4%) was rotavirus.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2621-x) contains supplementary material, which is available to authorized users.2017-07-17T00:00:00Z28716138PMC551452

Circulation and characterization of seasonal influenza viruses in Cambodia, 2012‐2015

Background: Influenza virus circulation is monitored through the Cambodian influenza‐like illness (ILI) sentinel surveillance system and isolates are characterized by the National Influenza Centre (NIC). Seasonal influenza circulation has previously been characterized by year‐round activity and a peak during the rainy season (June‐November). Objectives: We documented the circulation of seasonal influenza in Cambodia for 2012‐2015 and investigated genetic, antigenic, and antiviral resistance characteristics of influenza isolates. Patients/Methods Respiratory samples were collected from patients presenting with influenza‐like illness (ILI) at 11 hospitals throughout Cambodia. First‐line screening was conducted by the National Institute of Public Health and the Armed Forces Research Institute of Medical Sciences. Confirmation of testing and genetic, antigenic and antiviral resistance characterization was conducted by Institute Pasteur in Cambodia, the NIC. Additional virus characterization was conducted by the WHO Collaborating Centre for Reference and Research on Influenza (Melbourne, Australia). Results: Between 2012 and 2015, 1,238 influenza‐positive samples were submitted to the NIC. Influenza A(H3N2) (55.3%) was the dominant subtype, followed by influenza B (30.9%; predominantly B/Yamagata‐lineage) and A(H1N1)pdm09 (13.9%). Circulation of influenza viruses began earlier in 2014 and 2015 than previously described, coincident with the emergence of A(H3N2) clades 3C.2a and 3C.3a, respectively. There was high diversity in the antigenicity of A(H3N2) viruses, and to a smaller extent influenza B viruses, during this period, with some mismatches with the northern and southern hemisphere vaccine formulations. All isolates tested were susceptible to the influenza antiviral drugs oseltamivir and zanamivir. Conclusions: Seasonal and year‐round co‐circulation of multiple influenza types/subtypes were detected in Cambodia during 2012‐2015

U.S. Government engagement in support of global disease surveillance

Global cooperation is essential for coordinated planning and response to public health emergencies, as well as for building sufficient capacity around the world to detect, assess and respond to health events. The United States is committed to, and actively engaged in, supporting disease surveillance capacity building around the world. We recognize that there are many agencies involved in this effort, which can become confusing to partner countries and other public health entities. This paper aims to describe the agencies and offices working directly on global disease surveillance capacity building in order to clarify the United States Government interagency efforts in this space