Description and Utilization of the United States Department of Defense Serum Repository: A Review of Published Studies, 1985-2012

<div><p>Specimens in the United States Department of Defense (DoD) Serum Repository have accumulated in frozen storage since 1985 when the DoD began universal screening for human immunodeficiency virus. Use of the stored serum for health research has been carefully controlled, but the resulting publications have never been systematically identified or described. The Armed Forces Health Surveillance Center (AFHSC) information systems and open (online) sites were used as data sources. Through 2012, the repository contained 54,542,658 serum specimens, of which 228,610 (0.42%) have been accessed for any purpose. Between 2001 (the first year that comprehensive, digital records were available) and 2012, 65.2% of all approved requests for serum were for healthcare or public health investigations, but greater than 99% of all shipped samples were for research. Using two different methods – a structure search of PubMed and an exhaustive online search based on records from AFHSC – we identified 76 articles published between October 1988 and March 2013 that covered a multitude of infectious diseases, injuries, environmental exposures and mental health conditions through analysis of antibodies, biological metabolic, signaling and regulatory substances, Vitamin D, organochlorines, dioxin, omega-3-fatty acid, and portions of human deoxyribonucleic acid. Despite its operational and scientific value, it appears that the DoD Serum Repository has been underutilized. Changes to policy and increased capacity for specimen processing could increase use of the repository without risking privacy or the availability of specimens for the healthcare of individual service members in the future.</p></div

Distribution of ages^a at the time of collection for specimens in the DoD Serum Repository.

<p>a. Approximately 30,000 outliers younger than 17 years and older than 70 years were dropped.</p

Summary statistics for individuals’ ages at the time of serum collection and the timing of collections for specimens in the DoD Serum Repository.

<p>a. The maximum legal age for service members is between 17 and 62 years with few exceptions, so only those who were 17–70 years of age were included. Outliers were dropped.</p><p>b. A total of 4,642,870 individuals provided only 1 specimen.</p><p>Summary statistics for individuals’ ages at the time of serum collection and the timing of collections for specimens in the DoD Serum Repository.</p

Analytes^a from published studies that used specimens from the DoD Serum Repository and the number of articles in which each appears.

<p>a. Unless otherwise specified, mention of a microbe or vaccine refers to the human antibody to that microbe or induced by the vaccine. Antibodies to the same microbe but with different epitopes are grouped.</p><p>Analytes<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0114857#t003fn001" target="_blank">^a</a> from published studies that used specimens from the DoD Serum Repository and the number of articles in which each appears.</p

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for the results of the literature search using both the algorithmic and intense methods.

<p>Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for the results of the literature search using both the algorithmic and intense methods.</p

The numbers of individuals who provided specimens to the DoD Serum Repository and the numbers of specimens per person.

<p>The numbers of individuals who provided specimens to the DoD Serum Repository and the numbers of specimens per person.</p

Crude and Adjusted OR for Any Vaccine Received in 2008–2009.

<p>*Adjusted for sex, age group, and number of prior vaccinations.</p

Number of Hospitalized and Non-hospitalized pH1N1 Cases by Week.

<p> Light Bars = Non-Hospitalized Cases. Dark Bars = Hospitalized Cases.</p

Univariate Analysis and Characteristics of pH1N1 Cases and Controls.

<p>Note: OR = Odds Ratio.</p

Crude and Adjusted OR for Specific Age-Groups for Any Vaccine Received in 2008–2009.

<p>**Adjusted for sex and number of prior vaccinations.</p