Preparedness of Military Public Health for Epidemic and Pandemic Recognition and Response.

Disease epidemics have threatened American military preparedness and operational capabilities since 1775. The ongoing Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) pandemic, which began in 2019, again demonstrates the significant potential for infectious diseases to impact military units and threaten military readiness. We reviewed the historical and continuing threats to the U.

Military Epidemics, Then and Now: Smallpox and COVID-19.

We compared the COVID-19 experience in the first year of the current pandemic in the US with the smallpox experience of the 18th century, focusing on the US military but recognizing civilian and military populations are not separate and distinct. Despite the epidemics being separated by 21/2 centuries and with great advancements in technology having occurred over that time, we observed similarities which led us to several conclusions: • Infectious disease outbreaks will continue to occur and novel agents, naturally occurring or manipulated by humans, will threaten military and civilian populations nationally and globally. • Infectious disease outbreaks can affect both military and civilian populations, persist for long periods, and be catastrophic to military peacetime and wartime operations.

Estimating Chlamydia and Gonorrhea Burden Among US Army Soldiers From Military Health System Data: Mind the Gap.

Background: Reporting systems are commonly used for chlamydia and gonorrhea surveillance and community burden assessments. Estimates are conservative given high proportions of asymptomatic cases and underreporting. The military's unified health system, which includes laboratory and medical encounter data, could offer insight into surveillance gaps and improve burden analyses.

Hazardous Non-Combat Exposures in the U.S. Department of Defense.

Hazardous non-combat exposures are inherent to military service and occur in three settings: installation workplaces, installation environments, and deployment environments. Few military clinicians receive training in how to recognize, assess, and manage patients with these exposures, and systems improvements are needed to support clinicians with respect to exposure recognition and management. This commentary highlights key concepts surrounding military non-combat exposures by discussing three case examples of exposures occurring in each of these settings.

The Future of Military Occupational and Environmental Medicine in the Department of Defense.

Objective: Transfer of military medical facilities to the Defense Health Agency is transforming the Military Health System. Our objective is to inform this transformation with respect to optimum application of occupational and environmental medicine (OEM) expertise.

Methods: We defined and analyzed the external influences on military OEM practice using a structured framework to identify key drivers.

Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University.

Objective: To develop an actionable plan to sustain and improve the quality of the Uniformed Services University of the Health Sciences (USU) Occupational and Environmental Medicine (OEM) Residency Program.

Methods: Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities, and threats (SWOT analysis).

Results: Program strengths are stable funding, full-time faculty and large class size.

Uniformed Services University Occupational and Environmental Medicine Residency Program.

In 2019, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine celebrated the 30th anniversary of its Occupational and Environmental Medicine (OEM) Residency program. This unique program is among the largest preventive medicine residency programs in the United States.

The First 75 Years Timeline of United States Army Preventive, Occupational and Environmental Medicine, and Public Health History.

In 2017, the US Army Public Health Center (USAPHC) at Aberdeen Proving Ground, Maryland, celebrated its 75th Anniversary. The organization began in 1942 at The Johns Hopkins University School of Hygiene and Public Health in Baltimore, Maryland, as the US Army Industrial Hygiene Laboratory to provide Occupational Medicine, Industrial Hygiene and other Occupational Health services in support of the World War II military industrial base. In 1945, the organization moved to the Edgewood Area of Aberdeen Proving Ground and underwent organizational changes, mission changes and name changes.

Detection of Three Sexually Transmitted Infections by Anatomic Site: Evidence From an Internet-Based Screening Program.

Urogenital and rectal specimens collected from the "IWantTheKit" Internet-based sexually transmitted infection screening program were evaluated for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Of 881 paired specimens submitted from August 2013 to December 2016, 15.0% (n = 132) tested positive for 1 or more sexually transmitted infections, of which 50.

Use of Biomarkers to Assess Environmental Exposures and Health Outcomes in Deployed Troops.

Objective: This paper provides an overview of our Military Biomarkers Research Study (MBRS) designed to assess whether biomarkers can be used to retrospectively assess deployment exposures and health impacts related to deployment environmental exposures.

Methods: The MBRS consists of four phases. Phase I was a feasibility study of stored sera.

Outbreak of Chlamydia pneumoniae Infections and X-ray-Confirmed Pneumonia in Army Trainees at Fort Leonard Wood, Missouri, 2014.

Introduction: Chlamydia pneumoniae (Cp) is a bacterium that causes pneumonia and other respiratory diseases. Fever may be present early but absent by time of presentation to clinic. Increases in X-ray-confirmed pneumonia (XCP) and laboratory-confirmed Cp infections were observed in new soldiers in training at Fort Leonard Wood (FLW), Missouri, early in 2014.

Survey of Sexually Transmitted Disease Laboratory Methods in U.S. Army Laboratories, 2012.

Introduction: Sexually transmitted diseases (STD) affect primarily young people (17-24 years). The U.S.

Mortality Surveillance for Infectious Diseases in the U.S. Department of Defense (1998-2013).

Introduction: The Mortality Surveillance Division (MSD) of the U.S. Armed Forces Medical Examiner System was established in 1998 to improve surveillance for all military deaths although emphasizing deaths from infectious diseases.

The U.S. Army Occupational and Environmental Medicine Residency at Aberdeen Proving Ground, Maryland: 1960-1996.

Background: Reorganization of the Army and critical assessment of Army Graduate Medical Education programs prompted the Occupational and Environmental Medicine (OEM) Consultant to the Army Surgeon General to initiate a review of current Army OEM residency training. Available information indicated the Army OEM residency at Aberdeen Proving Ground, MD, was the first and longest operating Army OEM residency. Describing this residency was identified as the first step in the review, with the objectives of determining why the residency was started and sustained and its relevance to the needs of the Army.

Acute Respiratory Disease in US Army Trainees 3 Years after Reintroduction of Adenovirus Vaccine .

The 1999 cessation of vaccination against adenovirus types 4 and 7 among US Army trainees resulted in reemergence of acute respiratory disease (ARD) outbreaks. The 2011 implementation of a replacement vaccine led to dramatic and sustained decreases in ARD cases, supporting continuation of vaccination in this population at high risk for ARD.

Introduction to Department of Defense Research on Burn Pits, Biomarkers, and Health Outcomes Related to Deployment in Iraq and Afghanistan.

Objective: This paper provides an overview of our study that was designed to assess the health impact of environmental exposures to open pit burning in deployed troops.

Methods: The rationale for the study and the structure of the research plan was laid out. An overview of each article in the supplement was provided.

Utility of the Department of Defense Serum Repository in Assessing Deployment Exposure.

Objective: This paper describes why the research project was conducted in terms of demonstrating the utility of the Department of Defense Serum Repository in addressing deployment environmental exposures.

Methods: The history deployment exposure surveillance was reviewed and the rationale for developing validated biomarkers that were detected in sera in postdeployment samples and compared with nondeployed controls was described. The goal was to find validated biomarkers that are associated with both exposures and health outcomes.

Incidence of Chlamydia trachomatis infections and screening compliance, U.S. Army active duty females under 25 years of age, 2011-2014.

Reported chlamydia infection rates among active duty U.S. Army females less than 25 years old declined by 20% from 2011 to 2014 (11,028 infections per 100,000 person-years [p-yrs] to 8,793 infections per 100,000 p-yrs, respectively).

Maximizing the Capabilities of the DoD Serum Repository to Meet Current and Future Needs: Report of the Needs Panel.

In June 2013, the Armed Forces Health Surveillance Center, Silver Spring, MD, hosted two panels of civilian and military public health and laboratory professionals to address medical surveillance and primary care needs of the Department of Defense (DoD) that might be met by a biorepository that contained specimens that would be suitable for testing using emerging laboratory technologies. The first panel, the "needs panel," was asked to identify capabilities that were needed by the Military Medicine community to better perform their jobs but were either not presently available or not supported by specimens archived in the current DoD Serum Repository (DoDSR). A second panel, the "technology panel," considered whether current technology existed to support the needs identified by the first panel.