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Taylor KM, Ricks KM, Kuehnert PA, Eick-Cost AA, Scheckelhoff MR, Wiesen AR, Clements TL, Hu Z, Zak SE, Olschner SP, Herbert AS, Bazaco SL, Creppage KE, Fan MT, Sanchez JL. Seroprevalence as an Indicator of Undercounting of COVID-19 Cases in a Large Well-Described Cohort. AJPM Focus 2023; 2:100141. [PMID: 37885754 PMCID: PMC10598697 DOI: 10.1016/j.focus.2023.100141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction Reported confirmed cases represent a small portion of overall true cases for many infectious diseases. The undercounting of true cases can be considerable when a significant portion of infected individuals are asymptomatic or minimally symptomatic, as is the case with COVID-19. Seroprevalence studies are an efficient way to assess the extent to which true cases are undercounted during a large-scale outbreak and can inform efforts to improve case identification and reporting. Methods A longitudinal seroprevalence study of active duty U.S. military members was conducted from May 2020 through June 2021. A random selection of service member serum samples submitted to the Department of Defense Serum Repository was analyzed for the presence of antibodies reactive to SARS-CoV-2. The monthly seroprevalence rates were compared with those of cumulative confirmed cases reported during the study period. Results Seroprevalence was 2.3% in May 2020 and increased to 74.0% by June 2021. The estimated true case count based on seroprevalence was 9.3 times greater than monthly reported cases at the beginning of the study period and fell to 1.7 by the end of the study. Conclusions In our sample, confirmed case counts significantly underestimated true cases of COVID-19. The increased availability of testing over the study period and enhanced efforts to detect asymptomatic and minimally symptomatic cases likely contributed to the fall in the seroprevalence to reported case ratio.
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Affiliation(s)
- Kevin M. Taylor
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Keersten M. Ricks
- United States Army Medical Research Institute of Infectious Diseases, Frederick, Maryland
| | - Paul A. Kuehnert
- United States Army Medical Research Institute of Infectious Diseases, Frederick, Maryland
| | - Angelia A. Eick-Cost
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
| | - Mark R. Scheckelhoff
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
| | - Andrew R. Wiesen
- Health Readiness Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Washington, District of Columbia
| | - Tamara L. Clements
- United States Army Medical Research Institute of Infectious Diseases, Frederick, Maryland
| | - Zheng Hu
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
| | - Samantha E. Zak
- United States Army Medical Research Institute of Infectious Diseases, Frederick, Maryland
| | - Scott P. Olschner
- United States Army Medical Research Institute of Infectious Diseases, Frederick, Maryland
| | - Andrew S. Herbert
- United States Army Medical Research Institute of Infectious Diseases, Frederick, Maryland
| | - Sara L. Bazaco
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
| | - Kathleen E. Creppage
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
| | - Michael T. Fan
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland
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Weiss CD, Wang W, Lu Y, Billings M, Eick-Cost A, Couzens L, Sanchez JL, Hawksworth AW, Seguin P, Myers CA, Forshee R, Eichelberger MC, Cooper MJ. Neutralizing and Neuraminidase Antibodies Correlate With Protection Against Influenza During a Late Season A/H3N2 Outbreak Among Unvaccinated Military Recruits. Clin Infect Dis 2021; 71:3096-3102. [PMID: 31840159 PMCID: PMC7819518 DOI: 10.1093/cid/ciz1198] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/13/2019] [Indexed: 02/05/2023] Open
Abstract
Background Antibodies that inhibit hemagglutination have long been considered a correlate of protection against influenza, but these antibodies are only a subset of potentially protective antibodies. Neutralizing and neuraminidase antibodies may also contribute to protection, but data on their associations with protection are limited. Methods We measured preoutbreak hemagglutinin pseudovirus neutralization (PVN) and neuraminidase inhibition (NAI) antibody titers in unvaccinated military recruits who experienced an H3N2 influenza outbreak during training. We conducted a case-control study to investigate the association between titers and protection against influenza illness or H3N2-associated pneumonia using logistic regression. Results With every 2-fold increase in PVN titer, the odds of medically attended polymerase chain reaction–confirmed H3N2 infection (H3N2+) decreased by 41% (odds ratio [OR], 0.59; 95% confidence interval [CI], .45 to .77; P < .001). Among those who were H3N2+, the odds for pneumonia decreased by 52% (OR, 0.48; CI, .25 to .91; P = .0249). With every 2-fold increase in NAI titer, the odds of medically attended H3N2 infection decreased by 32% (OR, 0.68; 95% CI, .53 to .87; P = .0028), but there was no association between NAI titers and H3N2-associated pneumonia. There was also no synergistic effect of PVN and NAI antibodies. Conclusions PVN and NAI titers were independently associated with reduced risk of influenza illness. NAI titers associated with protection had greater breadth of reactivity to drifted strains than PVN titers. These findings show that PVN and NAI titers are valuable biomarkers for assessing the odds of influenza infection.
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Affiliation(s)
- Carol D Weiss
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Wei Wang
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yun Lu
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Monisha Billings
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Angelia Eick-Cost
- Armed Forces Health Surveillance Branch, Defense Health Agency, Department of Defense, Silver Spring, Maryland, USA
| | - Laura Couzens
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jose L Sanchez
- Armed Forces Health Surveillance Branch, Defense Health Agency, Department of Defense, Silver Spring, Maryland, USA
| | - Anthony W Hawksworth
- Operational Infectious Diseases, Naval Health Research Center, San Diego, California, USA
| | | | - Christopher A Myers
- Armed Forces Health Surveillance Branch, Defense Health Agency, Department of Defense, Silver Spring, Maryland, USA
| | - Richard Forshee
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Maryna C Eichelberger
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Branch, Defense Health Agency, Department of Defense, Silver Spring, Maryland, USA
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Forshey BM, Woodward A, Sanchez JL, Petzing SR. Military Participation in Health Security: Analysis of Joint External Evaluation Reports and National Action Plans for Health Security. Health Secur 2021; 19:173-182. [PMID: 33719585 DOI: 10.1089/hs.2020.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Militaries around the world play an important but at times poorly defined and underappreciated role in global health security. They are often called upon to support civilian authorities in humanitarian crises and to provide routine healthcare for civilians. Military personnel are a unique population in a health security context, as they are highly mobile and often deploy to austere settings domestically and internationally, which may increase exposure to endemic and emerging infectious diseases. Despite the role of militaries, few studies have systematically evaluated their involvement in global health security activities including the Global Health Security Agenda. We analyzed Joint External Evaluation (JEE) mission reports (n = 94) and National Action Plan for Health Security plans (n = 12), published as of July 2020, to determine the extent to which military organizations were involved in the evaluation process, military involvement in health security activities were described, and specific recommendations were provided for the country's military. For JEE reports, descriptions of military involvement were highest in 3 of the 4 core areas: Respond (76%), Prevent (39%), and Detect (32%). Similarly, National Action Plan for Health Security plans mentioned military involvement in the same 3 core areas: Respond (58%), Prevent (33%), and Detect (33%). Only 28% of JEE reports provided recommendations for the military in any of the core areas. Our results indicate that military roles and contributions are incorporated into some aspects of country-level health security activities, but that more extensive involvement may be warranted to improve national capabilities to prevent, detect, and respond to infectious disease threats.
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Affiliation(s)
- Brett M Forshey
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
| | - Alexandra Woodward
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
| | - Jose L Sanchez
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
| | - Stephanie R Petzing
- Brett M. Forshey, PhD, is a US Public Health Service Officer and an Epidemiologist and Alexandra Woodward, MPH, is a Senior Biosurveillance Specialist, Global Emerging Infections Surveillance; and Jose L. Sanchez, MD, is Deputy Chief; all with the Armed Forces Health Surveillance Division, Silver Spring, MD. Alexandra Woodward is also a Senior Biosurveillance Specialist, Cherokee Nation Strategic Programs, Tulsa, OK; and a DrPH Health Security Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Stephanie R. Petzing, PhD, is Senior Global Health Security Advisor, Henry M. Jackson Foundation, Center for Global Health Engagement, Bethesda, MD. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Department of Defense or of the US government
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Sanchez JL, Saeed S, Battistini H. 1250 Agrypnia Excitata in a Patient with Paraneoplastic Autoimmune Encephalitis. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Agrypnia Excitata (AE) is a syndrome characterized by loss of sleep with permanent motor and autonomic hyper activation. This case describes this peculiar syndrome in a patient with paraneoplastic autoimmune encephalitis.
Report of Case
DG is a 35 yr old male with a history of anti-Ma2 limbic encephalitis secondary to cystic teratoma of the left testis diagnosed 6 months prior to presenting in Sleep Clinic. His parents described significant sleep disturbances including short sleep and wake periods throughout the day and night with no apparent pattern, acting out dreams, motor activity during sleep including pulling at his clothes or using his hands to manipulate invisible objects. Additionally they described low-grade fevers, and severe hyperphagia. Polysomnogram showed absence of slow-wave sleep and what appeared to be an admixture of stage 1 non-rapid eye movement (NREM) with rapid-eye movement (REM) sleep. Multiple sleep-latency testing (MSLT) demonstrated a mean sleep latency of 5.2 minutes and four sleep-onset REM periods (SOREMPs). Magnetic resonance imaging of the brain revealed persistent inflammation of the mesial temporal lobes and hippocampal region. Cerebral spinal fluid testing showed persistent anti-Ma2 antibodies. Based on this clinical presentation we made a diagnosis of Agrypnia Excitata.
Conclusion
Agrypnia Excitata is a syndrome characterized by loss of the normal sleep-wake rhythm. Sleep consists of the disappearance of spindle-delta activities, and persistent stage 1 NREM sleep mixed with recurrent episodes of REM sleep. The second hallmark of AE is persistent motor and autonomic hyperactivity observed during wake and sleep. AE has been described in three distinct clinical syndromes: Morvan Syndrome (autoimmune encephalitis), Fatal Familial Insomnia, and Delirium tremens. The pathogenesis of AE consists of intra-limbic disconnection releasing the hypothalamus and brainstem reticular formation from cortico-limbic inhibitory control. In autoimmune encephalitis, antibodies that act on voltage-gated potassium channels within the limbic system have been implicated in the pathophysiology.
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Affiliation(s)
- J L Sanchez
- Department of Sleep Medicine - Medical College of Wisconsin
| | - S Saeed
- Department of Sleep Medicine - Medical College of Wisconsin
| | - H Battistini
- Department of Sleep Medicine - Medical College of Wisconsin
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Zemke JN, Sanchez JL, Pang J, Gray GC. The Double-Edged Sword of Military Response to Societal Disruptions: A Systematic Review of the Evidence for Military Personnel as Pathogen Transmitters. J Infect Dis 2020; 220:1873-1884. [PMID: 31519020 DOI: 10.1093/infdis/jiz400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/02/2019] [Indexed: 11/12/2022] Open
Abstract
Given their lack of immunity and increased exposure, military personnel have the potential to serve as carriers or reservoirs for infectious diseases into or out of the deployment areas, but, to our knowledge, the historical evidence for such transmission events has not previously been reviewed. Using PubMed, we performed a systematic review of published literature between 1955 and 2018, which documented evidence for military personnel transporting infectious pathogens into or out of deployment areas. Of the 439 articles screened, 67 were included for final qualitative and quantitative review. The data extracted from these articles described numerous instances in which thousands of military service members demonstrated potential or actual transmission and transportation of multiple diverse pathogens. These data underscore the immense importance preventive medical professionals play in mitigating such risk, how their public health efforts must be supported, and the importance of surveillance in protecting both military and civilian populations.
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Affiliation(s)
- Juliana N Zemke
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jose L Sanchez
- Department of Defense, Defense Health Agency, Public Health Division, Armed Forces Health Surveillance Branch, Silver Spring, Maryland
| | - Junxiong Pang
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for Infectious Disease Epidemiology & Research, Saw Swee Hock School of Public Health, National University of Singapore
| | - Gregory C Gray
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina.,Emerging Infectious Disease Program, Duke-National University of Singapore Medical School, Singapore.,Global Health Research Center, Duke-Kunshan University, Kunshan, China
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6
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Plant EP, Manukyan H, Sanchez JL, Laassri M, Ye Z. Immune Pressure on Polymorphous Influenza B Populations Results in Diverse Hemagglutinin Escape Mutants and Lineage Switching. Vaccines (Basel) 2020; 8:vaccines8010125. [PMID: 32168968 PMCID: PMC7157493 DOI: 10.3390/vaccines8010125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Mutations arise in the genomes of progeny viruses during infection. Mutations that occur in epitopes targeted by host antibodies allow the progeny virus to escape the host adaptive, B-cell mediated antibody immune response. Major epitopes have been identified in influenza B virus (IBV) hemagglutinin (HA) protein. However, IBV strains maintain a seasonal presence in the human population and changes in IBV genomes in response to immune pressure are not well characterized. There are two lineages of IBV that have circulated in the human population since the 1980s, B-Victoria and B-Yamagata. It is hypothesized that early exposure to one influenza subtype leads to immunodominance. Subsequent seasonal vaccination or exposure to new subtypes may modify subsequent immune responses, which, in turn, results in selection of escape mutations in the viral genome. Here we show that while some mutations do occur in known epitopes suggesting antibody escape, many mutations occur in other parts of the HA protein. Analysis of mutations outside of the known epitopes revealed that these mutations occurred at the same amino acid position in viruses from each of the two IBV lineages. Interestingly, where the amino acid sequence differed between viruses from each lineage, reciprocal amino acid changes were observed. That is, the virus from the Yamagata lineage become more like the Victoria lineage virus and vice versa. Our results suggest that some IBV HA sequences are constrained to specific amino acid codons when viruses are cultured in the presence of antibodies. Some changes to the known antigenic regions may also be restricted in a lineage-dependent manner. Questions remain regarding the mechanisms underlying these results. The presence of amino acid residues that are constrained within the HA may provide a new target for universal vaccines for IBV.
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Affiliation(s)
- Ewan P. Plant
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA; (H.M.); (M.L.); (Z.Y.)
- Correspondence: ; Tel.: +1-240-402-7319
| | - Hasmik Manukyan
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA; (H.M.); (M.L.); (Z.Y.)
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Branch, Public Health Division, Assistant Director for Combat Support (AD-CS), Defense Health Agency, Silver Spring, MD 20904, USA;
| | - Majid Laassri
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA; (H.M.); (M.L.); (Z.Y.)
| | - Zhiping Ye
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA; (H.M.); (M.L.); (Z.Y.)
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Bautista CT, Hollingsworth BP, Sanchez JL. Repeat Chlamydia Diagnoses Increase the Hazard of Pelvic Inflammatory Disease among US Army Women: A Retrospective Cohort Analysis. Sex Transm Dis 2019; 45:770-773. [PMID: 29870505 DOI: 10.1097/olq.0000000000000878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the US military, chlamydia is the mostly commonly diagnosed bacterial sexually transmitted infection and the rates of pelvic inflammatory disease (PID) have remained high since the early 2000s. METHODS The relationship between the number of chlamydia diagnoses and hazard of PID was investigated in a retrospective cohort analysis among US Army women from 2006 to 2012. Cox regression model was used to estimate hazard ratios for associations between the number of repeat chlamydia diagnoses and PID. RESULTS The study population comprised 33,176 women with chlamydia diagnosis. Of these, 25,098 (75%) were diagnosed only once ("nonrepeaters"). By comparison, 6282 (19%), 1435 (4%), and 361 (1%) women had one, two and three repeat chlamydia diagnoses, respectively. Among these 4 groups, 1111, 325, 72, and 25 PID diagnoses were noted. According to the Cox regression analysis, for every additional diagnosis of chlamydia, the hazard of PID increased by 28% (95% confidence interval, 19%-38%) compared with women with a single diagnosis or nonrepeaters. Moreover, the corresponding adjusted hazard ratio of 1.28, 1.35, and 1.97 represented a significantly greater risk for PID among the three "repeater" groups compared with nonrepeaters. CONCLUSIONS We found an increased hazard of PID among US Army women with repeat chlamydia diagnoses and the characterization of a dose-response relationship. These findings reinforce the notion that early diagnosis and treatment of chlamydia is necessary to avoid subsequent PID and associated morbidity.
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Affiliation(s)
| | | | - Jose L Sanchez
- Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, MD
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8
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Bautista CT, Wurapa EK, Sateren WB, Hollingsworth BP, Sanchez JL. Longitudinal association of gonorrhea and bacterial vaginosis with repeat chlamydia diagnoses among U.S. Army women: a retrospective cohort analysis. Mil Med Res 2018; 5:37. [PMID: 30373657 PMCID: PMC6206713 DOI: 10.1186/s40779-018-0184-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Historically, sexually transmitted infections have affected the health of the U.S. military. To determine whether gonorrhea, bacterial vaginosis, genital herpes, and trichomoniasis are predictors of repeat chlamydia diagnoses among U.S. Army women, medical data reported into the Defense Medical Surveillance System during the 2006-2012 period were analyzed. METHODS For all inpatient and outpatient medical records, the first and second International Classification of Diseases, version 9 (ICD-9) diagnostic positions were reviewed for each chlamydia case to determine the occurrence of repeat diagnoses. The Andersen-Gill regression model, an extension of the Cox model for multiple failure-time data, was used to study associations between predictors and repeat chlamydia diagnoses. RESULTS Among 28,201 women with a first chlamydia diagnosis, 5145 (18.2%), 1163 (4.1%), 267 (0.9%), and 88 (0.3%) had one, two, three, and four or more repeat diagnoses, respectively. Overall, the incidence of repeat chlamydia was 8.31 cases per 100 person-years, with a median follow-up time of 3.39 years. Gonorrhea (hazard ratio (HR) = 1.58, 95% CI: 1.44-1.73) and bacterial vaginosis (HR = 1.40, 95% CI: 1.09-1.79) were significant predictors for repeat chlamydia. These estimated hazard ratios were attenuated, but remained significant, after controlling for age, race/ethnicity, marital status, and military rank. No significant association was found for genital herpes (HR = 1.13, 95% CI: 0.55-2.29) and trichomoniasis (HR = 1.43, 95% CI: 0.43-4.68). CONCLUSIONS This large cohort study suggests that gonorrhea and bacterial vaginosis were associated with repeat chlamydia diagnoses among U.S. Army women. These findings can be used in formulating new interventions to prevent repeat chlamydia diagnoses.
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Affiliation(s)
| | - Eyako K Wurapa
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | - Jose L Sanchez
- Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, MD, USA
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9
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Bautista CT, Wurapa EK, Sanchez JL. Does the Hazard of Chlamydia Increase with the Number of Gonorrhea Diagnoses? A Large Population-Based Study Among U.S. Army Women. J Womens Health (Larchmt) 2018; 28:220-224. [PMID: 30010470 DOI: 10.1089/jwh.2018.7253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In the U.S. military, chlamydia and gonorrhea are common sexually transmitted infections, especially among female service members. The aim of this study was to determine whether the number of gonorrhea diagnoses sustained an increased hazard of chlamydia among military women. METHODS This population-based study involved an analysis of all female gonorrhea cases in the U.S. Army reported in the Defense Medical Surveillance System between 2006 and 2012. The effect of the number of gonorrhea diagnoses on the hazard of chlamydia was analyzed using the Prentice-Williams-Peterson gap-time model. RESULTS Among 3,618 women with gonorrhea diagnosis, 702 (19.4%) had a subsequent chlamydia diagnosis yielding a rate of 6.06 (95% CI = 5.63-6.53) cases per 100 person-years. Compared to women with one gonorrhea diagnosis, the hazard ratio of chlamydia for women with two gonorrhea diagnoses was 5.09 (95% CI = 4.42-5.86) and for women with three gonorrhea diagnoses was 6.53 (95% CI = 3.93-10.83). The median time to chlamydia diagnosis decreased from 2.39 to 0.67 years for women with two to three gonorrhea diagnoses. CONCLUSIONS The hazard of chlamydia increased significantly with the number of gonorrhea diagnoses and the median time to chlamydia diagnosis decreased with an increasing number of gonorrhea diagnoses among U.S. Army women.
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Affiliation(s)
| | - Eyako K Wurapa
- 2 Center for Infectious Disease Research, Walter Reed Army Institute of Research , Silver Spring, Maryland
| | - Jose L Sanchez
- 3 Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency , Silver Spring, Maryland
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10
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Mancuso JD, Garges EC, Hickey PW, Coldren RL, Korman AK, Keep LW, DeFraites RF, Sanchez JL. Outcomes From U.S. Military-Supported Overseas Training Rotations in Tropical Medicine and Global Health, 2006-2015. Mil Med 2018; 182:e1796-e1801. [PMID: 28885939 DOI: 10.7205/milmed-d-16-00408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Since 2006, the Division of Tropical Public Health at the Uniformed Services University (USU) has sponsored the Tropical Medicine Training Program (TMTP). Despite practice guidelines stating that global health education should include the collection and evaluation of data on the impact of the training experiences, no quantitative evaluation of program outcomes had previously occurred. The objective of this report was to evaluate TMTP outcomes to guide program improvement. METHODS We developed an anonymous, web-based survey to assess program outcomes as part of routine program evaluation. The survey addressed four main areas of potential TMTP impact: (1) career engagement, (2) military service contributions, (3) scholarly activity, and (4) acquisition of knowledge and skills. In February 2016, we sent the survey electronically to 222 program participants between Fiscal Years 2006 and 2015 who had e-mails available in DoD administrative systems. FINDINGS Ninety-eight (44%) of these responded to the survey. TMTP demonstrated impact in several areas. Increased knowledge and skills were reported by 81% of trainees, and 70% reported increased interest in serving at military overseas medical research laboratories. Subsequent career engagement by trainees included seven assignments to overseas research laboratories, 71 military deployments, and 193 short-term military missions. The ability to achieve many of the desired outcomes was associated with time elapsed since completion of formal medical education, including 24% who were still enrolled in graduate medical education. DISCUSSION/IMPACT/RECOMMENDATIONS The TMTP has improved the U.S. military's ability to perform surveillance for emerging tropical and infectious diseases and has contributed to force health protection and readiness. Although many of the outcomes, such as service in the overseas research laboratories and military deployments, are dependent on military service requirements, these results remain perhaps the most relevant ways that the TMTP meets global health requirements of the US military and the nation. Additional outcomes from this training are expected to accrue as these participants complete their medical postgraduate training programs.
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Affiliation(s)
- James D Mancuso
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Eric C Garges
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Patrick W Hickey
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Rodney L Coldren
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Amy K Korman
- Defense Health Agency, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042-5101
| | - Lisa W Keep
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Robert F DeFraites
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Jose L Sanchez
- Armed Forces Health Surveillance Branch, 503 Robert Grant Avenue, Silver Spring, MD 20910
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Swanson KC, Darling N, Kremer P, Doepking M, Steiner SC, Myers CA, Hawksworth AW, Sanchez JL, Harris S, Cooper MJ. Outbreak of influenza and rhinovirus co-circulation among unvaccinated recruits, U.S. Coast Guard Training Center Cape May, NJ, 24 July-21 August 2016. MSMR 2018; 25:2-7. [PMID: 29381076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Military and Coast Guard recruits are particularly susceptible to respiratory infections. Although seasonal influenza vaccinations are mandatory for recruits, the vaccine expires annually in June. On 29 July 2016, the U.S. Coast Guard Training Center Cape May, NJ, identified an increase in febrile respiratory illness (FRI) among recruits. During 24 July-21 August, a total of 115 recruits reported symptoms. A total of 74 recruits tested positive for respiratory infections: influenza A (H3) (n=34), rhinovirus (n=28), influenza/rhinovirus co-infection (n=11), and adenovirus/rhinovirus co-infection (n=1), while 41 recruits had no laboratory-confirmed specimen but were considered suspected cases. Only one recruit reported receiving the seasonal influenza vaccine within the previous 12 months. Influenza predominated during 24 July-6 August, whereas rhinovirus predominated during 7 August-20 August. Most (92.2%) cases were identified in four of 10 recruit companies; incidence rates were highest among recruits in weeks 2-4 of an 8-week training cycle. Key factors for outbreak control included rapid detection through routine FRI surveillance, quick decision-making and streamlined response by using a single chain of command, and employing both nonpharmaceutical and pharmaceutical interventions.
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12
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Bautista CT, Wurapa EK, Sateren WB, Morris SM, Hollingsworth BP, Sanchez JL. Association of Bacterial Vaginosis With Chlamydia and Gonorrhea Among Women in the U.S. Army. Am J Prev Med 2017; 52:632-639. [PMID: 27816380 DOI: 10.1016/j.amepre.2016.09.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/04/2016] [Accepted: 09/13/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Bacterial vaginosis (BV) is a common vaginal condition in women of reproductive age, which has been associated with Chlamydia trachomatis and Neisseria gonorrhoeae among commercial sex workers and women attending sexually transmitted infection clinics. Pathogen-specific associations between BV and other sexually transmitted infections among U.S. military women have not been investigated. METHODS A population-based, nested case-control study was conducted of all incident chlamydia and gonorrhea cases reported to the Defense Medical Surveillance System during 2006-2012. Using a density sampling approach, for each chlamydia or gonorrhea case, 10 age-matched (±1 year) controls were randomly selected from those women who were never diagnosed with these infections. Incidence rate ratios were estimated using conditional logistic regression. Statistical analysis was carried out in December 2015. RESULTS A total of 37,149 chlamydia cases and 4,987 gonorrhea cases were identified during the study period. Antecedent BV was associated with an increased risk of subsequent chlamydia (adjusted incidence rate ratio=1.51; 95% CI=1.47, 1.55) and gonorrhea (adjusted incidence rate ratio=2.42; 95% CI=2.27, 2.57) infections. For every one additional episode of BV, the risk of acquiring chlamydia and gonorrhea infections increased by 13% and 26%, respectively. A monotonic dose-response relationship was also noted between antecedent BV and subsequent chlamydia and gonorrhea infection. In addition, an effect modification on the additive scale was found between BV and African-American race for gonorrhea, but not for chlamydia. CONCLUSIONS Among U.S. Army women, antecedent BV is associated with an increased risk of subsequent chlamydia and gonorrhea infection.
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Affiliation(s)
- Christian T Bautista
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
| | - Eyako K Wurapa
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | - Sara M Morris
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | | | - Jose L Sanchez
- Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, Maryland
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Mancuso JD, Hickey PW, Coldren RL, Korman AK, Keep LW, DeFraites RF, Smith M, Mancuso LJ, Sanchez JL. DoD-Supported Overseas Training Rotations in Tropical Medicine and Global Health, 2000-2015. Mil Med 2017; 182:e1719-e1725. [PMID: 28290949 DOI: 10.7205/milmed-d-16-00108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In 1999, the Department of Defense developed a tropical medicine training program (TMTP) to train military physicians, medical students, and scientists in performing surveillance activities in an overseas environment. This review describes the competencies, educational approach, program participants, institutional collaborations, and process outcomes of the TMTP from 2000 to 2015. TMTP-sponsored rotations addressed a wide variety of interdisciplinary competencies, many of which have military-unique applications. Rotations consisted of both didactic and experiential (overseas) components. The program provided 282 rotations for 260 trainees between 2006 and 2015, the years for which data were available. The Department of Defense accrues benefits from this training program in three main ways: (1) building a cadre of health care professionals who will go on to work at the overseas research laboratories, (2) supporting force health protection and readiness through experiential tropical medicine training, and (3) engaging in global health collaborations and partnerships. The primary challenges include funding, health and security, trainee and site heterogeneity, supervision, trainee engagement, and burden on the host institution. The program will continue to focus on improvement in these areas, with special attention to trainee preparation, communication with both trainees and host sites, and increasing reciprocity with host sites and their faculty.
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Affiliation(s)
- James D Mancuso
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Patrick W Hickey
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Rodney L Coldren
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Amy K Korman
- Defense Health Agency, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042
| | - Lisa W Keep
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Robert F DeFraites
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Maria Smith
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Luke J Mancuso
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Jose L Sanchez
- Armed Forces Health Surveillance Branch, 11800 Tech Road, Silver Spring, MD 20904
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Horby PW, Laurie KL, Cowling BJ, Engelhardt OG, Sturm‐Ramirez K, Sanchez JL, Katz JM, Uyeki TM, Wood J, Van Kerkhove MD. CONSISE statement on the reporting of Seroepidemiologic Studies for influenza (ROSES-I statement): an extension of the STROBE statement. Influenza Other Respir Viruses 2017; 11:2-14. [PMID: 27417916 PMCID: PMC5155648 DOI: 10.1111/irv.12411] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Population-based serologic studies are a vital tool for understanding the epidemiology of influenza and other respiratory viruses, including the early assessment of the transmissibility and severity of the 2009 influenza pandemic, and Middle East respiratory syndrome coronavirus. However, interpretation of the results of serologic studies has been hampered by the diversity of approaches and the lack of standardized methods and reporting. OBJECTIVE The objective of the CONSISE ROSES-I statement was to improve the quality and transparency of reporting of influenza seroepidemiologic studies and facilitate the assessment of the validity and generalizability of published results. METHODS The ROSES-I statement was developed as an expert consensus of the CONSISE epidemiology and laboratory working groups. The recommendations are presented in the familiar format of a reporting guideline. Because seroepidemiologic studies are a specific type of observational epidemiology study, the ROSES-I statement is built upon the STROBE guidelines. As such, the ROSES-I statement should be seen as an extension of the STROBE guidelines. RESULTS The ROSES-I statement presents 42 items that can be used as a checklist of the information that should be included in the results of published seroepidemiologic studies, and which can also serve as a guide to the items that need to be considered during study design and implementation. CONCLUSIONS We hope that the ROSES-I statement will contribute to improving the quality of reporting of seroepidemiologic studies.
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Affiliation(s)
- Peter W. Horby
- Nuffield Department of MedicineCentre for Tropical Medicine and Global HealthUniversity of OxfordOxfordUK
| | - Karen L. Laurie
- WHO Collaborating Centre for Reference and Research on Influenzaat the Peter Doherty Institute for Infectious DiseasesMelbourneAustralia
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Othmar G. Engelhardt
- National Institute for Biological Standards and ControlMedicines and Healthcare products Regulatory AgencyPotters BarUK
| | - Katharine Sturm‐Ramirez
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Center (AFHSC) and Cherokee Nation Technology Solutions, IncSilver SpringMDUSA
| | - Jacqueline M. Katz
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - John Wood
- National Institute for Biological Standards and ControlMedicines and Healthcare products Regulatory AgencyPotters BarUK
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Deiss R, Bower RJ, Co E, Mesner O, Sanchez JL, Masel J, Ganesan A, Macalino GE, Agan BK. The Association between Sexually Transmitted Infections, Length of Service and Other Demographic Factors in the U.S. Military. PLoS One 2016; 11:e0167892. [PMID: 27936092 PMCID: PMC5148014 DOI: 10.1371/journal.pone.0167892] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous studies have found higher rates of sexually transmitted infections (STIs) among military personnel than the general population, but the cumulative risk of acquiring STIs throughout an individual's military career has not been described. METHODS Using ICD-9 diagnosis codes, we analyzed the medical records of 100,005 individuals from all service branches, divided in equal cohorts (n = 6,667) between 1997 and 2011. As women receive frequent STI screening compared to men, these groups were analyzed separately. Incidence rates were calculated for pathogen-specific STIs along with syndromic diagnoses. Descriptive statistics were used to characterize the individuals within each accession year cohort; repeat infections were censored. RESULTS The total sample included 29,010 females and 70,995 males. The STI incidence rates (per 100 person-years) for women and men, respectively, were as follows: chlamydia (3.5 and 0.7), gonorrhea (1.1 and 0.4), HIV (0.04 and 0.07) and syphilis (0.14 and 0.15). During the study period, 22% of women and 3.3% of men received a pathogen-specific STI diagnosis; inclusion of syndromic diagnoses increased STI prevalence to 41% and 5.5%, respectively. In multivariate analyses, factors associated with etiologic and syndromic STIs among women included African American race, younger age and fewer years of education. In the overall sample, increasing number of years of service was associated with an increased likelihood of an STI diagnosis (p<0.001 for trend). CONCLUSION In this survey of military personnel, we found very high rates of STI acquisition throughout military service, especially among women, demonstrating that STI-related risk is significant and ongoing throughout military service. Lower STI incidence rates among men may represent under-diagnosis and demonstrate a need for enhancing male-directed screening and diagnostic interventions.
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Affiliation(s)
- Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
- Naval Medical Center San Diego, San Diego, California, United States of America
- * E-mail:
| | - Richard J. Bower
- Naval Medical Center San Diego, San Diego, California, United States of America
| | - Edgie Co
- William Beaumont Army Medical Center, El Paso, Texas, United States of America
| | - Octavio Mesner
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, Maryland, United States of America
| | - Jennifer Masel
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Grace E. Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
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Bautista CT, Wurapa EK, Sateren WB, Morris SM, Hollingsworth BP, Sanchez JL. Repeat infection with Neisseria gonorrhoeae among active duty U.S. Army personnel: a population-based case-series study. Int J STD AIDS 2016; 28:962-968. [PMID: 27885067 PMCID: PMC5542132 DOI: 10.1177/0956462416681940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Little information is known on the rate of repeat gonorrhea infection among U.S. military personnel. We analyzed all gonorrhea cases reported to the Defense Medical Surveillance System during 2006–2012 to determine the rate of repeat infection. During the seven-year study period, 17,602 active duty U.S. Army personnel with a first incident gonorrhea infection were reported. Among the 4987 women with a first gonorrhea infection, 14.4% had at least one repeat infection. Among the 12,615 men with a first gonorrhea infection, 13.7% had at least one repeat infection. Overall, the rate of repeat gonorrhea infection was 44.5 and 48.9 per 1000 person-years for women and men, respectively. Service members aged 17–19 years (hazard ratio [HR] for women = 1.51; HR for men = 1.71), African-American personnel (HR for women = 1.26; HR for men = 2.17), junior enlisted personnel (HR for women = 2.64; HR for men = 1.37), and those with one year or less of service (HR for women = 1.23; HR for men = 1.37) were at higher risk of repeat infection. The findings from this study highlight the need to develop targeted prevention initiatives including education, counseling, and retesting to prevent gonorrhea reinfections among U.S. Army personnel.
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Affiliation(s)
| | - Eyako K Wurapa
- 2 Infectious Disease Research Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Warren B Sateren
- 2 Infectious Disease Research Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sara M Morris
- 1 Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Jose L Sanchez
- 3 Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, MD, USA
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Abstract
Tuberculosis (TB) is a communicable disease that poses a threat to force health protection to the U.S. military. The rate of TB disease in the military is low; however, there are unique challenges for its control in this setting. As a low-risk population, TB testing in the U.S. military can be scaled back from the universal testing approach used previously. Reactivation of latent TB infection (LTBI) present at accession into service is the most important factor leading to TB disease; therefore, its diagnosis and treatment among recruits should be given a high priority. Deployment and overseas military service is an uncommon but important source of TB infection, and rigorous surveillance should be ensured. Case management of TB disease and LTBI can be improved by the use of cohort reviews at the service and installation levels and case finding and delays in the diagnosis of TB disease can be improved by education of providers, as well as increased use of molecular diagnostic tests. Program outcomes can be improved by making LTBI treatment compulsory, offering shorter treatment regimens, and increasing accountability through oversight and evaluation. The diagnosis of LTBI can be improved by implementing targeted testing in all settings and reducing confirmatory interferon-gamma release assay testing.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center (AFHSC) and Cherokee Nation Technology Solutions, Inc., 11800 Tech Road, Suite 220, Silver Spring, MD 20904
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, 200 First Street SW, Rochester, MN 55905
| | - Michael J Cooper
- Armed Forces Health Surveillance Center (AFHSC), 11800 Tech Road, Suite 220, Silver Spring, MD 20904
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center (AFHSC), 11800 Tech Road, Suite 220, Silver Spring, MD 20904
| | - James D Mancuso
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Alibayeva G, Todd CS, Khakimov MM, Giyasova GM, Botros BA, Carr JK, Bautista CT, Sanchez JL, Earhart KC. Sexually transmitted disease symptom management behaviours among female sex workers in Tashkent, Uzbekistan. Int J STD AIDS 2016; 18:324-8. [PMID: 17524193 DOI: 10.1258/095646207780749637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this cross-sectional study was to assess prevalence and correlates of self-treatment of sexually transmitted diseases (STD) among female sex workers (FSW) in Tashkent, Uzbekistan. Enrolled FSW completed a self-administered questionnaire, HIV serologic testing and optional pelvic examination. STD diagnosis was based on physical examination and/or microscopic findings. Of 448 women, 337 (75.0%) accepted examination; of these, 316 (93.8%) received at least one STD-related diagnosis. Nearly half (45.4%) reported prior STD self-treatment, which was associated with HIV infection (age-adjusted odds ratio [AOR] = 3.20, 95% confidence interval [CI] = 1.45–7.53) and condom knowledge (AOR = 2.10, 95% CI = 1.16–3.80). For those with history of STD, immediate resumption of sex work before completing treatment was common (87.0%). STD self-treatment is common among FSW in Tashkent, particularly women with HIV infection. Confidential venues for STD care and condom utilization programmes targeted to FSW and their clients are needed to prevent STD in this setting.
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Affiliation(s)
- G Alibayeva
- Ministry of Health, Republic of Uzbekistan, Tashkent, Uzbekistan
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Koren M, Wang X, Blaylock JM, Okulicz JF, Whitman TJ, Deiss RG, Ferguson TM, O'Bryan TA, Sanchez JL, Lalani T, Agan BK, Macalino GE, Ganesan A. The epidemiology of herpes simplex virus type 2 infections in a large cohort of HIV-infected patients, 2006-2014. MSMR 2016; 23:11-15. [PMID: 27030927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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20
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Bautista CT, Wurapa EK, Sanchez JL. Brief report: Associations between antecedent bacterial vaginosis and incident chlamydia and gonorrhea diagnoses, U.S. Army females, 2006-2012. MSMR 2016; 23:32-34. [PMID: 26930150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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21
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Bautista CT, Wurapa E, Sateren WB, Morris S, Hollingsworth B, Sanchez JL. Bacterial vaginosis: a synthesis of the literature on etiology, prevalence, risk factors, and relationship with chlamydia and gonorrhea infections. Mil Med Res 2016; 3:4. [PMID: 26877884 PMCID: PMC4752809 DOI: 10.1186/s40779-016-0074-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/28/2016] [Indexed: 11/10/2022] Open
Abstract
Bacterial vaginosis (BV) is a common vaginal disorder in women of reproductive age. Since the initial work of Leopoldo in 1953 and Gardner and Dukes in 1955, researchers have not been able to identify the causative etiologic agent of BV. There is increasing evidence, however, that BV occurs when Lactobacillus spp., the predominant species in healthy vaginal flora, are replaced by anaerobic bacteria, such as Gardenella vaginalis, Mobiluncus curtisii, M. mulieris, other anaerobic bacteria and/or Mycoplasma hominis. Worldwide, it estimated that 20-30 % of women of reproductive age attending sexually transmitted infection (STI) clinics suffer from BV, and that its prevalence can be as high as 50-60 % in high-risk populations (e.g., those who practice commercial sex work (CSW). Epidemiological data show that women are more likely to report BV if they: 1) have had a higher number of lifetime sexual partners; 2) are unmarried; 3) have engaged in their first intercourse at a younger age; 4) have engaged in CSW, and 5) practice regular douching. In the past decade, several studies have provided evidence on the contribution of sexual activity to BV. However, it is difficult to state that BV is a STI without being able to identify the etiologic agent. BV has also emerged as a public health problem due to its association with other STIs, including: human immunodeficiency virus (HIV), herpes simplex virus type 2 (HSV-2), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). The most recent evidence on the association between BV and CT/NG infection comes from two secondary analyses of cohort data conducted among women attending STI clinics. Based on these studies, women with BV had a 1.8 and 1.9-fold increased risk for NG and CT infection, respectively. Taken together, BV is likely a risk factor or at least an important contributor to subsequent NG or CT infection in high-risk women. Additional research is required to determine whether this association is also present in other low-risk sexually active populations, such as among women in the US military. It is essential to conduct large scale cross-sectional or population-based case-control studies to investigate the role of BV as a risk factor for CT/NG infections. These studies could lead to the development of interventions aimed at reducing the burden associated with bacterial STIs worldwide.
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Affiliation(s)
| | - Eyako Wurapa
- Walter Reed Army Institute of Research, Maryland, USA
| | | | - Sara Morris
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Jose L Sanchez
- Armed Forces Health Surveillance Center and Cherokee Nation Technology Solutions, Maryland, USA
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Troja C, Deiss R, Mesner O, Sanchez JL, Ganesan A, Macalino GE, Agan B. Hepatitis B Virus Infection and Association With Sexually Transmitted Infections Among U.S. Military Personnel. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Van Kerkhove MD, Cooper MJ, Cost AA, Sanchez JL, Riley S. Risk factors for severe outcomes among members of the United States military hospitalized with pneumonia and influenza, 2000-2012. Vaccine 2015; 33:6970-6. [PMID: 26494627 DOI: 10.1016/j.vaccine.2015.09.115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/31/2015] [Accepted: 09/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The progression from hospitalization for a respiratory infection to requiring substantial supportive therapy is a key stage of the influenza severity pyramid. Respiratory infections are responsible for 300,000-400,000 medical encounters each year among US military personnel, some of which progress to severe acute respiratory infections. METHODS We obtained data on 11,086 hospitalizations for pneumonia and influenza (P&I) among non-recruit US military service members during the period of 1 January 2000 through 31 December 2012. From these, we identified 512 P&I hospitalizations that progressed to severe episodes using standard case definitions. We evaluated the effect of demographic and occupational characteristics, co-morbid conditions, and history of influenza vaccination on the risk of a hospitalized P&I case becoming a severe case. We also evaluated the risk of a severe outcome and the length of time since influenza vaccination (within 180, 60, and 30 days). RESULTS The median age of subjects at the time of the P&I episode was 32 years (range, 28-40) and subjects were predominantly male (89.5%). In a univariate analysis, demographic risk factors for a severe episode included service in the US Air Force (RR=1.6 relative to US Army, 95%CI 1.3-2.1), US Coast Guard (RR=2.1, 1.2-3.7) or US Navy (RR=1.4, 1.1-1.8). Being born in the US and recent influenza vaccination (within 180 days of episode) were protective against developing severe disease. Among co-morbid conditions, univariate risk factors for severe disease included chronic renal or liver disease (RR=4.98, 95%CI 4.1-6.1), diseases of the circulatory system (RR=3.1, 95%CI 2.6-3.7), diabetes mellitus (RR=2.3, 95%CI 1.5-3.6), obesity (RR=1.6, 95%CI 1.2-2.1), cancer (RR=1.6, 95%CI 1.3-2.0), and chronic obstructive pulmonary disease (RR=1.4, 95%CI 1.1-1.7). Although many of the risk factors found to be significant in univariate analysis were no longer significant under a multivariate analysis, receipt of any influenza vaccine within 180 days of episode remained protective (RR=0.81, 95%CI 0.67-0.99), while serving in the US Coast Guard (RR=1.9, 95%CI 1.1-3.4) or US Air Force (RR=1. 5, 95%CI 1.2-2.0), presence of renal or liver disease (RR=3.6, 95%CI 2.9-4.6), and diseases of the circulatory system (RR=2.2, 95%CI 1.8-2.8), remained significantly associated with a higher risk of developing severe disease. CONCLUSIONS In a large cohort, after adjusting for many possible risk factors, influenza vaccination was protective against severe episodes among P&I hospitalizations. The service-specific (US Coast Guard or US Air Force) increased risk may represent some differences in data (e.g., coding or reporting practices) as opposed to genuine differences in physiological outcome. Our findings suggest that renal and liver disease as well as diseases of the circulatory system may contribute to influenza severity in this population independently of age and other potential comorbidities. These findings provide additional evidence for the prioritization of specific risk groups within the US military for influenza vaccination.
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Affiliation(s)
- Maria D Van Kerkhove
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1 PG, UK; Center for Global Health, Institut Pasteur, Paris 75015, France.
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, 11800 Tech Road, Suite 220, Silver Spring, MD 20904, USA
| | - Angelia A Cost
- Armed Forces Health Surveillance Center, 11800 Tech Road, Suite 220, Silver Spring, MD 20904, USA; Cherokee Nation Technology Solutions, in support of the Armed Forces Health Surveillance Center, 11800 Tech Road, Suite 220, Silver Spring, MD 20904, USA
| | - Jose L Sanchez
- Cherokee Nation Technology Solutions, in support of the Armed Forces Health Surveillance Center, 11800 Tech Road, Suite 220, Silver Spring, MD 20904, USA
| | - Steven Riley
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1 PG, UK
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Background: The El Niño/Southern Oscillation (ENSO) is a global climate phenomenon that impacts human infectious disease risk worldwide through droughts, floods, and other climate extremes. Throughout summer and fall 2014 and winter 2015, El Niño Watch, issued by the US National Oceanic and Atmospheric Administration, assessed likely El Niño development during the Northern Hemisphere fall and winter, persisting into spring 2015.
Methods: We identified geographic regions where environmental conditions may increase infectious disease transmission if the predicted El Niño occurs using El Niño indicators (Sea Surface Temperature [SST], Outgoing Longwave Radiation [OLR], and rainfall anomalies) and literature review of El Niño-infectious disease associations.
Results: SSTs in the equatorial Pacific and western Indian Oceans were anomalously elevated during August-October 2014, consistent with a developing weak El Niño event. Teleconnections with local climate is evident in global precipitation patterns, with positive OLR anomalies (drier than average conditions) across Indonesia and coastal southeast Asia, and negative anomalies across northern China, the western Indian Ocean, central Asia, north-central and northeast Africa, Mexico/Central America, the southwestern United States, and the northeastern and southwestern tropical Pacific. Persistence of these conditions could produce environmental settings conducive to increased transmission of cholera, dengue, malaria, Rift Valley fever, and other infectious diseases in regional hotspots as during previous El Niño events.
Discussion and Conclusions: The current development of weak El Niño conditions may have significant potential implications for global public health in winter 2014-spring 2015. Enhanced surveillance and other preparedness measures in predicted infectious disease hotspots could mitigate health impacts.
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Affiliation(s)
- Jean-Paul Chretien
- Division of Integrated Biosurveillance, Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Assaf Anyamba
- Biospheric Sciences Laboratory, NASA Goddard Space Flight Center, Greenbelt, Maryland, USA
| | - Jennifer Small
- Biospheric Sciences Laboratory, NASA Goddard Space Flight Center, Greenbelt, Maryland, USA
| | - Seth Britch
- Center for Medical, Agricultural, and Veterinary Entomology, USDA Agricultural Research Service, Gainesville, Florida, USA
| | - Jose L Sanchez
- Division of Global Emerging Infections Surveillance and Response System (GEIS), Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, USA
| | - Alaina C Halbach
- Division of Global Emerging Infections Surveillance and Response System (GEIS), Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, USA
| | - Compton Tucker
- Earth Sciences Division, NASA/Goddard Space Flight Center, Greenbelt, Maryland, USA
| | - Kenneth J Linthicum
- Center for Medical, Agricultural, and Veterinary Entomology, USDA Agricultural Research Service, Gainesville, Florida, USA
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DeFraites RF, Sanchez JL, Brandt CA, Kadlec RP, Haberberger RL, Lin JJ, Taylor DN. An outbreak of Campylobacter enteritis associated with a community water supply on a U.S. military installation. MSMR 2014; 21:10-15. [PMID: 25436877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An outbreak of acute gastroenteritis involving 249 persons, 32% of whom were hospitalized, occurred on a U.S. Army installation in 1990. Campylobacter jejuni was isolated from 81 of 163 (50%) persons cultured. Seventeen isolates of C. jejuni available for serotyping were Lior serotype 5. The outbreak remained restricted to one recruit barracks area and adjacent Junior Reserve Officer Training Corps cadet barracks. Infection of sequential cohorts of recruits over an interval of 3 weeks suggested a continuing or intermittent common source. Contaminated food was not implicated because affected persons ate at separate dining facilities and other facilities with the same food sources had no associated illnesses. There was a strong association between the amount of water consumed by recruits and risk of diarrhea (chi-square test for trend, p<0.001). Samples of drinking water collected in the affected area had no residual chlorine and when cultured yielded greater than 200 colonies of coliform bacteria per 100 mL of water sampled. Although Campylobacter was not isolated from water, living and dead birds were found in an elevated water storage tank providing drinking water to the affected area. This and other similar outbreaks indicate that contamination of water storage tanks can lead to large outbreaks of Campylobacter enteritis.
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Chretien JP, Gaydos JC, George D, Sanchez JL, McCollum JT, Pavlin JA, Russell KL. Epidemiologic Modeling in the Department of Defense: Capability and Coordination Opportunities. Mil Med 2014; 179:604-11. [DOI: 10.7205/milmed-d-13-00406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Cost AA, Hiser MJ, Hu Z, Cooper MJ, Hawksworth AW, Radin JM, Brice GT, Zorich SC, DeMarcus LS, Tastad KJ, Sanchez JL. Brief report: mid-season influenza vaccine effectiveness estimates for the 2013-2014 influenza season. MSMR 2014; 21:15-17. [PMID: 24978474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Tsai AY, Dueger E, Macalino GE, Montano SM, Mbuchi M, Puplampu N, McClelland RS, Sanchez JL. P3.276 Neisseria Gonorrhoeae(GC) Resistance Surveillance in Selected Populations of Five Countries. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Riley P, Ben-Nun M, Armenta R, Linker JA, Eick AA, Sanchez JL, George D, Bacon DP, Riley S. Multiple estimates of transmissibility for the 2009 influenza pandemic based on influenza-like-illness data from small US military populations. PLoS Comput Biol 2013; 9:e1003064. [PMID: 23696723 PMCID: PMC3656103 DOI: 10.1371/journal.pcbi.1003064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 03/28/2013] [Indexed: 11/18/2022] Open
Abstract
Rapidly characterizing the amplitude and variability in transmissibility of novel human influenza strains as they emerge is a key public health priority. However, comparison of early estimates of the basic reproduction number during the 2009 pandemic were challenging because of inconsistent data sources and methods. Here, we define and analyze influenza-like-illness (ILI) case data from 2009-2010 for the 50 largest spatially distinct US military installations (military population defined by zip code, MPZ). We used publicly available data from non-military sources to show that patterns of ILI incidence in many of these MPZs closely followed the pattern of their enclosing civilian population. After characterizing the broad patterns of incidence (e.g. single-peak, double-peak), we defined a parsimonious SIR-like model with two possible values for intrinsic transmissibility across three epochs. We fitted the parameters of this model to data from all 50 MPZs, finding them to be reasonably well clustered with a median (mean) value of 1.39 (1.57) and standard deviation of 0.41. An increasing temporal trend in transmissibility ([Formula: see text], p-value: 0.013) during the period of our study was robust to the removal of high transmissibility outliers and to the removal of the smaller 20 MPZs. Our results demonstrate the utility of rapidly available - and consistent - data from multiple populations.
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Affiliation(s)
- Pete Riley
- Predictive Science Inc., San Diego, California, USA.
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Blazes DL, Bondarenko JL, Burke RL, Vest KG, Fukuda MM, Perdue CL, Tsai AY, Thomas AC, Chandrasekera RM, Cockrill JA, Von Thun AM, Baliga P, Meyers M, Quintana M, Wurapa EK, Mansour MM, Dueger E, Yasuda CY, Lanata CF, Gray GC, Saylors KE, Ndip LM, Lewis S, Blair PJ, Sloberg PA, Thomas SJ, Lesho EP, Grogl M, Myers T, Ellison D, Ellis KK, Brown ML, Schoepp RJ, Shanks GD, Macalino GE, Eick-Cost AA, Russell KL, Sanchez JL. Contributions of the Global Emerging Infections Surveillance and Response System Network to global health security in 2011. US Army Med Dep J 2013:7-18. [PMID: 23584903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In its 15th year, the Global Emerging Infections Surveillance and Response System (GEIS) continued to make significant contributions to global public health and emerging infectious disease surveillance worldwide. As a division of the US Department of Defense's Armed Forces Health Surveillance Center since 2008, GEIS coordinated a network of surveillance and response activities through collaborations with 33 partners in 76 countries. The GEIS was involved in 73 outbreak responses in fiscal year 2011. Significant laboratory capacity-building initiatives were undertaken with 53 foreign health, agriculture and/or defense ministries, as well as with other US government entities and international institutions, including support for numerous national influenza centers. Equally important, a variety of epidemiologic training endeavors reached over 4,500 individuals in 96 countries. Collectively, these activities enhanced the ability of partner countries and the US military to make decisions about biological threats and design programs to protect global public health as well as global health security.
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Affiliation(s)
- David L Blazes
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Eick-Cost AA, Hu Z, Cooper MJ, Sanchez JL, Radin JM, Hawksworth AW, Brice GT, Lloyd LV, Tastad KJ, Zorich SC, MacIntosh VH. Mid-season influenza vaccine effectiveness for the 2012-2013 influenza season. MSMR 2013; 20:15-16. [PMID: 23550929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Agan BK, Macalino GE, Nsouli-Maktabi H, Wang X, Gaydos JC, Ganesan A, Kortepeter MG, Sanchez JL. Human papillomavirus seroprevalence among men entering military service and seroincidence after ten years of service. MSMR 2013; 20:21-4. [PMID: 23461307 PMCID: PMC4519827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vaccination against human papillomavirus (HPV) is recommended to prevent cervical cancer among women. Vaccinating men against human papillomavirus (HPV) can prevent penile, anal, and oral cancers, anogenital warts, and the transmission of HPV to their sexual partners. This study characterized HPV acquisition among male military members by evaluating both seroprevalence at entry into service and seroincidence of HPV infection after ten years of service. At entry, 29 of 200 (14.5%) male service members were positive for HPV serotypes 6, 11, 16, or 18. Of 199 initially seronegative for at least one of the four HPV serotypes, 68 (34.2%) seroconverted to one or more serotypes at ten years; more than one-third of these were seropositive for oncogenic HPV serotypes. This estimate of HPV seroprevalence among male military accessions is higher than that reported among U.S. civilian males. Vaccination to prevent genital warts and cancers resulting from HPV infection may decrease health care system burdens. Further analyses are warranted to understand the potential costs and benefits of a policy to vaccinate male service members.
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Affiliation(s)
- Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Tsai AY, Dueger E, Macalino GE, Montano SM, Tilley DH, Mbuchi M, Wurapa EK, Saylors K, Duplessis CC, Puplampu N, Garges EC, McClelland RS, Sanchez JL. The U.S. military's Neisseria gonorrhoeae resistance surveillance initiatives in selected populations of five countries. MSMR 2013; 20:25-27. [PMID: 23461308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Multi-drug resistant Neisseria gonorrhoeae (GC) threatens the successful treatment of gonorrhea. This report presents preliminary findings with regard to the prevalence of laboratory-confirmed GC and the extent of drug-resistance among sample populations in five countries. Between October 2010 and January 2013, 1,694 subjects (54% male; 45% female; 1% unknown) were enrolled and screened for the presence of laboratory-confirmed GC in the United States, Djibouti, Ghana, Kenya, and Peru. Overall, 108 (6%) of enrolled subjects tested positive for GC. Antimicrobial susceptibility testing results were available for 66 GC isolates. Resistance to at least three antibiotics was observed at each overseas site. All isolates tested in Ghana (n=6) were resistant to ciprofloxacin, penicillin, and tetracycline. In Djibouti, preliminary results suggested resistance to penicillin, tetracycline, ciprofloxacin, cefepime, and ceftriaxone. The small sample size and missing data prevent comparative analysis and limit the generalizability of these preliminary findings.
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Affiliation(s)
- Alice Y Tsai
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
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Alayon S, Gonzalez de la Rosa M, Fumero FJ, Sigut Saavedra JF, Sanchez JL. Variability between experts in defining the edge and area of the optic nerve head. ACTA ACUST UNITED AC 2012; 88:168-73. [PMID: 23623016 DOI: 10.1016/j.oftal.2012.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 04/25/2012] [Accepted: 07/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Estimation of the error rate in the subjective determination of the optic nerve head edge and area. METHOD 1) 169 images of optic nerve disc were evaluated by five experts for the defining of the edges in 8 positions (every 45°). 2) The estimated areas of 26 cases were compared with the measurements of the Cirrus Optical Coherence Tomography (OCT-Cirrus). RESULTS 1) The mean variation of the estimated radius was ±5.2%, with no significant differences between sectors. Specific differences were found between the 5 experts (P <.001), each one compared with the others. 2) The disc area measured by the OCT-Cirros was 1.78 mm² (SD =0.27). The results corresponding to the experts who detected smaller areas were better correlated to the area detected by the OCT-Cirrus (r=0.77-0.88) than the results corresponding to larger areas (r =0.61-0.69) (P <.05 in extreme cases). CONCLUSIONS There are specific patterns in each expert for defining the disc edges and involve 20% variation in the estimation of the optic nerve area. The experts who detected smaller areas have a higher agreement with the objective method used. A web tool is proposed for self-assessment and training in this task.
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Affiliation(s)
- S Alayon
- Departamento de Ingeniería de Sistemas y Automática y Arquitectura y Tecnología de Computadores, Universidad de La Laguna, La Laguna, Spain.
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Eick-Cost AA, Tastad KJ, Guerrero AC, Johns MC, Lee SE, MacIntosh VH, Burke RL, Blazes DL, Russell KL, Sanchez JL. Effectiveness of seasonal influenza vaccines against influenza-associated illnesses among US military personnel in 2010-11: a case-control approach. PLoS One 2012; 7:e41435. [PMID: 22859985 PMCID: PMC3409214 DOI: 10.1371/journal.pone.0041435] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 06/22/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Following the 2009 influenza A/H1N1 (pH1N1) pandemic, both seasonal and pH1N1 viruses circulated in the US during the 2010-2011 influenza season; influenza vaccine effectiveness (VE) may vary between live attenuated (LAIV) and trivalent inactivated (TIV) vaccines as well as by virus subtype. MATERIALS AND METHODS Vaccine type and virus subtype-specific VE were determined for US military active component personnel for the period of September 1, 2010 through April 30, 2011. Laboratory-confirmed influenza-related medical encounters were compared to matched individuals with a non-respiratory illness (healthy controls), and unmatched individuals who experienced a non-influenza respiratory illness (test-negative controls). Odds ratios (OR) and VE estimates were calculated overall, by vaccine type and influenza subtype. RESULTS A total of 603 influenza cases were identified. Overall VE was relatively low and similar regardless of whether healthy controls (VE = 26%, 95% CI: -1 to 45) or test-negative controls (VE = 29%, 95% CI: -6 to 53) were used as comparison groups. Using test-negative controls, vaccine type-specific VE was found to be higher for TIV (53%, 95% CI: 25 to 71) than for LAIV (VE = -13%, 95% CI: -77 to 27). Influenza subtype-specific analyses revealed moderate protection against A/H3 (VE = 58%, 95% CI: 21 to 78), but not against A/H1 (VE = -38%, 95% CI: -211 to 39) or B (VE = 34%, 95% CI: -122 to 80). CONCLUSION Overall, a low level of protection against clinically-apparent, laboratory-confirmed, influenza was found for the 2010-11 seasonal influenza vaccines. TIV immunization was associated with higher protection than LAIV, however, no protection against A/H1 was noted, despite inclusion of a pandemic influenza strain as a vaccine component for two consecutive years. Vaccine virus mismatch or lower immunogenicity may have contributed to these findings and deserve further examination in controlled studies. Continued assessment of VE in military personnel is essential in order to better inform vaccination policy decisions.
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Affiliation(s)
- Angelia A. Eick-Cost
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
| | - Katie J. Tastad
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
| | - Alicia C. Guerrero
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
| | - Matthew C. Johns
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Seung-eun Lee
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Victor H. MacIntosh
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
| | - Ronald L. Burke
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - David L. Blazes
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Kevin L. Russell
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
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Sanchez JL, Conway EE, Rubin DH. Ribavirin treatment of respiratory synctial virus infection in neonatal intensive care unit survivors. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/tcic.12.4.169.172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Houng HSH, Garner J, Zhou Y, Lyons A, Kuschner R, Deye G, St Clair K, Douce RW, Chicaiza W, Blair PJ, Myers CA, Burke RL, Sanchez JL, Williams M, Halsey ES. Emergent 2009 influenza A(H1N1) viruses containing HA D222N mutation associated with severe clinical outcomes in the Americas. J Clin Virol 2011; 53:12-5. [PMID: 22036040 DOI: 10.1016/j.jcv.2011.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/02/2011] [Accepted: 09/07/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the 2010-2011 influenza season, a small sub-group of 2009 influenza A(H1N1) viruses (hereafter referred to as 2009 A(H1N1)) emerged that was associated with more severe clinical outcomes in Ecuador and North America. Genetically, the haemagglutinin (HA) of this sub-clade was distinct from HAs found in viruses associated with severe outbreaks in 2010 from the United Kingdom and from other global specimens isolated earlier in the season. OBJECTIVE We report the emergence of a novel 2009 A(H1N1) variant possessing a re-emergent HA D222N mutation obtained from patients with severe respiratory illnesses and phylogenetically characterise these D222N mutants with other severe disease-causing variants clustering within a common emerging sub-clade. CASE REPORTS In early 2011, three cases of 2009 A(H1N1) infection, two from Quito, Ecuador, and one from Washington, DC, USA, were complicated by severe pneumonia requiring mechanical ventilation, resulting in one fatality. These cases were selected due to the reported nature of the acute respiratory distress (ARD) that were captured in Department of Defence (DoD)-sponsored global influenza surveillance nets. RESULTS Genetically, the 2009 A(H1N1) strains isolated from two of the three severe cases carried a prominent amino acid change at position 222 (D222N) within the primary HA receptor binding site. Furthermore, these cases represent an emerging sub-clade of viruses defined by amino acid changes within HA: N31D, S162N, A186T and V272I. Phylogenetically, these viruses share a high degree of homology with strains associated with recent fatal cases in Chihuahua, Mexico. DISCUSSION Previously, enhanced virulence associated with the change, D222G, has been clinically linked to severe morbidity and mortality. Initial observations of the prevalence of a novel sub-clade of strains in the Americas suggest that viruses with a re-emergent D222N mutation may too correlate with severe clinical manifestations. These findings warrant heightened vigilance for emerging sub-clades of 2009 A(H1N1) and presumptive clinical implications.
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Affiliation(s)
- Huo-Shu H Houng
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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Sanchez JL, Johns MC, Burke RL, Vest KG, Fukuda MM, Yoon IK, Lon C, Quintana M, Schnabel DC, Pimentel G, Mansour M, Tobias S, Montgomery JM, Gray GC, Saylors K, Ndip LM, Lewis S, Blair PJ, Sjoberg PA, Kuschner RA, Russell KL, Blazes DL. Capacity-building efforts by the AFHSC-GEIS program. BMC Public Health 2011; 11 Suppl 2:S4. [PMID: 21388564 PMCID: PMC3092414 DOI: 10.1186/1471-2458-11-s2-s4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Matthew C Johns
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Ronald L Burke
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Mark M Fukuda
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - In-Kyu Yoon
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Miguel Quintana
- U.S. Army Public Health Command Region-South, Building 2472, Schofield Road, Fort Sam Houston, TX 78234, USA
| | - David C Schnabel
- U.S. Army Medical Research Unit-Kenya, U.S. Embassy, Attn: MRU, United Nations Avenue, P.O. Box 606, Village Market 00621 Nairobi, Kenya
| | - Guillermo Pimentel
- Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Moustafa Mansour
- Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Steven Tobias
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta, 10560, Indonesia
| | - Joel M Montgomery
- Naval Medical Research Center Detachment-Peru, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Gregory C Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Post Office Box 100188, Gainesville, FL 32610, USA
| | - Karen Saylors
- Global Viral Forecasting Initiative, One Sutter Street, Suite 600, San Francisco, CA 94104, USA
| | - Lucy M Ndip
- University of Buea, Department of Biochemistry and Microbiology, Faculty of Science, Post Office Box 63, Buea, South Western Province, Cameroon
| | - Sheri Lewis
- Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, MP2-160, Laurel, MD 20723-6099, USA
| | - Patrick J Blair
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Paul A Sjoberg
- U.S. Air Force School of Aerospace Medicine, Public Health and Preventive Medicine Department, 2513 Kennedy Circle, Building 180, Brooks City-Base, TX 78235-5116, USA
| | - Robert A Kuschner
- Walter Reed Army Institute of Research, Building 503, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - David L Blazes
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - the AFHSC-GEIS Capacity Building Writing Group
- Walter Reed Army Institute of Research, Building 503, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
- Kenyan Medical Research Institute, Mbagathi Post Office Box 54840, 00200, Nairobi, Kenya
- Landstuhl Regional Medical Center, CMR 402, Box 483, APO AE 09180, USA
- Makerere University Walter Reed Project, Plot 42, Nakasero Road, Post Office Box 16524, Kampala, Uganda
- Makerere University, Faculty of Veterinary Medicine & Medicine, Post Office Box 16524, Kampala, Uganda
- Navy Environmental and Preventive Medicine Unit Number 2, 1887 Powhatan Street, Norfolk, VA 23511-3394, USA
- PharmAccess Foundation, Skyway Building, Third Floor, Plot Number 149/32, Corner of Ohio Street/Sokoine Street, Post Office Box 635, Dar es Salaam, Tanzania
- Tanzania People’s Defence Forces, Defence Forces Headquarters Medical Services, Post Office Box 9203, Dar es Salaam, Tanzania
- U.S. Army Medical Department Activity & 65th Medical Brigade, Korea, Unit 15281, Box 769, APO AP 96205-5281
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702-5011, USA
- U.S. Army Public Health Command Region-Europe, Building 3810, CMR 402, Box 808, APO AE 09180
- U.S. Army Public Health Command Region-Pacific, Building 715, Camp Zama, Japan, Unit 45006, APO AP 96343-5006
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Burke RL, Vest KG, Eick AA, Sanchez JL, Johns MC, Pavlin JA, Jarman RG, Mothershead JL, Quintana M, Palys T, Cooper MJ, Guan J, Schnabel D, Waitumbi J, Wilma A, Daniels C, Brown ML, Tobias S, Kasper MR, Williams M, Tjaden JA, Oyofo B, Styles T, Blair PJ, Hawksworth A, Montgomery JM, Razuri H, Laguna-Torres A, Schoepp RJ, Norwood DA, MacIntosh VH, Gibbons T, Gray GC, Blazes DL, Russell KL. Department of Defense influenza and other respiratory disease surveillance during the 2009 pandemic. BMC Public Health 2011; 11 Suppl 2:S6. [PMID: 21388566 PMCID: PMC3092416 DOI: 10.1186/1471-2458-11-s2-s6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Armed Forces Health Surveillance Center's Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supports and oversees surveillance for emerging infectious diseases, including respiratory diseases, of importance to the U.S. Department of Defense (DoD). AFHSC-GEIS accomplishes this mission by providing funding and oversight to a global network of partners for respiratory disease surveillance. This report details the system's surveillance activities during 2009, with a focus on efforts in responding to the novel H1N1 Influenza A (A/H1N1) pandemic and contributions to global public health. Active surveillance networks established by AFHSC-GEIS partners resulted in the initial detection of novel A/H1N1 influenza in the U.S. and several other countries, and viruses isolated from these activities were used as seed strains for the 2009 pandemic influenza vaccine. Partners also provided diagnostic laboratory training and capacity building to host nations to assist with the novel A/H1N1 pandemic global response, adapted a Food and Drug Administration-approved assay for use on a ruggedized polymerase chain reaction platform for diagnosing novel A/H1N1 in remote settings, and provided estimates of seasonal vaccine effectiveness against novel A/H1N1 illness. Regular reporting of the system's worldwide surveillance findings to the global public health community enabled leaders to make informed decisions on disease mitigation measures and controls for the 2009 A/H1N1 influenza pandemic. AFHSC-GEIS's support of a global network contributes to DoD's force health protection, while supporting global public health.
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Affiliation(s)
- Ronald L Burke
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Angelia A Eick
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Jose L Sanchez
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Matthew C Johns
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Julie A Pavlin
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Richard G Jarman
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Jerry L Mothershead
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Miguel Quintana
- Public Health Region-South, Building 2472, Schofield Road, Fort Sam Houston, TX 78234, USA
| | - Thomas Palys
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
| | | | - Jian Guan
- Public Health Region-Pacific, Unit 45006, APO AE 96343, USA
| | - David Schnabel
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - John Waitumbi
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - Alisa Wilma
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Candelaria Daniels
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Matthew L Brown
- USAMEDDAC-Korea, Microbiology Section, Unit 15244, Box 459, APO AP 96205, USA
| | - Steven Tobias
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Matthew R Kasper
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Maya Williams
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Jeffrey A Tjaden
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Buhari Oyofo
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Timothy Styles
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
| | - Patrick J Blair
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Anthony Hawksworth
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Joel M Montgomery
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Hugo Razuri
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Alberto Laguna-Torres
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Randal J Schoepp
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - David A Norwood
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Victor H MacIntosh
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Thomas Gibbons
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Gregory C Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Post Office Box 100188, Gainesville, FL 32610, USA
| | - David L Blazes
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - AFHSC-GEIS Influenza Surveillance Writing Group
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
- Walter Reed Army Institute of Research, Emerging Infectious Diseases Research Unit, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, QLD 4051, Australia
- Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD 20723, USA
- U.S. Navy and Marine Corps Public Health Center, 620 John Paul Jones Circle, Suite 1100, Portsmouth, VA 23708, USA
- Laboratory for Emerging Infectious Diseases, University of Buea, Post Office Box 63, Buea, Cameroon
- Global Viral Forecasting Initiative, 1 Sutter, Suite 600, San Francisco, CA 94104, USA
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Johns MC, Burke RL, Vest KG, Fukuda M, Pavlin JA, Shrestha SK, Schnabel DC, Tobias S, Tjaden JA, Montgomery JM, Faix DJ, Duffy MR, Cooper MJ, Sanchez JL, Blazes DL, Wangchuk S, Dorji T, Gibbons R, Iamsirithaworn S, Richardson J, Buathong R, Jarman R, Yoon IK, Shakya G, Ofula V, Coldren R, Bulimo W, Sang R, Omariba D, Obura B, Mwala D, Kasper M, Brice G, Williams M, Yasuda C, Barthel RV, Pimentel G, Meyers C, Kammerer P, Baynes DE, Metzgar D, Hawksworth A, Blair P, Ellorin M, Coon R, Macintosh V, Burwell K, Macias E, Palys T, Jerke K. A growing global network's role in outbreak response: AFHSC-GEIS 2008-2009. BMC Public Health 2011; 11 Suppl 2:S3. [PMID: 21388563 PMCID: PMC3092413 DOI: 10.1186/1471-2458-11-s2-s3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense's (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization's (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. 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.
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Affiliation(s)
- Matthew C Johns
- Armed Forces Health Surveillance Center, 11800 Tech Rd, Silver Spring, MD 20904, USA.
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Fukuda MM, Klein TA, Kochel T, Quandelacy TM, Smith BL, Villinski J, Bethell D, Tyner S, Se Y, Lon C, Saunders D, Johnson J, Wagar E, Walsh D, Kasper M, Sanchez JL, Witt CJ, Cheng Q, Waters N, Shrestha SK, Pavlin JA, Lescano AG, Graf PCF, Richardson JH, Durand S, Rogers WO, Blazes DL, Russell KL. Malaria and other vector-borne infection surveillance in the U.S. Department of Defense Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance program: review of 2009 accomplishments. BMC Public Health 2011; 11 Suppl 2:S9. [PMID: 21388569 PMCID: PMC3092419 DOI: 10.1186/1471-2458-11-s2-s9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Vector-borne infections (VBI) are defined as infectious diseases transmitted by the bite or mechanical transfer of arthropod vectors. They constitute a significant proportion of the global infectious disease burden. United States (U.S.) Department of Defense (DoD) personnel are especially vulnerable to VBIs due to occupational contact with arthropod vectors, immunological naiveté to previously unencountered pathogens, and limited diagnostic and treatment options available in the austere and unstable environments sometimes associated with military operations. In addition to the risk uniquely encountered by military populations, other factors have driven the worldwide emergence of VBIs. Unprecedented levels of global travel, tourism and trade, and blurred lines of demarcation between zoonotic VBI reservoirs and human populations increase vector exposure. Urban growth in previously undeveloped regions and perturbations in global weather patterns also contribute to the rise of VBIs. The Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) and its partners at DoD overseas laboratories form a network to better characterize the nature, emergence and growth of VBIs globally. In 2009 the network tested 19,730 specimens from 25 sites for Plasmodium species and malaria drug resistance phenotypes and nearly another 10,000 samples to determine the etiologies of non-Plasmodium species VBIs from regions spanning from Oceania to Africa, South America, and northeast, south and Southeast Asia. This review describes recent VBI-related epidemiological studies conducted by AFHSC-GEIS partner laboratories within the OCONUS DoD laboratory network emphasizing their impact on human populations.
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Affiliation(s)
- Mark M Fukuda
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Terry A Klein
- Force Health Protection and Preventive Medicine, 65th Medical Brigade, Unit 15281, APO AP 96205-5281 USA (Republic of Korea
| | - Tadeusz Kochel
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Talia M Quandelacy
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | | | - Jeff Villinski
- US Army Medical Research Unit Kenya, United States Embassy, ATTN: MRU, United Nations Avenue, Post Office Box 606, Village Market, 00621 Nairobi, Kenya
| | - Delia Bethell
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Stuart Tyner
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Youry Se
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Chanthap Lon
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - David Saunders
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Jacob Johnson
- US Army Medical Research Unit Kenya, United States Embassy, ATTN: MRU, United Nations Avenue, Post Office Box 606, Village Market, 00621 Nairobi, Kenya
| | - Eric Wagar
- US Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Douglas Walsh
- US Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Matthew Kasper
- US Navy Medical Research Unit-2, U.S. Embassy Unit 8166 Box P, APO AP 96546, Phnom Penh, Cambodia
| | - Jose L Sanchez
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Clara J Witt
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Qin Cheng
- Australian Army Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, QLD 4051 Australia
| | - Norman Waters
- Australian Army Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, QLD 4051 Australia
| | - Sanjaya K Shrestha
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Julie A Pavlin
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Andres G Lescano
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Paul CF Graf
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Jason H Richardson
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Salomon Durand
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - William O Rogers
- US Navy Medical Research Unit-2, U.S. Embassy Unit 8166 Box P, APO AP 96546, Phnom Penh, Cambodia
| | - David L Blazes
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - the AFHSC-GEIS Malaria and Vector Borne Infections Writing Group
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
- US Army Medical Research Unit Kenya, United States Embassy, ATTN: MRU, United Nations Avenue, Post Office Box 606, Village Market, 00621 Nairobi, Kenya
- US Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
- US Navy Medical Research Unit-2, U.S. Embassy Unit 8166 Box P, APO AP 96546, Phnom Penh, Cambodia
- Australian Army Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, QLD 4051 Australia
- Naval Medical Research Center, 503 Robert Grant Ave. Silver Spring, MD 20910, USA
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Otto JL, Baliga P, Sanchez JL, Johns MC, Gray GC, Grieco J, Lescano AG, Mothershead JL, Wagar EJ, Blazes DL, Achila R, Baker W, Blair P, Brown M, Bulimo W, Byarugaba D, Coldren R, Cooper M, Ducatez M, Espinosa B, Ewings P, Guerrero A, Hawksworth T, Jackson C, Klena JD, Kraus S, Macintosh V, Mansour M, Maupin G, Maza J, Montgomery J, Ndip L, Pavlin J, Quintana M, Richard W, Rosenau D, Saeed T, Sinclair L, Smith I, Smith J, Styles T, Talaat M, Tobias S, Vettori J, Villinski J, Wabwire-Mangen F. Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005). BMC Public Health 2011; 11 Suppl 2:S5. [PMID: 21388565 PMCID: PMC3092415 DOI: 10.1186/1471-2458-11-s2-s5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military’s role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.
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Affiliation(s)
- Jean L Otto
- Armed Forces Health Surveillance Center, 11800 Tech Rd, Silver Spring, MD 20904, USA
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Singer DE, Bautista CT, O'Connell RJ, Sanders-Buell E, Agan BK, Kijak GH, Hakre S, Sanchez JL, Sateren WB, McCutchan FE, Michael NL, Scott PT. HIV infection among U.S. Army and Air Force military personnel: sociodemographic and genotyping analysis. AIDS Res Hum Retroviruses 2010; 26:889-94. [PMID: 20673143 DOI: 10.1089/aid.2009.0289] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Since 1985, the U.S. Department of Defense has periodically screened all military personnel for HIV allowing for the monitoring of the infection in this dynamic cohort population. A nested case-control study was performed to study sociodemographics, overseas assignment, and molecular analysis of HIV. Cases were newly identified HIV infections among U.S. Army and Air Force military personnel from 2000 to 2004. Controls were frequency matched to cases by gender and date of case first positive HIV screening test. Genotyping analysis was performed using high-throughput screening assays and partial genome sequencing. HIV was significantly associated with black race [odds ratio (OR) = 6.65], single marital status (OR = 4.45), and age (OR per year = 1.07). Ninety-seven percent were subtype B and 3% were non-B subtypes (A3, CRF01_AE, A/C recombinant, G, CRF02_AG). Among cases, overseas assignment in the period at risk prior to their first HIV-positive test was associated with non-B HIV subtype infection (OR = 8.44). Black and single military personnel remain disproportionately affected by HIV infection. Most non-B HIV subtypes were associated with overseas assignment. Given the increased frequency and length of assignments, and the expanding HIV genetic diversity observed in this population, there is a need for active HIV genotyping surveillance and a need to reinforce primary HIV prevention efforts.
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Affiliation(s)
- Darrell E. Singer
- Department of Defense HIV Program–Nigeria, Abuja, Nigeria; U.S. Military HIV Research Program, Rockville, Maryland
| | - Christian T. Bautista
- U.S. Military HIV Research Program; Henry Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland
| | - Robert J. O'Connell
- Division of Retrovirology, Walter Reed Army Institute of Research, Rockville, Maryland; U.S. Military HIV Research Program, Rockville, Maryland
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Sanders-Buell
- U.S. Military HIV Research Program; Henry Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Gustavo H. Kijak
- U.S. Military HIV Research Program; Henry Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland
| | - Shilpa Hakre
- U.S. Military HIV Research Program; Henry Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Center, Department of Defense Global Emerging Surveillance and Response System, Silver Spring, Maryland
| | - Warren B. Sateren
- Division of Retrovirology, Walter Reed Army Institute of Research, Rockville, Maryland; U.S. Military HIV Research Program, Rockville, Maryland
| | | | - Nelson L. Michael
- Division of Retrovirology, Walter Reed Army Institute of Research, Rockville, Maryland; U.S. Military HIV Research Program, Rockville, Maryland
| | - Paul T. Scott
- Division of Retrovirology, Walter Reed Army Institute of Research, Rockville, Maryland; U.S. Military HIV Research Program, Rockville, Maryland
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Jeremy Sueker J, Blazes DL, Johns MC, Blair PJ, Sjoberg PA, Tjaden JA, Montgomery JM, Pavlin JA, Schnabel DC, Eick AA, Tobias S, Quintana M, Vest KG, Burke RL, Lindler LE, Mansfield JL, Erickson RL, Russell KL, Sanchez JL. Influenza and respiratory disease surveillance: the US military's global laboratory-based network. Influenza Other Respir Viruses 2010; 4:155-61. [PMID: 20409212 PMCID: PMC4941663 DOI: 10.1111/j.1750-2659.2010.00129.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Please cite this paper as: Jeremy Sueker et al. (2010) Influenza and respiratory disease surveillance: the US military’s global laboratory‐based network. Influenza and Other Respiratory Viruses 4(3), 155–161. The US Department of Defense influenza surveillance system now spans nearly 500 sites in 75 countries, including active duty US military and dependent populations as well as host‐country civilian and military personnel. This system represents a major part of the US Government’s contributions to the World Health Organization’s Global Influenza Surveillance Network and addresses Presidential Directive NSTC‐7 to expand global surveillance, training, research and response to emerging infectious disease threats. Since 2006, the system has expanded significantly in response to rising pandemic influenza concerns. The expanded system has played a critical role in the detection and monitoring of ongoing H5N1 outbreaks worldwide as well as in the initial detection of, and response to, the current (H1N1) 2009 influenza pandemic. This article describes the system, details its contributions and the critical gaps that it is filling, and discusses future plans.
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Affiliation(s)
- J Jeremy Sueker
- Armed Forces Health Surveillance Center, US Army Public Health Command (Provisional), Silver Spring, MD 20910, USA
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Lama JR, Agurto HS, Guanira JV, Ganoza C, Casapia M, Ojeda N, Ortiz A, Zamalloa V, Suarez-Ognio L, Cabezas C, Sanchez JL, Sanchez J. Hepatitis B infection and association with other sexually transmitted infections among men who have sex with men in Peru. Am J Trop Med Hyg 2010; 83:194-200. [PMID: 20595501 PMCID: PMC2912599 DOI: 10.4269/ajtmh.2010.10-0003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 03/16/2010] [Indexed: 12/14/2022] Open
Abstract
To assess the epidemiology of hepatitis B virus (HBV) infection among men who have sex with men (MSM) in Peru, we evaluated the prevalence and associated risk factors for HBV serologic markers among participants of a HIV sentinel surveillance conducted in 2002-2003. The standardized prevalences for total antibodies to hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were 20.2% and 2.8%, respectively. Individuals with human immunodeficiency virus (HIV-1) infection had significantly higher anti-HBc (44.3% versus 19.3%) and HBsAg (9.5% versus 2.3%) prevalences than uninfected men. Increasing age (adjusted odds ratio [AOR] = 1.06), versatile sexual role (AOR = 1.59), sex in exchange for money/gifts (AOR = 1.58), syphilis (AOR = 1.74), HIV-1 infection (AOR = 1.64), and herpes simplex virus type 2 (HSV-2, AOR = 2.77) infection were independently associated with anti-HBc positivity, whereas only HIV-1 infection (AOR = 3.51) and generalized lymph node enlargement (AOR = 3.72) were associated with HBsAg positivity. Pre-existing HBV infection is very common among Peruvian MSM and was correlated with sexual risk factors. MSM in Peru constitute a target population for further HBV preventive and treatment interventions.
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Affiliation(s)
- Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru.
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Johns MC, Eick AA, Blazes DL, Lee SE, Perdue CL, Lipnick R, Vest KG, Russell KL, DeFraites RF, Sanchez JL. Seasonal influenza vaccine and protection against pandemic (H1N1) 2009-associated illness among US military personnel. PLoS One 2010; 5:e10722. [PMID: 20502705 PMCID: PMC2873284 DOI: 10.1371/journal.pone.0010722] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 04/08/2010] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Matthew C Johns
- Division of GEIS Operations, Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America.
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Otto JL, Lipnick RJ, Sanchez JL, DeFraites RF, Barnett DJ. Preparing military installations for pandemic influenza through tabletop exercises. Mil Med 2010; 175:7-13. [PMID: 20108836 DOI: 10.7205/milmed-d-09-00118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Effective Department of Defense (DoD) response to pandemic influenza requires robust and well-exercised plans at the installation level. This article describes proceedings and key findings from a half-day "train-the-trainer" pandemic influenza tabletop exercise for Tri-Service installation public health emergency officers (PHEOs) at the August 2008 Force Health Protection conference. Exercise participants were expected to facilitate the execution of a pandemic influenza exercise at their respective installations within 6 months of attendance. On a 6-month follow-up survey (N= 50), 68% indicated their installations had since created a new pandemic influenza plan or revised an existing one, whereas 44% indicated that their installation had since conducted a pandemic influenza exercise. Chief reported barriers to conducting installation-level pandemic influenza exercises included competing priorities, followed by time, personnel, and budget limitations. Relevant policy implications for installation-level pandemic influenza readiness include access to higher level plans, strategic utilization of assets to optimize surge capacity, and cross-training of personnel.
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Affiliation(s)
- Jean Lin Otto
- Armed Forces Health Surveillance Center, Silver Spring, MD 20910, USA
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Peinado JE, Sanchez JL, Lama JR. P06-09. Web based interviewing system for HIV-behavior research in the settings of vaccine and non vaccine prevention trials. Retrovirology 2009. [PMCID: PMC2768004 DOI: 10.1186/1742-4690-6-s3-p98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Botros BA, Aliyev QM, Saad MD, Michael AA, Sanchez JL, Carr JK, Earhart KC. HIV infection and associated risk factors among long-distance truck drivers travelling through Azerbaijan. Int J STD AIDS 2009; 20:477-82. [PMID: 19541890 DOI: 10.1258/ijsa.2008.008396] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to assess HIV prevalence and associated risk behaviours among international truck drivers (TDs) in Azerbaijan. The subjects signed consent and completed a questionnaire. Blood was tested using two rapid HIV tests: Determine and OraQuick. Genotyping was performed on 13 positives. Overall, 3763 TDs from 21 countries were enrolled. Fifty-eight (1.54%) were HIV-positive. Highest prevalence was among Russians (2.88%), Ukrainians (1.66%) and Azerbaijani (1.09%). On univariate analysis, highest prevalence (60%) was among injecting drug users (IDUs) compared with 0.4% among non-IDUs (P < 0.001). The prevalence in men who had sex with men (MSM) (42.9%) was high (P </= 0.001). On multivariate analysis, IDUs and MSM remained as the main HIV independent risk factors. Additional risk factors include no condom use, no circumcision and a history of an sexually transmitted infection. Eleven of 13 samples were subtype A. In conclusion, HIV was highly associated with IDU and MSM. The detected HIV subtypes A and B are those predominant in the former Soviet Union.
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Affiliation(s)
- B A Botros
- US Naval Medical Research Unit No. 3, Cairo, Egypt.
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