Workplace Determinants of Depression, Anxiety, and Stress in U.S. Mariners during the COVID-19 Pandemic

United States (U.S.) mariners continued sailing throughout COVID-19. Many aspects of their work could make them prone to adverse mental health outcomes but research on workplace determinants of their mental health during COVID-19 is limited. Between January and July 2021 an online survey assessed the outcomes of increased depressive symptoms, increased anxiety symptoms, and increased perceived stress in addition to concerns, worries, and experiences when sailing during COVID-19, job satisfaction, and safety climate in n = 1384 U.S. mariners. Demographic measures were also collected. Logistic regression models (for depression and anxiety) and a linear regression model (for stress) were developed. We found that increased COVID-19 concerns and poor self-reported mental health were related to increased odds of likely depression and anxiety and higher stress. Mariners who experienced more adverse experiences aboard a vessel had increased stress and increased odds of depression. Poor sleep quality was also related to increased odds of depression, and poor vessel support/safety culture was related to higher stress. Differences in outcomes were seen by vessel type, age, and credential in regression analyses. Results from this study will help to prioritize interventions to minimize the mental health impacts of COVID-19, and influence evidence-based recommendations to improve the mental health of mariners going forward.

Monkeypox in Patient Immunized with ACAM2000 Smallpox Vaccine During 2022 Outbreak

We report a case of monkeypox in the United States in a patient who had been vaccinated with ACAM2000 smallpox vaccine 8 years earlier. Despite his vaccination status, he still contracted disease. He showed prodromal symptoms preceding development of painless penile lesions that later coalesced.

Description of a COVID-19 Beta variant outbreak, Joint Base Lewis-McChord, WA, February-March 2021

An outbreak of SARS CoV-2 infection occurred in an infantry battalion from Joint Base Lewis-McChord following participation in a field training exercise in the vicinity of Yakima, WA in February of 2021. Extreme weather during the exercise disrupted planned COVID-19 mitigation measures and caused 110 soldiers to be sheltered in a small aircraft hangar for several nights. The probable index case reported to sick call with symptoms compatible with COVID-19, but the soldier was not diagnosed with COVID-19, was returned to duty, and was allowed to remain in the enclosed hangar for 3 additional days. In total, 143 individuals with epidemiologic ties to the field training exercise tested positive for SARS-CoV-2 during the outbreak. Nine samples sent for sequencing were determined to be the SARS-CoV-2 Beta variant. This report illustrates important lessons learned whose implementation in the future will enable better protection of service members from COVID-19 and similar health risks associated with training.

Risk Mitigation Strategies to Prevent Transmission of COVID-19 in the Military Classroom Setting: A Case of a Symptomatic SARS-CoV2 Positive Student without Apparent Spread to Classmates

Since the onset of the COVID-19 pandemic in late 2019, the world community has responded with ever-evolving measures to reduce the spread of SARS CoV-2, the virus that causes COVID-19 (Coronavirus Disease 2019)1. One particular area of interest is understanding the risk of the in-person classroom setting and if any mitigation efforts are effective in preventing the spread of disease in that setting. In this paper, we present a case study of a US Army Advanced Individual Training (AIT) course/classroom wherein a student was diagnosed with COVID-19, and there was no apparent spread to others in his classroom. We discuss the mitigation efforts put in place that appear to be, in this case, effective in preventive onward spread of the virus. These are social distancing, face coverings/masks, and hygiene practices including hand washing and sanitation of surfaces.

HGG-01. ENTRECTINIB IN RECURRENT OR REFRACTORY SOLID TUMORS INCLUDING PRIMARY CNS TUMORS: UPDATED DATA IN CHILDREN AND ADOLESCENTS

STARTRK-NG (phase 1/2) is evaluating entrectinib, a CNS-penetrant oral, TRK/ROS1/ALK tyrosine kinase inhibitor, in patients <21 years with recurrent/refractory solid tumors, including primary CNS tumors. After determining the recommended dose, 550mg/m²/day, in all-comers, expansion cohorts with gene-fusion-positive CNS/solid tumors (NTRK1/2/3, ROS1) are being enrolled. As of 5Nov2019 (data cut-off), 39 patients (4.9m–20y; median 7y) have been evaluated for response, classified as complete (CR) or partial response (PR), stable (SD) or progressive disease (PD) using RANO (CNS), RECIST (solid tumors), or Curie score (neuroblastoma). Responses in patients with fusion-positive tumors were Investigator-assessed (BICR assessments are ongoing) and occurred at doses ≥400mg/m². Best responses in fusion-positive CNS tumors (n=14) were: 4 CR (GKAP1-NTRK2, ETV6-NTRK3 [n=2], EML1-NTRK2); 5 PR (KANK1-NTRK2, GOPC-ROS1, ETV6-NTRK3, TPR-NTRK1, EEF1G-ROS1); 3 SD (BCR-NTRK2, ARHGEF2-NTRK1, KIF21B-NTRK1); 2 PD (PARP6-NTRK3, EML4-ALK); and in fusion-positive solid tumors (n=8) were: 3 CR (ETV6-NTRK3 [n=2], DCTN1-ALK); 5 PR (EML4-NTRK3, TFG-ROS1 [n=3], KIF5B-ALK). Responses (Investigator-assessed) in non-fusion tumors (n=17) were: 1 CR (ALK F1174L mutation), 3 SD, 10 PD, 3 no data/unevaluable. The objective response rate (CR+PR/total) in patients with fusion-positive tumors was 77% (17/22) versus 6% (1/17) in those with non-fusion tumors. All 39 patients experienced ≥1 adverse event (AE); the most frequent AEs included weight gain and anemia (both 48.7%); increased ALT, increased AST, cough and pyrexia (all 46.2%); increased creatinine and vomiting (both 43.6%); and bone fractures (n=10, in 9 patients). Entrectinib has produced striking, rapid, and durable responses in solid tumors with target gene fusions, especially high-grade CNS neoplasms.

Pulmonary and extrapulmonary coccidioidomycosis, active component, U.S. Armed Forces, 1999-2011

Coccidioidomycosis is an infection caused by inhalation of Coccidioides species of fungi, which grow in the soil of the southwestern United States. Many thousands of military service members are assigned to, or perform training in, the endemic region. During the 13 years 1999 through 2011, 483 active component service members were diagnosed with coccidioidomycosis (rate: 2.69 cases per 100,000 person-years). Twelve percent of all diagnoses specified extrapulmonary infection, indicating dissemination to other organ systems (e.g., skin, skeleton, or central nervous system). Service members of Asian/Pacific Islander race had markedly higher incidence rates of coccidioidomycosis, particularly extrapulmonary disease, compared to members of other racial/ethnic groups. Crude incidence rates of coccidioidomycosis in service members older than 40 and males were higher than the rates of their respective counterparts. Preventive strategies to reduce exposure to this environmental pathogen are discussed.