MSMR最新文献

This report summarizes incidence rates and trends of the 5 most frequently occurring sexually transmitted infections (STIs) from 2016 through 2024 among active component service members of the U.S. Armed Forces. The data for this report were derived from medical and public health surveillance of chlamydia, gonorrhea, and syphilis as nationally notifiable diseases; case data for 2 additional STIs, human papillomavirus (HPV) and genital herpes simplex virus (HSV), are also presented. Chlamydia infections were the most common during the surveillance period, followed, in decreasing order of frequency, by HPV, gonorrhea, genital HSV, and syphilis. In 2024, both chlamydia and gonorrhea rates dropped to their lowest points of the period of surveillance, falling 25.5% and 26.4%, respectively, from their 2019 peaks. Declines were predominantly concentrated among service members younger than 25 years of age-who were the largest contributors to overall incidence. Notably, syphilis incidence rose steadily throughout the surveillance period, among all age groups, and both sexes, with steepest rises after 2021, increasing nearly 70%. Non-Hispanic Black service members continue to bear the highest syphilis burden, among whom incidence peaked in 2023, before declining approximately 15% in 2024. Syphilis rates continued to rise among all other racial and ethnic groups through 2024, with the largest relative increase, 456%, among non-Hispanic White service women under age 25 years. Genital HSV demonstrated a downward trend throughout the surveillance period, with overall incidence reaching its lowest point in 2024. Incidence of genital HPV also decreased among all service members, with a more pronounced decrease among men. Chlamydia, gonorrhea, and genital HSV incidence rates dropped to their lowest points of the 9-year surveillance period. In contrast, total syphilis incidence rose among all age groups, and both sexes, with the highest incidence among service women ages 17-19 years. While syphilis incidence rates remain highest among non-Hispanic Black service members, its incidence has risen sharply in all other racial and ethnic groups, reflecting an evolving and expanding syphilis epidemiology within the military in addition to the general U.S. population.

While female U.S. Air Force and Space Force basic military trainees are screened universally for gonorrhea and chlamydia, male basic trainees are tested only when symptomatic or upon patient request. Epidemiology and follow-up testing of male basic trainees who test positive for gonorrhea or chlamydia in training is unclear. All active duty male basic trainees at Joint Base San Antonio-Lackland who tested positive for gonorrhea or chlamydia from 2017 through 2023 (50 of 182,726 total male trainees, 0.03%) were matched, 1-to-1, by age and accession date, with active duty female basic trainees who tested positive for the same pathogen. Medical records from military hospitals and clinics were reviewed for follow-up testing within 12 months of the initial positive test and subsequent diagnoses for chlamydia and gonorrhea up to 3 years afterwards, or July 1, 2024, whichever occurred first. Among 50 male basic trainees, 30 (60%) reported symptoms when presenting for testing. Most cases (86%) were due to chlamydia. Only 56% (n=28) of male trainees had follow-up testing within 1 year, compared to 76% (n=38) of matched female basic trainees (OR 0.4, 95% CI: 0.17, 0.95). Low screening for chlamydia and gonorrhea among male basic trainees may contribute to reduced follow-up testing and represents a missed opportunity to identify infections, prevent transmission, and reduce the burden of infection in this population. Male basic military trainees who tested positive for gonorrhea or chlamydia had follow-up testing rates significantly below guideline recommendations. Rates of future infections among male basic trainees were not, however, statistically lower than female trainee rates of future infections.

This report provides an update, through June 2025, of routine screening results for antibodies to the human immunodeficiency virus (HIV) among members of the U.S. military. The HIV-antibody seropositivity rates for active component service members from 2024 through mid-year 2025 were highest for the Navy (0.23 per 1,000 tested) and Marine Corps (0.22 per 1,000 tested), followed by the Army (0.17 per 1,000 tested), and lowest for the Air Force (0.13 per 1,000 tested) and Coast Guard (0.11 per 1,000 tested). Mid-year HIV seropositivity rates, in comparison to 2024, increased for active component service members of the Army but decreased or remained stable for all other services, as of June 2025. From January 2020 through June 2025, approximately 7 million U.S. military service members among the active component, reserve component, National Guard) were tested for antibodies to HIV, and 1,463 were identified as HIV-antibody-positive (seropositivity 0.21 per 1,000 tested). Of the 1,463 new infections identified during this period, only 40 (2.7%) were among female service members. The HIV-antibody screening program remains an important element of U.S. force health protection, particularly for men under age 35 years, for all branches of service and service components. The measurement of military retention for HIV-positive service members reflects changes in U.S. Department of Defense policies that allow asymptomatic individuals with undetectable viral loads to serve without restrictions.

Limited data on sexual networks in the U.S. military makes designing strategies to combat sexually transmitted infections (STIs) challenging. This retrospective evaluation assessed reported sexual networks of military service members with chlamydia, to inform future interventions for decreasing transmission of the infection. Thirty-two active duty service members at Joint Base San Antonio-Fort Sam Houston tested positive for chlamydia infection during the evaluation period, June through December 2023. Service members who tested positive for chlamydia were interviewed by Army Public Health Nursing staff and were asked to identify their sexual partners from the preceding 60 days, for routine contact tracing. Patient responses were then anonymized for comparisons of sexual networks of military service members-by sex, branch of service, and whether they were participating in military training or had completed training ("permanent party"). Service members with chlamydia were predominantly female (n=19, 59.4%), in the Army (n=18, 56.3%), and in military training (n=20, 62.5%). Of the 45 sexual contacts of the 32 service members identified through contact tracing, the majority (n=30, 66.7%) of those sexual contacts were civilians. Those still in military training were more likely to report sexual contacts who were also military service members, compared to permanent party service members (n=12, 50% vs. n=3, 14.3%, p=0.014). This evaluation determined that most service members who developed chlamydia were in sexual networks with only a single partner (n=22, 68.8%). These data should form an initial assessment of a military sexual network that needs to be confirmed in larger settings. This analysis of sexual networks at Joint Base San Antonio-Fort Sam Houston involving 32 military service members with chlamydia found that sexual networks for service members who were in training had a greater proportion of sexual partners who were also in the military compared to service members who were not in training (50% vs. 14.3%, p=0.014).

Measles, mumps, rubella, and varicella (MMR/V) cases have decreased in the U.S. Military Health System (MHS) overall, but in recent years, increasing numbers of MMR/V outbreaks in the U.S. have led to a rise in reported cases among the civilian population. Data were queried from the Defense Medical Surveillance System to identify total number of confirmed and possible MMR/V cases among all MHS beneficiaries from 2019 through 2024. The total numbers of confirmed and possible cases among MHS beneficiaries included 8 confirmed and 71 possible cases of measles, 18 confirmed and 193 possible cases of mumps, 13 confirmed and 265 possible cases of rubella, and 251 confirmed and 4,554 possible cases of varicella. During the surveillance period the numbers of all confirmed and possible cases decreased. Among service members, most cases were either partially vaccinated, or vaccination records were not available. In this 6-year surveillance period, cases of MMR/V decreased over time. No cases of measles were observed among U.S. service members during the surveillance period. This report emphasizes the importance of continued vaccination against MMR/V to limit morbidity among U.S. service members, as evidenced by the lower number of cases among service members, who are required to be vaccinated, when compared to non-service members.

Long COVID, or post-acute coronavirus disease syndrome, represents a potentially serious threat to military readiness. Forecasts of future long COVID diagnoses could help prepare senior leaders for disruptions. Few studies predicting the incidence of long COVID have been published to date, however. Using existing COVID-19 and long COVID diagnoses, as well as demographic and outpatient encounter data, 1- to 6-month ahead and full 6-month forecasts were generated using time series and machine learning models trained on various covariate data. Forecasting models generated accurate predictions of long COVID diagnoses up to 6 months ahead of the forecasted date. Several model and covariate combinations were within 5% of the observed number of diagnoses over the full 6-month testing period, while monthly forecasts of long COVID diagnoses had median absolute percentage errors ranging from 3% to 10% for the best performing model combinations. Simple forecasting models and distribution-based forecasts that utilize existing clinical databases can provide accurate predictions of incident long COVID up to 6 months in advance and can be used to prepare for the burden of new long COVID diagnoses. Accurate predictions of long COVID cases over a 6-month period were achieved by utilizing existing COVID-19 case and outpatient encounter data from January 1, 2020, through December 31, 2022. Long COVID symptoms can cause disruptions to military readiness and prevent a healthy force, especially after surges in COVID-19 cases. The ability to use existing data sources to accurately predict future cases of long COVID allows senior leaders to anticipate and prepare for potential changes in the availability of service members.

Prior studies have found a higher risk of adverse pregnancy outcomes due to COVID-19 infection; however, recent literature documents few adverse impacts to younger and otherwise healthy populations, but with limited information about military members. The study population comprised active component service women with a singleton delivery between 2021 and 2023. Adverse pregnancy outcomes were evaluated by COVID-19 infection and vaccination history, as well as by demographics and pre-existing comorbidities. During the surveillance period, 39,355 active component U.S. service women had a singleton delivery. After controlling for potential confounders in the adjusted logistic regression analysis, COVID-19 infection during pregnancy was associated with eclampsia (OR 2.18, p<0.05) and antepartum hemorrhage (OR 1.11, p<0.05), and COVID-19 infection prior to the start of pregnancy was associated with antepartum hemorrhage (OR 1.18, p<0.05). In comparison, after adjustment, COVID-19 vaccination during pregnancy and prior to start of pregnancy was not associated with increased odds of any adverse pregnancy outcome in active component service women. COVID-19 vaccines are recommended for pregnant women by the American College of Obstetricians and Gynecologists and, previously, the U.S. Centers for Disease Control and Prevention. This analysis found no significant difference in adverse pregnancy outcomes among those who received a COVID-19 vaccine prior to delivery compared to women who did not, between 2021 and 2023. COVID-19 infection prior to start of pregnancy was associated with antepartum hemorrhage whereas COVID-19 infection during pregnancy was associated with eclampsia and antepartum hemorrhage. The findings from this analysis suggest there is a benefit to vaccinating pregnant active component service women against COVID-19. There was no increased risk of these adverse pregnancy outcomes associated with receipt of a COVID-19 vaccine in this study population. In contrast, COVID-19 infection may be associated with increased occurrence of some adverse pregnancy events.

Few studies have investigated body mass index (BMI) and physical fitness factors related to coronavirus disease (COVID)-19 hospitalizations among U.S. active duty service members. This investigation examined associations between measures of physical fitness, BMI, and Army physical fitness test (APFT) performance with COVID-19 hospitalizations of U.S. Army active duty soldiers. From May 2020 through November 2021, 13,074 male soldiers were diagnosed with COVID-19 (90 hospitalized, 12,984 non-hospitalized) who also had an APFT and BMI record no more than 9 months from the COVID-19 diagnosis date. Female soldiers were excluded due to insufficient numbers of COVID-19 hospitalizations. In adjusted logistic regression models controlling for race and ethnicity as well as comorbidities, and including age, BMI, and their interactions, both BMI (adjusted odds ratio [aOR] 1.07; 95% CI 1.01, 1.14; p=0.021), and the age and BMI interaction were statistically significant (aOR 1.01; 95% CI 1.00, 1.02; p=0.004). Each additional year of age amplified the odds of hospitalization by an additional 1% for every 1 unit increase in BMI. Development and maintenance of a healthy body weight may reduce likelihood of COVID-19 hospitalization and sustain individual and unit health and medical readiness. For male U.S. Army active duty soldiers, the association between having a higher BMI and COVID-19 hospitalization was amplified by age, indicating about a 1% increase in the odds of hospitalization per BMI unit for each additional year of age. Maintaining a healthy body weight may reduce the risk of COVID-19 related hospitalization for military personnel. The U.S. Army's Holistic Health and Fitness Program is one example of a comprehensive health program established to simultaneously enhance several facets of military health and fitness.

Despite a longstanding U.S. Department of Defense (DOD) requirement for seasonal influenza vaccination of active component service members (ACSMs), quantifying the impact of the DOD immunization program is challenging. To measure the burden of severe influenza among this highly immunized ACSM population, this study evaluated seasonal and cumulative seasonal influenza hospitalization rates among ACSMs from 2010 through 2024, stratifying by sex, age group, race and ethnicity, service branch, recruit site, and location (U.S. vs. non-U.S.). In contrast to Centers for Disease Control and Prevention (CDC) U.S. population data, the highest ACSM cumulative seasonal influenza hospitalization rate was in the age group under 25 years (9.3 per 100,000 person-years [p-yrs]) and recruits (70.1 per 100,000 p-yrs). Non-U.S.-based ACSMs had lower influenza hospitalization rates (4.8 per 100,000 p-yrs) compared to ACSMs in the U.S. (8.0 per 100,000 p-yrs). Within the DOD, cumulative seasonal influenza hospitalization rates were highest in the youngest age group, particularly among recruits. This may influence DOD influenza vaccine distribution priority considerations in the future. Compared to U.S. national data, in which adult seasonal influenza hospitalization rates increase with age, the highest cumulative hospitalization rate among ACSMs occurred in the youngest age group, those younger than age 25 years, especially in recruit settings. Lower cumulative rates of seasonal influenza hospitalization in older age groups of ACSMs help quantify the impacts of the longstanding DOD vaccination requirement for influenza. The higher burden of hospitalization among recruits offers DOD vaccine distribution priority considerations in the future.