MSMR最新文献

Cold injuries are a predictable and preventable threat. Continuous surveillance is essential to prevent cold weather injuries and mitigate their adverse impacts on military operations. Military training and combat operations require continued emphasis on effective cold weather injury prevention strategies and adherence to relevant policies and procedures to protect service members against such injuries. For all active component service members (ACSM), the rate of cold weather injuries in 2022-2023 decreased by 15.2% compared to the preceding cold season. The decrease was most pronounced in the Marine Corps, with a 22.0% reduction in the incidence rate of cold injuries. This year's report includes cold injury rates for the Coast Guard. From July 2022 through June 2023, a total of 423 members of the active (n=376) and reserve (n=47) components of the U.S. Armed Forces had at least 1 cold weather injury. The crude overall incidence rate of cold injury among all ACSM during the 2022-2023 cold season was 28.5 per 100,000 person-years (p-yrs), 15.2% lower than the rate observed during the 2021-2022 cold season (33.6 per 100,000 p-yrs). The rates of cold injuries varied among the Armed Forces, with the highest rates per 100,000 p-yrs observed in the Army, at 50.9, followed by the Marine Corps, at 32.2, the Air Force, at 18.9, the Navy, at 8.1, and the Coast Guard, at 5.1. Consistent with previous cold seasons, frostbite (54.0%) remained the most common type of cold injury among ACSM during the 2022-2023 cold season, while the proportions of hypothermia and immersion injuries were 16.5% and 30.3%, respectively. Cold injury rates among ACSM during the 2018 to 2023 cold seasons were generally highest for males, non-Hispanic Blacks, those under 20 years of age, and enlisted members. The number of cold injuries identified in service members deployed outside the U.S during the 2022-2023 cold season (n=10) was comparable to the 2 preceding cold seasons (11 in 2020-2021 and 12 in 2021-2022), with frostbite accounting for half (n=5) of the 2022-2023 cases.

Colorectal cancer, which is more predominant among men than women, has been shown to be associated with environmental and occupational risk factors experienced by military members. The Defense Medical Surveillance System (DMSS) was used to determine the crude and age-adjusted incidence rates of colorectal cancer among active component service members from all military services from January 1, 2010 to December 31, 2022. Results from this analysis show higher crude incidence rates of colorectal cancer among those who are older and male. The overall age-adjusted incidence rate throughout the surveillance period ranged from 3.56 (95% CI: 2.54-4.58) to 7.92 (95% CI: 5.98-9.86) cases per 100,000 person-years. Age-adjusted colorectal cancer rates were similar for males and females (4.46 and 4.33 cases per 100,000 person-years, respectively) and rates were relatively similar by service as well as race and ethnicity. This finding could be attributed to the small number of cases in this study due to better screening practices in the Military Health System (MHS). Although non-Hispanic Black service members have historically had the highest incidence of colorectal cancer within the U.S. military, this study observed similar rates of colorectal cancer for all races and ethnicities after adjusting for age. Incident rates of colorectal cancer within the U.S. military increase monotonically with age, with service members over the age of 45 with the highest incidence, re-enforcing the need to promote wellness screening among military populations. The importance of the DHA guideline changes that decreased colorectal screenings to age 45 years is significant.

Malaria, caused by various species of the Plasmodium parasite, remains a significant health threat in most U.S. military regions-AFRICOM, CENT-COM, INDOPACOM, and SOUTHCOM-and although less prevalent, also poses periodic risks to military personnel in NORTHCOM through imported cases. Early diagnosis is crucial for effective malaria chemotherapy, and rapid diagnostic tests (RDTs) have proven valuable in resource-poor settings and operational environments. The BinaxNow Malaria RDT is currently the sole U.S. Food and Drug Administration (FDA)-approved test for use on U.S. military personnel. This simple RDT targets Plasmodium falciparum, the deadliest malaria species, by detecting the histidine-rich protein 2 (HRP2), as well as pan-Plasmodium species by detecting aldolase. The emergence of mutant P. falciparum parasites lacking pfhrp2/pfhrp3 genes and thus not expressing HRP2/HRP3 proteins poses a significant challenge in many malaria-endemic areas. This genetic variation has led to false-negative results in all HRP2-detecting RDTs including BinaxNow, undermining its utility. Current U.S. military force health protection (FHP) measures for preventing malaria, including chemoprophylaxis, permethrin-treated uniforms, and DEET application to exposed skin, are effective, but breakthrough infections still occur. The use of portable and user-friendly malaria diagnostics is necessary in remote locations that lack microscopy or nucleic acid-based diagnostic capabilities. The alarmingly high prevalence of mutant pfhrp2/3-deleted parasites poses a threat to malaria diagnosis in all Combatant Commands where point-of-care testing is vital. This review emphasizes the importance of ongoing monitoring to determine the frequency and distribution of mutant parasites. Urgent attention is needed to develop alternative RDTs that can effectively detect malaria infections caused by these mutant strains. These findings confirm that mutant pfhrp2/3-deleted parasites are highly prevalent in SOUTHCOM and parts of AFRICOM, rendering HRP2-based RDTs such as BinaxNow an unsuitable diagnostic tool for malaria in many of the SOUTHCOM and AFRICOM countries surveyed: Peru (14.3-62% between 2011-2018), Eritrea (62% in 2016 and 9.4% in 2020), Nigeria (13.3%), Sudan (11.2%), South Sudan (17.7%), and Uganda (3.3%). In INDOPACOM countries surveyed, no prevalence greater than 5% pfhrp2 deletions were observed. It is critical to continue surveillance on the frequency and distribution of these mutant parasites and develop alternative RDTs. WHO recommends that countries switch to non-HRP2-based RDTs when prevalence of pfhrp2/3 deletions that cause false-negative RDT results exceed 5%. Current prevalence of mutant pfhrp2/3-deleted parasites causing false-negative RDT results has exceeded this threshold in most parts of SOUTHCOM and several areas of AFRICOM. If alternative diagnostic tests are not utilized in areas affected, life-saving malaria treatment for U.S. military personnel coul

Complete and timely reporting of notifiable medical conditions among the Department of Defense (DOD) beneficiary population is important for the control of communicable and preventable diseases and injuries. The Defense Medical Surveillance System was used to identify all hospital and ambulatory care encounters during 2018-2022 for which a notifiable medical condition was indicated among active component service members as well as all other DOD beneficiaries. Inci-dent cases with diagnoses of DOD-notifiable medical conditions were matched with reportable medical events entered through the Disease Reporting System internet (DRSi). During the study period, 61.2% of notifiable hospitalized cases and 65.5% of notifiable ambulatory care cases at a military hospital or clinic among active component service members were reported. Among other beneficiaries treated at a military hospital or clinic, only 15.2% of notifiable hospitalized cases and 22.1% of notifiable ambulatory care cases were reported to DRSi. Reporting percentages were much lower for care at outsourced facilities, regardless of the population. The timeliness of reporting for active component service members fluctuated annually, but in both 2018 and 2022, 64.2% of notifiable cases at a military hospital were reported within 1 week. For ambulatory care cases, timeliness of reporting decreased over time, with 50.1% reported within 1 week in 2018 and 43.3% in 2022. A total of 1,306 hospitalized and 100,163 ambulatory incident cases for notifiable medical conditions among active component service members occurred from January 2018 to December 2022. Reporting of these events though the DRSi (Disease Reporting System Internet) increased since the last report in 2015, but timeliness decreased. Data on other beneficiaries and outsourced care facilities were added to the analysis for this report. Improvements to reporting and timeliness of active component service member notifiable medical conditions is needed to effectively track and mitigate communicable diseases and preventable injuries. Although reporting currently is not required for all non-service member beneficiaries, they present another source of communicable diseases that could affect disease among service members, making them a potential population for report consideration.

On an annual basis, approximately 2,500 U.S. Marines and Sailors deploy to Australia on 6-month training rotations. Active duty personnel are generally immunologically naïve to pathogens endemic to tropical Australia, a vulnerability that could significantly impact medical readiness. To estimate risk, we screened 628 post-deployment serum samples by ELISA for serological evidence of infection with Ross River virus (RRV), a mosquito-borne alphavirus endemic to tropical Australia. Samples that tested above the negative cutoff value were paired with their pre-deployment samples to identify deployment-related seroconversion. These paired samples were further investigated with a live virus neutralization assay to assess specificity. There was a single RRV seroconversion and 49 false-positive results. In the context of these analyses (i.e., limited sample numbers collected between the months of March and October), we assess the RRV risk to MRFD as low and encourage strategies such as avoiding and preventing mosquito bites to mitigate the existing risk over widespread vaccination programs, if an FDA-approved vaccine becomes available. The Panbio RRV ELISA lacks the specificity to draw conclusions based on seropositivity from large-scale surveys of U.S. personnel.