The value of pre-exposure prophylaxis: A case series of US Marines infected with leptospirosis.

BACKGROUND: Leptospirosis is an ever-present threat found in the freshwater areas in many tropical and sub-tropical regions throughout the world and travelers to these areas are at increased risk of infection. This study describes a case series of 47 US Marines who experienced a single point leptospirosis exposure in 2014 and were admitted to a military treatment facility. METHODS: Descriptive statistics were conducted for patient demographics, symptoms, laboratory results, and outcomes. Hypothesis tests were conducted to identify significant outcomes (length of hospitalization, severity of infection, intensive care unit (ICU) admission, and cholecystectomy). Patient data was applied to five leptospirosis scoring models to assess their accuracy in the context of this population. RESULTS: The patients were all male (n = 47, 100%), had a median age of 22 (range 19-37), a mean body mass index of 24.3 (SD 2.5), and most were taking antibiotic prophylaxis (n = 40, 85.1%). Most patients experienced thrombocytopenia (n = 37, 78.7%), proteinuria (n = 35, 74.5%), and transaminitis (n = 37, 78.7%). Correct classification of infection varied among the models from 42.6% (n = 20) to 10.6% (n = 5). Not taking pre-exposure prophylaxis was significantly correlated with severe infection (p = 0.02), undergoing a cholecystectomy (p = 0.01), and being admitted to the ICU (p < 0.01). No other results were found to be both clinically and statistically significant. CONCLUSIONS: Leptospirosis diagnostic models currently in use may be less effective in predicting disease severity in young and healthy populations who are taking antibiotic prophylaxis. The use of pre-exposure prophylaxis significantly correlates with less severe health outcomes.

COVID-19 Case and Contact Investigation in an Office Workspace.

This investigation report describes a case of COVID-19 in a combined military and civilian office workspace and the contact investigation and mitigation efforts that followed. This office space included an embedded public health officer who was able to conduct the contact investigation and advise on the outbreak response. Over a 3-day period, the index case unintentionally exposed 150 coworkers to SARS-CoV-2 through participation in carpools, conferences, and small meetings. Of these exposures 37 were considered medium risk at the time and 113 were considered low risk. A total of 5 contacts reported COVID-like-symptoms at the time of the investigation and another 5 developed symptoms during the 14-day quarantine period and all were directed to self-isolate. None of the contacts required hospitalization and all the symptomatic contacts tested negative for SARS-CoV-2. With the advice and aid of the embedded public health officer, the office authorized telework, conducted thorough cleaning of spaces, distributed informative messaging, conducted virtual question-and-answer forums, and evaluated outbreak policies. This report demonstrates that the close integration of public health and office management can lead to rapid identification of those at risk of infection and implementation of mitigation and control efforts to stop the spread of disease.

Vape and Aviate: Electronic-Cigarette Use and Misuse in Naval Aviation.

Introduction: Electronic cigarettes (EC) are an emerging form of nicotine replacement that has had a discernible increase in prevalence in the general population. Little is known regarding EC use among different military demographic groups or the extent of influence that social determinants of health may have on the behavior. The purpose of this study was to assess the prevalence and correlates of EC use in a select population of active duty U.S. Naval personnel. This study is unique in that it allows for EC behavior comparison between a traditionally healthy demographic (aviators, a subset of aircrew) and a representative general military population sample. Materials and methods: Cross-sectional survey data were collected anonymously and analyzed in 2015-2016. Active duty Naval personnel (n = 977) were asked about ever trying ECs, frequency of use, and when was the last time an EC was used. Participants were assessed similarly regarding cigarette use. Descriptive and inferential statistics as well as multinomial logistic regression analyses were conducted using categorical and ordinal variables assigned to usage and demographic factors. This protocol was approved by the Institutional Review Board at Naval Hospital Portsmouth located in Portsmouth, Virginia. Results: Within the study population, 31.4% have tried ECs, 9.3% were current users, and only 3.8% were dual (EC and cigarettes) users. EC use was significantly associated with paygrade (enlisted), primary job duty (non-aircrew), and education (less than a bachelor degree, p < 0.001, p < 0.01, and p < 0.001, respectively). ECs were used at some point as a smoking cessation tool for 43.6% of current EC users (p < 0.001), 21.6% of current smokers, and only 5.6% of former smokers. Continued EC use after ever trying ECs (30.0%) was only slightly more prevalent as continued cigarette use after ever trying cigarettes (27.3%). Smokers were nearly five times more likely to currently use ECs compared with non-smokers. Trying cigarettes was associated with nearly 12 times the risk for trying ECs compared with those who never tried cigarettes. No significant misuse of ECs was noted; however, several cases of drinking, tasting, and touching EC fluid were reported. Conclusion: This study is unique in that it examines the use of electronic cigarettes among selected healthy and baseline groups within the active duty U.S. Navy population. The current prevalence of EC use among active duty personnel is much higher than previously thought. Continued use of ECs after ever trying them appears to exceed that of cigarettes even among healthy populations such as aircrew. The findings of increased risk of EC use among those with lower income and less than a bachelor's degree suggest social determinants of health implications. This study sheds new light on EC use, characteristics of use, addiction implications, and highlights concerns for a growing health risk behavior.

Perceptions of harm from electronic-cigarette use among a sample of US Navy personnel.

INTRODUCTION: Scant information exists on the perceptions and behaviors surrounding electronic cigarette (EC) use in the U.S. military. The Health Belief Model (HBM) enables factors influencing behavior adoption to be assessed. Utilizing this model, this study explored five EC-related perceptions among a sample of active-duty Navy personnel. METHODS: Participants were invited to complete a questionnaire involving EC use and perceptions. Demographics were reported and perceptions assessed using multiple choice and answer questions. Analyses included benefit and harm ratios and non-parametric tests. RESULTS: Among the 977 participants, 29.7% tried ECs, 9.5% were current users and 3.8% were dual users. A large proportion of the population believed that ECs were less harmful than cigarettes, the safest alternative to cigarettes, accepted by non-users, and allowed in areas where cigarettes are prohibited. On the other hand, the majority believed that ECs did not make the user look cool or fit in and were not safe to use around children. EC users, cigarette smokers, men, those under 30 years of age, and those with less than a bachelor degree were more likely to have positive beliefs and perceptions about EC use. CONCLUSIONS: The majority of the population studied has negative perceptions and beliefs about EC use. Several groups have beliefs that highlight vulnerabilities to EC experimentation and use. The findings illustrated concepts related to cessation and behavior adoption, harm-to-self and second-hand vapor, and smoke-free zones. These findings may help to identify motivations for experimentation and use, as well as to direct future EC intervention and prevention efforts.