Characteristics of U.S. Army Beneficiary Cases of COVID-19 in Europe, 12 March 2020-17 April 2020.

In 2020, the SARS-CoV-2 virus caused an unprecedented pandemic of coronavirus disease 2019 (COVID-19). Army Public Health Command Europe monitored all cases of COVID-19 for Military Health System (MHS) beneficiaries seen in Army Military Treatment Facilities. Cases entered into the Army Disease Reporting System internet (ARDSi) were evaluated for symptomatology as this was a younger and healthier cohort than typically reported on at the time. During the surveillance period, 7.1% of COVID-19 cases among MHS beneficiaries were hospitalized; these cases presented with symptoms such as congestion, sore throat, and disturbances in taste and smell. Interventions to stop the outbreak included aggressive case finding with robust testing, control of cases and contacts, and the extreme social distancing measures seen in other countries. The outbreak was successfully brought under control in one month. Cases remained sporadic and were due largely to importation from the U.S. until the end of August 2020.

New ACC/AHA Blood Pressure Guidelines and the Operational Readiness of Naval Aviators and Aircrew.

INTRODUCTION: Hypertension, also known as high blood pressure, is the "silent killer" and may lead to more severe conditions if left unmanaged. Hypertension in service members of the U.S. military has the potential to negatively impact readiness. The aim of this study was to assess the potential impact to readiness of active duty Naval aviators and aircrew under the new 2017 ACC/AHA blood pressure guidelines.METHODS: This cross-sectional study used the Military Health System Data Repository for 2015. The population included all active duty Naval aviators and aircrew. The absolute number and proportion of those with hypertension were compared based on previous Joint National Committee 7 and 2017 ACC/AHA guidelines. Impact to readiness was calculated based on lost work days and the number of individuals with hypertension that fit the criteria to be medically grounded according to the U.S Naval Aeromedical Reference and Waiver Guide.RESULTS: Hypertension diagnoses will increase by 2904 individuals (599%) in the 23,492 Naval aviators and aircrew included in the population. Impact to readiness will result in an estimate of 510 lost work days.CONCLUSION: The 2017 ACC/AHA hypertension guidelines will lead to a dramatic increase in hypertension diagnoses in this population. Depending on the U.S. Navy disposition on hypertension, the impact can be minor or substantial, but the early opportunity for care made available with the 2017 ACC/AHA guidelines may provide long-term benefits of a healthy fighting force worth the immediate impact to readiness.Johnson MC, Banaag AL, Condie KJ, Servies TE, Pérez Koehlmoos TL. New ACC/AHA blood pressure guidelines and the operational readiness of Naval aviators and aircrew. Aerosp Med Hum Perform. 2019; 90(4):409-414.

A Study on the Leptospirosis Outbreak Among US Marine Trainees in Okinawa, Japan.

Introduction: The US Marines operate the Jungle Warfare Training Center (JWTC) in Northern Okinawa, where leptospirosis is endemic. The JWTC endurance course involves prolonged fresh and stagnant water exposures in a simulated jungle warfare environment. Since a leptospirosis outbreak in 1987, JWTC has required prophylactic use of doxycycline at 200 mg weekly during exposure to the endurance course. This policy is based on a 1982 study in a similar environment in Panama. In August and September of 2014, an outbreak of leptospirosis occurred among 81 Marines training at JWTC. We analyzed data from the largest reported outbreak of leptospirosis among US military members. Materials and Methods: Two hundred and thirty nine US Marines who completed the endurance course were interviewed by trained personnel regarding their exposures and use of prophylactic medication utilizing a standardized questionnaire. All available personnel who went through the course during the outbreak period were interviewed regardless of whether or not they became ill. The Armed Forces Health Surveillance Branch's case definition was used to identify cases. Results: Eighty-one cases in 239 personnel were identified (attack rate = 33.9%). Exposures linked to being a case were swallowing water in the stagnant pond (attack rate ratio [ARR] = 2.3, 95% confidence interval [CI] = 1.4-3.7), cuts on the body (ARR = 1.5, 95% CI = 1.01-2.11), and insect bites (ARR = 2.0, 95% CI = 1.2-3.4). Exposures not linked to being a case were taking doxycycline before the exposure (ARR = 3.2, 95% CI = 0.5-22.2), taking doxycycline after the exposure (ARR = 0.9, 95% CI = 0.6-1.3), and swallowing water in the natural stream (ARR = 1.3, 95% CI = 0.9-1.9). Conclusions: Attack rate data indicate that whether or not personnel took pre- or post-exposure doxycycline made no difference statistically. Increased internal exposure (via swallowing water or through broken skin) increased risk of symptomatic disease. This new study combined with a growing body of literature should prompt researchers to re-examine recommendations for those with significant water exposure in areas with high leptospirosis levels.

Substance use disorders in the U.S. Armed Forces, 2000-2011.

Drug misuse is associated with serious health consequences and has detrimental effects on military readiness. During 2000 to 2011, 70,104 service members received an incident diagnosis of a substance use disorder (SUD) (excluding alcohol and tobacco-related disorders). Incidence rates declined with increasing age, time in service, rank, and number of combat deployments. Service members in a combat occupation had 1.2 times the rate of individuals in a health care or administation/supply occupation. The median time to discharge after an SUD diagnosis was longest in the Air Force (327 days) and shortest in the Navy (133 days). The substances with the highest incidence rates were cannabis (160 per 100,000 person-years [p-yrs]), "mixed/unspecified/other" (125 per 100,000 p-yrs), and cocaine (61 per 100,000 p-yrs). Incidence rates of cannabis and cocaine use diagnoses generally declined while rates of mixed/unspecified/other and opioid use increased over the surveillance period. The increasing trend in opioid-related diagnoses since 2002 may reflect an increase in prescription drug misuse. The Department of Defense recently expanded its drug testing program to screen for hydrocodone and benzodiazepines.