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Military Health System

Medical Surveillance Monthly Report

thumbnail image of several MSMRsThe Medical Surveillance Monthly Report, published continually since 1995, is a peer-reviewed journal of the Armed Forces Health Surveillance Division. The MSMR publishes monthly reports describing the incidence, distribution, impact, or trends of illness and injuries among members of the United States Armed Forces and other beneficiaries of the Military Health System. The most widely read issue each year focuses on the annual absolute and relative morbidity burden attributable to various illness and injuries among service members and beneficiaries, which may be accessed here.

The MSMR is always seeking high quality, relevant submissions for publication. Prospective authors are welcome to review instructions and submit manuscripts within the aims and scope of the journal. Inquiries regarding content or material to be considered for publication should be directed to the MSMR Editor.

Download the MSMR

Here, you can download the current and past issues of the MSMR. 

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Citing the MSMR

When citing MSMR articles, please use the following formats:

Author Names Listed with the Article

Collier DA, Bayles MK, Barrett, JP. Acute gastroenteritis outbreak at the Armed Forces Retirement Home, Washington, DC, January 2011. MSMR. 2011;18(6):11-14.

No Author Name Listed (April 2007 to current)

Armed Forces Health Surveillance Branch. Mental disorders and mental health problems, active component, U.S. Armed Forces, January 2000 – December 2009. MSMR. 2010;17(11):6-13.

No Author Name Listed (Before April 2007)

Army Medical Surveillance Activity. Overhydration and hyponatremia among active-duty soldiers, 1997-1999. MSMR. 2000;6(3):9-11.

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Surveillance Trends for SARS-CoV-2 and Other Respiratory Pathogens Among U.S. Military Health System Beneficiaries, 27 September 2020–2 October 2021.

Article
7/1/2022
Staff Sgt. Misty Poitra and Senior Airman Chris Cornette, 119th Medical Group, collect throat swabs during voluntary COVID-19 rapid drive-thru testing for members of the community while North Dakota Army National Guard Soldiers gather test-subject data in the parking lot of the FargoDome in Fargo, N.D., May 3, 2020. The guardsmen partnered with the N.D. Department of Health and other civilian agencies in the mass-testing efforts of community volunteers. (U.S. Air National Guard photo by Chief Master Sgt. David H. Lipp)

Respiratory pathogens, such as influenza and adenovirus, have been the main focus of the Department of Defense Global Respiratory Pathogen Surveillance Program (DoDGRPSP) since 1976.1. However, DoDGRPSP also began focusing on SARS-CoV-2 when COVID-19 was declared a pandemic illness in early March 2020.2. Following this declaration, the DOD quickly adapted and organized its respiratory surveillance program, housed at the U.S. Air Force School of Aerospace Medicine (USAFSAM), in response to this emergent virus.

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Medical Surveillance Monthly Report

Suicide Behavior Among Heterosexual, Lesbian/Gay, and Bisexual Active Component Service Members in the U.S. Armed Forces.

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7/1/2022
  The DOD’s theme for National Suicide Prevention Month is “Connect to Protect: Support is Within Reach.” Deployments, COVID-19 restrictions, and the upcoming winter season are all stressors and potential causes for depression that could lead to suicidal ideations. Options are available to individuals who are having thoughts of suicide and those around them (Photo by Kirk Frady, Regional Health Command Europe).

Lesbian, gay, and bisexual (LGB) individuals are at a particularly high risk for suicidal behavior in the general population of the United States. This study aims to determine if there are differences in the frequency of lifetime suicide ideation and suicide attempts between heterosexual, lesbian/gay, and bisexual service members in the active component of the U.S. Armed Forces. Self-reported data from the 2015 Department of Defense Health-Related Behaviors Survey were used in the analysis.

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Brief Report: Phase I Results Using the Virtual Pooled Registry Cancer Linkage System (VPR-CLS) for Military Cancer Surveillance.

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7/1/2022
A patient at Naval Hospital Pensacola prepares to have a low-dose computed tomography test done to screen for lung cancer. Lung cancer is the leading cause of cancer-related deaths among men and women. Early detection can lower the risk of dying from this disease. (U.S. Navy photo by Jason Bortz)

The Armed Forces Health Surveillance Division, as part of its surveillance mission, periodically conducts studies of cancer incidence among U.S. military service members. However, service members are likely lost to follow-up from the Department of Defense cancer registry and Military Health System data sets after leaving service and during periods of time not on active duty.

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Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2021

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6/1/2022
Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2021

As in previous years, among service members deployed during 2021, injury/poisoning, musculoskeletal diseases and signs/symptoms accounted for more than half of the total health care burden during deployment. Compared to garrison disease burden, deployed service members had relatively higher proportions of encounters for respiratory infections, skin diseases, and infectious and parasitic diseases. The recent marked increase in the percentage of total medical encounters attributable to the ICD diagnostic category "other" (23.0% in 2017 to 44.4% in 2021) is likely due to increases in diagnostic testing and immunization associated with the response to the COVID-19 pandemic.

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Hospitalizations, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022
Hospitalizations, Active Component, U.S. Armed Forces, 2021

The hospitalization rate in 2021 was 48.0 per 1,000 person-years (p-yrs), the second lowest rate of the most recent 10 years. For hospitalizations limited to military facilities, the rate in 2021 was the lowest for the entire period. As in prior years, the majority (71.2%) of hospitalizations were associated with diagnoses in the categories of mental health disorders, pregnancy-related conditions, injury/poisoning, and digestive system disorders.

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Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2021

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6/1/2022
Surveillance snapshot: Illness and injury burdens, reserve component, U.S. Armed Forces, 2021

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Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2021

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6/1/2022
Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2021

In 2021, as in prior years, the medical conditions associated with the most medical encounters, the largest number of affected service members, and the greatest number of hospital days were in the major categories of injuries, musculoskeletal disorders, and mental health disorders. Despite the pandemic, COVID-19 accounted for less than 2% of total medical encounters and bed days in active component service members.

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Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2021

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6/1/2022
Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2021

In 2021, mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 and those aged 65 or older, musculoskeletal diseases accounted for the most morbidity and health care burdens. As in previous years, this report documents a substantial majority of non-service member beneficiaries received care for current illness and injury from the Military Health System as outsourced services at non-military medical facilities.

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Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

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6/1/2022
Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

The proportions of evacuations out of USCENTCOM that were due to battle injuries declined substantially in 2021. For USCENTCOM, evacuations for mental health disorders were the most common, followed by non-battle injury and poisoning, and signs, symptoms, and ill-defined conditions. For USAFRICOM, evacuations for non-battle injury and poisoning were most common, followed by disorders of the digestive system and mental health disorders.

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Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

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6/1/2022
Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

In 2021, the overall numbers and rates of active component service member ambulatory care visits were the highest of any of the last 10 years. Most categories of illness and injury showed modest increases in numbers and rates. The proportions of ambulatory care visits that were accomplished via telehealth encounters fell to under 15% in 2021, compared to 19% in 2020.

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Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

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6/1/2022
Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

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The Association Between Two Bogus Items, Demographics, and Military Characteristics in a 2019 Cross-sectional Survey of U.S. Army Soldiers

Article
5/1/2022
NIANTIC, CT, UNITED STATES 06.16.2022 U.S. Army Staff Sgt. John Young, an information technology specialist assigned to Joint Forces Headquarters, Connecticut Army National Guard, works on a computer at Camp Nett, Niantic, Connecticut, June 16, 2022. Young provided threat intelligence to cyber analysts that were part of his "Blue Team" during Cyber Yankee, a cyber training exercise meant to simulate a real world environment to train mission essential tasks for cyber professionals. (U.S. Army photo by Sgt. Matthew Lucibello)

Data from surveys may be used to make public health decisions at both the installation and the Department of the Army level. This study demonstrates that a vast majority of soldiers were likely sufficiently engaged and answered both bogus items correctly. Future surveys should continue to investigate careless responding to ensure data quality in military populations.

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Surveillance Snapshot: Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021

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5/1/2022
iStock—The castor bean tick (Ixoedes ricinus). Credit: Erik Karits

Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021. Tick-borne encephalitis (TBE) is a viral infection of the central nervous system that is transmitted by the bite of infected ticks, mostly found in wooded habitats in parts of Europe and Asia

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Evaluation of ICD-10-CM-based Case Definitions of Ambulatory Encounters for COVID-19 Among Department of Defense Health Care Beneficiaries

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5/1/2022
SEATTLE, WA, UNITED STATES 04.05.2020 U.S. Army Maj. Neil Alcaria is screened at the Seattle Event Center in Wash., April 5. Soldiers from Fort Carson, Colo., and Joint Base Lewis-McChord, Wash. have established an Army field hospital center at the center in support of the Department of Defense COVID-19 response. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army photo by Cpl. Rachel Thicklin)

This is the first evaluation of ICD-10-CM-based cased definitions for COVID-19 surveillance among DOD health care beneficiaries. The 3 case definitions ranged from highly specific to a lower specificity, but improved balance between sensitivity and specificity.

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Update: Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2013–2021

Article
5/1/2022
This illustration depicts a 3D computer-generated image of a number of drug-resistant Neisseria gonorrhoeae bacteria. CDC/James Archer

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2013–2021. In general, compared to their respective counterparts, younger service members, non-Hispanic Black service members, those who were single and other/unknown marital status, and enlisted service members had higher incidence rates of STIs.

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Last Updated: January 26, 2023
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