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AFHSB's health surveillance program supports Defense Department global health engagement efforts

U.S. Air Force Senior Airman Joshua Douglass, left, an aerospace medical technician, watches as Liberian health care workers properly put on their personal protective equipment as part response by the Defense Department operation to provide logistics, training and engineering support during the Ebola virus outbreak. (U.S. Army photo by Staff Sgt. Terrance D. Rhodes) U.S. Air Force Senior Airman Joshua Douglass, left, an aerospace medical technician, watches as Liberian health care workers properly put on their personal protective equipment as part response by the Defense Department operation to provide logistics, training and engineering support during the Ebola virus outbreak. (U.S. Army photo by Staff Sgt. Terrance D. Rhodes)

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Armed Forces Health Surveillance Branch | Global Emerging Infections Surveillance | Antimicrobial Resistance (AMR) Surveillance | Febrile and Vector-Borne Infections (FVBI) Surveillance | Enteric Infections (EI) Surveillance | GEIS Partners | Global Health Engagement | Global Health Engagement

Both the U.S. Armed Forces’ operational posture and the emergence and spread of infectious diseases relevant to military operations have evolved in recent decades. Worldwide, people are more mobile and interconnected than ever before. At the same time, land use in the developing world is changing in such a way that long-dormant pathogens have the opportunity to re-emerge and become health problems for a significant proportion of the population again. These conditions threaten not only the health of populations, but also the security and stability of nations around the world.

The Defense Department has long recognized the link between global health and security, and its global health engagement efforts address the intersection of these concerns. Defense Department health agencies are primarily focused on protecting the health of the force and medical readiness, but their global health engagement efforts also address other security priorities for the U.S. government such as helping partner nations build health capacity, combatting global health threats (e.g., emerging infectious diseases and antibiotic-resistant bacteria), and supporting U.S. government humanitarian assistance and disaster relief initiatives.

The Global Emerging Infections Surveillance (GEIS) section of the Armed Forces Health Surveillance Branch (AFHSB) supports global health engagement by leveraging a network of Defense Department laboratory partners that are positioned in critical locations globally and work with partner nations to combat infectious disease threats. Defense Department laboratories around the world execute coordinated, integrated surveillance efforts to detect and respond to febrile and vector-borne infections, respiratory infections, antimicrobial-resistant and sexually transmitted infections, and enteric infections regardless of the source. These efforts are conducted in more than 70 countries and serve to protect the health of a highly mobile force by informing risk assessments and countermeasure development, providing support to outbreak response efforts when they arise, and supporting operational access and freedom of movement in high-threat areas.

In support of the Defense Health Agency’s combat support efforts, the GEIS network’s ultimate goal is early, accurate detection of emerging infectious disease and rapid communication regarding those that potentially threaten the health of U.S. forces so that preventive measures can be taken to enable operational readiness and mitigate the risk of mission failure. Surveillance efforts are conducted in partnership with partner nation ministries of health and defense, thereby improving their health capacity by enabling rapid identification and response to infectious disease threats to their population and strengthening relationships with key U.S. partners. In this way, the GEIS program supports the U.S. geographic combatant commands (GCCs) in their areas of responsibility, advancing their campaign plans, lines of efforts, and end states. Additionally, by providing direct technical support to GCC-led international scientific coalitions and strategic engagement efforts, GEIS enhances Defense Department global health engagements and advances information sharing with partner nations. These activities ultimately better inform force health protection decision making at the GCCs and enable global health security for partner nations and U.S. government assets abroad.

Throughout December, in celebration of the Global Health Engagement Month, AFHSB will showcase some of the surveillance efforts conducted by GEIS’s laboratory partners around the world. These stories are available on DHA’s Global Health Engagement Spotlight page.

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March 10 is National Women & Girls HIV/AIDS Awareness Day

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3/3/2017
This graphic shows the results of routine screening for antibodies to Human Immunodeficiency Virus (HIV) among both female civilian applicants for U.S. military service and female service members of the U.S. Armed Forces, active component - Army during  January 2015 through June 2016 surveillance period. 94,763 females out of 463,132 civilian applicants for U.S. military service were tested for antibodies to HIV. Out of 124 civilian applicants that were HIV positive, 10 were female. Throughout the period, seroprevalences were much higher among males than females.  During 2015 – 2016 seroprevalences dropped to zero among female applicants.  As for U.S. Armed Forces active component, 81,963 female service members out of 548,974 were tested for antibodies to HIV. Out of 120 soldiers that were HIV positive 3 were female. Annual seroprevalences for male active component Army members greatly exceed those of females. During the 2015, on average, one new HIV infection was detected among active duty army soldiers per 5,265 screening tests.  HIV-1 is the cause of Acquired Immune Deficiency Syndrome (AIDS) and has had major impacts on the health of populations and on healthcare systems worldwide. Of 515 active component soldiers diagnosed with HIV infections since 2011, a total of 291 (57%) were still in the military. Get tested and learn more by reading the Medical Surveillance Monthly Report at Health.Mil/MSMR.

Human Immunodeficiency Virus type 1 (HIV-1) is the cause of Acquired Immune Deficiency Syndrome (AIDS) and has had major impacts on the health of populations and on healthcare systems worldwide. This infographic provides information on routine screening for antibodies to HIV among female civilian applicants of the U.S. Military Service and U.S. Armed Forces, January 2011 – June 2016.

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Counts, Rates, & Trends of Incedent Diagnoses of Melanoma

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3/3/2017
Melanoma is a leading cause of cancer death. This graphic shows facts from an analysis for counts, rates, and trends of incident diagnoses of Melanoma among active component military members conducted during a 10-year surveillance period from 2005 through 2014.   Although melanoma is more common among males in the general U.S. population, in this analysis, females had a higher crude rate of malignant melanoma compared to males. From 2005 – 2014, there were 1,571 malignant melanoma cancers diagnosed in the U.S. Armed Forces. Here are other key facts from the analysis: •	Among male service members, malignant melanoma was one of the most frequent cancer diagnoses after testicular cancer. •	Among females, malignant melanoma was the 2nd most frequent cancer diagnoses after breast cancer. •	White, non-Hispanic service members had a much higher crude rate of malignant melanoma relative to their counterparts in other race/ ethnicity groups. •	In general, the strongest demographic correlate of increased risk of cancer diagnosis was older age. To learn more information, visit Health.mil/AFHSB

Melanoma is a leading cause of cancer death. This infographic provides information on an analysis for the counts, rates, and trends of incident diagnoses of melanoma among active component military members. The analysis was conducted during a 10-year surveillance period from 2005 through 2014.

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Human Physiologic Responses to Cold Exposure

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1/9/2017
Human Physiologic responses to cold exposure preserve core body temperature, but those responses may not be sufficient to prevent hypothermia if heat loss is prolonged. This infographic offers helpful information on preserving core body temperature to counter the threat from cold environments. Physiologic responses include: •	Constriction of the peripheral (superficial) vascular system – may result in non-freezing injuries or hasten the onset of actual freezing of tissues (frostbite) •	Minimizing loss of body heat •	Protecting superficial tissues Protection includes:	 •	Nutrition •	Shelter •	Physical Activity •	Protective Clothing Learn more about preserving core body temperature by reading the Medical Surveillance Monthly Report at www.Health.mil/AFHSB

Human Physiologic responses to cold exposure preserve core body temperature, but those responses may not be sufficient to prevent hypothermia if heat loss is prolonged. This infographic offers helpful information on preserving core body temperature to counter the threat from cold environments.

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Rift Valley Fever Virus Ecology

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12/5/2016
This infographic describes Rift Valley Fever (RVF) virus ecology and how RVF infects livestock and humans.   •	First the enzootic cycle begins. It is maintained via transfer from parent mosquito to offspring. This is a local, low-level transfer of disease to livestock and happens during periods of average rainfall. •	Next, high rainfall and flooding enable Aedes mosquito breeding environments to flourish. This is followed by epizootic outbreaks, which cause abortion storms in animals, with > 90% mortality in newborns and 10-20% mortality in adults. Secondary vectors, including other mosquito genera such as Culex, can pass on the virus to humans and animals.  Spillover to humans includes exposure to blood and tissue of infected livestock and occurs during slaughter or birthing activities. Humans can also be infected with RVF via bites of infected mosquitos.

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Preserving the Health of U.S. Armed Forces with DMSS and DoDSR

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7/13/2016
The Defense Medical Surveillance System (DMSS) and the DoD Serum Repository (DoDSR) provide unprecedented capabilities for conducting comprehensive population-based surveillance of the U.S. Armed Forces while protecting the privacy and confidentiality of service members. The systems together provide glimpses of the capabilities and potential uses of public health surveillance systems of the future.  The research advantages of the DMSS and DoDSR The DMSS and DoDSR enable researchers to focus time and attention on solving methodological problems, interpreting results, producing summaries and reports.  DMSS includes personnel data, medical data, laboratory data, deployment data, and DoDSR data. Benefactors of the DMSS and DoDSR are epidemiologists, preventive medicine doctors, data analysts, DoD policy makers, Military Commanders and public health officers. Learn how to harness the full value of the DMSS and DoDSR at www.Health.mil/AFHSB

The Defense Medical Surveillance System (DMSS) and the DoD Serum Repository (DoDSR) provide unprecedented capabilities for conducting comprehensive population-based surveillance of the U.S. Armed Forces.

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HIV and AIDS in the U.S. Military

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6/27/2016
June 27th is National HIV Testing Day. HIV-1 infection is a major health importance for the U.S. military. Since the start of HIV-1 military health surveillance analysis during 1990-2013, service members diagnosed with the HIV-1 infection in recent years have remained longer in U.S. Armed Forces.  There were a total of 5,227 new diagnoses in 24-years of surveillance. The August 2015 Medical Surveillance Monthly Report (MSMR) reported that “Estimated median durations of service after initial HIV-1 diagnoses ranged from 2.29 years in Cohort 1 ( 1990-1994) to 3.65 years in Cohort 4 (2005-2009). Thus, in the 15 years between 1990-1994 and 2005-2009, the median durations of service after HIV-1 diagnoses increased by 1.4 years.” Factors contributing to longer service include: •	Availability and effectiveness of HIV treatments •	Decline in stigmas associated with diagnosis of the HIV infection •	Changes in U.S. military policy that allow the LGBT community to serve in its ranks  Note: Service members who are diagnosed with HIV-1 infections, regardless of their sexual orientations, may elect to continue their military service careers.  Get tested today – it’s the only way to know. Early HIV testing helps to prevent transmission and lowers the risk of severe health complications. Follow us on Twitter for more information: @AFHSBPAGE  Also on Twitter: National HIV Testing Day #NHTD

June 27th is National HIV Testing Day. HIV-1 infection is a major health importance for the U.S. military. Since the start of HIV-1 military health surveillance analysis during 1990-2013, service members diagnosed with the HIV-1 infection in recent years have remained longer in U.S. Armed Forces.

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The HPV Vaccine Saves Lives

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5/16/2016
The Defense Department recommends male and female military service members, ages 17-26 years, receive an HPV vaccine series to generate a robust immune response to the quadrivalent human papillomavirus vaccine (HPV4). This graphic highlights information the benefits of the HPV vaccine. The vaccine is most effective among fully vaccinated individuals.   Cancer Prevention Facts •	HPV is the most common sexually  transmitted infection (STI) •	There are more than 40 HPV types that can infect the genital areas •	Some HPV types give warts •	Some HPV types develop cancer  Effective Against STI Transmission •	The HPV vaccine is a safe and effective way to protect yourself from the virus •	The HPV vaccine provides nearly 100% protection from HPV types 6,11,16 and 18 •	HPV vaccine shows early signs of success in reducing HPV infections and related illnesses •	Protection is expected to be long-lasting  Safety Tips •	Getting your HPV vaccine and practicing safe sex such as wearing a condom may lower the risk of HPV •	Limiting the number of lifetime sex partners can also lower the risk of HPV •	When given the HPV vaccine, the body makes antibodies in response to the protection to clear it from the body  Get the Facts •	2,091 female service members aged 17-26 years received 1-3 HPV4 doses during 2006-2012, stratified by number of doses (1, 2, or 3).  Get the HPV Vaccine •	Only 22.5% of eligible service members initiated the series •	Of those, only 39.1% completed the full three-dose series as of June 2011.  Even though the 3 dose regiment provides nearly complete protection against HPV16 and HPV18, in the U.S., only 12% and 19% of female adolescents among commercial and Medicaid plans respectively complete the series.  Read HPV Facts from the CDC: https://www.ok.gov/health2/documents/IMM_Teens_HPV_Facts.pdf  Read the STI issue of the Medical Surveillance Monthly Report at Health.Mil/MSMR   Get the conversation started. Ask your healthcare provider about the HPV vaccine today. Follow us on Twitter @AFHSBPAGE and use hashtag #VaccinesWork.

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Helping partner nations to build and sustain their health system capacities promotes health security around the world. Global health engagement helps to prevent, detect, and respond to biological threats before they develop into global public health issues.

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