Back to Top Skip to main content

Medical evacuations out of the U.S. Central Command, active and reserve components, U.S. Armed Forces, 2018

Airmen from the 19th Medical Group litter-carry a simulated patient onto a C-130J during an aeromedical evacuation training mission at Little Rock Air Force Base in 2019. (Photo Courtesy of U.S. Air Force) Airmen from the 19th Medical Group litter-carry a simulated patient onto a C-130J during an aeromedical evacuation training mission at Little Rock Air Force Base in 2019. (U.S. Air Force photo)

Recommended Content:

Medical Surveillance Monthly Report

WHAT ARE THE NEW FINDINGS?    

The number of medical evacuations for battle injuries has decreased considerably since 2014. Most medical evacuations in 2018 were attributed to mental health disorders, followed by non-battle injury/poisoning; signs, symptoms, and ill-defined conditions; musculoskeletal disorders; and digestive system disorders.

WHAT IS THE IMPACT ON READINESS AND FORCE HEALTH PROTECTION?

Medical evacuations have a significant impact on military readiness because of loss of personnel and the resultant effects on unit cohesion and mission effectiveness. In addition, the costs of medical evacuations related to non-battle injuries are considerable. Military medical providers should continue to apply pre-deployment screening processes to optimize service members’ medical and psychological fitness to deploy.

BACKGROUND

Although there have been substantial reductions in combat operations taking place in the U.S. Central Command (CENTCOM) area of responsibility (AOR) in Southwest Asia,1–5 the number of service members deployed to the CENTCOM AOR is still significant. Reports indicate that there are currently about 14,000 to 15,000 service members in Afghanistan for Operation Resolute Support and another 2,000 reinforcing the Syrian Democratic Forces.6–8 In theaters of operations such as Afghanistan, most medical care is provided by deployed military medical personnel; however, some injuries and illnesses require medical management outside the operational theater. In these cases, the affected individuals are usually transported by air to a fixed military medical facility in Europe or the U.S. where the service members receive the specialized, technically advanced, and/or prolonged diagnostic, therapeutic, and rehabilitative care required.

Medical air transports, or medical evacuations, are costly and generally indicative of serious medical conditions. Some serious conditions are directly related to participation in or support of combat operations (e.g., battle wounds); however, many others are unrelated to combat and may be preventable. This report summarizes the natures, numbers, and trends of conditions for which male and female military members were medically evacuated from CENTCOM AOR operations during 2018 and compares them to the previous 4 years.

METHODS

The surveillance period was 1 January 2014 through 31 December 2018. The surveillance population included all members of the active and reserve components of the U.S. Army, Navy, Air Force, and Marine Corps who were deployed to the CENTCOM AOR during the period. The outcome of interest in this analysis was medical evacuations during the surveillance period from the CENTCOM AOR (e.g., Afghanistan or Iraq) to a medical treatment facility outside the CENTCOM AOR. Records of all medical evacuations conducted by the U.S. Transportation Command (TRANSCOM) maintained in the TRANSCOM Regulating and Command & Control Evacuation System (TRAC2ES) were utilized. Evacuations were included in the analyses if the affected service member had at least 1 inpatient or outpatient medical encounter in a permanent military medical facility in the U.S. or Europe during a time interval extending from 5 days before to 10 days after the reported evacuation date.

Medical evacuations included in the analyses were classified by the causes and natures of the precipitating medical conditions (based on information reported in relevant evacuation and medical encounter records). First, all medical conditions that resulted in evacuations were classified as “battle injuries” or “non-battle injuries and illnesses” (based on entries in an indicator field of the TRAC2ES evacuation record). Evacuations due to non-battle injuries and illnesses were subclassified into 17 illness/injury categories based on International Classification of Diseases, 9th/10th Revision, Clinical Modification (ICD-9-CM/ICD-10-CM) diagnostic codes reported on records of medical encounters after evacuation. For the purposes of this report, all records of hospitalizations and ambulatory visits from 5 days before to 10 days after the reported date of each medical evacuation were identified. In most cases, the primary (first-listed) diagnosis for either a hospitalization (if any occurred) or the earliest ambulatory visit after evacuation was considered indicative of the condition responsible for the evacuation. However, if the first-listed diagnostic code specified the external cause (rather than the nature) of an injury (ICD-9 E-code/ICD-10 V-, W-, X-, or Y-code) or an encounter for something other than a current illness or injury (e.g., observation, medical examination, or vaccination [ICD-9 V-codes/ICD-10 Z-codes other than those related to pregnancy]), then secondary diagnoses that specified illnesses and injuries (ICD-9 codes 001–999; ICD-10 codes A00–T88) were considered the likely reasons for the subject evacuations. If there was no secondary diagnosis or if the secondary diagnosis also was an external cause code, the first-listed diagnostic code of a subsequent encounter was used. 

Deployment data were no longer available in the Defense Medical Surveillance System (DMSS) beginning in 2018; therefore, rates of medical evacuations per deployed person-time were not calculated. The disposition after each medical evacuation was determined by using the disposition code associated with the medical encounter that was used for documenting the category of the medical evacuation. Inpatient disposition categories were returned to duty (code 01), transferred/discharged to other facility (codes 02–04, 09, 21–28, 43, or 61–66), died (codes 20, 30, 40–42, 50, or 51), separated from service (codes 10–15), and other/unknown. Outpatient disposition categories were released without limitation (code 1), released with work/duty limitation (code 2), immediate referral (code 4), sick at home/quarters (codes 3 or S), admitted/transferred to civilian hospital (codes 7, 9, A–D, or U), died (codes 8 or G), discharged home (code F), and other/unknown.

RESULTS

In 2018, a total of 1,264 medical evacuations of service members from the CENTCOM AOR were followed by at least 1 medical encounter in a fixed medical facility outside the operational theater (Table 1). Overall, there were more medical evacuations for mental health disorders (n=356; 28.2%) than for any other single category of illnesses or injuries (Table 1). In addition, the numbers of evacuations for non-battle injuries and poisonings (n=309; 24.5%); signs, symptoms, and ill-defined conditions (n=142; 11.2%); musculoskeletal system disorders (n=116; 9.2%); and disorders of the digestive system (n=91; 7.2%) were all higher than the number of evacuations for battle injuries (n=56; 4.4%). The top 3 categories—mental health disorders (most frequently adjustment and depressive disorders); non-battle injuries (primarily fractures of extremities, strains, and sprains); and signs, symptoms, and ill-defined conditions (primarily pain and swelling)—accounted for more than half (63.8%) of all evacuations (Table 1).

During 2014–2018, the annual number of medical evacuations attributable to battle injuries peaked in 2014 (n=126) then decreased in 2015 (n=35) and remained relatively low in 2016 (n=42) before increasing in 2017 (n=71) and decreasing again in 2018 (n=56) (data not shown). Over the 5-year period, the annual number of battle injury-related evacuations declined 55.6% from the peak year of 2014 through the most recent year, 2018. The annual number of medical evacuations attributable to non-battle injuries and diseases peaked in 2014 (n=1,807) and then decreased to relatively low levels in 2015 (n=1,050), 2016 (n=1,010), and 2017 (n=1,024) before increasing again in 2018 (n=1,208). In general, the annual numbers of medical evacuations over the course of the 5-year period varied in relation to the numbers of deployed service members, with the highest yearly count of medical evacuations occurring during the final year (2014) of Operation Enduring Freedom (OEF). The monthly numbers of medical evacuations decreased considerably in the later months of 2014 leading up to 1 January 2015, when U.S. Forces-Afghanistan formally ended OEF and began Operation Freedom’s Sentinel (OFS) (Figure).

Demographic and military characteristics

The number of medical evacuations in 2018 was higher among males (n=1,038) than females (n=226) (Table 1, 2). The most frequent causes of medical evacuations among male service members were mental health disorders (n=278; 26.8%); non-battle injury and poisoning (n=273; 26.3%); signs, symptoms, and ill-defined conditions (n=118; 11.4%); and musculoskeletal disorders (n=102; 9.8%) (Table 1). Among female service members, the most frequent causes of medical evacuations were mental health disorders (n=78; 34.5%); non-battle injury and poisoning (n=36; 15.9%); signs, symptoms, and ill-defined conditions (n=24; 10.6%); and genitourinary system disorders (n=19; 8.4%).

Compared to males, females had higher percentages of evacuations for about half of all illness and injury categories. Female service members had notably higher percentages of medical evacuations for mental health disorders and genitourinary system disorders compared to males (Table 1). In contrast, male service members had higher percentages of evacuation for injuries (both battle and non-battle related) and for musculoskeletal disorders. There were no medical evacuations of a female service member during 2018 for a battle injury.

Within the various demographic and military characteristics of those service members who were evacuated, the largest numbers and proportions of evacuees were among non-Hispanic white service members, those aged 20–24 years, members of the Army, junior and senior enlisted personnel, and those in repair/engineering occupations (Table 2).

Most medical evacuations (86.2%) were characterized as having routine precedence. The remainder had priority (11.3%) or urgent (2.5%) precedence. All but 25 (2.0%) of the medical evacuations were accomplished through military transport (Table 2).

Most frequent specific diagnoses

Among both males and females in 2018, “reaction to severe stress, and adjustment disorders” was the most frequent specific diagnosis (3-digit ICD-10 diagnosis code: F43) during initial medical encounters after evacuations (Table 3). The remaining 5 most common 3-digit diagnoses associated with evacuations of males were musculoskeletal disorders (“dorsalgia”), injuries (“fracture at wrist and hand level” and “dislocation and sprain of joints and ligaments of knee”), mental health disorders (“major depressive disorder, single episode”), and digestive system diseases (“inguinal hernia”) (Table 3).

Of the top 6 diagnoses most frequently associated with evacuations of female service members, 1 was a mental health disorder (“reaction to severe stress, and adjustment disorders”); 1 was a condition that primarily affects women (“unspecified lump in breast”); 2 were musculoskeletal disorders (“other joint disorder, not elsewhere classified” and “dorsalgia”); 1 was a sign, symptom, and ill-defined condition (“abdominal and pelvic pain”); and 1 was a potential health hazard related to socioeconomic and psychosocial circumstances (“problems related to employment and unemployment”) (Table 3).

Disposition

Of the 1,264 medical evacuations reported in 2018, a total of 451 (35.7%) resulted in inpatient encounters. More than two-thirds (69.0%) of all service members who were hospitalized after medical evacuations were discharged back to duty. About one-quarter (25.5%) of service members who were hospitalized after medical evacuations were transferred or discharged to other facilities (Table 4).

Return to duty dispositions were much more likely after hospitalizations for nonbattle injuries (65.1%) than for battle injuries (15.9%). The majority (81.8%) of battle injury-related hospitalizations and a little more than one-quarter (27.9%) of non-battle injury-related hospitalizations resulted in transfers/discharges to other facilities (Table 4).

Slightly more than two-thirds (n=813; 64.3%) of all medical evacuations reported resulted in outpatient encounters only. Of the service members who were treated exclusively in outpatient settings after evacuations, the majority (76.8%) were discharged back to duty without work/duty limitations, 18.5% were released with work/duty limitations, and less than 1% each were admitted/transferred to a civilian hospital, immediately referred, or discharged to “home sick” for recuperation. Service members treated as outpatients after battle injury-related evacuations were more likely to be released without limitations (n=12; 100.0%) than medical evacuees treated as outpatients for non-battle injuries (n=121; 54.3%) (Table 4).

EDITORIAL COMMENT

This report documented that only 4.4% of all medical evacuations during 2018 were associated with battle injuries. Counts of evacuations for battle injuries were considerably lower (55.6%) in 2018 than in 2014, which is likely a reflection of both the reduction in troop levels that took place during this period and the change in mission away from direct combat. Most evacuations in 2018 were attributed to mental health disorders, followed by non-battle injuries and poisonings; signs, symptoms, and ill-defined conditions; musculoskeletal disorders; and digestive system disorders. Evacuations during the 5-year surveillance period followed a similar but slightly different pattern, with mental health disorders being the most frequent, followed by non-battle injuries, musculoskeletal disorders, signs and symptoms, and digestive system syndromes. Of the major diagnostic categories for which there was more than 1 medical evacuation for both men and women, only percentages of evacuations for injuries (battle and non-battle) and musculoskeletal disorders were noticeably higher among males compared to females. As in previous years, the majority of service members who were evacuated were returned to normal duty status following their post-evacuation hospitalizations or outpatient encounters. However, only about one-third of those evacuated for battle injuries were returned to duty immediately after their initial healthcare encounters.

Overall, the changes in numbers of medical evacuations over the course of the surveillance period reflect the drawdown of U.S. troops from Afghanistan leading up to the end of OEF.9 As OFS began, U.S. troop withdrawal slowed and began to level off in 2015.9 The relatively low percentage of medical evacuations in 2018 suggests that most deployers were sufficiently healthy and ready for their deployments and received the medical care in theater necessary to complete their assignments without having to be evacuated. Moreover, the fact that very few medical evacuations were conducted for chronic conditions such as hematologic disorders and congenital anomalies supports the idea that most deployers were sufficiently healthy for deployment. However, deployed service members are not immune to such conditions. For example, there was 1 medical evacuation for congenital anomalies in 2018 that was due to an arteriovenous malformation of cerebral vessels (data not shown). Because congenital anomalies may not be identified and diagnosed until later in life,10 such diagnoses should not be ruled out.

The proportion of medical evacuations attributed to mental health disorders (28.2%) was slightly higher than the proportion reported in a recent MSMR analysis of medical evacuations in 2017 (23.6%)5 but considerably higher than the proportion (11.6%) reported in an earlier MSMR report examining evacuations from Iraq during a 9-year period between 2003 and 2011.1 However, that article also reported that during the last 4 years of the surveillance period (2008–2011), as the proportion of evacuations for battle injuries fell sharply, the proportions of evacuations for mental disorders increased dramatically for both males (peak of 20.9% in 2010) and females (peak of 26.6% in 2010). Although some studies have indicated improved access to mental health care in deployed settings, the results from the current analysis indicate that mental health diagnoses still represent the single most common basis for medical evacuations out of the CENTCOM AOR.11 This could be due, at least in part, to variations in the availability of mental health care in deployed settings. In these settings, the distribution of providers and clinics that deliver such services is uneven and varies according to factors such as the number of deployed personnel and the assessed needs of the particular unit.11 It is also likely that some service members with mental health diagnoses may be evacuated because their estimated recovery times are too long. In addition, although the number of mental healthcare providers in Afghanistan increased from 2005 through 2010, this number decreased after 2013 as part of the overall drawdown of U.S. troops from the region.11

Several important limitations should be considered when interpreting the results of this analysis. Because deployment data are no longer available in the DMSS, rates of medical evacuations per deployed person-time were not able to be calculated, precluding comparisons with recent MSMR analyses. In addition, direct comparisons of numbers and percentages of medical evacuations by cause, as between males and females, can be misleading; for example, such comparisons do not account for differences between the groups in other characteristics (e.g., age, grade, military occupation, locations, and activities while deployed) that are significant determinants of medical evacuation risk. Moreover, because data about the characteristics of the entire deployed population of service members were not available, it was not possible to determine if the members of demographic and military groups listed above were over- or underrepresented among the evacuees. Also, for this report, most causes of medical evacuations were estimated from primary (first-listed) diagnoses that were recorded during hospitalizations or initial outpatient encounters after evacuation. In some cases, clinical evaluations in fixed medical treatment facilities after medical evacuations may have ruled out serious conditions that were clinically suspected in the theater. For this analysis, the causes of such evacuations reflect diagnoses that were determined after evaluations outside of the theater rather than diagnoses—perhaps of severe disease—that were clinically suspected in the theater. To the extent that this occurred, the causes of some medical evacuations may seem surprisingly minor.

Overall, the results highlight the continued need to tailor force health protection policies, training, supplies, equipment, and practices based on characteristics of the deployed force (e.g., combat vs. support; male vs. female) and the nature of the military operations (e.g., combat vs. humanitarian assistance).

REFERENCES

1. Armed Forces Health Surveillance Center. Medical evacuations from Operation Iraqi Freedom/Operation New Dawn, active and reserve components, U.S. Armed Forces, 2003–2011. MSMR. 2012;19(2):18–21.

2. Armed Forces Health Surveillance Center. Surveillance snapshot: Medical evacuations from Operation Enduring Freedom (OEF), active and reserve components, U.S. Armed Forces, October 2001–December 2011. MSMR. 2012;19(2):22.

3. Armed Forces Health Surveillance Center. Medical evacuations from Afghanistan during Operation Enduring Freedom, active and reserve components, U.S. Armed Forces, 7 October 2001–31 December 2012. MSMR. 2013;20(6):2–8.

4. Armed Forces Health Surveillance Branch. Medical evacuations, active and reserve components, U.S. Armed Forces, 2013–2015. MSMR. 2017;24(2):15–21.

5. Armed Forces Health Surveillance Branch. Update: Medical evacuations, active and reserve components, U.S. Armed Forces, 2017. MSMR. 2018;25(7):17–22.

6. Garamone J. Dunford: U.S. Forces busy implementing defense strategy worldwide. DoD News. 28 August 2018. https://dod.defense.gov/News/Article/Article/1614521/dunford-us-forces-busy-implementing-defense-strategy-worldwide/. Accessed 11 March 2019.

7. Lead Inspector General for Overseas Contingency Operations. Operation Freedom’s Sentinel: Report to the United States Congress. https://media.defense.gov/2018/May/21/2001919976/-1/-1/1/FY2018_LIG_OCO_OFS2_MAR2018_3.PDF. Accessed 11 March 2019.

8. North Atlantic Treaty Organization. Resolute Support Mission (RSM): key facts and figures. https://www.nato.int/nato_static_fl2014/assets/pdf/pdf_2018_06/20180608_2018-06-RSM-placemat.pdf. Accessed 11 March 2019.

9. Defense Manpower Data Center. DoD personnel, workforce reports and publications. https://www.dmdc.osd.mil/appj/dwp/dwp_reports.jsp. Accessed 12 March 2019.

10. The Centers for Medicare and Medicaid Services and the National Center for Health Statistics. ICD-10-CM Official Guidelines for Coding and Reporting. FY 2018. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-CM-Coding-Guidelines.pdf. Accessed 12 March 2019.

11. United States Government Accountability Office. Report to Congressional Committees. Defense health care: DOD is meeting most mental health care access standards, but it needs a standard for follow-up appointments. April 2016. https://www.gao.gov/assets/680/676851.pdf. Accessed 12 March 2019.

Numbers of battle injury and disease vs. non-battle injury medical evacuations of U.S. service members, by month, 2014–2018

Numbers and percentages of medical encounters following medical evacuation from theater, by ICD-9/ICD-10 diagnostic cat-egory, U.S. Armed Forces, 2018

Numbers of medical encounters following medical evacuation, by demographic and military characteristics, U.S. Armed Forces, 2018

Most frequent 3-digit ICD-10 diagnoses from medical evacuations, by sex, U.S. Armed Forces, 2018

Dispositions after inpatient or outpatient encounters following medical evacuation, U.S. Armed Forces, 2018

You also may be interested in...

Ambulatory Visits, Active Component, U.S. Armed Forces, 2017

Infographic
5/23/2018
ACTIVE COMPONENT, U.S. ARMED FORCES, 2017  This report documents the frequencies, rates, trends, and characteristics of ambulatory healthcare visits of active component members of the U.S. Army, Navy, Air Force, and Marine Corps.

ACTIVE COMPONENT, U.S. ARMED FORCES, 2017 This report documents the frequencies, rates, trends, and characteristics of ambulatory healthcare visits of active component members of the U.S. Army, Navy, Air Force, and Marine Corps.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens, Attributable to Various Illnesses and Injuries, 2017

Infographic
5/23/2018
Absolute and Relative Morbidity Burdens, Attributable to Various Illnesses and Injuries, 2017

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report

Hospitalizations, Active Component, U.S. Armed Forces, 2017

Infographic
5/23/2018
This report documents the frequencies, rates, trends, and distributions of hospitalizations of active component members of the U.S. Army, Navy, Air Force, and Marine Corps during calendar year 2017.

This report documents the frequencies, rates, trends, and distributions of hospitalizations of active component members of the U.S. Army, Navy, Air Force, and Marine Corps during calendar year 2017.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Member, U.S. Armed Forces, 2017

Infographic
5/23/2018
Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Member, U.S. Armed Forces, 2017

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Heat Illness

Infographic
4/13/2018
Exertional, or exercise-associated, hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 milliequivalents/liter) that develops during or up to 24 hours following prolonged physical activity.

There were a total of 2,163 incident cases of heat illness among active component service members, including 464 cases of heat stroke and 1,699 cases of heat exhaustion.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Rhabdomyolysis

Infographic
4/13/2018
Rhabdomyolysis

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Hyponatremia

Infographic
4/13/2018
Exertional, or exercise-associated, hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 milliequivalents/liter) that develops during or up to 24 hours following prolonged physical activity.

Exertional, or exercise-associated, hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 milliequivalents/liter) that develops during or up to 24 hours following prolonged physical activity.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Cardiovascular Diseases

Infographic
4/4/2018
At the time of entry into military service, many members of the U.S. Armed Forces are young, physically active, and in good physical health. However, following entry, many service members develop or are discovered to have risk factors for cardiovascular disease (CVD). This report documents the incidence and prevalence of select risk factors for CVD among active component (AC) service members and provides estimates of the incidence rates of major categories of cardiovascular diseases themselves.

At the time of entry into military service, many members of the U.S. Armed Forces are young, physically active, and in good physical health. However, following entry, many service members develop or are discovered to have risk factors for cardiovascular disease (CVD). This report documents the incidence and prevalence of select risk factors for CVD among active component (AC) service members and provides estimates of the incidence rates of major categories of cardiovascular diseases themselves.

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report

Mental Health Problems

Infographic
4/4/2018
This report summarizes the numbers, natures, and rates of incident mental health disorder diagnoses as well as mental health problems among active component U.S. service members during 2007–2016.

This report summarizes the numbers, natures, and rates of incident mental health disorder diagnoses as well as mental health problems among active component U.S. service members during 2007–2016.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report

Surveillance for Vector-Borne Diseases, Active and Reserve Component Service Members, U.S. Armed Forces, 2010 – 2016

Infographic
2/14/2018
Within the U.S. Armed Forces considerable effort has been applied to the prevention and treatment of vector-borne diseases. A key component of that effort has been the surveillance of vector-borne diseases to inform the steps needed to identify where and when threats exist and to evaluate the impact of preventive measures. This report summarizes available health records information about the occurrence of vector-borne infectious diseases among members of the U.S. Armed Forces, during a recent 7-year surveillance period. For the 7-surveillance period, there were 1,436 confirmed cases of vector-borne diseases, 536 possible cases, and 8,667 suspected cases among service members of the active and reserve components. •	“Confirmed” case = confirmed reportable medical event. •	“Possible” case = hospitalization with a diagnosis for a vector-borne disease. •	“Suspected” case = either a non-confirmed reportable medical event or an outpatient medical encounter with a diagnosis of a vector-borne disease. Lyme disease (n=721) and malaria (n=346) were the most common diagnoses among confirmed and possible cases. •	In 2015, the annual numbers of confirmed case of Lyme disease were the fewest reported during the surveillance period. •	Diagnoses of Chikungunya (CHIK) and Zika (ZIKV) were elevated in the years following their respective entries into the Western Hemisphere: CHIK (2014 and 2015); ZIKV (2016). The available data reinforce the need for continued emphasis on the multidisciplinary preventive measures necessary to counter the ever-present threat of vector-borne disease. Access the full report in the February 2018 MSMR (Vol. 25, No. 2). Go to www.Health.mil/MSMR  Background graphic shows service member in the field and insects which spread vector borne diseases.

This infographic summarizes available health records information about the occurrence of vector-borne infectious diseases among members of the U.S. Armed Forces, during a recent 7-year surveillance period (2010 – 2016).

Recommended Content:

Health Readiness | Epidemiology and Analysis | Medical Surveillance Monthly Report | Preventing Mosquito-Borne Illnesses | Chikungunya | Malaria | Zika Virus

Malaria U.S. Armed Forces, 2017

Infographic
2/14/2018
Since 1999, the Medical Surveillance Monthly Report (MSMR) has published periodic updates on the incidence of malaria among U.S. service members. Malaria infection remains an important health threat to U.S. service members, who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. This update for 2017 describes the epidemiologic patterns of malaria incidence in active and reserve component service members of the U.S. Armed Forces. Findings •	A total of 32 service members were diagnosed with or reported to have malaria, which is the lowest number of cases in any given year during the 10-year surveillance period. •	Health records documented the performance of laboratory tests for malaria for 22 of the cases. The tests for 17 of the 22 were positive for malaria ( stick figure graphic visually depicts this information). •	In 2017, 75.0% (24 of 32) of malaria cases among U.S. service members were diagnosed during May – October (calendar graphic showing the months visually). •	Of the 32 malaria cases in 2017, more than 1/3 of the infections were considered to have been acquired in Africa. Two bar charts display the following information: •	Bar chart 1: Numbers of malaria cases by Plasmodium species and calendar year of diagnosis/report, active and reserve components, U.S. Armed Forces, 2008 – 2017  •	Bar chart 2: Annual numbers of cases of malaria associated with specific locations of acquisition, active and reserve components, U.S. Armed Forces, 2008 – 2017  The majority of U.S. military members diagnosed with malaria in 2017 were: •	Male (96.9%) •	Active component (81.3%) •	In the Army (75.0%) •	In their 20’s (56.3%) Access the full report in the February 2018 MSMR (Vol. 25 No. 2). Go to www.Health.mil/MSMR  Picture of a mosquito displays on the graphic.

This update for 2017 describes the epidemiologic patterns of malaria incidence in active and reserve component service members of the U.S. Armed Forces.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Epidemiology and Analysis | Medical Surveillance Monthly Report

Outbreak of Influenza and Rhinovirus co-circulation among unvaccinated recruits, U.S. Coast Guard Training Center Cape May, NJ, 24 July – 21 August 2016

Infographic
2/5/2018
On 29 July 2016, the U.S. Coast Guard Training Center Cape May (TCCM), NJ, identified an increase in febrile respiratory illness (FRI) among recruits who were unvaccinated against seasonal influenza as a result of the annual vaccine’s expiration. This report characterizes the outbreak and containment measures implemented at TCCM during the outbreak period. In 2016, respiratory infections affected more than 250,000 U.S. service members and comprised approximately 22% of medical encounters among military recruit populations – who are highly susceptible to respiratory infections. Seasonal influenza and rhinovirus are two of the leading respiratory pathogens. During the Surveillance Period: 115 recruits reported respiratory infection symptoms. Pie chart 1 shows the following data: •	41 (35.7%) suspected cases •	74 (64.3%) confirmed cases Among confirmed cases, lab specimens tested positive for: •	Influenza A 34 (45.9%) •	Rhinovirus 28 (37.8%) •	Influenza A and rhinovirus co-infection 11 (14.9%) •	Rhinovirus and adenovirus co-infection 1 (1.4%) Data above depicted in pie chart 2. •	24 July – 6 August, Influenza predominated •	7 August – 20 August, Rhinovirus predominated Although the outbreak significantly affected operations at TCCM, a timely and comprehensive response resulted in containment of the outbreak within 5 weeks. Key Factor for Outbreak Control •	Rapid detection through FRI sentinel surveillance •	Quick decision-making •	Streamlined response by using a single chain of command •	Rapid implementation of both nonpharmaceutical and pharmaceutical interventions Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

This report characterizes the outbreak and containment measures implemented at the U.S. Coast Guard Training Center Cape May (TCCM), New Jersey, during a July 24 – August 21, 2016 outbreak period.

Recommended Content:

Health Readiness | Medical Surveillance Monthly Report | Integrated Biosurveillance | Influenza Summary and Reports

Department of Defense Global, Laboratory-based Influenza Surveillance Program’s Influenza vaccine effectiveness estimates and surveillance trends, 2016 – 2017 Influenza Season

Infographic
2/5/2018
Each year, the Department of Defense (DoD) Global, Laboratory-based Influenza Surveillance Program performs surveillance for influenza among service members of the DoD and their dependent family members. In addition to routine surveillance, vaccine effectiveness (VE) studies are performed and results are shared with the Food and Drug Administration, Centers for Disease Control and Prevention, and the World Health Organization for vaccine evaluation. This report documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season VE results. The analysis was performed by the U.S. Air Force School of Aerospace Medicine Epidemiology Laboratory, and the DoD Influenza Surveillance Program staff at Wright-Patterson Air Force Base, OH. FINDINGS: A total of 5,555 specimens were tested from 84 locations: •	2,486 (44.7%) negative •	1,382 (24.9%) influenza A •	1,093 (19.7%) other respiratory pathogens •	443 (8.0%) influenza B •	151 (2.7%) co-infections The predominant influenza strain was A (H3N2), representing 73.8% of all circulating influenza. Pie chart displays this information. Graph showing the numbers and percentages of respiratory specimens positive for influenza viruses, and numbers of influenza viruses identified, by type, by surveillance week, Department of Defense healthcare beneficiaries, 2016 – 2017 influenza season displays. The vaccine effectiveness (VE) for this season was slightly lower than for the 2015 – 2016 season, which had a 63% (95% confidence interval: 53% - 71%) adjusted VE. The adjusted VE for the 2016 – 2017 season was 48% protective against all types of influenza.  Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

This infographic documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season vaccine effectiveness.

Recommended Content:

Health Readiness | Influenza Summary and Reports | Medical Surveillance Monthly Report | Vaccine-Preventable Diseases | Force Health Protection | Global Health Engagement

Insomnia and motor vehicle accident-related injuries, Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
Insomnia is the most common sleep disorder in adults and its incidence in the U.S. Armed Forces is increasing. A potential consequence of inadequate sleep is increased risk of motor vehicle accidents (MVAs). MVAs are the leading cause of peacetime deaths and a major cause of non-fatal injuries in the U.S. military members. To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia. After adjustment for multiple covariates, during 2007 – 2016, active component service members with insomnia had more than double the rate of MVA-related injuries, compared to service members without insomnia. Findings:  •	Line graph shows the annual rates of motor vehicle accident-related injuries, active component service members with and without diagnoses of insomnia, U.S. Armed Forces, 2007 – 2016  •	Annual rates of MVA-related injuries were highest in the insomnia cohort in 2007 and 2008, and lowest in 2016 •	There were 5,587 cases of MVA-related injuries in the two cohorts during the surveillance period. •	Pie chart displays the following data: 1,738 (31.1%) in the unexposed cohort and 3,849 (68.9%) in the insomnia cohort The highest overall crude rates of MVA-related injuries were seen in service members who were: •	Less than 25 years old •	Junior enlisted rank/grade •	Armor/transport occupation •	 •	With a history of mental health diagnosis •	With a history of alcohol-related disorders Access the full report in the December 2017 (Vol. 24, No. 12). Go to www.Health.mil/MSMR Image displays a motor vehicle accident.

To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia.

Recommended Content:

Armed Forces Health Surveillance Branch | Health Readiness | Medical Surveillance Monthly Report

Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD.

Recommended Content:

Health Readiness | Posttraumatic Stress Disorder | Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report
<< < 1 2 3 4 > >> 
Showing results 46 - 60 Page 4 of 4

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.