Skip to main content

Military Health System

Influenza Outbreak During Exercise Talisman Sabre, Queensland, Australia, July 2019

Image of Flight Lt. Michael Campion, an aviation medical officer from No. 3 Aeromedical Evacuation Squadron prepares a medical patient leaving Exercise Talisman Sabre to be transferred to a C-27J Spartan aircraft July 18, 2019 at Rockhampton Airport. No. 3 Aeromedical Evacuation Squadron is providing medical support to troops participating in Talisman Sabre 2019, a bilateral combined Australian and United States exercise designed to train respective military services in planning and conducting Combined and Joint Task Force operations, and improve the combat readiness and interoperability between Australian and US forces. (U.S. Army photo by Sgt. 1st Class John Etheridge). Flight Lt. Michael Campion, an aviation medical officer from No. 3 Aeromedical Evacuation Squadron prepares a medical patient leaving Exercise Talisman Sabre to be transferred to a C-27J Spartan aircraft July 18, 2019 at Rockhampton Airport. No. 3 Aeromedical Evacuation Squadron is providing medical support to troops participating in Talisman Sabre 2019, a bilateral combined Australian and United States exercise designed to train respective military services in planning and conducting Combined and Joint Task Force operations, and improve the combat readiness and interoperability between Australian and US forces. (U.S. Army photo by Sgt. 1st Class John Etheridge)

Recommended Content:

Medical Surveillance Monthly Report

What are the New Findings?

Influenza remains a threat during military exercises even in highly immunized populations mainly because of the virus's ability to cause illness in large numbers of soldiers which can overload an austere medical system designed mainly to care for traumatic injuries. Use of low-intensity clinical isolation areas is one means of limiting influenza's impact on major exercises scheduled during expected influenza transmission seasons.

What is the Impact on Readiness and Force Health Protection?

Immunization remains the primary force health protection measure for military exercises, but exercises that extend into the Southern Hemisphere may result in the inability to use the most appropriate hemispheric vaccine because of restricted access to products not manufactured for the domestic U.S. market.

Abstract

Influenza appeared in Queensland, Australia during Exercise Talisman Sabre (TS-19) in July 2019 with an early focus within the New Zealand Defence Force members arriving in Australia aboard HMNZS Canterbury. A total of 76 cases of influenza-like illness (ILI) were reported, of which 43 were confirmed by rapid diagnostic tests to be influenza A (n=32) and B (n=11). Australia’s influenza season (starting in March, peaked in July 2019) exposed large numbers of military members to a virus for which they had been suboptimally immunized either because of low uptake of the Southern Hemisphere vaccine by Australians/New Zealanders who were not mandated to be immunized, or because U.S. soldiers had received only the Northern Hemisphere vaccine for the 2018–2019 season. A low-intensity clinical unit separate from the main exercise was used as a means of isolating ILI cases both to facilitate their treatment and limit disease spread. Despite disease rates of <1%, influenza still had a major impact on TS-19 mostly in terms of the considerable medical resources required to manage ILI.

Background

Joint and combined military exercises concentrate large numbers of military members under circumstances that favor introduction of new viruses into stressed populations. Currently, the risk influenza poses to military exercises is not mass mortality but mass casualties that could overwhelm the usually limited medical support capabilities designed mainly to treat traumatic injuries during field exercises. This report summarizes an influenza epidemic that occurred within a combined military exercise, Talisman Sabre (TS-19), which took place in Queensland, Australia during July–August 2019.

Talisman Sabre is a long-running series of military exercises in which more than 32,000 soldiers, sailors, and marines mainly from Australia, New Zealand, and the U.S. gather in Queensland in northeastern Australia at mid-year for a 3-week field exercise. Although each national contingent operates under its own command chain, there is considerable intermixing of forces. Southern Hemisphere influenza transmission season occurs at midyear with a usual peak in August/September.

In 2009, when the influenza A(H1N1) virus's potential was not yet known, advanced diagnostic capability was deployed into the field during Talisman Sabre and enabled the detection of 12 persons with the pandemic influenza strain.1 Fortunately the pathogenic potential of the 2009 influenza A(H1N1) strain was inferior to its distant predecessor of 1918, and there was no serious disruption of the exercise although some naval units were removed from participation when influenza appeared shipboard.

Immunization remains the primary force health protection measure against influenza, although protection may be suboptimal depending on the degree to which the vaccine strains chosen for production match the viruses that eventually circulate. Although U.S. forces have high immunization participation rates because influenza vaccination is mandatory, they are immunized with vaccine tailored for the Northern Hemisphere and have usually been immunized more than 6 months prior to TS-19. While influenza immunization of Australian and New Zealand soldiers is strongly encouraged, it is not mandatory for exercise participation, and immunization rates are usually less than ideal.

Additional concerns regarding influenza during TS-19 were generated by the early start to the influenza season in March 2019 in Australia. The start of this season was dominated by influenza A(H3N2) viruses reminiscent of the relatively severe 2017 season (the so-called "Aussie flu").2 The U.S. Indo-Pacific Command (INDOPACOM) Surgeon's office had investigated the possibility of using the Southern Hemisphere influenza vaccine for U.S. forces during port visits of USS Carl Vinson to Sydney in June 2019, but timing and supply issues made such use of the vaccine impractical.

Methods

As the largest scheduled series of military exercises in Australia, the biennial TS-19 involved a great deal of preliminary healthcare planning which began during planning conferences in Hawaii in October 2018 and March 2019. Influenza was an identified medical threat subject to usual precautions and immunization. Deployed forces were supported by a Role 1 clinic (basic ambulatory care) at Rockhampton, a holding/isolation ward at Williamson Airfield, and a Role 2+ (enhanced care) facility from the 2nd General Health Battalion at Shoalwater Bay, as well as on-board medical capability from USS Wasp, HMAS Canberra, and HMAS Adelaide. Disease surveillance systems were instituted upon buildup to the official start of the exercise on 17 June 2019.

Influenza-like illness (ILI) was defined as an illness marked by fever greater than 100 °F with either cough or sore throat in the absence of a known cause other than influenza. Influenza testing was performed on nasal swabs using a rapid detection test, the Quidel QuickVue Influenza A+B test. All influenza-positive samples were then confirmed via polymerase chain reaction testing on the Biofire FilmArray using the Respiratory Panel 2 plus by the pathology department at the Role 2+ facility.

Results

ILI cases initially appeared among the New Zealand Defence Force (NZDF) contingent, which had arrived largely aboard the HMNZS Canterbury on or about 7 July 2019 after a 3-day transit from Auckland. Investigation of the ship's berthing arrangements indicated person-to-person spread of ILI in up to 12 cases while shipboard. The major concern was that the occurrence of several cases of influenza early in the exercise foreshadowed a much larger problem that would arise later when many more soldiers were involved under austere field conditions. A communicable disease plan was revised and instituted in early July 2019. The emphasis was on rapid identification of ILI cases and patient management in Rockhampton away from the main body of troops, which represented more an isolation effort than a quarantine effort. A 20-bed low-intensity clinical facility was set up (with contingency plans for another 20 beds if required) and largely staffed by Australian Defence Force (ADF) reserve component members. Patients did not require inpatient care but could not be left in an austere field environment with ILI symptoms. Oseltamivir was provided for treatment and to reduce infectiousness among those found to be rapid diagnostic test-positive for the influenza virus.

From 17 June 2019 through 27 July 2019, 254 sick call visits were recorded at the various medical treatment units and 76 patients were diagnosed with ILI on clinical grounds. Of the 76 ILI cases that were identified, 32 (42.1%) tested positive for influenza A and 11 (14.5%) for influenza B. These illnesses represented a substantial proportion of all sick call visits during TS-19 as shown in Figure 1. The remaining 33 tests (43.4%) were negative for influenza virus. National contingent composition is shown in Figure 2 and illustrates the early predominance of cases of influenza among NZDF members aboard Her Majesty's New Zealand Ship (HMNZS) Canterbury. No other shipboard outbreaks were noted. Confirmed influenza cases peaked at 10 per day on 12 July 2019 before the formal start of the exercise (data not shown).

Editorial Comment

Respiratory infections have long been known as threats to military operations and many modern exercises have been disrupted by viruses including influenza.3-4 TS-19 was not unique in this regard, but its location in Australia presented additional challenges. The exercise occurred during the peak of influenza season in the Southern Hemisphere, and the early phase of the outbreak placed particular focus on a naval ship. In addition, there was the possibility that influenza cases would affect a range of national groups (U.S., Australia, New Zealand, Canada, UK, Japan) each employing different approaches to addressing influenza. Rapid diagnostics have evolved to become important tools in the management of ILI; now it is possible to quickly determine whether the causative pathogen is influenza and then manage the public health consequences of a virus with such epidemic potential. For TS-19, a special isolation facility was set up, not because otherwise healthy soldiers were thought to be at risk of life-threatening disease, but rather because of the likelihood that the limited medical capability of usual field medical facilities would otherwise be overwhelmed by sick soldiers. During military exercises in a soldier population which has already been immunized, the remaining option in managing an influenza outbreak consists of isolating ILI cases from uninfected troops who are receiving prophylactic antiviral treatment. Isolation of cases within a health facility away from troops under antiviral treatment is the best way to minimize generalized spread in the population which should have already been immunized. The civilian healthcare system of Queensland was extremely supportive of military medical efforts during TS-19, but it could not be expected to house multiple influenza cases that did not otherwise require hospitalization. The low-intensity clinical facility in Rockhampton was a pragmatic response that worked well to optimize treatment and likely minimized the total number of ILI cases.

Influenza during joint and combined military exercises often is seen as particularly important to Air Forces because responding to the virus may require suspension of flight operations, but naval operations are also vulnerable to influenza. As demonstrated during a 1996 outbreak on the USS Arkansas, even highly vaccinated crews may be subject to high attack rates (42%) which may result in aborted exercises if single individuals with influenza A(H3N2) viruses poorly matched to seasonal influenza vaccine infect the ship's crew.5 The situation was never so dire on HMNZS Canterbury, but it did serve as a focus of initial influenza cases that could have infected a much larger number of soldiers in the absence of an effective communicable disease plan.

Influenza immunization is far from perfect, but there is hope that universal influenza vaccines may eventually be developed that will end the evolutionary arms race conducted each year using seasonal vaccines that are at best modestly effective.6 The particular problem experienced during TS-19 was that the Southern Hemisphere influenza A(H3N2) 2019 vaccine component (A/Switzerland/8060/2017) was an updated version of what the U.S. forces had been immunized against (A/Singapore/INFIMH-16-0019/2016) which used the Northern Hemisphere 2018–2019 vaccine.7 Whether this would have made a difference was unknown, but valid concerns had been raised because during the relatively severe 2017 Australian season the influenza A(H3N2) component's vaccine efficacy was estimated to be 10% (95% confidence interval: -16%–31%).6 Although adequate Southern Hemisphere 2019 vaccine was available, it was not approved by the U.S. Food and Drug Administration as there was no motivation for a manufacturer to register a vaccine not intended for U.S. use. Stringent regulatory authority approval by the Australian Therapeutic Goods Administration existed but was bureaucratically insufficient for use in U.S. forces. Further inquiry regarding exceptions to policy might be useful in improving management of influenza immunization for soldiers outside their usual jurisdiction. Such exceptions may prove important as future influenza pandemics are unlikely to provide sufficient time for preparation of stocks of new vaccines, as was demonstrated during 2009 when vaccine became available only after the peak of the pandemic.

Author Affiliations: Headquarters, Joint Operations Command. Bungendore, NSW, Australia (MAJ van Ash, COL Nasveld); 2nd General Health Battalion, Gallipoli Barracks, Enoggera, QLD, Australia (CAPT Zahra); Australian Defence Force Malaria and Infectious Diseases Institute, Enoggera, QLD, Australia (Dr. Shanks).

Acknowledgements: The authors thank the many military medical personnel from Australia, New Zealand, and the U.S. who helped manage the ill service members during Exercise Talisman Sabre 2019.

Disclaimer: The opinions expressed are those of the authors and do not necessarily reflect those of the Australian Defence Force or the U.S. Department of Defense. Conflicts of interest: The authors do not claim any conflict of interest.

Funding: Authors are employees of the Australian Defence Organization. No specific funding was given for this epidemiological study.

References

1. Inglis TJ, Merritt AJ, Levy A, et al. Deployable laboratory response to influenza pandemic; PCR assay field trials and comparison with reference methods. PloS One. 2011;6(10):e25526.

2. Australian Government Department of Health. Australian Influenza Surveillance Report No. 12– 23 September-6 October 2019. Canberra, Australia: Department of Health; 2019.

3. Shanks GD, Hodge J. The ability of seasonal and pandemic influenza to disrupt military operations. J Mil Veterans Hlth. 2011;19(4):13–18.

4. Sanchez JL, Cooper MJ, Myers CA, et al. Respiratory infections in the US military: recent experience and control. Clin Micro Rev. 2015;28(3):743–800.

5. Earhart KC, Beadle C, Miller LK, et al. Outbreak of influenza in highly vaccinated crew of U.S. Navy ship. Emerg Infect Dis. 2001 May- Jun;7(3):463–465.

6. Coleman R, Eick-Cost A, Hawksworth AW, et al. Department of Defense end-of-season influenza vaccine effectiveness estimates for the 2017–2018 season. MSMR. 2018;25:16–20.

7. CDC. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices— United States, 2018–19 influenza season. MMWR. 2018;67(3):1–20.

FIGURE 1. Epidemic curve of ILIa during Exercise Talisman Sabre, Queensland, Australia, 27 June–27 July 2019

FIGURE 2. ILIa during Exercise Talisman Sabre, by national group, Queensland, Australia, 4 July–26 July 2019

You also may be interested in...

MSMR Vol. 29 No. 09 - September 2022

Report
9/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

MSMR Vol. 29 No. 08 - August 2022

Report
8/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Medical Surveillance Monthly Report

Musculoskeletal Injuries During U.S. Air Force Special Warfare Training Assessment and Selection, Fiscal Years 2019–2021.

Article
8/1/2022
U.S. Air Force Capt. Hopkins, 351st Special Warfare Training Squadron, Instructor Flight commander and Chief Combat Rescue Officer (CRO) instructor, conducts a military free fall equipment jump from a DHC-4 Caribou aircraft in Coolidge, Arizona, July 17, 2021. Hopkins is recognized as the 2020 USAF Special Warfare Instructor Company Grade Officer of the Year for his outstanding achievement from January 1 to December 31, 2020.

Musculoskeletal (MSK) injuries are costly and the leading cause of medical visits and disability in the U.S. military.1,2 Within training envi­ronments, MSK injuries may lead to a loss of training, deferment to a future class, or voluntary disenrollment from a training pipeline, all of which are impediments to maintaining full levels of manpower and resources for the Department of Defense.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Pain and Post-Traumatic Stress Disorder Screening Outcomes Among Military Personnel Injured During Combat Deployment.

Article
8/1/2022
U.S. Air Force Airman 1st Class Miranda Lugo, right, 18th Operational Medical Readiness Squadron mental health technician and Guardian Wingman trainer, and Maj. Joanna Ho, left, 18th OMRS director of psychological health, discuss the suicide prevention training program, Guardian Wingman, at Kadena Air Base, Japan, Aug. 20, 2021. Guardian Wingman aims to promote wingman culture and early help-seeking behavior. (U.S. Air Force photo by Airman 1st Class Anna Nolte)

The post-9/11 U.S. military conflicts in Iraq and Afghanistan lasted over a decade and yielded the most combat casualties since the Vietnam War. While patient survivability increased to the high­est level in history, a changing epidemiology of combat injuries emerged whereby focus shifted to addressing an array of long-term sequelae, including physical, psychologi­cal, and neurological issues.

Recommended Content:

Medical Surveillance Monthly Report

Prevalence and Distribution of Refractive Errors Among Members of the U.S. Armed Forces and the U.S. Coast Guard, 2019.

Article
8/1/2022
Ophthamologist Air Force Maj. Thuy Tran evaluates a patient during an eye exam. (U.S. Air Force photo by Tech. Sgt. John Hughel)

During calendar year 2019, the estimated prevalence of myopia, hyperopia, and astigmatism were 17.5%, 2.1%, and 11.2% in the active component of the U.S. Armed Forces and 10.1%, 1.2%, and 6.1% of the U.S. Coast Guard, respectively.

Recommended Content:

Medical Surveillance Monthly Report

MSMR Vol. 29 No. 07 - July 2022

Report
7/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

Establishment of SARS-CoV-2 Genomic Surveillance Within the Military Health System During 1 March–31 December 2020.

Article
7/1/2022
Dr. Peter Larson loads an Oxford Nanopore MinION sequencer in support of COVID-19 sequencing assay development at the U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland. (Photo by John Braun Jr., USAMRIID.)

This report describes SARS-CoV-2 genomic surveillance conducted by the Department of Defense (DOD) Global Emerging Infections Surveillance Branch and the Next-Generation Sequencing and Bioinformatics Consortium (NGSBC) in response to the COVID-19 pandemic. Samples and sequence data were from SARS-CoV-2 infections occurring among Military Health System (MHS) beneficiaries from 1 March to 31 December 2020.

Recommended Content:

Medical Surveillance Monthly Report

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.

Recommended Content:

Medical Surveillance Monthly Report

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

Article
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.

Recommended Content:

Medical Surveillance Monthly Report

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

Article
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.

Recommended Content:

Medical Surveillance Monthly Report

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

Article
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.

Recommended Content:

Medical Surveillance Monthly Report

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.

Recommended Content:

Medical Surveillance Monthly Report

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

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

Recommended Content:

Medical Surveillance Monthly Report

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

Article
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.

Recommended Content:

Medical Surveillance Monthly Report

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

Article
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.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 13
Refine your search
Last Updated: December 13, 2021
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery