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Technical Documents and References

Communicable Diseases


Rudiger, C., Nowak G.(2016) Malaria Trends in the Navy and Marine Corps, 2005–2013. Mil Med, 181, 5 488-493

http://militarymedicine.amsus.org/doi/abs/10.7205/MILMED-D-15-00174

Abstact: U.S. Sailors and Marines routinely deploy to regions where malaria is endemic, such as Africa and Asia. This report describes the trends, demographic characteristics, and exposure type and location for active duty Navy and Marine Corps malaria cases from January 2005 to December 2013. Electronic clinical records for laboratory results and hospitalizations, as well as reported medical events, for malaria were used to identify cases. There were 112 malaria cases identified among Navy and Marine Corps service members during the study time frame. Most cases were associated with travel to Africa (58.9%) and were duty related (60.7%); however, one-fourth of cases were associated with personal travel. The majority of cases exposed while on personal travel were foreign born (74.2%). This comprehensive assessment of trends and burden of malaria among Sailors and Marines is essential to ensure mission readiness and the management and evaluation of malaria control programs. Further analysis may be warranted to explore the relationship between personal travel and foreign-born status in the Department of the Navy to determine potential for additional intervention and education.


Rossi, K., Nowak, G., Riegodedios, AJ. (2017) Pneumonia at Marine Corps Recruit Depots: Current Trends in Ambulatory Encounters and Inpatient Discharges. Mil Med, 182 (3): e1733-1740

http://militarymedicine.amsus.org/doi/full/10.7205/MILMED-D-16-00034

Abstract: Acute respiratory infections are recognized as a significant source of morbidity for military populations, particularly for recruits. This analysis aims to describe the pneumonia burden at Marine Corps Recruit Depots (MCRD) in Parris Island and San Diego during 2007-2014, as these two depots maintain noteworthy comparisons in vaccine and prophylaxis policies. First, both depots reinstated the adenovirus vaccine in October 2011. Second, San Diego provides the pneumococcal polysaccharide vaccine to all recruits within the first 2 days of arrival, although Parris Island does not routinely vaccinate for Streptococcus pneumoniae. Third, recruits at San Diego routinely receive three doses of penicillin G benzathine for group A Streptococcus bacterium prophylaxis, although those at Parris Island receive one dose year-round and a second dose during the winter months when group A Streptococcus bacterium burden is expected to increase. Monthly pneumonia rates were estimated using diagnostic codes from ambulatory encounters and inpatient discharge records, and specific causative organisms were assessed using code extenders within the International Classification of Diseases, Ninth Revision. Regression analyses and Spearman's correlation rank tests were used to describe significant trends and the relationship between ambulatory and inpatient rates at each depot. Although our results indicate the majority of ambulatory encounters and inpatient discharges are attributed to unspecified pneumonia diagnostic codes at both locations, these data still lend noteworthy trends. At both locations, linear trends in ambulatory pneumonia rates significantly declined over the 8-year period, whereas inpatient rates demonstrated less variability and did not significantly decline. Both depots experienced prolonged, heightened pneumonia trends from early 2009-2010, a period which included the global influenza pandemic. Following reimplementation of the adenovirus vaccine during October 2011, the average ambulatory rates at MCRD San Diego (38.02 per 1,000 recruit-months vs. 65.59 per 1,000 recruit-months) and MCRD Parris Island (10.9 per 1,000 recruit-months vs. 22.8 per 1,000 recruit-months) were approximately half the average rate before utilization of the adenovirus vaccine. At MCRD San Diego, a weak correlation between monthly inpatient and ambulatory pneumonia rates suggests that trends for potentially severe pneumonia do not follow those for generalized disease (rs = 0.43; p < 0.05), whereas correlation results at MCRD Parris Island indicate these monthly trends are positively associated (rs = 0.71; p < 0.05). These observations underscore the evidence that pneumonia burden among military recruits is not associated with one single etiology. Recruits are at risk for a range of etiologic agents, and control measures should include a combination of specific medical countermeasures that focus on a single bacterial or viral disease as well as nonmedical public health measures that reduce the overall burden of circulating infectious respiratory agents. The trends described in this report, coupled with the similarities and dissimilarities for public health prevention practices at each depot, may warrant further investigation for a systematic review of social and environmental factors within recruit populations at these two locations.


Tourdot, L. E., Jordan, N. N., Leamer, N. K., Nowak, G., & Gaydos, J. C. (2016). Incidence of Chlamydia trachomatis Infections and Screening Compliance, U.S. Army Active Duty Females Under 25 Years of Age, 2011–2014. Medical Surveillance Monthly Report, 23(2), 29-31.

https://www.afhsc.mil/documents/pubs/msmrs/2016/v23_n02.pdf#Page=29

Abstract: Reported chlamydia infection rates among active duty U.S. Army females less than 25 years old declined by 20% from 2011 to 2014 (11,028 infections per 100,000 person-years [p-yrs] to 8,793 infections per 100,000 p-yrs, respectively). An overall decline in the proportions of high-risk female soldiers tested for chlamydia occurred during the same period, declining from a high of 85% in 2011 to a low of 71% in 2012, with an increase to 80% in 2014. Chlamydia laboratory testing volume also decreased from 2011 to 2013 but the test positivity rate remained stable at 6.0%-6.4%. By using projected incidence rates based on 100% of at-risk women being screened with a stable laboratory positivity rate, there was an estimated 15% decline in chlamydia incidence from 2011 to 2014 (12,794 to 10,991 infections per 100,000 p-yrs, respectively). Surveillance for chlamydia infections must include consideration of screening program performance in addition to passive reporting.


Jordan, N. N., Lee, S., Nowak, G., Johns, N. M., & Gaydos, J. C. (2011, March). Chlamydia trachomatis Reported Among U.S. Active. MILITARY MEDICINE , 176, 312. Portsmouth: Navy and Marine Corps Public Health Center.

http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-10-00212

Abstract: Objectives: To review reported chlamydia infection trends in the U.S. military and identify reasons for differences. Methods: Defense Medical Surveillance System 2000–2008 reports for nondeployed, active duty members were studied. Incidence, rate ratios, and confidence intervals were generated. Age- and gender-specific rates were compared with US national rates. Screening and reporting policies and procedures were reviewed. Results: Overall incidence was 922 cases per 100,000 person-years, with considerable service variability (392–1,431 cases per 100,000 person-years in the Navy and Army, respectively). Navy-Marine Corps rates increased more than 2 fold in 2008. Rates were higher among women, minorities, and members under 25 years. Military rates exceeded national rates. Conclusions: The 2008 increase in Navy-Marine Corps rates may be due to the implementation of web-based reporting. Demographic differences were consistent with published reports. The civilian–military disparity may reflect higher percentages of military at-risk women screened.