Community incidence patterns drive the risk of SARS-CoV-2 outbreaks and alter intervention impacts in a high-risk institutional setting.

Optimization of control measures for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in high-risk institutional settings (e.g., prisons, nursing homes, or military bases) depends on how transmission dynamics in the broader community influence outbreak risk locally. We calibrated an individual-based transmission model of a military training camp to the number of RT-PCR positive trainees throughout 2020 and 2021. The predicted number of infected new arrivals closely followed adjusted national incidence and increased early outbreak risk after accounting for vaccination coverage, masking compliance, and virus variants. Outbreak size was strongly correlated with the predicted number of off-base infections among staff during training camp. In addition, off-base infections reduced the impact of arrival screening and masking, while the number of infectious trainees upon arrival reduced the impact of vaccination and staff testing. Our results highlight the importance of outside incidence patterns for modulating risk and the optimal mixture of control measures in institutional settings.

Fatigue and related comorbidities, active component, U.S. Armed Forces, 2007-2016.

Fatigue is a common complaint in the civilian population and may be a presenting symptom of more serious physical and mental disorders. Data from the Defense Medical Surveillance System (DMSS) were utilized to characterize the incidence and burden of fatigue in active component military members from 1 January 2007 through 31 December 2016. A subanalysis of 3 years within this surveillance period (2012-2014) was also conducted to assess the burden of comorbidities related to incident fatigue and the strength of the association between fatigue and selected comorbidities. The study identified 211,213 incident cases of fatigue with an overall incidence rate of 18.1 per 1,000 person-years between 2007 and 2016. Mental disorders and musculoskeletal disease accounted for about 35% of all medical encounters and about 40% of all hospital days within a year for those diagnosed with fatigue in 2013. The adjusted odds ratio for fatigue was highest in those with male hypogonadism, thyroid disorder, and sleep problems. These results show that fatigue is a common diagnosis with high incidence and burden among active component U.S. military. By focusing on the conditions that frequently occur and are highly associated with fatigue, more rapid diagnosis and treatment of the underlying cause of service member fatigue is possible.