Heat exhaustion and heat stroke among active component members of the U.S. Armed Forces, 2019-2023.

The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military's training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. In 2023, higher rates of heat stroke were observed among male service members compared to their female counterparts, and female service members experienced higher rates of heat exhaustion compared to male personnel. Heat illness rates were also higher among those younger than age 20, Marine Corps and Army service members, non-Hispanic Black service members, and recruits. Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions.

Surveillance of spotted fever rickettsioses at Army installations in the U.S. Central and Atlantic regions, 2012-2018.

Spotted fever rickettsioses (SFR) are emerging in the Atlantic and Central regions of the U.S., though cases have been reported across the contiguous U.S. Military populations may be at increased risk for SFR because of residence in these regions and frequent field training in tick habitats. Surveillance for Rocky Mountain spotted fever in the Army began in 1998 and was expanded to include all SFR in 2017. Between 2016 and 2017, the rate of active component cases reported from Army installations in the Atlantic and Central regions of the U.S. increased nearly five-fold from 2016 (0.55 per 100,000 person-years [p-yrs]) to 2017 (2.65 per 100,000 p-yrs). The majority of SFR cases were reported from Fort Leonard Wood, MO, and Fort Bragg, NC. Most reported cases had no documented symptoms consistent with SFR and could not be confirmed as "cases" by standard case-defining methods. SFR surveillance and control efforts in military populations can be improved by better adherence to guidelines for SFR diagnosis and through the use of available advanced laboratory techniques.