Workplace Determinants of Depression, Anxiety, and Stress in U.S. Mariners during the COVID-19 Pandemic.

United States (U.S.) mariners continued sailing throughout COVID-19. Many aspects of their work could make them prone to adverse mental health outcomes but research on workplace determinants of their mental health during COVID-19 is limited. Between January and July 2021 an online survey assessed the outcomes of increased depressive symptoms, increased anxiety symptoms, and increased perceived stress in addition to concerns, worries, and experiences when sailing during COVID-19, job satisfaction, and safety climate in n = 1384 U.S. mariners. Demographic measures were also collected. Logistic regression models (for depression and anxiety) and a linear regression model (for stress) were developed. We found that increased COVID-19 concerns and poor self-reported mental health were related to increased odds of likely depression and anxiety and higher stress. Mariners who experienced more adverse experiences aboard a vessel had increased stress and increased odds of depression. Poor sleep quality was also related to increased odds of depression, and poor vessel support/safety culture was related to higher stress. Differences in outcomes were seen by vessel type, age, and credential in regression analyses. Results from this study will help to prioritize interventions to minimize the mental health impacts of COVID-19, and influence evidence-based recommendations to improve the mental health of mariners going forward.

Monkeypox in Patient Immunized with ACAM2000 Smallpox Vaccine During 2022 Outbreak.

We report a case of monkeypox in the United States in a patient who had been vaccinated with ACAM2000 smallpox vaccine 8 years earlier. Despite his vaccination status, he still contracted disease. He showed prodromal symptoms preceding development of painless penile lesions that later coalesced.

Description of a COVID-19 Beta variant outbreak, Joint Base Lewis-McChord, WA, February-March 2021.

An outbreak of SARS CoV-2 infection occurred in an infantry battalion from Joint Base Lewis-McChord following participation in a field training exercise in the vicinity of Yakima, WA in February of 2021. Extreme weather during the exercise disrupted planned COVID-19 mitigation measures and caused 110 soldiers to be sheltered in a small aircraft hangar for several nights. The probable index case reported to sick call with symptoms compatible with COVID-19, but the soldier was not diagnosed with COVID-19, was returned to duty, and was allowed to remain in the enclosed hangar for 3 additional days. In total, 143 individuals with epidemiologic ties to the field training exercise tested positive for SARS-CoV-2 during the outbreak. Nine samples sent for sequencing were determined to be the SARS-CoV-2 Beta variant. This report illustrates important lessons learned whose implementation in the future will enable better protection of service members from COVID-19 and similar health risks associated with training.

COVID-19 Antibody Prevalence From July to September 2020: One Army Infantry Brigade's Experience.

OBJECTIVES: Lab companies developed serology tests for antibody detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with United States Food and Drug Administration (FDA) emergency use authorization. Antibody detection uses purified proteins of SARS-CoV-2 to determine antibody binding via enzyme-linked immunosorbent assay, chemiluminescent immunoassay (CLIA), or colloidal gold-based immunochromatographic assay. With the advent of coronavirus disease 2019 (COVID-19), nucleic acid amplification technology (NAAT) SARS-CoV-2 testing for active infection was not widely available to healthy, active-duty Soldiers. The purpose of this surveillance survey was to determine the prevalence of prior SARS-CoV-2 infection and symptoms of COVID-19 within a mechanized infantry brigade. MATERIALS AND METHODS: Active-duty military Servicemembers (= 18 years) from a mechanized infantry brigade provided serum samples for testing for the Elecsys® Anti-SARS-CoV-2 qualitative antibody test from June to September 2020 at Joint Base Lewis McChord (JBLM). In addition, participants filled out a questionnaire for symptoms and exposure to COVID-19 from January to September 2020. The surveillance team collected and analyzed antibody testing results and questionnaires from participants for antibody positivity rates and symptom prevalence. RESULTS: A total of 264 participants were tested, with one (0.4%) participant testing positive for the SARS-CoV-2 antibody. On the questionnaire, 144 of 264 (54.5%) endorsed symptoms of COVID-19 from January to September 2020. The most common symptoms were headache (35%), rhinorrhea (34%), cough (35%), and sore throat (31%). A total of 31 respondents (12%) had been quarantined as a trace contact to a COVID-19 positive patient. CONCLUSIONS: While there are limitations inherent to SARS-CoV-2 antibody testing and the survey, prevalence of prior SARS-CoV-2 infection is low. In this sample, symptoms for COVID-19 were prevalent with significant days of duty lost. Prevalence of prior SARS-CoV-2 infection in this sample may be generalizable to the larger brigade. Prevalence of symptoms of possible COVID-19 are not generalizable to the larger brigade. There is utility to further studies of SARS-CoV-2 antibody prevalence in military populations for purposes of vaccination triaging and deployment readiness.

Risk Mitigation Strategies to Prevent Transmission of COVID-19 in the Military Classroom Setting: A Case of a Symptomatic SARS-CoV2 Positive Student without Apparent Spread to Classmates.

Since the onset of the COVID-19 pandemic in late 2019, the world community has responded with ever-evolving measures to reduce the spread of SARS CoV-2, the virus that causes COVID-19 (Coronavirus Disease 2019)1. One particular area of interest is understanding the risk of the in-person classroom setting and if any mitigation efforts are effective in preventing the spread of disease in that setting. In this paper, we present a case study of a US Army Advanced Individual Training (AIT) course/classroom wherein a student was diagnosed with COVID-19, and there was no apparent spread to others in his classroom. We discuss the mitigation efforts put in place that appear to be, in this case, effective in preventive onward spread of the virus. These are social distancing, face coverings/masks, and hygiene practices including hand washing and sanitation of surfaces.

A Retrospective Cohort Study of Blood Lead Levels Among Special Operations Forces Soldiers Exposed to Lead at a Firing Range in Germany.

This report describes the results of testing for blood lead levels (BLLs) among special operations forces at a single installation in Germany where occupational exposures to lead were associated with use of a firing range. After recognition of elevated BLLs in some service members who used the firing range, a detailed industrial hygiene confirmation of lead exposures prompted mitigation measures undertaken by command authorities, facilities management, public health, and clinical occupational medicine. To assess the impact of the mitigation efforts, this study retrieved the results of all BLLs performed between 1 January 2016 and 30 September 2018 among SOF soldiers enrolled in an Occupational Safety and Health Administration (OSHA)-required medical surveillance program for lead exposure. Mitigation steps were taken during July-September 2017. BLLs from the periods before and after the mitigation efforts were compared. Among the 57 individuals who had levels measured both before and after the mitigation period, the range of BLL values fell from a range of 1-35 µg/dL to a range of 1-15 µg/dL. The number of individuals who had BLLs of greater than 20 µg/dL fell from 9 before, to 0 after the mitigation period. The various types of mitigation steps useful in reducing firing range-related lead exposure are described.

Case report: Tick-borne encephalitis virus infection in beneficiaries of the U.S. military healthcare system in southern Germany.

Tick-borne encephalitis (TBE) is caused by a flavivirus usually transmitted to humans via the bite of an infected Ixodes ricinus tick. The disease is endemic to central Europe, including Germany where it is a potential threat to U.S. service members and other beneficiaries. This report describes 3 cases of TBE in persons living during 2017 and 2018 in the region of Germany with the highest incidence of TBE: a 36-year-old active duty service member and 2 non-service member beneficiaries aged 17 and 7 years. Each patient presented with debilitating symptoms and, following recovery from their acute illnesses, experienced troubling sequelae for months afterward. The nature of their initial illnesses varied from one another, as did the length and nature of their sequelae. The criteria for diagnosing TBE based upon clinical symptoms and laboratory test results are described. Preventive strategies for protecting residents in Germany from TBE include measures to avoid tick bites. The potential for use of the TBE virus vaccine, not Food and Drug Administration- approved in the U.S. but available in Europe, is discussed.

Pupillometer Use: Validation for Use in Military and Occupational Medical Surveillance and Response to Organophosphate and Chemical Warfare Agent Exposure.

INTRODUCTION: To analyze the effectiveness and suitability of pupillometer use in military and occupational medicine, specifically when pupil size is measured as part of medical surveillance. Pupil size is the most sensitive physical exam finding in vapor exposure to substances that inhibit acetylcholinesterase, such as nerve agent (chemical warfare) and organophosphates (used in agriculture). Pupillometer use permits real-time, accurate pupil measurements, which are of significant value in occupational setting where exposure to organophosphates is suspected and in dynamic military settings where it may be unclear if service members were exposed to nerve agent or not. MATERIALS AND METHODS: In a worker population enrolled in medical surveillance including pupil size measurement, pupils were measured using a Colvard pupillometer, whereas their pupil size had previously been measured by manual measurement. Pupil size was compared pre- and post-pupillometer implementation. RESULTS: Pupil size range was broader post-pupillometer implementation, reflecting accepted ranges of physiologically normal pupil sizes. The correlation between pupil sizes pre- and post-pupillometer was low, and the overall mean pupil diameters were statistically different between the two modalities (p < 0.0001), strongly suggesting that pupillometer use helped correct inaccurate pupil size estimates. In two real-world situations, pupillometer use proved helpful in evaluating workers who may have been exposed to an organophosphate, providing information that was immediately available and clinically relevant as part of the initial medical evaluation/physical exam. CONCLUSIONS: Pupillometer use is feasible and robustly increases the precision and accuracy of pupil size measurement in military and occupational medicine settings caring for workers potentially exposed to organophosphates. It provides near-real-time quantitative data that are immediately pertinent to determining if a service member or employee has been exposed to these agents.

Monkey bites among US military members, Afghanistan, 2011.

Bites from Macaca mulatta monkeys, native to Afghanistan, can cause serious infections. To determine risk for US military members in Afghanistan, we reviewed records for September-December 2011. Among 126 animal bites and exposures, 10 were monkey bites. Command emphasis is vital for preventing monkey bites; provider training and bite reporting promote postexposure treatment.

Pulmonary and extrapulmonary coccidioidomycosis, active component, U.S. Armed Forces, 1999-2011.

Coccidioidomycosis is an infection caused by inhalation of Coccidioides species of fungi, which grow in the soil of the southwestern United States. Many thousands of military service members are assigned to, or perform training in, the endemic region. During the 13 years 1999 through 2011, 483 active component service members were diagnosed with coccidioidomycosis (rate: 2.69 cases per 100,000 person-years). Twelve percent of all diagnoses specified extrapulmonary infection, indicating dissemination to other organ systems (e.g., skin, skeleton, or central nervous system). Service members of Asian/Pacific Islander race had markedly higher incidence rates of coccidioidomycosis, particularly extrapulmonary disease, compared to members of other racial/ethnic groups. Crude incidence rates of coccidioidomycosis in service members older than 40 and males were higher than the rates of their respective counterparts. Preventive strategies to reduce exposure to this environmental pathogen are discussed.

Seroprevalence and distribution of arboviral infections among rural Kenyan adults: a cross-sectional study.

BACKGROUND: Arthorpod-borne viruses (arboviruses) cause wide-spread morbidity in sub-Saharan Africa, but little research has documented the burden and distribution of these pathogens. METHODS: Using a population-based, cross-sectional study design, we administered a detailed questionnaire and used ELISA to test the blood of 1,141 healthy Kenyan adults from three districts for the presence of anti-viral Immunoglobulin G (IgG) antibodies to the following viruses: dengue (DENV), West Nile (WNV), yellow fever (YFV), Chikungunya (CHIKV), and Rift Valley fever (RVFV). RESULTS: Of these, 14.4% were positive for DENV, 9.5% were WNV positive, 9.2% were YFV positive, 34.0% were positive for CHIKV and 0.7% were RVFV positive. In total, 46.6% had antibodies to at least one of these arboviruses. CONCLUSIONS: For all arboviruses, district of residence was strongly associated with seropositivity. Seroprevalence to YFV, DENV and WNV increased with age, while there was no correlation between age and seropositivity for CHIKV, suggesting that much of the seropositivity to CHIKV is due to sporadic epidemics. Paradoxically, literacy was associated with increased seropositivity of CHIKV and DENV.