Post -acute sequalae of COVID-19 and cardiac outcomes in U. S. military members.

Post -acute sequalae of COVID-19 (PASC) among U.S. military members remains unexplored. A cohort study of U. S. military members who had a COVID-19 test result, with the specimen collected between March 1, 2020 and November 30, 2021 was conducted. Demographic, inpatient and outpatient data including cardiac event diagnoses were extracted from electronic medical records and compared COVID-19 test-positive and COVID-19 test-negative service members. We used univariate and multivariable logistic regression methods to determine the effect PASC on select cardiac events. Among 997,785 service members, 15,779 (1.6%) were diagnosed with a cardiac event. In fully adjusted models, PASC was significantly associated with increased odds of any cardiac event [OR =1.64 (95% CI: 1.57, 1.71]. PASC was associated with increased odds of myocarditis [OR = 5.86 (95% CI: 4.22, 8.15)], pericarditis [OR =3.08 (95% CI: 2.31, 4.11)], syncope [OR =1.52 (95% CI: 1.41, 1.63)], tachycardia [OR =1.72 (95% CI: 1.56, 1.89)], heart failure [OR =2.15 (95% CI: 1.76, 2.63)], bradycardia [OR =1.71 (95% CI: 1.50, 1.96)], and atrial fibrillation [OR =1.33(95% CI: 1.02, 1.74)] in fully adjusted models. In a sensitivity analysis of military members with no history of cardiac events, PASC was still significantly associated with increased odds of any cardiac event [OR =1.75 (95% CI: 1.67, 1.84)]. In conclusion, we observed a significant association between PASC and cardiac outcomes including; myocarditis, pericarditis, and heart failure. These associations were observed in a relatively young and healthy population and among those without pre-existing cardiac diagnoses.

SARS-CoV-2 Infections and Serologic Responses from a Sample of U.S. Navy Service Members - USS Theodore Roosevelt, April 2020.

Compared with the volume of data on coronavirus disease 2019 (COVID-19) outbreaks among older adults, relatively few data are available concerning COVID-19 in younger, healthy persons in the United States (1,2). In late March 2020, the aircraft carrier USS Theodore Roosevelt arrived at port in Guam after numerous U.S. service members onboard developed COVID-19. In April, the U.S. Navy and CDC investigated this outbreak, and the demographic, epidemiologic, and laboratory findings among a convenience sample of 382 service members serving aboard the aircraft carrier are reported in this study. The outbreak was characterized by widespread transmission with relatively mild symptoms and asymptomatic infection among this sample of mostly young, healthy adults with close, congregate exposures. Service members who reported taking preventive measures had a lower infection rate than did those who did not report taking these measures (e.g., wearing a face covering, 55.8% versus 80.8%; avoiding common areas, 53.8% versus 67.5%; and observing social distancing, 54.7% versus 70.0%, respectively). The presence of neutralizing antibodies, which represent antibodies that inhibit SARS-CoV-2, among the majority (59.2%) of those with antibody responses is a promising indicator of at least short-term immunity. This report improves the understanding of COVID-19 in the U.S. military and among young adults in congregate settings and reinforces the importance of preventive measures to lower risk for infection in similar environments.

Assessing the Burden of Chlamydia and Gonorrhea for Deployed and Active Duty Personnel Assigned Outside the USA.

Sexually transmitted infections (STIs) have posed a threat to military service members throughout history, but limited evidence describes current sexually transmitted infection burden for personnel in-theater and stationed abroad. This study assessed chlamydia and gonorrhea rates by unit of country assignment and evaluated the demographic profile of affected personnel during deployment. Chlamydia and gonorrhea cases among active duty personnel were identified from laboratory results and ambulatory encounter records in the Military Health System from fiscal years October 2006 through September 2015; these were linked to personnel and deployment records to ascertain demographic characteristics, unit of country assignment, and if the case was captured during a period of deployment. Case rates were higher for chlamydia (1,321.7 per 100,000) than gonorrhea (222.7 per 100,000). Approximately 2% of both chlamydia and gonorrhea cases were identified during deployment, with significant differences by service, sex, and age. Elevated rates were identified in several countries of unit assignment outside the USA, warranting further assessment to better understand implications of screening programs or increased morbidity. Pertinent limitations for this study potentially underestimate STI cases during deployment, due to incomplete capture of records from shipboard and in-theater facilities.

Outbreak of Acute Respiratory Illness Associated with Adenovirus Type 4 at the U.S. Naval Academy, 2016.

Human adenoviruses (HAdVs) are known to cause respiratory illness outbreaks at basic military training (BMT) sites. HAdV type-4 and -7 vaccines are routinely administered at enlisted BMT sites, but not at military academies. During August-September 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak. During 22 August-11 September 2016, 652 clinic visits for ARI were identified using electronic health records. HAdV-4 was confirmed by realtime polymerase chain reaction assay in 18 out of 33 patient specimens collected and 1 additional HAdV case was detected from hospital records. Two HAdV-4 positive patients were treated for pneumonia including 1 hospitalized patient. Molecular analysis of 4 HAdV-4 isolates identified genome type 4a1, which is considered vaccine-preventable. Understanding the impact of HAdV in congregate settings other than enlisted BMT sites is necessary to inform discussions regarding future HAdV vaccine strategy.

Pneumonia at Marine Corps Recruit Depots: Current Trends in Ambulatory Encounters and Inpatient Discharges.

BACKGROUND: 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. METHODS: 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. FINDINGS: 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). DISCUSSION: 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.

Malaria Trends in the Navy and Marine Corps, 2005-2013.

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.

Incidence of Chlamydia trachomatis infections and screening compliance, U.S. Army active duty females under 25 years of age, 2011-2014.

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.

Terlipressin with limited fluid resuscitation in a swine model of hemorrhage.

BACKGROUND: Principles of damage control resuscitation include minimizing intravenous fluid (IVF) administration while correcting perfusion pressure as quickly as possible. Recent studies have identified a potential advantage of vasopressin over catecholamines in traumatic shock. Terlipressin (TP) is a vasopressin analogue used to reverse certain shock etiologies in some European countries. STUDY OBJECTIVE: We evaluated three dosages of TP when combined with a limited colloid resuscitation strategy on mean arterial pressure (MAP) and lactatemia in a swine model of isolated hemorrhage. METHODS: Sixty anesthetized swine underwent intubation and severe hemorrhage. Subjects were randomized to one of four resuscitation groups: 4 mL/kg Hextend(®) (Hospira Inc, Lake Forest, IL) only, 3.75 µg/kg TP + Hextend, 7.5 µg/kg TP + Hextend, or 15 µg/kg TP + Hextend. MAP and heart rate were recorded every 5 min. Baseline and serial lactate values at 30-min intervals were recorded and compared. RESULTS: Subjects receiving 7.5 µg/kg TP had significantly higher MAPs at times t15 (p = 0.012), t20 (p = 0.004), t25 (p = 0.018), t30 (p = 0.032), t35 (p = 0.030), and t40 (p = 0.021). No statistically significant differences in lactate values between TP groups and controls were observed. CONCLUSION: Subjects receiving 7.5 µg/kg of TP demonstrated improved MAP within 10 min of administration. When combined with minimal IVF resuscitation, TP doses between 3.75 and 15 µg/kg do not elevate lactate levels in hemorrhaged swine.

Chlamydia trachomatis reported among U.S. active duty service members, 2000-2008.

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.