Monitoring Exposure to Ebola and Health of U.S. Military Personnel Deployed in Support of Ebola Control Efforts - Liberia, October 25, 2014-February 27, 2015.

In response to the unprecedented Ebola virus disease (Ebola) outbreak in West Africa, the U.S. government deployed approximately 2,500 military personnel to support the government of Liberia. Their primary missions were to construct Ebola treatment units (ETUs), train health care workers to staff ETUs, and provide laboratory testing capacity for Ebola. Service members were explicitly prohibited from engaging in activities that could result in close contact with an Ebola-infected patient or coming in contact with the remains of persons who had died from unknown causes. Military units performed twice-daily monitoring of temperature and review of exposures and symptoms ("unit monitoring") on all persons throughout deployment, exit screening at the time of departure from Liberia, and post-deployment monitoring for 21 days at segregated, controlled monitoring areas on U.S. military installations. A total of 32 persons developed a fever during deployment from October 25, 2014, through February 27, 2015; none had a known Ebola exposure or developed Ebola infection. Monitoring of all deployed service members revealed no Ebola exposures or infections. Given their activity restrictions and comprehensive monitoring while deployed to Liberia, U.S. military personnel constitute a unique population with a lower risk for Ebola exposure compared with those working in the country without such measures.

Patient-centered medical home implementation effects on emergency room utilization: a case study.

The Patient-Centered Medical Home (PCMH) concept has been commended for its potential to increase access to primary care while improving quality and health outcomes. Numerous studies have documented the benefits of the PCMH healthcare delivery modality inclusive of decreased emergency room (ER) visits among PCMH enrollees. Yet a debate wages on whether PCMHs are conceptually sound and clinically effective with few empirical studies dedicated to the study of this relatively new care delivery model (Friedberg et al. 2014; Agency for Health Research and Quality 2012; Cassidy 2010). As part of the campaign to implement the PCMH care delivery modality throughout the Military Health System, the Army Medical Command constructed a medical home at Ft. Campbell, Kentucky, in December 2010. The authors evaluated the effectiveness of this medical home in reducing ER visits and found enrollees were 67% less likely than standard primary care clinic enrollees to visit the ER when controlling for age, gender, race, beneficiary category, marital status, and outpatient visits. Additionally, men were nearly half as likely as women to visit the ER, and high outpatient users were twice as likely to visit the ER. This is an encouraging study for proponents of the PCMH model. Limitations and suggestions for future research are also presented.

Glucose-6-phosphate dehydrogenase deficiency in two returning Operation Iraqi Freedom soldiers who developed hemolytic anemia while receiving primaquine prophylaxis for malaria.

Use of antimalarial prophylaxis continues to be routine practice among military personnel returning from areas where malaria is endemic. Primaquine may be used for terminal prophylaxis against Plasmodium ovale and Plasmodium vivax. Serious complications of this regimen are infrequent. We report the occurrence of significant hemolytic anemia for two soldiers returning from Operation Iraqi Freedom. They presented with dark urine, headaches, and classic laboratory findings of hemolysis. Both soldiers were subsequently found to have glucose-6-phosphate dehydrogenase deficiency, and both responded to conservative treatment and cessation of medication. Although this complication is unusual, medical personnel involved in the care of recently returned deployed service members should be alert to its potential occurrence among patients who are receiving antimalarial prophylaxis. This complication could be completely avoided with prescreening of personnel for glucose-6-phosphate dehydrogenase deficiency, as is currently done in the Air Force and Navy, before the use of primaquine.