Norovirus outbreak in Army service members, Camp Arifjan, Kuwait, May 2018.

In May 2018, an outbreak of gastrointestinal illnesses due to norovirus occurred at Camp Arifjan, Kuwait. The outbreak lasted 14 days, and a total of 91 cases, of which 8 were laboratory confirmed and 83 were suspected, were identified. Because the cases occurred among a population of several thousand service members transiting through a crowded, congregate setting of open bays of up to 250 beds, shared bathrooms and showers, and large dining facilities, the risk of hundreds or thousands of cases was significant. The responsible preventive medicine authorities promptly recognized the potential threat and organized and monitored the comprehensive response that limited the spread of the illness and the duration of the outbreak. This report summarizes findings of the field investigation and the preventive medicine response conducted from 18 May-3 June 2018 at Camp Arifjan.

A retrospective cohort study of military deployment and postdeployment medical encounters for respiratory conditions.

Deployed military personnel are exposed to inhalational hazards that may increase their risk of chronic lung conditions. This evaluation assessed associations between Operation Iraqi Freedom (OIF) deployment and postdeployment medical encounters for respiratory symptoms and medical conditions. This retrospective cohort study was conducted among military personnel who, between January 2005 and June 2007, were deployed to either of two locations with burn pits in Iraq, or to either of two locations without burn pits in Kuwait. Incidence rate ratios (IRRs) were estimated using two nondeployed reference groups. Rates among personnel deployed to burn pit locations were also compared directly to those among personnel deployed to locations without burn pits. Significantly elevated rates of encounters for respiratory symptoms (IRR = 1.25; 95% confidence interval [CI]: 1.20-1.30) and asthma (IRR = 1.54; 95% CI: 1.33-1.78) were observed among the formerly deployed personnel relative to U.S.-stationed personnel. Personnel deployed to burn pit locations did not have significantly elevated rates for any of the outcomes relative to personnel deployed to locations without burn pits. These results are consistent with the hypothesis that OIF deployment is associated with subsequent risk of respiratory conditions. Elevated medical encounter rates were not uniquely associated with burn pits.

Assessing potentially hazardous environmental exposures among military populations: 2010 symposium and workshop summary and conclusions.

From May 19 to May 21, 2010, the Armed Forced Health Surveillance Center and the Uniformed Services University cosponsored an educational symposium and workshop on the assessment of potentially hazardous environmental exposures among military populations. Symposium participants reviewed and analyzed historical exposure events, from herbicides in Vietnam to the 1991 Gulf War oil well fires and World Trade Center dust exposure in 2001, using the framework that the Institute of Medicine developed for addressing environmental exposures and their possible impact on military populations. Historical exposures were critically assessed in terms of methods used to identify and define harmful exposures, to prevent or limit exposures, and to define the health risks to exposed people. The lessons learned were then used during small group discussions to deliberate on the current scientific approach for dealing with hazardous environmental exposures. This article summarizes the major conclusions and proceedings of the symposium and provides suggestions to improve the U.S. military's current strategy on identifying and assessing potentially hazardous environmental exposures.

Responses to occupational and environmental exposures in the U.S. military--World War II to the present.

Since the Civil War, a proportion of U.S. service members continues to return from war with new health problems and continues to reference battlefield exposures as the cause. Hence, one of the most pressing public health debates in military policy, the determination of causality and linking of battlefield exposures to health outcomes in veterans, continues. The advances in military environmental and occupational epidemiologic research and Department of Defense policy concerning battlefield exposures are summarized and examples from World War II through the first Gulf War are provided. The limitations associated with the unique battlefield environment, multiple environmental exposures, and the inherent stresses of war, beget challenges for researchers responsible for determining causality. In light of these difficulties, six strategies for addressing environmental exposures and their possible impact on veterans were recommended by the Institute of Medicine post Operation Desert Storm. These strategies, along with their respective progress and remaining gaps, are addressed.

Exposure science in U.S. military operations: a review.

Since 1991, the U.S. Department of Defense has conducted deployment occupational and environmental health surveillance activities in the geographic combatant commands for major conflicts, military exercises, and humanitarian and peace-building missions. The DoD has made significant improvements in documenting and assessing deployment environmental hazards and threats since 1991, illustrated by accomplishments in Bosnia, Kosovo, and Operations Noble Eagle (following the September 11, 2001 terrorist attacks); Enduring Freedom-Afghanistan; and Iraqi Freedom (2003-2010). Sampling is now recommended as part of the DoD Exposure Assessment Method, a dynamic process that is performed during all phases of military operations: I--Predeployment, II--Mobilization, III--Conflict, and IV-Postdeployment. From 2001 to 2009, deployed personnel collected over 24,500 air, water, soil, and bulk samples during operations. These efforts have lead to the creation of an environmental health surveillance database that has been used to investigate public health issues. However, gaps exist, especially in the assessment of individual exposures during deployment.

The AFHSC-Division of GEIS Operations Predictive Surveillance Program: a multidisciplinary approach for the early detection and response to disease outbreaks.

The Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System Operations (AFHSC-GEIS) initiated a coordinated, multidisciplinary program to link data sets and information derived from eco-climatic remote sensing activities, ecologic niche modeling, arthropod vector, animal disease-host/reservoir, and human disease surveillance for febrile illnesses, into a predictive surveillance program that generates advisories and alerts on emerging infectious disease outbreaks. The program's ultimate goal is pro-active public health practice through pre-event preparedness, prevention and control, and response decision-making and prioritization. This multidisciplinary program is rooted in over 10 years experience in predictive surveillance for Rift Valley fever outbreaks in Eastern Africa. The AFHSC-GEIS Rift Valley fever project is based on the identification and use of disease-emergence critical detection points as reliable signals for increased outbreak risk. The AFHSC-GEIS predictive surveillance program has formalized the Rift Valley fever project into a structured template for extending predictive surveillance capability to other Department of Defense (DoD)-priority vector- and water-borne, and zoonotic diseases and geographic areas. These include leishmaniasis, malaria, and Crimea-Congo and other viral hemorrhagic fevers in Central Asia and Africa, dengue fever in Asia and the Americas, Japanese encephalitis (JE) and chikungunya fever in Asia, and rickettsial and other tick-borne infections in the U.S., Africa and Asia.

The relationship between mosquito abundance and rice field density in the Republic of Korea.

BACKGROUND: Japanese encephalitis virus (JEV), the causative agent of Japanese encephalitis (JE), is endemic to the Republic of Korea (ROK) where unvaccinated United States (U.S.) military Service members, civilians and family members are stationed. The primary vector of the JEV in the ROK is Culex tritaeniorhynchus. The ecological relationship between Culex spp. and rice fields has been studied extensively; rice fields have been shown to increase the prevalence of Cx. tritaeniorhynchus. This research was conducted to determine if the quantification of rice field land cover surrounding U.S. military installations in the ROK should be used as a parameter in a larger risk model that predicts the abundance of Cx. tritaeniorhynchus populations. Mosquito data from the U.S. Forces Korea (USFK) mosquito surveillance program were used in this project. The average number of female Cx. tritaeniorhynchus collected per trap night for the months of August and September, 2002-2008, was calculated. Rice fields were manually digitized inside 1.5 km buffer zones surrounding U.S. military installations on high-resolution satellite images, and the proportion of rice fields was calculated for each buffer zone. RESULTS: Mosquito data collected from seventeen sample sites were analyzed for an association with the proportion of rice field land cover. Results demonstrated that the linear relationship between the proportion of rice fields and mosquito abundance was statistically significant (R2 = 0.62, r = .79, F = 22.72, p < 0.001). CONCLUSIONS: The analysis presented shows a statistically significant linear relationship between the two parameters, proportion of rice field land cover and log10 of the average number of Cx. tritaeniorhynchus collected per trap night. The findings confirm that agricultural land cover should be included in future studies to develop JE risk prediction models for non-indigenous personnel living at military installations in the ROK.