Ivermectin prescription fill rates among U.S. Military members during the coronavirus disease 2019 (COVID-19) pandemic.

This report describes ivermectin prescription fill rates among U.S. active component service members (ACSM) over time during the early phases of the COVID-19 pandemic. Information about the unsubstantiated benefits of ivermectin for coronavirus 2019 (COVID-19) prevention and treatment was widely available online early in the COVID-19 pandemic. Ivermectin prescription fill rates increased among ACSM during periods of Alpha and Delta coronavirus variant predominance, but not during the predominance of the Omicron variant. At the peak of the fill rate curve, in August 2021, rates were higher among men compared to women, older compared to younger age groups, senior officers compared to junior officers, senior enlisted compared to junior enlisted service members, and those with a bachelor's or advanced degree compared to those without a bachelor's degree. Ivermectin prescriptions were more likely to have been filled at a retail pharmacy than at a military hospital or clinic. During the COVID-19 pandemic fill rates for ivermectin prescriptions among ACSM increased, including those without a qualifying diagnosis. Rates peaked in August 2021 but subsequently declined. The decrease in ivermectin fill rates was coincident with vigorous efforts to correct previous misinformation and implement pre-authorization requirements for prescriptions. Research on the impact of unproven online claims about clinical and public health interventions has potential to curtail future unnecessary and potentially harmful treatments.

Weight loss medication prescription prevalence in the active component, 2018-2023.

The U.S. military has witnessed rising obesity among active component service members. The Department of Defense authorized coverage of weight loss medications in 2018, but no study has evaluated prescription prevalence within the active component. This descriptive retrospective cohort study analyzed data from active component U.S. military service members from January 2018 through June 2023. The study used data from the Defense Medical Surveillance System to determine prescription period prevalence of weight loss medication. Data on demographics, body mass index, and history of diabetes were considered. The study revealed a 100-fold increase in the prescription period prevalence of weight loss agents in the active component from their initial authorization date. Demographics associated with higher prescription period prevalence were non-Hispanic Black race and ethnicity, female sex, and older age. Service members in the health care occupations and the Navy had higher prevalence compared to other service branches and occupations. The findings indicate a significant rise in the period prevalence of weight loss prescriptions over time. Further research is recommended to assess the effectiveness, safety, and use in austere military environments.

Celiac Disease on the Rise in the US Military Population: A 22 Year Retrospective Epidemiologic Study.

INTRODUCTION: We describe celiac disease epidemiology in the US military population. METHODS: This is a population-based study from data collected between 2000 and 2021. Incidence and prevalence rates and descriptive statistics for demographics are presented. RESULTS: Overall, 2248 incident cases of celiac disease were identified. The incidence rate increased from 1.2 to 14.0 per 100,000 person-years and the overall lifetime prevalence increased from 3.1 to 57.4 per 100,000 service members. In gastroenterology clinics, the incidence rate increased from 1.4 to 8.2 per 100,000 person-years, while prevalence increased from 3.3 to 33.4 per 100,000 service members. DISCUSSION: In this study, celiac disease incidence and prevalence increased significantly.

Incidence and Management of Chronic Insomnia, Active Component, U.S. Armed Forces, 2012 to 2021.

The Department of Veterans Affairs and Department of Defense Clinical Practice Guideline (VA/DOD CPG) provides evidence-based management pathways to mitigate the negative consequences of common sleep disorders among service members (SMs). This retrospective cohort study estimated the incidence of chronic insomnia in active component military members from 2012 through 2021 and the percentage of SMs receiving VA/DOD CPG-recommended insomnia treatments. During this period, 148,441 incident cases of chronic insomnia occurred, with an overall rate of 116.1 per 10,000 person-years (p-yrs). A sub-analysis of SMs with chronic insomnia diagnosed during 2019-2020 found that 53.9% received behavioral therapy and 72.7% received pharmacotherapy. As case ages increased, the proportion who received therapy decreased. Co-existing mental health conditions increased the likelihood of receiving therapy for insomnia cases. Clinician education about the VA/DOD CPG may improve utilization of these evidence-based management pathways for SMs with chronic insomnia.

Increased Prevalence of Overweight and Obesity and Incidence of Prediabetes and Type 2 Diabetes During the COVID-19 Pandemic, Active Component Service Members, U.S. Armed Forces, 2018 to 2021

This study evaluated trends in the prevalence of overweight, obesity, and diabetes among active component service members between 2018 and 2021, before and after the start of the COVID-19 pandemic. This study also investigated the incidence of prediabetes and type 2 diabetes mellitus (T2DM) diagnoses during the same period. Between 2018 and 2021, the prevalence of obesity among active component service members who completed a Periodic Health Assessment (PHA) increased from 16.1% to 18.8%. The incidence of prediabetes increased from 588.2 to 763.8 cases per 100,000 person-years (p-yrs), and the incidence of T2DM increased from 55.5 to 69.6 per 100,000 p-yrs. The largest relative increases in obesity prevalence were in the youngest (<30 years) age categories. Navy members and Hispanic service members experienced the largest absolute and relative increases in rates of new diabetes diagnoses. These findings indicate that during the COVID-19 pandemic active component service members experienced increased prevalence of obesity, prediabetes, and diabetes. Evaluation of lifestyle factors associated with these chronic diseases among service members may be useful to enhance deployment readiness and operational effectiveness.

COVID-19 Booster Vaccination in the U.S. Military, August 2021-January 2022.

INTRODUCTION: A booster dose of messenger RNA vaccine protects against severe COVID-19 outcomes. This study examined the incidence of COVID-19 booster vaccination among active-duty U.S. military servicemembers between August 2021 and January 2022, factors associated with vaccination uptake, and trends over time. METHODS: This was a retrospective cohort study of active-duty military personnel using data from the Defense Medical Surveillance System. Participants were included if they served in the active component from August 2021 through January 2022 and were eligible to receive a COVID-19 booster dose by January 2022. Adjusted hazard ratio estimates of time to booster vaccination were calculated using Cox proportional hazards regression. RESULTS: Lower booster vaccine uptake was seen in the U.S. military (25%) than among the general U.S. population at the same time (45%). Booster vaccination increased with older age, with greater education, with higher income, among women, and among those stationed overseas; it decreased with previous COVID-19 infection and use of the Janssen vaccine. There were no significant racial or ethnic disparities in booster vaccination. CONCLUSIONS: In the absence of a compulsory vaccination policy, lower booster vaccine uptake was seen among servicemembers than among the general U.S. population, particularly among members who were younger, were male, Marines, and had a previous history of infection. Low vaccination rates not only increase the risk of acute and long-term health effects from COVID-19 among servicemembers, but they also degrade the overall readiness of the U.S. military.

Evaluation of the MSMR Surveillance Case Definition for Incident Cases of Hepatitis C.

The validity of military hepatitis C virus (HCV) surveillance data is uncertain due to the potential for misclassification introduced when using administrative databases for surveillance purposes. The objectives of this study were to assess the validity of the surveillance case definition used by the Medical Surveillance Monthly Report (MSMR) for HCV, the over and underestimation of cases from surveillance data, and the true burden of HCV disease in the U.S. military. This was a validation study of all potential HCV cases in the active component U.S. military from calendar year 2019 obtained using several different data sources: 1) outpatient, inpatient, and reportable medical event (RME) records in the Defense Medical Surveillance System, 2) Health Level 7 (HL7) laboratory data obtained from the Navy Marine Corps Public Health Center, and 3) chart review of the electronic medical records of all potential HCV cases, to include those from privately-sourced care. The sensitivity of the MSMR case definition was 83.6% and the positive predictive value (PPV) was 60.0%. This study suggests that the U.S. military should have confidence that the previous estimates derived using the MSMR surveillance case definition were moderately close to the true burden of incident chronic HCV infection (the true incidence of chronic disease being about 27% lower), but these reports likely dramatically overestimate the incidence of acute HCV. Since HCV was selected as an RME to guide public health action, it is most suitable to invest public health efforts in strengthening the use of confirmed RMEs as the surveillance case definition.

Viral hepatitis C, active component, U.S. Armed Forces, 2011-2020.

This study reports updated numbers and incidence rates of hepatitis C virus (HCV) infection among active component members of the U.S. military using a revised case definition during a 10-year surveillance period between 2011 and 2020. During the surveillance period, there were 547 incident cases of HCV infection, resulting in an overall incidence rate of 4.1 per 100,000 person years (p-yrs), which was much lower than that seen in the general U.S. population. The incidence rate trended downward from 4.8 per 100,000 p-yrs in 2011 to 1.6 per 100,000 p-yrs in 2020. Incidence of HCV infection was higher in males, those identifying as non-Hispanic White, Navy members, those in healthcare occupations, and among those in the youngest age category (17-19 years). When stratified by year of birth, the incidence of hepatitis C was highest among those born in 1964 or prior; however, when stratified by time in service, incidence was highest among those with less than 2 years of military service. The updated incidence of and factors associated with HCV infection in the U.S. military provided in this report may be useful in evaluating the impact of current HCV screening policies and in guiding updates to them.

Racial and Ethnic Disparities in COVID-19 Infection and Hospitalization in the Active Component US Military.

Objectives. To assess COVID-19 disparities in the active component US military with an emphasis on race and ethnicity. Methods. In this retrospective cohort study, we calculated the incidence of COVID-19 testing, infection, and hospitalization in the active component US military in calendar year 2020. Results. Overall, 61.3 per 100 population per year were tested for COVID-19, 10.4% of tests were positive, and 1.1% of infected individuals were hospitalized. Non-Hispanic Blacks and Hispanics had a rate of testing for COVID-19 similar to that of Whites but had a higher risk of infection (adjusted risk ratio [ARR] = 1.25 and 1.26, respectively) and hospitalization (ARR = 1.28 and 1.21, respectively). Conclusions. Although of lower magnitude than seen in civilian populations, racial and ethnic disparities in COVID-19 infection and hospitalizations exist in the US military despite universal eligibility for health care, similar rate of testing, and adjustment for comorbidities and other factors. Simply making health care coverage available may be insufficient to ensure health equity. Interventions to mitigate disparities in the US military should target the patient, provider, health care system, and society at large. (Am J Public Health. 2021;111(12):2194-2201. https://doi.org/10.2105/AJPH.2021.306527).

Long-acting reversible contraceptive use, active component service women, U.S. Armed Forces, 2016-2020.

Long-acting reversible contraceptives (LARCs) are highly effective means of birth control that can improve service women's overall health and readiness. This report expands upon prior data and summarizes the annual prevalence (overall and by demographics) of LARC use from 2016 through 2020 among active component U.S. service women, compares LARC prevalence to the prevalence of short-acting reversible contraceptives (SARCs), and evaluates the probability of continued use of LARCs by type. LARC use increased from 21.9% to 23.9% from 2016 through 2019 while SARC use decreased from 28.3% to 24.9%. Both SARC and LARC use decreased in 2020 which may have been related to the coronavirus disease 2019 (COVID-19) pandemic. The prevalence of intrauterine devices (IUDs) was greater than implants, and IUDs also had a higher probability of continuation than implants. At 12 months, the continuation for IUDs was 81% compared to 73% for implants. At 24 months, the probabilities of continuation were 70% for IUDs and 54% for implants. Probabilities of continuation were similar across outsourced care and direct care settings. The increased use of LARCs along with their high frequency of continuation in U.S. service women may have a positive impact on overall health and readiness.

Serological and RT-PCR Surveillance for COVID-19 in an Asymptomatic US Army Trainee Population.

BACKGROUND: Significant variability exists in the application of infection control policy throughout the US Army initial entry training environment. To generate actionable information for the prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) transmission among new recruits, active enhanced surveillance was conducted for evidence of and exposure to SARS-CoV-2/COVID-19. METHODS: We serially tested recruits with a reverse transcriptase polymerase chain reaction (RT-PCR) COVID-19 and/or total antibody to SARS-CoV-2 tests at days 0, 14, and week 10 upon arrival for basic combat training at a location in the Southern United States. RESULTS: Among 1403 recruits who were enrolled over a 6-week period from August 25 through October 11, 2020, 84 recruits tested positive by RT-PCR, with more than half (55%, 46/84) testing positive at arrival and almost two-thirds (63%, 53/84) also testing seropositive at arrival. Similarly, among an overall 146 recruits who tested seropositive for SARS-CoV-2 during the period of observation, a majority (86%) tested seropositive at arrival; no hospitalizations were observed among seropositive recruits, and antibody response increased at week 10. CONCLUSIONS: These findings that suggest serological testing may complement current test-based measures and provide another tool to incorporate in COVID-19 mitigation measures among trainees in the US Army.

Sepsis hospitalizations among active component service members, U.S. Armed Forces, 2011-2020.

The objective of this study was to assess the incidence and trends of sepsis hospitalizations in the active component U.S. military over the past decade. Between 1 January 2011 and 31 December 2020, there were 5,278 sepsis hospitalizations of any severity recorded among the active component. The overall incidence was 39.8 hospitalizations per 100,000 person-years (p-yrs). Annual incidence increased 64% from 2011 through 2019, then dropped considerably in 2020. Compared to their respective counterparts, rates were highest among female service members, the oldest and youngest age groups, and recruits. The gap in sepsis hospitalization rates between female and male service members increased over the surveillance period. Pneumonia was the most commonly co-occurring infection, followed by genitourinary infections. Among female service members, genitourinary infections were more commonly diagnosed compared to pneumonia. The most common non-infection co-occurring diagnoses were acute kidney failure and acute respiratory failure. This study demonstrates an apparent sex disparity in sepsis rates and further study is recommended to understand its cause.

Malignancy in U.S. Air Force fighter pilots and other officers, 1986-2017: A retrospective cohort study.

OBJECTIVE: This study sought to determine the incidence rates of cancer, overall and by site, among active component U.S. Air Force fighter pilots, and to compare the rates with those in other active component Air Force officers. METHODS: Using a matched retrospective cohort design, U.S. Air Force fighter pilots were compared with other commissioned officers who entered active component service between 1 January 1986 and 31 December 2006. The cohort was followed for cancer diagnoses in TRICARE and the Veterans Health Administration from 1 October 1995 through 31 December 2017. Fighter pilots and non-fighter pilot officers were compared after matching on sex, age at first observation (15 age groups), and age at last observation (15 age groups). Sex-stratified overall and site-specific cancer rates were compared with matched Poisson regression to determine incidence rate ratios with 95% confidence intervals. RESULTS: During 1,412,590 person-years of follow-up, among the study population of 88,432 service members (4,949 fighter pilots and 83,483 matched officers), 977 incident cancer cases were diagnosed (86 in fighter pilots and 891 in matched officers). Male fighter pilots and matched officers had similar rates of all malignant cancers (RR = 1.04; 95% CI: 0.83-1.31) and of each cancer site. Female fighter pilots and matched officers also had similar rates of all malignant cancers (RR = 0.99; 95% CI: 0.25-4.04). DISCUSSION: In the active component U.S. Air Force, fighter pilots and their officer peers had similar overall and site-specific cancer rates.

Food-allergy anaphylaxis and epinephrine autoinjector prescription fills, active component service members, U.S. Armed Forces, 2007-2016.

Food-allergy anaphylaxis is an immunoglobulin E-mediated, systemic reaction that is often unanticipated and can rapidly lead to death. Active duty service members with a history of food-allergy anaphylaxis or a systemic reaction to food do not meet military accession or retention standards. In spite of this, the incidence rate of food-allergy anaphylaxis among active component service members approximates that found in the general population and appears to be increasing. The overall incidence of food-allergy anaphylaxis among active component service members was 39.1 cases per 100,000 person-years (p-yrs) during the 2007-2016 surveillance period. The incidence increased over the surveillance period from 32.0 per 100,000 p-yrs in 2007 to 55.8 per 100,000 p-yrs in 2016. First-line treatment of anaphylaxis includes rapid administration of epinephrine. In this study, 29% and 58% of incident anaphylaxis cases had filled a prescription for an epinephrine autoinjector (EAI) within 18 months before or 3 months after the incident diagnosis, respectively. Increasing awareness of food-allergy anaphylaxis, properly identifying at-risk individuals, and ensuring availability of EAIs have the potential to mitigate the risk associated with anaphylaxis.