OCTOBER 18, 2022 – One of the most recognized roles of the public health community is disease prevention, particularly the prevention of disease caused by infectious agents.
Infection is caused by many types of microorganisms including bacteria, viruses, parasites or fungi. Depending on the type of disease, the infectious agents – sometimes referred to as infectious “germs” – are transmitted from an infected person, animal or contaminated object to a susceptible host.
As explained by the Centers for Disease Control and Prevention, to develop into a “disease,” the transmitted germs that enter the body increase in number and cause the body to react.
Some people may also be more likely to develop an infectious disease due to personal characteristics, such as age, gender, or pre-existing medical conditions. In healthcare facilities or other settings where numerous people are housed in close quarters, the amount of exposure to infectious germs may be higher, thus increasing the likelihood of disease.
While the only way to avoid all germs would be to live in a bubble, clearly this is not practical. Because some germs cause diseases that can have a big impact on the population, public health organizations conduct surveillance to track disease trends.
The U.S. Army Public Health Center’s Preventive Medicine Division routinely monitors military health system data for many infectious diseases that impact the military population in particular and can detract from force readiness.
Monitoring can help reduce the problem
“Our disease surveillance data can help identify potential clusters or outbreaks of infection that are important to service members and beneficiaries,” says Dr. Alicia Trueblood, an epidemiologist and biostatistician working for APHC’s PMD.
This surveillance information helps to identify ways to limit the spread and severity of disease outbreaks, as well as prevent future occurrences.
Most of the data collected are from the Disease Reporting Surveillance Internet, or DRSI, which military medical facilities are required to use to capture all cases that meet the criteria of a Reportable Medical Event.
Some diseases that have been around for years, such as acute respiratory disease (referred to as ARD), influenza, and vector-borne diseases (including tick-borne diseases, such as Lyme), are regularly reported through APHC’s publicly-available reports.
ARD is generally defined by a fever and at least one sign or symptom of acute respiratory tract inflammation, such as sore throat, cough, runny nose, chest pain, shortness of breath, headache, fluid from the tonsils, or tender, swollen lymph nodes in the head or neck.
When diagnosing a Soldier with ARD, a medical provider will typically assign a limited duty profile that limits physical training (e.g., run at own pace and distance) and/or removes the Soldier from duty for at least 24 hours (e.g., placed on quarters).
“ARD is a leading cause of illness in military trainees,” says Trueblood. “It can be devastating to a group of basic trainees due to their unique controlled environment and vigorous training schedule.”
Influenza, known as “the flu,” is probably the most commonly known cause of ARD. Since flu viruses change each year, each year’s seasonal influenza disease is a variation of the prior year’s disease. Though the timing and duration of influenza seasons in the U.S. vary each year, the disease season is usually October through May, peaking between December and March.
To prevent transmission of ARD, you should avoid close contact with those who are sick, stay home when sick, cover coughs and sneezes, wash hands thoroughly and frequently, and clean commonly touched surfaces. Vaccines are available for some ARD, such as influenza, and immunization is another important tool to prevent transmission and severe illness.
Because the influenza virus changes each year, and because a person’s immune protection from flu vaccination declines over time, an annual vaccination is needed to ensure the best protection. The CDC currently recommends that all persons older than 6 months receive a yearly influenza vaccination. The flu vaccination may prevent you from getting sick with flu, or at least significantly reduce the risk of flu-associated hospitalization.
Vector-borne diseases tracked by the APHC include primarily tick-borne diseases such as Lyme disease. While contact with the ticks that transmit the disease can occur all year, APHC data have shown most cases are reported during the summer months.
The APHC also monitors sexually transmitted infections, known as STIs. The most commonly reported STIs are chlamydia, gonorrhea and syphilis. While the CDC monitors cases of these STIs in the U.S. population, the APHC tracks them among U.S. Soldiers.
Within the Army, as in the overall U.S. population, reportable STI rates have been increasing for the past several years – with an estimated 1 in 5 U.S. adults having an STI. Though there is an epidemic of STIs in both populations, Soldiers are estimated to have twice the rate of chlamydia as the general U.S. adult population.
“In the U.S., 15-24 year-olds account for almost half of these STIs,” explains Nikki Jordan, a senior APHC epidemiologist. “Since approximately half of the Army is under 25, it is not surprising that Soldiers represent a high-risk subgroup of the overall U.S. population.”
Emerging disease threats
As new diseases emerge in military populations, the APHC PMD investigates and monitors the disease cases reported in DRSI and supporting military medical data systems. Past examples include Ebola and Zika.
Most recently, the APHC has been monitoring military cases of COVID-19, monkeypox, and acute pediatric hepatitis. While not publicly available, the ongoing surveillance of these diseases provides insight to military policy makers. Data include breakdowns of cases by installations, hospitalizations, and deaths among Department of Defense service members and beneficiaries.
You can protect yourself now
Awareness of the current statistics and trends of these diseases can help determine the best policies and practices to prevent or mitigate these illnesses and possibly highlight problems to address in the future. However, there are simple public health practices that every individual can follow to protect themselves and their loved ones from all infectious diseases:
- Maintain distance from potential sources of infection, and avoid others if you are sick.
- Wear protection, such as condoms, masks, and insect repellent.
- Practice good hygiene – wash your hands; cover your mouth when coughing or sneezing.
- Get vaccinated (when vaccines are available).
- Get tested, and follow medical advice to enable rapid recovery.
- Maintain optimal immune function by practicing healthy habits such as eating a balanced diet, getting adequate sleep, and exercising.
The U.S. Army Public Health Center focuses on promoting healthy people, communities, animals, and workplaces through the prevention of disease, injury, and disability of Soldiers, retirees, family members, veterans, Army civilian employees, and animals through population-based monitoring, investigations, and technical consultations.
By V. Hauschild, MPH, U.S. Army Public Health Center