SEPTEMBER 9, 2025 – The Defense Health Agency is committed to protecting the total force from heath threats through the efforts of the Armed Forces Health Surveillance Division.
“We play a combat support role at AFHSD, and we are responsible for protecting the Joint Force,” said Navy Capt. Richard Langton, chief of AFHSD. “We carry out our assigned duties through retrospective, near real-time, and prospective health surveillance — in a nutshell, full-spectrum health surveillance.”
AFHSD is a public health component of the DHA and the U.S. military’s central public health entity. The division focuses on global health surveillance, providing operational forces with early warning, health threat assessments, and force-readiness data.
The division is organized into three branches: Epidemiology and Analysis, Global Emerging Infections Surveillance, and Integrated Biosurveillance.
AFHSD is the central repository of medical surveillance data for the armed forces. This is done through technical infrastructure, expertise in database management for the Defense Medical Surveillance System and related applications, and operations, and management of the Department of Defense Serum Repository.
The DMSS houses current and historical data on diseases and medical events. These include hospitalizations, ambulatory visits, reportable medical events, laboratory tests, immunizations, periodic and deployment-related health assessments, and casualty data affecting service members throughout their military careers. It contains billions of data records on service members and other Military Health System beneficiaries.
Leveraging data to manage seasonal respiratory illnesses
The AFHSD uses this wealth of data to analyze and anticipate potential threats.
“AFHSD plays a key role in integrating biosurveillance efforts by collecting data and information in near real-time of the threats from endemic diseases and emerging infectious diseases relevant to the military worldwide,” said Juan I. Ubiera, chief of the IB branch. “IB also conducts forecasting analytics to predict and communicate seasonal respiratory illnesses threats.”
This surveillance information enables weekly trend analysis and situation reports on seasonal respiratory illnesses. It also includes a report on respiratory illness activity on and around selected installations, to assist senior leaders in making decisions regarding resource and personnel distribution.
IB also supports early warnings and monitoring of various syndromes, including respiratory illnesses at military hospitals and clinics, communicated through the Electronic Surveillance System for the Early Notification of Community Based Epidemics, or ESSENCE. This program, according to the Centers for Disease Control and Prevention, allows public health professionals to analyze events of public health interest, monitor health care data for events that could affect public health, and share data and analyses.
Raising awareness with the Medical Surveillance Monthly Report
The AFHSD disseminates important biosurveillance information through a peer-reviewed journal, the Medical Surveillance Monthly Report.
“The MSMR publishes summaries of notifiable diseases, trends of illnesses of special interest, and field reports describing outbreaks and case occurrences,” said Shauna Stahlman, senior epidemiologist in the E&A branch.
“Launched in 1995, the journal provides evidence-based estimates of the incidence, distribution, impact, and trends of illness and injuries among U.S. military service members and associated populations,” she said.
According to Stahlman, the MSMR publishes “pertinent articles on military public health, epidemiology, surveillance, and disease and injury prevention, continuously evaluating manuscript submissions for scientific accuracy.”
“The journal reports present data, public health information, and original research with direct relevance to the operational fitness of military members or MHS beneficiaries’ health, safety, and well-being,” she added.
Future of biosurveillance
Each branch has specific goals in their continuing efforts to meet the needs of service members and other MHS beneficiaries.
“The E&A branch’s goal is to be flexible, responsive, and predictive to our customers by releasing accurate, timely, and actionable surveillance data, and leveraging partnerships and networks within and outside of DHA public health to better predict and respond to their needs,” said Stahlman.
“In addition, we also aim to reduce the spread of medical misinformation and disinformation, which were identified as potential vulnerabilities for biodefense in the 2023 Biodefense Posture Review,” she noted.
The GEIS branch is expanding capabilities for pathogen-agnostic genomic sequencing, a method for detecting unknown pathogens to determine the cause of an illness, and wastewater surveillance, said June Early, deputy chief of the GEIS branch. “The future development, implementation, and expansion of these capabilities will enable a more comprehensive understanding of infectious disease threats.”
“Also, our respiratory infections focus area oversees the coordination of the DOD global influenza vaccine effectiveness analysis,” said Early. “These analyses directly inform selection and composition of the following season’s northern hemisphere influenza vaccine.”
The IB branch is enhancing biosurveillance early warning content and information dissemination on the Health Surveillance Explorer, the DHA’s mapping application that provides near real-time integrated global health surveillance information for force health protection.
“We are increasing syndromic surveillance capabilities through collaborative partnerships with additional states,” said Ubiera. “IB is working with combatant commands and services to provide tailored biosurveillance information. We are also working to expand global biosurveillance capabilities by working with partner nations and allies to exchange information. This is one of the reform initiatives established in the 2023 Biodefense Posture Review.”
Capturing the high ground in health surveillance
Military public health surveillance is vital in detecting and mitigating emerging health threats, Langton said.
“We’re very proud of the capabilities we already bring to the fight. But future success requires us to move beyond the current state,” he said. “The task before us is to capture the high ground in health surveillance. We are meeting that head-on by adopting new capabilities and tapping into the unique capabilities of our partners to create synergies that endure and allow us to dominate the health surveillance space.”
Story by Ken Cornwell
Defense Health Agency