AUGUST 16, 2023 – One of the main duties performed by the U.S. military is countering threats across multiple domains. This includes some that we can’t always see, like disease. The Department of Defense has dedicated experts to address this threat as well as the potential hazards that cause disease.
“When a service member, their spouse, or their child becomes ill, that service member may not be in an ideal physical or mental health condition ready to protect and defend our country,” says Dr. Raul Mirza, a physician and former Army major who works for the Clinical Public Health and Epidemiology Directorate of the Defense Centers for Public Health – Aberdeen.
Mirza says that to prevent and mitigate exposure-related injury and disease, DCPH-A epidemiologists, industrial hygienists, environmental science officers and clinicians provide ongoing advice, education and training about military hazardous exposures to military leaders.
Surveillance systems, investigations and training instead of tanks and ships
“Disease prevention at the public health level is often not recognized as the ongoing war that it is,” says Kiara Scatliffe-Carrion, DCPH-A epidemiologist. “But as the threats are often evolving, we must routinely track cases and evaluate data for hazardous exposures or risk patterns.”
DCPH-A epidemiologists’ primary activity is surveillance of 71 conditions known as military reportable medical events, or RMEs, among military healthcare system beneficiaries.
“We monitor the RMEs among service members and their dependents that public health professionals at military medical treatment facilities have reported into the Disease Reporting System internet, or DRSi,” says Scatliffe-Carrion.
The RMEs include notifiable diseases identified by the Centers Disease Control and Prevention, like certain acute respiratory conditions, vector-borne and zoonotic diseases such as Lyme disease, malaria, leishmaniasis, and certain sexually transmitted infections as well as military-unique conditions such as certain severe heat illnesses and cold weather injuries.
DCPH-A epidemiologist Katherine Kotas says the use of the DRSi was particularly helpful when DCPH-A began mpox, formerly known as monkeypox, outbreak surveillance efforts in May 2022 after cases were confirmed in the U.S. By the end of 2022, 72 mpox cases had been identified among U.S. Army Soldiers or their beneficiaries using the DRSi. The DCPH-A developed a variety of products to inform healthcare providers, Soldiers and families of the evolving evidence regarding mpox symptoms, risk factors, prevention and vaccines.
Because the DRSi is not tied to individuals’ medical records and requires separate reporting by local installation public health personnel, the data are subject to underreporting. Therefore, DCPH-A epidemiologists have found ways to use additional laboratory data and medical encounter data from systems like the Military Health System Management and Reporting Tool when analyzing health information.
“Bringing multiple data sources together to more accurately describe health patterns is necessary for threat response,” says Scatliffe-Carrion. “The effort has already proven beneficial in the development of the Defense Health Agency’s Weather-Related Injury Repository, which was established to identify additional cases of heat- and cold-weather related illnesses that may have been diagnosed but are not reported in the DRSi.”
Sometimes disease battles have a global impact
“Monitoring health conditions is especially necessary to evaluate if health interventions are successful by comparing the occurrence of disease before and after the interventions are executed,” says Scatliffe-Carrion.
During the early years of the COVID-19 pandemic, surveillance reports were developed to monitor the pandemic’s effects on Army installations. If an installation reported excessively high case numbers, alerts would signal these unusual increases. Jacob Smith, a DCPH-A epidemiologist, says this allowed epidemiologists to communicate with installation leadership to determine if additional control measures were needed.
Local battles routinely occur at many locations
Disease surveillance isn’t the only way these experts support DOD.
“In addition to disease surveillance, we continue to support our Army leaders and public health nurses in providing information about topics such as women’s health, sexually transmitted infections, and child and youth concerns,” says Army Lt. Col. Christine Bacsa, an Army Public Health Nurse, or APHN, at the DCPH-A.
Ensuring the health and well-being of service members’ children is an especially important aspect of the military’s public health responsibility. Not only can many diseases be spread between a child and parent, but caring for a sick child places an added burden on the military family, which can detract from readiness.
DCPH-A directs public health expertise to childcare facilities since they are known to be high-risk locations for the spread of certain diseases. Specifically, the APHN branch serves as the strategic level Child and Youth Services health consultant to U.S. Army Family and Morale, Welfare and Recreation Child and Youth Services, or CYS, and APHNs at more than 60 installations.
“Last fall, we received questions from Army CYS facilities about masking, screening, testing and quarantine guidance for respiratory syncytial virus, also known as RSV,” says Jouelle Lamaute, a DCPH-A APHN. “RSV is a common respiratory virus that circulates during the fall and winter. Nationwide, there was a high number of severe cases resulting in hospitalizations being reported among infants, toddlers, and children.”
Lamaute says much of the guidance developed by the DCPH-A APHN Branch is to address child- and youth-related disease prevention. Examples include recommended cleaning and disinfection practices at CYS, and increasing parents’ awareness of common health practices like the how-to of handwashing and information about childhood vaccines.
Disease prevention includes training local experts
“Continued education and professional development are important to the success of our public health mission,” says Bacsa. “We share information on our webpages to provide easy access to information and ensure training is provided to our public health nurses and partners in CYS to enhance our practice to prevent illness and disease.”
The DCPH-A also provides public health occupational medicine training to military healthcare providers to ensure clinicians are familiar with how to screen for potential diseases among the workforce.
A key example is the use of spirometry, a basic test that measures how well a person’s lungs work by measuring the amount of air inhaled, amount of air exhaled and the speed at which that air is exhaled.
“While spirometry has limitations, it’s a valuable test for personnel who may be exposed to airborne hazards in the workplace, including those required to wear a respirator,” says Don Zugner, a physician assistant working for DCPH-A CPHE. “We provide training to clinicians to choose the best testing frequency and interpret results according to their patient’s unique needs.”
Mirza says spirometry training is just one example of occupational health training that has helped improve the military’s public health efforts to reduce the ill effects of hazardous exposures and sustain individual medical readiness. “We train medical providers about screening tests to determine the workforce is medically qualified to safely perform their essential job duties and detect pre-clinical disease associated with occupational and environmental hazards.”
Local military entities are encouraged to contact the CPHE experts to address disease concerns. Whether supporting Service members, beneficiaries, or DoD civilians (firefighters, police, laboratory or industrial workers), DCPH-A CPHE public health experts continue to combat disease.
Courtesy Story
Defense Centers for Public Health-Aberdeen