Robert F. DeFraites

Non-battle injury casualties during the Persian Gulf War and other deployments.

OBJECTIVE To review injury occurrence and to evaluate various injury surveillance systems used on recent deployments of U.S. military personnel. BACKGROUND Injuries that occur in a deployed military force are more likely to have an immediate and detrimental effect on the military mission than those in garrison or training. These injuries have a direct impact on deployed personnel and unit readiness and consume limited field medical resources. METHODS Data collected during four recent deployments were evaluated. Administrative databases established for the routine collection of death and hospital admissions were used to characterize mortality and morbidity in the Persian Gulf War. Surveillance teams deployed to Haiti, Somalia, and Egypt provided inpatient and outpatient data for those missions. RESULTS Data collected by these surveillance systems are presented. Unintentional trauma accounted for 81% of deaths during the Persian Gulf War and 25% of hospital admissions. During operations in Somalia and Haiti, 2.5% to 3.5% of about 20,000 troops in each deployment sought medical treatment for an injury or orthopedic problem each week. In Egypt, injuries accounted for about 25% of all outpatient visits to medical treatment facilities. CONCLUSIONS Injuries were the leading cause of death and a leading cause of morbidity during recent deployments of U.S. troops. Comprehensive injury surveillance systems are needed during deployments to provide complete and accurate information to commanders responsible for the safety of the force. Recommendations for establishing such systems are made in this article.

Hepatitis A in the US Army: epidemiology and vaccine development

Control of hepatitis A has been an important concern for US military forces in war and peace. Immune serum globulin, although effective, is exceedingly cumbersome to use. The prevalence of antibody against hepatitis A is decreasing in young American soldiers, putting them at risk of hepatitis A during deployment. The US Army has been an active participant in development of hepatitis A vaccine. The first successful cell-culture-derived, formalin-inactivated hepatitis A vaccine was developed at the Walter Reed Army Institute of Research. This prototype vaccine was shown, in 1986, to be safe and immunogenic for humans. Since then we have evaluated the following issues related to the use of inactivated hepatitis A vaccines in military populations. Immunogenicity of vaccine derived from the CLF and HM175 strains; immunogenicity of hepatitis A vaccine given by jet injector; immunogenicity of hepatitis A vaccine when given with hepatitis B vaccine; immunogenicity when given in shortened schedules; safety and immunogenicity in Thai children; and efficacy under field conditions in the tropics. The hepatitis A vaccines which we tested are safe and highly immunogenic. Immunization by jet gun confers immunity equivalent to immunization by needle. Hepatitis A vaccine is equally potent when given with hepatitis B vaccine. Data on rapid immunization schedules and efficacy are under evaluation. We conclude that hepatitis A vaccine is a major improvement in our ability to prevent hepatitis A in soldiers.

Helicobacter pylori Infection in Desert Storm Troops

To determine whether military personnel deployed outside the United States are at increased risk of Helicobacter pylori infection, we evaluated U.S. Army personnel who served in the Persian Gulf from August 1990 to April 1991. Of 204 subjects from whom paired predeployment and postdeployment serum specimens were obtained, 76 (37%) were seropositive for IgG antibody to H. pylori before deployment by an enzyme-linked immunosorbent assay. Of the 111 initially seronegative subjects evaluated before and after a 7.5-month deployment, five (4.5%) seroconverted. The calculated annual seroconversion rate was 7.3%. In a postdeployment questionnaire, 62% of soldiers reported an episode of diarrhea while deployed, but there was not an increased rate of diarrhea or upper gastrointestinal symptoms in soldiers who were infected before deployment or in those who seroconverted. These data suggest that the risk of H. pylori infection increases during long-term deployment and that acute infection is not distinguishable from other gastrointestinal illnesses encountered during deployment.

Gaining Experience with Military Medical Situational Awareness and Geographic Information Systems in a Simulated Influenza Epidemic

The purpose of medical situational awareness is to provide useful and actionable information for preparing and employing medical assets in support of a wide variety of operational missions around the world, and monitoring and protecting the health of the force in the face of rapidly changing health threats. Since 2005, the Medical Situational Awareness in the Theater Advanced Concept Technology Demonstration has exploited advances in information technology, geographic information systems, and open systems architecture to produce a functioning prototype of a medical situational enhancement capability. In May 2006, this prototype supported the medical staff of a combined/joint task force in a realistic command postexercise featuring a simulated outbreak of influenza during Exercise COBRA GOLD in Thailand. The proliferation and maturation of geographic information systems present many opportunities for the military medical community to improve the health of the populations for which it is responsible.

Towards Shared Situational Awareness and Actionable Knowledge - An Enhanced, Human-Centered Paradigm for Public Health Information System Design

Technology has exerted an increasingly dominant influence on the ways and means that objectives of informatics projects are pursued and has extended the capabilities of informatics systems in general. However, literature examining the importance of human links between situational awareness-related processes and decision-making capabilities remains relatively sparse. Substantial knowledge gaps exist in information system implementation between technology and public health surveillance. The purpose of this article is to present an enhanced conceptual framework, built upon innovative perspectives of a human-centered paradigm of implementation, to enable and enhance human-centric decision-making. To clarify this concept, we employ a case of situational awareness in the setting of a recent command post exercise in order to illustrate core concepts and practices. We divide the framework into methods, tools, and goals to broaden the context of discussion, and conclude with lessons learned from this field operation exercise. The present study could be of value to military commanders, policy leaders, and analysts across multiple disciplines, such as in the public health, counterinsurgency, and bioterrorism surveillance communities.