Global Health Surveillance at the
Armed Forces Health Surveillance Center
(AFHSC)
Central Asia Regional Health Security Conference
17-19 April 2012, Garmisch-Partenkirchen, Germany
COL Robert J. Lipnick, MS, MSS, ScD
Chief, Division of Communications, Standards and Training
Robert.Lipnick@us.army.mil
UNCLASSIFIED
Global EIDs: Selected Examples
UNCLASSIFIED
US Military Around the Globe
UNCLASSIFIED
AFHSC Mission and Vision
• Vision: To be the central epidemiological resource and a global
health surveillance proponent for the U.S. Armed Forces
• Mission:
Provide timely, relevant, actionable, and comprehensive
health surveillance information in order to promote, maintain, and
enhance the health of military, military-associated populations
– Acquire, analyze/interpret, disseminate information, and recommend
evidence-based policy
– Develop, refine, and improve standardized surveillance methods
– Serve as focal point for sharing health surveillance products, expertise
and information
– Coordinate a global program of militarily relevant infectious disease
surveillance
UNCLASSIFIED
AFHSC Relationships
Similar in nature to CDC and State and local health departments
Armed Forces
Health Surveillance
Center
CDC
State
Depts
County
Metro
Depts
PHC(P)
POPM
NMCPHC
BUMED
DoD
USAFSAM
AFMOA
Public
Health
Centers
MTFs
Dashed line indicates directUNCLASSIFIED
contact under appropriate circumstances
AFHSC Overview
• Division of Epidemiology and Analysis
– Utilizes the Defense Medical Surveillance System (DMSS)
– Periodic reporting of DoD health statistics and surveillance
– Customized analysis and reports for military leadership
• Division of Communications, Standards and Training
– Coordinating web-presence, publications and public affairs
– Develop and document surveillance standards
– Organize and execute training exercises and conferences
• Division of GEIS Operations
– Funding of infectious disease and surveillance research
– Coordination among overseas laboratories and other partners in the global
surveillance network
– Response to outbreak alerts and emergency notifications
• Data Management and Technical Support
– Design, operation and management of the DMSS
– Operation of the DoD Serum Repository
UNCLASSIFIED
Defense Medical Surveillance System
(DMSS)
Longitudinal Database
Ambulatory Data
234 million records
MEPS
12.4 million persons
27.4 million records
Immunizations
100 million records
In-Patient
Hospitalizations
2.6 million records
Personnel Data
9.5 million persons
114.4 million records
Chemistry
19.2 million recor
Health Risk
Assessments
575,000 records
PostDischarge
PreInduction
Deployments
5.1 million records
Serum Specimens
(DoD Serum Repository)
54.2 million specimens
All counts current as of December 2011
Reportable
Diseases
291,000 records
Microbiology
1.8 million records
Pre / Post-Deployment
Surveys
9,435,580 surveys
UNCLASSIFIED
Casualty Data
50,339 AD Deaths
DoD Serum Repository (DoDSR)
• World’s largest serum repository
• Unrivaled potential for sero-epi studies
• 54M serial serum specimens from 9.5M individuals
• Linked to demographic, military, and medical
information via the DMSS
UNCLASSIFIED
Serologic Studies
Examples Using the DoDSR
• Adenovirus among military and Coast Guard recruits
• Risk of HIV sero-conversion in US soldiers
• Susceptibility of measles and rubella among US Army
recruits
• Leishmaniasis serology in Gulf War veterans
• Persistence of antibody to Japanese encephalitis vaccine
• Sero-prevalence of hepatitis A, B and C in recruit
applicants
• Hantavirus in military personnel from four corners area
• Serologic evaluation for mycoplasm in Gulf War veterans
• PSA levels and PSA velocity and the risk of prostate
cancer
• Prevalence of West Nile Virus in NY military applicants
UNCLASSIFIED
AFHSC Periodic Reports in One Year
Versions
Recipients
per year
Versions
Recipients
per year
DOD Communicable Disease
Weekly
1
42
52
Weekly MedEvacs report for DMDC
Weekly
1
7
52
JTF Communicable Disease
Weekly
1
27
52
DMSS Counts
Monthly
1
1
12
Influenza Surveillance
Weekly*
1
108 +Web
32
MHS Dashboard Measures
Monthly
6
5
72
Malaria YTD Korea
Monthly
1
1
12
Special Surveillance: Amputations, DVT, Leish, ARDs
Monthly
1
1
12
Monthly Malaria Case Finding Report
Monthly
1
5
12
MSMR Special Surveillance MVA
Monthly
1
1
12
Meningococcal Report Line Listing
Monthly
1
1
12
MSMR Deployment Health
Monthly
1
1
12
AFPMB report for arthropod borne hemorrhagic fever
Annual
1
Web
1
EUCOM RMES Monthly Report
Monthly
1
1
12
AFPMB report for mosquito borne encephalitis
Annual
1
Web
1
Disease and Injury Distribution by service:
Quarterly
2
4
8
AFPMB report for dengue/hemorrhagic fever
Annual
1
Web
1
PreDeployment Health Assessment (DD2795) Summary
Monthly
2
50
24
AFPMB report for Lyme disease
Annual
1
Web
1
PostDeployment Health Assessment (DD2796) Summary
Monthly
2
50
24
AFPMB report for West Nile fever
Annual
1
Web
1
PostDeployment Health Reassessment (DD2900)
Monthly
2
50
24
AFPMB report for Leishmaniasis
Annual
1
Web
1
Civilian PreDeployment Health Assessment (DD2795)
Quarterly
1
2
4
Annual HIV Update
Annual
1
Web
1
Civilian PostDeployment Health Assessment (DD2796)
Quarterly
1
2
4
Injury Installation Reports
Monthly
1
Web
12
DOD Eye Injury
Quarterly
1
1
4
Lost Duty Application
Monthly
1
Web
12
DOD Hearing Injury
Quarterly
1
1
4
Force Health Protection Council Metrics
Monthly
1
1
12
Civilian PostDeployment Health Reassessment (DD2900)
Quarterly
1
2
4
Reserve Lost Duty Metrics
Monthly
2
4
24
Deployment Health Compliance Report
Quarterly
4
50
16
Ill, Injured and Wounded Report
Monthly
1
1
12
Deployment Health Civilian Compliance Report
Quarterly
1
2
4
TRADOC Injury Report
Monthly
2
7
24
Deployment Health Report
Quarterly
1
2
4
TMDS D&I Report
Quarterly
1
1
4
Army DD2900 Delinquency Report
Semi-annual
1
3
2
USASOC Special Reportable Events
Semi-Annual
1
1
3
DOD Annual Eye Injury
Annual
1
1
1
Army Annual Injury Report
Annual
1
1
1
DOD Annual Hearing Injury
Annual
1
1
1
USCG Burden of Disease
Annual
1
1
1
USCG PHA, PDHA PDHR
Annual
3
1
3
TRADOC Heat Injury Report
Yearly
1
1
1
Smallpox Vaccine Adverse Events – Cardiac
Monthly
1
1
12
TRADOC Cold Injury Report
Yearly
1
1
1
Reportable Events Vaccine Adverse Events (VAERS)
Monthly
HA PTSD Monthly
Monthly
2
5
24
DCoE TBI diagnoses for DTM
Monthly
1
1
12
Totals for one year
versions
TBI Positive Screenings Line Listing
Monthly
1
1
12
USASOC Mental Health and TBI Monthly Report
Monthly
1
1
12
HA Mental Health Report
Quarterly
1
5
12
USASOC Mental Health and TBI Quarterly Report
Quarterly
1
1
12
HA TBI
Quarterly
2
5
8
DoD Consolidated TBI Healthcare Encounter Report
Quarterly
4
1
16
AFSOC Mental Health and TBI Quarterly Report
Quarterly
1
1
12
AFSOC Mental Health and TBI Annual Report
Yearly
1
1
12
Report Name
Period
Report Name
*=seasonal
UNCLASSIFIED
Disease Reports
Injury Reports
Mental Health/ PTSD/TBI
Period
1
1
12
81
reports
757
Special Reports
Deployment
Vaccine Reports
Medical Surveillance Monthly Report
(MSMR)
– the MMWR of the military health system
– Over 150 issues since April 1995
• First full-color issue—August 2011
– 1,067 subscribers to the print edition
• 175 new requests per year
• 500 email subscribers
– 21% of 2011 articles were outside submissions
– Archives accessible online
– Average MSMR issue viewed 1,483 times
during its first 60 days online
– Indexed in MEDLINE since Jan 2011
• Searchable using PubMed
UNCLASSIFIED
UNCLASSIFIED
Medical Surveillance Monthly Report
(MSMR)
UNCLASSIFIED
Training
COMBATANT COMMAND ENGAGEMENTS
Trilateral Civilian-Military Forum on Outbreak Response and Bioterrorism
Investigation (USEUCOM)
Chisinau, Moldova; October 2010
Emerging Infectious Diseases Conference (USCENTCOM)
Amman, Jordan; October 2010
Malaria Symposium (USAFRICOM)
Stuttgart, Germany; April 2011
Countering Biological Threats Conference (USEUCOM)
Tbilisi, Georgia; May 2011
Command Post Exercise (USSOUTHCOM)
Belmopan, Belize; May 2011
One Health Surgeon’s Conference (USNORTHCOM)
Colorado Springs, CO; June 2011
Infectious Disease Border Issues Conference (USCENTCOM)
Amman, Jordan; June 2011
Infectious Diseases and Disaster Response Conference (USCENTCOM)
Abu Dhabi, UAE; July 2011
International Disease Surveillance Conference (USPACOM)
Kurumba, Maldives; September 2011
UNCLASSIFIED
Div of GEIS Operations
Vision and Mission
• Vision:
Be a scientifically credible and recognized
worldwide surveillance system for emerging infections, fully
integrating a global network of laboratory capabilities with a
comprehensive DoD health surveillance system.
• Mission:
Successfully develop, implement, support, and
evaluate an integrated global emerging infections
surveillance and response system that supports the AFHSC
and contributes to force health protection in US Forces, the
Military Health System, and the global public health
community.
“Partnering in the Fight against Emerging Infections”
UNCLASSIFIED
15
Global Emerging Infectious Surveillance
and Response System – Network Partners
FHP Research, Biosurveillance, Capacity Building
USAFSAM WRAIR
NMRC
NHRC
NAMRU-6
LRMC
USAMRU-G (prop)
NAMRU-3
AFRIMS
NAMRU-2 HI
NAMRU-2 PP
USAMRU-K
OCONUS Laboratories
Participating Countries
UNCLASSIFIED
Division of AFHSC-GEIS
Strategic Goals and Priority Pillars
AR = Antimicrobial Resistance
STI
STI
DRO
AR
FVBI = Febrile and Vectorborne Infection
GIGI
RI
GI = Gastrointestinal Infection
ARD
RI = Respiratory Infection
Febrile
FVBI Dis
Force Health Protection
STI = Sexually Transmitted
Infection
Surveillance and Response
Training and Capacity Building
Research, Innovation and Integration
Assessment and Communication of Value Added
UNCLASSIFIED
GEIS Supported Surveillance Programs
UNCLASSIFIED
FY12 PACOM Activities
Summary by Country
Bhutan
• Gastrointestinal
• Respiratory
Republic of Korea
• Influenza
• Malaria
• FVBI
• Hantavirus
• Rickettsia
Nepal
• Antimicrobial Resistance
• Gastrointestinal
• Salmonella
• E. coli
• FVBI
• Capacity Building
• Respiratory
Vietnam
• FVBI
• Malaria
• Respiratory
• Capacity Building
The Philippines
• Capacity Building
• FVBI
• Respiratory
• Malaria
Myanmar
• Malaria
Thailand
• Antimicrobial Resistance
• Capacity Building
• Respiratory
• Malaria
•Gastrointestinal
• Salmonella
• E. coli
• STI
• FVBI
• Leptospirosis
• Arbovirus
Indonesia
• FVBI
Japan
• Respiratory
• Malaria
• FVBI
•Hantavirus
Guam
• Respiratory
• Malaria
Sri Lanka
• Malaria
Solomon Islands
• Malaria
Laos
• Capacity Building
• Respiratory
Samoa
• Malaria
Singapore
• Capacity Building
• Respiratory
• FVBI
Vanuatu
• Malaria
Cambodia
• Malaria
• FVBI
• Capacity Building
• Respiratory
• Gastrointestinal
• E. coli
Australia
• Malaria
UNCLASSIFIED
19
GEIS AFRICOM FOOTPRINT
FY12
Burkina Faso, Mali, Mauritania, Morocco & Libya
•Capacity Building –Respiratory (NICs)
Ghana
•Capacity Building
•Malaria
•STI
•Respiratory
•FVBI
•ARO
•Enterics
Sudan
•FVBI
•Capacity Building
Sierra Leone
•FVBI
•Capacity Building
Liberia
•FVBI
•Malaria
•Enterics
Uganda
•Malaria
•Respiratory
•ARO
Cote d’Ivoire & Togo
•Respiratory
•Capacity Building
Nigeria
•Respiratory
•Malaria
Cameroon
•Capacity Building
•Respiratory
•STI
Djibouti
•FVBI
•Respiratory
•STI
•Malaria
•Enterics
Gabon
•Malaria
•Enterics
Tanzania
•Respiratory
•Capacity Building
•Malaria
•FVBI
UNCLASSIFIED
Kenya
•Capacity Building
•FVBI
•Enterics
•Malaria
•Respiratory
•STI
•ARO
2
EUCOM Activities by Country
Poland
•Respiratory
Ukraine
• Febrile illness
United Kingdom
•Respiratory
Belgium
•Respiratory
Germany
•Respiratory
•Multi-drug
resistant pathogens
Georgia
•Respiratory
•Febrile illness
•Sexually transmitted infections
Spain
•Respiratory
Portugal
•Respiratory
Italy
•Respiratory
Kosovo
•Respiratory
Greece
•Respiratory
Turkey
•Respiratory
Bulgaria
• Febrile illness
UNCLASSIFIED
21
CENTCOM Activities by Country
Iraq
•Respiratory
Jordan
•Hospital acquired infections
•Respiratory
Afghanistan
•Capacity building
Egypt
• Crimean Congo
Hemorrhagic Fever
•Capacity building
•Respiratory
•Enteropathogens
Oman
•Respiratory
Qatar
•Respiratory
Yemen
•Chikungunya
•Dengue
•Respiratory
UNCLASSIFIED
22
NAMRU-3 Activities in CENTCOM
EUCOM AFRICOM
NAMRU-3, Egypt
Ghana Detachment
Afghanistan Satellite
Lab
Active Duty Site
Antimicrobial Resistance
Febrile / Vector Borne
(VBI) / Malaria
Febrile / VBI / Neurological
Gastrointestinal Infections
Respiratory Infections
Sexually Transmitted Infections
Laboratory capacity building
UNCLASSIFIED
23
Outbreak Investigation (FY11)
• Over 50 Outbreaks in 15 countries
– Influenza, cholera, dengue, malaria and others
• Multiple populations
– 16 at US installations (CONUS & OCONUS)
– 18 in partnership with foreign civilian entities
– 3 in collaboration with foreign military partners
– 8 in animal populations
• Field support, epidemiological consultation, laboratory diagnostics
UNCLASSIFIED
AFHSC’s Website
http://www.afhsc.mil
UNCLASSIFIED
Questions?
COL Robert J. Lipnick, MS, MSS, ScD
Chief, Division of Communications, Standards & Training
Robert.Lipnick@us.army.mil
UNCLASSIFIED