Citation
Medical surveillance monthly report

Material Information

Title:
Medical surveillance monthly report
Alternate title:
MSMR
Creator:
U.S. Army Center for Health Promotion and Preventive Medicine
Armed Forces Health Surveillance Center (U.S.)
Place of Publication:
Silver Spring, MD
Publisher:
Armed Forces Health Surveillance Branch
Publication Date:
Frequency:
Monthly
regular
Language:
English

Subjects

Subjects / Keywords:
Medicine, Military -- Periodicals -- United States ( lcsh )
Medicine, Preventive -- Periodicals -- United States ( lcsh )
Military Personnel ( mesh )
Morbidity ( mesh )
Population Surveillance ( mesh )
Wounds and Injuries -- epidemiology ( mesh )
Medicine, Military ( fast )
Medicine, Preventive ( fast )
United States ( mesh )
United States ( fast )
Genre:
Statistics.
serial ( sobekcm )
statistics ( marcgt )
federal government publication ( marcgt )
periodical ( marc )
Statistics ( mesh )

Notes

Dates or Sequential Designation:
Began with: Vol. 1, issue 1 (Apr. 1995).
General Note:
"A publication of the Armed Forces Health Surveillance Center."

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
This item is a work of the U.S. federal government and not subject to copyright pursuant to 17 U.S.C. §105.
Resource Identifier:
671268376 ( OCLC )
2010201449 ( LCCN )
2158-0111 ( ISSN )
ocn671268376
Classification:
ISSN RECORD ( lcc )
355 ( ddc )
W1 MS245L ( nlm )

UFDC Membership

Aggregations:
University of Florida
Digital Military Collection

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USACHPPMMSMR Data in the MSMR is provisional, based on reports and other sources of data available to the Medical Surveillance Activity. Notifiable conditions are reported by date of onset (or date of notification when date of onset is absent). Only cases submitted as confirmed are included. Table of Contents Chemical agent exposure, Germany ............................ 3 Selected notifiable conditions ....................................... 4 Notifiable sexually transmitted diseases ....................... 6 Influenza-like illness, Ft Benning .................................. 7 ARD update ................................................................. 8 Supplement #1: 1994 Hospitalization Summary Active Duty Hospitalizations .............................. 10 Hospitalization rates .......................................... 11 Total Hospital Sickdays ...................................... 12 Non-Effective Rates ........................................... 13 Supplement #2: 1994 Reportable Disease Summary Reports submitted by MTF ................................. 14 Notifiable sexually transmitted diseases ............. 15 All notifiable conditions ...................................... 16 Heat / Cold weather injuries .............................. 18 Force strength (December 1994) ................................. 19 VOL. 01 NO. 01APRIL 1995Medical Surveillance Monthly Report

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MSMR 2 April, 1995 The Medical Surveillance Monthly Report (MSMR): A Mirror on the Health, Fitness, and Medical Readiness of AmericaÂ’s Army The MSMR will be a principal vehicle for disseminating medical surveillance information of broad interest. It will routinely publish summaries of notifiable diseases, trends of illnesses of special surveillance interest, and field reports describing outbreaks and case occurrences with significance beyond the setting in which they occurred. Initially, we anticipate that the MSMR will appeal primarily to medical audiences. As time passes, we hope it will gain interest among troop leaders who have ultimate responsibility for the health, fitness, and readiness of their commands. The ultimate goal in summarizing surveillance data is to provide readily available information necessary to inform, motivate, and empower commanders, their surgeons, and medical staffs to design, implement, and resource programs that enhance health, fitness, and readiness. Readers will notice that much information in the current MSMR is incomplete. Obviously, the information in the MSMR will always reflect the completeness and accuracy of underlying data sources. If the MSMR acts as a mirror on the health and disease experience of the Army, the clarity of the mirrorÂ’s reflection depends, to a great extent, on the effort of the viewers to focus and refine the image. We hope the MSMR will encourage and justify more complete and reliable reporting to medical data systems. If the MSMR is not useful to its readers, it will have no value. In this light, the MSMRÂ’s success or failure can be judged only by its readers. We solicit suggestions, comments, and criticisms. We also solicit positive comments so we will not be tempted to fix something that works well. Finally, we gratefully acknowledge the enormous, largely unheralded contributions of individuals and organizations that collect, store, and share the data that are the basis of MSMR summaries. If the MSMR has value, it derives from their efforts. John Brundage, MD General Sullivan, chief of staff of the Army, has stated, "Information is power." This clear and simple statement has provided challenges and abundant opportunities to the Army Medical Department. In part, the AMEDD has responded by establishing the Army Medical Surveillance Activity in the US Army Center for Health Promotion and Preventive Medicine (USACHPPM). The Medical Surveillance Monthly Report (MSMR) is one of the first widely visible products of the new Medical Surveillance Activity. Executive Editor John F. Brundage, MD, MPH Director Epidemiology and Disease Surveillance, USACHPPM Editor Mark V. Rubertone, MD, MPH Chief, Army Medical Surveillance Activity, USACHPPM Managing Editor Vacant Writers / Editorial staff Bruce H. Jones, MD, MPH Vincent P. Fonseca, MD, MPH Sharon L. Ludwig, MD, MPH Views and opinions expressed are not necessarily those of the Department of the Army. Prepared by the Medical Surveillance Activity, Directorate of Epidemiology and Disease Surveillance, United States Army Center for Health Promotion and Preventive Medicine. Inquiries regarding content or material to be considered for publication should be directed to the editor, MAJ Mark Rubertone, Walter Reed Army Institute of Research, Bldg T-20, Rm 213, Washington DC, 20307-5100, DSN 662-1335, commercial (202) 782-1335. E-mail: "rubertone@wrair-emh1.army.mil". Publishing office is the Executive Communications Division, U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, Maryland 21010-5422, telephone 1-800-2229698, DSN 584-2088, Commercial 410 6712088. FAX 410 671-2084.

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MSMR Vol. 01 / No. 01 3 Information regarding CS gas was obtained from the Industrial Hygiene Division, Center for Health Promotion and Preventive Medicine Europe Health effects, and treatment for CS ExposureCS gas is a chemical agent used primarily for riot control. There are a number of manufacturers and a variety of combinations of ingredients. In this incident, the canister containing the CS powder was unmarked so the exact components could not be determined. However, the brand thought to be most commonly used in this area contains 2-chloroacetophenone as the principal ingredient. The Material Safety Data Sheet (MSDS) characterizes the compound as a mucous membrane irritant with routes of entry being inhalation (primary), skin and ingestion. Overexposure may cause cough, pulmonary edema and coma. There is no carcinogenic risk. Emergency first aid consists of removal from the environment, ventilation, flushing of eyes with water (for eye contact), removal of clothing and soap and water cleansing (for skin contact). In cases of ingestion it is recommended that subjects be given water and induced to vomit, if conscious. When handling material above the Permissible Exposure Limit set by OSHA (0.05 ppm) it is recommended that workers wear respiratory protection, chemical safety goggles and chemical gloves and that an eye wash station be readily available. On the morning of 2 February 1995 soldiers of the 29th Medical Detachment in Baumholder, Germany, were conducting NBC training when they came upon an unmarked can. A soldier opened the can and soon realized the can contained CS powder. CS powder is a mucous membrane irritant commonly used in conjunction with M-17 Mask training (see below). In the course of events some of the powder became airborne. The soldier exited the area and began opening windows to enhance ventilation of the area. Unfortunately, this led to drafting of a small amount of the powder into the adjacent clinic. The clinic was ventilated, but a total of 27 persons (9 active duty Army, 10 Army family members, and 8 DA civilians) were potentially exposed to the CS powder. The exposure was characterized as minor, with most patients displaying no symptoms whatsoever. All patients were evaluated in the acute care clinic and released. No patients were hospitalized. The EUR-HSSA Environmental Science Officer (ESO) was notified and traveled to the clinic the same day. He evaluated the incident and recommended the following:Submitted by James E. Cook, MAJ, MC, Epidemiology Consultant(CHPPM-EUR).; DSN 486-8113/8800/8546, commercial 011-49-6371-86-8113, FAX 486-7198, email “cookj@landstuhl-lab.army.mil”.1) Inventory of all hazardous materials within the clinic. 2) Turn in of all NBC chemicals. 3) Initiation of a HAZCOM program. 4) Notification to the community Base Support Battalion (BSB) Environmental Office and Safety Officer for completion of appropriate incident reports. Report from the FieldCS Powder Exposure, Baumholder, Germany

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MSMR 4 April, 1995 TABLE I. Cases of selected notifiable conditions, United States Army.* March, 1995 Total number Environmental Injuries Viral Hepatitis MalariaVaricella Reporting of reports Active Duty COActiveActiveOther MTF/Post** submitted HeatCold intox. ABC DutyDutyAdult this period Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 NORTH ATLANTIC HSSA Walter Reed AMC 13----2---Aberdeen Prov. Ground 2--------FT Belvoir, VA16--------FT Drum, NY24-21-----11FT Eustis, VA13--------FT Knox, KY61--------FT Lee, VA14------7FT Meade, MD0-------USMA, West Point, NY0--------CENTRAL HSSA Fitzsimons AMC 0--------FT Carson, CO69-------4FT Leonard Wood, MO32-1--1--192 FT Leavenworth, KS0-------FT Riley, KS0--------SOUTH CENTRAL HSSA Brooke AMC 0--------FT Hood, TX129----1--151 FT Polk, LA0--------FT Sill, OK0--3 -----Panama152--21 ---SOUTHEAST HSSA Eisenhower AMC 29-----1-1FT Benning, GA 0-10------FT Bragg, NC0-------FT Campbell, KY95-------2FT Jackson, SC24-------4FT McClellan, AL0--------FT Rucker, AL0--------FT Stewart, GA0--------SOUTHWEST HSSA Wm Beaumont AMC 8-------32 FT Huachuca, AZ0--------FT Irwin, CA0--------NORTHWEST HSSA Madigan AMC 0--------FT Wainwright, AK23-16------PACIFIC HSSA Tripler AMC 75------4-OTHER LOCATIONS Europe 15-41-----Korea0------1Total 65725242514675 * Based on date of onset. ** Reports are included from parent and daughter clinics. Not all sites reporting.Date of Report:7-Apr-95

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MSMR Vol. 01 / No. 01 5 TABLE I. Cases of selected notifiable conditions, United States Army* (continued). March, 1995 SalmonellosisShigellaCampylobacteriosisTuberculosis Reporting Active Other Active Other Active Other ActiveOther MTF/Post**Duty AdultChild Duty AdultChild Duty AdultChild Duty Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 Cum. 1995 NORTH ATLANTIC HSSA Walter Reed AMC ----------Aberdeen Prov. Ground ----------FT Belvoir, VA-11-------FT Drum, NY-----1----FT Eustis, VA----------FT Knox, KY----------FT Lee, VA ----------FT Meade, MD ----------USMA, West Point, NY----------CENTRAL HSSA Fitzsimons AMC ----------FT Carson, CO-11-----1-FT Leonard Wood, MO--1 -------FT Leavenworth, KS ----------FT Riley, KS----------SOUTH CENTRAL HSSA Brooke AMC ----------FT Hood, TX ----1-----FT Polk, LA----------FT Sill, OK ----------Panama225-1--27-SOUTHEAST HSSA Eisenhower AMC ----------FT Benning, GA ----------FT Bragg, NC111---1 ---FT Campbell, KY---1-2----FT Jackson, SC---------2FT McClellan, AL----------FT Rucker, AL----------FT Stewart, GA----------SOUTHWEST HSSA Wm Beaumont AMC ----------FT Huachuca, AZ----------FT Irwin, CA----------NORTHWEST HSSA Madigan AMC ----------FT Wainwright, AK----------PACIFIC HSSA Tripler AMC --1---3---OTHER LOCATIONS Europe --1---11--Korea----------Total 351112353820 * Based on date of onset. ** Reports are included from parent and daughter clinics. Not all sites reporting.Date of Report:7-Apr-95

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MSMR 6 April, 1995 TABLE II. Cases of notifiable sexually transmitted diseases, United States Army. March, 1995Reporting ChlamydiaGonorrhea Herpes Simplex Syphilis Prim/Sec Syphilis Latent Urethritis non-spec. Other STDs** MTF/Post**Cur.Cum.Cur.Cum.Cur.Cum.Cur.Cum.Cur.Cum.Cur.Cum.Cur.Cum. Month1995Month1995Month1995Month1995Month1995Month1995Month1995 NORTH ATLANTIC HSSA Walter Reed AMC -------------2 Aberdeen Prov. Ground 418-8-------2-FT Belvoir, VA442622-1----11 FT Drum, NY5122927-----6-FT Eustis, VA-6-6---------FT Knox, KY22223322-------FT Lee, VA15318-1----11-FT Meade, MD-------------USMA, West Point, NY-------------CENTRAL HSSA Fitzsimons AMC -------------FT Carson, CO2984938318----2292-1 FT Leonard Wood, MO6206141112--314-1 FT Leavenworth, KS-------------FT Riley, KS-------------SOUTH CENTRAL HSSA Brooke AMC -------------FT Hood, TX25177898-5-316226-2 FT Polk, LA-------------FT Sill, OK-------------Panama---4--35-----1 SOUTHEAST HSSA Eisenhower AMC 72331145-1--12-1 FT Benning, GA -------------FT Bragg, NC-------------FT Campbell, KY3810193646-1--1351-FT Jackson, SC144131227---1---1 FT McClellan, AL---1---------FT Rucker, AL-------------FT Stewart, GA-8---2-----5-1 SOUTHWEST HSSA Wm Beaumont AMC -------------FT Huachuca, AZ-------------FT Irwin, CA-------------NORTHWEST HSSA Madigan AMC -------------FT Wainwright, AK29-5----11---PACIFIC HSSA Tripler AMC 16518201829-------OTHER LOCATIONS Europe -11---1-------Korea--------------Total 173 592 56 289 38 86 4 13 2 842199111 * Reports are included from parent and daughter clinics. Not all sites reporting.Date of Report: 7-Apr-95 ** Other STDs: (a) Chancroid (b) Granuloma Inguinale (c) Lymphogranuloma Venereum (d) Syphilis unspec. (e) Syph, tertiary (f) Syph, congenital

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MSMR Vol. 01 / No. 01 7 Figure 1. Number of ARD Admissions per Day, January 19953 4 6 15 14 13 6 2 0 2 4 6 8 10 12 14 16 2021222324252627 Date of AdmissionCases Submitted by Daniel R. Davidson, LTC, MC, Chief, Preventive Medicine Service, Fort Benning, GA 319056100; DSN 835-1144/4140, commercial 706 5451144, FAX 835-1449, email “bennpms@ftbenningamedd.army.mil”.Influenza Outbreak in Basic Trainees, Fort Benning, GA Report from the Field During the period from 20 January 27 January 1995, 63 basic trainees were admitted to Martin Army Hospital for acute respiratory disease (ARD). The ARD rate for all basic trainees during the week was 1.9%. Two battalions, 1/38 Infantry Regiment and 2/54 Infantry Regiment had the highest rates, 1.8% and 4.8% respectively. One company, A Company, 2/54 Infantry Regiment had an ARD rate of 14.7%, which was greater than any other company. The epidemic curve for cases in the outbreak is depicted in Figure 1. The clinical presentation for all soldiers began with abrupt onset of fever as high as 103.20F. Other symptoms beginning with the most frequent were dry cough, headache, myalgias, nausea, dizziness and pharyngitis. Two soldiers had chest x-rays consistent with viral pneumonia. None of the 48 strep cultures obtained during the outbreak period were positive. Viral cultures were obtained for 33 of the 63 affected soldiers. Two cultures were positive for influenza, type A. No culture was positive for adenovirus. Later in the outbreak it was determined that none of the soldiers in 1/38 Infantry Regiment or 2/ 54 Infantry Regiment had received annual influenza immunizations. Based on similar case presentations and two positive cultures, we believe that influenza A was the most likely cause of this outbreak. Two other outbreaks of influenza A have been reported in the state of Georgia during the 1994-1995 influenza season. The low yield on cultures for influenza A may have been due to a delay in receiving viral culture media. The optimal time for collecting influenza cultures is during the acute febrile period, and some soldiers were beyond this period when the cultures were obtained.

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MSMR 8 April, 1995 Top 10 diagnostic categories* among US soldiers hospitalized in Saudi Arabia during Operation Desert Storm/Shield.ICD9 code Diagnostic category n % 724Other/unspecified disorders of back988 4.02 558Other noninfective gastroenteritis/colitis946 3.85 959Injury, other or unspecified590 2.40 493Asthma542 2.21 786Symptoms involving respiratory system or other chest symptoms485 1.98 722Intervertebral disc disorders461 1.88 836Dislocation of knee427 1.74 592Calculus of kidney or ureter415 1.69 844Sprains or strains of knee or leg398 1.62 780General symptoms358 1.46* Excludes follow-up examinations and encounters for administrative purposesSource: Individual Patient Data System, USA Patient Administration Systems and Biostatistical Activity, Fort Sam Houston, TX.Adenovirus Vaccine Shortage ARD UpdateSince 1971, vaccines for adenoviruses types 4 and 7 have been administered to new basic trainees as part of their initial medical in-processing. Before the vaccine was available, 600-800 adenovirus admissions per week (1) were not unusual at some basic training installations during the winter. In some cases tents had to be set up outside the hospital to accommodate the overflowing ARD wards. The impact of these outbreaks was tremendous. The initiation of adenovirus vaccination, along with meningococcal vaccination and Acute Respiratory Disease (ARD) surveillance (permitting early outbreak intervention), are thought to be responsible for a notable decrease in ARD rates among basic trainees over the years. Although still a cause of significant morbidity, wintertime ARD rates have dropped from 5 to 8% of trainees per week in the 1960Â’s (2) to 0.35% per week in the 1990Â’s (3). This decrease represents a Preventive Medicine victory, but not a reason for complacency. In December the CHPPM became aware of a shortage of adenovirus vaccine at basic training posts that began as early as May 1994. There was great concern about entering the winter without protection from this historically severe threat to trainee health and mission accomplishment. With input from the CHPPMÂ’s Directorates of Clinical Preventive Medicine (DCPM) and Epidemiology and Disease Surveillance (DEDS), the MEDCOM issued a policy on adenovirus surveillance and outbreak response for the six basic training posts (4). The ARD surveillance guidelines were modified to increase vigilance for upward trends in overall ARD rates, and decrease the threshold used to detect epidemics (from 1.5% of trainees per week for two weeks to 1.5% per week for one week). When the rates exceeded this threshold, specific laboratory and inpatient surveillance measures were to be instituted. Epidemic Consultation (EPICON) assistance was offered for outbreaks that might exceed the capabilities of local and regional preventive medicine assets. This winter there has been only one ARD epidemic. It was short (no more than two weeks)(Continued on next page) T op 10 Corner

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MSMR Vol. 01 / No. 01 9 Notice to ReadersThe following tables and supplements are additions to the current volume. Hospitalization Summary: IPDS data for Army active duty soldiers will be summarized quarterly with an annual summary appearing in the April issue. Reportable Disease Summary: Case reports submitted from MTFs through Preventive Medicine Services on reportable diseases/conditions will be summarized annually in the April issue. Force Strength: Based on data from the Defense Manpower Data Center (DMDC) this table will be produced quarterly. ARD update continued and apparently not due to adenovirus (see report from the field). The high risk season, however, is not over, and large spring and summer adenovirus outbreaks have been documented. A one year’s supply of the vaccines is now in stock.References (1) Top, FH Jr. Control of adenovirus acute respiratory disease in US Army trainees. Yale J Biol Med, 1975;48:185-95. (2) Gaydos, CA and JC Gaydos. Adenovirus vaccines in the US military: A success story threatened. In press. (3) Brundage, JF et al. Epidemiology and control of febrile acute respiratory disease and group A beta hemolytic streptococcus in military trainee populations: Recent US Army Experience. In press. (4) Memorandum, HQ MEDCOM, MCHO-CL, 25 January 1995, subject: Acute Respiratory Disease (ARD) and Adenovirus Surveillance Programs. Submitted by Sharon L. Ludwig, MAJ, MC, Respiratory Disease Project Officer, USACHPPM, Aberdeen Proving Ground, MD, 31905-6100; DSN 662-1303, commercial (202) 782-1303, FAX 662-0745, email “ludwig@wrair-emh1.army.mil”.

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MSMR 10 April, 1995 Supplement #1 (Hospitalization Summary, 1994) TABLE S1. Active Duty Hospitalizations, United States Army, 1994MalesFemales All ICD-9 Category< 2020-2425-2930-3435-39>= 40 Total M < 2020-2425-2930-3435-39>= 40 Total F Infectious and Parasitic Diseases50991933517213486 2155 20125081362715 6102765Neoplasms28219174144211324 1100 159298131148121 6051705Endocrine, Nutritional, and Metabolic Disease and Immunity Disorders267660545878 352 134031191723 143495Diseases of the Blood and Blood-Forming Organs104027171420 128 11159484 51179Mental Disorders3821730909561505315 4402 1623501741647844 9725374Diseases of the Nervous System and Sense Organs115405324229251314 1638 5210184666768 4382076Diseases of the Circulatory System52275235233358703 1856 105540394954 2472103Diseases of the Respiratory System9811537617404317278 4134 2793841411035937 10035137Diseases of the Digestive System412244412478729081062 6945 166584267147137132 14338378Diseases of the Genitourinary System98463326252245257 1641 135638412339280199 20033644Complications of Pregnancy, Childbirth, and the Puerperium* -------4033657175686732222 70277027Diseases of the Skin and Subcutaneous Tissue16549122715211082 1227 366642393124 2381465Diseases of Musculoskeletal System and Connective Tissue80230782211181516571399 10962 191626396313273226 202512987Congenital Abnormalities6517299484028 452 7322212102 85537Symptoms, Signs, and illDefined Conditions148489319266398479 2099 60167108656357 5202619Injury and Poisoning56327301436767474339 6309 88281122927649 7087017Disease, not fully coded3311292824652605615 4319 195758475296186148 20586377Injury, not fully coded119053192010 203 456342 24227All Hospitalizations 4698164509423665763056389499222028810142642735183512272019070112* Includes normal delivery Source: Individual Patient Data System, USA Patient Administration Systems and Biostatistical Activity, Fort Sam Houston, TX

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MSMR Vol. 01 / No. 01 11 TABLE S2. Active Duty Hospitalization Rates, United States Army, 1994* MalesFemales All ICD-9 Category< 2020-2425-2930-3435-39>= 40 Total M < 2020-2425-2930-3435-39>= 40 Total F Infectious and Parasitic Diseases31.06.03.12.12.01.7 4.5 70.710.74.82.93.12.7 8.75.0 Neoplasms1.71.41.61.73.26.5 2.3 5.33.95.810.516.921.4 8.63.1 Endocrine, Nutritional, and Metabolic Disease and Immunity Disorders1.60.50.50.70.91.6 0.7 4.61.71.81.51.94.1 2.00.9 Diseases of the Blood and Blood-Forming Organs0.60.30.20.20.20.4 0.3 3.90.60.50.30.90.7 0.70.3 Mental Disorders23.311.48.36.87.66.3 9.2 57.015.010.313.18.97.8 13.89.8 Diseases of the Nervous System and Sense Organs7.02.73.02.83.86.3 3.4 18.34.35.05.37.712.1 6.23.8 Diseases of the Circulatory System3.21.82.12.85.414.1 3.9 3.52.42.43.15.69.6 3.53.8 Diseases of the Respiratory System59.810.15.64.94.75.6 8.6 98.116.48.38.26.76.6 14.39.3 Diseases of the Digestive System25.116.011.410.513.621.3 14.5 58.425.015.811.715.723.4 20.415.2 Diseases of the Genitourinary System6.03.03.03.03.75.1 3.4 47.527.324.327.032.035.3 28.56.6 Complications of Pregnancy, Childbirth, and the Puerperium** -------141.7156.5103.669.236.83.9 100.112.8 Diseases of the Skin and Subcutaneous Tissue10.13.22.11.81.61.6 2.6 12.72.82.53.13.54.3 3.42.7 Diseases of Musculoskeletal System and Connective Tissue48.920.220.121.924.828.0 22.9 67.126.823.425.031.240.1 28.823.6 Congenital Abnormalities4.01.10.90.60.60.6 0.9 2.51.41.31.01.10.4 1.21.0 Symptoms, Signs, and illDefined Conditions9.03.22.93.26.09.6 4.4 21.17.16.45.27.210.1 7.44.8 Injury and Poisoning34.317.913.19.27.16.8 13.2 30.912.07.27.38.78.7 10.112.8 Disease, not fully coded20.28.57.57.99.112.3 9.0 68.632.428.023.621.326.2 29.311.6 Injury, not fully coded0.70.60.50.20.30.2 0.4 1.40.20.40.20.50.4 0.30.4All Hospitalizations 286.6108.085.880.294.4127.9104.2713.0346.7251.6218.2209.8217.5287.5127.5 * Rates are calculated per 1000 soldiers per year based on mid-interval 1994 DMDC Data.** Includes normal delivery Source: Individual Patient Data System, USA Patient Administration Systems and Biostatistical Activity, Fort Sam Houston, TX

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MSMR 12 April, 1995 TABLE S3. Total Active Duty Hospital Sickdays, United States Army, 1994*MalesFemales All ICD-9 Category< 2020-2425-2930-3435-39>= 40 Total M < 2020-2425-2930-3435-39>= 40 Total F Infectious and Parasitic Diseases202540832691187917751494 13947 5558343741202372110 344717394Neoplasms32670203657186330957311 23272 56756928145133001599 809031362Endocrine, Nutritional, and Metabolic Disease and Immunity Disorders12186725613716253889 7129 38148409161127147 10308159Diseases of the Blood and Blood-Forming Organs8060747746157326 1693 18262342663157 6682361Mental Disorders37733414125115164561532112486 107292 97140383459366725071682 16324123616Diseases of the Nervous System and Sense Organs97874168097685934474810 31607 3487291718494561336 418635793Diseases of the Circulatory System168303926922955418812205 25247 8375205291801412 209227339Diseases of the Respiratory System310466593805335825581584 21068 69416861198391302506 477725845Diseases of the Digestive System1936113456115539447227674 37186 48219942940959778654 780744993Diseases of the Genitourinary System2952253191015372173831 8999 56525032651186415751461 1061919618Complications of Pregnancy, Childbirth, and the Puerperium** -------3131306581449265402429182 5743257432Diseases of the Skin and Subcutaneous Tissue78429982969521408784 8464 164296454155312163 154410008Diseases of Musculoskeletal System and Connective Tissue23223527226160214362366525312 134167 22559834960425241882953 22561156728Congenital Abnormalities110167513888644441015 5496 1846869386941 12886784Symptoms, Signs, and illDefined Conditions31544464408216318462561 15739 2871006539781677216 350619245Injury and Poisoning51033509817144753762556038 77175 52123607128401021553 600783182Disease, not fully coded159818540105901195071328663 58473 191277505234350221531929 2248080953Injury, not fully coded511455207121516352 4007 3945614295 1834190All Hospitalizations 1769148640497035100324043721857174041 2308911954577974580961618912685812966755002 * Includes bed days, convalescent sickdays and medical hold days** Includes normal delivery Source: Individual Patient Data System, USA Patient Administration Systems and Biostatistical Activity, Fort Sam Houston, TX

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MSMR Vol. 01 / No. 01 13 TABLE S4. Non-Effective Rates, Active Duty Hospitalization, United States Army, 1994* MalesFemales All ICD-9 Category< 2020-2425-2930-3435-39>= 40 Total M < 2020-2425-2930-3435-39>= 40 Total F Infectious and Parasitic Diseases123.526.824.522.626.629.9 29.1 195.135.722.195.942.519.5 49.131.6Neoplasms19.946.133.322.546.3146.4 48.6 19.732.454.8115.8377.3283.4 115.257.0Endocrine, Nutritional, and Metabolic Disease and Immunity Disorders7.45.72.316.59.477.9 14.9 13.46.324.112.814.526.1 14.714.8Diseases of the Blood and Blood-Forming Organs4.94.04.30.62.46.5 3.5 6.311.22.021.23.510.1 9.54.3Mental Disorders230.1224.2228.7198.3229.3250.0 224.0 341.4172.8204.1292.6286.6298.1 232.4224.9Diseases of the Nervous System and Sense Organs59.748.773.782.751.696.3 66.0 122.331.2101.439.464.159.5 59.665.1Diseases of the Circulatory System10.220.024.535.662.7244.4 52.7 2.816.012.123.291.673.0 29.849.7Diseases of the Respiratory System189.343.734.740.538.331.7 44.0 244.072.170.731.234.589.7 68.047.0Diseases of the Digestive System118.174.555.765.070.7153.6 77.6 169.485.3173.576.588.9115.9 111.281.8Diseases of the Genitourinary System18.014.817.418.532.516.6 18.8 198.6107.1156.5148.7180.1258.9 151.235.7Complications of Pregnancy, Childbirth, and the Puerperium** ------1100.71312.0855.3521.8277.732.3 817.8104.5Diseases of the Skin and Subcutaneous Tissue47.819.727.06.36.115.7 17.7 57.712.726.812.435.728.9 22.018.2Diseases of Musculoskeletal System and Connective Tissue141.6231.6238.3258.3354.3506.8 280.2 79.1256.0292.7339.3478.8523.3 321.2285.1Congenital Abnormalities6.711.012.610.46.620.3 11.5 6.320.04.13.079.30.2 18.312.3Symptoms, Signs, and illDefined Conditions19.229.240.126.127.651.3 32.9 100.943.131.862.377.438.3 49.935.0Injury and Poisoning311.3230.5156.190.893.6120.9 161.2 183.2101.042.067.0116.798.0 85.5151.3Disease, not fully coded97.5121.796.5144.0106.8173.5 122.1 672.2331.7308.9279.4246.1341.9 320.1147.3Injury, not fully coded3.19.618.92.62.41.0 8.4 13.71.93.60.33.30.9 2.67.6All Hospitalizations 140811621089104111671943121335272649238621432499229824781373 * Rates are calculated as lost duty days per 1000 soldier per year based on mid-interval 1994 DMDC data.** Includes normal de livery Source: Individual Patient Data System, USA Patient Administration Systems and Biostatistical Activity, Fort Sam Houston, TX

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MSMR 14 April, 1995 Supplement #2 (Reportable Disease Summary, 1994) TABLE S5. Cases of notifiable conditions reported through Medical Surveillance System* ReportingPilot MTF/Post**PhaseMay '94Jun '94Jul '94Aug '94Sep '94Oct '94Nov '94Dec '94Total NORTH ATLANTIC HSSA Walter Reed AMC 11985103881678 Aberdeen Prov. Ground ---------0 FT Belvoir, VA--8-1611761563 FT Drum, NY301121915218896 FT Eustis, VA-211-12-14-2169 FT Knox, KY---4830740---395 FT Lee, VA-1332191915---98 FT Meade, MD ---------0 USMA, West Point, NY---------0CENTRAL HSSA Fitzsimons AMC --4110----15 FT Carson, CO--11711121218999124717 FT Leonard Wood, MO---182415221610105 FT Leavenworth, KS-1---2---3 FT Riley, KS---------0SOUTH CENTRAL HSSA Brooke AMC 1033-------106 FT Hood, TX ------472-49 FT Polk, LA---------0 FT Sill, OK ----31--15 Panama -2113516271570SOUTHEAST HSSA Eisenhower AMC ---------0 FT Benning, GA -577--8--27 FT Bragg, NC5 -411133422 FT Campbell, KY---1134604322161 FT Jackson, SC893371463330308268 FT McClellan, AL--551-----56 FT Rucker, AL----610---16 FT Stewart, GA21146672763415035-540SOUTHWEST HSSA Wm Beaumont AMC ---------0 FT Huachuca, AZ---------0 FT Irwin, CA---------0NORTHWEST HSSA Madigan AMC 35223816-461 FT Wainwright, AK--1151011852575PACIFIC HSSA Tripler AMC -143532254347379242OTHER LOCATIONS Europe 105-855662911-1275 Korea-1----13--14Total 508127268478761421451329283 3626 * Based on date of receipt. ** Reports are included from parent and daughter clinics. Not all sites reporting.

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MSMR Vol. 01 / No. 01 15 TABLE S6. Cases of notifiable sexually transmitted diseases, United States Army, 1994* Chlamydia Urethritis non-spec. Gonorrhea Herpes Simplex Syphilis Prim/Sec Syphilis Latent R epor ti ng MTF/Post** A c ti ve Duty Other A c ti ve Duty Other A c ti ve Duty Other A c ti ve Duty Other A c ti ve Duty Other A c ti ve Duty Other MFMFMFMFMFMFMFMFMFMFMFMF NORTH ATLANTIC HSSA Walter Reed AMC ----------------------Aberdeen Prov. Ground ----------------------FT Belvoir, VA2-221---2117-112 ----1--1 FT Drum, NY102-39---14--21---1--111-FT Eustis, VA7612 ----21838----1 ------FT Knox, KY1044117115----5849112019430---13--1 FT Lee, VA11282163---181252-2--------FT Meade, MD ----------------------USMA, West Point, NY----------------------CENTRAL HSSA Fitzsimons AMC -1-4-------1----------FT Carson, CO9849790256-11196266271812-191----1-FT Leonard Wood, MO6341427-3-152-311--------FT Leavenworth, KS ----------------------FT Riley, KS----------------------SOUTH CENTRAL HSSA Brooke AMC ------1---------------FT Hood, TX383022915---47 9362--111--31-3 FT Polk, LA----------------------FT Sill, OK ----------------------Panama -------9343-1-1---1 ---SOUTHEAST HSSA Eisenhower AMC ---1---------1--------FT Benning, GA ----------------------FT Bragg, NC ----------------------FT Campbell, KY16581477822-329-91---1------FT Jackson, SC159610311---152668-17341--1---FT McClellan, AL----------------------FT Rucker, AL1-------1-------------FT Stewart, GA431-50224-911073442111113-1--1--SOUTHWEST HSSA Wm Beaumont AMC ----------------------FT Huachuca, AZ----------------------FT Irwin, CA----------------------NORTHWEST HSSA Madigan AMC ----------------------FT Wainwright, AK1612321----82-2----------PACIFIC HSSA Tripler AMC 5128642----5512-10218-141---3--OTHER LOCATIONS Europe 3323-41----284-2--1-------Korea-1-1----41-1---2 --------Sub-Total 4124095552861322625301224110685731086720412305Total 821583615286521471589694155* Incomplete data January May, 1994. Active Duty refers to Army Active Duty only. ** Reports are included from parent and daughter clinics. Not all sites reporting.Date of Report: 7-Apr-95

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MSMR 16 April, 1995 TABLE S7. Notifiable conditions reported through Medical Surveillance System* Jan '94 DiagnosisApr '94**May '94Jun '94Jul '94Aug '94Sep '94Oct '94Nov '94Dec '94Total Amebiasis2-2----11 6 Anthrax--------0 Arboviral fever,unsp--------0 Asbestosis--------0 Botulism (adult) --------0 Botulism (infant)--------0 Brucellosis--------0 Campylobacteriosis 336568373 44 Carbon monoxide intx -------10 10 Chancroid1--1 ----2 Chemical agent exp4--1 ----5 Chlamydia18176163131155153197210149 1415 Cholera--------0 Coccidioidomycosis1-------1 CWI, unspecified7-------7 CWI, frostbite11-----1113 26 CWI, hypothermia------1-1 CWI, immersion type--------0 Dengue fever ------134 Diphtheria--------0 Ehrlichiosis--------0 Encephalitis ----1---1 Fatality, trainee-1-1----2 Fatality, occupat. --------0 Giardiasis221354331 24 Gonorrhea10156889011675999290 807 Granuloma Inguinale --------0 Guillain-Barre Syn1--1 ----3 5 H. influenzae, inv ----1122 6 Heat exhaustion3416101 05212 53 Heat stroke2-105421-24 Hemorrhagic fever --------0 Hepatitis A, Acute--14 41214 17 Hepatitis B, Acute 754744243 40 Hepatitis C, Acute1--21---1 5 Hepatitis, unspec ----13-31 8 Herpes Simplex591624273230232320 254 Influenza, unspec. --------0 Influenza, type A --------14 14 Influenza, type B --------0 Kawasaki syndrome1-------1 Lead poisoning -------11 Legionellosis1-----1-1 3 Leish, unspecified1-------1 Leish, cutaneous2--1-11-4 9 Leish, mucocutaneous --------0 Leish, visceral-1------1 Leish, viscerotropic--------0 Leprosy1------1 Leptospirosis --------0 Listeriosis----1---1 Lyme disease1-11---25 Lymphogranuloma Vnrm-12243-11 14(Continued)

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MSMR Vol. 01 / No. 01 17 TABLE S7. Notifiable conditions reported through Medical Surveillance System* (continued). Jan '94 DiagnosisApr '94**May '94Jun '94Jul '94Aug '94Sep '94Oct '94Nov '94Dec '94Total Malaria, unspecified61--2--110 Malaria, vivax1132332-21 27 Malaria, falciparum--------0 Malaria, malariae-----1--1 Malaria, ovale--------0 Measles--------1 1 Meningitis, Viral221111211 12 Meningitis, Bact.142-21227 21 Mercury intoxication--------0 Mumps (adults only) --------0 Mycobacterial inf.---1 ----1 Pertussis---31---4 Plague --------0 Pneumococcal pneum.--1----1 2 Poliomyelitis--------0 Psittacosis------1-1 Q fever--1-----1 Rabies, human--------0 Radiation, ionizing--------0 Radiation, non-ion.-47-----47 Relapsing fever--------0 Reye syndrome--------0 Rhabdomyolysis-123 41322 18 Rheumatic fever --------0 Rift Valley Fever--------0 RMSF-3----1-1 5 Rubella--------0 Salmonellosis1117167141066 78 Schistosomiasis--------0 Shigellosis112152016920114 108 Smallpox--------0 Syphilis, unspec.32-2--1-1 9 Syphilis, prim/sec1-232212 13 Syphilis, latent6-411-5320 Syphilis, tertiary --------0 Syphilis, congenital --------0 Tetanus --------0 Toxic shock syndrome--------0 Toxoplasmosis1-------1 Trichinellosis--------0 Trypanosomiasis,Afr --------0 Trypanosomiasis,Amer --------0 Tuberculosis (TB)2-241-1111 TB, multi-drug res--------0 Tularemia--------0 Typhoid fever --------0 Typhus fever --------0 Urethritis, Non-Spec913562817289765782 645 Vaccine advrs event-111242213 Varicella,adult only-441---13 13 Yellow fever--------0Total 519 282 424 429 459 414 463 455 435 3880* Based on date of onset. ** Incomplete data prior to May 1994. Date of report: 7-Apr-95

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MSMR 18 April, 1995 TABLE S8. Cases of Heat and Cold Weather Injuries, United States Army, 1994* Heat InjuriesCold Weather Injuries Reporting MTF/Post** Heat Exhaustion Heat Stroke FrostbiteHypothermiaImmersionUnspecified MFMFMFMFMFMF NORTH ATLANTIC HSSA Walter Reed AMC -----------Aberdeen Prov. Ground -----------FT Belvoir, VA-----------FT Drum, NY----3------FT Eustis, VA--1--------FT Knox, KY3----------FT Lee, VA--1 --------FT Meade, MD -----------USMA, West Point, NY-----------CENTRAL HSSA Fitzsimons AMC -----------FT Carson, CO----2------FT Leonard Wood, MO1-1---1---FT Leavenworth, KS -----------FT Riley, KS-----------SOUTH CENTRAL HSSA Brooke AMC -----------FT Hood, TX -----------FT Polk, LA-----------FT Sill, OK1 ----------Panama31 ---------SOUTHEAST HSSA Eisenhower AMC -----------FT Benning, GA 4-4--------FT Bragg, NC -----------FT Campbell, KY-----------FT Jackson, SC1-1--------FT McClellan, AL-----------FT Rucker, AL322--------FT Stewart, GA-----------SOUTHWEST HSSA Wm Beaumont AMC -----------FT Huachuca, AZ-----------FT Irwin, CA-----------NORTHWEST HSSA Madigan AMC -----------FT Wainwright, AK----144-----PACIFIC HSSA Tripler AMC 2-2--------OTHER LOCATIONS Europe -----------Korea2-----------Total 203120194100000 * Incomplete data January May, 1994. Army active duty cases only. ** Reports are included from parent and daughter clinics. Not all sites reporting.Date of Report:7-Apr-95

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MSMR Vol. 01 / No. 01 19 TABLE S9. Active Duty Force Strength by MTF, United States Army, Dec 1994* MalesFemales All MTF/Post**< 2020-2425-2930-3435-39>= 40 Total M < 2020-2425-2930-3435-39>= 40 Total F NORTH ATLANTIC HSSA Walter Reed AMC6815751477168020533730105836445598564515601272913312 Aberdeen Prov. Ground274528354472536445260947137956046324173026 FT Belvoir, VA23924363943754392038314113110198735472585 FT Drum, NY2383844240014281034644958811386194127734083110419 FT Eustis, VA2411446111210879649915841373943002211529311977038 FT Knox, KY953315719861861175311761088641329303213182101116912055 FT Lee, VA45092063663862151337782004232401951386112575035 FT Meade, MD1293611691069101413205520333329227823917013156835 USMA, West Point, NY12823747969931871435341631371591221036885041 CENTRAL HSSA Fitzsimons AMC2618725223125828012344931236668744281662 FT Carson, CO228548642442715179411921565925768583305195104198017639 FT Leonard Wood, MO436180510131040100056658601533972181981098011557015 FT Leavenworth, KS2332933049698981029777878475122484233400 FT Riley, KS2124839331321371517913129311960337024916781148914420 SOUTH CENTRAL HSSA Brooke AMC1909011015105510301194538514837937941935135020267411 FT Hood, TX740129099321590544262810361119520951490865555312541241523 FT Polk, LA1734005271718741296714107791450233119413585126112040 FT Sill, OK9534777272919231525973128801845731022813584123214112 Panama1814521510108489772656878257202157122718176504 SOUTHEAST HSSA Eisenhower AMC731203614451273159214868563173576466396325279221510778 FT Benning, GA115951903352236216611011147351540233623914278121215947 FT Bragg, NC444134829914694348262950385593815391183738451223417242731 FT Campbell, KY306732757823505231113372056824944631364217105228522853 FT Jackson, SC817190073882568942653955139803683071647424067801 FT McClellan, AL369855572730715609385093268183165119668944744 FT Rucker, AL411002125389163362244422021117210869436235065 FT Stewart, GA308667746982871201012051776930757655384205131216219931 SOUTHWEST HSSA Wm Beaumont AMC322358527641882161415301169746659444288200196183313530 FT Huachuca, AZ13113511196102885469552555638924721916410211776432 FT Irwin, CA721424980779593380422851931317948324884716 NORTHWEST HSSA Madigan AMC2925812436431352254180217659531044735457305260285420513 FT Wainwright, AK392207174911537804306358327420317893658167174 PACIFIC HSSA Tripler AMC228594843982881203813841687717720639460319233238819265 OTHER LOCATIONS Europe4902064017410122889279599366100713139249517551253711942475524 Korea587910063764585383825222700811016171063750518296435431362 Unknown26739214453645455874821 25934 62635726777648369 3320 29951 Total 1185214276810820581643652874951045969621722273617057123388764582668996529389 * Based on duty zip code. Does not account for TDY. Includes unknown age groups and unknown gender. ** Includes any subordinate catchment areas not listed separately. Source: Defense Manpower Data Center (DMDC)

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DEPARTMENT OF THE ARMY U.S. Army Center for Health Promotion and Preventive Medicine (Provisional) Aberdeen Proving Ground, MD 21010-5422 OFFICIAL BUSINESS MCHB-DD-A