msmr MEDICAL SURVEILLANCE MONTHLY REPORT INSIDE THIS ISSUE: A publication of the Armed Forces Health Surveillance Center Summary tables and figures

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1 VOL. 17 NO. 09 SEPTEMBER 2010 msmr A publiction of the Armed Forces Helth Surveillnce Center MEDICAL SURVEILLANCE MONTHLY REPORT Source: CDC INSIDE THIS ISSUE: Contct trnsfer of vccini virus from U.S. militry smllpox vccinees, U.S. Armed Forces, ember 2002-My Updtes: Routine screening for ntibodies to HIV-1, civilin pplicnts for U.S. militry service nd U.S. Armed Forces, ctive nd reserve components 7 Summry tbles nd figures Sentinel reportble medicl events, service members nd beneficiries, U.S. Armed Forces, cumultive numbers through August of 2009 nd Updte: Deployment helth ssessments, U.S. Armed Forces, September Deployment-relted conditions of specil surveillnce interest 26 Red the MSMR online t:

2 2 VOL. 17 / NO. 09 Contct Trnsfer of Vccini Virus from U.S. Militry Smllpox Vccinees, U.S. Armed Forces, ember 2002-My 2010 Smllpox is contgious, life-thretening infectious disese tht is cused by the vriol virus. In generl, smllpox trnsmission requires close nd prolonged interction between contgious, infected host nd n immunologiclly susceptible contct; the virus cn lso be trnsmitted through contct with contminted body fluids or physicl objects. For centuries, smllpox cused mssive outbreks nd numerous deths in civilin nd militry popultions nd ws persistent nd significnt thret to militry opertions. Although worldwide vccintion progrm ws ble to erdicte the disese in 1977, stored specimens could be used to develop smllpox-bsed wepons, nd such wepons could be used to produce mss terror nd deths. Smllpox vccine is live virus vccine; it consists of vccini virus which is closely relted to, but much milder in its clinicl expression thn, vriol virus. Routine vccintion of the U.S. generl popultion cesed in However, since the 1940s (except from 1990 to 1998), members of the U.S. Armed Forces hve been routinely vccinted ginst smllpox. In ember 2002, due to renewed concerns tht smllpox virus might be used s biowepon, the U.S. Deprtment of Defense (DoD) implemented the current smllpox vccintion progrm. 1 According to the Militry Vccine Agency (MILVAX), between ember 2001 nd September 2010, pproximtely two million designted U.S. service members hd been vccinted ginst smllpox; for 89 percent of these individuls, the vccintion during militry service ws their first exposure to smllpox vccine. Nerly ll first-time vccinees (nd lrge proportion of revccinees) experience significnt skin rections t the vccini injection site; in the usul cse, vccintion produces vesicle (9-10 dys post vccintion) nd then scb tht seprtes two to three weeks post vccintion. 2 During this two- to three-week period, vccini virus cn be trnsmitted from the heling injection site to other prts of the vccinee s body (primry trnsfer), to other individuls who hve close contct with the vccinee (secondry trnsfer) nd, in rre cses from secondry contcts to other individuls (tertiry trnsfer). Such vccini virus trnsmissions usully result in mild, locl skin rections; extreme cses my cuse serious (nd potentilly ftl) dverse rections. 3, 4 To prevent vccini trnsfers, recipients of smllpox vccine re counseled to keep injection sites covered nd void unnecessry contct with infnts, immunocompromised individuls, nd those with dermtologic conditions tht contrindicte smllpox immuniztion. This report summrizes cses of secondry nd tertiry trnsfers of vccini virus where the source ws U.S. militry member who hd recently received smllpox vccintion. Methods: The surveillnce period ws 1 ember 2002 to 31 My Probble nd possible cses of vccini virus trnsmission from U.S. militry member to nother individul were identified from reviews of three dt sources: cse reports published in peer-reviewed medicl journls; reports to the Vccine Adverse Event Reporting System (VAERS) 5 ccessed through the CDC Wonder online dtbse; nd reports of vccine dverse events to the notifible event reporting systems of the Services (which re trnsmitted to, nd rchived in, the Defense Medicl Surveillnce System [DMSS]). Ech probble nd possible Tble 1. Types of contct with vccinee nd ntomic loctions of infection, probble cses of vccini trnsfer from U.S. service members (n=58), ember 2002-My 2010 Type of contct with vccinted service member No. of men (n=17) No. of women (n=35) No. of children (n=6) Household contct or shring bed Wrestling, grppling, bsketbll, footbll 14.. Unknown type 3.. Antomic loctions of vccini infections b No. of men (n=17) No. of women (n=35) No. of children (n=6) Fce, neck Arm, shoulder Genitls (lbi, vulv or perineum). 11. Trunk Hnd, wrist Leg. 6. Mouth, lip. 3 1 Eye (oculr infection). 2. More thn 2 sites of infection Two wrestlers lso shred household with the source cse b Includes multiple sites per individul

3 SEPTEMBER cse ws identified by reviewing nrrtive descriptions (in published cse reports or text fields of dverse event reports) of vccini trnsfers to presumbly non-vccinted contct. For surveillnce purposes, cse reports tht specificlly stted tht U.S. militry member ws the source of vccini trnsfer were considered probble cses. Cse reports in which the source of contct trnsfer ws not explicitly identified s militry member were clssified s possible cses nd nlyzed seprtely. The following informtion regrding ech vccini infected contct ws scertined from nrrtive descriptions nd relevnt dt fields of dverse event reports: demogrphic chrcteristics; reltionship to vccinee; ntomic site(s) of vccini infection(s); smllpox vccintion sttus; type of contct with the index vccinee; relevnt lbortory results, tretments nd clinicl outcomes. For surveillnce purposes, the month of ech vccini trnsfer ws considered to be either the month of the initil clinicl presenttion of the contct ptient (if reported) or the month in which the cse report ws submitted. Becuse mny cses were documented in more thn one of the three dt sources, temporl, demogrphic, geogrphic nd clinicl detils of ech probble nd possible cse were compred to those of ll other cses. Cse reports tht closely mtched other reports were considered duplictes nd excluded from the nlysis. Eighty-nine reports of contct trnsfer were identified in VAERS; 16 cses were described in peer-reviewed medicl journls; 2, 6-13 nd eight reports were identified in the DMSS. After duplicte reports were removed, 58 unique reports of vccini virus trnsfer from vccinted service member to contct were considered probble cses. Lbortory confirmtion ws vilble for 23 of the 58 probble cses; lbortory results were pending for four others. For 42 other vccini trnsfer cses, the source ws not specificlly identified s U.S. service member. These cses were considered possible cses nd re summrized seprtely in this report. Probble Cses Results: Of the 58 vccini contct trnsfers where the index vccinee ws identified s U.S. service member, 53 were secondry (i.e., from service member to close contct) nd five were tertiry (i.e., from service member to contct to nother individul) trnsfers. For summry purposes, secondry nd tertiry cses were grouped for nlysis. Nerly one-hlf (n=27, 46.6%) of ll probble vccini trnsfer cses occurred in 2003 (the first yer of the current DoD smllpox vccintion progrm). There were ten cses in 2004, nd two to five cses in ech subsequent yer of the period (Figure 1). The numbers of vccini trnsfer cses were similr during the two yers before (n=7) nd fter (n=9) introduction of newer, second-genertion smllpox vccine (ACAM2000 ). Age, gender nd militry sttus Two-thirds (n=38; 65.5%) of vccini trnsfer contcts were femles; most by fr were yers old (n=52; 86.7%). Six children were trnsfer contct cses: two were less thn 1 yer, nd four were between 1 nd 8 yers old. Only one trnsfer contct hd reported history of smllpox vccintion: femle in her fifties hd been vccinted s child. Ten vccini trnsfer contcts, ll mle, were ctive duty militry members serving in the Air Force (n=2), Mrine Corps (n=1), Cost Gurd (n=1), or in n unspecified service (n=6). Vccini trnsfers to militry members comprised pproximtely 20 percent of ll dult contct cses nd nerly 60 percent of ll trnsfers to mles. Only ten vccini trnsfer contcts were reported s civilins or persons who sought cre t civilin medicl fcility (hence, probbly civilin). Of note, mjority (61.5%) of ll vccini trnsfer cse reports mong dults did not specify the sttus (militry, civilin) of the trnsfer contct. Reltionships of vccini contcts to vccinees More thn 70 percent of the contcts were women (n=35, 60.3%) or children (n=6, 10.3%) who lived in the sme household nd/or shred bed with recently vccinted service member (Tble 1). All dult femle contcts except one ( tertiry trnsfer cse inoculted by her brother) were described s spouse, prtner, fincée, girlfriend or intimte contct of the service member. Nerly 30 percent of ll trnsfer contcts (n=17) were men who hd recently wrestled or plyed other sports with vccinee (n=14) or whose reltionship to vccinee ws not mentioned (n=3). At lest two mle wrestling-ssocited contcts lived in the sme household or brrcks s the service member who ws the source of the vccini (Tble 1). Geogrphic loctions In 49 cses (84.5%), the residence of the trnsfer contct ws reported. The sttes with the most trnsfer contcts were York (n=6) nd North Crolin (n=5); four of the York cses two secondry nd two tertiry were linked to the sme militry vccinee. Hwii, Cliforni, Wshington nd Texs were the home sttes of four trnsfer contcts ech. One trnsfer contct ws U.S. militry member overses. Type of contct In most dult femle trnsfer cses, the ffected women reported close physicl/intimte contct with recently vccinted service member; in other cses, close contct ws inferred by the cse s reltionship to the vccinee or the

4 4 VOL. 17 / NO. 09 Figure 1. Probble nd possible cses of vccini virus contct trnsfer, by month, ember 2002-My Probble cses of vccini virus contct trnsfer (n=58) from U.S. militry members No. of probble cses reported Tertiry trnsfer Secondry trnsfer Dryvx ACAM Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr b. Possible cses of vccini virus contct trnsfer (n=42) from individuls not specifi clly identifi ed s militry members 7 6 No. of possible cses reported Dryvx ACAM Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr Jun Sep Mr ntomic site of inocultion (e.g., 11 women hd genitl lesions). Other ctivities tht were implicted in vccini virus trnsfers to women included sleeping beside vccinee (n=3), hndling lundry of vccinee (n=2) nd chnging vccintion site dressings (n=2). Of the 17 dult mle trnsfer cses, wrestling, grppling or rough-housing were the ctivities most frequently implicted in the trnsfers (n=12). Three reports cited bsketbll or footbll; nd one mle contct reportedly chnged the bndge of recently-vccinted brrcks-mte (with whom he lso grppled). Three reports of trnsfers to dult mles mentioned only contct with vccinted militry member. Activities tht were implicted in vccini trnsfers to children included hugging, wrestling, shring bed, bthing nd diper chnging. One four-yer old touched her fther s injection site nd ws treted for lesions on her index finger. Two of the five cses of tertiry trnsfer involved children. Bndges or other coverings of smllpox vccintion sites were mentioned in fewer thn hlf of ll cse reports (n=26). Of these reports, 42 percent (n=11) stted tht the vccinee kept the injection site covered (though one report cited oozing through the bndge) nd 58 percent (n=15) described some exposure to n uncovered injection site. Some reports noted bndges tht hd fllen off during ctivities (e.g. wrestling, swimming); others reported tht vccinees hd left their injection sites bre. Clinicl mnifesttions The mjority (n=51, 87.9%) of vccini trnsfer cses mnifested mild locl skin rections with slight edem, pin, redness, nd itching t lesion sites. Flu-like symptoms (e.g., fever, mlise) (n=12) nd swollen lymph nodes (n=7) were lso noted on multiple cse reports. Two vccini trnsfer cses resulted in serious complictions. A two-yer-old developed eczem vccintum fter contct with recently vccinted service member. The child ws treted during six-week hospitliztion with vccine immunoglobulin (VIG) nd n investigtionl drug

5 SEPTEMBER (ST-246). 9 Another trnsfer contct ws treted with VIG for oculr vccini during one-week hospitliztion. 12 Four dditionl vccini trnsfer contcts were hospitlized: 5-month old child ws treted for vccini lesions in the mouth 8, 11 ; n infnt ws hospitlized with scttered ppulr rsh nd fever; n irmn ws treted for fever, vomiting nd swollen lymph nodes; nd womn ws hospitlized to rule out generlized vccini. Antomic sites of infection Among dult femles, the ntomic sites most frequently ffected were the genitls (n=11), rm/shoulder (n=11), fce/neck (n=9) nd leg (n=6) (Tble 1). Six women (17.1%) hd vccini lesions t three or more ntomic sites. Most men were inoculted on the fce/neck (n=10) or rm/shoulder (n=7); five men (29.4%) hd three or more infection sites. Two of six children were infected on either the wrist or hnd; two others (33.3%) hd three or more infection sites (Tble 1). Temporl reltionships In the 13 cses with relevnt dt, the men period between vccintion nd trnsfer contct ws 12 dys (rnge 0-39 dys). In the 12 cses with relevnt dt, the men period between trnsfer contct nd initil symptoms ws 7 dys (rnge: 1-26 dys); nd in eight cses, the men time from vccintion of the index to initil symptoms of the trnsfer contct ws 17 dys (rnge: 6-36 dys). In the 18 cses with relevnt dt, the men time from trnsfer contct to the first clinicl encounter for evlution nd tretment ws 12 dys (rnge: 1-31 dys); nd in 10 cses, the time from the first clinicl visit of the trnsfer contct to the dignosis of vccini ws 17 dys (rnge: 0-80 dys). Possible Cses For 42 vccini trnsfer cses (ll identified from VAERS reports), the vccinee ws not specificlly identified s U.S. militry member; hence, they re considered possible cses for surveillnce purposes (Figure 1b). The infected contcts of vccinees who were possibly militry members included 24 women (57.1%), 11 men (26.2%) nd 7 children (16.7%). The most common residences of possible trnsfer contcts were North Crolin (n=8) nd Cliforni (n=6). Three-qurters of the "possible contct cses" were women or children who shred household or bed with recent vccinee. All of the dult femle contcts (except one helth cre worker) were described s the spouse, fincée, girlfriend or intimte contct of vccinee; ll of the ffected children were offspring of vccinee. One-third of the ffected dult mles (n=4, 36.3%) were either household contcts or wrestling prtners of vccinee; reltionships between the other ffected men (n=7) nd vccinees were not specified. Most reports of possible cses described mild locl skin rections; swollen lymph nodes (n=5) nd flu-like symptoms (n=3) were other reported clinicl mnifesttions. In generl, the most frequently ffected ntomic sites were similr mong probble nd possible trnsfer contct cses. Eight possible cses (19.0%) hd lbortory confirmtion of vccini (per the cse reports). Two of the possible cses were hospitlized, nd none hd life-thretening mnifesttions or were treted with VIG. Editoril comment: This surveillnce summry documents 100 reports of trnsfers of vccini virus from recent vccinee to close contct. The ffected contcts included fmily members, U.S. militry members, nd other close contcts (e.g., sexul prtners). In 58 of the cse reports, the index vccinee ws specificlly identified s U.S. militry member (i.e., probble cses); it is likely, however, tht most if not ll of the other possible cses lso involved U.S. militry vccinees. Of the 100 cses overll, 39 occurred during the first yer of the current U.S. militry smllpox vccintion progrm. This is not surprising becuse mny more U.S. militry members were vccinted during the first compred to subsequent yers of the progrm. For severl resons, the cses summrized here likely represent frction of the ctul number of vccini trnsfers through contct with militry member. For exmple, vccini infection through contrct trnsmission is not notifible event; helth cre providers re not required to report such cses. 6,14 Also, severl vccini trnsfer cse reports documented initil misdignoses nd multiple clinic encounters with multiple cre providers before the dignosis of vccini infection ws mde. 6,11,12 Mny of the cses were intimte contcts of recent vccinees; thus, they were not eligible for cre in the militry helth system, nd civilin providers my be reltively unlikely to cliniclly suspect vccini virus infections in unvccinted ptients. In ddition, vccini trnsfers from service members who deploy soon fter smllpox vccintions my not be known or reported to U.S. bsed surveillnce systems. Of note in this regrd, only one trnsfer cse in this summry (reported to the CDC) involved militry member outside the U.S. Finlly, trnsfer contcts with only mild clinicl mnifesttions or STI-like symptoms my not seek medicl tretment. Cses of contct trnsfer of vccini virus hve been described since In modern times, contct trnsfer of vccini is considered n infrequent compliction of vccintion. Since ember 2002, the rte of vccini contct trnsfer from U.S. militry members is pproximtely 3.3 cses per 100,000 primry (first-time) vccinees (58 trnsfers of vccini from pproximtely 2 million vccinees, of whom 89 percent were primry vccinees). If possible cses were included in the estimte, the vccini trnsfer rte would be 5.7 per 100,000 primry vccinees. The estimtes re comprble

6 6 VOL. 17 / NO. 09 to the rtes of contct trnsfers during the 1960s in the United Sttes: 2 to 6 cses per 100,000 primry vccinees. 16 Vccini virus persists t sites of vccintion in primry nd secondry vccinees for t lest three weeks fter vccintion; primry vccinees produce higher virl lods then those with previous exposures. 17,18 Virl shedding is thought to be gretest during the first two-weeks fter vccintion. This report documents vccini trnsmissions from recently vccinted U.S. militry members to household members, other intimte contcts, nd individuls tht engge in wrestling or other contct sports with recent vccinees. With only one exception, ll of the contcts to whom vccini virus ws trnsferred were under the ge of 30. In the United Sttes, routine childhood smllpox vccintions ended in 1972; hence, there is lrge popultion of individuls (i.e., under 38 yers old in 2010) with no immunity to vccini virus. The findings nd implictions of this report should be used to reiterte the guidnce tht is given to militry members t times of vccintion. The contgiousness of the vccine rsh, the importnce of covering the vccintion site with clen dressing, nd the possibility of trnsmitting potentilly dngerous infection to fmily member or friend through close physicl contct should be emphsized. In prticulr, for exmple, vccinees should be reminded tht bndges, clothing, sheets nd other items tht directly contct vccintion sites could spred vccini infection. Helth cre providers prticulrly those who provide primry cre to service members nd their fmily members should be lerted to the usul clinicl presenttions of contct trnsfer vccini infections; in ddition, they should be encourged to report cliniclly suspected cses to supporting public helth officils. Informtion regrding the smllpox vccine nd the U.S. militry s vccintion progrm is vilble t: vccines.mil/. References: 1. Grbenstein JD, Winkenwerder W,Jr. US Militry Smllpox Vccintion Progrm Experience. JAMA Jun 25;289(24): Muzny CA, King H, Byers P, Currier M, Noln R, Men L. Vulvr vccini infection fter sexul contct with smllpox vccinee. Am J Med Sci Apr;337(4): Neff JM, Lne JM, Fulginiti VA, Henderson DA. Contct vccini-- trnsmission of vccini from smllpox vccintion. JAMA Oct 16;288(15): Vellozzi C, Lne JM, Averhoff F, et l. Generlized vccini, progressive vccini, nd eczem vccintum re rre following smllpox (vccini) vccintion: United Sttes surveillnce, Clin Infect Dis Sep 1;41(5): United Sttes Deprtment of Helth nd Humn Services (DHHS) PHSP, Centers for Disese Control (CDC) / Food nd Drug Administrtion (FDA). Vccine Adverse Event Reporting System (VAERS) ,"CDC WONDER On-line Dtbse Accessed t gov/vers.html on Sep 23, :20:58 pm. 6. Centers for Disese Control nd Prevention. Vccini virus infection fter sexul contct with militry smllpox vccinee-wshington, MMWR Morb Mortl Wkly Rep Jul 2;59(25): Centers for Disese Control nd Prevention. Smllpox vccine dverse events mong civilins--united Sttes, Mrch 4-10, MMWR Morb Mortl Wkly Rep Mr 14;52(10): Centers for Disese Control nd Prevention. Secondry nd tertiry trnsfer of vccini virus mong U.S. militry personnel--united Sttes nd worldwide, MMWR Morb Mortl Wkly Rep Feb 13;53(5): Centers for Disese Control nd Prevention. Household trnsmission of vccini virus from contct with militry smllpox vccinee-- Illinois nd Indin, MMWR Morb Mortl Wkly Rep My 18;56(19): Egn C, Kelly CD, Rush-Wilson K, et l. Lbortory-confi rmed trnsmission of vccini virus infection through sexul contct with militry vccinee. J Clin Microbiol Nov;42(11): Grde V, Hrper D, Firchok MP. Tertiry contct vccini in brestfeeding infnt. JAMA Feb 11;291(6): Hu G, Wng MJ, Miller MJ, et l. Oculr vccini following exposure to smllpox vccinee. Am J Ophthlmol Mr;137(3): Lorich MF, Smith SB, Bessinger GT, Olivere JW. Conjugl trnsfer vccini. J Am Acd Dermtol Sep;51(3): Armed Forces Helth Surveillnce Center. Tri-Service Reportble Events Guidelines nd Cse Defi nitions, June Sepkowitz KA. How contgious is vccini? N Engl J Med Jn 30;348(5): Lne JM, Fulginiti VA. Trnsmission of vccini virus nd rtionle for mesures for prevention. Clin Infect Dis Jul 15;37(2): Cummings JF, Polhemus ME, Hwkes C, Klote M, Ludwig GV, Wortmnn G. Persistence of vccini t the site of smllpox vccintion. Clin Infect Dis Jn 1;46(1): Frey SE, mn FK, Yn L, Lottenbch KR, Belshe RB. Response to smllpox vccine in persons immunized in the distnt pst. JAMA Jun 25;289(24):

7 SEPTEMBER Updtes: Routine Screening for Antibodies to HIV-1, Civilin Applicnts for U.S. Militry Service nd U.S. Armed Forces, Active nd Reserve Components Humn immunodeficiency virus, type 1 (HIV-1), cuses life thretening illness with prolonged clinicl course. The virus is generlly trnsmitted from person-to-person in blood (e.g., trnsfusions, contminted needles) or during sexul encounters. The immune deficiency tht occurs fter HIV-1 infection degrdes the helth nd militry opertionl cpbilities of ffected service members. In order to provide pproprite medicl evlutions, tretment, nd counseling, prevent unwitting HIV-1 infection trnsmissions, nd protect the bttlefield blood supply, service members in the ctive nd reserve components re routinely nd periodiclly screened to detect newly cquired HIV-1 infections. Also, infection with HIV-1 is mediclly disqulifying condition for militry service. Since October 1985, the U.S. militry hs conducted routine screening for ntibodies to HIV-1 mong civilin pplicnts for U.S. militry service. Since 1986, ll members of the ctive nd reserve components of the U.S. Armed Forces hve been periodiclly screened for ntibodies to HIV-1. In 2004, the Deprtment of Defense set stndrd testing intervl of two yers for ll service members. This report summrizes prevlences nd trends of HIV- 1 ntibody seropositivity mong civilin pplicnts for militry service who hve been screened since It lso summrizes incident (first time per individul) dignoses of HIV-1 ntibody seropositivity mong members of the ctive nd reserve components of the Services. Methods: Among civilin pplicnts for U.S. militry service nd U.S. service members, prevlences of HIV-1 ntibody seropositivity were ssessed by mtching specimen numbers nd serologic test results to the personl identifiers of the individuls who provided the specimens. All results (except those from U.S. Air Force members) were ccessed from records routinely mintined in the Defense Medicl Surveillnce System. Summry dt from U.S. Air Force testing from 1 Jnury 1996 through were provided by the U.S. Air Force for use in this report. For summry purposes, n incident dignosis of HIV-1 ntibody seropositivity ws defined s two positive results from serologic testing of two different specimens from the sme individul (or one positive result from serologic testing of the most recent specimen provided by n individul). Annul prevlences of HIV-1 seropositivity mong civilin pplicnts for service were clculted by dividing the number of pplicnts identified s HIV-1 ntibody seropositive during ech clendr yer by the number of pplicnts during the corresponding yer. Of note, becuse of refinements in the methods used to identify HIV tests mong civilin pplicnts for U.S. militry service, the numbers of pplicnts ech yer s reported in this summry differ from those reported in previous HIV updtes in the MSMR. For nnul summries of routine screening mong U.S. service members, denomintors were the numbers of individuls in ech component of ech Service who were t lest once during the relevnt clendr yer. For summries of results by gender, the 10- yer verge gender rtios of ech service were used to impute genders for the reltively few test records in which they were missing or miscoded. Civilin pplicnts for U.S. militry service During the 18-month period from Jnury 2009 to June 2010, 424,325 tests for ntibodies to HIV-1 were conducted mong 421,743 civilin pplicnts for militry service. During the period, 126 pplicnts were detected with ntibodies to HIV-1 (seroprevlence: 0.30 per 1,000 ) (Tble 1). Among civilin pplicnts overll, nnul prevlences of HIV-1 ntibody seropositivity were reltively stble between 1996 nd 2006 nd then incresed in 2007 (0.47 per 1,000) nd 2008 (0.47 per 1,000). Among mle pplicnts, seroprevlences generlly incresed from 2003 to 2007 (0.32 per 1,000 to 0.55 per 1,000) nd then slightly decresed (2008: 0.53 per 1,000; 2009: 0.40 per 1,000) (Tble 1, Figure 1). Among femle pplicnts, nnul seroprevlences hve been reltively low nd stble since 2002 compred to previous yers (Tble 1, Figure 1). As in the pst, in 2009, the seroprevlence ws shrply higher mong pplicnts who were blck non-hispnic (1.35 per 1,000) compred to white non-hispnic (0.19 per 1,000) or Hispnic/other (0.17 per 1,000) rcil/ethnic identities (Tble 2, Figure 2). U.S. Army Active component: During the 18-month period from Jnury 2009 through June 2010, 865,989 tests for ntibodies to HIV-1 were conducted mong 690,578 soldiers in the ctive component of the U.S. Army. During the period, 120 soldiers (0.17 per 1,000 persons ) were detected with ntibodies to HIV-1 (Tble 3).

8 8 VOL. 17 / NO. 09 Tble 1. Dignoses of HIV-1 infections by gender, civilin pplicnts for U.S. militry service, Jnury 1990-June 2010 Yer Totl HIV tests Totl persons Mles Femles Totl HIV-1(+) HIV-1(+) Mle HIV-1(+) Femle Overll rte per 1000 Mle rte per 1000 Femle rte per , , ,560 55, , , ,920 49, , , ,990 53, , , ,714 52, , , ,040 52, , , ,503 45, , , ,406 54, , , ,239 55, , , ,807 56, , , ,975 61, , , ,367 67, , , ,661 67, , , ,774 70, , , ,796 56, , , ,902 45, , , ,955 46, , , ,949 52, , , ,052 47, , , ,018 53, , , ,521 54, , , ,102 26, Totl 5,895,646 5,801,289 4,676,249 1,125,040 2,514 2, Through 30 June 2010 Figure 1. Dignoses of HIV-1 infections by gender, civilin pplicnts for U.S. militry service, Jnury 1990-June Mle 0.90 Femle Number of HIV+ individuls per 1, Through 30 June 2010 Yer

9 SEPTEMBER Tble 2. Dignoses of HIV-1 infections by rce/ethnicity, civilin pplicnts for U.S. militry service, Jnury 1990-June 2010 Yer Totl HIV tests Through 30 June 2010 Totl persons White non- Hispnic Blck non- Hispnic Hispnic Totl nd others HIV-1(+) White non- Hispnic HIV-1(+) Blck non- Hispnic HIV-1(+) Hispnic nd others HIV-1(+) Overll rte per 1000 White non- Hispnic rte per 1000 Blck non- Hispnic rte per 1000 Hispnic nd others rte per , , ,600 64,743 37, , , ,231 47,791 35, , , ,817 49,013 36, , , ,392 46,072 34, , , ,900 46,649 39, , , ,625 40,515 37, , , ,522 47,361 40, , , ,607 51,636 44, , , ,666 49,242 46, , , ,398 53,833 46, , , ,522 58,480 49, , , ,696 54,777 49, , , ,346 52,743 52, , , ,392 40,728 49, , , ,095 31,319 44, , , ,812 29,892 44, , , ,267 34,986 47, , , ,643 33,009 45, , , ,229 42,326 54, , , ,934 40,857 51, , ,033 97,434 20,326 20, Totl 5,895,646 5,801,289 3,957, , ,863 2, , Figure 2. Dignoses of HIV-1 infections by rce/ethnicity, civilin pplicnts for U.S. militry service, Jnury 1990-June Blck non-hispnic Hispnic nd others White non-hispnic Number of HIV+ individuls per 1, Through 30 June 2010 Yer

10 10 VOL. 17 / NO. 09 Tble 3. dignoses of HIV-1 infections, by gender, ctive component, U.S. Army, Jnury 1990-June 2010 Yer Totl HIV tests Through 30 June 2010 Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte HIV-1(+) still in ctive service t yer , , ,673 54, , , ,980 48, , , ,158 55, , , ,250 51, , , ,024 49, , , ,613 49, , , ,171 50, , , ,407 52, , , ,108 52, , , ,116 51, , , ,248 53, , , ,962 56, , , ,399 55, , , ,840 59, , , ,696 59, , , ,443 57, , , ,518 58, , , ,779 56, , , ,163 58, , , ,797 57, , , ,040 36, Totl 9,754,657 7,729,899 6,604,383 1,125,516 1,602 1, Figure 3. dignoses of HIV-1 infections by gender, ctive component, U.S. Army, Jnury 1990-June Mle Femle Number of HIV+ individuls per 1, Through 30 June 2010 Yer

11 SEPTEMBER During 2009, there were 86 incident dignoses of HIV- 1 infection mong ctive component soldiers. The overll prevlence of seropositivity ws 0.20 per 1,000 soldiers ; on verge, one new HIV-1 infected soldier ws detected per 6,491 screening tests (Tble 3). From 2000 through 2007, nnul seroprevlences were reltively stble; in 2008, there were more incident dignoses of HIV-1 infections nd higher prevlence of HIV-1 ntibody seropositivity thn in ny yer since The increses in the numbers nd prevlences of incident dignoses of HIV-1 overll in 2008 were entirely ttributble to increses mong men; of note, in 2009, the prevlence of HIV-1 ntibody seropositivity mong mle soldiers slightly declined. Annul seroprevlences of HIV-1 seropositivity hve been reltively stble mong ctive component femle soldiers since 2001 (Figure 3). Finlly, of the 1,602 ctive component soldiers dignosed with HIV-1 infections since 1990, 436 (27.2%) remin in service in 2010 (Tble 3). Army Ntionl Gurd: During the 18-month period from Jnury 2009 through June 2010, 370,806 tests for ntibodies to HIV-1 were conducted mong 321,137 members of the U.S. Army Ntionl Gurd. During the period, 72 soldiers (0.22 per 1,000 persons ) were detected with ntibodies to HIV-1 (Tble 4). During 2009, there were 56 incident dignoses of HIV- 1 infection mong Ntionl Gurd soldiers. The overll prevlence of seropositivity ws 0.28 per 1,000 soldiers. The nnul prevlence in 2009 ws consistent with the nnul prevlences documented in the Army Ntionl Gurd since In 2009, on verge, one new HIV-1 infected Ntionl Gurd soldier ws detected per 4,327 screening tests. Of the 940 Ntionl Gurd soldiers dignosed with HIV-1 infections since 1990, 156 (16.6%) remin in service in 2010 (Tble 4). Army Reserve: During the 18-month period from Jnury 2009 through June 2010, 172,596 tests for ntibodies to HIV-1 were conducted mong 148,990 soldiers in the U.S. Army Reserve. During the period, 45 soldiers (0.30 per 1,000 ) were detected with ntibodies to HIV-1 (Tble 5). During clendr yer 2009, there were 32 incident dignoses of HIV-1 infection mong U.S. Army Reserve soldiers; the overll seropositivity ws 0.34 per 1,000 soldiers. In 2009, on verge, one new HIV-1 infected soldier ws detected per 3,492 screening tests. The prevlence of HIV-1 ntibody seropositivity mong femles remins low; mong femle reserve soldiers, there were two incident dignoses of HIV-1 seropositivity in 2009 nd none in the first hlf of Of the 837 Army Reservists dignosed with HIV-1 infections since 1990, 166 (19.8%) remin in service in 2010 (Tble 5). U.S. Nvy Active component: During the 18-month period from Jnury 2009 through June 2010, 430,731 tests for ntibodies to HIV-1 were conducted mong 376,865 silors of the ctive component of the U.S. Nvy. During the period, 121 silors (0.32 per 1,000 persons ) were detected with ntibodies to HIV-1 (Tble 6). During 2009, there were 83 incident dignoses of HIV- 1 infections mong ctive component silors. The overll prevlence of seropositivity ws 0.35 per 1,000 silors. Rtes in femles hve remined low; mong femle ctive component silors, there ws one incident dignosis of HIV-1 seropositivity in 2009 nd none in the first hlf of 2010 (Tble 6, Figure 4). In 2009, on verge, one new HIV-1 infected silor ws detected per 3,383 screening tests. Of the 2,138 ctive component silors dignosed with HIV- 1 infections since 1990, 454 (21.2%) remin in service in 2010 (Tble 6). Nvy Reserve: During the 18-month period from Jnury 2009 through June 2010, 84,006 tests for ntibodies to HIV- 1 were conducted mong 72,408 silors in the U.S. Nvy Reserve. During the period, 26 silors (0.36 per 1,000 ) were detected with ntibodies to HIV-1 (Tble 7). During clendr yer 2009, there were 10 incident dignoses of HIV-1 infection mong U.S. Nvy Reserve silors; the overll seropositivity ws 0.22 per 1,000 silors. Among femle reserve silors, there hve been no incident dignoses of HIV-1 seropositivity since 2007 (nd only 13 reported in the pst 20 yers). In 2009, on verge, one new HIV-1 infected silor ws detected per 5,418 screening tests. Of the 371 reserve component silors dignosed with HIV-1 infections since 1990, 73 (19.7%) remin in service (Tble 7). U.S. Mrine Corps Active component: During the 18-month period from Jnury 2009 through June 2010, 291,141 tests for ntibodies to HIV-1 were conducted mong 245,114 members of the ctive component of the U.S. Mrine Corps. During the period, 32 Mrines (0.13 per 1,000 persons ) were detected with ntibodies to HIV-1 (Tble 8). During 2009, there were 23 incident dignoses of HIV- 1 infection mong ctive component Mrines. The overll prevlence of seropositivity ws 0.15 per 1,000 Mrines (Tble 8, Figure 5). In 2009, on verge, one new HIV-1 infected Mrine ws detected per 8,354 screening tests. Of the 417 ctive component Mrines dignosed with HIV-1 infections since 1990, 94 (22.5%) remin in service in 2010 (Tble 8).

12 12 VOL. 17 / NO. 09 Tble 4. dignoses of HIV-1 infection, by gender, Ntionl Gurd, U.S. Army, Jnury 1990-June 2010 Yer Totl HIV tests Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte HIV-1(+) still in Gurd t yer , , ,841 18, , , ,008 15, , , ,258 20, , , ,432 14, , , ,413 17, , , ,645 13, ,123 85,030 76,065 8, ,478 98,365 86,890 11, , ,584 92,140 12, , ,042 98,515 13, , ,622 93,109 14, , , ,268 16, , , ,220 18, , , ,588 24, , , ,970 23, , , ,112 24, , , ,397 23, , , ,842 24, , , ,395 29, , , ,596 27, , , ,351 16, Totl 4,028,209 3,558,377 3,168, , Through 30 June 2010 Tble 5. dignoses of HIV-1 infection, by gender, reserve component, U.S. Army, Jnury 1990-June 2010 Yer Totl HIV tests Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte HIV-1(+) still in Reserve t yer , , ,399 38, , , ,509 29, , , ,535 38, , , ,475 31, , , ,134 30, , ,715 86,554 25, ,858 67,918 50,823 17, ,387 62,165 46,094 16, ,246 55,993 41,169 14, ,723 56,495 41,969 14, ,227 59,693 43,756 15, ,549 71,273 53,064 18, ,328 80,706 60,878 19, , , ,429 30, , ,218 88,687 25, ,407 99,297 78,039 21, ,668 84,682 66,145 18, ,743 98,804 76,525 22, ,183 97,455 74,534 22, ,737 94,254 73,196 21, ,859 54,736 42,877 11, Totl 2,467,389 2,139,432 1,654, , Through 30 June 2010

13 SEPTEMBER Tble 6. Dignoses of HIV-1 infections, by gender, ctive component, U.S. Nvy, Jnury 1990-June 2010 Yer Totl HIV tests Through 30 June 2010 Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte HIV-1(+) still in ctive service t yer , , ,499 36, , , ,327 35, , , ,214 39, , , ,964 41, , , ,742 44, , , ,194 40, , , ,466 42, , , ,835 43, , , ,559 44, , , ,654 41, , , ,128 44, , , ,845 46, , , ,760 46, , , ,668 47, , , ,730 44, , , ,323 44, , , ,609 41, , , ,472 37, , , ,001 38, , , ,846 39, , , ,077 23, Totl 7,794,018 6,491,367 5,624, ,454 2,138 2, Figure 4. dignoses of HIV-1 infection, by gender, ctive component, U.S. Nvy, Jnury 1990-June Mle Femle Number of HIV+ individuls per 1, Through 30 June 2010 Yer

14 14 VOL. 17 / NO. 09 Tble 7. dignoses of HIV-1 infections by gender, reserve component, U.S. Nvy, Jnury 1990-June 2010 Yer Totl HIV tests Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte HIV-1(+) still in Reserve t yer ,919 94,296 80,314 13, ,691 96,090 81,786 14, , ,443 85,233 15, ,818 97,525 82,186 15, ,375 85,994 71,822 14, ,580 68,962 57,016 11, ,614 71,250 58,748 12, ,167 71,314 58,580 12, ,395 69,133 56,440 12, ,858 67,053 54,370 12, ,280 65,113 52,414 12, ,820 67,844 54,711 13, ,249 71,060 56,906 14, ,421 73,876 59,064 14, ,264 71,479 57,248 14, ,073 68,377 54,628 13, ,297 49,808 40,252 9, ,492 48,959 39,693 9, ,595 46,946 38,110 8, ,179 45,292 36,839 8, ,827 27,116 22,161 4, Totl 1,695,560 1,457,930 1,198, , Through 30 June 2010 Reserve component: During the 18-month period from Jnury 2009 through June 2010, 46,806 tests for ntibodies to HIV-1 were conducted mong 41,772 Mrines in the U.S. Mrine Corps Reserve. During the period, 11 Mrine Corps Reservists (0.26 per 1,000 ) were detected with ntibodies to HIV-1 (Tble 9). During 2009, there were six incident dignoses of HIV-1 infection mong Mrine Corps Reservists; the overll seropositivity ws 0.24 per 1,000 Mrines. In 2009, on verge, one new HIV- 1 infected Mrine ws detected per 4,888 screening tests (Tble 9). Of note, in the pst 20 yers, there hve been no incident dignoses of HIV-1 infection mong femle Mrine Reservists. Of the 102 Mrine Reservists dignosed with HIV-1 infections since 1990, 25 (24.5%) remin in service in 2010 (Tble 9). U.S. Cost Gurd Active component: During the 18-month period from Jnury 2009 through June 2010, 34,515 tests for ntibodies to HIV-1 were conducted mong 32,682 members of the ctive component of the U.S. Cost Gurd. During the period, nine Cost Gurd members (0.28 per 1,000 persons ) were detected with ntibodies to HIV-1 (dt not shown). During 2009, there were six incident dignoses of HIV- 1 infection mong ctive component Cost Gurd members. The overll prevlence of seropositivity ws 0.29 per 1,000 Cost Gurdsmen. In 2009, on verge, one new HIV- 1 Cost Gurd member ws detected per 3,680 screening tests. Of the 48 ctive component Cost Gurdsmn dignosed with HIV-1 infections since 1990, 21 (43.8%) remin in service. In the first hlf of 2010, two femle Cost Gurd members were dignosed with HIV-1; these were the first incident dignoses of seropositivity mong femles since 1996 (dt not shown). Reserve component: In the twenty yer surveillnce period, there were three incident dignoses of HIV-1 seropositivity mong mle members of the Cost Gurd Reserve; no members remin in service (dt not shown). U.S. Air Force Active component: From Jnury 2009 through 2010, 464,246 tests for ntibodies to HIV-1 were conducted mong 404,272 members of the ctive component of the U.S. Air Force. During the period, 75 irmen (0.19 per 1,000 ) were detected with ntibodies to HIV-1. On verge, one new HIV-1 infection ws detected per 6,190 screening tests (Tble 10). The seroprevlence mong ctive component irmen in 2009 ws slightly lower thn in the prior two yers. Of note, since 2000, there hve been only 14 incident

15 SEPTEMBER Tble 8. dignoses of HIV-1 infections by gender, ctive component, U.S. Mrine Corps, Jnury 1990-June 2010 Yer Totl HIV tests Through 30 June 2010 Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte per 1000 HIV-1(+) still in ctive service t yer , , ,084 7, , , ,044 7, , , ,205 7, , , ,291 7, , , ,465 7, , , ,783 7, , , ,456 8, , , ,504 9, , , ,373 9, , , ,472 9, , , ,875 9, , , ,369 9, , , ,392 9, , , ,336 9, , , ,383 8, , , ,520 10, , , ,389 9, , , ,602 9, , , ,677 9, , , ,819 10, ,010 91,116 84,644 6, Totl 3,908,953 3,187,006 3,003, , Figure 5. dignoses of HIV-1 infection, ctive component, U.S. Mrine Corps, Jnury 1990-June Mle Femle Number of HIV+ individuls per 1, Yer Through 30 June 2010

16 16 VOL. 17 / NO. 09 Tble 9. dignoses of HIV-1 infection by gender, reserve component, U.S. Mrine Corps, Jnury 1990-June 2010 Yer Through 30 June 2010 Totl HIV tests Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte HIV-1(+) still in Reserve t yer ,964 35,827 34,603 1, ,791 30,646 29,628 1, ,651 32,958 31,928 1, ,336 33,612 32,470 1, ,384 33,741 32,681 1, ,778 31,572 30,435 1, ,701 31,714 30,486 1, ,620 30,585 29,360 1, ,506 31,574 30,243 1, ,440 30,535 29,237 1, ,244 28,608 27,333 1, ,201 30,581 29,253 1, ,766 32,041 30,641 1, ,739 33,573 32,171 1, ,131 29,816 28,587 1, ,537 33,990 32,495 1, ,484 26,105 24,944 1, ,871 25,542 24,413 1, ,489 25,953 24,859 1, ,327 25,028 23,988 1, ,479 16,744 16, Totl 769, , ,818 24, dignoses of HIV-1 infections mong ctive component Air Force femles (Tble 10, Figure 6). Air Ntionl Gurd: From Jnury 2009 through 2010, 46,322 tests for ntibodies to HIV-1 were conducted mong 40,649 members of the Air Ntionl Gurd. During the period, four irmen (0.10 per 1,000 ) were detected with ntibodies to HIV-1. No femle Air Ntionl Gurd member hs been dignosed with HIV-1 infection since 2004 (nd only one since 2000) (Tble 11). The overll prevlence in 2009 ws slightly higher thn in In 2009, on verge, one new HIV-1 infection ws detected per 11,581 screening tests of Air Ntionl Gurd members (Tble 11). Reserve component: From Jnury 2009 through 2010, 43,177 tests for ntibodies to HIV-1 were conducted mong 39,510 members of the U.S. Air Force Reserve. During the period, 13 irmen (0.33 per 1,000 ) were detected with ntibodies to HIV-1. In 2009, on verge, one new HIV-1 infection ws detected per 3,321 screening tests (Tble 12). The seroprevlence mong those in 2009 ws reltively low compred to recent prior yers (Tble 12). Dt summries for the U.S. Air Force provided by USAFSAM. Editoril comment: The U.S. militry begn routine screening for ntibodies to HIV-1 mong civilin pplicnts for ll militry services in October Routine periodic screening of ll members of ll components of the Services begn shortly therefter. During the first rounds of HIV-1 ntibody testing in the Services, detections of new infections were reltively frequent becuse most service members hd not previously been ; both longstnding (prevlent) nd recently cquired (incident) infections were subject to detection through routine screening. By 1990, nerly ll service members hd been for ntibodies to HIV-1 t lest once s civilin pplicnts for militry service nd/or while serving in the militry. As result, since then, routine periodic screening hs detected infections tht were cquired since the lst negtive test of the service member (incident infections). Results of routine, periodic screening for HIV-1 in dynmic (i.e., continuously chnging) militry popultions must be interpreted cutiously; in prticulr, comprisons of nnul rtes nd trends of seropositivity cross services nd components cn be misleding. For exmple, prevlences of seropositivity in repetedly screened popultions depend not only on rtes t which new infections re cquired but lso on testing frequencies. Even if rtes of cquisition of

17 SEPTEMBER Tble 10. dignoses of HIV-1 infections, by gender, ctive component, U.S. Air Force, Jnury Yer Totl HIV tests Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte per 1000 Femle rte , ,801 93,143 30, , , ,312 33, , , ,975 39, , , ,480 43, , , ,157 48, , , ,467 51, , , ,449 56, , , ,029 57, , , ,618 59, , , ,073 48, , , ,212 44, , , ,074 42, , , ,215 47, , , ,826 48, , , ,589 31, Totl 3,373,654 3,218,523 2,511, , Through Figure 6. dignoses of HIV-1 infection by gender, ctive component, U.S. Air Force, Jnury Mle Femle Number of HIV+ individuls per 1, Through Yer

18 18 VOL. 17 / NO. 09 Tble 11. dignoses of HIV-1 infections, by gender, U.S. Air Ntionl Gurd, Jnury Yer Totl HIV tests Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte per 1000 Femle rte ,407 24,383 20,532 3, ,473 24,454 20,137 3, ,514 28,492 23,041 3, ,787 28,761 23,893 4, ,128 36,115 29,992 5, ,087 43,075 34,180 5, ,120 41,088 33,666 6, ,956 41,922 34,808 6, ,704 43,666 35,313 7, ,999 35,643 28,903 6, ,902 21,861 18,020 3, ,692 26,729 22,338 4, ,976 23,004 19,020 3, ,577 27,083 22,684 4, ,745 13,566 11,247 2, Totl 476, , ,774 70, Through Tble 12. dignoses of HIV-1 infections, by gender, reserve component, U.S. Air Force, Jnury Yer Through Totl HIV tests Totl persons Mles Femles Totl new Mle Femle Overll rte Mle rte Femle rte ,614 16,612 12,790 3, ,561 18,555 14,101 4, ,027 19,003 14,346 4, ,120 14,095 10,613 3, ,283 13,272 10,157 2, ,599 12,593 9,347 2, ,452 22,432 16,989 4, ,683 35,654 27,162 7, ,237 31,234 23,675 6, ,874 23,927 18,566 5, ,545 23,636 18,279 5, ,415 28,141 21,959 6, ,487 24,054 18,581 5, ,720 24,882 19,364 5, ,457 14,628 11,292 3, Totl 345, , ,221 69, HIV-1 infections (infection incidence rtes) were identicl in two serilly popultions, prevlences of seropositivity would be different if the intervls between testing rounds were not the sme (becuse the longer the intervl, the more undetected infections ccumulte between testing rounds). Thus, for exmple, increses or declines in observed seroprevlences during routine periodic screening could reflect chnges in rtes of infection cquisition nd/or decreses or increses, respectively, in test intervls. In turn, differences in observed seroprevlences cross services or components could reflect differences in rtes of infection cquisition nd/ or differences in testing policies nd prctices. Of note in this regrd, there is now stndrd two-yer intervl (pplicble to ll services) between mndtory period HIV-1 ntibody tests; still however, some service members re more frequently (given other indictions for testing). With the bove cvets in mind, the monitoring of results nd trends of HIV-1 seroprevlences in vrious militry popultions cn help trget nd focus prevention inititives. The results presented here suggest tht, in generl, prevlences of HIV-1 infection mong civilin pplicnts for militry service nd mong ctive nd reserve component members of the Services remin reltively low, prticulrly mong femles.

19 SEPTEMBER Sentinel reportble events mong service members nd beneficiries t U.S. Air Force medicl fcilities, cumultive numbers for clendr yers through 31 August 2009 nd 31 August 2010 b Reporting loctions Air Force Number of Food-borne Vccine preventble reports ll Cmpylobcter d events c Slmonell Shigell Heptitis A Heptitis B Vricell Air Combt Cmd 1, Air Eduction & Trining Cmd 1, Air Force Dist. of Wshington Air Force Mteriel Cmd Air Force Specil Ops Cmd Air Force Spce Cmd Air Mobility Cmd Pcifi c Air Forces U.S. Air Forces in Europe U.S. Air Force Acdemy Other Totl 4,608 3, Arthropod-borne Sexully trnsmitted Environmentl Trvel ssocited Reporting loction Lyme disese Mlri Chlmydi Gonorrhe Syphilis Cold d Het d Q Fever Tuberculosis Air Combt Cmd Air Eduction & Trining Cmd Air Force Dist. of Wshington Air Force Mteriel Cmd Air Force Specil Ops Cmd Air Force Spce Cmd Air Mobility Cmd Pcifi c Air Forces U.S. Air Forces in Europe U.S. Air Force Acdemy Other Totl ,904 3, Events reported by Sep 8, 2010 b AFRESS dt interruption occured in August/September of 2010 during scheduled reloction of USAFSAM servers. c Sixty-seven medicl events/conditions specifi ed by Tri-Service Reportble Events Guidelines nd Cse Defi nitions, June d Service member cses only. Note: Completeness nd timeliness of reporting vry by fcility.

20 20 VOL. 17 / NO. 09 Sentinel reportble events mong service members nd beneficiries t U.S. Army medicl fcilities, cumultive numbers for clendr yers through 31 August 2009 nd 31 August 2010 NORTHERN Reporting loctions Number of Food-borne Vccine preventble reports ll Cmpylobcter c events b Slmonell Shigell Heptitis A Heptitis B Vricell Aberdeen Proving Ground, MD Fort Belvoir, VA Fort Brgg, NC 1,266 1, Fort Dix, NJ Fort Drum, NY Fort Eustis, VA Fort George G Mede, MD Fort Knox, KY Fort Lee, VA Fort Monmouth, NJ Wlter Reed AMC, DC West Point Militry Reservtion, NY SOUTHERN Fort Benning, GA Fort Cmpbell, KY Fort Gordon, GA Fort Hood, TX 1,417 1, Fort Jckson, SC Fort Polk, LA Fort Rucker, AL Fort Sm Houston, TX Fort Sill, OK Fort Stewrt, GA WESTERN Fort Bliss, TX Fort Crson, CO Fort Huchuc, AZ Fort Levenworth, KS Fort Leonrd Wood, MO Fort Lewis, WA Fort Riley, KS Fort Winwright, AK NTC nd Fort Irwin, CA PACIFIC Hwii Jpn Kore EUROPEAN Heidelberg Lndstuhl Bvri CENTCOM LOCATIONS CENTCOM Totl 11,620 11, Army Events reported by Sep 8, 2009 nd 2010 b Sixty-seven medicl events/conditions specifi ed by Tri-Service Reportble Events Guidelines nd Cse Defi nitions, June c Service member cses only. Note: Completeness nd timeliness of reporting vry by fcility.

21 SEPTEMBER Sentinel reportble events mong service members nd beneficiries t U.S. Army medicl fcilities, cumultive numbers for clendr yers through 31 August 2009 nd 31 August 2010 NORTHERN Reporting loction Arthropod-borne Sexully trnsmitted Environmentl Trvel ssocited Lyme Mlri Chlmydi Gonorrhe Syphilis Cold disese c Het c Q Fever Tuberculosis Aberdeen Proving Ground, MD Fort Belvoir, VA Fort Brgg, NC Fort Dix, NJ Fort Drum, NY Fort Eustis, VA Fort George G Mede, MD Fort Knox, KY Fort Lee, VA Fort Monmouth, NJ Wlter Reed AMC, DC West Point Militry Reservtion, NY SOUTHERN Fort Benning, GA Fort Cmpbell, KY Fort Gordon, GA Fort Hood, TX ,105 1, Fort Jckson, SC Fort Polk, LA Fort Rucker, AL Fort Sm Houston, TX Fort Sill, OK Fort Stewrt, GA WESTERN Fort Bliss, TX Fort Crson, CO Fort Huchuc, AZ Fort Levenworth, KS Fort Leonrd Wood, MO Fort Lewis, WA Fort Riley, KS Fort Winwright, AK NTC nd Fort Irwin, CA PACIFIC Hwii Jpn Kore EUROPEAN Heidelberg Lndstuhl Bvri CENTCOM LOCATIONS CENTCOM Totl ,196 9,009 1,372 1, Army

22 22 VOL. 17 / NO. 09 Sentinel reportble events mong service members nd beneficiries t U.S. Nvy medicl fcilities, cumultive numbers for clendr yers through 31 August 2009 nd 31 August 2010 Reporting loctions NATIONAL CAPITOL AREA Number of Food-borne Vccine preventble reports ll Cmpylobcter events b Slmonell Shigell Heptitis A Heptitis B Vricell c NNMC Bethesd, MD NHC Annpolis, MD NHC Ptuxent River, MD NHC Quntico, VA NAVY MEDICINE EAST NH Beufort, SC NH Cmp Lejeune, NC NH Chrleston, SC NH Cherry Point, NC NH Corpus Christi, TX NHC Gret Lkes, IL NH Guntnmo By, Cub NH Jcksonville, FL NH Nples, Itly NHC Englnd, RI NH Penscol, FL NMC Portsmouth, VA NH Rot, Spin NH Sigonell, Itly NAVY MEDICINE WEST NH Bremerton, WA NH Cmp Pendleton, CA NH Gum-Agn, Gum NHC Hwii, HI NH Lemoore, CA NH Ok Hrbor, WA NH Okinw, Jpn NMC Sn Diego, CA NH Twentynine Plms, CA NH Yokosuk, Jpn NAVAL SHIPS COMNAVAIRLANT/CINCLANTFLEET COMNAVSURFPAC/CINCPACFLEET OTHER LOCATIONS Other 2,754 2, Totl 5,417 5, Nvy Events reported by Sep 8, 2010 b Sixty-seven medicl events/conditions specifi ed by Tri-Service Reportble Events Guidelines nd Cse Defi nitions, June c Service member cses only. Note: Completeness nd timeliness of reporting vry by fcility.

23 SEPTEMBER Sentinel reportble events mong service members nd beneficiries t U.S. Nvy medicl fcilities, cumultive numbers for clendr yers through 31 August 2009 nd 31 August 2010 Reporting loction NATIONAL CAPITOL AREA Arthropod-borne Sexully trnsmitted Environmentl Trvel ssocited Lyme Mlri Chlmydi Gonorrhe Syphilis Cold disese c Het c Q Fever Tuberculosis NNMC Bethesd, MD NHC Annpolis, MD NHC Ptuxent River, MD NHC Quntico, VA NAVY MEDICINE EAST NH Beufort, SC NH Cmp Lejeune, NC NH Chrleston, SC NH Cherry Point, NC NH Corpus Christi, TX NHC Gret Lkes, IL NH Guntnmo By, Cub NH Jcksonville, FL NH Nples, Itly NHC Englnd, RI NH Penscol, FL NMC Portsmouth, VA NH Rot, Spin NH Sigonell, Itly NAVY MEDICINE WEST NH Bremerton, WA NH Cmp Pendleton, CA NH Gum-Agn, Gum NHC Hwii, HI NH Lemoore, CA NH Ok Hrbor, WA NH Okinw, Jpn NMC Sn Diego, CA NH Twentynine Plms, CA NH Yokosuk, Jpn NAVAL SHIPS COMNAVAIRLANT/CINCLANTFLEET COMNAVSURFPAC/CINCPACFLEET OTHER LOCATIONS Other ,261 1, Totl ,385 4, Nvy