Military medicine
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The U.S. DoD is a multidimensional agency of the government that employs health engagement activities within partner nations for medical operations, humanitarian assistance, threat reduction, and improved health outcomes toward sustainable global health and security. The composition and size of a health engagement team is critical for effective implementation; however, an ideal team makeup to achieve optimal operational readiness, health outcomes, and security cooperation objectives has not been established. This study was conducted to retrospectively describe and analyze medical mission activities in relation to ideal team characteristics in El-Salvador, Guatemala, and Honduras between 2012 and 2017. ⋯ Findings from this study reveal a broad spectrum of health and medical missions conducted in El Salvador, Guatemala, and Honduras between 2012 and 2017 by DoD. Critical elements indicative of overall team capability for successful engagement such as team size, team member skillset, global health expertise, and appropriate language capability were rarely documented. Team characteristics could not be well-correlated with the Global Health Engagement type or desired mission outcomes. In the future, deliberate crafting and preparation of health engagement teams aimed at attaining desired security cooperation impact, operational readiness development, and positive health outcomes is essential for more effective Global Health Engagement.
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We describe a case of prolonged shedding of live Severe Acute Respiratory Syndrome Coronavirus, 2 in the setting of a mild novel Coronavirus Disease 2019 (COVID-19) infection in a healthy young adult male. The patient did not require hospitalization or any supplemental oxygen. ⋯ The extended duration of positive viral culture with his concurrent mild symptomatology is at odds with current CDC and DOD isolation policies for positive COVID-19 patients. This case is important as health agencies around the world grapple with how to advise patients and create protocols for isolation precautions after positive COVID-19 results.
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At the start of the coronavirus disease 2019 (COVID-19) pandemic, Walter Reed Army Institute of Research (WRAIR) mobilized to rapidly conduct medical research to detect, prevent, and treat the disease in order to minimize the impact of the pandemic on the health and readiness of U.S. Forces. WRAIR's major efforts included the development of the Department of Defense (DoD) COVID-19 vaccine candidate, researching novel drug therapies and monoclonal antibodies, refining and scaling-up diagnostic capabilities, evaluating the impact of viral diversity, assessing the behavioral health of Soldiers, supporting U.S. DoD operational forces overseas, and providing myriad assistance to allied nations. WRAIR personnel have also filled key roles within the whole of government response to the pandemic. WRAIR had to overcome major pandemic-related operational challenges in order to quickly execute a multimillion-dollar portfolio of COVID-19 research. Consequently, the organization learned lessons that could benefit other leaders of medical research organizations preparing for the next pandemic. ⋯ An effective pandemic response requires comprehensive institutional preparedness that facilitates flexibility and surge capacity. The single most important action leaders of medical research organizations can take to prepare for the next pandemic is to develop a quick-reaction force that would activate under prespecified criteria to manage reprioritization of all science and support activities to address pandemic response priorities at the velocity of relevance.
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Sickle cell trait (SCT) is a heterozygotic state defined by having one normal hemoglobin gene and one sickle hemoglobin gene. Individuals with SCT are at increased risk for negative health outcomes during intense physical exertion, especially in hot climates and high-elevation locations, or when dehydrated. The U.S. Air Force mitigates this risk through universal screening after accession followed by education of SCT-positive airmen. Airmen who are SCT positive but remain asymptomatic are not restricted in occupation choice or deployment/duty locations based on their SCT status. Previous studies have analyzed the relationship between SCT and health and fitness outcomes. The objective of this study was to analyze the relationship between SCT and career and operational outcomes in a large cohort of airmen and secondarily to analyze the relationship between hemoglobin S (HgbS) percentage and these outcomes. ⋯ SCT-positive and SCT-negative airmen had similar career and operational outcomes, with two exceptions: SCT-positive airmen were less likely to be promoted to staff sergeant within 4 years, and they spent less time at a high-elevation location during their first 6 years of service. The underlying explanation of these findings should be explored with an aim to support SCT-positive airmen and to reduce potentially unwarranted discrepancies. Efforts should continue to reduce the stigma associated with SCT.
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In the United States, vaccine hesitancy has been identified as a major barrier to vaccination against COVID-19, but attitudes toward COVID-19 vaccination among military personnel are not well understood. We evaluated the prevalence and correlates of COVID-19 vaccine consent or refusal among deployed personnel in a joint environment. ⋯ Overall vaccine acceptance was greater among deployed military personnel than that reported in the U.S. population as a whole. However, lower vaccine acceptance among personnel from marginalized populations suggests a need to ensure that all service members have sufficient opportunities to have a frank and ongoing discussion with health care providers to address concerns related to vaccination. Additionally, lower vaccine acceptance among Reserve and National Guard personnel indicates a need for innovative educational approaches to counter vaccine hesitancy in the premobilization phase of deployment.