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COL Robert J. Lipnick, MS, MSS, ScD Chief, Division of Communications, Standards and Training

Global Health Surveillance at the Armed Forces Health Surveillance Center (AFHSC) Central Asia Regional Health Security Conference 17-19 April 2012, Garmisch-Partenkirchen, Germany. COL Robert J. Lipnick, MS, MSS, ScD Chief, Division of Communications, Standards and Training

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COL Robert J. Lipnick, MS, MSS, ScD Chief, Division of Communications, Standards and Training

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  1. Global Health Surveillance at the Armed Forces Health Surveillance Center (AFHSC)Central Asia Regional Health Security Conference17-19 April 2012, Garmisch-Partenkirchen, Germany COL Robert J. Lipnick, MS, MSS, ScD Chief, Division of Communications, Standards and Training Robert.Lipnick@us.army.mil

  2. Global EIDs: Selected Examples

  3. US Military Around the Globe

  4. AFHSC Mission and Vision • Vision: To be the central epidemiological resource and a global health surveillance proponent for the U.S. Armed Forces • Mission: Provide timely, relevant, actionable, and comprehensive health surveillance information in order to promote, maintain, and enhance the health of military, military-associated populations • Acquire, analyze/interpret, disseminate information, and recommend evidence-based policy • Develop, refine, and improve standardized surveillance methods • Serve as focal point for sharing health surveillance products, expertise and information • Coordinate a global program of militarily relevant infectious disease surveillance

  5. AFHSC RelationshipsSimilar in nature to CDC and State and local health departments Armed Forces Health Surveillance Center DoD CDC State Depts NMCPHC BUMED USAFSAM AFMOA PHC(P) POPM Public Health Centers County Metro Depts MTFs Dashed line indicates direct contact under appropriate circumstances

  6. AFHSC Overview • Division of Epidemiology and Analysis • Utilizes the Defense Medical Surveillance System (DMSS) • Periodic reporting of DoD health statistics and surveillance • Customized analysis and reports for military leadership • Division of Communications, Standards and Training • Coordinating web-presence, publications and public affairs • Develop and document surveillance standards • Organize and execute training exercises and conferences • Division of GEIS Operations • Funding of infectious disease and surveillance research • Coordination among overseas laboratories and other partners in the global surveillance network • Response to outbreak alerts and emergency notifications • Data Management and Technical Support • Design, operation and management of the DMSS • Operation of the DoD Serum Repository

  7. Ambulatory Data 234 million records Immunizations 100 million records In-Patient Hospitalizations 2.6 million records MEPS 12.4 million persons 27.4 million records Health Risk Assessments 575,000 records Personnel Data 9.5 million persons 114.4 million records Deployments 5.1 million records Reportable Diseases 291,000 records Serum Specimens (DoD Serum Repository) 54.2 million specimens Pre / Post-Deployment Surveys 9,435,580 surveys Casualty Data 50,339 AD Deaths Defense Medical Surveillance System (DMSS) Longitudinal Database Chemistry 19.2 million records Post- Discharge Pre- Induction Microbiology 1.8 million records All counts current as of December 2011

  8. DoD Serum Repository (DoDSR) • World’s largest serum repository • Unrivaled potential for sero-epi studies • 54M serial serum specimens from 9.5M individuals • Linked to demographic, military, and medical information via the DMSS

  9. Serologic Studies Adenovirus among military and Coast Guard recruits Risk of HIV sero-conversion in US soldiers Susceptibility of measles and rubella among US Army recruits Leishmaniasis serology in Gulf War veterans Persistence of antibody to Japanese encephalitis vaccine Sero-prevalence of hepatitis A, B and C in recruit applicants Hantavirus in military personnel from four corners area Serologic evaluation for mycoplasmin Gulf War veterans PSA levels and PSA velocity and the risk of prostate cancer Prevalence of West Nile Virus in NY military applicants Examples Using the DoDSR

  10. AFHSC Periodic Reports in One Year

  11. Medical Surveillance Monthly Report (MSMR) • the MMWR of the military health system • Over 150 issues since April 1995 • First full-color issue—August 2011 • 1,067 subscribers to the print edition • 175 new requests per year • 500 email subscribers • 21% of 2011 articles were outside submissions • Archives accessible online • Average MSMR issue viewed 1,483 times during its first 60 days online • Indexed in MEDLINE since Jan 2011 • Searchable using PubMed

  12. Medical Surveillance Monthly Report (MSMR)

  13. Training COMBATANT COMMAND ENGAGEMENTS Trilateral Civilian-Military Forum on Outbreak Response and Bioterrorism Investigation (USEUCOM) Chisinau, Moldova; October 2010 Emerging Infectious Diseases Conference (USCENTCOM) Amman, Jordan; October 2010 Malaria Symposium (USAFRICOM) Stuttgart, Germany; April 2011 Countering Biological Threats Conference (USEUCOM) Tbilisi, Georgia; May 2011 Command Post Exercise (USSOUTHCOM) Belmopan, Belize; May 2011 One Health Surgeon’s Conference (USNORTHCOM) Colorado Springs, CO; June 2011 Infectious Disease Border Issues Conference (USCENTCOM) Amman, Jordan; June 2011 Infectious Diseases and Disaster Response Conference (USCENTCOM) Abu Dhabi, UAE; July 2011 International Disease Surveillance Conference (USPACOM) Kurumba, Maldives; September 2011

  14. Div of GEIS Operations Vision and Mission • Vision: Be a scientifically credible and recognized worldwide surveillance system for emerging infections, fully integrating a global network of laboratory capabilities with a comprehensive DoD health surveillance system. • Mission:Successfully develop, implement, support, and evaluate an integrated global emerging infections surveillance and response system that supports the AFHSC and contributes to force health protection in US Forces, the Military Health System, and the global public health community. “Partnering in the Fight against Emerging Infections”

  15. Global Emerging Infectious Surveillanceand Response System – Network PartnersFHP Research, Biosurveillance, Capacity Building LRMC USAMRU-G (prop) USAFSAM WRAIR NMRC NHRC NAMRU-3 AFRIMS NAMRU-2 HI NAMRU-2 PP USAMRU-K NAMRU-6 OCONUS Laboratories Participating Countries

  16. Force Health Protection RI GI AR STI FVBI Surveillance and Response Training and Capacity Building Research, Innovation and Integration Assessment and Communication of Value Added Division of AFHSC-GEIS Strategic Goals and Priority Pillars RI = Respiratory Infection GI = Gastrointestinal Infection FVBI = Febrile and Vector-borne Infection AR = Antimicrobial Resistance STI = Sexually Transmitted Infection ARD GI DRO STI Febrile Dis

  17. GEIS Supported Surveillance Programs

  18. FY12 PACOM Activities Summary by Country • Republic of Korea • Influenza • Malaria • FVBI • Hantavirus • Rickettsia • Nepal • Antimicrobial Resistance • Gastrointestinal • Salmonella • E. coli • FVBI • Capacity Building • Respiratory • Japan • Respiratory • Malaria • FVBI • Hantavirus • Vietnam • FVBI • Malaria • Respiratory • Capacity Building • Bhutan • Gastrointestinal • Respiratory • The Philippines • Capacity Building • FVBI • Respiratory • Malaria • Myanmar • Malaria • Guam • Respiratory • Malaria • Indonesia • FVBI • Thailand • Antimicrobial Resistance • Capacity Building • Respiratory • Malaria • Gastrointestinal • Salmonella • E. coli • STI • FVBI • Leptospirosis • Arbovirus • Sri Lanka • Malaria • Solomon Islands • Malaria • Laos • Capacity Building • Respiratory • Samoa • Malaria • Singapore • Capacity Building • Respiratory • FVBI • Vanuatu • Malaria • Cambodia • Malaria • FVBI • Capacity Building • Respiratory • Gastrointestinal • E. coli • Australia • Malaria

  19. GEIS AFRICOM FOOTPRINTFY12 • Burkina Faso, Mali, Mauritania, Morocco & Libya • Capacity Building –Respiratory (NICs) • Ghana • Capacity Building • Malaria • STI • Respiratory • FVBI • ARO • Enterics • Djibouti • FVBI • Respiratory • STI • Malaria • Enterics • Sudan • FVBI • Capacity Building • Sierra Leone • FVBI • Capacity Building • Uganda • Malaria • Respiratory • ARO • Liberia • FVBI • Malaria • Enterics • Cote d’Ivoire & Togo • Respiratory • Capacity Building • Kenya • Capacity Building • FVBI • Enterics • Malaria • Respiratory • STI • ARO • Nigeria • Respiratory • Malaria • Gabon • Malaria • Enterics • Cameroon • Capacity Building • Respiratory • STI • Tanzania • Respiratory • Capacity Building • Malaria • FVBI 20

  20. EUCOM Activities by Country • Poland • Respiratory • Ukraine • Febrile illness • United Kingdom • Respiratory • Belgium • Respiratory • Germany • Respiratory • Multi-drug resistant pathogens • Georgia • Respiratory • Febrile illness • Sexually transmitted infections • Spain • Respiratory • Turkey • Respiratory • Portugal • Respiratory • Italy • Respiratory • Greece • Respiratory • Kosovo • Respiratory • Bulgaria • Febrile illness

  21. CENTCOM Activities by Country Iraq • Respiratory Jordan • Hospital acquired infections • Respiratory Afghanistan • Capacity building Egypt • Crimean Congo Hemorrhagic Fever • Capacity building • Respiratory • Enteropathogens Oman • Respiratory Qatar • Respiratory Yemen • Chikungunya • Dengue • Respiratory

  22. NAMRU-3 Activities in CENTCOM EUCOM AFRICOM NAMRU-3, Egypt Ghana Detachment Afghanistan Satellite Lab Active Duty Site Antimicrobial Resistance Febrile / Vector Borne(VBI) / Malaria Febrile / VBI / Neurological Gastrointestinal Infections Respiratory Infections Sexually Transmitted Infections Laboratory capacity building

  23. Outbreak Investigation (FY11) • Over 50 Outbreaks in 15 countries • Influenza, cholera, dengue, malaria and others • Multiple populations • 16 at US installations (CONUS & OCONUS) • 18 in partnership with foreign civilian entities • 3 in collaboration with foreign military partners • 8 in animal populations • Field support, epidemiological consultation, laboratory diagnostics

  24. AFHSC’s Website http://www.afhsc.mil

  25. Questions? COL Robert J. Lipnick, MS, MSS, ScD Chief, Division of Communications, Standards & Training Robert.Lipnick@us.army.mil

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