DOD Center Tracks Health, Illness in U.S. Forces

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By Cheryl Pellerin

A new Defense Department agency employs combined medical expertise to track health, illness and injury across the military services, the center director said. Army Col. (Dr.) Robert F. DeFraites heads the Maryland-based Armed Forces Health Surveillance Center, which serves servicemembers, family members, deployed civilian workers, beneficiaries and retirees.

"The mission is to be the strategic-level public health surveillance agency for the Department of Defense, almost a very small version of the U.S. Centers for Disease Control for the DOD," DeFraites told American Forces Press Service. "We are a central resource for epidemiology, which is the study of health and disease in populations," he said.

The center does its work through three divisions, including Data and Analysis and Global Emerging Infections Surveillance and Response Systems Operations, called GEIS operations.

The Army Medical Surveillance Activity, for many years recognized as the DOD center for deployment surveillance, became the heart of the new centers data and analysis division, DeFraites said.

"A doctor or nurse might monitor a patient by taking a temperature and vital signs. In public health we do the same thing but for people in a community," he said.

Such public health surveillance involves accumulating statistics on rates of illnesses and injuries across a population, monitoring the trends and taking the information to those who can act on it if necessary.

The data comes from pre- and post-deployment health assessments of those who enter the military services, and from the military health system and the Tricare medical network.

"We combine that with information on what we call demographics -- rank, age, marital status, race -- and then we associate that with whos injured or ill, and their immunization status."


The division operates the following systems:

-- The Defense Medical Surveillance System, a growing database of health-related information on servicemembers collected from the time they enter military service until they are no longer eligible for care.

-- The Defense Medical Epidemiology Database, which gives users around the world access to anonymous data from the Defense Medical Surveillance System.

-- The DOD Serum Repository, established in 1989 for routine HIV testing, is the worlds largest serum repository with nearly 50 million specimens from 11 million individuals.

Just as military populations do their work worldwide, the center has an international reach through its GEIS operations, DeFraites said.

GEIS was created in 1997 by a presidential directive that expanded the role of federal agencies, including DOD, to improve domestic and international infectious disease surveillance, prevention and response.

In 2008, GEIS became part of the Armed Forces Health Surveillance Center. GEIS has partner laboratories in North and South America, Asia, Africa, Europe and Australia.

"Our key partners internationally are the overseas Army and Navy laboratories," DeFraites said, including the U.S. Army Medical Research Unit in Kenya, the Naval Medical Research Unit 3 in Cairo, Egypt, and the U.S. Army Center for Health Promotion and Preventive Medicine in Landstuhl, Germany.

GEIS began global disease surveillance in 1997 with very modest funding, Navy Capt. (Dr.) Kevin Russell, director of GEIS operations, told American Forces Press Service.

"It came at an opportune time for the overseas labs because they had never been given funding that was flexible enough to tend to the needs of the local communities" that hosted them, Russell said.

The labs were in place -- originally in Egypt, Indonesia, Peru and Thailand -- for strict force-health protection and military research and development, Russell said.

With new funding the labs began to perform vaccine, antibiotic and anti-parasitic trials that have benefited host country and military populations.

Today, as part of the health surveillance center, GEIS is a $50-million-a-year program that coordinates projects in 80 countries and has more than 500 collection sites.

GEIS partner labs located worldwide have a record of success. Two GEIS-funded laboratories in the United States identified the first four cases of pandemic flu in 2009 and reported them to CDC. GEIS labs conducted global emerging infection surveillance and response efforts with 39 partners in 111 countries.

The laboratories expanded the DOD global flu surveillance program to 72 countries, 20 Navy ships, one foreign ship and six clinics along the Mexican border. They also serve as a primary resource for global avian flu surveillance worldwide.

In some countries U.S. military laboratories work with the host nations ministry of health; in others, the ministry of defense, Russell said.

In each country an important role for the labs is to build the capacity of laboratories and technicians to monitor, detect and report to the World Health Organization outbreaks of diseases like flu that could affect people around the world.

The International Health Regulations, revised in 2005 and in effect in 2007, help guide the work of capacity building to allow countries to meet their obligations under the regulations, Russell said. The regulations describe the roles of each countrys government agencies, including military agencies, to participate in public health surveillance and outbreak response.

"Its a very dynamic time right now in global biosurveillance," Russell said. "From the presidents national strategy to counter biological threats to the International Health Regulations, we have a lot of responsibility in the DOD to be a leader in this field."

Because national government military and civilian surveillance programs are expanding, from the CCDs Global Disease Detection program to the Defense Threat Reduction Program and others, "there are a lot of challenges for all of us in how to work together," he said.

The future role of GEIS, Russell added, should be to concentrate on the military-to-military piece of disease surveillance and capacity building.

A recent meeting hosted by the Armed Forces Health Surveillance Center in St. Petersburg, Russia, on emerging infectious diseases and the role of militaries under the International Health Regulations, drew representatives from the medical departments of 43 different militaries throughout the world, Russell said.

"We need to continue working with militaries throughout the world, doing capacity building, sample collection, laboratory processing with them more and more," Russell said, "as the Department of State and other agencies work with the civilian sector."

Cheryl Pellerin is with the American Forces Press Service.