Navy Preventive Medicine Update for by rpr20748

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									 Navy Preventive Medicine Update
                      for
Armed Forces Epidemiological Board
       17 September 2002
       CAPT Jeff Yund, MC, USN
        Bureau of Medicine and Surgery
        Division of Preventive Medicine
           and Occupational Health
                     Topics
        Updates                  New Topics
•   Sickle crises at MWTC   • Smallpox Response Plan
•   AVA and birth defects   • Syndromic surveillance
•   Meningitis outbreak
•   Reportable Medical
    Events
•   Hep B vaccine
 Sickle Crises in SCT+ Marines
• USMC Mountain Warfare Training Center
• 3 cases confirmed; 3 cases probable
  – 6/55 SCT+, ~11% AR during Jan-Apr (3300)
• Recommendations:
  – reemphasize hydration to staff and trainees
  – oxygen available as high as practical
  – track all SCT+ trainees
• No additional cases since April
       AVA and Birth Defects
• Elevated risk of “major birth defects” in
  women who received AVA in 1st trimester
• Issues:
  – Quality of electronic immunization data
  – Accuracy of pregnancy dates
  – “Major birth defect” determination
• “Validation” effort
  AVA/BD - Validation Update
• ~11,000 health records copied and extracted
• 1,500 mark:
  – +/- 1 day: agreement “strong” (k > .8)
  – +/- 7 days: agreement “very strong” (k > .9)
• Analysis just getting underway
• ~10% of women received AVA
  – by paper or electronic record
    AVA/BD Validation (cont.)
• MOU with CDC for dysmorphologists to
  review first-year-of-life health records for
  280 infants with “major birth defect”
  diagnoses
• ~150 records anticipated
• 70 in hand now, will be en route soon
        Meningitis Outbreak
• 2 Navy cases among >250 recruits immunized
  on 16 Jan. with lot# “UB093AA”
• UB093AA vs UB095AA
• 40 sera from 093, 095, 3 other lots
• initial testing at CDC: no obvious differences
  among lots - analysis incomplete
    Reportable Medical Events
• Low success rates in Navy/Marine Corps…?
• Ongoing efforts:
  – Laboratory reporting
  – Unit > NEPMU > NEHC > AMSA
     • Unit > NEHC/NEPMU > AMSA
  – NDRS incorporated in SAMS 8.02
  – Navy Message re-emphasizing importance of
    reporting
    Hep B Vaccine for Recruits
• Implementation message released in early Aug.
• Coverage: all active and reserve Navy and
  Marine Corps accessions.
• Specific product: local decision
       Smallpox Response Plan
• CDC Interim Smallpox Response Plan
• DoD Interim Smallpox Response Plan
• Service implementation next
• BUMED: chartering a formal working group to engineer
  Navy Medicine implementation of DoD plan
  – PM, MTF Ops, NavMed Logistics Cmd, OHLS,
    N931 (SG’s Resources and Plans shop under CNO)
  – NEHC, Atlantic Fleet, Nav Med Cen Portsmouth,
    ASN(M&RA), ASN(I&E)
      Smallpox Response Plan
• First order of business:
  – Smallpox Epi Response Teams
  – Smallpox Vaccination Teams
• We will be busy.
      Syndromic Surveillance
• Defense Planning Guidance language
• Purpose...
• Multiple systems at various stages in
  development
• OSD push to learn how well the Services
  have done complying, identify best current
  system or composite system, and transition
  to a unified system across DoD.

								
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