Army Public Health Weekly Update, 10 September 2021

Date Published: 9/10/2021
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​The Army Public Health Update is a collection of articles taken from public sources to offer awareness of current health issues and the media coverage given to them. The articles do not necessarily represent U.S. Army Medical Command opinions, views, policy, or guidance, and should not be construed or interpreted as being endorsed by the U.S. Army Medical Command.

The Army Public Health Weekly Update does not analyze the information as to its strategic or tactical impact on the U.S. Army and is not a medical intelligence product. Medical intelligence is available from the National Center for Medical Intelligence External Link .

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Table of Contents


    Army Medicine Campaign Research to Practice Education Series

    The Army Medicine Campaign Research to Practice Education Series for military providers and staff covers medical readiness topics such as injury prevention, health promotion, and physical performance optimization.  The series is held five times a year on Defense Collaboration Services (DCS) and is co-sponsored by OTSG Physical Performance Service Line and APHC Injury Prevention.

    Next Seminar: 13 September 2021 (1300-1410 ET)

    Presentation Topic:

    -Risk for Energy Deficiency in Male Service Members (USU)

    For seminar announcements, subscribe to the Research to Practice Education Series distribution list.

    FY21 Registration: Registration is required. All attendees must register:

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    4. Type Activity ID 2021-0060 or FY21 Army Medicine Campaign Research to Practice Education Series into the search box, click Search

    5. Follow prompts to complete registration. Once registered, you are registered for the entire fiscal year. 

    6. If you have questions, please contact the CME Planner. APHC


    For colon cancer patients Military Health System shows better results

    3 September- Colon cancer patients in the Military Health System had significantly higher survival rates compared to patients in the general population, according to a study the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland conducted. The researchers found that MHS patients with colon cancer had an 18% lower risk of death, compared to patients in the general population. The study included patients aged 18 or older from different racial groups and a median follow-up time of 56 months for MHS patients and 49 months for patients in the general population. The improved survival benefit tended to be larger among black patients than white patients, according to the study. The MHS provides health care with little or no financial barriers to its beneficiaries. The study's authors said the results suggest the importance of reducing financial barriers to improve survival for colon cancer. "In addition to survival, we also looked at tumor stage at diagnosis to assess whether there were differences in tumor stage, which could partially account for the difference in survival," said Dr. Craig Shriver, director of the Murtha Cancer Center Research Program at the Walter Reed National Military Medical Center in Bethesda, Maryland and one of the study's authors. In the MHS population, the study showed patients were 10% less likely to be diagnosed with a later phase of the disease, compared to the general population. "This study shows that the survival outcomes of colon cancer were improved in the MHS compared to the general population," Shriver said. "It's important to look into this data because disparities in access to medical care influence the survival outcome of cancer patients." According to the study, colorectal cancer is the third most diagnosed cancer and third leading cause of cancer death in the United States. The good news is the rate of new colorectal cancer cases has been decreasing steadily since the early 2000s in older adults, according to the National Institutes of Health. External Link

    Fort Knox leadership provides COVID-19 updates during live-streamed event

    2 September- Installation leaders and Fort Knox medical professionals hosted a live-streamed Facebook town hall meeting Sept. 1 to address community questions regarding the latest COVID-19 guidelines and recent vaccine mandates for service members. With several changes occurring over the past several months, Chief of the Department of Preventive Medicine Dr. James Stephens, along with U.S. Army Cadet Command and Fort Knox Commander Maj. Gen. Johnny Davis and other post leaders talked about a variety of topics to include mask mandates, the delta variant, available vaccinations, and how they're being administered. Davis told a virtual audience, which reached over 3,000 within a day, that he understands some may have questions about the current state of things. "We didn't get to this point overnight," said Davis. "It's been 18 months plus of pain and a lot of changes in our great nation, especially within the Army. We're going to do this right, we're going to do this professionally, and we're going to ensure we educate and that we take all the necessary steps for each and every one of our men and women in uniform and their Families." Stephens echoed Davis, pointing out that the numbers say it all. "Across the world, we've had over 219 million cases with over 4.5 million deaths," said Stephens. "In the United States, we've had over 40 million cases with over 660,000 deaths." DVIDS External Link


    AstraZeneca bosses warn against rush for boosters

    8 September- Moving too quickly to give people Covid booster jabs would deprive scientists of data on how well the vaccines work, AstraZeneca bosses have said. "We do not yet know whether that third dose is clinically needed," they say in the Telegraph. It has already been announced half a million of the most vulnerable in the UK will be offered a third dose. But a separate booster program, planned for September, has yet to be confirmed. Health Secretary Sajid Javid said, on Wednesday, he was "confident" a booster programme could begin this month but was awaiting advice on who should be eligible. In their article, AstraZeneca chief-executive Pascal Soriot and biopharmaceuticals-research-and-development executive-vice-president Sir Mene Pangalos say giving the most vulnerable, who may not have built up a full immune response from the first two, a third, top-up dose is "sensible". But any decision to give a third, booster jab "to large swathes of the population", to extend their protection from the first two, must be based on clinical data, which is only a few weeks away from being published. That data, from a variety of sources, will show how protection from the vaccines is holding up six months on from the start of second doses being administered. Meanwhile, another study will show how mixing vaccines might help. "Moving too quickly to boost across the entire adult population will deprive us of these insights, leaving this important decision to rest on limited data," Mr. Soriot and Sir Mene write. "We don't know what mix of antibodies and T-cells are needed to prevent serious illness - the so-called correlates of protection. "This is why we need the weight of the clinical evidence gathered from real-world use before we can make an informed decision on a third dose." And they are concerned about the "unnecessary burden on the NHS over the long winter months" of a booster rollout. BBC External Link

    Children 6 months and up should get flu shot, delay during severe COVID-19 illness: Pediatrics group

    7 September- Children aged 6 months and older should receive a flu vaccine this fall, the American Academy of Pediatrics advised Tuesday, however kids with moderate-to-severe COVID-19 should delay flu shots until they have recovered. Experts are concerned about an uptick in flu activity this winter amid the return to in-person learning, the group noted. "During the COVID-19 pandemic, it's important to remember that influenza is also a highly contagious respiratory virus that can cause severe illness and even death in children," Dr. Flor Munoz, lead author of the policy statement and technical report, developed by the AAP Committee on Infectious Diseases, said in a statement issued Tuesday. "The flu vaccine is safe, effective, and can be given alongside other routine immunizations and the COVID-19 vaccine." The pediatrics group doesn't prefer one type of flu vaccine over the other; depending on age and health kids can receive an injection or nasal spray. Other recommendations include flu vaccinations among kids in high-risk groups, those with an egg allergy and for pregnant and postpartum women. Flu shots can lower the risk of severe illness or hospitalization with the flu, and the AAP estimated that 80% of pediatric flu deaths in years past were among those not yet vaccinated, with about half of deaths in otherwise healthy children. The AAP also recommended COVID-19 vaccine for all kids aged 12 and older. Fox News External Link 

    COVID-19 breakthrough cases are expected to continue

    6 September- Some fully vaccinated people have developed COVID-19, called a 'breakthrough infection,' explained Sara Berg, Senior News Writer with the American Medical Association (AMA) News team. However, with the SARS-CoV-2 beta coronavirus Delta variant spreading rapidly throughout the USA, more COVID-19 vaccine breakthrough infections are expected. A breakthrough case is defined as "detection of SARS-CoV-2 RNA or antigen in respiratory specimens collected from a person 14-days after receiving all recommended doses said AMA member Devang K. Sanghavi, M.D. That means two weeks after the second shot of SpikeVax (Moderna) or Comirnaty (Pfizer-BioNTech) mRNA vaccines or two weeks after the one-shot J&J - Janssen COVID-19 vaccine. According to the U.S. CDC report on September 2, 2021, from December 2020, through August 30, 2021, the VAERS reporting system had received 7,218 reports of death (0.0020%) among people who received a COVID-19 vaccine.  While there is still more that physicians and scientists have to learn about this fast-moving topic, Dr. Sanghavi, an intensivist at the Mayo Clinic in Jacksonville, Florida, discussed what doctors wish patients knew about COVID-19 breakthrough infections. The full AMA news article is available at this link. The AMA has developed related FAQs on COVID-19 vaccination covering safety, allocation and distribution, administration, and more; one designed to answer patients' questions, and another to address physician COVID-19 vaccine questions. Precision Vaccinations External Link

    Delta variant lowers mRNA COVID-19 vaccine effectiveness

    4 September- Eurosurveillance published observational data regarding mRNA COVID-19 vaccine effectiveness (VE) against the Delta (B1617.2) coronavirus variant on September 2, 2021. This study found mRNA COVID-19 vaccine VE was about 65% in Norway during August 2021. The Comirnaty and SpikeVax VE against infection were lower for the Delta variant than the Alpha variant among partly and fully vaccinated individuals. Nevertheless, fully vaccinated individuals (2-doses) had a lower risk of infection with the Delta (HR 0.35 (95% CI: 0.32–0.39)) and Alpha variant (HR 0.16 (0.13–0.18)) compared to unvaccinated individuals. This finding is in line with previous studies that assessed VE against symptomatic infections, said these researchers. However, these researchers stated, 'Our estimates of VE should be interpreted with caution since they are based on observational data.' 'In addition, comparisons with other studies should take into account different study designs, e.g., in our study, we included both symptomatic and asymptomatic infections.' 'Effectiveness of COVID-19 vaccines against SARS-CoV-2 infection with both the Delta and Alpha variants appears to be considerable among fully vaccinated people in Norway,' concluded these researchers. In Norway, the Delta variant was first identified in April 2021 and accounted for 67% of all sequenced samples by July, overtaking the Alpha variant (B.1.1.7) as the dominating variant. As of September 4, 2021, about 69% of adults in the EU/EEA were fully vaccinated against COVID-19. Precision Vaccinations External Link

    New AI algorithm proves to be 99% accurate in detecting pre-Alzheimer's changes in the brain

    8 September- An AI algorithm developed by a team of researchers from Lithuania could prove extremely valuable in the future when it comes to diagnosing Alzheimer's Disease. In a report by Science Alert, the AI algorithm has shown itself to be over 99% accurate in identifying specific changes in the brain that could lead to Alzheimer's. This is massive news, especially when you consider the fact that it can take a really long time for a human doctor to properly diagnose the disease. By the time the diagnosis is officially made, it's often too late to slow the damage down.  The artificial intelligence analyzed data taken from fMRI brain scans of 138 individuals. From this data alone, the AI is able to pinpoint signs of so-called mild cognitive impairment (MCI). This is defined as a step towards cognitive decline, which is perhaps the biggest hallmark of Alzheimer's. It's also worth noting that MCI often doesn't come with physical symptoms. A person could seem all perfectly sharp one day, and then the dementia symptoms set in almost rapidly. With this new AI algorithm, there is an excellent chance that brain damage can be slowed down significantly.  While human doctors do have the skills to diagnose Alzheimer's Disease by looking for MCI, they're nowhere near as fast or even as accurate as techniques that employ AI and deep learning. That's because the machines can infer from mountains of data. Tech Times External Link

    New polio cases confirmed in five countries

    4 September- The Global Polio Eradication Initiative reported on September 2, 2021, new polio cases were confirmed last week in these countries:

    -Ethiopia: two cVDPV2 cases

    -Mali: one cVDPV2 case

    -Nigeria: twenty-three cVDPV2 cases

    -Sierra Leone: one cVDPV2 case

    -Tajikistan: one cVDPV2 case

    Polio is a crippling and potentially deadly disease that affects the nervous system, says the U.S. CDC. However, polio can be prevented with a vaccine. The CDC says 'everyone should be fully vaccinated against poliovirus before any international travel. And 'anyone unvaccinated, incompletely vaccinated, or with an unknown polio vaccination status should complete the routine polio vaccine series.' Since 2000, the inactivated polio vaccine (IPV) is most often given in the USA. And, certain combination vaccines also protect against disease from Polio and include the three types of poliovirus: Type 1 (Mahoney), Type 2 (MEF-1), and Type 3 (Saukett). Additionally, good hand washing practices can help prevent the spread of this disease. Precision Vaccinations External Link

    Schools opening after Labor Day could see fresh burst of coronavirus cases -- if mitigation measures aren't followed

    7 September- Back-to-school after the Labor Day weekend could mean fresh spread of coronavirus unless schools take strong action to keep the virus in check, doctors and education experts are warning. August saw an explosion of Covid-19 cases when some schools resumed in-person classes without mask measures in place and tens of thousands of students and staff were forced into quarantine. Some classrooms even returned to online learning temporarily. It could happen again. Virus is still circulating at unabated levels in most communities across the country, with the Delta variant causing more than 98% of all infections nationwide. Therefore, the risk of Covid-19 outbreaks occurring again within schools this week appears to be the same -- unless mitigation measures are in place, Dr. Tina Tan, a professor of pediatrics at Northwestern University's Feinberg School of Medicine and a former board member for the Infectious Diseases Society of America, told CNN. "One thing we saw earlier in the month of August is that there were many schools that opened but didn't have mask mandates in place and were not using protective mitigation protocols, and we saw a number of outbreaks that happened in those situations where the school opened and then closed like a week later because there were so many teachers and students that got infected," Tan said. "It is hoped that when schools open after Labor Day, that these people will be smarter and they'll have mask mandates in place and use protective mitigation protocols in order to prevent the potential to have future outbreaks occur in the school setting," she said. "We know that there are going to be cases that occur, but there are methods to decrease the number of potential cases that might occur." Overall, the chances of a school staying open safely amid the ongoing pandemic do not just depend on what mitigation measures the school has in place -- but also how much coronavirus spread is in the surrounding community and whether the community practices mitigation strategies, Noelle Ellerson Ng, associate executive director of advocacy and governance for the School Superintendents Association, told CNN. CNN External Link


    CDC: Weekly U.S. Influenza Surveillance Report

    2020-2021 Influenza Season for Week 34, ending August 28, 2021:

    Influenza-Associated Hospitalizations- The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. As in previous seasons, patients admitted for laboratory-confirmed influenza-related hospitalization after April 30, 2021, will not be included in FluSurv-NET. Data on patients admitted through April 30, 2021, will continue to be updated as additional information is received.

    Influenza-Associated Pediatric Mortality- No influenza-associated pediatric deaths were reported to CDC during week 34. CDC External Link


    European Butcher brand bacon 'chuncks' recalled because of Listeria concerns

    7 September- European Butcher is recalling European Butcher brand "Bacon Chuncks" from the marketplace because of possible Listeria monocytogenes contamination. The recalled product was distributed in Ontario, CA. This recall was triggered by test results. The Canadian Food Inspection Agency (CFIA) is conducting a food safety investigation, which may lead to the recall of other products. The CFIA is verifying that the industry is removing the recalled product from the marketplace. There is concern that consumers may have unused portions of the recalled product in their homes because the expiration rates run through October. Consumers can use the following information to determine whether they have the recalled bacon in their homes. As of the posting of this recall, there have been no reported illnesses associated with the consumption of this product. Consumers should check to see if they have the recalled product in their home. Recalled products should be thrown out or returned to the store where they were purchased. Food Safety News External Link


    The combination of sun, heat and masks can worsen rosacea- Here's what else you need to know

    7 September- An estimated 16 million Americans have rosacea, according to the National Rosacea Society, and this long, hot pandemic summer is probably adding to their discomfort. Ultraviolet rays and high temperatures are common triggers for rosacea, a chronic inflammatory disorder that causes the skin to flush and become hypersensitive. According to a study by the National Rosacea Society, wearing a mask on top of being exposed to the heat and the sun can "significantly worsen" the condition. But the medical community is continuing to learn about rosacea, and there are medical and skin-care treatments that can help. Rosacea has typically been thought to affect women older than 30 who are of Northern European descent and have fair skin. But the experts we spoke with challenged that notion. "One of the problems that we're trying to correct is that rosacea has been vastly underdiagnosed with people who have darker skin color," said dermatologist and microbiologist Richard Gallo, an Irma Gigli distinguished professor and the founding chairman of the department of dermatology at the University of California at San Diego. The Washington Post External Link


    Monkeypox in Nigeria: Six confirmed cases in August

    7 September- According to the Nigeria Centre for Disease Control (NCDC), in August 2021, a total of nine suspected monkeypox  cases, six confirmed cases and 0 deaths were reported from six states (one each from Rivers, Bayelsa, Delta, FCT, Niger and Ogun). This is up from the four confirmed cases reported in July. In 2021, 79 suspected cases have been reported between January and August 31, 2021. Of the suspected cases, 23 were confirmed from eight states Delta (7), Lagos (4), Bayelsa (4), Rivers (4), Edo (1), FCT (1), Niger (1), Ogun (1) and, no deaths recorded from all States. Since September 2017,when Nigeria saw a return of monkeypox, a total of 493 suspected cases have been reported, including eight deaths, from 31 states in the country Monkeypox, a rare zoonosis that occurs sporadically in forested areas of Central and West Africa, is an orthopoxvirus that can cause fatal illness. The disease manifestations are similar to human smallpox (eradicated since 1980), however human monkeypox is less severe. The disease is self-limiting with symptoms usually resolving within 14–21 days. Treatment is supportive. Outbreak News Today External Link


    Dengue fever in Taiz, Yemen: 4,770 cases since the beginning of the year

    28 August- Health officials in Yemen said this week that 4,770 cases of  dengue fever had been detected in Taiz governorate in the southwestern part of the country since the beginning of the year through the end of July. Taysir Al-Sami'i, Deputy Director of Information at the Ministry of Health's office in Taiz said the neighborhoods of the city of Taiz, the capital of the governorate, recorded a greatest spread of the disease compared to other areas in the most populous governorate in Yemen. He attributed the spread of dengue fever to several reasons, most notably the spread of mosquitoes that transmit the disease, and the health authorities' preoccupation with confronting the COVID-19 epidemic, which led to the neglect of other infectious diseases. Dengue is a viral infection transmitted by the bite of an infected mosquito. There are four closely related but antigenically different serotypes of the virus that can cause dengue (DEN1, DEN 2, DEN 3, DEN 4). Outbreak News Today External Link


    Anthrax outbreak kills dozens of cattle in Spain

    8 September- The Veterinary Health Alert Network (Rasve) of the Ministry of Agriculture, Fisheries and Food (MAPA) has reported an outbreak of anthrax in a bovine farm in Ciudad Real. According to the World Organization for Animal Health (OIE), 25 animals died from the disease. They also report the outbreak has originated in an area of pasture usually covered by the Guadiana River, which has been exposed by the drop in flow. All surviving animals have been removed from the area and vaccinated with the Antravax vaccine. At the moment, as a result of this outbreak, there have been no cases in humans. However, almost at the same time, the Management of the Don Benito y Villanueva de la Serena Health Area of the Extremadura Ministry of Health has issued an epidemiological alert after the appearance in the area of several possible cases of anthrax in both animals and in humans. Anthrax is a bacterial pathogen in livestock and wild animals. Ruminants such as bison, cattle, sheep and goats are highly susceptible, and horses can also be infected. Anthrax is a very serious disease of livestock because it can potentially cause the rapid loss of a large number of animals in a very short time. Affected animals are often found dead with no illness detected. When conditions become favorable, the spores germinate into colonies of bacteria. An example would be a grazing cow ingests spores that in the cow, germinate, grow spread and eventually kill the animal. Anthrax is caused by the bacterium, Bacillus anthracis. This spore forming bacteria can survive in the environment for decades because of its ability to resist heat, cold, drying, etc. This is usually the infectious stage of anthrax. There are no reports of person-to-person transmission of anthrax. People get anthrax by handling contaminated animal or animal products, consuming undercooked meat of infected animals and more recently, intentional release of spores. Outbreak News Today External Link 


    Nipah virus update: 8 close contacts test negative

    7 September- In a follow-up on the Nipah virus situation in Kerala, India, the state government reports (computer translated) the test results of eight symptomatic close contacts on the 12-year-old boy who died from the virus had tested negative by the National Institute of Virology in Pune. According to officials, 257 people are on the contact list, including 141 health care workers. 51 people are hospitalized, but none have serious symptoms. Nipah treatment and isolation has been set up at Kozhikode Medical College. The availability of ICU beds and ventilators was ensured. A negative pressure ICU exclusively for patients was set up. Those at high risk were transferred to the Medical College Isolation Ward. Ambulance facilities were made available to take those in contact with the patient to the Medical College Hospital immediately. Steps have been taken to recruit additional staff and to train trained personnel for Nipah treatment. Great efforts are also being made to trace the source of the Nipah. Those on the primary contact list are called from the control room to ask for health information and provide counseling. Four from Wayanad district, eight from Malappuram, three from Kannur, one each from Ernakulam, Palakkad and Kollam districts have been included in the Nipah contact list. People from Kannur and Malappuram have been brought to Kozhikode. They are being treated and cared for. No one has any serious symptoms. Teams trained in the NIPA-confirmed area will conduct home visits and collect information, including symptoms. Outbreak News Today External Link


    U.S.: Dallas- 11th human West Nile virus case reported this year

    8 September- Dallas County health officials reported the eleventh human West Nile virus (WNV) case of 2021 in a Dallas resident. The patient was diagnosed with West Nile Neuroinvasive Disease (WNND). So far this year, Dallas officials have reported one fatality due to WNV. WNV is a mosquito-borne illness that can cause serious health problems. WNV is transmitted by mosquitoes, generally in summer and fall. Nearly 80 percent of people infected with WNV will not become ill. While only a little less than 20 percent of those infected with the virus will develop West Nile fever with mild symptoms (fever, headache, body aches, a skin rash on the chest or back and swollen lymph glands), one in 150 people infected will develop severe infection (West Nile encephalitis or meningitis). Symptoms of severe WNV infection include headache, high fever, stiff neck, and/or tremors and muscle weakness. The elderly and those with weakened immune systems are most at risk. Anyone who experiences any of these severe symptoms should seek medical help immediately. Symptoms may progress to stupor, disorientation, coma, convulsions, paralysis and possibly death. Outbreak News Today External Link


    Mad cow disease reported in two Brazil states

    7 September- The Brazilian Bovine Spongiform Encephalopathy (BSE) Surveillance System detected two cases of atypical BSE, type H in two beef cows in meat plants in two different states–Minas Gerais and Mato Grosso. The case in Minas Gerais was a 11-year-old beef cow destined for emergency slaughter in a slaughterhouse, while Mato Grosso case was a 10-year-old beef cow destined for emergency slaughter in a slaughterhouse. The samples were sent to the OIE Reference Laboratory for BSE at the Canadian Food Inspection Agency in Lethbridge, Alberta. The results of the confirmatory test were obtained on September 3, 2021. These are the fourth and fifth cases of atypical BSE identified during 23 years of surveillance in Brazil. The last case was detected in 2019. The meat and other products of these animals will not enter the food chain and do not represent a risk to ruminant populations. BSE (bovine spongiform encephalopathy) is a progressive neurological disorder of cattle.  BSE has been called "mad cow disease." Outbreak News Today External Link