Army Public Health Weekly Update, 30 April 2021

Date Published: 4/30/2021
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​NOTICE: There will be no Army Public Health Weekly Update next week. Publication will resume on 14 May 2021.

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


    Interim Public Health Recommendations for Fully Vaccinated People: Summary of recent changes

    Updates as of April 27, 2021:

    - Guiding principles for fully vaccinated people are now provided.

    - Underscores that immunocompromised people need to consult their healthcare provider about these recommendations, even if fully vaccinated.

    - Fully vaccinated people no longer need to wear a mask outdoors, except in certain crowded settings and venues.

    - Clarification that fully vaccinated workers no longer need to be restricted from work following an exposure as long as they are asymptomatic.

    - Fully vaccinated residents of non-healthcare congregate settings no longer need to quarantine following a known exposure.

    - Fully vaccinated asymptomatic people without an exposure may be exempted from routine screening testing, if feasible. CDC External Link


    DHA Appointing Portal simplifies signing up for COVID-19 vaccination

    23 April- When a new online and easy-to-use COVID-19 vaccine appointment portal was launched as a pilot program at 28 military medical treatment facilities last December, the hope was to expand it globally in the first few months of 2021. That goal is being accomplished, and in the last month, military service members and beneficiaries around the world have been able to quickly and easily make their own COVID-19 vaccination appointments using the tool, called the DHA Appointing Portal (DAP). "DAP is a simple online tool to help patients schedule the time and date for your COVID-19 vaccine appointment at your closest military hospital or clinic," said Air Force Lt. Col. Regina Tow, project manager, DHA COVID-19 Vaccine Information Technology Planning. "It's accessible from outside the Department of Defense network on any computer, tablet, or smartphone." The innovation originated at Madigan Army Medical Center, Joint Base Lewis-McChord in Washington state, last year, and after the pilot, it is now "stood up from Landstuhl (Medical Center), Germany, all the way to Korea," said Rick Barnhill, deputy chief medical information officer at Madigan Army Medical Center, JBL-M. Barnhill was quick to credit his lead computer scientist, Scott Evans, with development of the low-cost tool. Army Maj. Heather Woodruff, chief of the Clinical Systems Support Department for the Directorate of Healthcare Operations at Fort Belvoir Community Hospital in Virginia, was involved with the pilot program. "Across our Military Health System, one of our biggest constraints was having a good scheduling platform for our beneficiaries and for those (non-military) personnel eligible to receive the COVID-19 vaccine," said Woodruff, DAP's administrator at Fort Belvoir. "We didn't have an appointing center ... and not everybody had access to TRICARE online, so it was really kind of challenging. External Link

    DHA's immunization health care specialists support vaccine rollout

    26 April- The Defense Health Agency's Immunization Healthcare Division has been instrumental in ensuring that all the Department of Defense's military medical treatment facilities guarantee safety protocols during the complex process of receiving, distributing, storing, and administering COVID-19 vaccinations. The process, ongoing since December 2020, involves IHD's immunization health care specialists at four regional safety vaccine hubs across the United States assisting DOD MTFs around the world to ensure COVID-19 vaccination operations follow the eight standards for military immunization, a set of guidelines IHD developed from a combination of Centers for Disease Control and Prevention-issued recommendations and joint DOD-issued policy. "Immunization health care specialists are our 'boots on the ground' professionals strategically embedded to provide expeditious support to DOD immunization sites", said Air Force Col. Tonya Rans, chief of IHD. "They assist with the safe and effective implementation of DOD's immunization programs, coordinate redistribution of vaccines when needed, and engage during potential immunization storage or handling temperature excursions. Their input unequivocally helps us identify and close immunization training gaps in the field." The safety protocols include ensuring the immunization staff members at each MTF adhere to cold-chain management principles during transportation, storage, and administration of vaccines; assisting the MTF staff in developing standard operating procedures and ensuring they include proper packing protocols for transporting and shipping vaccines; and supporting MTFs with mass immunization events, explained Brian Canterbury, one of the IHD's immunization health care specialists assigned to the South Atlantic Regional Vaccine Safety Hub (SARVSH), which covers 12 states, 334 clinics, U.S. Central Command, U.S. Southern Command, and U.S. Special Operations Command. Although immunization health care specialists ensure the MTFs always follow the standard guidelines for all DOD immunization efforts, the COVID-19 vaccines presented unique challenges that required adapting standard protocols to properly handle, transport, and store the vaccines. The Pfizer-BioNTech vaccine, for example, has strict handling guidelines to ensure maximum efficacy, including the requirement to remain frozen in ultra-cold temperatures between -80 degrees Celsius and -60 degrees Celsius prior to removal and thawing, at which point it can be refrigerated for a maximum of five days before having to be discarded. Wayne Chardon, an immunization health care specialist assigned to SARVSH, works from Naval Hospital Pensacola at Naval Air Station Pensacola, Florida, in support of all MTFs north of the I-10 corridor in Florida as well as those in Louisiana, southern Mississippi, and the Caribbean. External Link

    METC NDT trainees learn about brain disorders and care

    23 April- Neurodiagnostic Week, April 18-24, is an annual campaign that serves to bring attention to and acknowledge the efforts of neurodiagnostic professionals around the world. This year in particular has been particularly challenging with the Coronavirus pandemic, as neurodiagnostic technologists (NDT) face additional challenges while remaining committed to providing a high-level of patient care. NDTs, including those in the military, perform many tests that diagnose problems with the brain and nervous system, as well as sleep disorders. They use state-of-the-art digital equipment to record electrical patterns throughout the brain and nervous system, which result in valuable data that the doctor needs to diagnose and treat their patients. The data gathered from these tests can help diagnose conditions like epilepsy, other seizure disorders, strokes, degenerative brain disease, and traumatic brain injuries, among others. Military NDTs usually work in hospitals and clinics. Military NDT training is conducted at the Medical Education and Training Campus (METC) on Joint Base San Antonio-Fort Sam Houston, Texas. Students in the METC NDT program arrive with a medical background, either as a Navy hospital corpsman or Air Force medical technician. Air Force Tech. Sgt. Stephanie Shishido, service lead and instructor for the METC NDT program, is one of only 48 neuro techs in the entire military. "The NDT career field is amazing to me," she stated. "We have the autonomy to work independently from a neurologist, and our studies can directly dictate the course of treatment and/or diagnosis." External Link


    Covid: One dose of vaccine halves transmission - study

    28 April- A single dose of a coronavirus vaccine can reduce household transmission of the virus by up to half, a study shows. Those given a first dose of either the Pfizer or AstraZeneca vaccines - and who became infected three weeks later - were between 38% and 49% less likely to pass the virus on than unvaccinated people, PHE found. Health Secretary Matt Hancock described the study's results as "terrific news". He has urged "everybody to get their vaccines as soon as they are eligible". In the study, protection against Covid was seen from about 14 days after vaccination, with similar levels of protection regardless of age of cases or contacts, PHE said in a statement. It added that this protection was on top of the reduced risk of a vaccinated person developing symptomatic infection in the first place, which is around 60 to 65% - four weeks after one dose of either vaccine. Dr. Mary Ramsay, head of immunization at PHE, said: "Vaccines are vital in helping us return to a normal way of life. Not only do vaccines reduce the severity of illness and prevent hundreds of deaths every day, we now see they also have an additional impact on reducing the chance of passing Covid-19 on to others." But, while she said the findings were "encouraging", she said it was important people continue to act like they have the virus, "practice good hand hygiene and follow social distancing guidance". Households are high-risk settings for transmission, meaning the study provides early evidence on the impact of vaccines in preventing onward transmission, PHE said. BBC External Link

    COVID-19 treatment has improved, but many wish for an easy pill

    26 April- If Priscila Medina had gotten COVID-19 a year ago, she would have had no treatments proven safe and effective to try. But when the 30-year-old nurse arrived at a Long Island hospital last month, so short of breath she could barely talk, doctors knew just what to do. They quickly arranged for her to get a novel drug that supplies virus-blocking antibodies, and "by the next day I was able to get up and move around," she said. After two days, "I really started turning the corner. I was showering, eating, playing with my son." Treatments like these can help newly diagnosed patients avoid hospitalization, but they are grossly underused because they require an IV. Other medicines for sicker patients can speed recovery, but only a few improve survival. While vaccines are helping to curb the pandemic, easier and better treatments are needed, especially as virus variants spread. "We're seeing more and more young people get into serious trouble ... serious disease requiring hospitalization, and occasionally even tragic deaths," the U.S. government's top infectious disease expert, Dr. Anthony Fauci, recently told the National Press Club. The biggest need is for a convenient medicine such as a pill "that can prevent people with symptoms from getting worse and needing hospitalization," he said. Fox News External Link 

    Over 95 million people can go 'mask-less'

    27 April- The US Centers for Disease Control and Prevention (CDC) announced today 'Outdoor visits and activities are safer than indoor activities. And fully vaccinated people can participate in some indoor events safely, without much risk.' The CDC says vaccinated people can 'gather or conduct activities outdoors without wearing a mask, except in certain crowded settings and venues. And people can gather indoors with fully vaccinated people without wearing a mask or staying 6 feet apart.' The CDC reported yesterday that 95,888,088 people have been fully vaccinated against COVID-19. However, If you have a condition or are taking medications that weaken your immune system, you may not be fully protected even if you are fully vaccinated. Talk to your healthcare provider. Even after vaccination, you may need to continue taking all precautions, stated the CDC on April 27, 2021. As of April 27, 2021, the US Food and Drug Administration had authorized three experimental COVID-19 vaccines for use in the USA. Precision Vaccinations External Link

    Parents' diet and exercise habits, even before birth, may contribute to child's well-being

    28 April- The lifestyles of soon-to-be mothers and fathers could shape the health of their unborn offspring in lasting ways, according to a surprising new animal study of exercise, diet, genetics and parenthood. The study found that rodent parents-to-be that fatten on a greasy diet before mating produce offspring with sky-high later risks for metabolic problems. But if the mothers stay active during their pregnancies, those risks disappear. The study involved mice, not people, but does suggest that when a mother exercises during pregnancy, she may help protect her unborn children against the unhealthy effects of their father's poor eating habits, as well as her own. The findings add to our growing understanding of the ways in which parents influence children's long-term health, even before birth, and suggest how physical activity during pregnancy might help to ensure that those impacts are beneficial. Researchers have known for some time that parents, and especially mothers, begin influencing the health and behavior of their offspring well before conception. Studies involving both animals and people show that mothers with diabetes, obesity, insulin resistance or other metabolic problems before pregnancy tend to have babies with a predisposition to those same conditions as adults, even if the offspring follow healthy lifestyles. Mothers who are lean and physically active during pregnancy, meanwhile, tend to have children who, as adults, are active and metabolically healthy. The New York Times External Link

    Pfizer CEO says COVID-19 oral pill could arrive at the end of 2021

    28 April- Pfizer CEO said that we could see a potential pill to COVID-19 by the end of 2021. The pill is known to be a treatment for the virus during its early stage. Moreover, the pill is taken for oral use, and it works as an antiviral medicine for the regular variant. as well as the other types of coronavirus. It hinders the virus to reproduce inside the human body. The drug named PF-07321332 could be a game-changer to the war against COVID-19. Bourla said that there's no need anymore for a person to head to the hospital to seek coronavirus treatment. Furthermore, Bourla stated that fighting different coronavirus variants, it could pose a much more effective result compared to the previous medications. Currently, remdesivir remains as a lone drug that is confirmed to be an effective treatment for the virus. However, like many vaccines and other treatments, it has many side effects which could range from mild to severe. For those patients who are staying at the hospital, remdesivir can only be given via intravenous injection. Tech Times External Link

    U.S. Covid-19 vaccination efforts may start to slow, official says- Here's why

    26 April- Covid-19 vaccination efforts may begin to slow down as more Americans get vaccinated, an official told CNN on Sunday. More than 42% of the US population has gotten at least one Covid-19 vaccine dose, according to data from the US Centers for Disease Control and Prevention. Roughly 28.5% of the population is fully vaccinated. "We're going continue to make progress, it might not be as fast as the first 50% (of the population vaccinated), I think that it's going to be slower. But I think we're going to continue to get there," said Andy Slavitt, White House senior adviser for Covid-19 response. Experts say the US is facing some major challenges when it comes to getting more shots into arms, including vaccine hesitancy. While the country is still nowhere near widespread levels of protection, some areas have already begun to see a slowing demand for vaccines. By next month, vaccine enthusiasm will likely reach a "tipping point" and efforts to encourage Covid-19 vaccinations will become much harder, a recent report found. CNN External Link

    Waivers for vaccine production "not a solution" - BioNTech

    28 April- The granting of intellectual property waivers is not the right way to increase output of COVID-19 vaccines, the founder of German vaccine maker BioNTech (22UAy.DE) said on Wednesday, advocating instead the award of production licenses. Such waivers are among the options being considered by the Biden administration for maximizing the production and supply of vaccines, though no decision has been made, White House press secretary Jen Psaki said on Tuesday. "This is not a solution," BioNTech CEO Ugur Sahin said. BioNTech, which makes and markets its messenger RNA-based shot in partnership with U.S. drug maker Pfizer (PFE.N), considers close cooperation with selected production partners to be the right approach because its vaccine is hard to make. "We are considering ways to issue special licenses to competent producers," Sahin told an online briefing hosted by the German foreign correspondents' association. This would ensure that the quality of vaccines delivered to different regions of the world is consistent, Sahin said, adding that production by licensees could make a contribution towards the end of this year at the earliest. The BioNTech/Pfizer shot has been widely administered in countries including Israel, the United States and Britain, and is also the lead vaccine in the European Union's inoculation campaign. Reuters External Link


    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 15, ending April 17, 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.

    Influenza-Associated Pediatric Mortality- No influenza-associated pediatric deaths were reported to CDC during week 15. CDC External Link


    Dutch cucumbers suspected in UK E. coli outbreak

    26 April- An E. coli O157 outbreak in the United Kingdom that affected 36 people has been linked to a fast food product containing imported cucumbers. Investigations into the Shiga toxin-producing E. coli (STEC) outbreak this past year pointed to a certain fast food meal sold at one restaurant chain with contaminated cucumbers from the Netherlands. Findings provide further evidence that salad items are an important vehicle of STEC outbreaks, said researchers in the International Journal of Infectious Diseases. People fell sick from early to mid-August 2020 and investigations into the spike in reported infections began that month. Hospital visits for a third of patients Twenty-four patients were female. Sick people ranged between 13 and 60 years old and 27 lived across England, with 21 from two regions in the Midlands, and nine in Wales. Clinical information for 33 people shows 13 were hospitalized and 25 had bloody diarrhea but there were no reports of Hemolytic Uremic Syndrome (HUS). Food Safety News External Link


    Should I wear a mask outside? Experts weigh in on scenarios

    22 April- As more Americans are vaccinated against the coronavirus and a growing body of scientific evidence suggests that the risk of outdoor transmission is low, many people are wondering: Do we need to keep wearing face masks outside? The short answer is that masking outdoors can be "optional," says Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women's Hospital in Boston. While Sax says people should don masks indoors in public and around large crowds, he and other experts believe statewide mandates for wearing masks outdoors all the time may no longer be necessary. (Update: The Centers for Disease and Control and Prevention has echoed this view in its latest guidance on mask wearing for vaccinated individuals.) "The science of the viral transmission is advanced enough that we really don't want to be kind of confusing people by forcing them to wear masks in places where really they're at minimal risk," he says. But before you start spending all your time outdoors barefaced, experts emphasize that decisions about when to wear a mask outside largely depend on personal risk assessments involving a variety of virus-related factors. What is your vaccination status? How many other people could you be interacting with? Do you know their vaccination status? How much prolonged close contact could you have with them? Are you, or is anyone in your household, at increased risk for becoming severely ill from covid-19? The Washington Post External Link


    Impending measles outbreak looms over Africa over vaccination stalls

    24 April- A measles outbreak may soon hit several African countries as vaccination efforts to combat it have recently stalled, new report from the World Health Organization shows. Statistics from WHO indicate that 15 African countries postponed immunization drives against measles in 2020 to help deal with the COVID-19 pandemic. According to Matshidiso Moeti, WHO regional director for Africa, the countries that have delayed measles immunization in the continent could experience a resurgence of the disease that affects young children. "Recent outbreaks of measles, but also yellow fever, cholera, and meningitis all point to worrying gaps in immunization coverage and surveillance in Africa," Moeti said. She added that it requires at least 95 percent immunization coverage in a given population to avert a measles outbreak while administering the first dose of the measles-containing vaccine has stagnated around 69 percent in Africa since 2013 and only seven countries achieved the 95 percent coverage in 2019. Outbreak News Today External Link


    COVID-19 pandemic situation in Iraq continues to be quite concerning

    8 April- The World Health Organization (WHO) reports a sustained increase in the number of reported cases since the first weeks of 2021. During the last week of March, the Iraqi Ministry of Health reported 41,140 new cases of COVID-19 infections, which represents 6.76% increase compared with the week prior, and 251 new deaths with a 22.44% increase compared to the previous week. During the week, the positivity rate was 15 percent, marking continuity of community transmission1 of the COVID-19 pandemic. Iraq has reported more than 900,000 total cases in the pandemic, including 14,600 deaths. Outbreak News Today External Link


    Sweden: Officials decide to recommend a continued break for Janssen's vaccine

    24 April- The Swedish Public Health Agency has decided that Janssen's vaccine, just like AstraZeneca's vaccine, should only be recommended for people born in 1956 and earlier. This is after blood clots with a low level of platelets were classified as a very rare but serious side effect linked to Janssen's vaccine against covid-19. The cases of this side effect have mainly been reported among younger people, while the elderly are at a greatly increased risk of dying or suffering from severe covid-19 disease. The vaccine was to be delivered to Sweden in larger quantities in May. As the vaccine is still not recommended for people under the age of 65, the Swedish Public Health Agency decides to currently recommend a continued break for the use of Janssen's vaccine in Sweden for all age groups. We think it is better to recommend the vaccines that healthcare is now used to using. People over the age of 65 will still be able to get vaccines of the other three varieties, says Anders Tegnell, state epidemiologist. Outbreak News Today External Link


    Cook Islands dengue outbreak now 162 cases, dozens hospitalized

    27 April- The Cook Islands Ministry of Health (Te Marae Ora) reports that the number of probable and confirmed dengue fever virus-type 2 (DEN-2) has risen to 162 since the outbreak was declared on February 2. Thirty-four people required hospitalization for their illness. No deaths have been attributed to dengue. The majority of cases have been found in Rarotonga, however single cases have also been identified in Aitutaki and Mauke. Officials have carried out island-wide clean-up operations and awareness campaigns on both islands. Cook Islands News reports Dr Anura Jayasinghe, a public health specialist with Te Marae Ora Ministry of Health, said: "The public has a responsibility to maintain a clean environment." "Once we identify a case, we'll do spraying, but it will only target adult mosquitos. If breeding sites are intact, more mosquitos will come from those sites." Outbreak News Today External Link

    Philippines: Dengue warning in General Santos City

    24 April- The General Santos City government is warning the public about the rise in dengue fever. Since the beginning of the year, 503 cases, including six deaths have been recorded. Acting head of the City Health Office, Dr. Rochelle Oco said the numbers are 69 percent higher than the 298 cases and one fatality reported in the same period in 2020. "Our current cases are significantly higher than last year so while we continue to combat Covid-19 (coronavirus disease 2019), we should be also vigilant against the spread of dengue in our communities," Dr. Oco said. The government is advising the public to observe of the 4S strategy and the "4'oclock habit" down to the household level. Outbreak News Today External Link


    U.S.: Second measles case confirmed in Connecticut

    25 April- The child is a household contact of the child who contracted the first case of measles announced on April 9. These are the first cases of measles in Connecticut since 2019. So far during 2021, other than in Connecticut, no other measles cases have been confirmed in the United States. Measles is a highly contagious disease that can spread quickly among unvaccinated people. However, the majority of people exposed to measles are not at-risk of developing the disease since most people have either been vaccinated or have had measles in the past, before vaccination became routine. "The single best way to protect yourself and your children from measles is to be vaccinated," said DPH Acting Commissioner Dr. Deidre Gifford. "One dose of measles vaccine is about 93% effective, while two doses are about 97% effective. We must ensure we continue to protect our children from vaccine preventable illnesses through on-time vaccination." Very few people—about three out of 100—who get two doses of measles vaccine will still get measles if exposed to the virus. Measles vaccine does not cause measles illness. Outbreak News Today External Link


    Brazil: Paraná reports increase in chikungunya cases

    20 April- The Paraná State Department of Health (Sesa) warned today of the increase in cases of chikungunya, a disease also transmitted by the Aedes aegypti mosquito, as well as dengue and zika virus. According to The Weekly Report on Arboviruses, Paraná currently has 193 notifications for chikungunya and 29 confirmed cases. "Sesa is alert to this sudden increase in cases; we have already advised all 22 Regional Health Offices, mainly assistance services, for increased attention to possible cases. The correct notification points us to where the viral circulation is and enables the action ", affirmed the State Secretary of Health, Beto Preto. "Today the state of São Paulo is going through an outbreak of chikungunya; the proximity to Paraná and the flow of people between the states may have led to an increase in cases here ", explains Sesa's Environmental Surveillance coordinator, Ivana Belmonte. Outbreak News Today External Link