Defense Public Health Weekly Update, 06 January 2023

Date Published: 1/6/2023
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​The Defense Public Health Weekly 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 Defense Health Agency opinions, views, policy, or guidance, and should not be construed or interpreted as being endorsed by the Defense Health Agency.

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Table of Contents


    Changes to TRICARE Expected in 2024​​

    22 December-  A new TRICARE contract that facilitates beneficiary health care in the civilian sector, known as T-5, is expected to start in 2024. The changes will improve the delivery, quality, and cost of health care services for services for service members, retirees, and their families. There will continue to be two regional contractors. On December 22, 2022, the Defense Health Agency (DHA) announced that Humana Government Business and TriWest Healthcare Alliance Corporation will be the regional contractors, also known as managed care support contractors. If you live in the TRICARE East Region, Humana Government Business (Humana Military) will administer your health plan and provide TRICARE coverage. If you live in the TRICARE West Region, TriWest Healthcare Alliance Corporation will administer your health plan and provide TRICARE coverage. “I am pleased that our new T-5 TRICARE contracts will continue to focus on enhancing the experience of care and great health care outcomes for our service members, retirees, and their families,” said Lt Gen Ronald Place, Director, Defense Health Agency.  The biggest change is the shift six East Region states will make to the West Region. This will affect approximately 1.5 million beneficiaries. The states moving from the East Region to the West Region are:

    - Arkansas

    - Illinois

    - Louisiana

    - Oklahoma

    - Texas

    - Wisconsin

     Moving these six states into the West Region will create a more even balance to the TRICARE population each regional contractor manages. The move will also streamline processes and standards for both regions.​ TRICARE External Link


    AFRL launches wearable biomolecular sensors program for DoD, transfers technology to Sensate Biosystems​​

    20 December- The Air Force Research Laboratory, or AFRL, has partnered with the Nano Bio-Materials Consortium, or NBMC, and Case Western Reserve University to create wearable sensors that measure biomarkers in Airmen and Guardians. The term “biomarker” refers to any physiological or molecular information that can be tracked for human health. The collaboration, called Biomolecular Structure and Integration for Sensors, or BioSIS, connects AFRL’s Materials and Manufacturing Directorate, the 711th Human Performance Wing, the NBMC and Case Western Reserve University. In 2022, the body of research accumulated by Bio SIS since 2018 led to the founding of private spinoff company Sensate Biosystems. The NBMC provided funding to Case Western Reserve University to license the existing AFRL patent, assemble its own team and kickstart the company to develop wearable molecular sensor research for dual use in the commercial market. Human performance monitoring wearable sensors optimize capability in capturing and monitoring molecular signatures in body fluids such as saliva, interstitial fluid and perspiration. This technology is key to tracking well-being during critical missions, sensing when Airmen and Guardians become overly fatigued, stressed or hyperstimulated, according to Dr. Lawrence Drummy, senior materials engineer in the Materials and Manufacturing Directorate and BioSIS technical lead. “Historically, we have very few sensors on the Airmen,” Drummy said. “We are looking to equip them with more advanced human monitoring capabilities so mission commanders can integrate that information and make more rapid decisions. ”Wearable sensor technology has the potential to quantitatively measure human stress levels during missions, notify personnel to return to safety zones and monitor biomolecular responses in those who become sick or injured. “These wearable sensors can take on a variety of forms such as mouthguards, patches applied to the skin or microneedle patches that just penetrate the epidermis into the interstitial fluid, for example,” Drummy said. “These sensors will be integrated into a network, not just used as stand-alones, so that a global picture of performance can be generated.” Air Force Medical Service​ External Link​​​

    Whole Genome Sequencing at Tripler Army Medical Center​

    29 December- Tripler Army Medical Center, a Military Health System hospital serving military communities in Hawaii, established a fully functional whole genome sequencing surveillance program for SARS-CoV-2 during the pandemic. The Honolulu-based hospital consistently reported samples with some of the fastest turn-around-times in the network. "This is credited to their ongoing dedication to the mission and close collaboration with the on-site clinic and other military hospitals and clinics," said Kathleen Creppage, who holds a doctorate in epidemiology and is a senior epidemiologist and science advisor for Department of Defense's Global Respiratory Pathogen Surveillance. TAMC also has access to unique samples from Pacific Navy vessels, residents in Hawaii, and other locations within the U.S. Indo-Pacific Command area of responsibility. As the only military hospital with sequencing capability in the INDOPACOM area, TAMC continues to strengthen its capability and plans to assist other similar military-owned laboratories to implement sequencing. "TAMC had been partnering with GEIS (Global Emerging Infections Surveillance network) efforts for evaluating new technologies for respiratory disease in the Pacific region for several years before the COVID-19 pandemic," said Catherine Uyehara, who holds a doctorate and is the director of research for the Defense Medical Readiness Research Directorate of the Regional Health Command-Pacific. The Armed Forces Health Surveillance Division GEIS Next Generation Sequencing and Bioinformatics Consortium established a critical data-sharing network and connection with scientists at TAMC with the shared passion to focus on expanding the knowledge needed to combat this unprecedented pandemic. The scientific collaboration of former GEIS director U.S. Navy Capt. Guillermo Pimental, TAMC, and experts at United States Army Medical Research Institute of Infectious Diseases, resulted in the sharing of valuable ideas and data, as well as developing solutions. "We were also very fortunate to have Dr. Jonathan D'Ambrozio, who had just arrived at TAMC and happened to have the necessary expertise in bioinformatics needed to spearhead the establishment of a dedicated TAMC genome sequencing lab," said Uyehara. "The initial funding that GEIS provided helped TAMC procure the molecular genome sequencing supplies and extra technical help needed to hone in on examining the evolution of SARS-CoV-2 and detection of variants in our patient population in Hawaii." This work is important to military and local civilian populations. "Being in the middle of the Pacific, with the constant crossing of travelers through our island state from all over the world, makes our military and local civilian population at risk of respiratory disease spread," said Uyehara. "It is usually not a matter of if, but when we get exposed to the latest evolving disease." Health.​mil External Link


    College students' mental distress still high 15 months after COVID pandemic began​​​

    3 January- A survey of nearly 45,000 college students in France reveals a high prevalence of stress, anxiety, depression, suicidal thoughts, and post-traumatic stress disorder (PTSD) 15 months after the COVID-19 pandemic began. A team led by a researcher from the Centre Hospitalo-Universitaire de Lille fielded the third of three online mental health surveys among 44,898 university students at 82 French universities from Jul 21 to Aug 31, 2021. Most respondents (70.7%) were women, and the median age was 19 years. The first survey was conducted after the first pandemic lockdown (T1), and the second was sent 1 month after the lockdown ended (T2). Half of the students (50.6%) were in their first year of college, 81.9% were bachelor students, and 2.0% were in the sixth year or more. A total of 7.3% reported being from another country, 1.5% had children, 44.3% lived in an urban area, 26.3% resided in a suburb, and 29.4% lived in a rural setting. About 1 in 8 students reported having major financial difficulties (13.0%), a figure that rose to 1 in 3 (35.3%) when considering both major and moderate financial difficulties. A total of 8.9% of respondents said they had a history of psychiatric illness, 10.5% said they had a chronic condition, 27.0% said they previously had COVID-19, 4.5% of respondents said they were socially isolated, and the median score of quality of COVID-19 information they had been given was 5 out of 10. There was a high prevalence of stress (20.6%), anxiety (23.7%), depression (15.4%), suicidal thoughts (13.8%), and PTSD (29.7%) 15 months after the pandemic began (T3). Relative to rates at T2, stress, anxiety, and depression rose by 2.5%, 13.9%, and 22.2%, respectively, by T3. The rate of suicidal thoughts continued to rise from T1 (10.6%) to T3 (13.8%), and the prevalence of suspected PTSD climbed from 1 in 5 students to 1 in 3 from T2 to T3. CIDRAP​ External Link

    Demand for blood thinners rapidly fluctuated amid COVID​​

    3 January- Last week in The American Journal of Health-System Pharmacy, a team led by University of Southern California researchers reported disruptions in the demand for anticoagulant and antiplatelet medications at US hospitals during the COVID-19 pandemic. The team used IQVIA National Sales Perspective data to measure the monthly volume of the blood clot-preventing drugs procured by US hospitals from January 2018 to February 2021. The authors noted that these drugs have a role in COVID-19 treatment. Driven by a drop in heparin volume, the total volume of anticoagulants and antiplatelet medications at US hospitals fell 43.4% at the onset of the pandemic in March 2020. Average monthly volumes declined significantly for parenteral (delivered intravenously) anticoagulants (-106,691,340 extended units [EUs], or numbers of packages multiplied by the number of tablets, capsules, vials, grams, or milliliters), oral anticoagulants (-354,800 EUs), and parenteral antiplatelet drugs (-391,880 EUs). Relative to before the pandemic, the monthly volume of oral anticoagulants, parenteral anticoagulants, and parenteral antiplatelets rose significantly after the emergence of SARS-CoV-2. Most of the growth was seen in the anticoagulants apixaban, argatroban, enoxaparin, tirofiban, and heparin and the antiplatelet eptifibatide. Apixaban and heparin volumes continued a prepandemic upward pattern, while argatroban and eptifibatide volumes reversed their downward trends. The researchers said the initial steep decrease in volumes of anticoagulant and antiplatelet drugs may be explained by the drop in healthcare usage in the first months of the pandemic, while subsequent increased demand for anticoagulants may reflect both the growing understanding of the relationship between severe COVID-19 and blood clots and the rise in hospitalizations for acute cardiovascular disease after May 2020. CIDRAP​ External Link

    Personalized Cancer Vaccine Program gets a Green Light​​

    3 January- Evaxion Biotech A/S today announced that the U.S. Food and Drug Administration ("FDA") determined that the Company may proceed with its Phase 2b clinical trial of EVX-01. The study (EVX-01 plus Pembrolizumab 25 MG/ML) was first initiated in Australia in September 2022. EVX-01 is a peptide-based cancer therapy intended for the first-line treatment of various metastatic and unresectable melanoma. In November 2022, the Company submitted an Investigational New Drug Application ("IND") along with a Fast Track designation application to the FDA for a On December 22, 2022, the FDA issued approval for the Company to proceed with its Phase 2b clinical trial of EVX-01 in combination with KEYTRUDA® for treating patients with metastatic melanoma. "Receiving a green light from the FDA is a tremendous boost for our personalized cancer vaccine program. EVX-01 is already actively enrolling patients in Australia, and the FDA approval expands our ability to move forward quickly with our lead program in malignant melanoma," commented Erik Heegaard, Chief Medical Officer at Evaxion, in a press release on January 3, 2022.​​ Precision Vaccinations​ External Link

    Still Searching For Herpes Vaccines​​

    30 December- As 2022 comes to a close, searches for a U.S. Food and Drug Administration (FDA) herpes vaccine peaked in December. According to analyses, more website visitors sought the latest herpes vaccine news than any other disease, including COVID-19. Unfortunately, most searchers were disappointed to learn that herpes vaccine development efforts continue in early-stage clinical trials. However, there is optimism heading into 2023. BioNTech SE recently announced its mRNA-based BNT163 herpes simplex virus vaccine candidate is currently under development to prevent genital lesions caused by Herpes Simplex Virus-2. Announced on December 21, 2022, BioNTech's Phase 1 clinical trial is expected to enroll around 100 healthy adult volunteers without current or history of symptomatic genital herpes infections. The U.S.-based study consists of a first dose escalation part focusing on safety evaluations and assessing the optimal dose-response. The trial's second part is designed to expand the safety characterization for the selected dosing of BNT163 for a more comprehensive assessment of the impact of pre-existing herpes virus immunity on BNT163 vaccine-induced immune responses. The World Health Organization says vaccines against sexually transmitted infections (STIs) are a significant priority. The development of new STI vaccines is critical because of the many infections worldwide, the resulting adverse sexual, reproductive, and maternal-child health outcomes, and the known limitations of existing STI interventions.​ Precision Vaccinations​ External Link

    The new omicron subvariant XBB.1.5: What you must know now​​​

    ​2 January- A new omicron variant is quickly spreading across the U.S. just in time for the New Year. The strain, known as XBB.1.5, accounts right now for almost 41% of confirmed COV​ID-19 cases nationwide, according to data from the Centers for Disease Control and Prevention (CDC). The XBB mutation has picked up concerning speed over the past week as it’s jumped from just 21% on Christmas Eve. During the last week of December 2022, XBB.1.5 made up 75.3% of COVID-19 cases in northeastern states. Those states include Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.​ In New York and New Jersey, the strain showed up in 72.2% of cases also during the last week of the year. XBB has officially replaced the previously concerning BQ.1 and BQ.1.1 subvariants as the most common strains. Fox News​ External Link​​


    Flu activity still high but continued to decline before Christmas, CDC data shows​​

    30 December- Among visits to a health care provider last week, 6.1% were for respiratory illness. The cumulative hospitalization rate was more than four times higher than it has been at this point in the season in more than a decade. The number of hospital admissions for flu decreased nationally for the third week in a row. Nearly 19,000 patients were admitted to hospitals with influenza last week, down from a season high of more than 26,000 new admissions in the week after Thanksgiving. Among children, 14 deaths were reported last week for a total of 61 this season. “An annual flu vaccine is the best way to protect against flu. Vaccination helps prevent infection and can also prevent serious outcomes in people who get vaccinated but still get sick with flu,” CDC researchers wrote in their weekly flu report Friday. “CDC continues to recommend that everyone ages 6 months and older get an annual flu vaccine as long as flu activity continues.” Respiratory virus activity remains “high” or “very high” in most states, and public health experts warn that activity may increase again following New Year’s Eve. Among the states with the highest level of activity is New Mexico, where the US Department of Health and Human Services sent a team from the National Disaster Medical System to the University of New Mexico Children’s Hospital on Friday, “providing much needed support to an overwhelmed emergency department.” HHS Secretary Xavier Becerra sent a letter to US governors in early December outlining the federal resources that were available amid a surge of respiratory illnesses.​ CNN​​ External Link


    Chocolate recalled in Canada over plastic in product​​

    3 January- Sanders Candy, LLC is recalling its brand of Dark Chocolate Sea Salt Caramels because of pieces of plastic in the product. The recalled product has been sold in Ontario, Quebec, New Brunswick, Nova Scotia and Newfoundland and Labrador, Canada, according to the Canadian Food Inspection Agency. The Canadian Food Inspection Agency (CFIA) is advising retail and consumers to not use, sell, serve or distribute the affected product. Food Safety News External Link

    More sprouts recalled as outbreak investigation continues​​

    ​​30 December- SunSprout Enterprises has expanded a recall of raw alfalfa sprouts because of potential contamination with Salmonella. This recall is a result of an investigation by Nebraska and the federal CDC of an outbreak of illness associated with the alfalfa sprouts. Nebraska officials are urging the public to avoid eating alfalfa sprouts after at least a dozen people have been confirmed sick in an outbreak of Salmonella Typhimurium.  The company directly distributed 1,406 pounds of product to five food service and grocery customers in Nebraska, Kansas, and Iowa between November and December 2022. ​

    - The raw alfalfa sprouts are packaged in 4-ounce clamshells and 2.5lb packages with best-sold buy dates between 12/10/2022 and 1/7/2023 and lot codes #4211, 5211, 3212, and 4212. 

    - The best-sold buy date can be found on the front of the package.

    Customers with products from this lot number in their possession should stop using them and dispose of them immediately. Consumers are also encouraged to follow all safe handling instructions and wash their hands and all preparation surfaces and storage areas after handling any raw product. Food Safety News ​External Link​​


    Why Less Sunlight in the Wintertime Can Put You at Risk of Depression​​

    7 December- During winter months at Fort Wainwright in Alaska, the sun comes up around 10 a.m. and sets a little bit before 3 p.m. Along with the frigid weather, the extended darkness creates an increased risk of depression and other mental health problems. That’s why at installations like Fort Wainwright, military officials are acutely aware of the risks of Seasonal Affective Disorder, also known as SAD, which is the medical term for a seasonally triggered change in behavior that can affect anyone but especially at higher latitudes where the days are shortest. SAD can be hard to recognize because its onset is as slow as the changing seasons. “One of the most challenging things about identifying Seasonal Affective Disorder is that the onset can be very subtle,” said Army Capt. Julie Dederer, a psychologist at Bassett Army Community Hospital at Fort Wainwright near Fairbanks, Alaska, said. “This can cause delays in patients identifying that something is wrong, and in accurately identifying it for treatment once the patient does seek treatment for it.” The problem becomes most acute around this time of year, near the winter solstice, or the northern hemisphere’s shortest day of the year, which usually falls on Dec. 21. Anyone can be affected each year regardless of latitude. “SAD can occur regardless of geographic location, especially if people have a history of mental health issues or depression,” said U.S. Public Health Service Officer Lt. Hana Kim, the assistant department head of the outpatient behavioral health department at the Navy Medicine Readiness and Training Command in Jacksonville, Florida. There is a relatively high rate of reoccurrence “in that individuals who experience an episode of SAD are significantly more likely to experience another episode the next year,” Dederer said. The good news is that this “provides an opportunity for preventive measures.” At Fort Wainwright, soldiers can borrow light boxes, which provide broad-spectrum light that mimics daylight. Light boxes are best used in the morning, Kim said. “For mild to moderate SAD, light box therapy is the first line of therapy,” she said. For more severe cases, antidepressant medications such as selective serotonin reuptake inhibitors, known as SSRIs, might be prescribed.​​ External Link


    Hospital Debt, Detention and Dignity in Africa's Healthcare​

    4 January- Detaining people for their inability to pay for healthcare is an epidemic across Africa. A study by Chatham House shows this disturbing trend in Kenya, Nigeria, South Africa, Cameroon, DR Congo, Ghana, Zimbabwe and Uganda. The detention of patients is dehumanizing and comes with other traumas, writes Dr. Stellah Bosire a Senior New Voices Fellow at the Aspen Institute. In one case, 60 women were held next to an overflowing toilet in a Kenyan hospital; and one victim reported being told by nurses that she was "stupid" for not knowing she was pregnant after being raped. In another, a Nigerian woman was chained to a urinal pipe during her detention. These abuses are atrocious and despicable. The right to health is a fundamental right without which other rights are indispensable. Kenya has safeguarded the right to health by anchoring it in the Constitution of 2010, which provides that all Kenyans have a right to the highest attainable standard of health, including reproductive health, Dr Bosire writes. The reality is that detention of patients due to medical bills violates the right to liberty, dignity and non-discrimination. Further, it can impact the mental health of patients negatively, and also increase their risk of contracting hospital acquired infections. All Africa​ External Link


    After months of calm, Yemen looks anxiously to the new year​​

    4 January- When 2022 began, and with war raging in his home country Yemen, Abdu felt that there was only one way for him to make money and help his family. The 25-year-old packed his bags, left the Yemeni capital Sanaa, and headed north. “Out of despair, I decided at the start of the year to travel to Saudi Arabia to find work,” Abdu said, with a deep sigh as he remembered his trip to the kingdom, Yemen’s richer neighbour, which had also spent several years conducting air attacks across Yemen in support of the government. Abdu did not apply for a work visa because he could not afford it. Like many others, he instead turned to smugglers to reach his destination, the southern Saudi city of Khamis Mushait, 12 hours away. “I arrived there in the second week of January [2022]. I found a job as a shepherd. And I started receiving 1,500 Saudi riyals ($399) monthly,” Abdu told Al Jazeera. But only three months after Abdu’s arrival in Saudi Arabia, his own expectations for how the year would pan out for Yemen were upended.​​ Al Jazeera​ External Link


    Russia: Measles outbreak reported in Samara region​​

    28 December- Health officials in Samara Oblast in the Volga Federal District of Russia are reporting a measles outbreak this month. Six cases of the dangerous disease have been officially registered in Samara, according to a a local media report. Caused by a highly contagious virus, measles spreads from person to person by breathing, coughing, or sneezing. Signs and symptoms of measles include rash, high fever and a cough, runny nose, or red, watery eyes. People can spread measles up to 4 days before and 4 days after they have a rash. Measles can lead to serious complications, such as pneumonia (infection of the lungs), and even death.​ Outbreak News Today​ External Link


    China media plays down COVID severity as WHO seeks detail on variants​

    3 January- State media in China played down the severity of a surge of COVID-19 infections ahead of an expected briefing on Tuesday by its scientists to the World Health Organization, which is hoping for a "detailed discussion" on the evolution of the virus. China's abrupt U-turn on COVID controls on Dec. 7, as well as the accuracy of its case and mortality data, have come under increasing scrutiny at home and abroad. China's foreign ministry labelled travel entry curbs imposed by some countries as "simply unreasonable", saying they "lacked scientific basis". "We are willing to improve communication with the world," foreign ministry spokeswoman Mao Ning told reporters in Beijing. "But ... we are firmly opposed to attempts to manipulate the epidemic prevention and control measures for political purposes, and will take corresponding measures in different situations according to the principle of reciprocity." China's shift away from a "zero-COVID" policy that had been championed by President Xi Jinping followed protests that had marked the strongest show of public defiance during his decade in power and had coincided with the economy's slowest growth in nearly half a century. As the virus spreads unchecked, funeral parlours have reported a spike in demand for their services and international health experts predict at least one million deaths in China this year.​ Reuters​ External Link


    Omicron offshoot XBB.1.5 could drive new Covid-19 surge in U.S.​​

    3 January- For weeks, scientists have been watching a slew of Omicron descendants duke it out for dominance of Covid-19 transmission in the United States, with the BQs – BQ.1 and BQ.1.1 – seeming to edge out all the others to claim a slight lead. The result has been a gradual rise in cases and hospitalizations that never seemed to reach the peaks of this summer’s BA.5 wave and was certainly nothing like the tsunami of illness caused by the original Omicron strain a year ago. But on Friday, the US Centers for Disease Control and Prevention’s Covid-19 variant dashboard revealed a new dark horse that could soon sweep the field: XBB.1.5. The CDC estimates that XBB.1.5 has more than doubled its share of the Covid-19 pie each week for the last four, rising from about 4% to 41% of new infections over the month of December. In the Northeast, the CDC estimates, XBB.1.5 is causing 75% of new cases. “For a few months now, we haven’t seen a variant that’s taken off at that speed,” said Pavitra Roychoudhury, director of Covid-19 sequencing at the University of Washington School of Medicine’s virology lab. CNN​ External Link​​


    Leptospirosis in Puerto Rico: More than 700 total cases since Hurricane Fiona​

    31 December- The Puerto Rico Department of Health reports nearly 800 total (confirmed, probable and suspect) cases of leptospirosis in the aftermath of Hurricane Fiona on September 18, 2022. According to their data, 33 confirmed, 89 probable and 649 suspect cases (771 total) have been reported from week 38 (ending September 24) through week 50 (ending December 17). The 771 cases were reported in 74 municipalities of all the health regions. The Health Region with the most reported total cases was Caguas (164). The ​municipality with the highest number of total cases reported was Caguas (52). The municipality with the highest number of confirmed and probable cases was Utuado (8). Currently, seven deaths are under investigation. In all of 2022, Puerto Rico has seen 944 total cases of leptospirosis, including 14 fatalities. Leptospirosis is an acute febrile disease with varied manifestations. The severity of the disease ranges from asymptomatic or subclinical to self-limited systemic disease (approximately 90% of patients) to a life-threatening disease with jaundice (yellowing of the skin, mucous membranes or eyes), kidney failure (oliguria or anuria), myocarditis, hemorrhage (particularly pulmonary), and refractory shock (organ damage).​​ Outbreak News Today External Link