Defense Public Health Weekly Update, 03 March 2023

Date Published: 3/3/2023
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​​​​​​​​​NOTICE: There will be no Defense Public Health Weekly Update next week. Publication will resume on 17 March 2023.​

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


    Army rescinds COVID-19 vaccination requirements​​

    24 February- Secretary of the Army Christine Wormuth has issued a memorandum today that rescinds all policies associated with the DOD COVID-19 vaccination mandate. In accordance with the memorandum:

    - Currently serving Soldiers will not be separated for refusing to receive the COVID vaccine if they sought an exemption on religious, administrative or medical grounds.

    - Ongoing reviews of COVID vaccine exemption requests have ceased and will be deemed resolved.

    - Records of Soldiers who requested COVID vaccine exemptions will be updated to remove and/or correct any adverse actions associated with denials of such requests, as well as any flags associated with those adverse actions.

    - Reenforces that Covid vaccinations are no longer required for accessions or pre-commissioning programs.

    - Reenforces that official Army travel restrictions based solely on COVID vaccination status have been removed (however, other policies such as combatant-command and theater-specific entry requirements will remain in effect).

    - Former Soldiers may petition the Army Discharge Review Board and the Army Board for Correction of Military Records to request corrections to their records.

    “I am proud of the efforts the Department of the Army has taken to respond to the COVID-19 pandemic,” Wormuth said. “We will continue to promote and encourage COVID-19 vaccination for all personnel to ensure readiness, facilitate mission accomplishment and protect the force.”​On Dec. 23, 2022, Section 525 of the 2023 National Defense Authorization Act required the Secretary of Defense to rescind the COVID-19 vaccination mandate for service members within 30 days. Shortly thereafter, on Dec. 29, 2022, the Army directed commanders to suspend separation actions for Soldiers refusing the COVID-19 vaccine. On Jan. 10, 2023, the Secretary of Defense issued a memorandum, in accordance with the 2023 NDAA, that rescinded the COVID-19 vaccination requirement.​ Army​.mil​ External Link


    CDC to review medical records of military patients sickened by Red Hill fuel spills​

    27 February- Experts from the Centers for Disease Control and Prevention are in Hawaii looking at medical records of military families who got sick from the Red Hill fuel spill. The site visit comes after the CDC’s own Red Hill surveys showed many participants reported worse health after the 2021 fuel spill, which contaminated the Navy’s drinking water system around Pearl Harbor. Whitney Trimble, chief of public affairs for Defense Health Agency Region Indo-Pacific, said the 11-member team is made up of toxicology and epidemiology experts and tasked with conducting a “HIPAA-compliant medical record review of patients experiencing long-term health effects that may be related to the Red Hill fuel spill.” On Friday, at a National Guard public meeting on future water testing in Waiawa, state toxicologist Dr. Diana Felton was asked questions about the Red Hill contamination. HawaiiNews​ External Link​​​

    Military Services Will Amend COVID Vaccine Refuser Records So They Aren't Passed Over for Promotions​

    27 February- All of the military services are currently reworking their policies to adjust separation and promotion records for service members who refused to get the COVID-19 vaccine, after the Pentagon ended the inoculation mandate last month. The Pentagon directed all the services to "formally rescind any policies, directives, and guidance implementing those vaccination mandates as soon as possible, if they have not already done so," according to a Friday press release. The service branches must notify the Pentagon that they've made the changes no later than March 17. The new policy guidance to the services makes no mention of reinstating service members who were separated from the military for refusing the shot. The same day the Pentagon set the deadline for the services, several of the branches -- namely the Army and Air Force -- began issuing their guidance, which stated they would remove or correct adverse actions in records related to vaccine refusal. The Department of the Air Force, which also issues guidance for the Space Force, has detailed it will be rescinding letters of admonishment, counseling or reprimand; records of individual counseling; nonjudicial punishments; and current involuntary discharge proceedings connected to vaccine refusal. Additionally, "promotion records will be corrected by the [Department of the Air Force] who will remove or redact all adverse actions related to vaccine refusal," according to a Friday press release. The Army also annou​nced in a Friday press release that ongoing reviews of COVID vaccine exemption requests, records of soldiers who requested COVID vaccine exemptions, vaccine requirements for accessions or pre-commissioning programs, and travel restrictions based solely on COVID vaccination status will be removed or amended. "Former Soldiers may petition the Army Discharge Review Board and the Army Board for Correction of Military Records to request corrections to their records," the service's press release said.​ External Link

    New Army policies increase access to Soldier, Family reproductive health care​​​​

    27 February- The Army published policies increasing privacy and access to reproductive health care for Soldiers and Army Family members. The policies, which derive from the recently published Department of Defense memos, establish new standards for pregnancy notifications to commanders and requesting administrative absences and funded travel for non-covered reproductive health care. “Reproductive health care decisions are extremely important and personal,” said Dr. Agnes Schaefer, Assistant Secretary of the Army (Manpower and Reserve Affairs). “The Army knows this policy updates is necessary to give our Soldiers and Families the flexibility and support to control their health and well-being.” Soldiers can now delay notifying their command of a pregnancy until the 20th week of gestation, except when there is a direct to impact to their duty, safety, or when participating in a pre-deployment health screening. Other policies include allowing Soldiers to request an authorized absence of up to 21 days without being charged leave and a travel allowance to facilitate access to non-covered reproductive health care. The absence and funded travel can be related to non-covered care for the Soldier or their dependent. External Link​​


    7 Misconceptions About Covid-19 Exposed by Experts​

    28 February- A series of assessments by recognized scholars has shown that public health professionals during the Covid-19 outbreak were often inaccurate. But to be clear, they were not in the wrong when they made suggestions based on the information they had at the time. ​They were inaccurate because they stubbornly stuck to their original orders despite new information. They ignored facts that contradicted their policy and silenced critics. An investigation examined 65 key studies on natural immunity from 19 nations. Natural immunity outperformed the core Covid vaccination series, according to the researchers. Notwithstanding Facebook's "misinformation" policy, 160 research provided scientific facts. The majority of Americans sacked for not getting the Covid vaccination already had antibodies that neutralized the virus, but the government did not recognize them. Tech Times​ External Link​​

    Adderall users struggle with ongoing shortage while reason – and resolution – remain uncertain​​

    23 February- The 17-year-old Utah native has been named a 2023 National Merit Scholarship finalist. And she heads to Brigham Young University as a freshman this fall. But despite all of her achievements, Clara has one thing weighing on her mind: What if she fails? Clara was diagnosed with attention-deficit/hyperactivity disorder (ADHD) in 10th grade, during the summer of 2020, after months of digital schooling had started to take its toll. “For the first time, I started struggling with getting my homework done [and] having a set schedule that I had to do myself,” Clara said. “It was because of online school.” So along with her mother, Rebekah, she made the decision to try medication. “I didn’t realize just how much my ADHD was inhibiting me from acting the same way as all of my friends until I had that experience of leveling the playing field,” Clara said. By December 2020, Clara was prescribed 10 milligrams of Adderall, a formulation of amphetamine mixed salts, to be taken twice a day. Immediately, she noticed a difference. “It seemed like​ the logical course of action, like something that shouldn’t have been happening in my brain was being fixed,” Clara said. “Naturally, my brain goes really, really fast, and I don’t even notice it because it’s what I’ve grown up with, and it’s the only mind I’ve ever experienced. But once I started having a different experience mentally, I felt a lot calmer.” For the two years that followed, Clara was finally able to lead what she called a normal life, managing school, extracurricular activities and social life – all with the help of Adderall. But in October 2022, Clara’s sense of calm was stripped away when the US Food and Drug Administration announced a shortage of Adderall and its generic counterparts. “I hadn’t heard anything about a shortage,” she said. “I didn’t really take it seriously at first until later that week – maybe three or four days later – when I started to hear news about the shortage, and it really started to sink in.”​​ CNN​ ​External Link

    CDC issues warning over an increase of drug-resistant bacteria​​

    25 February- The US Centers for Disease Control and Prevention has issued a health advisory to warn the public of an increase of a drug-resistant bacteria called Shigella. There are limited antimicrobial treatments available for these particular drug-resistant strains of Shigella and it’s also easily transmissible, warned the CDC in the Friday advisory. It’s also able to spread antimicrobial resistance genes to other bacteria that infect the intestines. Shigella infections known as shigellosis can cause a fever, abdominal cramping, tenesmus and diarrhea that is bloody. The bacteria can be spread by a fecal-oral route, person-to-person contact, and contaminated food and water. While typically shigellosis affects young children, the CDC says it has started to see more of the antimicrobial-resistant infections in adult populations – especially in men who have sex with men, people experiencing homelessness, international travelers and people living with HIV.​ “Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission,” the advisory said. The CDC says patients will recover from shigellosis without any antimicrobial treatment and it can be managed with oral hydration, but for those who are infected with the drug-resistant strains there are no recommendations for treatment if symptoms become more severe. The percentage of infections from drug-resistant strains of the bacteria increased from zero in 2015 to 5% in 2022, according to the CDC. Nationwide, there are nearly 3 million antimicrobial-resistant infections each year, and more than 35,000 people die as a result, according to the CDC. A recent report by the United Nations said roughly 5 million deaths worldwide were associated with antimicrobial resistance in 2019 and the annual toll is expected to increase to 10 million by 2050 if steps are not taken to stop the spread of antimicrobial resistance. CNN​ External Link

    Irregular sleep could put you in the danger zone for heart disease, says study​​​

    1 March- If you go to bed and wake up at different times throughout the week — or if your sleep gets disrupted during the night — you could face a higher risk of heart disease, according to a new study published by the American Heart Association. The study looked at 2,032 older adults, measuring both the duration and timing of their sleep.  For a seven-day period, participants kept a sleep diary and wore a special wristwatch that tracked their sleep quality by measuring movements and oxygen levels. Those who had irregular sleep patterns — including differences in the times they went to bed and interruptions in their sleep throughout the night — were more likely to show signs of atherosclerosis. Atherosclerosis, also known as coronary artery disease, is a "thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery," as defined on Johns Hopkins Medicine’s website. Researchers adjusted for outside factors, including prior cardiovascular disease, obstructive sleep apnea and other sleep disorders.​ Fox News​ External Link

    MIT Engineers Devise New Method to Make Protein Drugs Cheaper​

    28 February- Purification, or isolating the protein from the bioreactor that produced it, is one of the most expensive procedures in the production of protein drugs like insulin or antibodies. This process may cost as much as half of the overall price of producing a protein. Now, MIT engineers have developed a novel technique for carrying out this type of filtration to lower production costs. Their method, which quickly crystallizes proteins using specialized nanoparticles, may make protein drugs more affordable and available, particularly in underdeveloped nations. "This work uses bioconjugate-functionalized nanoparticles to act as templates for enhancing protein crystal formation at low concentrations," Kripa Varanasi, senior author of the study, said in a press release statement. "The goal is to reduce the cost so that this kind of drug manufacturing becomes affordable in the developing world." The scientists showed that their method may be used to crystallize insulin and the antibacterial enzyme lysozyme. They believe that it might be used for other beneficial proteins, such as vaccinations and antibody-based medications. A family of medications known as biologics, which also includes molecules like DNA and RNA and cell-based therapies, includes antibodies and other protein-based medications. In massive bioreactors, live cells like yeast manufacture the majority of protein medications. After these proteins are produced, they must be separated from the reactor, which is typically accomplished through a procedure known as chromatography.  Chromatography, which divides proteins according to their size, needs specific materials, which raises the cost of the procedure significantly.​ Tech Times​ External Link​​

    Pfizer gets FDA panel's backing in RSV vaccine race​​

    ​28 February- A panel of outside advisers to the U.S. health regulator on Tuesday recommended Pfizer Inc's (PFE.N) respiratory syncytial virus (RSV) vaccine, bringing it closer to becoming one of the first approved RSV shots for older adults in the United States. The Food and Drug Administration's (FDA) advisory committee voted 7-4 in favor of the vaccine, saying data from the company's study established that the shot was effective and safe in preventing lower respiratory tract disease caused by RSV in people aged 60 years and older. One member abstained during voting.GSK (GSK.L), which is another forerunner in a crowded race to develop the first RSV vaccine, will face scrutiny from a panel of experts to the FDA on Wednesday.​ Companies such as Johnson & Johnson (JNJ.N), Moderna Inc. (MRNA.O) and Merck (MRK​.N) are also looming on the horizo. While panelists backed Pfizer's vaccine, concerns were voiced over insufficient efficacy data in the company's study for adults 80 and above, who need the vaccine the most, and suggested a need for detailed post-marketing safety surveillance to address issue of any serious adverse event.​ Reuters​ ​External Link

    Prior COVID infection provides just as much protection as vaccines, new study finds​

    ​​20 February- A new study found that a previous COVID-19 infection offers at least the same level of protection as two doses of high-quality mRNA vaccines, such as Moderna and Pfizer-BioNTech. Additionally, people who are infected with the virus may be protected from reinfection for 40 weeks or longer, the study found. It was published in The Lancet on Feb. 16. Protection from reinfection was highest for the ancestral (original) strain of COVID-19 and the alpha, beta and delta variants, remaining at more than 78% after 40 weeks. Protection was lower for the omicron BA.1 variant, which dropped to 36.1% in that same time frame. Fox News​ External Link​​


    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 7, ending February 18, 2023​​​:

    - Seasonal influenza activity is low nationally.

    - Six of 10 HHS regions were below their outpatient respiratory illness baselines.

    - The number and weekly rate of flu hospital admissions decreased compared to week 6.

    - Hospitals reported 1,778 influenza hospitalizations to HHS Protect during week 7 compared to 2,091 reported during week 6.

    - The weekly rate of flu hospital admissions in the FluSurv-NET declined again during week 7.

    - Of the 53 influenza A viruses detected and subtyped during week 7, 54.7% were influenza A(H3N2) and 45.3% were influenza A(H1N1).

    - Four influenza-associated pediatric deaths that occurred during the 2022-2023 season were reported this week, for a total of 115 pediatric flu deaths reported so far this season.

    - CDC estimates that, so far this season, there have been at least 25 million illnesses, 280,000 hospitalizations, and 18,000 deaths from flu.

    - The majority of influenza viruses tested are in the same genetic subclade as and antigenically similar to the influenza viruses included in this season’s influenza vaccine.

    - All viruses collected and evaluated this season have been susceptible to the influenza antivirals peramivir, zanamivir, and baloxavir, and all viruses except for one (> 99.9%) have been susceptible to the influenza antiviral oseltamivir.

    - CDC continues to recommend that everyone ages 6 months and older get an annual flu vaccine as long as flu activity continues.

    - There are also prescription flu antiviral drugs that can be used to treat flu illness; those need to be started as early as possible.​​ CDC​ External Link


    Canned shrimp recalled over reports of swelling, leaking and bursting cans​

    27 February- Kawasho Foods USA Inc. of New York, NY, is recalling one lot of canned GEISHA Medium Shrimp 4oz. because of reported swelling, leaking or bursting cans. The company is concerned that the product might have been under-processed, which could lead to the potential for spoilage organisms or pathogens. According to the company announcement posted by the FDA, the recalled product was distributed to retail stores including Walmart, Associated Food Stores, Stater Bros Markets, Safeway and Albertsons in California, Utah, Arizona and Colorado.​

    Recalled product:

    - The GEISHA Medium Shrimp is packaged in a 4oz. metal can.

    - UPC 071140003909. 

    - The lot being recalled is LGC12W12E22.

    BEST BY: MAY/12/2026.

    - Code appears on the bottom of the product can.

    As of the posting of this recall, no illnesses or other adverse consequences have been reported to date in connection with this product. Food Safety News​ ​External Link​​​

    CDC declares Salmonella outbreak linked to sprouts over​

    1 March- On Feb. 28, 2023, the Centers for Disease Control and Prevention (CDC) announced that the multistate outbreak of Salmonella Typhimurium infections linked to Sun Sprouts-brand alfalfa sprouts grown by SunSprout Enterprises of Fremont, NE, is over. CDC reports a total of 63 illnesses, with 10 people requiring hospitalization. Illnesses were reported in eight states with the last illness onset on Feb. 2, 2023. States with cases include Arizona (1), Iowa (6), Kansas (6), Missouri (9), Nebraska (26), New Hampshire (1), Oklahoma (1) and South Dakota (13). The investigation was conducted by the U.S. Food and Drug Administration (FDA), along with the Centers for Disease Control and Prevention (CDC) and state and local partners. On Dec. 29, 2022, SunSprout Enterprises initiated a voluntary recall of two lots (# 4211 and 5211) of raw alfalfa sprouts because of potential contamination with Salmonella. On the same day, SunSprout Enterprises expanded their voluntary recall to include two additional lots (# 3212, and 4212) of raw alfalfa sprouts. The raw alfalfa sprouts for all recalled lots (#4211, 5211, 3212, and 4212) are packaged in 4-ounce clamshells and 2.5-lb packages with best sold-by dates between 12/10/2022 and 1/7/2023. Recalled products were sold fresh and are now past shelf-life and should no longer be available for sale. In general, FDA recommends that anyone who received recalled products use extra vigilance in cleaning and sanitizing any surfaces and containers that may have come in contact with these products to reduce the risk of cross-contamination. Food Safety News​ External Link


    Flexibility: Essential Stretches for Your Workout​

    28 February- Want to stay limber and pain-free as you age? If so, your workout routine should include stretches for flexibility. Building flexibility exercises into your workout routine is important, as it can help you get more out of each sweat session and avoid injury too. To help you do all that, the following slides offer eight key stretches from the book “Fitness After 40” by Dr. Vonda Wright, a double board-certified orthopedic sports medicine surgeon specializing in shoulder, hip and knee arthroscopy for athletes and active people of all ages. These stretches can be useful for people of all ages, though. And there’s certainly no minimum age for staying flexible. Health.usnews​ External Link


    Mozambique commences cholera vaccination drive as outbreak tops 5,000 cases​

    27 February- Mozambique today kicked off a cholera vaccination campaign targeting around 720,000 people in eight districts as the country steps up control measures against an outbreak in which 5260 cases and 37 deaths have been recorded to date since September 2022. People aged one year and older will be vaccinated in the five-day campaign, which started just 10 days after the country took delivery of vaccine doses. Alongside the vaccination campaign, health authorities are also reinforcing disease surveillance, prevention and control measures, treatment as well as raising public awareness to curb the spread of the disease and end the outbreak. “The vaccination campaign will be crucial in stemming the spread of cholera and help save lives,” said Dr. Severin von Xylander, World Health Organization (WHO) Representative in Mozambique. “We are also working with the health authorities to bolster key outbreak response measures and have deployed staff in the three most affected provinces to support the provincial health authorities to detect, prevent and halt cholera this outbreak.” Outbreak News Today​ External Link​​


    Cholera outbreak in quake-hit northwestern Syria kills two people​​

    28 February- Two people have died of cholera in northwestern Syria after devastating earthquakes hit the region, emergency responders in the opposition-held area say. The total number of cholera deaths recorded in the northwest since the outbreak began last year has now risen to 22 with another 568 non-fatal cases reported, the Syria Civil Defence, also known as the White Helmets, said in a tweet on Tuesday. “The destruction of infrastructure, water and sewage lines after the earthquake increases the possibility of an outbreak of the disease,” the volunteer group posted. The earthquakes have worsened conditions in refugee camps in the area, which already lacked sanitation and access to clean water. “Even before the earthquake, the area was severely affected by a lack of proper sewerage systems as 63 percent of the refugee camps lacked proper sewerage and 43 percent lacked access to clean water,” activist Nour Qormoosh told Al Jazeera. Qourmoosh said hospitals and health workers are struggling to treat people injured in the February 6 earthquakes. "They are trying to cope with a lack of funds as the UN’s response is getting slower with time and is not meeting the increasing need for medical attention,” he said. Al Jazeera​ External Link​​​


    Hepatitis B Vaccine Available in Great Britain​​​

    28 February- Dynavax Technologies Corporation today announced that the United Kingdom's Medicines and Healthcare products Regulatory Agency had granted Marketing Authorization in Great Britain for HEPLISAV B® for the active immunization against hepatitis B virus infection (HBV) caused by all known subtypes of hepatitis B virus in adults. "Hepatitis B is a highly infectious and potentially deadly virus with increasing infection rates, and over 250 million people infected worldwide. Thankfully, it can be prevented with effective vaccination," commented Ryan Spencer, Chief Executive Officer of Dynavax, in a press release on February 28, 2023. HEPLISAV-B combines hepatitis B surface antigen with Dynavax's proprietary Toll-like Receptor 9 agonist adjuvant CpG 1018 to enhance the immune response. HEPLISAV-B is indicated for preventing infection caused by all known subtypes of HBV in adults aged 18 years and older in the U.S. Precision Vaccinations​ External Link​​


    FBI chief Christopher Wray says China lab leak most likely​​

    28 February- FBI Director Christopher Wray has said that the bureau believes Covid-19 most likely originated in a Chinese government-controlled lab. "The FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident," he told Fox News. It is the first public confirmation of the FBI's classified judgement of how the pandemic virus emerged. Many scientists point out there is no evidence that it leaked from a lab. And other US government agencies have drawn differing conclusions to the FBI's. Some of them have said - but with a low level of certainty - that the virus did not start in a lab but instead jumped from animals to humans. The White House has said there is no consensus across the US government on the origins. A joint China-World Health Organization (WHO) investigation in 2021 called the lab leak theory "extremely unlikely". However, the WHO investigation was deeply criticized and its director-general has since called for a new inquiry, saying: "All hypotheses remain open and require further study."Mr. Wray's comments come a day after the US ambassador to China called for the country to "be more honest" about Covid's origins. In his interview on Tuesday, Mr. Wray said China "has been doing its best to try to thwart and obfuscate" efforts to identify the source of the global pandemic. He said details of the agency's investigation were classified but the FBI had a team of experts focusing on the dangers of biological threats. In response, Beijing accused Washington of "political manipulation". "The conclusions they have reached have no credibility to speak of," said Chinese foreign ministry spokeswoman Mao Ning. BBC News​External Link


    U.S. FDA approves Reata's rare genetic disorder drug​​

    28 February- The U.S. Food and Drug Administration on Tuesday approved Reata Pharmaceuticals Inc's (RETA.O) drug for the treatment of a rare genetic disorder that causes progressive damage to the nervous system, sending shares up nearly 160% after the bell. The drug, Skyclarys, is Reata's first product to gain approval, and Jefferies analyst Maury Raycroft projected that U.S. sales of the drug could reach $400 million by 2030. Reata estimates the disorder, called Friedreich's ataxia, affects about 5,000 patients in the United States. Friedreich's ataxia is a neuromuscular disorder that causes muscle weakness, loss of coordination and can lead to patients being bound to a wheelchair in their mid-20s and premature death. Raycroft, before the FDA decision, estimated the drug could be priced at about $425,000 per patient annually.​​ Reuters​ External Link


    Dengue in Bolivia update: More than 11,000 cases, 33 deaths​​

    28 February-  In a follow-up on the dengue outbreak in Bolivia, health officials reported an additional 296 cases, bringing to total to 11,076. The death toll now stands at 33.​ The department of Santa Cruz reports the highest number of infected with a total of 8,305, Beni 1,156 Tarija 869, La Paz 331, Pando 72, Chuquisaca 232 and Cochabamba 111. As part of the battle against dengue, the national government strengthened the fight against dengue with the delivery of a team for Intensive Care, medicines and supplies for the timely care of minors affected with dengue who are admitted to the hospital. Children’s Hospital in the city of Santa Cruz de la Sierra. In addition, the Ministry of Health and Sports made available a technical team so that the Government of that region unlocks its administrative procedures and uses the 17.9 million Bolivians it has in its coffers. “We have delivered a team, in the same way they have coordinated with the Pharmacy to deliver preservative morphine, omeprasol, physiological solutions and we are also delivering supplies so that the Children’s Hospital can count on this strengthening,” said the Vice Minister of Health Insurance and Management of the Unified Health System, Alejandra Hidalgo, in contact with the journalists.​ Outbreak News Today​ External Link