Defense Public Health Weekly Update, 24 March 2023

Date Published: 3/24/2023
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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


    DOD Announces Next Steps on Suicide Prevention in the Military​

    16 March- Today, Secretary of Defense Lloyd J. Austin III issued a memorandum on the Next Steps on Suicide Prevention in the Military.  On March 22, 2022, Secretary Austin established the Suicide Prevention and Response Independent Review Committee (SPRIRC) to conduct a comprehensive review of the Department's efforts to address and prevent suicide. For the past year, committee members have studied suicide prevention and response activities, policies, and programs. The SPRIRC visited a range of military installations, both in the continental United States and outside the continental United States, and received input through focus groups and individual interviews. Recently, the SPRIRC delivered its report, which provides a range of recommendations to eliminate suicide in the military, to Secretary Austin. As a result, Secretary Austin has approved a two-phase approach to drive progress on implementation.  In the first phase, Secretary Austin approved the immediate implementation of the recommendations addressing service member well-being and access to behavioral and mental health care based on existing authorities and available resources, with adjustments made as appropriate, with a focus on rapid and effective implementation. In the second phase, the Under Secretary of Defense for Personnel and Readiness, will swiftly establish a Suicide Prevention Implementation Working Group as the primary body to: (1) assess the advisability and feasibility of implementing each of the remaining recommendations; (2) identify specific policy and program changes needed to implement each remaining recommendation, as appropriate; (3) provide cost and manpower estimates required to implement each remaining recommendation; (4) provide an estimated timeline to implement each remaining recommendation; (5) identify barriers to implementing the remaining recommendations, if any; and (6) to the extent applicable, identify recommendations for which implementation can be synchronized with current Department prevention activities and capabilities resulting from the Independent Review Commission on Sexual Assault in the Military.​​ External Link​​


    DHA’s New Senior Enlisted Leader Aims to “Make a Difference Every Day”​​

    ​​10 March- The Defense Health Agency welcomed U.S. Air Force Command Chief Master Sgt. Tanya Y. Johnson as the new senior enlisted leader in a ceremony at the ​​Defense Health Headquarters in Falls Church, Virginia, on March 10. Johnson is the agency’s first female senior enlisted leader. DHA Director U.S. Army Lt. Gen. Telita Crosland welcomed Johnson in her new role. “Dedicated and inspired teams of professionals driving military health’s next evolution is the foundation of the Defense Health Agency’s priorities and … there’s no doubt in my mind that you’ll thrive as our next senior enlisted advisor,” Crosland said. “I am truly excited to have you as my battle buddy during this enormous period of opportunity.” Before the passing of the colors signifying the leadership change, Crosland opened the ceremony by recognizing the work of former Senior Enlisted Leader Command Sgt. Maj. Michael L. Gragg. “His positive thoughtful leadership was instrumental in the DHA’s ability to maintain focus as we executed the health care mission for the joint force,” said Crosland. “All [that] you've done for the Defense Health Agency, the Army and the Department of Defense: Our heartfelt thanks to you for your service.” Gragg reflected on his service to the incoming senior enlisted leader: “As I turn it over to you, I was reminded of when I was sitting in that seat about three years ago, and the nervous pride and excitement that I had to be able to serve in such a complex and important and central mission for military medicine.” Johnson then shared her dedication to improve the readiness of our forces. “I hope that we make a difference. I hope that I make a difference while we're improving health and building readiness across the world and changing the Military Health System to where they can be—anytime, anywhere—always,” said Johnson. She also noted her commitment to the care of the 9.6 million beneficiaries in the MHS. “I am so honored to be able to do this and so humbled to be able to evolve health care for America’s sons and daughters,” Johnson said. Johnson entered the U.S. Air Force in October 1993 and graduated from the Medical Laboratory Apprentice Technical Training Course in December 1994. Her professional background includes positions as a clinical laboratory technician, protocol assistant for the 375th Airlift Wing Commander, and executive assistant to the Aeronautical Systems Center and Air Education and Training Command’s Command Chief Master Sergeant. In addition, she has held various leadership positions within the Air Force Medical Service. In her previous role at DHA, Johnson served as the senior enlisted leader for the DHA’s Director of Staff. Retired U.S. Army Lt. Gen. (Dr.) Ronald Place, the former director of Defense Health Agency, attended the event along with Sgt. Maj. of the Army Michael A. Grinston and additional senior leaders in military medicine. External Link

    Military health study publishes cancer research findings

    ​​15 March- The Millennium Cohort Study, the largest and longest running health study in the US military analyzed 661 cancer deaths between 2001 to 2018 among 194,689 service members and veterans. Researchers found that military personnel who deployed to Southwest Asia had a lower risk of dying from cancer than non-deployed personnel, according to the study led by Dr. Neika Sharifian and researchers from the Naval Health Research Center and the Veterans Affairs (VA) Puget Sound Health Care System. The researchers compared the risk of cancer death between personnel who deployed and did not experience combat, those who deployed and experienced combat, and those who did not deploy. Non-deployers were 34% more likely to die from cancer compared with deployers who did not experience combat, accounting for smoking and other health behaviors, age, sex, race, ethnicity, and military characteristics. For cancer deaths before the age of 45 years, non-deployers were 80% more likely to die from cancer than deployers who did not experience combat. The risk of cancer death did not differ between deployers who experienced combat compared with those without combat experience. These findings are consistent with the healthy deployer effect where personnel who deploy are considered healthier and more physically fit than those who do not. The study also found that enlisted personnel were almost three times as likely to die from lung cancer than officers, even after accounting for smoking and other risk factors. This finding may be due to tasks more frequently performed by enlisted personnel that expose them to occupational airborne hazards such as exhausts, emissions, and other respiratory toxicants. Med.Navy.Mil​ ​External Link

    New VA/DoD Pain Guideline Urges Buprenorphine Use Over Full Agonist Opioids​​

    17 March- Recent VA/DoD guidelines call for new measures to reduce the use of opioid pain relievers in the management of chronic pain, including the preferential use of buprenorphine over full agonist opioids. The 2022 updated guideline also urged physicians to assess for behavioral health risk when considering prescribing opioids, including screening patients with acute pain for pain catastrophizing, such as anticipating that pain will last an extended period of time. It also suggested that clinicians offer education before surgery to help reduce the risk of opioid painkillers overuse during the recovery period. Many of the previous recommendations were confirmed by the latest guideline development group, including not recommending the use of opioids in the daily management of chronic pain because the benefits are small and outweighed by risks to the patient. If opioids are required, they write, the lowest possible dose for the shortest amount of time should be used. A synopsis of the guidelines, approved last year by VA and DoD leadership, appeared last month in the Annals of Internal Medicine. The authors said the report highlighted the recommendations they considered most important. US Medicine​ External Link

    Service members need to remember signs, symptoms of heat illness as weather warms​

    ​​Service members need to remember signs and symptoms of heat illness as weather warms​20 March- Despite effective techniques to prevent heat-related medical conditions, military personnel continue to experience severe and sometimes fatal life-threatening heat-related illnesses during both training activities and combat. As an Army officer and physician in an infantry unit, I have witnessed or treated cases of acute dehydration, heat cramps, heat exhaustion, and rhabdomyolysis, which is a serious medical condition where proteins and electrolytes from damaged muscle tissue are released into the bloodstream. I have also treated more severe heat-related cases such as acute kidney failure. Hyponatremia, which is a potentially fatal imbalance of the body’s chemistry caused by excessive fluid consumption, may also occur. Because heat-related medical conditions in the military tend to be the combined result of warmer weather conditions and physically vigorous activities, they are categorized for medical purposes as exertional heat illness, or EHI. The Defense Centers for Public Health–Aberdeen, formerly known as the Army Public Health Center, tracks and reports the most serious EHI- and weather-related conditions among Soldiers at various installations. Each year, an average of two to three Soldiers die from EHI, and more than 1,000 Soldiers develop an EHI that requires medical attention and/or lost duty time. Military leaders and Soldiers are trained to routinely monitor themselves and their battle buddies for signs of EHI. Milder cases of EHI include heat cramps and heat exhaustion; the most serious cases result in heat stroke, which can be fatal.​ While EHIs occur year-round, they begin to increase as the weather gets warmer, especially at temperatures above 75 degrees Fahrenheit. In addition to temperature, it is important to consider the amount of sunlight, humidity, and wind speed to determine heat risk. The military uses the Wet Bulb Globe Temperature, known as the WBGT, to characterize heat risk based on these combined climate factors. The DCPH-A has identified trends in EHI; the highest occurrence of heat casualties occurs at installations where temperatures are warmer and military trainees are conducting outdoor activities. It’s important to be vigilant when monitoring oneself or others as temperatures increase.​ External Link


    COVID antiviral Paxlovid steps closer to full FDA approval​​

    16 March- A federal advisory panel recommended Food and Drug Administration approval for Paxlovid on Thursday, more than a year after the agency authorized the antiviral under emergency use. The Antimicrobial Drugs Advisory Committee said the drug's benefits outweigh the risks when used to treat mild to moderate COVID-19 in adults who are at high risk for severe disease, hospitalization or death. The FDA typically follows the committee's recommendations and is expected to officially approve Paxlovid. Made by Pfizer, Paxlovid is a combination of two drugs: ritonavir and nirmatrelvir. Nirmatrelvir, an oval, pink pill, is a so-called protease inhibitor – the same type of drug that turned HIV into a manageable disease. It stops the SARS-CoV-2 virus from replicating. Ritonavir, a white or off-white pill, boosts the activity of nirmatrelvir. Paxlovid is given in a five-day course with three pills taken twice a day, with most people feeling better by the second or third day on the drug.  Over 8 million COVID-19 patients in the  U.S. have received Paxlovid since it was first authorized by the FDA emergency use in December 2021. USA Today​ External Link​​

    LDL Lowering Vaccine Candidate Launches Phase 1 Study​​

    21 March- Vaxxinity, Inc. today announced that the first subjects had been dosed in a randomized, double-blind, placebo-controlled Phase 1 clinical trial of VXX-401, an investigational vaccine designed to lower low-density lipoprotein (LDL) cholesterol, a known factor contributing to heart disease. Heart disease remains the leading cause of death globally, claiming over 18 million deaths yearly. VXX-401 is designed to induce robust, long-acting antibodies against PCSK9 to lower LDL cholesterol. The multicenter Phase, 1 dose-escalation trial, aims to enroll 48 subjects aged 18 to 75 years with LDL cholesterol between 2.59 and 4.89 mmol/L. The trial evaluates safety, tolerability, and immunogenicity (as measured by serum anti-PCSK9 antibody titers). LDL cholesterol levels will measure the pharmacodynamics of the immune response, an established model of PCSK9 inhibition in hypercholesterolemia. This study was last updated on March 16, 2023. VXX-401 was designed using Vaxxinity's proprietary synthetic peptide vaccine platform and is being developed to treat hypercholesterolemia. The platform is designed to harness the immune system to convert the body into its own natural "drug factory," stimulating the production of antibodies. "This is an exciting milestone for VXX-401 and Vaxxinity in our pursuit to vaccinate the world against heart disease with a preventative option that is convenient and accessible, addressing an unmet need to combat the leading global cause of death," said Mei Mei Hu, Chief Executive Officer of Vaxxinity, in a press release on March 20, 2023. "PCSK9 antibody therapies are well-tolerated and effective, but huge, unmet patient need remains." "In order to solve the problem of heart disease, the world needs a scalable, accessible technology that can reach the hundreds of millions, if not billions, of people at risk." "With an LDL-lowering vaccine, we can offer an option that's cost-effective, safe, convenient, long-acting, and deployable."​ Precision Vaccinations​ External Link

    PrEP: Learn About the Highly Effective Drug to Prevent HIV​​

    ​20 March-HIV pre-exposure prophylaxis drugs, otherwise known as PrEP, are powerful weapons against HIV. Through education and raising awareness of HIV exposures, the risks of getting the disease are lower than ever. According to the Centers for Disease Control and Prevention Opens CDC website, when taken as prescribed, these drugs can reduce the risk of getting HIV through sex by almost 99%. “Preventing a service member who might otherwise be at very high risk from acquiring HIV infection ensures that this soldier, sailor, or airman [or Marine] stays in the fight and remains worldwide deployable,” said U.S. Army Col. Jason M. Blaylock, director for medical services at Walter Reed National Military Medical Center Opens WRNMMC website. The Food and Drug Administration approved a daily oral Prep Opens CDC webs​ite pill in 2012, and in December 2021 approved a long-acting injectable version that’s given every two months. The pills are commonly available in the Military Health System, while the shot is less widely available. “PrEP is recommended for people who are HIV-negative but are at risk for acquiring the virus from either sex or injection drug use,” said Blaylock.

    The PrEP should be taken if you:

    - Have had unprotected sex in past six months

    - Have a sexual partner with HIV

    - Have been diagnosed with a sexually transmitted disease in past six months

    - Inject drugs and have an injection partner with HIV

    - Share needles, syringes, or other drug injection equipment

    Side effects of PrEP can include diarrhea, nausea, headache, fatigue, and stomach pain, and usually go away over time.​​​ External Link


    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 10, ending March 11, 2023- 

    - Seasonal influenza activity remains low nationally.

    - Nationally, outpatient respiratory illness is now below baseline, and six of 10 HHS regions are below their respective baselines.

    - The number and weekly rate of flu hospital admissions has remained stable compared to week 9.

    - Of the 35 influenza A viruses detected and subtyped during week, 34% were influenza A(H3N2) and 66% were influenza A(H1N1).

    - Seven influenza-associated pediatric deaths that occurred during the 2022-2023 season were reported this week, for a total of 132 pediatric flu deaths reported so far this season.

    - CDC estimates that, so far this season, there have been at least 26 million illnesses, 290,000 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​​


    Meat and poultry sfihas recalled over lack of inspection​​​

    20 March- WOW Frozen Food LLC, of Plantation, FL, is recalling approximately 488 pounds of meat and poultry sfihas products that were produced without the benefit of federal inspection, according to the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS). FSIS is concerned that some products may be in retailers’ and consumers’ freezers. The problem was discovered during routine FSIS surveillance activities when various frozen sfihas meat and poultry products that did not have the USDA mark of inspection were observed at a retail location. Upon further investigation, FSIS determined that the products were not produced in an FSIS-inspected establishment. These items were shipped to retail locations in Florida and sold through Instagram. The frozen, not-ready-to-eat sfihas items were produced on various dates since Oct. 2022. Food Safety News​ External Link​​

    Metal found in beef products shipped to schools prompts recall​​

    20 March- Hoyo, SBC, of Bloomington, MN, is recalling approximately 1,046 pounds of ready-to-eat beef sambusa products that may be contaminated with extraneous materials, specifically thin, wire-like metal. These items were shipped to schools in Minnesota. While the product was distributed to schools, it was through a commercial sale and was not part of the food provided by the U.S. Department of Agriculture’s Food Safety for the National School Lunch Program. The problem was discovered when the firm notified the USDA’s Food Safety and Inspection Service (FSIS) that it received a report from a school that food handlers found thin, wire-like metal on the outside of the product during preparation. The material was not reported to be embedded in the product. The frozen, ready-to-eat beef sambusa items were produced on Dec. 30, 2022, and Feb. 21, 2023. 

    Recalled product:

    - Bulk boxes containing 75 pieces of “HOYO Beef Sambusa Ground Beef Pastry with Onions and Spices” and lot codes N341-S and N333-S.

    The product subject to recall bears the establishment number “EST. 47424” inside the USDA mark of inspection. 

    As of the posting of this recall, there have been no confirmed reports of adverse reactions due to the consumption of these products. Anyone concerned about an injury or illness should contact a healthcare provider.

    The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is concerned that some products may be in school freezers. Schools are urged not to serve this product. This product should be thrown away or returned to the place of purchase. Food Safety News​ External Link​​


    Caffeine, the wonder drug? Study suggests more coffee could lower body fat and prevent type 2 diabetes​​

    20 March- That morning cup of coffee might provide more benefits than just a quick energy boost. New research suggests that consuming higher levels of caffeine could help curb body fat and reduce the risk of developing type 2 diabetes. Researchers at the University of Bristol, the Karolinska Institute in Sweden and Imperial College in London conducted the study, which was published in the journal BMJ Medicine. Analyzing genetic data from 9,876 European individuals who participated in six different long-term studies, the researchers specifically monitored the CYP1A2 and AHR genes, which influence the rate at which the body will metabolize caffeine. Those who had genes that metabolized caffeine at a faster rate were associated with having a lower body mass index (BMI) and lower whole body fat mass. They were also found to have a reduced risk of type 2 diabetes. Fox News​ External Link


    Call for Applications: African Public Health Emergency Management Fellowship​​

    20 March- Combating the several public health threats across the African continent requires adequately trained and equipped workforce.
    Africa Centres for Disease Control and Prevention (Africa CDC) has called for a new public health order that includes workforce development, suitably aligned with the vision of the African Union (AU) and its desire to build capacity in public health through medium- and long-term training in identified areas of need. The commencement of the Africa CDC Public Health Emergency Management (PHEM) fellowship will carter for the dire need of skilled workforce to lead and manage emergency management programs that includes timely detection and response to emergencies when they occur. Goal: To develop a cadre of African public health workforce who are highly skilled to coordinate and lead preparedness and response to public health emergencies in Africa.

    - Provide fellows up-to-date knowledge regarding public health emergency management and Public Health Emergency Operations Centers (PHEOCs)
    - Provide fellows in-depth exposure to the role of PHEOCs in preparing for and responding to various public health emergencies
    - Building the skills of fellows in managing the various functions of PHEOC, and leading the response to public health emergencies
    - Institutionalize a sustainable program for PHEM in the African continent Africa CDC​ External Link​​


    Israel reports more polio cases​​

    12 March- The Israeli Health Ministry recently reported following the case of polio in an 8-year-old girl from the Safed area who was not vaccinated against polio as part of routine vaccinations, the Northern District of the Ministry of Health conducted an epidemiological investigation, during which it was found that three other children who came in close contact with the case, were found to be positive for the virus the polio. The three children at this stage have no clinical symptom. In recent months, there is evidence of continued discharge of polio into the sewers in many settlements in Israel, when in Israel there are over 150,000 children who are not vaccinated against polio. The Ministry of Health mentions that the main way to protect children from paralysis is through a killed vaccine against polio. In addition, to prevent further transmission of the virus, it is important to maintain hand hygiene. The Ministry of Health will continue monitoring and update the findings. Outbreak News Today​ External Link​​


    Warnings against 'reckless' weight loss surgery abroad​

    21 March- Seven British patients who travelled to Turkey for weight loss surgery died after operations there, a BBC investigation into the trend has found. Others have returned home with serious health issues after having had gastric sleeve operations, during which more than 70% of the stomach is removed. The operations, used to treat morbid obesity, are carried out in the UK. But, because it can take years to get one through the NHS, some people are looking abroad for treatment. Social media advertising has helped fuel interest in travelling overseas for weight loss surgery in recent years. Katie (not her real name) from Belfast first considered travelling to Turkey after seeing an advert online. Like many others, she had watched "before and after" weight loss videos on social media - the TikTok hashtag #gastric sleeve has had 292 million views in the UK in the past three years. Katie flew out for surgery in October 2021. Soon after the procedure, she says she was in agony, but the Turkish clinic told her it was just trapped gas. After flying home and "squealing" in pain, she was rushed to hospital with sepsis and pneumonia days later. Katie spent almost a year in and out of hospital, contracting sepsis on six separate occasions. NHS doctors were forced to remove her entire stomach. She says the procedure has left her constantly tired and unable to continue in her job as a support worker for the elderly. "It's the worst mistake I've ever made," she says. "It's ruined my life." Katie says her treatment and care were "nothing like" the promotional material she saw online. BBC News​ External Link​​


    China OKs its first mRNA vaccine, from drugmaker CSPC​​​

    22 March- China has approved its first domestically developed mRNA vaccine against COVID-19, CSPC Pharmaceutical Group Ltd (1093.HK) said on Wednesday, a major achievement in a country that has declined to use Western COVID shots to support domestic research. China, whose home-grown vaccines are seen as less effective than the Moderna (MRNA.O) and Pfizer (PFE.N)-BioNTech (22UAy.DE) mRNA shots, has been racing to develop vaccines using messenger RNA (mRNA) technology since early 2020.The long-awaited approval comes as infections have fallen sharply across China since it suddenly dropped its strict "zero-COVID" curbs in December, making the sales outlook for the newly approved vaccine moderate.​ But it would give China an additional option to tackle future outbreaks and a base for development against newly emerging variants. The news of China's first successful mRNA vaccine did not generate much buzz in domestic social media on Wednesday, as the country has returned to normal and its borders have re-opened.​ Reuters​ External Link​​


    An emerging fungal threat spread at an alarming rate in US health care facilities, study says​​

    20 March- Clinical cases of Candida auris, an emerging fungus considered an urgent threat, nearly doubled in 2021, according to new data from the US Centers for Disease Control and Prevention. There was also a tripling of the number of cases resistant to echinocandins, the first-line treatment for Candida auris infections. The research, published Monday in the Annals of Internal Medicine, evaluated cases of Candida auris reported to the CDC from 2016 – the year in which cases were first reported in the US – to 2021.The study authors found that clinical cases increased each year, rising from 53 in 2016 to 330 in 2018 and then skyrocketing from 476 in 2019 to 1,471 in 2021. Cases of Candida auris also expanded geographically. Although it was initially confined mostly to the New York City and Chicago areas, Candida auris is now present in more than half of US states. Between 2019 and 2021, 17 states identified their first cases. The CDC has called Candida auris an “urgent threat” because it is often multidrug-resistant, easily spreads through health care facilities and can cause deadly disease. It is also resistant to some common disinfectants and can be carried on people’s skin without causing symptoms, facilitating its spread to others. The researchers wrote that the timing of this increased spread suggests that it may have been exacerbated by “pandemic-related strain on the health care and public health system.” “The rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests, and adherence to proven infection prevention and control,” CDC epidemiologist Dr. Meghan Lyman, lead author of the study, said in a news release.​ CN​N​ External Link


    ​Dengue vaccine: Takeda’s QDENGA® approved in Brazil​

    20 March- Biopharmaceutical company, Takeda, announced recently the company’s dengue vaccine, QDENGA® (Dengue Tetravalent Vaccine [Live, Attenuated]) (TAK-003), was approved in Brazil by the National Health Surveillance Agency (ANVISA) for the prevention of dengue caused by any of the four virus serotypes that can be found in individuals from 4 to 60 years of age. The use of QDENGA should be in accordance with official recommendations of the regulatory agency. QDENGA is the only dengue vaccine approved in Brazil for use in individuals regardless of previous exposure to dengue and without the need for pre-vaccination testing. “Brazil has a high prevalence of dengue, and the country needs effective and safe vaccine options to help manage the significant burden dengue places on its health care systems and its communities,” said José Manuel Caamaño​, president of Takeda in Brazil. “We are proud to make our vaccine available to the Brazilian government and health care providers with the hope that it may become an important tool to help combat dengue as part of an integrated dengue management program along with vector control. Based on our clinical trial results, we are hopeful that QDENGA could have a positive impact on the incidence of symptomatic dengue in Brazil, including dengue cases that require hospitalization. Bringing QDENGA to countries around the world remains a top priority for Takeda, and this approval is a step toward our purpose to deliver better health for people, and a brighter future for the world.” Outbreak News Today​ External Link​​