Defense Public Health Weekly Update, 28 April2023

Date Published: 4/28/2023
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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


    NASA and Partners Small Business and HBCU Summit​​

    When: Thursday, April 27, 2023 (In-Person)

    Where:  Southern University New Orleans
    Arts, Humanities, and Social Sciences Building
    6400 Press Drive
    New Orleans, LA 70126 

    Join the NASA Office of Small Business Programs and partners for an in-person small business conference event that will include tips, tools, and resources on doing business with the agency for small businesses and Historically Black Colleges and Universities. Attendees will have an opportunity to learn about the procurement process at NASA, the NASA Mentor-Protégé Program, Federal Government opportunities, working with agency prime contractors, resources from trade associations, and much more.

    To register, go to: event registration site.

    • Start Date: 4/27/2023, 8:00 AM

    • End Date: 4/27/2023, 5:00 PM​​ External Link​​


    New support program encourages Airmen to seek C.A.R.E.​​​​

    21 April- Though Airmen are often hailed as heroes for being in service to our country, the uniform does not shield them from painful life situations such as domestic violence or sexual assault. It’s that reason Maj. Ayanna Glenn, 78th Medical Group Education and Training Flight commander, is putting her care for other Airmen into action at Robins Air Force Base, Georgia. “I started a support group called C.A.R.E., which stands for Challenges, Advocacy, Resiliency and Empowerment,” said Glenn. “This is for women, active duty or civilians, who are survivors of domestic violence, be it verbal or physical, as well as sexual assault." The group’s goal is to improve quality of life by focusing on the whole person through promoting mental, spiritual, physical and social fulfillment. “C.A.R.E. will provide an additional outlet for women to talk about their experiences as they heal,” she continued. “This is important to let them know they are not alone and to let them know they certainly aren’t the only person overcoming these types of situations.” The trained nurse and mother of three said she has always had a passion for helping people. This endeavor falls in line with her character, and it is even more important to her as a survivor. “It’s taken me three years to get to this point of healing and where I can help others,” said Glenn. “People still have a stigma around this subject, especially for those wearing the uniform. There’s a mindset that if you admit to going through any of those issues that it will affect your career, but that’s not true. If you hold it in, that can negatively impact your career, because you will be consumed with the trauma and unable to focus on your mission.” The first C.A.R.E. meeting was held in March. In order to participate, individuals must be receiving or have completed professional treatment from the Robins Family Advocacy Program or the 78th MDG Mental Health Clinic. “We had several people in attendance, which included some young Airmen,” said Glenn. “At the end of the meeting, one of the young ladies told me that hearing my story, as a higher ranking person, encourages her to not let her painful circumstance consume her life or derail her goals. “Of course I didn’t want what happened to me to happen, but it did,” said Glenn. ”And I am using that to help others. I believe that’s my calling. I am using my voice to speak up and pleading with others to not suffer in silence.” C.A.R.E meets monthly, every second Tuesday from 11:30 a.m. to 12:30 p.m. at the Refuge. For more information, email DVIDS​ External Link


    ALS: FDA Considering Approval of Drug Tofersen for Rare Form of Disease​​

    11 April- People with a rare genetic form of amyotrophic lateral sclerosis (ALS) are waiting to see if the Food and Drug Administration (FDA) will approve a new drug designed to treat it. A decision is expected later this month. ALS, also known as Lou Gehrig’s disease, is a fatal neurological disease that targets nerve cells in the spinal cord and brain. As the disease progresses, people with ALS lose control of the muscles they need to move, speak, eat, and breathe. About 2% of people living with ALS globally have a mutation in a gene called superoxide dismutase 1 (SOD1). In the United States, it’s estimated this form of ALS affects about 330 people. The drug tofersen from Biogen targets the genetic mutation by stopping toxic SOD1 proteins from being made. Tofersen was tested in a phase three clinical trial called VALOR. The trial spanned 28 weeks with 108 participants from 10 countries. The drug is injected via lumbar puncture into the spinal canal. Researchers concluded that tofersen reduced concentrations of SOD1 and reduced another protein called neurofilament light (NFL) over the 28 weeks. However, they said it “did not improve clinical end points and was associated with adverse events.” Dr. Timothy Miller is a professor of neurology and the director of the Miller Lab and the ALS Center at the Washington University School of Medicine in St. Louis, Missouri. He is also the principal investigator in the Tofersen trial. He has been involved in the research of the drug for more than two decades. The trial was sponsored by Biogen, but Miller is an independent researcher. “It (Tofersen) did not achieve statistical significance on the difference between placebo and drug at 28 weeks. There is a hundred percent agreement on that,” Miller told Healthline. “But if you look at it at 52 weeks… now you see statistically significant differences that are much more clear and stabilization of function,” he added.​ Healthline​ ​External Link

    Birth control with up to 92% lower hormone doses could still be effective

    14 April- Hormonal contraceptives are a popular option for preventing pregnancy. Sometimes they can cause side effects, though, which led a group of researchers in the Philippines to find out whether it is possible to both lower the hormone dosage in contraceptives and the administration timing while retaining their effectiveness. Their study, which appears in the journal PLOS Computational Biology, suggests that it is possible to reduce hormones in both estrogen-only and progesterone-only contraceptives by a significant degree and still prevent ovulation. Doctors often prescribe hormonal contraceptives to female patients who are trying to prevent pregnancy. According to the Centers for Disease Control and Prevention Trusted Source (CDC), in the United States, 12.6% of females aged 15 to 49 years use an oral contraceptive, and 10.3% of women use long-acting reversible contraceptives. Hormonal contraceptive devices work by using synthetic hormones, such as estrogen and progesterone, to prevent pregnancy. A few types of hormonal contraceptives include pills, which can be a combination pill or progestin-only, the arm implant (Nexplanon), the contraceptive patch (Xulane), and intrauterine devices or IUDs (Mirena or Skyla). In addition to prescribing contraceptives to prevent pregnancy, sometimes doctors will prescribe them to help those with polycystic ovary syndrome (PCOS) to reduce the size of cysts and thereby reduce pain, or in the treatment of endometriosis, to help control pain and excessive bleeding. Medical News Today​ ​External Link​​

    Learn the role of nutrition, physical activity in America’s war on obesity​

    20 April- The year 2023 is bringing many changes to body composition standards across the services. New policies will go into effect for the Marines, Air Force, and Army, as part of continuing efforts to increase military readiness. Many policy changes are focused on the growing concern of the American obesity epidemic. However, the latest Department of Defense Health of the Force Report found 21.6% of active-duty service members across the Army, Navy, Air Force, and Marines were obese. This is a concern for service members because becoming overweight or obese increases the chances of musculoskeletal injuries, non-availability, and are a contributing factor to a nearly 20% 2-year premature attrition rate across the DoD. The American obesity epidemic is reaching beyond service members, the most recent National Health and Nutrition Examination Survey indicated that 19.7% of children aged 2-19 were found to be obese, and 41.9% for those aged 20 and older were obese. Obese children are more likely to be obese as an adult, and adult obesity has been linked to the leading causes of death (diabetes, heart disease, and some forms of cancers). Additionally, the obesity epidemic leaves only 2 in 5 young adults weight eligible and physically prepared for basic training - not including other limitations on qualification for service. As the American armed forces face recruiting and retention challenges, rates of overweight and obesity and specifically the health of American service members and children should remain a central focus and everyone has a role, so what can we do about it? Focus on nutrition. The Standard American Diet, or SAD, consists of foods higher in added sugars, saturated fats, and sodium. These foods are often processed and lead to increased inflammation - a leading cause of weight gain and precursor to a number of diseases (e.g., diabetes, high blood pressure, etc.). JBSA.milExternal Link

    ​​Melatonin gummies may have a higher dose than what’s on the label​

    25 April- The chewy melatonin gummies that many people take before bedtime to promote sleep may contain far more of the hormone than what’s printed on the label, a study shows. The findings, published as a letter in JAMA, follow a government report last year about a surge in excessive pediatric ingestions of melatonin over the past decade. The new research included a warning to parents that giving the gummies to children could result “in ingestion of unpredictable quantities” of the hormone. The researchers, from Cambridge Health Alliance and the University of Mississippi, tested 25 supplements of melatonin, a hormone that is produced naturally in the body and released by the brain. Among their findings:​

    - Most of the products contained 20, 30 or 50 percent more — and in one case, about 2.5 times more — than the quantity listed on the label.

    - Four products had less melatonin than promised, including one that didn’t have any detectable levels of the hormone.

    - Of the 25 products tested, 22 were “inaccurately labeled,” defined as being more than 10 percent above or below the amount listed on the label.

    - Five of the products listed cannabidiol (CBD) as an ingredient, and the researchers found all of them had slightly higher levels of CBD than indicated on the label, as well.

    An increasing number of people are taking melatonin supplements to help them fall asleep. The rise in consumer demand has also made it easier for children to get their hands on the supplements. In 2020, melatonin was the substance most often cited in calls about children to U.S. poison control centers, according to a report on pediatric melatonin ingestions published last year by the Centers for Disease Control and Prevention.​ The Washington Post​ External Link

    [STUDY] Food Packaging Plastic Entering Brain Could Increase Neurodegeneration Risks, Claim Experts!​​​

    ​25 April- Many people think that food packaging plastic is harmless because they are not being digested directly. However, a new study claimed that this widely used plastic can actually enter the brain after ingesting the food contained in the packaging. Health researchers shared this alarming finding at the University of Vienna. They warned that polystyrene, a plastic commonly used in food packaging, can be detected inside the human brain two hours after ingestion. According to Interesting Engineering's latest report, food packaging plastic in the brain could increase the risks of neurodegeneration, neuroinflammation, and other similar diseases. "In the brain, plastic particles could increase the risk of inflammation, neurological disorders, or even neurodegenerative diseases such as Alzheimer's or Parkinson's," warned the study's leading author, Lukas Kenner. Kenner and other involved health experts conducted their new study using six mice; these rodents were euthanized so that they could harvest their brains.  After studying the mice's brains, they discovered that the MNPs crossed the blood-brain barrier. Because of this, Kenner and his team are now urging the public to limit exposure and restrict the use of plastic in food packaging.  ​Tech Times​ External Link


    CDC: Weekly U.S. Influenza Surveillance Report

    Key Updates for Week 15, ending April 15, 2023​​​:

    - Seasonal influenza activity remains low nationally.

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

    - The number and weekly rate of flu hospital admissions remain low.

    - During week 15, 59.5% of viruses reported by public health laboratories were influenza A and 40.5% were influenza B. Of the 13 influenza A viruses detected and subtyped during week 15, one was influenza A(H3N2) and 12 were influenza A(H1N1).

    - Two influenza-associated pediatric deaths that occurred during the 2022-2023 season were reported this week, for a total of 143 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 19,000 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​​


    Labeling oversight leads to recall of 30 tons of halal meat and poultry sausages​​​

    24 April- Alef Sausage Inc., of Mundelein, IL, is recalling 61,574 pounds of ready-to-eat (RTE) halal meat and poultry sausage products because of misbranding and possible temperature abuse, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced. The problem was discovered when the New York State Department of Agriculture and Markets notified FSIS that it had observed the meat salami product stored at non-refrigerated temperatures at a retail store in Brooklyn, New York. The product is not shelf stable but was not labeled with a handling statement indicating that it should be kept refrigerated. FSIS’ investigation identified additional varieties of halal meat and poultry sausage products with the brand name “Sheikh” produced by Alef Sausage Inc. in commerce that did not bear a handling statement. FSIS is concerned that some product may be on retailers’ shelves or in consumers’ pantries. These items were shipped to retail locations in New York and distributors in New Jersey and Pennsylvania. The RTE meat and poultry sausage products were produced and distributed into commerce on various dates from 2018 through April 2023. Food Safety News​ ​External Link​​


    Activity snacking may help with type 1 diabetes - study​v​​

    24 April- Walking for three minutes every half an hour could help improve blood sugar levels, a small trial presented at a UK diabetes charity's conference suggests. The study of 32 people with type 1 diabetes showed blood sugar levels lowered when they took regular walking breaks over a seven-hour period. Diabetes UK said these "activity snacks" could offer practical, cost-free changes. Type 1 diabetes affects about 400,000 people in the UK.​ The condition happens when the body's immune system attacks insulin-producing cells in the pancreas. This means the pancreas can no longer produce insulin - leading to high blood sugar levels. People need to take regular insulin medication. Over long periods of time high blood sugar can result in complications like kidney failure, eye problems and heart attacks. Dr. Elizabeth Robertson, director of research at Diabetes UK, which funded the study, said for people with type 1 diabetes, managing blood sugar levels day in, day out, can be "relentless". She added: "It is incredibly encouraging that these findings suggest that making a simple, practical change - such as taking phone calls while walking, or setting a timer to remind you to take breaks - to avoid sitting for long periods - could have such a profound effect on blood sugar levels.​ "We look forward to further research to understand the long-term benefits of this approach." Lead researcher Dr Matthew Campbell, from the University of Sunderland, said he was surprised by the magnitude of the results with low level activity. He said for some people with type 1 diabetes "activity snacking" could be an important stepping stone towards more regular physical activity and for others it could be a simple intervention to help manage blood glucose levels. He added: "Importantly, this strategy does not seem to increase the risk of potentially dangerous blood glucose lows which are a common occurrence with more traditional types of physical activity and exercise." In the early-stage trial, which has not yet been published, 32 adults with type 1 diabetes completed two seven-hour sessions of sitting down. In one session they remained seated. In the other they broke up the seven hours with three-minute bouts of light intensity walking (at their own pace) every 30 minutes. Their blood sugars were monitored continuously for 48 hours from the start of each session and they all had similar food during the seven hours and did not change their insulin treatment. Taking regular walking breaks resulted in lower average blood sugar levels (6.9 mmol/L) over the 48-hour study period compared to uninterrupted sitting (8.2 mmol/L).​ BBC News​ External Link


    Tanzania reports another Marburg virus infection, death​​

    25 April- Tanzania, battling its first Marburg virus outbreak, has reported another case and another death, according to the latest weekly health emergencies report from the World Health Organization (WHO) African regional office. The latest case raises the country's outbreak total to nine cases, and the death lifts the fatality count to six, for a case-fatality rate of 66.7%. All of the country's cases are in Bukoba rural district in the Kagera region, located in northwestern corner of Tanzania. Of 212 contacts, 206 have completed their monitoring period. In its previous weekly update, the WHO said two of the earlier cases involved healthcare workers, including one who died. Many of the contacts under monitoring were healthcare workers. The outbreak was first reported in the middle of March, with the index patient developing symptoms after returning from an island in Lake Victoria. Marburg virus is closely related to Ebola virus, which is thought to jump to humans from fruit bats that harbor the virus. Like Ebola, Marburg virus spreads among humans through contact with an infected person's body fluids. However, unlike Ebola, there are no approved vaccines or treatments for Marburg virus infections. CIDRAP​ ​External Link


    Pakistan confirms its first case of mpox​​

    26 April- The first case of mpox in Pakistan has been confirmed by the National Institute of Health in the capital Islamabad. A traveler who recently arrived in Pakistan tested positive and has been isolated at a hospital in the capital, along with other individuals who are being tested, a health ministry press release said. There is no evidence of localized transmission of the viral disease in Pakistan, the NIH added.​ Mpox - which spreads via close contact and tends to cause flu-like symptoms and pus-filled skin lesions - was declared a global health emergency by the World Health Organization in July 2022. The organization maintained its alert in November. On Nov. 28 the WHO named the disease mpox to replace the older term monkeypox, citing concerns of stigma and racism associated with the name. In Pakistan, the NIH, provincial health departments, border health services and district health authorities have been advised to ensure surveillance through laboratory diagnostics, contact tracing, rapid identification of suspected cases, and to provide care and isolate cases to prevent transmission.​ Reuters​External Link


    EU publishes proposed drug laws overhaul, setting up tussle with industry​

    26 April- Brussels on Wednesday published a long-awaited draft of its proposed overhaul of laws governing the European Union's pharmaceuticals industry, setting up a tussle with drugmakers which warn they will invest and innovate elsewhere. The biggest overhaul of existing medical laws in two decades is aimed at ensuring all Europeans have access to both innovative new treatments and generic drugs, and ending huge divergences in access and price between countries, EU Health Commissioner Stella Kyriakides told reporters after publication. There were few major changes in the proposal from the draft reviewed by Reuters earlier this month, except for details of changes to protections before generic versions of drugs enter the market. The Commission proposes to cut the length of basic market exclusivity that drugmakers get before generics can enter the market to eight from 10 years. But it also offers a sweetener for companies: they get two more years of protection if they launch their new medicines in all 27 member states within two years. Reuters​ External Link​​


    Guaifenesin: WHO issues alert over another India-made cough syrup​

    26 April- The World Health Organization has said that a batch of contaminated India-made cough syrup has been found in the Marshall Islands and Micronesia. The WHO said that the tested samples of Guaifenesin TG syrup, made by Punjab-based QP Pharmachem Ltd, showed "unacceptable amounts of diethylene glycol and ethylene glycol". Both compounds are toxic to humans and could be fatal if consumed. The WHO statement did not specify if anyone had fallen ill. The latest alert comes months after the WHO linked other cough syrups made in India to child deaths in The Gambia and Uzbekistan. Sudhir Pathak, managing director of QP Pharmachem, told the BBC that the company had exported the batch of 18,346 bottles to Cambodia after getting all due regulatory permissions. He said he didn't know how the product had reached the Marshall Islands and Micronesia. "We did not send these bottles to the Pacific region, and they were not certified for use there. We don't know under what circumstances and conditions these bottles reached the Marshall Islands and Micronesia," he said, adding that his company has sent a legal notice to the firm that exported the batch of medicines to Cambodia. The WHO statement said that the product, which is used to relieve chest congestion and cough symptoms, was tested by Australia's drug regulator, the Therapeutic Goods Administration. The syrup was marketed by Trillium Pharma, based in Haryana state. The BBC couldn't reach a Trillium representative on the phone. The Indian government has not reacted to the latest alert. The statement added that "neither the stated manufacturer nor the marketer have provided guarantees to WHO on the safety and quality of these products".​ BBC News​ External Link


    Florida surgeon general altered Covid-19 vaccine analysis to suggest higher risk for younger men, Politico reports​​

    25 April- Politico said it obtained a document as part of a public records request that shows Ladapo’s changes to the eight-page analysis. The changes deleted comments that said a link with slightly increased risk of cardiac-related deaths after Covid-19 vaccination was “no longer significant” for multidose vaccines and “there is little suggestion of any effect immediately following vaccination.” The document shows an added line that says mRNA vaccines may be driving an increased risk of cardiac-related death in males, especially those ages 18-39. The version released publicly in October 2022 said Covid-19 vaccination was “associated with a modestly increased risk for cardiac-related mortality 28 days following vaccination,” and says the vaccines may be driving the risk, especially among younger men. In a statement to CNN, Ladapo said it’s typical for an assessment of surveillance data to include revisions, he has “expertise and training to make these decisions,” and the revisions were appropriate.​ “To say that I ‘removed an analysis’ for a particular outcome is an implicit denial of the fact that the public has been the recipient of biased data and interpretations since the beginning of the mRNA COVID-19 vaccine campaign. I have never been afraid of disagreement with peers or media,” Ladapo’s statement said. The Florida analysis was not peer-reviewed or published in a medical journal, but was posted online by the Florida Department of Health and shared in a news release. Based on that analysis, Ladapo and the Department of Health released guidance that recommended against mRNA Covid-19 vaccines for males ages 18 to 39, saying the “abnormally high risk of cardiac-related death among men in this age group,” likely outweighed the benefits. The state Department of Health said Tuesday that Ladapo stands by his guidance to recommend against the vaccine for certain groups.​ CNN​ External Link


    Brazil: 16 cities account for 80% of Plasmodium falciparum malaria cases​​

    25 April- Eliminating malaria in Brazil by 2035 is one of the priorities of the Ministry of Health. The disease represents a major public health problem in the country, with 99% of cases concentrated in the Amazon region and with a higher incidence in populations with greater social vulnerability. Faced with this scenario, the Ministry launched, this Tuesday (25), World Malaria Day, the campaign to raise awareness about forms of prevention and treatment. For the first time, the launch took place in the Amazon region, a priority focus for combating the disease, in the city of Ananindeua (PA).With the slogan “The fight against malaria takes place with the participation of all: citizens, community and government”, the campaign aims to alert the population, health professionals and managers about the prevention, control and elimination of the disease. Advertising will run on television, radio, internet, social networks and billboards starting this Tuesday (25) in the states of the Amazon region (AC, AM, AP, MA, MT, PA, RO, RR and TO). The campaign will also be publicized in sound cars and boats, so that the information reaches the population in the most vulnerable locations. In​ 2022, according to preliminary data, 129.1 thousand cases were registered in the country, with a reduction of 8.1% compared to 2021. Despite the drop, the country did not reach the established target, of a maximum of 113 thousand notifications for the number of autochthonous cases, reaching a result of almost 127 thousand locally contracted cases. Regarding deaths, Brazil recorded 37 deaths from the disease in 2019, 51 in 2020, 58 in 2021 and 50 deaths in 2022.​​​ Outbreak News Today​ External Link