Legionella
The name
Legionellosis, a diagnosis monitored by the military, is now used to refer to both Legionnaires' disease (a form of severe pneumonia, a lung infection with onset 2-14 days), and Pontiac fever, a milder flu-like illness (onset hours to days) without pneumonia. These diseases are caused by
Legionella, a bacteria found naturally in freshwater environments like lakes and rivers, and sometimes soil and drinking water.
- Low levels of Legionella bacteria in water are common and don't usually cause illness. However, if it multiplies to high levels, people can get sick if they breath in tiny water droplets (aerosolization) containing Legionella bacteria.
- Legionella bacteria reproduce to high numbers in warm, stagnant water (90-100°F), such as in certain plumbing systems and hot water tanks, cooling towers and evaporative condensers of large air-conditioning systems (hotels), and hot tubs or whirlpool spas.
Outbreaks occur when two or more people are exposed to Legionella in the same place and get sick at about the same time. The last outbreak confirmed by the military was in 2010 at Selfridge Air National Guard Base, Michigan. Risk of Legionella is lower now that scientists have learned more about its cause and effective prevention tactics.
Take steps at home
to avoid germs that grow in pipe slime or devices that use water:
- Flush faucets and showerheads that have not been used in a while (for example, a week or more) before using them again.
- Clean devices that use water (for example, humidifiers and neti pots).
Additional Legionella Resources
Case Reporting (Military Treatment Facility/MTF)
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MRSA Infections
About 30% of people carry
Staphylococcus aureus, or “staph" bacteria on their skin or in their nose without any problems. However, staph bacteria are a common cause of skin infections.
“Staph" bacteria that cannot be treated with several types of common antibiotics are called methicillin resistant or "MRSA". When people who are healthy and have not been in a hospital get a MRSA infection it is often called "community acquired", or CA-MRSA. About 2% of people carry MRSA bacteria on their skin or in their nose, usually without any problems.
Most staph skin infections are minor (such as pimples or boils) and get better on their own without medical treatment. Staph bacteria can also cause more serious infections (such as abscesses, cellulitis, bloodstream infections, or pneumonia) that require medical treatment.
If a skin infection is caused by MRSA, it can be more severe and more difficult to treat
because of its resistance to commonly used antibiotics. Most MRSA skin infections first look like a bump or area of the skin that may be red, swollen, painful or tender, warm to the touch, full of pus or fluid, and/or accompanied by a fever. MRSA infections are often confused with a spider bite; however, unless a spider is seen, it is likely not a spider bite.
People are at higher risk of getting a CA-MRSA skin infection when they participate in activities or live in places that involve crowding, skin-to-skin contact, or sharing of towels, razors, and other personal items. Individuals at higher risk include athletes, daycare and school students, military personnel living in barracks, people who were recently hospitalized, and prison inmates.
To Prevent MRSA Infection
- Keep your hands and body clean – wash your hands thoroughly and frequently, and clean your body regularly, especially after exercise.
- Keep cuts, scrapes, and wounds clean and covered until they heal.
- Do not touch other people's wounds or bandages.
- Do not share personal items such as razors, towels, and uniforms.
- Wash laundry in hot water and laundry detergent.
- Clean gym equipment, such as weight benches, before use or use a barrier such as a towel or shirt between your skin and the equipment.
Reduce the Risk
Finding infections early and getting care will decrease the chance that the infection will become severe. Untreated MRSA infections can become severe and life-threatening – see a doctor as soon as you develop symptoms. Most MRSA infections are treatable with antibiotics. If you believe you have MRSA symptoms, cover the area with a bandage, wash your hands, and contact a doctor. Always keep the wound covered to prevent others from getting infected.
Additional MRSA Information
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Ebola
Ebola Virus Disease (EVD) is a rare and deadly disease in people and non-human primates. The viruses that cause EVD are located mainly in sub-Saharan Africa. People can get EVD through direct contact with an infected animal (bat or nonhuman primate) or a sick or dead person infected with Ebola virus.
Ebola virus spreads from person to person by direct contact with blood, secretions, organs or other bodily fluids (such as sweat, vomit, and diarrhea) of infected people. Only people who have symptoms of EVD, or have recently died from EVD, can transmit the virus to others. The risk of spreading the infection to others increases as the disease progresses. CDC guidance for U.S. care settings includes initiating standard, contact and droplet precautions for suspected EVD.
Vaccine
The U.S. Food and Drug Administration (FDA) approved the first Ebola vaccine rVSV-ZEBOV (called Ervebo®) in December 2019. This single dose vaccine has been found to be safe and protective against Zaire ebolavirus. In February 2020, the Advisory Committee on Immunization Practices (ACIP) recommended pre-exposure prophylaxis vaccination with rVSV-ZEBOV for adults in the U.S. population who are at potential occupational risk of exposure to Zaire ebolavirus. Military personnel should check for required and recommended vaccinations designated for world-wide Area of Operations.
Outbreaks
Outbreaks have been reported sporadically in West African countries since Ebola was first recognized in 1976. To date, the largest outbreak began in Guinea in December 2013, and spread to surrounding West African nations, with isolated travel-related cases diagnosed in Spain, Italy, the UK, and the US. In August 2014 the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC). It wasn't until June 2016, after more than 28,000 cases were reported with 11,325 deaths, that all affected countries were declared Ebola-free. During the widespread 2014 outbreak, the US military supported Operation United Assistance (OUA), through provision of engineering, logistical and training support. The overwhelming majority of tasks U.S. military personnel performed in West Africa were deemed to pose no risk for infection given the absence of direct exposure to infected patients or contaminated articles.
Although the spread of EVD in West Africa was contained in the affected areas, additional cases continue to occur. For example, in 2022, an outbreak of Ebola (Sudan virus) was reported in Uganda and the Democratic Republic of the Congo (DRC).
Military personnel travelling or deployed to these areas should determine the level of medical threats and vaccinations protocols required.
Additional Ebola Information Sources
Case Reporting (Military Treatment Facilities/MTFs)
- EVD and Viral Hemorrhagic Fever cases are reportable medical events –
see guidance here
- Inform the local health department (MTFs must ensure clinical Ebola specimen submission and testing on patients is coordinated with the MTF lab, MTF Preventive Medicine Department and the state/local public health department)
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Mpox
Mpox (formerly known as monkeypox) is a rare infectious disease caused by the mpox virus, which is in the same family of viruses that causes smallpox.
The most known symptom is the mpox rash (which may look like pimples or blisters) and can occur on hands, feet, chest, face, mouth, or on or near the genitals or anus. Other symptoms may include fever, chills, swollen lymph nodes, muscle aches, backache, headache, exhaustion and/or respiratory symptoms. The rash can be confused with other rashes associated with sexually transmitted infections (STIs), such as still-common herpes and syphilis. It is also possible to be infected with both mpox and an STI. Mpox is treatable, however the disease is occasionally fatal.
There are two types of mpox virus. While both types spread the same way and have similar symptoms, the severity of the resulting mpox is different:
- Clade I – mainly found in Central Africa, can make people very sick and has caused deaths at higher rates (up to 10%) in some outbreaks.
- Clade II – mainly found in West Africa, results in a less severe illness. Less than 1% of people infected with clade II die.
Outbreaks
- August 2024 - outbreak of Clade I in the Democratic Republic of Congo (DRC) and other African countries was declared a public health emergency of international concern. However, no confirmed mpox cases were reported among Military Health System beneficiaries within the U.S. Africa Command area of operations. The risk of mpox infection to service members identified as low. See:
Mpox - What Service members SHOULD KNOW.
- 2022 worldwide outbreak – caused by Clade II, resulted in thousands of cases in the U.S; most cases adult males who reported intimate physical contact with other males. Only a few cases identified in the Military Health System, overall risk identified as low.
Key Prevention Tactics
Mpox can be spread from the time symptoms start until all sores have healed and a fresh layer of skin has formed; this can take several weeks. Mpox spreads by close, personal, and direct skin-to-skin contact with mpox rash, sores, or scabs or contact with objects, clothing, bedding, or towels, and surfaces that have been used by someone with mpox. Mpox may spread through respiratory droplets or oral fluids from a person with mpox, but is less transmissible through the airborne-only route than COVID or flu.
Steps to reduce risk include:
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Avoid close contact with someone with mpox and lower your risk during sex.
- Avoid contact with wild animals (alive or dead) in areas where mpox regularly occurs; this includes avoiding eating or preparing meat from wild animals or using products (creams, lotions, powders) derived from wild animals.
- If eligible, get vaccinated: CDC recommends vaccination for people who have been exposed to mpox and people who are at higher risk of being exposed to mpox (U.S. military personnel can consult with their provider about vaccination)
Additional Mpox Information Sources
Information for Providers and Public Health Professionals
