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Is the military's casualty (mortality) reporting system a reliable surrogate for International Classification of Diseases-coded death certificate information? To answer this question, the investigators compare official casualty data to the Air Force Mortality Registry for injury-related deaths occurring in 1991-1997. The investigators first derived International Classification of Diseases, Ninth Revision and Supplementary Classification of External Causes of Injury and Poisoning (E) codes for each death from casualty data and then compared the precision of those codes with the registry's E codes derived and medically coded from death certificates and autopsy reports. Sixty-five percent of registry E codes were "precise" vs. 35% from casualty data. The registry listed nonspecific E codes for 1% (12 deaths) vs. 6% (81 deaths) for casualty data. Unlike casualty data, the registry included expectant deaths that occurred within 120 days after medical retirement. The study concludes that casualty information compares poorly with that of the registry. Air Force Mortality Registry data should be used instead of casualty data for epidemiological research.

Influenza virus is one of the most ubiquitous organisms on the planet, causing illness in much of the population each year. The dynamic nature of the influenza virus requires similarly dynamic surveillance and prevention initiatives. The efforts of national surveillance programs, overseen by the World Health Organization and administered by institutions such as the U.S. Centers for Disease Control and Prevention, the U.S. armed forces, and 60 to 70 collaborating laboratories, annually culminate in the development of effective influenza vaccines. The U.S. Air Force's contribution is via Project Gargle, through which bases in various locations worldwide conduct active surveillance and submit throat swab specimens for virus isolation and characterization; the results of these laboratory analyses help determine the composition of the following year's influenza vaccine. These collaborative efforts have resulted in an identical or close antigenic match between vaccine and epidemic strains in 8 of the last 9 influenza seasons.

We report results of a hospital-based case control study of 137 consecutive patients diagnosed with aplastic anemia (AA) in participating hospitals over a 4-year period. Diagnoses were made by a single laboratory, subjects were age- and gender-matched to two controls and interviewed concerning previous disease, work histories and exposures to potential etiologic agents. Analysis was conducted on two distinct subgroups: severe aplastic anemia (SAA) and moderate aplastic anemia (MAA). In univariate regression models, the strongest associations were observed for exposure to benzene and SAA (OR=3.12, 95% CI=1.12-8.65) and life on a farm and MAA (OR=3.08, 95% CI=1.44-6.56). Benzene exposure did not show a strong dose-response relationship with either subtype. When accounting for all of the potential confounders we considered in conditional regression models, the previous relationships persisted. Other explanatory variables included hair-dye use for MAA and farm exposures, such as livestock for SAA, although most of these additional variables fell just short of statistical significance. Adjusted R-squared values were only 10% for each subtype, leaving 90% of AA occurrence unexplained. Our results suggest that: (a) benzene exposure is more strongly related to SAA than MAA, (b) farm and livestock exposures are related to both forms of AA, confirming some previous results, and (c) a large percentage of AA remains unexplained, which may indicate that individual susceptibility has a major influence on AA occurrence.