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Objective: In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation. Methods: The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates. Results: This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7–12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3–8.3). Conclusions: Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox. [ABSTRACT FROM AUTHOR]

Malaria was eradicated and the Republic of Korea (ROK) declared "malaria free" in 1979. However, in 1993, a temperate strain of vivax malaria, expressing both latent and nonlatent disease populations, re-emerged near the demilitarized zone (DMZ), rapidly spread to civilian sectors near the DMZ, and increased exponentially in ROK military, veteran, and civilian populations through 1998. Malaria among all ROK populations decreased 5-fold from a high of 4,142 cases in 2000 to a low of 826 cases in 2004, before increasing again to 2,180 cases by 2007. Each malaria case in the ROK is reported in the metropolitan area/province where the diagnosis is made, which may be at some distance from the area where infection occurred. Therefore, it is difficult to ascertain transmission sites since approximately 60% of vivax malaria in Korea is latent with symptoms occurring >1 month to 24 months after infection. A review of case diagnosis for civilian, veteran, and military populations shows that nearly all malaria south of Gyeonggi and Gangwon Provinces is the result of veterans exposed in malaria high-risk areas along the DMZ and returning to their hometowns where they later develop malaria. Thus, malaria currently remains localized near the DMZ with limited transmission in provinces south of Seoul and has not spread throughout Korea as previously hypothesized. This report describes the reemergence of vivax malaria cases in civilian and military ROK populations and U.S. military personnel and assesses variables related to its transmission and geographic distribution. [ABSTRACT FROM AUTHOR]

Malaria is a significant health threat to U.S. combat forces that are deployed to malaria-endemic regions. From 1979. when the Republic of Korea (ROK) was declared malaria free, malaria did not present a health threat to U.S. forces deployed in Korea until the early 1990s, In 1993, a temperate strain of vivax malaria expressing both latent (long prepatent incubation periods of usually 6-18 months after infection) and nonlatent (short prepatent incubation periods <30 days after infection) disease reemerged near the demilitarized zone (DMZ) and once again presented a primary health threat to U.S. military populations in the ROK. Following its reemergence, malaria rates increased dramatically through 1998 and accounted for >44% of all malaria cases among U.S. Army soldiers from 1997 to 2002. More than 60% of all Korean-acquired malaria among U.S. soldiers was identified as latent malaria. Nearly 80% of all latent malaria attributed to exposure in Korea was diagnosed in the U.S. or other countries where soldiers were deployed, These data illustrate the requirement for a comprehensive malaria education program, especially for those soldiers residing or training in malaria high-risk areas, to inform soldiers and providers of the risk of developing malaria after leaving Korea. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Rabies, Readiness, and Role 1 Medical Care" by Louis A. Dainty et al. in a 2013 issue of the journal.

Background: Increasing numbers of Staphylococcus aureus infections demonstrate antibiotic resistance. Military populations experiencing crowding are at increased risk of community-acquired methicillin-resistant S. aureus (CA-MRSA) infection. High prevalence of CA-MRSA infection among Army personnel was previously documented at Fort Benning, GA from 2002 to 2007. Purpose: To ascertain recent CA-MRSA trends at Fort Benning regarding antibiotic susceptibility, infection rates, and treatment regimens among Army personnel. Methods: Incident CA-MRSA cases among active duty members/trainees from January 2008 to December 2010 were identified using active surveillance and laboratory data. Results: In total, 2,171 infections were identified, representing 5,794 CA-MRSA-related clinic visits. Annual rates decreased from 33 to 27 infections per 1,000 soldiers from 2008 to 2010. Approximately 78% of isolates were from training units. Approximately 4% of infections required hospitalization. Most infections (97%) were treated with antibiotics (36% received antibiotics and wound drainage). Antibiotic susceptibility patterns remained comparable to previous assessments. Conclusion: The observed decline in CA-MRSA rates and associated hospitalizations, coupled with stable antibiotic susceptibility patterns, is encouraging. Passive surveillance using laboratory records proved useful in identifying infection and could enhance detection across training sites. Given the continued high CA-MRSA prevalence among trainees, providers/public health personnel should remain vigilant to bolster prevention, detection, and treatment efforts. [ABSTRACT FROM AUTHOR]

The United States (US) Army implemented a comprehensive HIV characterization program in 2012 following repeal of the Don't Ask, Don't Tell policy banning openly homosexual individuals from serving in the US military. Program staff administered a standardized case report form to soldiers newly diagnosed with HIV from 2012 to 2014 in compliance with new program requirements. The case report form documented sociodemographic, sexual, and other risk behavior information elicited from US Army regulation-mandated epidemiologic interviews at initial HIV notification. A majority of HIV-infected soldiers were male and of black/African American racial origin. In the HIV risk period, male soldiers commonly reported male-male sexual contact, civilian partners, online partner-seeking, unprotected anal sex, and expressed surprise at having a positive HIV result. Don't Ask, Don't Tell repeal allows for risk screening and reduction interventions targeting a newly identifiable risk category in the US Army. At-risk populations need to be identified and assessed for possible unmet health needs.