Nowak Gosia

Group A beta-hemolytic Streptococcus (GABHS) has caused outbreaks in recruit training environments, where it leads to significant morbidity and, on occasion, has been linked to deaths. Streptococcal surveillance has long been a part of military recruit public health activities. All Navy and Marine Corps training sites are required to track and record positive throat cultures and rapid tests on weekly basis. The Navy and Marine Corps have used bicillin prophylaxis as an effective control measure against GABHS outbreaks at recruit training sites. Though streptococcal control program policies vary by site, a minimum prophylaxis protocol is required and mass prophylax is indicated when local GABHS rates exceed a specific threshold. Before July 2007, prophylaxis upon initial entry was required between October and March, and when the local rate exceeded 10 cases per 1000 recruits. In July 2007, the Navy instituted a policy of mass prophylaxis upon initial entry throughout the year. Evaluation of GABHS cases before and after implementation of the new policy, including overall rates, identification of outbreaks, and inpatient results will help enhance the Navy’s ability to evaluate threshold levels, provide  systematic/standardized monitoring across the three recruit sites, and inform prophylaxis and monitoring strategies.

Objective

To compare trends of GABHS among recruits before and after changes in prophylaxis implementation using electronic laboratory and medical encounter records.

Since the largest epidemic of Zaire ebolavirus (EBOV) in recorded history began in Guinea in December 2013, the epidemic has spread to neighboring countries of Liberia and Sierra Leone resulting in an estimation of over 27,000 total cases and over 11,000 deaths to date. In response to the widespread social disruption caused by this epidemic in West Africa, President Obama committed approximately 2,000 US service members to deploy to the region and provide humanitarian aid. US military physicians were called upon to evaluate service members returning from West Africa (WA) to rule out EVD. The US military also has a considerable number of beneficiaries who travel to WA to visit friends and relatives placing them at risk for exposure to EBOV and the development of illness upon returning to the US.

We are conducting an expanded surveillance program that employs a standard questionnaire that all providers can use when evaluating a patient at-risk for EVD that will also capture information from historical encounters. The data collected from the questionnaire will be used to assess the frequency with which clinicians are called to evaluate patients for EVD and the resources required. However, we realize that many encounters may not be captured with this method, especially those that are not high enough risk to require consultation with infectious disease (ID) specialists, and are developing ways to screen the Electronic Health Record (EHR) to find additional patients.

Objective

To present methods of screening chief complaints and laboratory orders to find patients who presented for Ebola Virus Disease (EVD) screening, in order to determine the impact Ebola concern had on the Military Health System (MHS).