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NATO UNCLASSIFIED Releasable to the INTERNET1
Jeffery Paulson, CAPT, MC USNFleet Forces Command
Norfolk, VA, USA
L06 Understand DNBI in the Maritime Environment
NATO UNCLASSIFIED Releasable to the INTERNET
Implement FHP
FHP
Elements of DNBI
Challenges of a Ship Environment
Management of Outbreaks
Sources of Information
NATO UNCLASSIFIED Releasable to the INTERNET
FHP
Force Health Protection
“Actions taken to counter the effects of the environment, occupational health risks and disease through preventive and reactive measures”
AJMEDP-1, AJP-3.14
NATO UNCLASSIFIED Releasable to the INTERNET
Implement FHP
Goals of FHP{Environment, Occupation, Disease}
Maximize Health of the Forces
Protect the Health of the Forces
Minimize threats
NATO UNCLASSIFIED Releasable to the INTERNET
Implement FHP
Measures of FHP
Disease Rates
Injury Rates
Baseline Measures
Metrics of Changes
NATO UNCLASSIFIED Releasable to the INTERNET
FHP Process
Hazard Identification
Health Risk Assessment
Health Risk Management
Health Risk Control
Health Risk Communication
Evaluation
AJMedP-4
NATO UNCLASSIFIED Releasable to the INTERNET
Medical Surveillance
Medical/Morbidity Surveillance Amount and type of illness – Readiness
Health Needs Assessment – Requirements
Incidence /Prevalence – Alert Systems
CBRN/Toxin releases
Medical Intelligence
Audit
NATO UNCLASSIFIED Releasable to the INTERNET
Ex: Preventive Medicine
Arthropod borne diseases
Animal associated diseases
Infection Control in MTF’s
Outbreak Control
Non-infections disease
Oral Health and Oral Disease
Mental Illness
NATO UNCLASSIFIED Releasable to the INTERNET
DNBI
BI, KIA, WIA
DNBI Disease Non-Battle Injury
High Rates MAY signal a need for countermeasures or an investigation
Potential Adverse Impact on Readiness!
Designed for Higher Authority
Less useful at the deckplate level
NATO UNCLASSIFIED Releasable to the INTERNET
DNBI categories -US
Fever, unexplained
Influenza –like illness
Lower respiratory illness
Rash
Localized cutaneous lesion
GI – infectious
Botulism-like
Neurological
NATO UNCLASSIFIED Releasable to the INTERNET
DNBI categories -US
Psychiatric, Mental Disorders
Heat/Cold Injuries
Injury, Recreational/Sport
Injury, Motor Vehicle Accident
Injury, Work/Training
Injury, Other
All other
Totals
Outbreak: Acute Respiratory Illness
• USS Mystery from 01 Feb to 22 May 2xxx. Epidemiological data and the subsequent investigation and report by Navy PH officials indicated:– DNBI reports indicated to Navy PH officials that lower respiratory illness rates were
excessive, so the PMU contacted the Surgeons to offer assistance.– The problem lingered on and eventually PH investigators were flown to the ship to
determine the nature of the problem and hopefully get it under control before the ship’s Tiger cruise passengers joined the crew in HI
– Outbreak involved 162 episodes of illness and 67 admissions to the medical ward. 50 were admitted with x-ray-confirmed pneumonia.
– The event originated in a small cluster of cases in early February following a port visit to Jebel Ali, Dubai. It was concentrated in a particular berthing area.
– Epidemiologic study indicated that the clinical presentation was consistent with an etiology of Mycoplasma pneumonia. Lab data later confirmed this diagnosis.
– The epidemic lasted several weeks– The PMU investigator reported that DNBI surveillance might have provided an
opportunity for an earlier interdiction of the disease.
Pandemic Influenza 2009
• Fleet DNBI process was updated to capture influenza like illnesses.• Fleet ILI information from DNBi surveillance was reported by the SG’s
staff to the CNO in weekly Pandemic SITREPS.• Affected and non-affected ships were known precisely.• The extent to which different ships were affected was known.• Health surveillance information was shared liberally between the Navy and
Marine Corps Public Health Center and the Naval Health Research Center (NHRC), since NHRC was providing lab support to ships experiencing outbreaks.
• Calculated expected ILI rates were used to develop a OPNAV Pandemic Influenza response matrix based on varying levels of ill in fleet units.
NATO UNCLASSIFIED Releasable to the INTERNET
Ship Challenges
Isolated
Austere
Close Quarters
Little Recreational Time
And….a target during hostile action
NATO UNCLASSIFIED Releasable to the INTERNET
SUMMARY
Force Health ProtectionDefinitions, Issues and Considerations
Disease, Non-Battle InjuryDefinitions, Example
Ship Considerations and Outbreaks
Future CourseEffective DNBI data and analysis is key
NATO UNCLASSIFIED Releasable to the INTERNET
Jeffery Paulson, CAPT MC USNDirector, Surface Medicine Navy Bureau of Medicine and Surgery
Fleet Forces Command, Norfolk, VA USA
757-836-0106 Email: [email protected]
Questions…
Norovirus: Outbreak Prevention and Control
• DNBI data was used to estimate the burden of GI and norovirus illnesses and outbreaks occurring aboard fleet units.– During the 24 month period from 01 Jan 2009 to 31 Dec 2010 we estimated: – there were 21,840 unique health care (HC) visits for complaints of GI illness from all
etiologies in the U.S. Fleet. – 158 outbreaks of GI illnesses may have occurred causing about 12,000 of the unique HC
visits for GI illnesses of which roughly 80 (causing 6000 unique HC visits) might be attributed to NoV infections.
• DNBI data: – Can be used as an outcome measure for prevention efforts detailed in a new NMCPHC
prevention and control guide – Illustrates that norovirus illnesses are an important source of morbidity in fleet units.– Can provide information about the fleets performance of Medical Event Reporting. For
example, 65 GI outbreaks were reported/identified via DNBI surveillance. Six of those affected units completed MERs to detail the event and their responses to it.