Introduction and background
FY09 Funded Partners | Primary Countries Engaged | |
---|---|---|
1 |
65
th
Medical Brigade – Korea
| Republic of South Korea |
2 |
Armed Forces Institute of Pathology – Washington, DC
| Global U.S. DoD visibility |
3 |
Armed Forces Research Institute of Medical Sciences – Bangkok, Thailand
| Thailand, Cambodia, Lao PDR, Philippines, Nepal & Bhutan and US Embassies and Consulate offices throughout Southeast Asia |
4 |
Australian Army Malaria Institute – Enoggera, Australia
| Australia, Vanuatu & Solomon Islands |
5 |
Center for Disaster and Humanitarian Assistance Medicine – Bethesda, MD
| Numerous with global distribution |
6 |
DoD Veterinary Food Analysis & Diagnostic Laboratory – Fort Sam Houston, TX
| Overseas food & water production facilities with DoD procurement contracts and US military installations supporting Military Working Dogs and food facilities |
7 |
University of Iowa – Iowa City, IA
| Thailand, Cambodia, Mongolia, Nigeria & Romania |
8 |
Johns Hopkins University Applied Physics Laboratory – Laurel, MD
| US military installations; Philippines, Peru & Cambodia |
9 |
Landstuhl Regional Medical Center – Germany
| US military treatment facilities in Southwest Asia, Germany, Italy, Belgium, Spain, United Kingdom, Turkey, Poland & Ukraine |
10 |
National Aeronautics and Space Administration – Greenbelt, MD
| Numerous with distribution primarily in Africa, Southeastern Europe and Central Asia |
11 |
Naval Health Research Center – San Diego, CA
| US military training facilities; 2nd, 3rd and 7th US Naval Fleets and deployed US Naval & Marine Corps personnel in Western Pacific region; US/Mexico border clinics with US CDC |
12 |
Navy and Marine Corps Public Health Center – Portsmouth, VA
| US military treatment facilities within the military health system (MHS) |
13 |
Navy Environmental Preventive Medicine Unit – 2 – Norfolk, VA
| US military treatment facilities in Djibouti, Kuwait, Qatar, Bahrain, Iraq & Afghanistan; deployed US Naval & Marine Corps personnel in Southwest Asia & shipboard activities in the Atlantic |
14 |
Navy Medical Research Center – Silver Spring, MD
| Numerous with global distribution |
15 |
Navy Medical Research Center Detachment – Lima, Peru
| Eleven countries in Central & South America |
16 |
Navy Medical Research Unit – 3 – Cairo, Egypt
| Thirty-four countries in West/North Africa, the Middle East & Central Asia and deployed US Forces throughout Southwest Asia and Eastern Europe |
17 |
Navy Medical Research Unit-2 – Jakarta, Indonesia
| Cambodia, Lao PDR, Indonesia & Singapore |
18 |
Pacific Air Force – Hickman AFB, HI
| Lao PDR & Vietnam |
19 |
Public Health Command Region - Europe (formerly CHPPM-Eur) – Landstuhl, Germany
| US military treatment facilities in Southwest Asia, Germany, Italy, Belgium, Spain, United Kingdom, Turkey, Poland & Ukraine |
20 |
Public Health Command Region - Pacific (formerly CHPPM-Pac) – Camp Zama, Japan
| US military treatment facilities & deployed US Forces in Japan & South Korea |
21 |
Public Health Command Region - South (formerly CHPPM-South) – Fort Sam Houston, TX
| US military treatment facilities; civilian MoH laboratory centers in Guatemala, El Salvador, Honduras, Nicaragua & Panama |
22 |
San Antonio Military Medical Center (formerly BAMC) – San Antonio, TX
| US military treatment facilities in Southwestern US |
23 |
U.S. Army Medical Research Institute of Infectious Disease – Fort Detrick, MD
| US military treatment facilities & overseas VHF laboratory in Sierra Leone |
24 |
U.S. Army Medical Research Unit – Kenya – Nairobi, Kenya
| Kenya, Tanzania, Uganda, Cameroon & Nigeria |
25 |
U.S. Northern Command – Colorado Springs, CO
| US military installations & coordination with Mexico and Canadian counterparts |
26 |
U.S. Southern Command – Miami, FL
| Deployed US Forces throughout Latin America |
27 |
UCLA/Global Viral Forecasting Initiative – San Francisco, CA
| Cameroon |
28 |
Uniformed Services University of the Health Sciences – Bethesda, MD
| US military treatment facilities & overseas military research laboratories in Peru, Egypt, Kenya, Thailand, Indonesia & Korea |
29 |
United States Africa Command – Stuttgart, Germany
| Deployed US Forces throughout Africa |
30 |
United States Air Force School of Aerospace Medicine – Wright Patterson AFB, Ohio
| US Military MTF sentinel sites around the world |
31 |
United States Central Command – MacDill AFB, FL
| Deployed US Forces throughout Southwest and Central Asia |
32 |
United States European Command –Stuttgart, Germany
| Deployed US Forces throughout Europe & Central Asia |
33 |
United States Pacific Command – Camp H.M. Smith, HI
| Deployed US Forces throughout Far East, Southeast Asia & the Pacific |
34 |
Walter Reed Army Institute of Research, Division of Bacterial Diseases – Silver Spring, MD
| US military treatment facilities & overseas military research laboratories in Peru, Egypt, Kenya, Thailand & Indonesia |
35 |
Walter Reed Army Institute of Research, Division of Clinical Trials – Silver Spring, MD
| Support to global system |
36 |
Walter Reed Army Institute of Research, Division of Entomology – Silver Spring, MD
| Numerous with global distribution |
37 |
Walter Reed Army Institute of Research, Division of Experimental Therapeutics – Silver Spring, MD
| Support to global system |
38 |
Walter Reed Army Institute of Research, Division of Virus Diseases – Silver Spring, MD
| Over 35 US embassies & deployed military personnel worldwide; overseas military research laboratories in Peru & Thailand |
39 |
Walter Reed Army Medical Center - Washington, DC
| Support to military personnel deployed to Iraq & Afghanistan |
The current global biosurveillance landscape
Why the Department of Defense?
Implementation of the AFHSC/GEIS program: methods
Communication of value added
1.Funding NMRC for development, production and sharing within partner network of rickettsial diagnostic tests |
2.Funding USAMRIID for development, production and sharing within partner network of lassa fever and other select agent diagnostic tests |
3.Funding BAMC for development, production and sharing within partner network of leptospiral diagnostic tests
|
4.Facilitation of sample sharing for advanced characterizations
|
a.Partner H1N1 samples to WRAIR for full-genome sequencing
|
b.Shipboard outbreak respiratory and serum samples to NHRC for determination of etiology and immune status
|
5.Facilitation of ongoing discussions and updates on outbreaks among host-country populations and U.S. military beneficiaries in all regions under surveillance
|
6.Facilitation of brief summaries and updates of activity related to the 2009 pandemic of A/H1N1
|
a.Provided a forum for case reporting and regional surveillance findings among network labs and near partners within the countries (InstitutPasteur, PAHO, academic partners)
|
1.Conducted active infectious disease surveillance, capacity building, training or outbreak investigations in approximately 92 countries and 500 locations through a global network of partners. |
2.Served as the primary source for global avian influenza detection. Of globally reported H5N1 infections, 71 percent (37 of 52) were identified or confirmed at DoD partner laboratories funded by AFHSC-GEIS, with the vast majority being performed at the NAMRU-3 laboratory in Cairo, Egypt. |
3.Detected the first four cases of novel A/H1N1 through two partner laboratories, the Naval Health Research Center and the U.S. Air Force School of Aerospace Medicine. Communicated results to the CDC. |
4.Supported the diagnostic confirmation of the first novel A/H1N1 cases in 14 countries (Bhutan, Cambodia, Colombia, Djibouti, Ecuador, Egypt, Kenya, Kuwait, Lao People’s Democratic Republic, Lebanon, Nepal, Peru, Republic of the Seychelles). |
5.Centrally consolidated over eight laboratory- and region-specific partner reports into an extremely well-received and informative one-page dynamic document of the “Department of Defense Global Surveillance Summary.” |
6.Improved infrastructure at 52 laboratories in 46 countries, including eight military and 44 civilian laboratories, with emphasis on influenza, and leveraged capability for other emerging infectious disease initiatives. |
7.Sponsored and/or conducted 123 training exercises with more than 3,130 representatives from 40 countries. |
8.Responded to more than 76 outbreaks in 53 countries; 24 outbreaks were at U.S. domestic and foreign installations, 36 were in partnership with foreign civilian entities and 15 with foreign militaries. |
9.More than 15 reports of first laboratory confirmation of etiologic disease causes in regions where the disease had not been previously reported, including leptospirosis, yellow fever, Q fever, brucellosis, St. Louis encephalitis, Venezuelan equine encephalitis, various rickettioses and other pathogens. |
10.Supported partners tested more than 72,000 respiratory samples, of which more than 17,000 (24 percent) were influenza-positive and more than 10,000 (15 percent) were novel A(H1N1). |
Accomplishments: fiscal year 2009
1.Of three influenza reference strains provided to WHO (A/California/7/2009, A/California/4/2009 and A/Texas/5/2009) by NHRC and USAFSAM, the A/California/7/2009 was selected as the seed strain. |
2.Two biosafety-level 3 (BSL-3) laboratories were commissioned in 2009 at NHRC in San Diego, Calif., and AFRIMS in Bangkok, Thailand; and two BSL-2 laboratories were commissioned, one at the University of Buea, Cameroon, and one on the campus of the Cameroonian Army installation in Yaoundé, Cameroon, under supervision of the Global Viral Forecasting Initiative. |
3.NAMRU-3 partners reported the first definitive evidence of human cutaneous leishmaniasis from Leishmania major infections in Ghana. |
4.AFRIMS published the first report of clinically significant Plasmodium falciparum malaria resistance to the potent artemisinin antimalarial drug class, spurring WHO, Bill & Melinda Gates Foundation and host national malaria control officials to institute aggressive measures to contain and eliminate artemisinin-resistant malaria in Southeast Asia. |
5.The first documented cases of Venezuelan equine encephalitis, brucellosis, dengue and Q fever in Ecuador were reported by NMRCD-Lima, and the first laboratory-confirmed cases of leptospirosis in the border areas of Thailand and Myanmar were reported by AFRIMS. |
6.AFRIMS provided timely outbreak response services to the Nepali National Public Health laboratory, ultimately characterizing (by pulse-field gel electrophoresis) nearly 6,000 cases of multidrug-resistant typhoid fever originating from a single point source, and uniformly quinolone-resistant. |
7.NAMRU-3 worked closely with WHO to conduct novel A/H1N1 laboratory diagnostic training for 73 participants representing 32 different countries in a strategic and timely two-week period in May 2009. |
8.NEPMU-2, NAMRU-3, and AFHSC collaboratively supported CENTCOM efforts in establishing in-theatre novel A/H1N1 testing and isolation of servicemembers deployed or deploying to sites around the world. |
9.The WRAIR/USAMRU-K Malaria Diagnostics and Control Center of Excellence, established in 2003, having trained more than 600 malaria microscopists, established new malaria diagnostics training capabilities in Nigeria and Tanzania, leading to a visit by the president of Tanzania to WRAIR to establish new collaborations between the U.S. Army and Tanzania. |
10.NMRCD, as part of its expansive febrile-disease surveillance network in the Amazon basin, published the first comprehensive study of the etiologies of undifferentiated febrile illness in Ecuador, documenting the first laboratory-confirmed cases of Venezualan equine encephalitis, brucellosis, dengue and Q fever in Ecuador. |
Publications and presentations
The way forward: tools for success
International Health Regulations (2005)
Military-to-military cooperation and collaboration
Country
|
Focus of Collaboration
|
Nature of Exchange
|
Cambodia | Influenza surveillance & EID lab training | Standardization of laboratory procedures (QA/QC) |
Cameroon | Influenza surveillance & EID lab capability | Influenza & EID reporting capability |
Kenya | Influenza surveillance | Influenza reporting capability |
Lao People’s Democratic Republic | Influenza surveillance & EID lab training | Standardization of laboratory procedures (QA/QC) |
Malaysia | Influenza surveillance & EID lab training | Subject-matter expert |
Nigeria | Influenza surveillance & EID lab capability | Influenza & EID reporting |
Pakistan | Influenza surveillance & EID lab capability | Subject-matter expert |
Peru | Electronic disease surveillance | EID and influenza laboratory |
Influenza & EID lab capability | capacity & training; disease reporting capability | |
Poland | Influenza surveillance & EID lab capability | Influenza & EID reporting capability |
Singapore | Influenza surveillance, EID lab capability & disease surveillance | Standardization of laboratory procedures (QA/QC) |
Tanzania | Influenza surveillance & EID lab capability | Influenza & EID reporting capability |
Thailand | Unit-based electronic surveillance | EID and influenza laboratory |
Influenza & EID lab capability | capacity & training; disease reporting capability | |
Uganda | Influenza surveillance | Influenza reporting capability |
Vietnam | Influenza surveillance & EID lab training | Standardization of laboratory procedures (QA/QC) |