Connecting to our military customers

Infectious disease improvements in the military should be a global alliance, and we can accomplish this by connecting to our military customers.

A long-standing benefit to the infectious disease specialty is that of structure. It is a medical specialty with very specific visibility to disease. Pathogens may have preference to environments and vectors, yet pathogens are a threat to all humans. Pathogens do not discriminate based on geopolitical uniform. Infectious disease is a relatively structured division of healthcare, with formal pathways to diagnostics, care management guidelines and therapeutics. It is a relatively structured specialty for networks as well, with international peers in private industry alongside academia and alongside public health. Infectious disease is a connected specialty.

A global movement in military healthcare should connect professional networks and pathways for infectious disease management improvements. This can be accomplished in united front; consideration to various military infectious disease risks and initiatives already steers informal discussions as well as formal insight.

An international military health collaborative can improve infectious disease management for all members of militaries. Steps should include work to:

1. Clarify military surveillance and epidemiology of infectious disease. To what extent are infectious diseases tracked, reported and addressed for: deployment, routine military population health (STDs, influenza, others), environmental illness (food-borne outbreaks, others), and healthcare acquired infections? Where are the country comparisons in how military infectious disease is approached (1), and how are military metrics included in national disease surveillance?

2. Streamline surveillance with interoperability and alignment. Examining EpiNATO-2 (2) for infectious disease components would be a good start.

3. Expand surveillance for specific projects, with data sharing and real-time uploads that do not compromise national security. US military surveillance with Zika (3), UK seroconversion post-deployment from Afghanistan (4) and recent Georgian military baseline laboratory data (5) on zoonotic and arthropod disease are isolated studies that have components readied for routine, mainstream operations.

4. Compare and align routine chemoprophylaxis guidelines across borders. Overall deployment chemoprophylaxis should be standard, and identified risks by country military aligned with general protocols. Individual military risks and variance, such as tandem Group A Strep protocols in the United States (6) and UK military anti-malarial chemoprophylaxis (7), could be examined for improvements.

5. Incorporate the surveillance work within a military’s borders as a part of greater global health. This work is important for environmental and climate health. This work should also trigger basic prevention and risk reduction bundled protocols, including chemoprophylaxis, uniform treatments, international military peer notifications, etc. Regional changes in military malaria cases have been insightful for Korea (8), regional differences in sandfly fever in Iranian military members are noteworthy (9), malaria cases in Egypt from deployed peacekeepers are of international concern (10) and variance in leishmaniasis strains noted in Colombian military members are important to global environmental health (11).

6. Share data for medical intelligence planning. UK military cases with febrile and dermatologic investigation are notable (12), French military data on Q fever cases with French Guiana deployments are notable (13), and the delayed diagnosis of lobomycosis in Colombia servicemen is notable (14). These publications are very small subsets of great infectious disease insight for strategic planning.

7. Improve matched healthcare acquired infection (HAI) data. US military healthcare studies on HAI MSSA and MRSA have pulled from hospital records (15), as mandatory reporting requirements likely do not match public reporting databases. A HAI mismatch between militaries and national health quality is inappropriate in advanced delivery systems. HAI in other military care is just as opaque.

8. Designate antibiotic stewardship to militaries. Healthcare delivery and antibiotic stewardship is intertwined with military care. Wound management guidelines and innovative therapeutic prioritization are two areas that a global military health table could lead. A recent US article on wounds and stenotrophomonas maltophilia (16) is an excellent example of a small starting point. Work that incorporates Indian military health alongside Indian community health for multi-drug resistance is another important example (17).

9. Aggregate sexual health and infectious disease data robustly. This data likely remains understood within military units and department reports, yet international military movement should benefit across borders. Ongoing behaviors and interventions around HIV and STDs (18) are not applicable to only one military population. Cultural differences in surveillance approach are sensitive yet should not hinder medical progress.

10. Support military hospital and research infrastructure. Indonesian military research expansion (19), Sudanese military hospital work with malaria (20) and Pakistan military hospital work with dengue (21) should be applauded and greater epidemiological and research infrastructures supported.

11. Support infection preventionist training between military charitable care. Many militaries, including the United States, provide healthcare to other countries. Onsite infection prevention should be available for military healthcare worker protection as well as host country training.

12. Fund identified need in diagnostics. Militaries in every country need better diagnostics, including for malaria (22) and Chikungunya virus (23).

13. Fund quality improvement initiatives in virus identification. A recent Tanzanian military health network initiative is notable (24).

14. Fund needed vaccines. Publications have been noting needs for years, such as a 1999 article from Germany on Chikungunya (25). Work and issues around vaccine science for diseases such as Q Fever (26) should be noted and addressed.

15. Align for strategic zoonotic disease prevention. The human-animal relationship and interactions are a cultural difference across borders. Risks and disease trajectories do not discriminate, however. Alliance with military zoonotic disease benefits all, including host countries. Q fever in Brazilian military members (27), brucellosis post-deployment from Iraq (28), leptospirosis in Malaysian military members (29) and work with US serviceperson rabies exposure (30) are all costly. Historically, once these diseases are identified, host countries, veterinarian networks and local officials assist. All of this work could be applied as a unified, preventive effort though. And preventive efforts with zoonosis always benefit a local country’s community.

16. Set expectations for public health and military partnerships. Chagas surveillance with Colombian military members may speak to ongoing public health efforts (31). Conversely, a foodborne hepatitis outbreak in India (32) could drive new regulatory requirements of which public health could oversee. Public health could also assist in environment, air and water sampling for infectious disease alerts. Set expectations for public health partnerships with global military infectious disease alignment.

The greater healthcare industry and greater global alliances should step in as partners, bridging and connecting to our military customers. Our pharmaceutical, biotechnology, laboratory science, healthcare technology, surveillance software and philanthropic partners can assist in improving infectious disease prevention and management for military members worldwide.

Infectious disease improvements in the military should be a global alliance, and we can accomplish this by connecting to our military customers.

Traveling with the Refs:

1. https://academic.oup.com/cid/article/44/3/424/314476

2. https://pubmed.ncbi.nlm.nih.gov/30859532/

3. https://europepmc.org/article/med/31347372

4. https://wwwnc.cdc.gov/eid/article/20/12/13-1830_article

5. https://europepmc.org/article/med/29889971

6. https://www.sciencedirect.com/science/article/pii/S0091743518303426

7. https://www.sciencedirect.com/science/article/abs/pii/S1477893916300849

8. https://link.springer.com/article/10.1186/s40249-016-0111-3

9. https://europepmc.org/article/med/27017407

10. https://aeji.journals.ekb.eg/article_8732.html