Appendix E
Selected Department of Defense Entities with Relevant Programs

GLOBAL EMERGING INFECTIONS SURVEILLANCE AND RESPONSE SYSTEM

The Global Emerging Infections Surveillance and Response System supports and coordinates infectious disease programs through a global network of military and nonmilitary partners. The four goals of this organization are surveillance and detection; response and readiness; integration and innovation; and cooperation and capacity building. Key priority areas include respiratory diseases (especially pandemic and avian influenza), gastroenteritis syndromes, febrile illness syndromes such as malaria and dengue, antimicrobial resistance, and sexually transmitted diseases and illnesses. (www.geis.fhp.osd.mil/)

NAVAL MEDICAL RESEARCH AND DEVELOPMENT

Naval Medical Research and Development (NMR&D) conducts health and medical research, development, testing, evaluation, and surveillance to enhance the operational readiness and performance of Department of Defense (DOD) personnel worldwide. Research is multifaceted and covers the following disciplines: biological defense, infectious diseases (for example, rickettsial diseases), combat casualty care, dental and biomedical research, directed energy bioeffects, environmental health, aerospace medicine, undersea medicine, tropical medicine, bone marrow donation, medical modeling, simulation and mission support, and war-fighter performance, as well as epidemiology and behavioral sciences. This broad range of disciplines is supported by 10 different laboratories scattered across the United States and the globe, including the Naval Medical Research Center (Maryland); Naval Medical Research Unit 3 (NAMRU-3, Cairo, Egypt), with field sites in Ghana and Afghanistan; NAMRU-2 (Jakarta,



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Appendix E Selected Department of Defense Entities with Relevant Programs GLOBAL EMERGING INFECTIONS SURVEILLANCE AND RESPONSE SYSTEM The Global Emerging Infections Surveillance and Response System sup- ports and coordinates infectious disease programs through a global network of military and nonmilitary partners. The four goals of this organization are surveillance and detection; response and readiness; integration and innovation; and cooperation and capacity building. Key priority areas include respiratory diseases (especially pandemic and avian influenza), gastroenteritis syndromes, febrile illness syndromes such as malaria and dengue, antimicrobial resistance, and sexually transmitted diseases and illnesses. (www.geis.fhp.osd.mil/) NAVAL MEDICAL RESEARCH AND DEVELOPMENT Naval Medical Research and Development (NMR&D) conducts health and medical research, development, testing, evaluation, and surveillance to enhance the operational readiness and performance of Department of Defense (DOD) personnel worldwide. Research is multifaceted and covers the following disci- plines: biological defense, infectious diseases (for example, rickettsial diseases), combat casualty care, dental and biomedical research, directed energy bioef- fects, environmental health, aerospace medicine, undersea medicine, tropical medicine, bone marrow donation, medical modeling, simulation and mission support, and war-fighter performance, as well as epidemiology and behavioral sciences. This broad range of disciplines is supported by 10 different laborato- ries scattered across the United States and the globe, including the Naval Medi- cal Research Center (Maryland); Naval Medical Research Unit 3 (NAMRU-3, Cairo, Egypt), with field sites in Ghana and Afghanistan; NAMRU-2 (Jakarta, 

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 APPENDIX E Indonesia), with field sites in Cambodia and Singapore; and Naval Medical Research Center Detachment (Lima, Peru), with a field site in Iquitos, Peru. NMR&D also has a medical liaison officer at the World Health Organization in Geneva, Switzerland. (www.med.nay.mil/sites/nmrc/Pages/index.htm) Following are additional details on some key NMR&D units: • NAMRU-3 holds cooperative research agreements with institutions in Egypt and other areas in the region for the surveillance of influenza, dengue, and antimalarial drug resistance. Cohort studies are currently being conducted for zoonotic diseases, arbovirus infections, and enteric pathogens in selected communities throughout Egypt. (namru.med.nay.mil/Default/aspx) • NAMRU-2, located in Indonesia, has expanded operations to other coun- tries in Southeast Asia, including Laos, Singapore, Thailand, and Cambodia. Recently, NAMRU-2 helped Laos implement the Early Warning Outbreak Rec- ognition system, which provides the only electronic system of disease outbreak recognition and warning in the country. (www.nmrc.nay.mil/namru_.htm) • U.S. Army Medical Research Unit-Kenya’s activities include comprehen- sive regional monitoring for drug resistance in malaria and enteric pathogens, etiology identification of undiagnosed hemorrhagic fever, use of remote sensing in assessing risk from vector-borne diseases, and analyses of atypical transmis- sion patterns throughout eastern Africa. (usamrukenya.org) • Naval Medical Research Unit, located in Peru, works in collabora- tion with the ministries of health and defense in Peru, Bolivia, and Ecuador. Research interests include antibiotic and antimalarial drugs’ resistance patterns in pathogens, arbovirus maladies, and diarrheal diseases. (www.nmrc.nay. mil/nmrcd.htm) • Armed Forces Research Institute of Medical Science, situated in Bang- kok, Thailand, operates as a joint American-Thai military medical research institute with both U.S. and Royal Thai Army components. The U.S. compo- nent functions as a special foreign activity of the Walter Reed Army Institute of Research (WRAIR) in Washington, D.C., and of the U.S. Army Medical Research and Materiel Command. Scientific publications have covered Japa- nese encephalitis, hepatitis A, dengue, hepatitis E, traveler’s diarrhea, malaria, and drug-resistant scrub typhus. (www.afrims.org) 18TH MEDICAL COMMAND The 18th Medical Command provides a comprehensive system of Theater Health Support to the Eighth United States Army and all supported forces throughout the Korean Theater of Operations during both peacetime engage- ments and combat operations. Primary infectious disease concerns for United States Forces Korea include avian and human influenza, hantavirus, Japanese encephalitis, scrub typhus, malaria, pulmonary syndrome, leptospirosis, murine

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 APPENDIX E typhus, ehrlichiosis, anaplasmosis, and spotted fever group rickettsia. Monitor- ing for vector- and rodent-borne diseases continues to be a public health initia- tive. (www.seoul.amedd.army.mil/) WALTER REED ARMY INSTITUTE OF RESEARCH (WRAIR) Located in Washington, D.C., WRAIR is the largest biomedical research facility administered by DOD. The institute is a subordinate unit of the U.S. Army Medical Research and Materiel Command. Satellite laboratories include the U.S. Army Dental Research Detachment (Illinois); U.S. Army Medical Research Detachment (Texas); Medical Research Unit (Germany); Medi- cal Research Unit (Kenya); and the Armed Forces Research Institute of Medi- cal Sciences (Thailand). WRAIR has made significant contributions to the global mapping and modeling of mosquito vectors, malaria drug resistance surveillance, and malarial diagnostics. (wrair-www.army.mil) U.S. ARMY MEDICAL RESEARCH INSTITUTE OF INFECTIOUS DISEASES (USAMRIID) USAMRIID at Fort Detrick, Maryland, serves as the Department of Defense’s lead laboratory for medical aspects of biological defense. The insti- tute develops vaccines, drugs, diagnostics, and information to protect U.S. service members from biological warfare threats and endemic diseases. It is the site of DOD’s only laboratory equipped to allow the study of highly hazardous viruses (for example, Ebola) that require maximum containment at biosafety level 4 (BSL-4). (www.usamriid.army.mil/) U.S. ARMY VETERINARY SERVICE The U.S. Army Veterinary Service provides veterinary medical and surgi- cal care, food and water safety, and biomedical research and development as well as military veterinary expertise in response to natural disasters and other emergencies in the United States and abroad. The Veterinary Service also provides food defense inspection for the army, navy, Marine Corps, and DOD agencies. The Veterinary Service is an essential component of the military medi- cal research team with comprehensive research devoted to developing vaccines against emerging zoonotic diseases and diagnostic devices for rapid detection of infectious agents in the field. Veterinary Corps officers have been involved in evaluating the safety and efficacy of new treatments for combat injuries such as trauma and hemorrhagic shock; studying the effects of directed energy (laser, microwave) exposure; and researching the safety of prophylactic therapeutics that could help save the lives of combatants or civilians potentially exposed to

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 APPENDIX E weaponized or commercial biological and chemical agents. (www.eterinary serice.army.mil/dodsa.html) ARMED FORCES INSTITUTE OF PATHOLOGY (AFIP) Based in Washington, D.C., AFIP is a premier reference and training insti- tute dedicated to world-class consultations on pathologic specimens of human or veterinary origin (domestic and international) and scientific research in the disciplines of environmental pathology and toxicology, infectious diseases, oncology, and forensic sciences. AFIP also has a comprehensive tissue reposi- tory. AFIP resources are to be redirected to the Joint Pathology Center as part of the new Walter Reed National Military Medical Center. (www.afip.org/) CENTER FOR DISASTER AND HUMANITARIAN ASSISTANCE MEDICINE (CDHAM) CDHAM is located in Bethesda, Maryland, and supports the U.S. armed services with a wide range of health-related activities around the world. Key contributions include (1) the Online Preparedness Education Program, which provides health care professionals with current clinical information to enhance preparedness for a chemical, biological, radiation-nuclear, or explosive mass casualty incident; (2) the Online Disaster and Humanitarian Assistance Portal; and (3) a weekly Grand Rounds seminar series. In addition, there are two key overseas CDHAM initiatives in progress to date: (1) the Afghanistan Medical Reachback, which is designed to facilitate the development of a health care system for the Afghan National Security Force and its beneficiaries; and (2) the Avian and Pandemic Influenza Program, which provides support to the U.S. Combatant Commands. (www.cdham.org/) NATIONAL CENTER FOR MEDICAL INTELLIGENCE The National Center for Medical Intelligence at Fort Detrick, Maryland, formerly the Armed Forces Medical Intelligence Center, is charged with moni- toring and analyzing health events that could negatively impact the health of U.S. military and civilian populations. Such events include the emergence of pandemic influenza, novel zoonotic diseases, or incidents of bioterrorism. NAVAL HEALTH RESEARCH CENTER The Naval Health Research Center in San Diego, California, manages operational medicine research, development, testing, and evaluation programs for DOD and the U.S. Navy. The center’s mission is to promote, protect, and maintain the health of navy and Marine Corps personnel and beneficiaries

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 APPENDIX E through biomedical research and to support the medical readiness of the armed services. (nhrc.nay.mil/) NAVY AND MARINE CORPS PUBLIC HEALTH CENTER The Navy and Marine Corps Public Health Center, located in Portsmouth, Virginia, provides leadership and expertise to ensure mission readiness through disease prevention and health promotion in support of the National Military Strategy. The top arthropod-borne diseases of interest include malaria, dengue, Lyme disease, and West Nile virus. (www-nehc.med.nay.mil/) PACIFIC AIR FORCES One of the major U.S. Air Force commands, the Pacific Air Forces has received supplemental funding for pandemic and avian influenza. It has trained military and civilian personnel throughout the Asia-Pacific region to respond rapidly to influenza outbreaks. Training exercises have been carried out with Hawaiian public health emergency officers from the military and their civil- ian counterparts. Other exercises have involved personnel from Malaysia and Cambodia. (www.pacaf.af.mil/) U.S. AIR FORCE SCHOOL OF AEROSPACE MEDICINE (USAFSAM) Formerly the Air Force Institute for Operational Health, USAFSAM conducts routine, global, laboratory-confirmed influenza surveillance. The goals of the program include detecting local respiratory outbreaks, providing isolates to the World Health Organization, and detecting emerging strains. USAFSAM manages a surveillance program that includes global surveil- lance among 128 sites worldwide. Unique sentinel sites include activities at three DOD overseas medical research laboratories. (www.brooks.af.mil/units/ airforceinstituteforoperationalhealth/index.asp) U.S. ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE The U.S. Army Center for Health Promotion and Preventive Medicine pro- vides worldwide scientific expertise and services in clinical and field preventive medicine, environmental and occupational health, health promotion and well- ness, epidemiology and disease surveillance, toxicology, and related laboratory sciences. The center is located at the Aberdeen Proving Ground, Maryland. (usachppm.apgea.army.mil/)

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0 APPENDIX E COMBATANT COMMANDS Each of the unified combatant commands listed below includes a medi- cal unit led by a command surgeon with a small staff. The medical units are charged with protecting the health of U.S. forces, as well as enhancing the military medical capacities of partner nations and supporting basic medical care in partner countries, including responding to disasters. One important element of the force protection program is medical threat assessment, which includes strengthening systems for global surveillance and response to infec- tious diseases, such as those caused by biological pathogens. • USAFRICOM (Stuttgart, Germany) www.africom.mil • USNORTHCOM (Peterson Air Force Base, Colorado) www.northcom.mil/ • USSOUTHCOM (Miami, Florida) www.southcom.mil/appssc/index.php • USEUCOM (Stuttgart, Germany) www.eucom.mil/english/index.asp • USPACOM (Honolulu, Hawaii) www.pacom.mil/ • USCENTCOM (MacDill Air Force Base, Florida, and Qatar) www.centcom.mil/