Military Public Health Research Articles

The Nigerian Military Public Health Response to COVID-19: A 14-Month Appraisal.

The COVID-19 pandemic has caused significant morbidity and mortality since its emergence in December 2019. In Nigeria, the government inaugurated the Presidential Task Force on COVID-19 to coordinate resources while the Nigeria Centre for Disease Control led the public health response. The Nigeria Ministry of Defence Health Implementation Programme (MODHIP), in partnership with the US Army Medical Research Directorate - Africa/Nigeria, responded immediately to the pandemic by establishing a public health emergency operations center to coordinate the military response in support of national efforts. MODHIP has 5 functional units and 6 pillars that coordinate testing, surveillance, case management, risk communication, logistics, research, and infection prevention and control. It developed an incident action plan and each pillar had its own terms of reference to guide specific response activities while preventing duplication of efforts within the military and the Nigeria Centre for Disease Control. In addition, awareness and sensitization sessions were conducted on preventive practices for COVID-19 and infrastructure was provided for hand hygiene and screening at all military facilities. Military laboratories were configured for SARS-CoV-2 testing while selected military health facilities were equipped and designated as COVID-19 treatment centers. Research proposals aimed at better understanding the disease and controlling it were also developed. The traditional combat role of the military was redirected to complement this public health emergency response. In this article, we highlight gaps, opportunities, and lessons to improve military participation in public health emergency response in the future. More funding and multisectoral collaboration with civilian institutions are key to strengthening military public health emergency preparedness and response capabilities.

Civilian-military malaria outbreak response in Thailand: an example of multi-stakeholder engagement for malaria elimination

BackgroundIn April 2017, the Thai Ministry of Public Health (MoPH) was alerted to a potential malaria outbreak among civilians and military personnel in Sisaket Province, a highly forested area bordering Cambodia. The objective of this study was to present findings from the joint civilian-military outbreak response.MethodsA mixed-methods approach was used to assess risk factors among cases reported during the 2017 Sisaket malaria outbreak. Routine malaria surveillance data from January 2013 to March 2018 obtained from public and military medical reporting systems and key informant interviews (KIIs) (n = 72) were used to develop hypotheses about potential factors contributing to the outbreak. Joint civilian-military response activities included entomological surveys, mass screen and treat (MSAT) and vector control campaigns, and scale-up of the “1–3–7” reactive case detection approach among civilians alongside a pilot “1–3–7” study conducted by the Royal Thai Army (RTA).ResultsBetween May–July 2017, the monthly number of MoPH-reported cases surpassed the epidemic threshold. Outbreak cases detected through the MoPH mainly consisted of Thai males (87%), working as rubber tappers (62%) or military/border police (15%), and Plasmodium vivax infections (73%). Compared to cases from the previous year (May–July 2016), outbreak cases were more likely to be rubber tappers (OR = 14.89 [95% CI: 5.79–38.29]; p < 0.001) and infected with P. vivax (OR=2.32 [1.27–4.22]; p = 0.006). Themes from KIIs were congruent with findings from routine surveillance data. Though limited risk factor information was available from military cases, findings from RTA’s “1–3–7” study indicated transmission was likely occurring outside military bases. Data from entomological surveys and MSAT campaigns support this hypothesis, as vectors were mostly exophagic and parasite prevalence from MSAT campaigns was very low (range: 0-0.7% by PCR/microscopy).ConclusionsIn 2017, an outbreak of mainly P. vivax occurred in Sisaket Province, affecting mainly military and rubber tappers. Vector control use was limited to the home/military barracks, indicating that additional interventions were needed during high-risk forest travel periods. Importantly, this outbreak catalyzed joint civilian-military collaborations and integration of the RTA into the national malaria elimination strategy (NMES). The Sisaket outbreak response serves as an example of how civilian and military public health systems can collaborate to advance national malaria elimination goals in Southeast Asia and beyond.

The Process of Developing a Unit-Based Army Resilience Program.

We review military doctrine, military public health data, medical literature, and educational literature with the intent of condensing key precepts into a succinct, pragmatic description of the essential steps for leaders looking to build a resilience program to provide secondary prevention services. Although there continues to be a shortage of high-level evidence in support of specific preventive programs, there are numerous large-scale reviews of prevention and health promotion efforts. When combined with population-specific analyses, several essential concepts emerge as most relevant for smaller-scale prevention programs. The key tenets that program leaders should embrace to optimize program effectiveness include utilization of an instructional design approach, focus on evidence-based practices, and teaching resilience skills in order to decrease risk factors and increase protective factors for improved mental health outcomes.

Longitudinal prediction of sexual harassment and sexual assault by male enlisted Navy personnel

ABSTRACTUsing longitudinal survey data, this study explores patterns and predictors of the sexual harassment and sexual assault of women by male Navy personnel (N = 573) in their second year of service. A modifiversion of the Malamuth Confluence Model, informed by the Navy Sexual Assault Continuum of Harm, was used to predict both types of sexual aggression. Perpetration of sexual assault was significantly associated with perpetration of sexual harassment (Odds ratio = 4.66), and a common set of risk factors could be used to predict both types of sexual aggression. In a longitudinal evaluation of the relative importance of multiple risk factors (hostility toward women, impersonal sex, heavy drinking, delinquency/misconduct, and hypermasculinity), both prior levels of risk and recent increase in risk across multiple factors significantly predicted second-year sexual harassment and sexual assault. Furthermore, current harassment perpetration partially mediated the effects of other risk factors on current sexual assault perpetration. These results support the hypothesis that sexual harassment is both a part of the spectrum of sexual aggression and an important independent risk factor for sexual assault perpetration by male service members. Military public health efforts should continue to target the modifiable risk factors for sexual aggression identified in this study.

Overuse Injuries Among Female Combat Warriors in the Israeli Defense Forces: A Cross-sectional Study.

Integration of females in combat units poses a unique challenge for army commanders around the world. The purpose of this study is to provide a detailed up-to-date situation report regarding overuse injuries among combat female warriors in the IDF (Israeli Defense Forces) in order to enable evidence-based decision-making, prevention policy, and further research of this highly significant military public health issue. A cross-sectional descriptive study was conducted including 2,519 females recruited to combat duties during the year of 2013. The main data source was the IDF's computerized medical consultation records package (CPR). Descriptive statistics was performed and some results were compared with males using data from other reports and studies of the IDF. The overall injury rate was 28.3%. Of all injuries, 86% were in the ankle and calf (41%), the lower back (23%), and the knee (22%) regions. The average lost training days was 11 d for females as compared with 8 d for males. The overall rates of stress fractures and the rates of femur and femoral neck stress fractures were significantly higher among females as compared with males (11.2% vs. 2.5%, p = 0.0032, and 7.8% vs. 1.6% p = 0.00001, respectively). The overuse injury rates among females in the IDF are high and may be considered a significant military public health problem. In order to reduce the numbers of overuse injuries, which is expected to significantly increase after the IDF's policy change regarding to combat duties open for females, we recommend planning and implementation of policies and intervention programs and further research regarding to overuse injuries among female combat warriors with special focus on the calf and ankle, lower back, and knee regions and femoral stress fractures.

Overuse Injuries in the IDF's Combat Training Units: Rates, Types, and Mechanisms of Injury.

Overuse injuries are responsible for most lost training days and attrition from combat training in the Israeli Defense Forces (IDF) as in armies around the world. The purpose of this study is to understand the rates, types, and mechanism of occurrence of overuse injuries in the IDF in order to provide the IDF's commanders a detailed updated situation report in order to enable commanders decision-making, prevention policy, and further research of this highly significant military public health issue. A cross-sectional study including 20,000 soldiers recruited to combat units during the year of 2013 was performed. Most of the data were collected from the IDF's computerized medical consultation records package. Descriptive statistics (percent, mean, standard deviation, and median) were used in order to express results. The study was approved by the IDF's institutional review board. The overall injury rate was 24.5%. The total number of injuries was 6,393 with an average of 1.32 ± 0.22 injuries per injured soldier. The injury rate was 18.4% in the infantry units and 36.1% in non-infantry units. Of all injuries, 87% occurred in the lower back and lower limb regions. The most frequent injury sites were the calf and ankle (34%), the knee region (22%), and the lower back (19%). Of all injuries, 74% occurred during running (45%) or long-distance walking (29%). The average lost training days due to injuries was 9 d per soldier and 6.5 d per injury. The total number of stress fractures was 494-2.5% of all soldiers (four fractures per 100 person years). The calf and ankle region was the most frequent site of stress fractures and accounted for 84% of all stress fractures, the vast majority of them (95%) were fractures of the distal tibia. The average number of lost training days due to stress fractures was 16 ± 6.1 per fracture. As in other armies around the world, overuse injuries in the IDF are a major public health problem and poses a significant challenge to the IDF's commanders and the medical corps policy leaders. Further studies should be performed in order to identify the risk factors for these injuries especially in the lower back and the lower limb regions as part of the effort to try and reduce the rates of these injuries as much as possible. This study emphasizes the need for a continuous surveillance and monitoring system for overuse injuries as a significant and integral component of any intervention plan in the domain of overuse injuries.

Use of Rifapentine and Isoniazid Directly Observed Therapy for the Treatment of Latent Tuberculosis Infection in a Military Clinic.

There are 8.6 million cases of active tuberculosis (TB) worldwide, and an estimated one-third of the world population has latent tuberculosis infection (LTBI). In the United States, up to 80% of active cases may be caused by untreated reactivated latent infection. A case of TB can spread rapidly impacting the readiness of a unit. To prevent the development of TB, it is critical that active duty service members with LTBI complete treatment. The use of isoniazid (INH) and rifapentine (RPT) as a directly observed therapy (DOT) treatment option was recommended by the Centers for Disease Control and Prevention in late 2011. Since then, there have been limited studies on the use of this treatment regimen in a civilian clinic setting and to our knowledge no studies within a military setting. This study compares the completion rate of LTBI treatment in 2 military public health clinics, using a retrospective chart review of 179 subjects who attempted treatment with INH/RPT DOT and 186 with the non-INH/RPT non-DOT regimen. When compared to other LTBI regimens completed or attempted in this period, completion rates were higher in INH/RPT DOT regimens. The INH/RPT DOT treatment regimen allowed enough flexibility with completion between 11 and 16 weeks for active duty service members to increase completion to 94.6%, compared to 73% in the non-INH/RPT regimen. This project demonstrated the feasibility of INH/RPT DOT treatment within the military population resulting in a higher completion rate than the non-INH/RPT non-DOT regimen. The use of the INH/RPT DOT regimen should be considered for use in all military or similar populations.

Mortality Surveillance for Infectious Diseases in the U.S. Department of Defense (1998-2013).

The Mortality Surveillance Division (MSD) of the U.S. Armed Forces Medical Examiner System was established in 1998 to improve surveillance for all military deaths although emphasizing deaths from infectious diseases. Establishment of the MSD was part of the 1997 Department of Defense initiative to improve surveillance and response for emerging infectious diseases. Before 1998, mortality surveillance was limited to compiling information from death certificates, a system that provided limited useful information and lacked the timeliness needed to take meaningful action to address emerging infectious disease threats. The MSD was tasked to quickly identify all infectious disease deaths and the infecting agents. The system developed by the MSD staff identified deaths in near real-time and immediately notified military Public Health authorities of situations that warranted an investigation. Autopsy, medical, and investigative reports were collected. Testing specimens for agent identification was encouraged. The data and information collected were archived in the MSD-developed Medical Mortality Registry (MMR), a database that included all active duty Service Member deaths and contained manner and cause of death with medical, demographic, circumstantial, and diagnostic information. The MMR was the only comprehensive, autopsy-based source for mortality information on active duty military deaths. During 1998-2013, 217 (1.3%) infectious disease deaths were identified among 16,192 noncombat deaths. Of the 217 deaths, 29.5% were classified as respiratory, 18.0% cardiac, 15.2% blood borne, 12.9% nervous system, and 12.4% sepsis. A pathogen was identified for 64.5%. Agents of military interest identified included Neisseria meningitidis, influenza viruses, adenoviruses, and malaria. Neisseria meningitidis was identified in 10 fatal cases; grouping of the agent was done for eight cases. Four were group B, two were C, and two were Y. All eight had been immunized with a quadrivalent meningococcal vaccine. The most commonly detected respiratory agent was influenza virus (nine deaths), three of which were the 2009 pandemic H1N1 influenza virus. Adenoviruses were identified as the infectious agents in a total of nine deaths. Two deaths resulted from Plasmodium falciparum malaria infections acquired in Africa during military deployments. An important but unexplained finding was that Black Service Members made up only16.3% of all military personnel but accounted for 28.6% of all infectious disease deaths. The time lag between death and notification of the MSD at the start of this surveillance program was 24 to 48 hours. The lag at the end of the reported surveillance period was 8 to 24 hours. The MSD surveillance system identified an agent in 140 of 217 (64.5%) uniformed deaths. In a similar program by the Centers for Disease Control and Prevention, in 122 cases with specimens, an agent could be identified in 34 (28%). MMR data and information provided strong support for re-establishing the military recruit adenovirus vaccination program, which ceased in 1999 and was finally re-established in 2011. MMR data and information also assisted in monitoring the military meningococcal vaccine program, helped to describe the virulence of circulating influenza viruses, and identified areas where deadly malaria infections were not being prevented.

Prevecencija anenovirusnog konjunktivitisa - revijalni rad

Epidemic viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. The exact incidence of adenoviral conjunctivitis is still poorly known, but there are two well-defined adenoviral keratoconjunctivitis clinical syndromes: epidemic keratoconjunctivitis (EKC) and pharyngoconjunctival fever (PCF). Epidemic keratoconjunctivitis is also the most severe form and presents with watery discharge, hyperemia, chemosis and ipsilateral lymphadenopathy. Diagnosis is mainly clinical, but its etiology can be confirmed using cell cultures, antigen detection, polymerase chain reaction or immune-chromatography. Multiple treatments have been tried for this disease, but none of them seem to be completely effective. Viruses are resistant to desiccation and certain common surface disinfectants. Prevention is the most reliable and recommended strategy to control this epidemic infection. Global epidemic surveillance system definitely needs to be established to monitor and analyze the epidemic conjunctivitis in the future. There is clearly a need for the national and the military public health institutions to work together on guidelines to handle future challenges.

Identification of Fall Prevention Strategies for the Military: A Review of the Literature.

In the U.S. Army, falls have historically been among the top five causes of hospitalization and a leading cause of nonbattle injuries in military operations overseas. For safety and public health professionals, commanders, and supervisors looking to address this problem, a literature review was conducted to identify and summarize existing fall prevention strategies applicable to a working-age population. A total of nine literature databases were searched for articles published from 1970 to 2011. Article titles and abstracts were screened to select original research with an injury or noninjury outcome. Intervention studies were reviewed in detail and quality scored by 3 public health scientists. The search identified over 2,200 articles. Of these, 525 met inclusion criteria and were reviewed in more detail, resulting in identification of 9 interventions. Nearly all of the identified interventions had been implemented in occupational environments. Study quality was rated and scores ranged from 4.5 to 8.0 (maximum 10 points). Few intervention studies were identified. Multifaceted programs showed the greatest promise for translation to military environments. Additional evaluation research is greatly needed to further efforts to address this leading military public health problem.

Maximizing the Capabilities of the DoD Serum Repository to Meet Current and Future Needs: Report of the Needs Panel.

In June 2013, the Armed Forces Health Surveillance Center, Silver Spring, MD, hosted two panels of civilian and military public health and laboratory professionals to address medical surveillance and primary care needs of the Department of Defense (DoD) that might be met by a biorepository that contained specimens that would be suitable for testing using emerging laboratory technologies. The first panel, the "needs panel," was asked to identify capabilities that were needed by the Military Medicine community to better perform their jobs but were either not presently available or not supported by specimens archived in the current DoD Serum Repository (DoDSR). A second panel, the "technology panel," considered whether current technology existed to support the needs identified by the first panel. This report summarizes the findings of the needs panel, to include recommendations regarding both current capabilities using the DoDSR and possible future capabilities.

Enhancing the Department of Defense's Capability to Identify Environmental Exposures Into the 21st Century.

Military service members come in contact with a wide range of hazardous substances especially during deployment. The identification of service member's with potential exposures to infectious diseases and environmental toxic substances has been a problem for the U.S. military almost since the formation of the services and continues to be an issue today. In June and July of 2013, the Armed Forces Health Surveillance Center sponsored two meetings to address the need by the Department of Defense to perform retrospective exposure analysis that would support military force health protection efforts. The first meeting included medical professionals who were familiar with health problems that followed potential environmental or infectious disease exposures but that the military health system was unprepared to address. The second group was composed of technical experts who were asked to suggest potential material and nonmaterial solutions to address the needs of the military public health community. This supplement to Military Medicine includes the outcome of these two meetings, descriptions of some of the Department of Defense biorepositories including the large serum repository housed at Armed Forces Health Surveillance Center and discussion of additional topics related to the establishment and use of biorepositories that would support public health practice in the 21st century.

Ten years experience of syndromic surveillance for civil and military public health, France, 2004-2014

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The state of antimicrobial resistance surveillance in the military health system: a review of improvements made in the last 10 years and remaining surveillance gaps.

During a military public health laboratory symposium held in 1999, concerns were raised that the military health system lacked a standardized antimicrobial resistance (AMR) surveillance system that allowed comparison of data across sites, investigation of trends, and understanding of resistance mechanisms. The purpose of this review was to assess if current AMR activities in the military health system have addressed the aforementioned gaps. It was determined that much progress has already been made within the Department of Defense with respect to monitoring and understanding AMR through initiatives such as the Antimicrobial Resistance Monitoring and Research Program-a strong Department of Defense-wide surveillance program. These surveillance efforts can be made more robust through harmonization of testing and reporting structures across military treatment facilities, and by encouraging military treatment facility participation.

Global Health Diplomacy Training for Military Medical Researchers

Given the unprecedented growth of global health initiatives in the past decade, informal diplomacy between technical partners plays an increasingly important role in shaping opportunities and outcomes. This article describes a course developed and executed specifically to equip U.S. military health professionals with core skills in practical diplomacy critical to help them successfully plan and implement public health surveillance, research, and capacity building programs with partner nation governments and organizations. We identified core competencies in practical diplomacy for laboratory and public health researchers, catalogued and evaluated existing training programs, and then developed a pilot course in global health diplomacy for military medical researchers. The pilot course was held in June 2012, and focused on analyzing contemporary issues related to global health diplomacy through the framework of actors, drivers, and policies that affect public health research and capacity-building, beginning at the level of global health governance and cooperation and moving progressively to regional (supranational), national, and institutional perspective. This course represents an approach geared toward meeting the needs specific to U.S. military public health personnel and researchers working in international settings.

Cost-Minimization Analysis of the U.S. Army Accession Screening and Immunization Program

Significant Army resources are utilized to identify nonimmune recruits for targeted vaccinations against hepatitis A, hepatitis B, measles, rubella, and varicella. Therefore, a cost-minimization analysis between the Accession Screening and Immunization Program (ASIP) and the previously utilized universal vaccination program will assist military public health policy makers in decisions that enhance force health protection. Serological immunity data on 41,146 Fort Leonard Wood, Missouri, Army basic training recruits aged 17 to 42 years from October 1, 2007 to September 30, 2009 were utilized. Vaccination, serology, and other direct and indirect costs were determined using the Federal Supply Schedule and local base immunization data. TreeAge Pro 2009 version 1.0.2 was used for the analysis. The cumulative annual cost for the universal vaccination program totaled $1,504,587, whereas the cumulative costs for the ASIP totaled $1,094,025, for a cost-savings of $410,561 annually at this basic training site. Over $400,000 of annual savings was realized from the ASIP compared to universal vaccination at Fort Leonard Wood, thus confirming the cost-savings theorized by the implementation of the ASIP.

Mortality among active-duty male French Armed Forces, 2006-10

In the Armed Forces, knowledge about the causes of deaths is required in order to develop prevention strategies. This study presents the main characteristics of causes of deaths among male active-duty personnel in the French Armed Forces during the 2006-10 period and compares them with the general French male population. The data are provided by military public health surveillance. Comparisons of the specific mortality rates (MR) were performed using a Poisson regression. Standardized mortality ratios (SMRs) were calculated to compare mortality with the general French male population. There were 1455 deaths among male active-duty personnel during the study period [MR: 100.9 per 100,000 person-years (PY); 95% confidence interval 95.7-106.1]. The 17-24 age group was characterized by violent deaths: transport accident (MR: 45.9 per 100,000 PY) and suicide (18.8 per 100 000 PY). Overall SMRs show significantly lower MR compared with the French national MR with the exception of SMR for transport accident and suicide in the 17-24 age group. There is a significantly lower deficit of mortality compared with the French male general population, reflecting a strong healthy worker effect. However, health promotion programmes should continue to put emphasis on transport accident especially among the 17-24 age group.

Military Public Health

Public health is a key contributor to military effectiveness. Successful operations depend on the underlying fitness of personnel and the maintenance of health through effective prevention of, or protection from, harmful environmental exposures and behaviours. Public health practice in the military covers the main domains of health promotion and improvement, health protection and the provision of quality health services. The information resources underpinning this work differ from those available to civilian practitioners, but it is possible to derive population level information from the joint personnel administration system, aggregated pseudo-anonymised military primary care data, deployed hospital, aeromedical evacuation and mental health databases, patient tracking systems and a number of surveillance systems covering, for example, climatic injury and communicable disease. Difficulty in identifying military patients as a sub-set limits the usefulness of many of the national and regional health information sources routinely used in civilian practice. The medical examination of individuals during the selection process screens out declared or detectable major physical and psychological problems and creates a healthy worker effect. However, military personnel are drawn from the civilian population and reflect the health behaviours of the groups from which they are recruited. Poor levels of dental health on entry and higher than average levels of cigarette smoking are present in sections of the military population. Harmful drinking behaviour is common. The prevalence of risk factors is not evenly distributed. The population is heavily skewed towards the under-30 age group, with males the predominant proportion. Nevertheless, sub-groups within the military population, such as females, personnel recruited from overseas and young personnel with low levels of educational attainment, have particular needs that require targeted approaches. An overall defence health strategy directs and supports the work of the chain of command in developing healthy polices and providing a healthpromoting environment as far as is possible. Paradoxes exist in military health promotion. Unlike their civilian counterparts, many among the Armed Forces population undertake high levels of physical activity. The development and maintenance of good physical fitness is essential to prepare all deploying personnel for the demands of operations. But the necessarily robust physical training results in sports injuries and overuse injuries that may require prolonged recovery periods. Surveillance of injuries and modification of training schedules and activities is an ongoing process moving towards an irreducible minimum level of sports and training injury. Individual behaviour is another area with conflicting drivers. The demands of operations may inherently steer the selective recruitment of individuals with tendencies towards risk-taking behaviour, and those who work well in groups, conforming to peer group behaviours. Clearly these qualities need control and direction rather than to be stifled, and the fine line managed by commanders is supported by focussed and pertinent health promotion efforts. …

Efficacy of Aerial Spray Applications Using Fuselage Booms on Air Force C-130H Aircraft Against Mosquitoes and Biting Midges1

The effectiveness of a novel fuselage boom configuration was tested with flat-fan nozzles on U.S. Air Force C-130H aircraft to create ultra-low volume sprays to control mosquitoes (Culicidae) and biting midges (Ceratopogonidae). The mortality of mosquitoes and biting midges in bioassay cages and natural populations, using the organophosphate adulticide, naled, was measured. Mosquitoes in bioassay cages had 100% mortality at 639 m downwind in all single-pass spray trials, and most trials had >90% mortality up to 1491 m downwind. Mosquito mortality was negatively correlated with distance from the spray release point (r2 = 0.38, P < 0.001). The volume median diam of droplets collected was 44 tm at 213 m and decreased to 11 microm at 2130 m downwind of the release point. Droplet density decreased from an average of 18.4 drops/cm2 at 213 m to 2 drops/cm2 at 2130 m. Droplet densities of 10-18 droplets/cm2 were recorded at sampling stations with high mosquito mortality rates (>90%). In wide-area operational applications, numbers of mosquitoes from natural populations 1 wk postspray were 83% (range 55%-95%), lower than prespray numbers (P < 0.05). Biting midge numbers were reduced by 86% (range 53%-97%) on average (P = 0.051) after 7 days. The results of these field trials indicate that the fuselage boom configuration on C-130H aircraft are an effective method to conduct large-scale aerial sprays during military operations and public health emergencies.

The Pandemic Influenza Policy Model: A Planning Tool for Military Public Health Officials

The Pandemic Influenza Policy Model (PIPM) is a collaborative computer modeling effort between the U.S. Department of Defense (DoD) and the Johns Hopkins University Applied Physics Laboratory. Many helpful computer simulations exist for examining the propagation of pandemic influenza in civilian populations. We believe the mission-oriented nature and structured social composition of military installations may result in pandemic influenza intervention strategies that differ from those recommended for civilian populations. Intervention strategies may differ between military bases because of differences in mission, location, or composition of the population at risk. The PIPM is a web-accessible, user-configurable, installation-specific disease model allowing military planners to evaluate various intervention strategies. Innovations in the PIPM include expanding on the mathematics of prior stochastic models, using military-specific social network epidemiology, utilization of DoD personnel databases to more accurately characterize the population at risk, and the incorporation of possible interventions, e.g., pneumococcal vaccine, not examined in previous models.