Volume 4, Number 4—December 1998
Can the Military Contribute to Global Surveillance and Control of Infectious Diseases?
To the Editor: Numerous networks—both formal (e.g., Ministries of Health and WHO Collaborating Centers and collaborating laboratories) and informal (e.g., nongovernmental and humanitarian organizations, the media, and electronic discussion groups)—contribute to WHO's network of networks for the global surveillance of infectious diseases (1).
A potential source of additional information on infectious diseases is the network of military health facilities and laboratories throughout the world. In addition to health facilities serving populations at high risk for infectious diseases, the military also has laboratories, often among the better-equipped, in developing countries. To evaluate the feasibility and potential usefulness of including military laboratories in the WHO global surveillance network, we conducted three surveys.
The first survey identified military laboratories willing to participate in global surveillance activities and obtained information about their infectious diseases reporting systems. Of the 107 countries surveyed, 76 replied. Among them, 53 (70%) reported having a central military laboratory that coordinates laboratory activities throughout the military, and 62 (82%) reported that military clinical facilities had a reporting system for infectious diseases.
The second survey quantified laboratory capabilities in the 53 laboratories identified in the first survey and obtained details about the 62 reporting systems. Among the 39 (74%) laboratories that replied, all can perform at least one of the following activities: isolating and identifying bacterial, viral, or parasitic agents. Twenty-nine (55%) have the capacity for specialized immunologic or molecular study. In addition, one of these laboratories has a biosafety level 4 facility, six have a biosafety level 3 facility, and 10 have a biosafety level 2 facility. Twenty-seven (51%) of the laboratories perform compulsory screening of new recruits for HIV, 17 (33%) for hepatitis B, 7 (13%) for hepatitis C, 39 (74%) for tuberculosis, 35 (67%) for syphilis, 18 (34%) for intestinal parasites, 13 (25%) for schistosomiasis, 12 (23%) for malaria, and 2 (4%) for Chagas disease.
Among the 54 reporting systems for which further information was obtained, clinical diagnoses (in some countries laboratory confirmed) are reported through the hierarchical chain, normally by mail or facsimile, but in two countries by electronic links. Almost all military reporting systems are parallel to civilian systems. Thirty-four (63%) of 54 systems feed into the civilian system, with a built-in mechanism to avoid duplicate reporting; 16 (30%) systems feeding into the civilian system have no such mechanism in place; and four have no link with the civilian system.
The third survey addressed vaccination policies. Among 52 countries that replied, 47 (90%) have a compulsory military vaccination schedule: 45 (87%) for tetanus, 30 (58%) for diphtheria, 23 (44%) for typhoid, 16 (31%) for bacillus Calmette-Guérin and polio, 12 (23%) for meningococcal meningitis, and 10 (19%) for measles, mumps, and rubella.
These surveys show that military populations are protected against many infectious diseases and that a wealth of information is obtained by military laboratories and health-care facilities on populations at high risk for infectious diseases. While most of the information collected from the health-care facilities is reported through civilian systems as well, incorporating the military network of laboratories into the WHO global surveillance network could ensure broader coverage.
- Heymann DL, Rodier GG. Global surveillance of Communicable Diseases. Emerg Infect Dis. 1998;4:362–5.