On June 9, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Compared with the volume of data on coronavirus disease 2019 (COVID-19) outbreaks among older adults, relatively few data are available concerning COVID-19 in younger, healthy persons in the United States (1,2). In late March 2020, the aircraft carrier USS Theodore Roosevelt arrived at port in Guam after numerous U.S. service members onboard developed COVID-19. In April, the U.S. Navy and CDC investigated this outbreak, and the demographic, epidemiologic, and laboratory findings among a convenience sample of 382 service members serving aboard the aircraft carrier are reported in this study. The outbreak was characterized by widespread transmission with relatively mild symptoms and asymptomatic infection among this sample of mostly young, healthy adults with close, congregate exposures. Service members who reported taking preventive measures had a lower infection rate than did those who did not report taking these measures (e.g., wearing a face covering, 55.8% versus 80.8%; avoiding common areas, 53.8% versus 67.5%; and observing social distancing, 54.7% versus 70.0%, respectively). The presence of neutralizing antibodies, which represent antibodies that inhibit SARS-CoV-2, among the majority (59.2%) of those with antibody responses is a promising indicator of at least short-term immunity. This report improves the understanding of COVID-19 in the U.S. military and among young adults in congregate settings and reinforces the importance of preventive measures to lower risk for infection in similar environments. In mid-January, the USS Theodore Roosevelt was deployed to the western Pacific. An outbreak of COVID-19 occurred during deployment, which resulted in the aircraft carrier stopping in Guam at the end of March. During this time, approximately 1,000 service members were determined to be infected with SARS-CoV-2, the virus that causes COVID-19. The United States Navy and CDC investigated this ongoing outbreak during April 20-24; 382 service members voluntarily completed questionnaires and provided serum specimens (a convenience sample comprising 27% of 1,417 service members staying at the base on Guam or on the ship). The 1,417 included persons who were previously infected, currently infected, or never infected. Among these 382 service members,

The 2008 increase in Navy-Marine Corps rates may be due to the implementation of web-based reporting. Demographic differences were consistent with published reports. The civilian-military disparity may reflect higher percentages of military at-risk women screened.

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Sexually transmitted infections (STIs) have posed a threat to military service members throughout history, but limited evidence describes current sexually transmitted infection burden for personnel in-theater and stationed abroad. This study assessed chlamydia and gonorrhea rates by unit of country assignment and evaluated the demographic profile of affected personnel during deployment. Chlamydia and gonorrhea cases among active duty personnel were identified from laboratory results and ambulatory encounter records in the Military Health System from fiscal years October 2006 through September 2015; these were linked to personnel and deployment records to ascertain demographic characteristics, unit of country assignment, and if the case was captured during a period of deployment. Case rates were higher for chlamydia (1,321.7 per 100,000) than gonorrhea (222.7 per 100,000). Approximately 2% of both chlamydia and gonorrhea cases were identified during deployment, with significant differences by service, sex, and age. Elevated rates were identified in several countries of unit assignment outside the USA, warranting further assessment to better understand implications of screening programs or increased morbidity. Pertinent limitations for this study potentially underestimate STI cases during deployment, due to incomplete capture of records from shipboard and in-theater facilities.

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U.S. Sailors and Marines routinely deploy to regions where malaria is endemic, such as Africa and Asia. This report describes the trends, demographic characteristics, and exposure type and location for active duty Navy and Marine Corps malaria cases from January 2005 to December 2013. Electronic clinical records for laboratory results and hospitalizations, as well as reported medical events, for malaria were used to identify cases. There were 112 malaria cases identified among Navy and Marine Corps service members during the study time frame. Most cases were associated with travel to Africa (58.9%) and were duty related (60.7%); however, one-fourth of cases were associated with personal travel. The majority of cases exposed while on personal travel were foreign born (74.2%). This comprehensive assessment of trends and burden of malaria among Sailors and Marines is essential to ensure mission readiness and the management and evaluation of malaria control programs. Further analysis may be warranted to explore the relationship between personal travel and foreign-born status in the Department of the Navy to determine potential for additional intervention and education.

sexual activity when calculating Chlamydia incidence and screening rates, particularly for adolescents. Using data from a provincial adolescent health survey we assessed the impact of adjusting for sexual activity on population-based Chlamydia incidence and screening rates among adolescents in British Columbia (BC), Canada. Methods We estimated the proportion of adolescent males (15-18 years) and females (14-18 years) who had ever had sexual intercourse (i.e., sexually active) using data from a cluster-stratified survey of public school students (Grades 7-12) completed by ~30,000 BC students in 2003 and 2008. Using provincial Chlamydia surveillance and testing data we compared adolescent Chlamydia screening and incidence rates in BC by age and gender, using total and sexually active populations as denominators. Results During these time periods, an estimated 32% and 33% of males 15-18 years and 28% and 31% of females 14-18 years were sexually active in 2003 and 2008 respectively. Regardless of denominator used, screening and incidence rates increased with age, and were higher among females compared to males. Sexually active incidence and screening rates were consistently higher with a more pronounced impact at younger ages. For example, in 2008 screening rates among 14 year old females were 26.2% vs 2.5% in sexually active and total populations respectively, while the corresponding rates among 18 year old females were 60.2% vs 28.9% (2.1 times higher). Conclusions Using data representing the entire population of BC adolescents we demonstrated that without adjustment for sexual behaviour, adolescent Chlamydia incidence and screening rates are substantially under-estimated, particularly at younger ages. Adjusting for sexual behaviour using population survey data is essential for accurately monitoring the population impact of prevention and screening programmes among adolescents. Background The burden of sexually transmitted infections (STI) within the US military is primarily assessed through review of case reports for notifiable conditions (e.g., Chlamydia, gonorrhoea, and syphilis). The degree to which under-reporting affects burden approximations is unknown. This study was conducted to assess the burden of Chlamydia and gonorrhoea infections and compare case capture across multiple military medical data systems. Methods Incident infections among Army active duty soldiers from January 2007-December 2011 were identified using three data sources: Health Level 7 laboratory records (HL7), Military Health System Data Repository (MDR) medical records, and case reports from the Disease Reporting System internet (DRSi) and its predecessor, the Reportable Medical Event System (RMES). A thirty day rule was used to define incident cases; i.e., successive records logged within 30 days were excluded. Results 53,228 incident Chlamydia infections and 11,065 incident gonorrhoea infections were identified over five years; calendar year 2011 incidence rates were 22.0 and 4.2 infections per 1000 personyears, respectively. Chlamydi...