VOLUME 4
Pull out your smartphone: QR codes
Quick Response codes can communicate a lot of information a small amount of space…2 yourself in every week, limiting television time and exercising for about ISSUE 2 an hour each day. The best diet is not a diet l
but a way of life that lets you "eat to live," as you enjoy healthy food, exercise, and optimal health.
June 2012
Off on safari
Health and safety issues that safari-goers are likely to encounter are mostly predictable and largely avoidable. The best insurance for carefree trips is…3
Shipmate, can you hear me now?
Bugbytes
Tinnitus, or ringing in the ears, and hearing loss are the number one and two service-connected disabilities on record for Veterans. What are we doing about it?…5
A publication of Navy Environmental and Preventive Medicine Unit TWO
W
elcome to this edition of Bug Bytes. Summer is a great opportunity to spend time outdoors with friends and family. However, for our deployed Sailors and Marines the warmer weather and port calls to exotic locations pose a new set of challenges. Getting the right information can help mitigate the risks to the health of our shipmates.
Helping You Promote Public Health This latest installment addresses the topics of hearing conservation, HIV, travel medicine, food safety, natural pesticides, and mean ants that can ruin your picnic. As always, NEPMU-2 is ready to provide subject matter experts for your force health protection, anytime and anywhere.
A.F. Vaughn CDR MC USN OIC NEPMU-2
LTJG Nii Adjei Oninku, assigned to NEPMU-2, interacts with a Ghanaian child at Supumu Dunkwa Health Center in Sekondi, Ghana. He was there as part of the NEPMU-2 site assessment team in support of the African Partnership program.
Forbidden Fruit: Can Eating Healthy Cause Foodborne Illness? LTJG Lucian Ionescu
Melons are considered potentially hazardous foods. This means that they are capable of growing microbes that may contribute to foodborne illness. Of recent concern were Salmonella outbreaks occurring due to contamination of cantaloupes with pathogens such as Salmonella Litchfield (51 people ill in 2008), Salmonella Panama (20 people ill in 2011), and Listeria (146 people ill, 30 deaths, and 1 miscarriage in 2011). Being a potentially hazardous food is one criterion of these outbreaks; however, melon contamination is facilitated largely by surface texture.
Pathogens can also infiltrate through melon stem scars and rind blemishes. “Nothing astonishes men so much as common sense
Melons may possess smooth or netted rind surfaces. Typically, more foodborne illness outbreaks are associated with netted rind melons. Netted rind melons provide the necessary environment for pathogens to adhere and survive on. The melon texture makes it more difficult to eliminate pathogens.
Ground spots have been shown to possess considerably larger microbial populations than on a melon without a ground spot.
and plain dealing.” Ralph Waldo Emerson Frequent soil contact during growth and development is also an enabling factor for contamination. Farmers mitigate this by placing melons on cups, small plastic pads, or covered beds to reduce soil contact and thereby minimizing ground spots. Hand turning can also be performed to reduce the development of ground spots.
Forbidden Fruit: Safety Tips, continued on page 3.
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Did you know? - At least 40 million Americans suffer from chronic, long-term sleep disorders each year.
Doctor’s Orders: Force Health Protection Plan Mark Humphrey, MD, MPH
- Doctors have described more than 70 sleep disorders
Q: My unit is deploying to AFRICOM/EUCOM. A Naval Message sent 11 Apr 2012 from NAVEUCOM/NAVAFCOM requires that a Force Health Protection (FHP) plan be sent prior to deployment to the COMNAVSIXTHFLT Surgeons Office prior to deployment. What information is required in the FHP?
- PT early, not late- it fatigues your body, but wakes up your mind.
In general terms, a force protection plan should include an assessment of the physical, chemical and infectious disease hazards present in the country of the proposed mission, and how those risks will be eliminated, minimized or otherwise addressed. The form containing the specific requirements for the mandatory FHP is: www.naveur-navaf.navy.mil/surgeon.html.
- No caffeine after dinner.
Q: What is a HIV positive service member's eligibility for a CENTCOM deployment?
- Good ventilation in your room is helpful to getting good sleep. - If you snore, maybe you should have that checked out- sleep apnea is common. - Don’t have a fixed bedtime.
Next Issue
- Do have a fixed get up time.
31 March 2010
- Do limit your activities in bed.
After reviewing SECNAV 5300.30D and MOD 11 closely, MOD 11 (section 15.G.1) states that HIV positive status is an automatic disqualifier for deployment. "15.G.1. HIV TESTING. HIV LAB TESTING, WITH DOCUMENTED NEGATIVE RESULT, WILL BE WITHIN 120 DAYS PRIOR TO DEPLOYMENT. IAW REF Y, HIV INFECTION IS A NON-DEPLOYABLE CONDITION." Moreover, SECNAV 5300.30D leaves a little wiggle room when it discusses the topic of assignments in section 9.c and 9.d, but I think MOD 11 closes the door on this option. MOD 11 is available in its unclassified version on our COCOM Threat Assessment page.
E-mail: NEPMU2NorforlkThreatAssessment@med.navy.mil Country Threat Assessment resources: http://www.med.navy.mil/sites/nepmu2/Pages/threat_assessment.aspx
- Don’t stay in bed if fully awake. - Don’t nap during the day. - If you have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician.
Pull Out Your Smartphone: QR Codes Scan these QR codes. Need a scanner? Visit ez.com/getreader.
Adapted from the Sleep Hygiene talk by Dr. Michael J. Strunc MD. NMCP- Division Head, Sleep Medicine NEPMU-2 News Article http://1.usa.gov/LdIRYU
NEPMU-2 Contact Info Email us your feedback
Summer Reading List LTJG R. Wayne Quinn Is your ship set for deployment?
Get your norovirus surveillance kit. NEPMU-2 has developed an easy to use kit that can be stored and shipped at room temperature. Samples needed for pilot study. Email your request to: NEPMU2NorfolkMicroBiology@med.navy.mil
Need training? Take a class. Click here for full class schedule
For further info contact Jeff Bolden:
NEPMU2NorfolkEducationandTraini ng@med.navy.mil
Newsletter Editors LT Chris Coetzer LT Matthew Montgomery
Level IV: Virus Hunters of the CDC Joseph B. McCormick, et al. Real life account of people who have worked with the CDC, having been all over the world looking for the infectious agents associated with outbreaks of exotic diseases. No Hollywood hype; a true adventure.
Biohazard Ken Alibek Discover the secrets behind the discovery of an invisible, untraceable new class of biological agents. A chilling work of realworld intrigue shares the never-before-told story of Russia's darkest, deadliest, and most closely guarded Cold War secret.
Quickbytes LT Robert Hontz, PhD, Microbiologist was selected by a panel of senior MSC officers to attended the Army Medical Department sponsored Junior Officers’ (JO) Week. During the four days of the event, the JOs were exposed to powerful and passionate briefs by many senior level officers. NEPMU-2 is recipient of its 4th consecutive and annual Navy Surgeon General Blue H GOLD award for health promotion (HP) and wellness command excellence. Thank you and BZ to everyone's efforts. Visit our Health Promotion webpage to learn how we can assist your command with earning the Blue H award. LCDR Eric Deussing, Preventive Medicine Officer, deploys in support of Operation Pacific Partnership. The goal of this mission is to bring humanitarian aid and assistance operations projecting US soft power in the Pacific Rim. NEPMU-2 Microbiology laboratory, and the co-located, Comprehensive Industrial Hygiene Laboratory (CIHL) Detachment Norfolk, were awarded COLA accreditation, formerly the Committee on Office Laboratory Accreditation, a nationally recognized certification for compliance with Clinical Laboratory Improvement Amendments (CLIA) and the DOD Clinical Laboratory Improvement Program (CLIP) requirements. NEPMU-2 Blog: nempu2.blogspot.com NEPMU-2 Photos on Flickr: flickr.com/photos/nepmu2
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
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Off On Safari
CAPT Mark Olsen, MD, MPH, MBA, CIME
With summer travel planning well underway for many families, you and your more adventurous kin may be considering taking the trip of a lifetime, an African safari. Arguably the ultimate in adventure travel, an African safari is also an easily doable family vacation, and with a little research, not much more difficult to arrange than a week at a Caribbean resort. Health and safety issues that safari-goers are likely to encounter are mostly predictable and largely avoidable. The best insurance for carefree trips is a pre-travel consultation with a travel health provider. Many Navy MTFs have occupational health or infectious disease clinics which provide this service to eligible beneficiaries. Advice must be itinerary- and game park-specific. Immunizations and preventive medications necessary for one park may not be necessary for others. Parks are thousands of miles apart and located in countries with different health standards, dissimilar climates, and at various altitudes. And health information for the country may not be sufficiently specific for a park within that country. Malaria, for example, may be a minor problem in South Africa and Namibia, but may be an issue at some parks in these countries, sometimes only seasonally. Generally, proper preparations, common sense precautions, the short duration of most trips (usually ≤2 weeks), experienced
The ultimate in adventure travel, an African safari comes with health and safety issues that every safari-goer must consider. Photo: LT Chris Coetzer. guides, leaving the driving to others, and spending little time in the large cities make safaris relatively low-risk undertakings for travelers of all ages. Travelers’ diarrhea is the most common ailment, and most cases are mild. Sensible food and water selections may reduce the incidence. Illness may occur even on deluxe trips. Carrying medication for self-treatment is generally recommended. Rabies exists in most parts of Africa. While most cases result from bites and licks from dogs, all mammals can be rabid. All wounds from animals must be considered rabid until proven otherwise. In addition to rabies, bats can also transmit other diseases, such as viral hemorrhagic fevers, to
humans. Travelers should be encouraged to avoid entering caves where bats are known to be present. Measures to prevent malaria help reduce the risk of two other, albeit rare, diseases among travelers: African tickborne fever and trypanosomiasis. Tickborne fever occurs primarily in rural Southern Africa. Prevention includes tucking pant legs into socks and daily “tick checks.” Sleeping sickness (trypanosomiasis ) is transmitted by day-biting tsetse flies. Wearing light-colored clothing seems to deter the flies. Insect repellents are only partially effective. Symptoms include fever, eschar at the site of the bite, headache, and signs of central nervous system involvement.
Reference for Travel Medicine: http://wwwnc.cdc.gov/travel/yellowbook/2012 From front page, Forbidden Fruit: Safety Tips
Dude, Where’s My Boat?
Remember that cantaloupes/melons are grown close to the soil, where bacterial contamination can occur. Keep in mind:
The weather is getting warmer, so it is time to break out the boats, jet skis, sailboards and other such watercraft. Who doesn’t enjoy a day spent out on the water: the sun, the swimming, and maybe consuming alcohol? But hold that throttle! If you are the one behind the helm and you have been enjoying your adult beverage of choice, you could lose your ability to call yourself Captain. That’s right, boating and drinking is illegal, and you can suffer some of the same consequences for doing so as if you were behind the wheel of a car.
• Before purchasing, inspect the melons. Do • • • • •
not purchase those with visible damage and blemishes. Hold off on washing until you are ready to serve. Chances of mold growth will decrease. Wash with cool water before slicing. Remove soil from the rind with a clean brush. Wash hands, and use a clean sanitary cutting board and knife to cut melons. After the melon is sliced, refrigerate at 41 degrees or below. If it’s a pre-cut melon, store it in the refrigerator at 41 degrees or below. Remember to look for the “use by” date on the package.
LTJG R. Wayne Quinn
A Coast Guard study estimates that boat operators with a blood alcohol concentration above 0.1% are 10 times more likely to be killed in a boating accident than boat operators with zero blood alcohol concentration (the legal limit is 0.08%). Boating Under the Influence (BUI) is serious business. In Virginia, should you be cited for BUI, you could face fines of up to $2,500, up to a year in jail, the loss of your privileges to operate a water vessel for 12 months and you will have to attend an Alcohol Safety Action Program. In some states, you may even lose your driver’s license as well. In federal waters, the US Coast Guard enforces such laws; if it’s state waters, they will simply turn you over to the dry land police for action. So, how do we avoid all this? Simple, if you are operating a boat, don’t drink. If you do drink, make sure that there is another qualified operator onboard and turn the boat over to them. Similarly, passengers that have been drinking have an increased risk of injury or death. Falling overboard is one hazard. While you may be an excellent swimmer, the impairment from the alcohol may very well take your swimming ability from that of an Olympic great to that of a rock. For more information on boating safety please visit www.uscgboating.org, and for more on BUI visit www.operationdrywater.org
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
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A Natural Pesticide (That Actually Works)
GET YOUR ANSWERS HERE EMAIL NEPMU-2 click on the links below Fleet/FMF -Entomology -Environmental Health -Industrial Health -Health Promotion
N Neexxtt IIssssuuee
Training
3311Assessment M Maarrcchh 22001100 Threat EPM Senior Enlisted Leader
RESOURCE LINKS
There are plenty of urban legends and old wive’s tales out there about natural pesticides: basil, cedar, catnip, etc. While these are typically nothing more than ineffective means to avoid the supposed harm of using man-made pesticides, there are some naturally occurring compounds out there with proven insect killing abilities. Boric acid acts as a stomach poison when ingested by insects. At the same time it also kills pests by abrading their exoskeleton when they come in contact with it.
Where to Order Hazardous Noise Signs
Boric acid occurs naturally in the environment and is of very low toxicity to humans. In fact, the EPA has determined because boric acid is of such low toxicity it is exempted from maximum residue limits on raw fruits and vegetables.
It may be beneficial to have your supply folks find the signs via Fedlog or GSA advantage search.
To protect against ants, cockroaches, silverfish, and termites you can sprinkle boric acid around your house several times a year.
As per the instruction guidance, the equivalent can be placed, so long as it meets the minimum requirements laid out in chapter B4 of 5100.19E.
For any hearing conservation information questions/concerns/issues please contact us at: NEPMU-2 INDUSTRIAL HYGIENE
Boric Acid, and derivative compounds such as sodium borate, sodium tetraborate, or disodium tetraborate are produced from borax. These compounds are usually white powders consisting of soft colorless crystals that dissolve easily in water and used in detergents. Borax was first discovered in dry lake beds in Tibet and was imported via the Silk Road to Arabia.
Disodium Tetraborate Molecular formula: Na2B4O7
NMCPHC (NEHC) Navy and Marine Corps Public Health Center Instructions Navy Medicine Publications PrevMed Topic Page NMCPHC (NEHC) supported page of Preventive Medicine topics and resources USAPHC U.S. Army Public Health Command
RIFA Madness: When Red Ants Attack LT Matthew Montgomery Red Imported Fire Ants (RIFA) have been spreading like fire throughout the southern half of the U.S. since their accidental introduction from Brazil in the 1930s. Along the way they’ve outcompeted native ant species, killed countless ground nesting birds and reptiles, and ruined innumerable picnics. It’s not just their ability to kill the competition that has helped them spread; RIFAs are adept at forming relationships with native aphids. The ants provide protection to the aphids and feed off of their nutritious honeydew secretions in return. As their range continues to expand, more and more populations will encounter this urban pest.
WHO Fact Sheets World Health Organization publications and fact sheets
Humans typically encounter RIFAs on lawns, which are ideal RIFA habitat on account of their being plenty of water and loose soil available. When a RIFA mound is disturbed, they respond by aggressively swarming the perceived threat and attacking with their powerful stings. While a small percentage of people will experience a life threatening allergic reaction, most will simply experience an intense burning sensation and red and white pustules on the skin. It is important to not scratch the wounds as this can cause secondary infections.
AFPMB Armed Forces Pest Management Board online Bug Bytes Archive Back issues of the NEPMU 2 newsletter available online
Red Fire Ant can bite, but it's their stinger that causes the painful sores.
Next Issue
15 Aug 2012
Unfortunately, as with cockroaches the goal of RIFA control is “tolerable levels” and not elimination, as the latter is simply unachievable at this time. Although insect viruses, importing parasitic flies, and other novel means of control are being researched, these control methods are years away. That’s not to say, however, that there aren’t easily managed control measures already available.
A common remedy for treating individual mounds is to pour an approved RIFA pesticide or even boiling water directly into the mound. Spreading insecticidal baits around an infested area is another proven method. The limitation with most control methods is that they often fail to reach the RIFA queen(s) and the ant population will eventually rebound unless treatment is regularly repeated.
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
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Shipmate, Can You Hear Me Now?
LT Chris Coetzer
Tinnitus, or ringing in the ears, and hearing loss are the number one and two service-connected disabilities on record for Veterans, respectively, as reported by the 2011 Veterans Benefits Association (VBA) annual report. “The primary focus of the three Navy Operational Audiologists is not just to prevent the loss of hearing sensitivity in our personnel, but to maintain a high level of auditory readiness across job classifications. We believe that this will enhance quality of life by allowing our members to complete their careers with the best hearing performance we could possibly retain,” said Navy Environmental and Preventive Medicine Unit FIVE (NEPMU-5) Operational Audiologist, CDR Antony Joseph. The annual requirement for hearing screening necessitates that Sailors leave their work-center to complete testing. Time away from the workcenter represents lost man-hours to their commands. However, if they demonstrate a change (shift) in hearing (i.e., hearing loss), a series of mandatory follow-up tests are called for, which could lead to a further loss in manhours that may have been prevented. LCDR Paula Johnson from Naval Medical Center San Diego has studied the impact of hearing loss due to lost man-hours to demonstrate how enforcement of hearing conservation policies can actually reduce productivity losses. In 2010, it is estimated that service members on active duty lost about 16,000 man-hours due to mandatory follow-up hearing testing. To put this into perspective, 14,560 man-hours represent 7 years of labor from a Sailor. “This is an example where Operational Audiologists stationed at Navy Environmental and Preventive Medicine Units (NEPMUs) can help to identify problems between Navy Medicine policy and the actual day-to-day operations in the Fleet,” said CDR Joel Bealer, Audiologist at NEPMU-2 in Norfolk. There are three NEPMUs that serve the Fleet: NEPMU-2 for the eastern U.S., Africa, South America, the Middle East, and Europe, NEPMU-5 for the western U.S., and NEPMU-6 for Asia and the Pacific. “The role of the NEPMU Operational Audiologist is to support Fleet Operations by developing methods to enhance the mission rather than interfere with it,” Joseph commented. The sole purpose of the NEPMU Operational Audiologist is to engage with operational forces and to bridge the gap between policy and implementation. They serve as a Fleet advocate during periodic policy reviews. This ensures that the Fleet has a representative, ensuring that
Petty Officer 1st Class Rick Ware listens attentively as U.S. Navy Environmental and Preventive Medicine Unit TWO (NEPMU-2) audiologist CDR Joel Bealer explains procedure for the Fit Check test. This test will allow preventive medicine staff to test the level of hearing loss protection that the current pre-formed earplugs provide and to educate sailors and marines in the proper wear of these devices. proposed program requirements can be applied on the deck plates. This should make Hearing Conservation Programs more efficient, less burdensome, and easier to comply with. “There is a movement to condone the development of custom-molded hearing protective devices for the Fleet. In order for us to make an informed decision about what is the best way to go, we need to examine the problem from as many aspects as we can to make sure that there are not other influencing factors,” said Bealer. One of the things that is lacking for the hearing protection program is training. CDR Joseph at NEPMU-5 in San Diego conducted his PhD dissertation on the effectiveness of hearing protection use when proper training has been provided. One of the factors he demonstrated was that even a brief, informative training session has a clinically and statistically significant effect on the end-user, in our case the Sailor and the Marine, effectively wearing their hearing protective devices. The training he recommends involves how to insert your hearing protector, how to check if you are wearing them properly, and what it should feel and sound like if you have a properlyinserted earplug. Surprisingly, he determined that the vast majority of new earplug users obtain no protection because they are unable to properly insert hearing protectors. According to CDR Bealer, the method that Dr. Joseph used included a short multimedia training presentation and portable-computerized fit-test method. The system, Fit-Check, is an objective tool connected to a laptop computer that allows
hearing conservationists to test Sailors quickly and determine how much protection they are truly receiving. This test is not intended to replace the annual audiogram, but verify that our personnel exposed to hazardous noise are adequately protected. “Now we are testing to see if this educational program will be effective across the Fleet. The reason this is important is that the custom-made ear plugs require a lot of infrastructure and cost at least $80 each compared to the ones we use now that cost pennies,” said Bealer. “So, before we recommend custom-made earplugs, we need to be very sure that we really need a new kind of device and not just better education.” Custom-mold ear pieces have been an effective tool in the case of pilots since those earplugs have built-in communication devices. However, if the extra training gives a return on hearing protection that is equivalent to using custom-molded ear pieces, then there really is no value added to requiring more expensive earplugs as a universal requirement. The current NEPMU Hearing Loss Prevention Project, led by CDR Bealer and CDR Joseph, has identified ships with high program compliance with crew members that show significant hearing shift. This target audience will receive a training program and earplug screening measurement developed by Joseph to demonstrate if there is an improvement in the protective value current earplugs. Moreover, the long term hearing health of members who have received this Hearing Loss Prevention Training will be tracked to determine if the appropriate insertion of hearing protection is sustained over time and whether it makes an impact over time.
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
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New Editors Are Taking Over...But Not Yet!* It is hard to let go of something you really enjoyed doing for almost three years. But it’s time to move on, and pass editorial control over to the new crew. Yes, we do have real jobs in the Navy, but four times a year we get to put together a fun, factual newsletter. In our vision for Bug Bytes fun and informative are not mutually exclusive. We wanted this newsletter to be something our readers would want to read, find useful, and more importantly, pass on to others to read. Thank you for all the wonderful positive feedback. *Baseball cards are not real. All star photos by J. Moody.
Biochemist
Entomologist
Environmental Health Officer
Rutgers University, New Jersey
University of California Davis, California
Old Dominion University, Virginia
I take full responsibility/credit for coming up with the idea for this baseball card theme “Hail and Farewell” page. It’s all tongue-in-cheek of course; Matt and I would never take ourselves that seriously.
It’s been great having the privilege to write about all of the interesting things that take place here at NEPMU-2 and in the Navy public health community.
It was a pleasure working on this newsletter with Matt over the past 3 years. He really made my job easy.
The most satisfying part of this job has been when Sailors out in the Fleet have actually called NEPMU-2 for advice after reading Bug Bytes and seeing the services that NEPMU-2 has to offer.
Matt took care of the text and the grammar, while I created the graphics and layouts. Coming up with a theme for each issue and keeping authors in line was always a collaborative effort.
LT Coetzer has been an awesome coeditor. I just do the bland grammar stuff; he comes up with the captivating layouts and interesting themes that have made this newsletter a success.
The biggest take away from this whole project for me has been that there are so many smart and interesting people working here at NEPMU2. However, very few have time to stop and tell the world about the outstanding work that they are doing or the resources that they have to share with the Fleet.
It’s been fun to be able to write about whatever entomological topic came to mind, rather than the day to day issues of cockroaches on ships.
I hope that somewhere in the world our newsletter found its way to someone who read an article or clicked a resource link that helped them to complete their mission. My mission here is done. Next stop: Navy Drug Screening Lab San Diego.
While I’m going to miss my newsletter work here at NEPMU-2, I know that Bug Bytes is being left in some very capable hands. LT Moody and LT Goodman are two very creative individuals. I can’t wait to read the next issue. I’m off to 1st Medical Battalion over in Camp Pendleton. Thanks for reading.
Environmental Health Officer University of North Texas, Texas
Contact us: Phone (757) 953-6600 DSN 377 Fax (757) 953-7212 1285 West D St, Norfolk, VA 23511-3394 Website: http://www.med.navy.mil/sites/nepmu2
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