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From July 2024 through June 2025, a total of 806 members of the active (n=702) and reserve (n=104) components of the U.S. Armed Forces had at least 1 cold weather injury. Compared to the 2023-2024 cold season, the cold weather injury rates during the 2024-2025 cold season increased by 41.8% (from 38.6 to 54.7 per 100,000 person-years) and 45.8% (from 8.5 to 12.4 per 100,000 person-years) in the active and reserve components, respectively. The Army, Navy, and Marine Corps recorded their highest cold weather injury rates during the 2024-2025 season of the 5-year surveillance period. Frostbite was the most common cold weather injury in the Army, Navy, and Marine Corps, with the Marine Corps experiencing the largest surge in frostbite rates. Over the entire surveillance period, U.S. active component service member cold weather injury rates were generally higher among male service members, non-Hispanic Black individuals, and those under age 20 years. The incidence rate of cold weather injuries among active component service members increased by over 40% between the 2023-2024 and 2024-2025 cold seasons, resulting in a 5-year rate of 41.5 per 100,000 person-years. This increase was primarily attributable to higher rates in the Army, Navy, and Marine Corps. The Marine Corps evinced the largest incidence rate increase (77.4%) during the 2024-2025 cold season. This year's update expanded cold injury surveillance to include "other specified and unspecified effects of reduced temperature," to provide a more comprehensive assessment of cold weather injuries.

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Limited data on sexual networks in the U.S. military makes designing strategies to combat sexually transmitted infections (STIs) challenging. This retrospective evaluation assessed reported sexual networks of military service members with chlamydia, to inform future interventions for decreasing transmission of the infection. Thirty-two active duty service members at Joint Base San Antonio-Fort Sam Houston tested positive for chlamydia infection during the evaluation period, June through December 2023. Service members who tested positive for chlamydia were interviewed by Army Public Health Nursing staff and were asked to identify their sexual partners from the preceding 60 days, for routine contact tracing. Patient responses were then anonymized for comparisons of sexual networks of military service members-by sex, branch of service, and whether they were participating in military training or had completed training ("permanent party"). Service members with chlamydia were predominantly female (n=19, 59.4%), in the Army (n=18, 56.3%), and in military training (n=20, 62.5%). Of the 45 sexual contacts of the 32 service members identified through contact tracing, the majority (n=30, 66.7%) of those sexual contacts were civilians. Those still in military training were more likely to report sexual contacts who were also military service members, compared to permanent party service members (n=12, 50% vs. n=3, 14.3%, p=0.014). This evaluation determined that most service members who developed chlamydia were in sexual networks with only a single partner (n=22, 68.8%). These data should form an initial assessment of a military sexual network that needs to be confirmed in larger settings. This analysis of sexual networks at Joint Base San Antonio-Fort Sam Houston involving 32 military service members with chlamydia found that sexual networks for service members who were in training had a greater proportion of sexual partners who were also in the military compared to service members who were not in training (50% vs. 14.3%, p=0.014).

Malaria proved decisive in determining the outcome of the Pacific theater during the Second World War. In 1943 alone, over 100,000 malaria cases were reported among the U.S. military in the Southwest Pacific and South Pacific. Thousands of sick soldiers were evacuated from their units and hospitalized for weeks or months of rehabilitation due to malaria. The primary challenge was not treatment of acute infections, as death rates were very low, but rather an inability to return recovered soldiers quickly to their units. Relapsing Plasmodium vivax malaria posed a particular problem, with many soldiers stationed at Guadalcanal or New Guinea suffering more than 10 relapses. Secondary gain from residual symptoms became apparent when around 1% of malaria patients were repatriated for ‘chronic malaria’. Future conflicts disrupted by infectious diseases will almost certainly include diffuse, post-infection symptoms that must be anticipated to prevent catastrophic war-fighter attrition.

Prior studies have found a higher risk of adverse pregnancy outcomes due to COVID-19 infection; however, recent literature documents few adverse impacts to younger and otherwise healthy populations, but with limited information about military members. The study population comprised active component service women with a singleton delivery between 2021 and 2023. Adverse pregnancy outcomes were evaluated by COVID-19 infection and vaccination history, as well as by demographics and pre-existing comorbidities. During the surveillance period, 39,355 active component U.S. service women had a singleton delivery. After controlling for potential confounders in the adjusted logistic regression analysis, COVID-19 infection during pregnancy was associated with eclampsia (OR 2.18, p<0.05) and antepartum hemorrhage (OR 1.11, p<0.05), and COVID-19 infection prior to the start of pregnancy was associated with antepartum hemorrhage (OR 1.18, p<0.05). In comparison, after adjustment, COVID-19 vaccination during pregnancy and prior to start of pregnancy was not associated with increased odds of any adverse pregnancy outcome in active component service women. COVID-19 vaccines are recommended for pregnant women by the American College of Obstetricians and Gynecologists and, previously, the U.S. Centers for Disease Control and Prevention. This analysis found no significant difference in adverse pregnancy outcomes among those who received a COVID-19 vaccine prior to delivery compared to women who did not, between 2021 and 2023. COVID-19 infection prior to start of pregnancy was associated with antepartum hemorrhage whereas COVID-19 infection during pregnancy was associated with eclampsia and antepartum hemorrhage. The findings from this analysis suggest there is a benefit to vaccinating pregnant active component service women against COVID-19. There was no increased risk of these adverse pregnancy outcomes associated with receipt of a COVID-19 vaccine in this study population. In contrast, COVID-19 infection may be associated with increased occurrence of some adverse pregnancy events.

This report updates previous summaries of the numbers, rates, trends and causes of death among U.S. active component, National Guard, and reserve component members from 2010 through 2020. Mortality rates &#x200b;among service members in all components decreased from 2011 to 2014, corresponding with a drawdown of U.S. military operations in U.S. Central Command. Compared to their respective counterparts, all-cause mortality rates were highest in the guard and reserve component and among Army soldiers, male service members, non-Hispanic White individuals, those in the oldest age category (age 55 years and older), and service members in combat-related occupations. Suicide and self-inflicted injury was the leading cause of death for both U.S. service women and men. Mortality rates for all causes of death among military service members were lower than the in U.S. population after adjustments for age, sex, and race and ethnicity-with the exception of suicide and self-inflicted injury, for which rates were higher. These findings demonstrate the need for a continued emphasis on suicide prevention programs to improve service member well-being. By identifying the specific subpopulations at highest risk for various causes of mortality, these surveillance data provide information for the Department of War to refine and more effectively target its prevention efforts and resources. Continued mortality surveillance is essential to identify emerging threats, evaluate the effectiveness of interventions, and protect both the health and readiness of the force.

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Traditional, mutually exclusive approaches to racial and ethnic classification obscure important differences within major demographic groups and among multiracial populations. This study offers a novel examination of obstetric and neonatal outcomes among pregnant U.S. military service members, by applying multiple approaches to racial and ethnic classification and presenting disaggregated data. Overall, 235,608 births were identified among pregnant service members from 2010 through 2021. Inclusion of service members who identified with each racial group, whether alone or in combination with any other group, increased the American Indian or Alaska Native and Native Hawaiian or Pacific Islander birth populations by 209.7% and 94.0%, respectively, when compared to mutually exclusive classifications. Prevalences of obstetric outcomes such as cesarean delivery varied among racial and ethnic groups, particularly Asian and Latino populations, for example, Asian Indian, 36.7%; Filipino, 32.3%; Chinese, 26.5%; Puerto Rican, 30.2%; Mexican, 23.2%; and between distinct multiracial populations. Disaggregated estimates ultimately increased visibility of multiracial and Native service members and elucidated patterns indiscernible in aggregated data. Wider adoption of disaggregated racial and ethnic data methods is needed to improve understanding of health outcomes in the Military Health System. Reporting of non-mutually exclusive racial and ethnic groups as well as disaggregated Asian, Hispanic or Latino, and multiracial populations elucidates important differences in obstetric and neonatal outcomes.

Trends in obesity among U.S. active component service members (ACSMs) and civilians are relevant to military recruitment and retention, as excess body weight is a common disqualification for military service. This study utilized measured height and weight data from the Military Health System Data Repository for ACSMs (cumulative n=12,262,745) and the National Health and Nutrition Examination Survey for civilians ages 17-62 years (cumulative n=19,334). Accounting for the design of each data source, the prevalence of obesity (body mass index&#x2265;30 kg/m2) and body mass index (BMI) distributions were calculated. Joinpoint software and polynomial regression regression were used to assess trends over time. From 2013 through 2023, obesity prevalence increased among ACSMs, from 14.7% to 24.2%. Although obesity rates among civilians were consistently higher, this gap narrowed over the course of the decade. The same pattern was seen in young men (ages 17-24 years). Civilians have greater proportions within the highest classes of BMI than ACSMs. Persistently high obesity prevalence among ACSMs overall and in young men, particularly since 2019, may affect military recruitment, retention, and ultimately, strength and readiness. From 2013 through 2023, the prevalence of obesity increased significantly among U.S. ACSMs, 2019 to 2023 in particular, while prevalence among civilians remained consistently high. The pattern of obesity is especially relevant in young men, the largest source of potential and newly accessed military recruits.

This report provides an update, through June 2025, of routine screening results for antibodies to the human immunodeficiency virus (HIV) among members of the U.S. military. The HIV-antibody seropositivity rates for active component service members from 2024 through mid-year 2025 were highest for the Navy (0.23 per 1,000 tested) and Marine Corps (0.22 per 1,000 tested), followed by the Army (0.17 per 1,000 tested), and lowest for the Air Force (0.13 per 1,000 tested) and Coast Guard (0.11 per 1,000 tested). Mid-year HIV seropositivity rates, in comparison to 2024, increased for active component service members of the Army but decreased or remained stable for all other services, as of June 2025. From January 2020 through June 2025, approximately 7 million U.S. military service members among the active component, reserve component, National Guard) were tested for antibodies to HIV, and 1,463 were identified as HIV-antibody-positive (seropositivity 0.21 per 1,000 tested). Of the 1,463 new infections identified during this period, only 40 (2.7%) were among female service members. The HIV-antibody screening program remains an important element of U.S. force health protection, particularly for men under age 35 years, for all branches of service and service components. The measurement of military retention for HIV-positive service members reflects changes in U.S. Department of Defense policies that allow asymptomatic individuals with undetectable viral loads to serve without restrictions.

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Tuberculosis (TB) remains a force health protection threat to the U.S. military, particularly in crucial populations at increased risk of exposure or re-activation. This analysis examined TB testing trends and the prevalence of latent tuberculosis infection (LTBI) among U.S. Army active component soldiers from 2014 through 2023, the first decade following a major policy shift to targeted testing. Defense Medical Surveillance System data indicate that a total of 339,465 TB tests were administered, primarily (81.0%) tuberculin skin tests. Of those tests, 22,762 (6.7%) were positive, leading to the identification of 18,018 (5.3%) LTBI diagnoses. Asian/Pacific Islander soldiers demonstrated the highest LTBI diagnosis proportion (10.2%), followed by non-Hispanic Black (8.6%), Hispanic (5.6%), and Non-Hispanic White (2.9%) soldiers; the data also include 'other' (6.8%) and 'unknown/missing' (3.6%) categories. Recruits exhibited a significantly higher LTBI diagnosis proportion (11.0%) than non-recruits (3.6%), highlighting a high prevalence of LTBI among incoming personnel at time of accession. A marked decline in testing volume-a 72% decrease from 2014 to 2023 in the annual numbers of tests administered-followed the 2013 U.S. Army Medical Command policy shift. The substantially higher average proportion (6.7%) of positive tests from 2014 to 2023 compared to the average from the pre-policy era (1.3%) of universal screening demonstrates the successful concentration of testing resources on those most at risk, thereby improving diagnostic yield within a low-prevalence military force. This analysis's findings describe the epidemiological outcomes of the Army's targeted testing policy and underscore the importance of ongoing, targeted surveillance to mitigate TB risks in military settings. The 2013 policy that successfully transitioned the U.S. Army from universal tuberculosis screening to a targeted, risk-based strategy reduced testing volume by 72% over the next decade. The decline in tuberculosis testing volume coincided with a substantial increase in diagnostic yield, with the overall positivity proportion rising from 1.3% in the pre-policy era to 6.7% in 2023. The 2013 policy revision to a targeted, risk-based tuberculosis testing strategy succeeded in focusing valuable public health resources on high-risk groups. The high prevalence (14.0%) of latent tuberculosis infection that has been identified in recruits confirms that accession is the most critical juncture for tuberculosis control within the Army. Slight but notable differences in testing type positivity suggests opportunity for further policy refinement.

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Measles, mumps, rubella, and varicella (MMR/V) cases have decreased in the U.S. Military Health System (MHS) overall, but in recent years, increasing numbers of MMR/V outbreaks in the U.S. have led to a rise in reported cases among the civilian population. Data were queried from the Defense Medical Surveillance System to identify total number of confirmed and possible MMR/V cases among all MHS beneficiaries from 2019 through 2024. The total numbers of confirmed and possible cases among MHS beneficiaries included 8 confirmed and 71 possible cases of measles, 18 confirmed and 193 possible cases of mumps, 13 confirmed and 265 possible cases of rubella, and 251 confirmed and 4,554 possible cases of varicella. During the surveillance period the numbers of all confirmed and possible cases decreased. Among service members, most cases were either partially vaccinated, or vaccination records were not available. In this 6-year surveillance period, cases of MMR/V decreased over time. No cases of measles were observed among U.S. service members during the surveillance period. This report emphasizes the importance of continued vaccination against MMR/V to limit morbidity among U.S. service members, as evidenced by the lower number of cases among service members, who are required to be vaccinated, when compared to non-service members.

This report summarizes incidence rates and trends of the 5 most frequently occurring sexually transmitted infections (STIs) from 2016 through 2024 among active component service members of the U.S. Armed Forces. The data for this report were derived from medical and public health surveillance of chlamydia, gonorrhea, and syphilis as nationally notifiable diseases; case data for 2 additional STIs, human papillomavirus (HPV) and genital herpes simplex virus (HSV), are also presented. Chlamydia infections were the most common during the surveillance period, followed, in decreasing order of frequency, by HPV, gonorrhea, genital HSV, and syphilis. In 2024, both chlamydia and gonorrhea rates dropped to their lowest points of the period of surveillance, falling 25.5% and 26.4%, respectively, from their 2019 peaks. Declines were predominantly concentrated among service members younger than 25 years of age-who were the largest contributors to overall incidence. Notably, syphilis incidence rose steadily throughout the surveillance period, among all age groups, and both sexes, with steepest rises after 2021, increasing nearly 70%. Non-Hispanic Black service members continue to bear the highest syphilis burden, among whom incidence peaked in 2023, before declining approximately 15% in 2024. Syphilis rates continued to rise among all other racial and ethnic groups through 2024, with the largest relative increase, 456%, among non-Hispanic White service women under age 25 years. Genital HSV demonstrated a downward trend throughout the surveillance period, with overall incidence reaching its lowest point in 2024. Incidence of genital HPV also decreased among all service members, with a more pronounced decrease among men. Chlamydia, gonorrhea, and genital HSV incidence rates dropped to their lowest points of the 9-year surveillance period. In contrast, total syphilis incidence rose among all age groups, and both sexes, with the highest incidence among service women ages 17-19 years. While syphilis incidence rates remain highest among non-Hispanic Black service members, its incidence has risen sharply in all other racial and ethnic groups, reflecting an evolving and expanding syphilis epidemiology within the military in addition to the general U.S. population.

An examination of Guillain-Barr&#xe9; Syndrome (GBS) cases among U.S. active component service members from 2014 through 2022 revealed an incidence rate of 1.6 cases per 100,000 person-years. Individuals younger than age 20 years and those in basic training exhibited higher incidence. The type of antecedent event, either illness or immunization, was not associated with higher disability ratings at long-term follow-up. The analysis also quantified morbidity among service members with GBS, finding that 28.0% of cases had a subsequent chronic pain diagnosis, and 28.7% of cases were referred to the medical evaluation board. The need for neuropathic pain medication during the acute phase predicted poorer long-term functional outcomes. Furthermore, electrodiagnostic evidence of axonal or mixed nerve damage correlated with greater disability after 1 year. Although basic trainees had higher incidence, their long-term morbidity was comparable to other groups. These findings underscore the considerable impact that GBS can have on affected military personnel and identify factors associated with long-term complications. There were 1.6 cases of Guillain-Barr&#xe9; syndrome per 100,000 person years among active component U.S. service members from 2014 through 2022. There was no association between persistent disability and associated antecedent event (e.g., infection or immunization). Many patients experienced incomplete recovery, with 28.7% resulting in medical board referrals. Persistent disability was independently associated with chronic pain diagnosis.

Although mental health conditions are the leading underlying cause of maternal mortality, there is limited research on the prevalence of perinatal mental health conditions among active duty service women (ADSW). In this study of live-born deliveries among U.S. ADSW (n=62,729) with pregnancy start and end dates (i.e., dates of last menstrual period and infant delivery, respectively) from October 1, 2016 through December 31, 2021, International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes were used to identify mental health conditions: trauma and stressor-related disorders, anxiety and panic disorders, depressive disorders, suicidal ideation or attempt, and eating disorders. Data were collected through 1 year postpartum, until December 31, 2022. The prevalence of diagnosed mental health conditions from 1 year prior to pregnancy through 1 year postpartum was 33.8%. Trauma and stressor-related disorders were most prevalent (23.1%), followed by anxiety and panic disorders (16.9%), depressive disorders (14.6%), suicidal ideation or attempt (1.6%), and eating disorders (0.4%). The prevalence of mental health conditions was higher in the postpartum period (22.0%) compared to pregnancy (18.4%) and prior to pregnancy (15.0%). Overall, higher prevalence of these conditions was found among non-Hispanic Black ADSW (37.4%), and those who were unmarried (38.4%), never deployed (34.9%), or in the Army (37.4%) and Navy (36.4%). One in 3 active duty service women were diagnosed with a mental health condition in the year preceding pregnancy through 1 year postpartum. Overall, non-Hispanic Black and junior enlisted active duty service women demonstrated higher prevalences of mental health conditions compared to all other racial and ethnic groups and military ranks.

Few studies have investigated body mass index (BMI) and physical fitness factors related to coronavirus disease (COVID)-19 hospitalizations among U.S. active duty service members. This investigation examined associations between measures of physical fitness, BMI, and Army physical fitness test (APFT) performance with COVID-19 hospitalizations of U.S. Army active duty soldiers. From May 2020 through November 2021, 13,074 male soldiers were diagnosed with COVID-19 (90 hospitalized, 12,984 non-hospitalized) who also had an APFT and BMI record no more than 9 months from the COVID-19 diagnosis date. Female soldiers were excluded due to insufficient numbers of COVID-19 hospitalizations. In adjusted logistic regression models controlling for race and ethnicity as well as comorbidities, and including age, BMI, and their interactions, both BMI (adjusted odds ratio [aOR] 1.07; 95% CI 1.01, 1.14; p=0.021), and the age and BMI interaction were statistically significant (aOR 1.01; 95% CI 1.00, 1.02; p=0.004). Each additional year of age amplified the odds of hospitalization by an additional 1% for every 1 unit increase in BMI. Development and maintenance of a healthy body weight may reduce likelihood of COVID-19 hospitalization and sustain individual and unit health and medical readiness. For male U.S. Army active duty soldiers, the association between having a higher BMI and COVID-19 hospitalization was amplified by age, indicating about a 1% increase in the odds of hospitalization per BMI unit for each additional year of age. Maintaining a healthy body weight may reduce the risk of COVID-19 related hospitalization for military personnel. The U.S. Army's Holistic Health and Fitness Program is one example of a comprehensive health program established to simultaneously enhance several facets of military health and fitness.