IDCRP Science Symposium
The dates for the 2025 IDCRP Symposium are February 24th - 28th, 2025. It will be held at the Bethesda Auditorium at 6720A Rockledge Drive, Bethesda, MD 20817. The registration link will be coming soon!
Diarrheal Diseases
Diarrhea, a scourge upon humanity since preliterate times, has been the particular nemesis of military forces. The Armed Forces of the United States have been in the forefront in the diagnosis, treatment, and prevention of diarrheal illness. U.S. military scientists and physicians implemented the first mandatory typhoid inoculation program, contributed to advances in water chlorination, and pioneered the use of antibiotics for typhoid fever. U.S. Navy physicians refined the intravenous treatment of cholera, reducing the death rate from 20% to less than 1%. Their studies of electrolyte and fluid balance in cholera, and the subsequent development of oral rehydration therapy for cholera and other diarrheal illness, have saved millions of lives worldwide. U.S. Army researchers refuted the desquamation theory of cholera pathogenesis, isolated the cholera exotoxin, and developed improved cholera vaccines. U.S. Army and Navy researchers pioneered the use of antibiotics for the treatment of typhoid fever, made major contributions to the treatment of dysentery, developed algorithms for the treatment of traveler’s diarrhea, and continue active development of traveler’s diarrhea and dysentery vaccines. U.S. military diarrheal research has directly contributed to the welfare of hundreds of millions of people.
COVID-19
Recent Findings from the IDCRP Acute Respiratory Infections Research Area:
COVID-19:
Epsi NJ, et al. Precision symptom phenotyping identifies early clinical and proteomic predictors of distinct COVID-19 sequelae. J Infect Dis. 2024 Jun 25:jiae318. https://doi.org/10.1093/infdis/jiae318.
Mühlemann B, et al. Comparative analysis of SARS-CoV-2 neutralization titers reveals consistency between human and animal model serum and across assays. Sci Transl Med. 2024 May 15;16(747):eadl1722. https://doi.org/10.1126/scitranslmed.adl1722.
Andronescu LR, et al. Evaluating SARS-CoV-2 Saliva and Dried Blood Spot Surveillance Strategies in a Congregate Population Emerg Infect Dis. 2023 Sep;29(9):1925-1928. https://doi.org/10.3201/eid2909.230417.
Richard SA, et al. Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) COVID-19 Cohort Study Group. Persistent COVID-19 Symptoms at 6 Months After Onset and the Role of Vaccination Before or After SARS-CoV-2 Infection. JAMA Netw Open. 2023 Jan 3;6(1):e2251360. https://doi.org/10.1001/jamanetworkopen.2022.51360.
Wang W, et al. Bivalent Coronavirus Disease 2019 Vaccine Antibody Responses to Omicron Variants Suggest That Responses to Divergent Variants Would Be Improved with Matched Vaccine Antigens. J Infect Dis. 2023 Aug 16;228(4):439-443. http://doi.org/10.1093/infdis/jiad111.
Richard SA, et al. Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study. Open Forum Infect Dis. 2023 Nov 17;10(12):ofad579. http://doi.org/10.1093/ofid/ofad579.
Levin MJ, et al. AZD7442 (Tixagevimab/Cilgavimab) for Post-Exposure Prophylaxis of Symptomatic Coronavirus Disease 2019. Clin Infect Dis. 2023 Apr 3;76(7):1247-1256. http://doi.org/10.1093/cid/ciac899.
Wang W, et al. Antigenic cartography of well-characterized human sera shows SARS-CoV-2 neutralization differences based on infection and vaccination history. Cell Host Microbe. 2022 Dec 14;30(12):1745-1758.e7. http://doi.org/10.1016/j.chom.2022.10.012. Epub 2022 Oct 21.
Epsi NJ, et al. Understanding "Hybrid Immunity": Comparison and Predictors of Humoral Immune Responses to Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2) and Coronavirus Disease 2019 (COVID-19) Vaccines. Clin Infect Dis. 2023 Feb 8;76(3):e439-e449. https://doi.org/10.1093/cid/ciac392.
Lusvarghi S, et al. SARS-CoV-2 BA.1 variant is neutralized by vaccine booster-elicited serum but evades most convalescent serum and therapeutic antibodies. Sci Transl Med. 2022 May 18;14(645):eabn8543. https://doi.org/10.1126/scitranslmed.abn8543. Epub 2022 May 18.
Wolfe CR, et al. Baricitinib versus dexamethasone for adults hospitalised with COVID-19 (ACTT-4): a randomised, double-blind, double placebo-controlled trial. Lancet Respir Med. 2022 Sep;10(9):888-899. https://doi.org/10.1016/S2213-2600(22)00088-1.
Kalil AC, et al. Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19. N Engl J Med. 2021 Mar 4;384(9):795-807. https://doi.org/10.1056/NEJMoa2031994.
Gonorrhea
Gonococcal Resistance
Gonococcal (GC) infections have re-emerged as a significant global public health problem. The IDCRP Sexually Transmitted Infections (STI) Research Area (RA) is leading a global effort to identify the prevalence and risk factors of drug resistant GC infections among US military seeking care in a wide variety of geographic settings, currently from several sites across the globe. The IDCRP is the Coordinating Center for the DoD Gonococcal Repository & Reference Laboratory (GC-RRL) in Dr. Ann Jerse’s lab at USU. An IDCRP protocol outlines the Program's role as Coordinating Center for a global GC Repository, with efforts including study site development; human subjects protection assistance; comparison protocols for GC microbiology and antimicrobial resistance testing technical support; standard operating procedures for isolate and data management and transfer; utilization of repository; and interfacing of microbiology and clinical research. This effort also aims to test the sensitivity of early stream urine culture and identify the prevalence of Chlamydia by urine nucleic acid amplification test (NAAT) testing among symptomatic and asymptomatic US military service members. This project is supported as an AFHSB GEIS Sustainment 3-year workplan.
HIV
Due to mandatory routine HIV testing, the active duty force in the US is a screened population. This unique aspect of the military setting allows understanding of early events and the time course of HIV disease. Because this population is also healthy, racially diverse, and educated, with open access to healthcare and medications, IDCRP is able to conduct investigations without many confounders that plague other cohort studies, such as drug abuse, non-compliance, and poor follow-up. Combined, these assets have resulted in hundreds of published manuscripts that have advanced the fields of HIV science and care. At present, these aspects are being leveraged in many studies, including toward understanding and predicting individual risk of non-AIDS complications.
Identify, treat, and prevent HIV associated neurocognitive disorders in the US military health care system
The principal objective of IDCRP’s human immunodeficiency virus (HIV) research program is to build evidence toward maintaining the health, function, and longevity of HIV+ active duty service members and beneficiaries. This is primarily accomplished through our 28-year U.S. Military HIV Natural History Study, a resource hailed as a “national treasure,” having been leveraged to address contemporary HIV/AIDS-related issues.
As individuals live longer with HIV, thanks to antiretroviral therapy, attention has turned to conditions other than AIDS. HIV-associated neurocognitive disorder (HAND) has emerged as an important concern for the military and the broader population, where it affects up to 50% of HIV+ individuals. In a recent IDCRP study, nearly 20% of HIV+ military members met criteria for HAND. Neurocognitive domains affected by HAND (motor function/dexterity, memory, learning, recall, and executive function) are highly relevant to military duties, and concern over impairment has been a key factor in restricting duty status of HIV+ personnel. This affects not only the individual service member, but is a significant loss to the military of a trained asset; our study may help inform the revision of this policy through an improved understanding of HAND.
In collaboration with the Walter Reed National Military Medical Center Bethesda, the Naval Medical Center San Diego, the National Institute of Neurologic Disorders and Stroke, and five other NIH institutes and centers, IDCRP have undertaken a 5-year study of military HIV+ individuals to better understand the causes and development of HAND, improve diagnosis and screening, and form the basis for studies of treatment and prevention. Partnerships with other DoD and HJF programs, including the U.S. Military HIV Research Program (MHRP) and USU Center for Neuroscience and Regenerative Medicine (CNRM), as well as Veterans Affairs (VA) investigators, are being built and strengthened.
The military HIV+ population, comprised of young, healthy, racially diverse individuals with little illicit drug use and fewer mental health illnesses than other studied populations, offers an exciting opportunity to better understand HAND. IDCRP will extensively characterize the cognitive health of volunteers over time through comprehensive neuropsychiatric testing supplemented by neuroimaging and analysis of cerebrospinal fluid. Initial investigations will include validation of a HAND screening tool developed from our prior study and evaluation of potential biomarkers to improve the objective diagnosis of HAND. With far-reaching goals, IDCRP’s study will benefit both the military and broader population.
Wound Infections Wartime Preparedness
Wound Infections Research Area Initiatives Support Combat Trauma-Related Infection Evidence-Based Management and Wartime Preparedness
One of the priority initiatives of the Wound Infections Research Area is to support evidence-based clinical practice guidelines (CPGs) for the prevention and treatment of combat trauma-related infections. In support of this, the Wound Infections Research Area Trauma Infectious Disease Outcomes Study (TIDOS) team is collaborating with investigators from the University of Minnesota and University of Michigan Medicine to conduct retrospective analyses on registry data collected from military and civilian trauma patients to evaluate outcomes with different prevention and treatment strategies. Combined with the results of complex intervention systematic review conducted by the University of Minnesota Evidence-Based Practice Center, the findings from the analyses will be provided to an expert consensus panel to support refining the existing Joint Trauma System (JTS) CPG on the prevention of combat trauma-related infections and to a develop a new JTS CPG with recommendations on treatment of combat trauma-related infections.
Another priority is to support wartime preparedness in the event of future conflicts. Presently, the Wound Infections Research Area team are working to develop technical recommendations to support a streamlined, next-generation Infectious Disease Module of the JTS Department of Defense Trauma Registry to include improved interoperability. Scientific and regulatory frameworks for Wartime Specimen and Isolate Repositories for use in future conflicts are also being developed. Furthermore, the team is working with Dr. Scott Evans and his team of the George Washington Biostatistics Center to develop ‘on-the-shelf’ clinical trial protocols for activation during future conflicts to assess combat trauma-related infection prevention strategies and the effectiveness of treatment approaches with the goal of improving outcomes among wounded warriors.