2000 U.S. Armed Forces Medical Intelligence Tutorial


This unclassified tutorial on Medical Intelligence has been prepared to
facilitate collection on an issue of importance to the Department of Defense and its
components, national policy officials, and other federal agencies. The document was
prepared by the Armed Forces Medical Intelligence Center, and was coordinated with
the National HUMINT Requirements Tasking Center and Defense HUMINT Service.

Comment: I believe this document will help the team determine DOD requirements for information about and national security risks associated with infectious disease. Each section of the document lists questions to answer when analyzing a disease, disease outbrea, and a country's medical infrastructure and ability to respond to disease.

Highlights From The Document


pg 11:

Infectious Disease Definitions

  • Arboviral diseases: caused by viruses transmitted by arthropods such as mosquitoes, sand flies, ticks, or biting midges
>
* Demographics: statistical data of human populations; for example, size, density, and vital statistics
  • Endemic: naturally occurring baseline disease levels within a population or area
  • Epidemic: a higher than expected number of disease cases associated in time and place
  • Incidence: the rate of occurrence of new cases of a particular disease within a population
  • Outbreak: a cluster of disease cases associated in time and place
  • Prevalence: the percentage of a population affected with a particular disease at a given time
  • Vector-borne diseases: diseases that are spread by vectors such as insects, ticks, or mites.
  • Zoonoses: diseases that are spread from animals to humans

pg 7:

Questions on Outbreaks of Infectious Diseases of Operational

Importance

(Outbreaks involve disease levels higher than expected, new location, or new time of year)

1. Name of disease(s) (including local/slang names if available)
2. Was the disease laboratory-confirmed?
  • Name/type of diagnostic test
3. Disease among humans
  • Signs and symptoms
  • Number of cases
  • Number of hospitalizations
  • Number of deaths
4. Disease among animals
  • Signs and symptoms
  • Number of cases
  • Number of deaths
5. Number of people in the area of the outbreak (population)
6. Dates of outbreak
  • Date began (first reported)
  • Date ended (last reported)
  • Is outbreak still going on?
7. Location of outbreak (city, state/province/country)
8. Characteristics of those affected
  • Age groups
  • Sex (was one sex more commonly affected?)
  • Occupation (was the outbreak associated with a particular occupation)?
10. Drugs used to treat the disease
11. Has any drug resistance been reported?
  • If so, what drugs?
12. Have control measures been implemented?
  • Vaccines?
  • Drug treatment?
  • Control of vectors?
Other? Explain
Official reports, news reports, and any personal insight relevant to outbreaks can be extremely useful.

pg: 8

Questions on Infectious Diseases of Operational Importance (Nonoutbreaks)

(Non-outbreaks involve diseases that routinely occur within the population)

1. Name of disease
2. How does the region test for the disease?
  • Name/type of diagnostic test
3. Numbers of cases reported (weekly, monthly, annually)
4. Geographical location of disease occurrence
  • Countrywide or specific areas of risk (for example, confined to a province, only along the north border, low vs. high altitude areas, etc.)
5. Seasonality of disease
  • Year-round or specific times (for example, rainy months or warmer months--specify months)
6. Characteristics of those affected
  • Age groups
  • Sex
  • Occupation
7. Number of people in the region where the disease is occurring (population)
8. Drugs used to treat the disease
9. Has any drug resistance been reported?
  • If so, what drugs?
10. Have any control measures been implemented?
  • Vaccines?
  • Drug treatments?
  • Control of vectors?
  • Others? Explain:
  • Official reports, news reports, and any personal insight relevant to routinely occurring infectious

pg: 9

Infectious Diseases of Operational Importance

(in alphabetical order; including common names)


Animal-Associated Diseases

  1. Anthrax (Malignant pustule, Malignant edema, Ragpicker disease, Woolsorter disease)
  2. Brucellosis (Bangs Disease, Malta fever, Mediterranean fever, Undulant fever)
  3. Hantaviral Diseases
  4. Hemorrhagic fever with renal syndrome (Epidemic hemorrhagic fever, Korean
  5. hemorrhagic fever, Nephropathia epidemica, Hemorrhagic nephrosonephritis, HFRS)
  6. Hantavirus Pulmonary Syndrome (Hantavirus adult respiratory distress syndrome,
  7. ARDS)
  8. Lassa fever
  9. Leptospirosis (Canicola fever, Mud fever, Hemorrhagic jaundice, Swineherd disease,
  10. Weill disease)
  11. Q fever
  12. Rabies (Lyssa hydrophobia)

Food- or waterborne diseases

  1. Acute diarrhea caused by bacteria, protozoans, and viruses
  2. Cholera
  3. Hepatitis A (epidemic jaundice)
  4. Hepatitis E (epidemic non-A non-B hepatitis)
  5. Typhoid fever (enteric fever, typhus abdominalis)

Respiratory-borne diseases

  1. Meningococcal meningitis
  2. Tuberculosis (TB)

Sexually Transmitted Diseases/Bloodborne diseases

  1. Gonorrhea
  2. Hepatitis B (Serum hepatitis)
  3. Hepatitis D (Hepatitis delta virus)
  4. Hepatitis C
  5. HIV/AIDS
  6. Syphilis

Vector-borne diseases (insect/tick/mite-borne)

  1. Arboviral fevers
  2. Chikungunya virus disease
  3. Crimean-Congo hemorrhagic fever (CCHF)
  4. Dengue fever (Breakbone fever)
  5. Japanese Encephalitis (JE)
  6. Kyasanur Forest disease
  7. Mayaro virus disease
  8. O’nyong-nyong fever
  9. Omsk hemorrhagic fever
  10. Oropouche virus disease
  11. Rift Valley fever
  12. Ross River fever
  13. Sandfly fever (Phlebotomus fever)
  14. Sindbis virus disease (Ockelbo)
  15. Tick-borne encephalitis
  16. Venezuelan equine encephalitis
  17. West Nile fever
  18. Yellow fever
  19. Filariasis
  20. Leishmaniasis (Baghdad boil, Aleppo evil, Oriental sore)
  21. Loiasis (Loa loa infection, Eyeworm disease of Africa)
  22. Lyme disease (Lyme borreliosis)
  23. Malaria
  24. Onchocerciasis (River blindness)
  25. Plague (Pestis)
  26. Rickettsioses, tick-borne
  27. African tick typhus
  28. Boutonneuse fever
  29. India tick typhus
  30. Kenya tick typhus
  31. Marseilles fever
  32. Mediterranean tick fever
  33. Mediterranean spotted fever
  34. North Asian tick fever
  35. Rickettsial pox
  36. Spotted fever group
  37. Trypanosomiasis (Sleeping sickness)
  38. Typhus
  39. Epidemic louse-borne typhus fever (Louse-borne typhus, Typhus exanthematicus,
  40. Classic typhus fever)
  41. Murine typhus fever (Flea-borne typhus, Endemic typhus fever, Shop typhus)
  42. Scrub typhus (Tsutsugamushi disease, Mite-borne typhus fever)

Other infectious diseases

  1. Ebola-Marburg viral diseases
  2. Schistosomiasis
  • For signs and symptoms of infectious diseases refer to the Control of Communicable Diseases
Manual on the AFMIC MEDIC CD-ROM
diseases can be extremely useful.

pg: 30

Questions to Answer When Analyzing a Country's Civilian and Military Infrastructure

1. How is the country’s civilian health care system organized? Provide wiring diagrams, if
available.
2. What is the organizational structure of the military’s health care system? Provide wiring
diagrams, if available.
3. Are the organizational structures of the civilian and military health care systems centralized or
decentralized? Are the command and control structures effective? Are the civilian and military
systems interoperable?
4. Is there a mix of civilian health care services—national and state governments, religious
organizations, international organizations, private practices, etc.? How much does each
contribute to the country’s health care system? For example, does the majority of the population
use government facilities? Are private facilities only available to the very wealthy? Are
international aid organizations the primary health providers for the population? Is the only
quality health care available provided by aid organizations?
5. Which services--government, military, private, etc.--provide the best health care? What, if
any, interaction occurs between them?
6. Is funding available? If so, is it used wisely and what is its intended use? Is it subject to misuse
or misappropriation? Does the bulk of the funding go to urban or rural medical infrastructures? If
possible, provide information such as actual versus budgeted amounts, funding trends, shortages
in funding, etc.
7. Is funding available for military medical services? If so, is it used wisely and what is its
intended use? Is it subject to misuse or misappropriation? Does the bulk of the funding go to
medical services for particular units (such as Republican Guard, Special Forces, etc.)? If
possible, provide information such as actual versus budgeted amounts, funding trends, shortages
in funding, etc.
8. What are the government’s priorities for civilian sector medical development and spending--
facilities, disaster and emergency response systems, training and education of medical personnel,
or medical transportation assets, etc.?
9. What are the priorities for military medical development and spending--facilities, equipment,
training and education of medical personnel, or medical transportation assets, etc.? Does the
military receive a significant portion of the country’s funds? Does the military medical system
receive an adequate amount of the funding to support the services?
10. What place do civilian leaders of the medical organizational structure hold in the
government/political hierarchy (cabinet level, ministry, etc.)?
11. What place do leaders of the military medical organizational structure hold in the military,
government, or political hierarchies?
12. If possible, provide definitive information on the civilian health care infrastructure. For
example, regional medical centers have up to 1,000 beds, provide a multitude of services
including trauma centers, and are located in major cities; district hospitals have 500 beds,
provide a multitude of services, and are located in large towns; and community hospitals have
100 beds or less, limited services, etc.
13. If possible, provide definitive information on the number, size, and mix of military hospital
and health care services, including field health units. For example, Army military regional
medical centers have up to 1,000 beds, provide a wide variety of services, and are located in
major cities; Navy military district hospitals have 500 beds, provide a multitude of services, and
are located at naval bases; battalion aid stations are manned by one physician’s assistant and
three medics, have two field ambulances, etc. In addition, provide information on allocation of
medical units, such as one field hospital per corps, three aid stations per battalion, etc.
14. Are there indications of mismanagement and/or corruption in the civilian or military health
care systems? If so, please explain.
15. Does the civilian or military system have established health care programs? What are they?
Are they funded, staffed, and effective?
16. What is the government’s health care emphasis—primary care, preventive care, etc.?
17. Are there written medical doctrines and procedural guidance for the civilian government
and/or military? Please provide.
18. How reliant is the structure on international assistance? (In some countries, health care would
not be available if it were not for international assistance).

pg: 32

Economic, Political, Religious, and Sociological Impact on Health Care

Questions on Health Care Impact
1. Does the government subsidize or fund the majority of health care for the population? Is there
an appearance of discrimination in the provision of health care? Does the subject of health care
funding receive positive or negative press?
2. Is there an increase in religious “fervor” that may affect health care provision for a particular
element within the culture. For example, in Afghanistan, the Taliban’s religious views have
hindered health care provision for females.
3. Are there cultural or religious health care practices that appear to be on the increase or
decrease? For example, in some countries, blood transfusion recipients expect or demand to
receive blood only from family members. Is the acceptance of blood from non-family members
on the rise?
4. Are civilian government leaders strong proponents of health care for the population? Have
leaders proposed plans and programs to improve health care? Are programs being implemented?
Are established programs working? Are they adequately funded?
5. Are there indications of health care discrimination against persons of certain gender, race,
religion, culture, or economic status? Does there appear to be an increase in discriminatory
behavior?