Johns et al. BMC Public Health 2011, 11(Suppl 2):S3 http://www.biomedcentral.com/1471-2458/11/S2/S3 Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand; the U.S. Army Medical Research Unit-Kenya (USAMRU-K) in Nairobi, Kenya; the U.S. Naval Medical Research Center Detachment (NMRCD) in Lima, Peru; the U.S. Naval Medical Research Unit No. 2 (NAMRU-2) in Jakarta, Indonesia; and the U.S. Naval Medical Research Unit No. 3 (NAMRU-3) in Cairo, Egypt. Addi- tionally, the AFHSC-GEIS network includes substantial contributions from three U.S.-based research laboratories and a major regional medical center in Europe. The Naval Health Research Center (NHRC) in San Diego, California, conducts population-based surveillance among basic military trainees at eight of the 10 major training centers in the United States; disease surveillance among shipboard service members in the 2nd (Atlantic), 3rd (Pacific), and 7th (Far East) U.S. Naval fleets; and infectious disease surveillance in six clinics and two hos- pitals along the United States-Mexico border [in colla- boration with the U.S. Centers for Disease Control and Prevention (CDC) and the County of San Diego Health Department]. The U.S. Air Force School of Aerospace Medicine (USAFSAM) in San Antonio, Texas, which serves as the Air Force’s clinical reference laboratory and public health center, is the lead organization for the U.S. military’s installation-based, influenza sentinel surveil- lance program. The Walter Reed Army Institute of Research’s Division of Viral Diseases (WRAIR-DVD) in Silver Spring, Md., provides full-length genomic sequen- cing capability and conducts surveillance among U.S. civilians assigned to Department of State embassies over- seas. Additionally, Landstuhl Regional Medical Center (LRMC) and the United States Army Public Command Health Region-Europe (PHCR-Europe) in Landstuhl, Germany, function as a regional military medical center and support surveillance for respiratory pathogens and other emerging infectious diseases (EID) within the U.S. European Command. Additionally, AFHSC-GEIS has been a member institution and contributing partner in the WHO’s Global Outbreak Alert and Response Network since 1999. Rapid identification of outbreaks and support of timely response efforts are key components of complying with the World Health Organization’s (WHO) International Health Regulations (IHR) (2005), and are core focus areas and strategic goals of the AFHSC-GEIS network [5]. Support for these efforts, provided in response to host country requests for assistance with new or ongoing outbreaks, consists of a wide range of functions, such as field team support, epidemiology or consultative support, and laboratory diagnostic support. These efforts and collaborative exchanges strengthen relationships, build and maintain trust, and are a critical component of the long-standing relationships between the network partners and their sponsor host countries. Many of the Page 2 of 9 partnerships between the United States and host coun- try militaries (mil-mil) partnerships that have developed over the years have served to empower the host country military’s role in supporting outbreak response activities within their own countries [6]. In late 2006, Chretien et al., provided a detailed break- down of how the broad-ranging DoD’s global disease sur- veillance network could potentially serve as a model for other global public health entities to adequately identify and respond to these complex threats [7]. This paper describes how the AFHSC-GEIS network has significantly contributed toward effective outbreak identification and response and capacity building within partner host coun- tries [8] under the guiding principles of the WHO’s IHR (2005) [9]. For clarity and for the purposes of this assess- ment, we will describe the accomplishments of the AFHSC-GEIS network during fiscal year 2009 (Oct. 1, 2008 through Sept. 30, 2009) through two categories: respiratory disease outbreaks and non-respiratory EID outbreaks. Accomplishments General The AFHSC-GEIS network responded to 76 outbreaks (Table 1, Figure 1) in 53 countries during the 2009 fiscal year (FY09), several in direct support of the IHR (2005). The most common diseases investigated were influenza (47), cholera (four), dengue fever (four) and hepatitis (three). Human disease was present in all but one of these outbreaks, and specific causative agents were iden- tified in 69 (92 percent) of them. The population affected ranged from less than 10 individuals to several thousand, and support efforts were often ongoing engagements beyond the initial investigation. The type of population supported also varied, depending on the relationship and the nature of the mission of the laboratory partner. Thirty-six (48 percent) of the outbreak investigations involved partners supporting civilian entities through for- mal bilateral requests or as part of their role as a WHO regional reference laboratory (NAMRU-3, AFRIMS and USAMRU-K). In the majority of these instances, testing of samples from civilian populations was performed. Twenty-four (32 percent) of the partner responses involved outbreaks among U.S. troops stationed in the continental United States (CONUS) or at overseas loca- tions, while 15 (20 percent) of the responses involved investigations in collaboration with foreign military part- ners and multinational forces involved in peacekeeping activities or exercises. One investigation involved influ- enza testing of U.S. expatriates through the U.S. Embassy clinic in Jakarta, Indonesia. Response activities included a range of efforts from the provision of simple consultative services to com- prehensive outbreak packages that included field