DeFraites BMC Public Health 2011, 11(Suppl 2):S1 http://www.biomedcentral.com/1471-2458/11/S2/S1 operational relevance. The information is especially use- ful for developing precise estimates of prevalence and incidence of infectious diseases in the armed forces. Another major theme in the years preceding establish- ment of AFHSC was the recognition of the global health threat posed by emerging and re-emerging infectious dis- eases [11] and the important role DoD, through its net- work of clinical, reference and research laboratories in the U.S. and elsewhere, should play in the national effort [12]. To address these needs, DoD-GEIS was established in 1996, with a central hub at the Walter Reed Army Institute of Research. As in the case of AMSA, DoD- GEIS operated as an Army Medical Department DoD Executive Agency. In 2009, AFHSC and its partner organizations were presented many opportunities to build on this proud legacy and make important health surveillance contribu- tions, many of which are described below in relation to the singular public health event of the year, the influ- enza H1N1 pandemic. Response coordination Upon recognition of the novel influenza virus H1N1 in April 2009, AFHSC mobilized the military public health community by convening a series of teleconferences linking community of interest, surveillance and public health professionals at armed forces public health cen- ters, Centers for Disease Control, Combatant Com- mands and staffs of the Service Surgeons General to share information and resources and to standardize the collective approach to surveillance, case reporting and disease control. The center provided a consolidated DoD pandemic H1N1 report on a weekly basis for the remainder of 2009, as the epidemic spread through mili- tary population worldwide. Additionally, AFHSC staff augmented those of the Naval Environmental and Pre- ventive Medicine Unit 5 in evaluating an outbreak of pandemic H1N1 aboard the USS Boxer in July 2009. Reporting of public health emergencies of international concern As the Defense Department’s lead public health agency, AFHSC is positioned to play a key role in coordinating the reporting of DoD public health emergencies of inter- national concern (PHEIC), in accordance with Interna- tional Health Regulations as updated in 2005. In general, DoD is responsible for identifying PHEICs in its population, including events occurring in military com- munities abroad, and reporting these through appropri- ate U.S. government channels to the World Health Organization (WHO). The onset of the influenza pandemic forced the early exercise of this role, and facilitated its clarification as the year continued. DoD Instruction 6200.03 (Subject: Page 2 of 4 “Public Health Emergency Management within the Department of Defense,” March 5, 2010), formalizing this role, had not yet been completed, and the experi- ence of the center through the initial months of the pandemic helped define and resolve some policy issues regarding roles, responsibilities and communication links. Development and promulgation of military public health surveillance standards Public health information becomes more meaningful when data can be compared across multiple agencies over time. Counts, rates and conclusions drawn from the information are rendered more valuable when agen- cies share common definitions for key terms and adopt standard procedures for calculating important indicators using these definitions. The center has been charged with leading the U.S. military public health community in the adoption and promulgation of numerous important health surveillance standards. For several years, military medical depart- ments have used a common set of definitions for repor- table medical events requiring individual case reports to service public health centers and AFHSC. As a result, this list includes approximately 70 conditions of military public health interest, including infectious diseases, such as malaria and leishmaniasis, as well as noninfectious conditions, such as heat and cold injury and lead expo- sure. The center coordinated the most recent update of this list, adopted in June 2009 [13], culminating the efforts of a multiservice work group during the previous year. In a similar manner, AFHSC worked in close coor- dination with staff of the DoD Centers of Excellence for Psychological Health and Traumatic Brain Injury (espe- cially the Defense and Veterans Brain Injury Center), to develop surveillance case definitions for traumatic brain injury. As the influenza pandemic of 2009 progressed, the surveillance requirements appropriately changed from an initial approach that emphasized individual case find- ing, laboratory confirmation and documentation of spread to previously unaffected areas, to one that focused on vulnerable populations and clinical severity measures. The center, working with partners in the Ser- vices and elsewhere, coordinated DoD’s effort to ensure that the pandemic was tracked in a standard, appropri- ate and timely manner, while yielding vital statistics required by senior leaders. Seminars, exercises and symposia Epidemiology is AFHSC’s core competency, since another of its mission areas is training and continuing education in epidemiology and public health. The center was especially active during 2009 with symposia on