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Background New military members undergo a highly-regimented 7-week training course during which trainees live and work within the same group of approximately 50 subjects for nearly 24 hours a day. This creates an optimal environment for assessing the impact of communal living on the collective skin microbiome. Purpose: The objective of this pilot study was to investigate dynamic changes of the skin microbiome in basic military trainees (BMT), in light of the unique environmental influences faced by this population. Patients and methods We evaluated collective changes in the skin microbiome of normal healthy adult basic trainees in response to communal living and universal Group A Strep prophylaxis with penicillin over the course of their initial 7-week training course. Samples from 10 flights of trainees were collected by swabbing upon arrival at Lackland AFB for their training (week 0) which is prior to prophylaxis with penicillin, at the 4 week point, and at the conclusion of their 7-week course of basic military training. Three separate high-throughput sequencing platforms and three bioinformatic pipeline analysis tools were utilized to assess the data. Results: At all three time points we found that the top three bacterial genus identified were Propionibacterium , Staphylococcus , and Corynebacterium . We detected a community membership difference between the initial week 0 samples and the week 4 and 7 samples. A strong inverse correlation between Propionibacterium and Staphylococcus was noted with Propionibacterium being high at week 0 and much lower at weeks 4 and 7; conversely, Staphylococcus was low at week 0 and higher at weeks 4 and 7, this relationship was noted in both the individual and collective specimens. Conclusion: The collective dermatologic microbiome in the military trainee population examined exhibited a relative increase in Staphylococcus and Corynebacterium abundance coupled with a relative decrease in Propionibacterium abundance in this observational pilot study. Additional studies are needed to further assess the causal impact of communal living and widespread penicillin chemoprophylaxis.

Since 2003, the U.S. Army has vaccinated deploying troops for smallpox. In 2008, the U.S. military transitioned to the second-generation vaccine ACAM2000. Cutaneous adverse events associated with this vaccine are rarely characterized. We review the medical literature on cutaneous adverse events with ACAM2000 and describe four new cases that occurred in primary vaccinees at Fort Wainwright, Alaska. Four cases of disseminated papulovesicular lesions occurred out of 500 smallpox vaccinations given at Fort Wainwright, Alaska. Each case was followed by dermatology and preventive medicine. Biopsy specimens were examined at Walter Reed Army Medical Center and the U.S. Centers for Disease Control and Prevention. Three of the cases had variable clinical history of dermatitis. Case 1 experienced the most extensive lesions and case duration, and Case 4 the least. All biopsy sample results confirmed immune-mediated hypersensitivity. This study relied on self-reporting and on surveillance by unit medical staff to identify cases. Each case also received multiple other concurrent vaccinations. Further study is needed to increase our knowledge of these cutaneous reactions and demonstrate possible associated or causal factors.

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