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Article History

Accepted: 28 June 2025

First Online: 12 July 2025

Declarations

:

: Funding for this project was provided by the Uniformed Services University through the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. under Cooperative Agreement #HU00011920042. The views expressed are solely those of the authors and do not reflect the official policy or position of the Uniformed Services University, US Army, US Navy, US Air Force, the Department of Defense, the US Government, or the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.

: The authors (M.S.P., M.Y.A., C.T.C., M.M., G.H., and K.B.H.) have no relevant financial or nonfinancial interests to disclose.

: This retrospective observational study was provided an exempt research determination by the Uniformed Services University Institutional Review Board (DBS.2024.728).

: Not applicable.

: Not applicable.

: The datasets generated and analyzed in this study are not publicly available owing to data sharing regulations and requirements of the US Department of Defense. Requests for data must be made directly to the US Defense Health Agency by investigators through data sharing agreement procedures, as indicated here: .

: Not applicable.

: All authors provided substantial contributions and approved the final manuscript. All authors read and approved the final version. Specific contributions are detailed as follows: M.S.P. carried out conceptualization, methodology, project administration, supervision, writing of original draft, review and editing of final draft. M.Y.A. carried out conceptualization, methodology, formal analysis, investigation, software, visualizations, writing of original draft, review and editing of final draft. C.T.C. carried out conceptualization, methodology, writing of original draft, review and editing of final draft. M.M. carried out conceptualization, methodology, writing of original draft, review and editing of final draft. G.H. carried out conceptualization, methodology, protocol development and regulatory approval, writing of original draft, and review and editing of final draft. K.B.H. carried out conceptualization, methodology, protocol development and regulatory approval, project administration, supervision, writing of original draft, and review and editing of final draft.