About

Hunter Jackson Smith, MD, MPH, MBE, FACPM, is a Major in the U.S. Army Medical Corps and serves as the Focus Area Lead for Antimicrobial Resistant Infections at the Department of Defense Global Emerging Infections Surveillance Branch in Silver Spring, MD. He oversees the DoD’s disease surveillance efforts worldwide for antimicrobial resistance, enteric pathogens, and sexually transmitted infections. Smith is an Assistant Professor at the Uniformed Services University in the Department of Preventive Medicine and Biostatistics, where he teaches preventive medicine, epidemiology, and emerging infectious disease topics. Additionally, he is an Adjunct Assistant Professor at the Johns Hopkins Berman Institute of Bioethics, teaching bioethics across various topics. He practices travel medicine at the Walter Reed National Military Medical Center, supervising preventive medicine residents. Smith has been elected to the Board of Regents for the American College of Preventive Medicine and serves on editorial boards for the Journal of Law, Medicine, & Ethics and AJPM Focus. He participates in several national task forces, including the U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria, the Transatlantic Taskforce on Antimicrobial Resistance, and the VA/DoD Evidence-Based Practice Working Group. He is board certified in General Preventive Medicine and Public Health. Smith holds degrees from Tulane University in Philosophy and Religious Studies, Epidemiology, and Medicine, and earned an MBE from Johns Hopkins Bloomberg School of Public Health. His research interests include the intersection of epidemiology and bioethics, military medicine, emerging infectious diseases, social determinants of health, and obesity.

Research topics

• Medicine
• Virology
• Biology
• Environmental health
• Microbiology

Selected publications

• Does Gabapentin Use Following ACDF Decrease Opioid Utilization? A Retrospective Propensity-Matched Analysis Conducted in Academic Medical Centers

  Global Spine Journal · 2026-03-20

  articleOpen access

  Study Design Retrospective Propensity-Matched Analysis. Objectives Optimal control of postoperative pain while minimizing opioid consumption is paramount in spine surgery. While gabapentinoids have robust utilization for the treatment of neuropathic pain and neuroprotective effects, their interplay in multimodal analgesia following ACDF is unclear. The objective of the present study was to investigate the association between postoperative gabapentinoid use and postoperative opioid use following ACDF. Methods We conducted a retrospective cohort study using the TriNetX Research network, identifying adult patients who underwent ACDF between 2003-2023. Patients with chronic opioid use were excluded. After 1:1 propensity score matching, cohorts were constructed based on receipt of postoperative gabapentinoids vs acetaminophen monotherapy. Outcomes included opioid utilization and surgical/systemic complications across standardized follow-up intervals (30 days, 90 days, 6 months, 1 year, 2 years, and 5 years). Risk ratios with 95% confidence intervals were calculated, and Kaplan-Meier analyses assessed time-to-event outcomes. Results After matching, 32 455 patients were included in each group. Gabapentinoid use was associated with higher opioid consumption at every interval, persisting through 5 years (2.29% vs 0.51% at 5 years, RR 4.61, P < 0.001). Gabapentinoid recipients had a greater risk of pneumonia and respiratory failure across multiple timepoints. Kaplan-Meier curves demonstrated durable separation between groups for pneumonia, respiratory failure, and opioid use (all log-rank P < 0.001). Conclusion Gabapentinoids use following ACDF was associated with increased opioid utilization and higher complication rates, challenging their presumed benefit in this setting. These findings suggest that gabapentinoids may not be an effective adjunct in multimodal pain regimens for ACDF.

  PublisherDOI

• ACDF and cervical disc replacement for single-level cervical spine degenerative disease: a frailty driven propensity score-matched comparative analysis

  European Spine Journal · 2026-02-04

  article
  PublisherDOI

• Surgical Site Infection After Primary Posterior Lumbar Fusion Increases the Risk of New-Onset Mental Health Disorders:

  Spine Open · 2026-02-16

  articleOpen access

  Study Design: Retrospective cohort study using the TriNetX Global Research Network. Objective: To evaluate whether surgical site infection (SSI) after primary posterior lumbar fusion (PLF) is associated with increased risk of developing new mental health disorders (MHDs) over short-term and long-term follow-up. Summary of Background Data: Surgical site infections affect up to 9% of patients undergoing spine surgery and are known to increase physical morbidity. However, the psychological impact of SSI is poorly understood. Although postoperative complications have been linked to new-onset MHDs in general surgical populations, the specific risk attributable to SSI in primary PLF patients remains unclear. Methods: Adult patients (≥18 yr) undergoing primary PLF were identified and stratified by the presence or absence of postoperative SSI. Patients with pre-existing MHDs were excluded. Propensity score matching was performed 1:1 based on age, sex, race and ethnicity, BMI, comorbidities, preoperative labs, nicotine use, and socioeconomic factors, yielding 1,859 matched pairs. New-onset diagnoses of depression, anxiety, and substance use disorder (SUD) were assessed at 30 days, 90 days, 6 months, 1 year, and 2 years, and risk ratios (RR) with 95% CIs were calculated using χ 2 testing and Kaplan-Meier methods. Results: At 30 days, anxiety was more common in the SSI cohort (RR 2.63, P =0.004), whereas depression and SUD were not significantly different (both P >0.05). By six months, depression (RR: 1.69, P =0.021), anxiety (RR: 1.97, P =0.001), and SUD (RR: 1.87, P =0.04) were all elevated in the SSI group. At one year, depression (RR: 1.64, P =0.013) and anxiety (RR: 1.41, P =0.046) remained significantly higher, whereas SUD was similar between cohorts (RR: 0.98, P =0.93). Conclusions: Postoperative SSI significantly increases the risk of long-term psychological morbidity emphasizing the need for early mental health screening and intervention after infection.

  PublisherDOI

• Utility of Expanded Genetic Analysis for Pediatric Patients with Primary Immunodeficiency

  Medical Research Archives · 2026-01-01

  articleOpen access1st authorCorresponding

  Background Given the heterogenicity among primary immune deficiency (PID) or inborn errors of immunity (IEI) presentations, genetic testing can aid in diagnosis. Despite the convenience of genetic testing, numerous challenges arise, including accessibility and cost. Aims Our goal was to determine if a gene panel approach was sufficient in identifying PID or if expanded testing would be more beneficial. Methods A retrospective chart review analyzed the diagnostic yield for all patients with suspected PID that underwent PID panel testing at our hospital. Subsequently, from January 2021 to August 2024 caregivers of patients with a negative or non-diagnostic PID panel result were consented for additional exome analysis. Expanded analysis was performed via genotypic-based and phenotypic-driven analysis derived from Human Phenotype Ontology terms from chart notes. Variants of potential clinical interest were identified utilizing American College of Medical Genetics and Genomics recommendations for sequence variant interpretation. Variants of interest were cross-referenced to patient phenotype. Results Of the 174 panels run, there was a positive diagnostic yield of 19%. Twelve patients had expanded analysis completed with mean age of symptom presentation of 4.3 years. Expanded analysis identified numerous additional variant of uncertain significance as well as 1 new pathogenic variant. Conclusion This analysis resulted in a minimal increase in diagnostic yield compared to panel testing. Although only 1 new pathogenic variant consistent with the patient's phenotype was identified; the increase in variants of interest from the expanded analysis supports the value of ongoing genomic reanalysis. Given the comparable diagnostic yield, PID panels remain a cost-effective approach at this time.

  PublisherOA PDFDOI

• Concordance Between Self-Reported and Objectively Assessed Substance Use Amongst Patients Receiving Methadone or Buprenorphine for Opioid Use Disorder

  Drug and Alcohol Dependence · 2025-02-01

  article1st authorCorresponding
  PublisherDOI

• CARB Your Enthusiasm: An Ethics-Informed Analysis for Clinicians of the US National Action Plan for Combating Antibiotic-Resistant Bacteria

  Clinical Infectious Diseases · 2025-08-30

  articleOpen access1st authorCorresponding

  The United States National Action Plan for Combating Antibiotic-Resistant Bacteria provides strategic direction within the nation's interagency to mitigate antibiotic resistance. This commentary provides an ethics-informed analysis of this document's implications for clinical management of infectious diseases and antibiotic prescribing.

  PublisherOA PDFDOI

• Food allergen introduction practices and parent/caregiver attitudes based on family history of food allergy

  Frontiers in Allergy · 2025-03-19 · 1 citations

  articleOpen access1st authorCorresponding

  Background: The National Institute of Allergy and Infectious Disease (NIAID) addendum guidelines for primary prevention of peanut allergy1 provide recommendations regarding peanut introduction, and a recent consensus statement highlighted the importance of timely introduction of other commonly allergenic solids, and the role of family history as a risk factor.2ObjectiveTo determine whether children in households with a food allergic parent/caregiver or sibling have different rates of being fed commonly allergenic solids during the first year of life than children lacking this family history. Methods: A pretested survey was administered between January-February 2021 to a U.S. sample of 3,062 parents/caregivers of children born since the NIAID Addendum guidelines. Survey-weighted chi-square statistics and logistic regression models tested the independence of key variables across strata of interest before and after covariate adjustment. Results: Peanut, almond, shellfish, and other tree nuts are more likely to be introduced to children with one or more food-allergic caregivers. Respondents with food-allergic parents (39.3%) and siblings with FA (35.8%) were more familiar with the 2017 NIAID guidelines compared to parents (12.9%) and siblings without FA (12.7%). Conclusion: Findings suggest that respondents with food-allergic parents and siblings are more likely to have many of the most prevalent allergens introduced at younger ages, which could be due to knowledge related to the NIAID-sponsored guidelines and other national guidance, but that even among these higher-risk families overall rates of "early" introduction during infancy still remain relatively low.

  PublisherOA PDFDOI

• Loss to Follow-Up and Visit Nonadherence in an HIV Incidence Cohort in Kisumu, Kenya

  JAIDS Journal of Acquired Immune Deficiency Syndromes · 2025-12-26

  article

  BACKGROUND: Adherence to study visits enhances safety and validity of human research studies. We identified characteristics associated with missed visits in a Kenyan HIV incidence study to inform retention strategies. METHODS: We enrolled volunteers 18-35 years of age, without HIV, who reported 2+ sex partners into a study with visits every 3 months for 24 months. We used zero-inflated Poisson regression to assess sociobehavioral and demographic characteristics associated with missed visits and loss-to-follow-up. Latent class analysis (LCA) identified clusters of characteristics associated with each outcome. RESULTS: Among 619 participants without HIV, 278 (44.9%) were women with median age of 24 years (interquartile range: 21-28). During follow-up, 134 (21.6%) missed 1+ and 84 (13.6%) missed 2+ visits. Missed visits were more common among participants with 3+ sexual partners than among 2 partners (adjusted risk ratio: 1.50, 95% confidence interval: 1.13 to 1.97) and less common in participants who completed secondary school (aRR: 0.74, 95% CI: 0.56 to 0.99, compared with some primary school or less). Women were more likely to be lost to follow-up (aRR: 1.85, 95% CI: 1.05 to 3.26). LCA showed that missed visits were more likely among women aged 24+ years with less than secondary education who reported transactional sex than among largely younger unmarried men with less than secondary education and 3+ sexual partners (RR: 1.24, 95% CI: 1.01 to 1.54) and poorly educated, largely older married men (RR: 1.41, 95% CI: 1.05 to 1.90). CONCLUSION: Older unmarried women with less education, more sexual partners, and transactional sex may benefit from targeted retention strategies such as optimizing accessibility to testing and prevention services and frequent visit reminders.

  PublisherDOI

• Molecular Surveillance of Multidrug-Resistant Bacteria among Refugees from Afghanistan in 2 US Military Hospitals during Operation Allies Refuge, 2021

  Emerging infectious diseases · 2024-10-01 · 4 citations

  articleOpen access

  ) and 16S methyltransferases (rmtC and rmtF). Considering the rising transmission of antimicrobial resistance and unprecedented population displacement globally, these data are a reminder of the need for robust infection control measures and surveillance.

  PublisherDOI

• Genomic Epidemiology of Multidrug-Resistant <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> in Kenya, Uganda, and Jordan

  Emerging infectious diseases · 2024-10-01 · 7 citations

  articleOpen access

  Surveillance of antimicrobial resistance in Kenya, Uganda, and Jordan identified multidrug-resistant high-risk bacterial clones: Escherichia coli sequence types 131, 1193, 69, 167, 10, 648, 410, 405 and Klebsiella pneumoniae sequence types 14, 147, 307, 258. Clones emerging in those countries exhibited high resistance mechanism diversity, highlighting a serious threat for multidrug resistance.

  PublisherDOI

Frequent coauthors

• Joy Piotrowski

  Providence College

  10 shared

• Zackary Berger

  Johns Hopkins University

  9 shared

• Solomon Otieno

  United States Army Medical Research Directorate - Africa

  8 shared

• Carolyne Kifude

  8 shared

• Stephen Ocholla

  United States Army Medical Research Directorate - Africa

  8 shared

• Janet Oyieko

  United States Army Medical Research Directorate - Africa

  8 shared

• Jack Hutter

  United States Army Medical Research Directorate - Africa

  8 shared

• Lillian Musila

  United States Army Medical Research Directorate - Africa

  7 shared

Education

• MBE

  Johns Hopkins Bloomberg School of Public Health

  2019

• MPH

  Tulane University School of Public Health and Tropical Medicine

  2017

• MD

  Tulane University School of Medicine

  2017

• BA

  Tulane University

  2013

Awards & honors

• MBE from the Johns Hopkins Bloomberg School of Public Health