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Richard SA, Danaher PJ, White B, Mende K, Colombo RE, Burgess TH, Coles CL. Respiratory Infections Are More Common Than Healthcare Records Indicate: Results From an Anonymous Survey. Mil Med 2022; 188:usac016. [PMID: 35134203 PMCID: PMC9383359 DOI: 10.1093/milmed/usac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Influenza-like illnesses (ILIs) are common in military populations and can impair mission-readiness, particularly in the current severe acute respiratory syndrome coronavirus 2 pandemic; therefore, it is important to identify potential risk factors for infection and better understand the burden of infection. MATERIALS AND METHODS A survey was administered to military medical trainees living in a congregated setting on JBSA Fort Sam Houston, Texas, from January 2017 to February 2019. The survey included questions about ILI experience and potential ILI risk factors. RESULTS 2,121 individuals completed the survey. Respondents had a median age of 21 years, 46% were female, 32.6% were Air Force, 33.6% were Army, and 33.8% were Navy/Marines. Among the 815 (38%) who reported an ILI during training, 40% sought health care. The primary reasons for seeking healthcare included illness severity, concern about transmission, and accessibility of healthcare. Over half (54%) of the trainees who reported an ILI said the ILI had an impact on their performance, including reduced study time, missed physical training, and missed class. Multivariate model results indicate that women and younger trainees (<30 years) were more likely to report having had an ILI (women: OR 1.58, (95% CI 1.30, 1.92); age <30 years: OR 1.58, (1.06, 2.36)). In a subset analysis, those who reported washing their hands 10+ times per day were less likely to report an ILI (OR 0.61 (0.42, 0.89)). CONCLUSIONS ILIs are likely to be more common during training than healthcare records indicate and may result in decreased training effectiveness. Increasing access to handwashing facilities and education about the importance of handwashing to prevent the spread of disease will likely reduce the ILI burden in this population.
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Butler CR, Kasper KB, Huggins RA, Cropper TL, Frankel DN, Pawlak MT, Casey T, Casa DJ. Deaths Among U.S. Air Force Basic Military Trainees, 2008-2020. Mil Med 2022; 188:usab493. [PMID: 35043203 DOI: 10.1093/milmed/usab493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The U.S. Air Force (USAF) Basic Military Training (BMT), a rigorous training program for all enlisted members of the USAF, trains roughly 36,000 recruits annually. Transforming civilians into ready warrior airmen has inherent risks to trainee health, which has infrequently included death. While the average death rate at USAF BMT has decreased between 1956 and 2007 due to process improvement and preventive medicine efforts, further review is warranted to examine the deaths that have occurred since the last published period (1997-2007) and to determine the impact policy changes and updates have had on death rates since that time. Therefore, the purpose of this paper is to identify death rates and types from 2008 to 2020, explore policy implementation, and identify areas needing further improvement or modifications to the overall safety, fitness, and health of USAF BMT trainees. MATERIALS AND METHODS All deaths were examined and reviewed from 2008 through 2020 for trainees attending the USAF BMT using medical records and autopsy reports. Death rates were calculated using the total population of trainees in a given year as well as over the entire 13-year study period. RESULTS From 2008 to 2020, five deaths occurred among USAF BMT trainees (one cardiac, two exertional sickling due to sickle cell trait, one infection, and one suicide). This resulted in an overall average death rate of 1.08 per 100,000 trainees, as compared to 1.46 per 100,000 from 1997 to 2007. The last death in the study period occurred in 2016. CONCLUSION A modest downward trend of average death rate has continued since 2007, and no deaths from 2016 through 2020 represents the longest time frame without any deaths at USAF BMT over all times reported (dating back to 1956) which suggest that emergency best practice policies are/have improved. However, cardiac death rate and suicide rate have not changed since the last report. Policies and practices should be continuously reviewed and refined to reduce the risk of death at USAF BMT.
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Gentile G, Fréchard G, Dia A, Buzens A, Vives R, Jego M, Pommier de Santi V, Simon F. Incidence of acute respiratory tract infections (2006-2015) and influenza (2006-2013) among French armed forces. Med Mal Infect 2019; 50:689-695. [PMID: 31759689 DOI: 10.1016/j.medmal.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/21/2018] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We aimed to assess the incidence of respiratory tract infections in military settings between 2006 and 2015. PATIENTS AND METHODS We performed a retrospective epidemiological study of the entire military population from 2006 to 2015. Comprehensive data was collected from all medical centers, operational medical units, naval services, and army training hospitals and provided by the epidemiological surveillance of the armies. RESULTS The annual average population of the study was 331,394 soldiers. For acute respiratory tract infections (2006-2015), 22,818 cases were reported in metropolitan France, 3,211 cases in French overseas territories, 1,595 cases in the French Navy, and 1,318 cases in external military operations for a total of 28,942 cases. For influenza (2006-2013), 934 cases were reported in metropolitan France, 101 cases in French overseas territories, and 23 cases in external operations, for a total of 1,058 cases. The mean incidence rate of acute respiratory tract infections expressed as case number per 1,000 person-years (PY) was 8.7 PY (95% CI [8.6-8.8]) with an exceptional increased incidence rate in 2009 (25.9 PY, 95% CI [25.4-26.4]). The mean incidence rate of influenza was 0.35 PY (95% CI [0.33-0.37]) with a peak incidence rate of 1.9 PY in 2009. CONCLUSION Acute respiratory tract infections are at the forefront of infectious episodes in the French armies. Although not necessarily severe, current prevention measures are not enough to reduce the incidence threshold of these infections and need to be improved.
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Affiliation(s)
- G Gentile
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France; Inserm 1106, Institut des neurosciences des systèmes, Aix Marseille université, 13885 Marseille, France; Comité pédagogique, hôpital d'instruction des Armées Laveran, 13384 Marseille, France.
| | - G Fréchard
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France
| | - A Dia
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - A Buzens
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - R Vives
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - M Jego
- Département universitaire de médecine générale, faculté de médecine, Aix Marseille université, 13885 Marseille, France; Centre d'études et de recherche sur les services de santé et qualité de vie (CERESS), Aix Marseille université, 13385 Marseille, France
| | - V Pommier de Santi
- Centre d'épidémiologie et de santé publique des armées, 13014 Marseille, France
| | - F Simon
- Comité pédagogique, hôpital d'instruction des Armées Laveran, 13384 Marseille, France; Department of infectious diseases and tropical medicine, Laveran military teaching hospital, 13384 Marseille, France
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Rayne F, Wittkop L, Bader C, Kassab S, Tumiotto C, Berciaud S, Wodrich H, Lafon ME. Rapid Adenovirus typing method for species identification. J Virol Methods 2017; 249:156-160. [PMID: 28918074 DOI: 10.1016/j.jviromet.2017.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/28/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
Adenoviruses are characterized by a large variability, reflected by their classification in species A to G. Certain species, eg A and C, could be associated with increased clinical severity, both in immunocompetent and immunocompromised hosts suggesting that in some instances species identification provides clinically relevant information. Here we designed a novel "pVI rapid typing method" to obtain quick, simple and cost effective species assignment for Adenoviruses, thanks to combined fusion temperature (Tm) and amplicon size analysis. Rapid typing results were compared to Sanger sequencing in the hexon gene for 140 Adenovirus-positive clinical samples included in the Typadeno study. Species A and C could be identified with a 100% positive predictive value, thus confirming the value of this simple typing method.
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Affiliation(s)
- Fabienne Rayne
- Univ Bordeaux, CNRS, UMR 5234 Fundamental Microbiology and Pathogenicity, F-33000, Bordeaux, France
| | - Linda Wittkop
- Univ Bordeaux, ISPED Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, F-33000 Bordeaux, France
| | - Clément Bader
- CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, F-33000 Bordeaux, France
| | - Somar Kassab
- Univ Bordeaux, CNRS, UMR 5234 Fundamental Microbiology and Pathogenicity, F-33000, Bordeaux, France
| | - Camille Tumiotto
- Univ Bordeaux, CNRS, UMR 5234 Fundamental Microbiology and Pathogenicity, F-33000, Bordeaux, France; CHU de Bordeaux, Pôle de Biologie et Pathologie, Laboratoire de Virologie, F-33000 Bordeaux, France
| | - Sylvie Berciaud
- CHU de Bordeaux, Pôle de Pédiatrie, F-33000 Bordeaux, France
| | - Harald Wodrich
- Univ Bordeaux, CNRS, UMR 5234 Fundamental Microbiology and Pathogenicity, F-33000, Bordeaux, France
| | - Marie-Edith Lafon
- Univ Bordeaux, CNRS, UMR 5234 Fundamental Microbiology and Pathogenicity, F-33000, Bordeaux, France; CHU de Bordeaux, Pôle de Biologie et Pathologie, Laboratoire de Virologie, F-33000 Bordeaux, France.
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Hang J, Vento TJ, Norby EA, Jarman RG, Keiser PB, Kuschner RA, Binn LN. Adenovirus type 4 respiratory infections with a concurrent outbreak of coxsackievirus A21 among United States Army Basic Trainees, a retrospective viral etiology study using next-generation sequencing. J Med Virol 2017; 89:1387-1394. [PMID: 28198541 DOI: 10.1002/jmv.24792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/30/2017] [Indexed: 11/09/2022]
Abstract
Human adenoviruses (HAdV), in particular types 4 and 7, frequently cause acute respiratory disease (ARD) during basic military training. HAdV4 and HAdV7 vaccines reduced the ARD risk in U.S. military. It is important to identify other respiratory pathogens and assess their potential impact on military readiness. In 2002, during a period when the HAdV vaccines were not available, throat swabs were taken from trainees (n = 184) with respiratory infections at Fort Jackson, South Carolina. Viral etiology was investigated initially with viral culture and neutralization assay and recently in this study by sequencing the viral isolates. Viral culture and neutralization assays identified 90 HAdV4 isolates and 27 additional cultures that showed viral cytopathic effects (CPE), including some with picornavirus-like CPE. Next-generation sequencing confirmed these results and determined viral genotypes, including 77 HAdV4, 4 HAdV3, 1 HAdV2, 17 coxsackievirus A21 (CAV21), and 1 enterovirus D68. Two samples were positive for both HAdV4 and CAV21. The identified genotypes are phylogenetically close to but distinct from those found during other years or in other military/non-military sites. HAdV4 is the predominant respiratory pathogen in unvaccinated military trainee. HAdV4 has temporal and demographic variability. CAV21 is a significant respiratory pathogen and needs to be evaluated for its current significance in military basic trainees.
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Affiliation(s)
- Jun Hang
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Todd J Vento
- Preventive Medicine Department, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Erica A Norby
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Paul B Keiser
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Robert A Kuschner
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Leonard N Binn
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Clemmons NS, McCormic ZD, Gaydos JC, Hawksworth AW, Jordan NN. Acute Respiratory Disease in US Army Trainees 3 Years after Reintroduction of Adenovirus Vaccine 1. Emerg Infect Dis 2017; 23:95-98. [PMID: 27748651 PMCID: PMC5176242 DOI: 10.3201/eid2301.161297] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The 1999 cessation of vaccination against adenovirus types 4 and 7 among US Army trainees resulted in reemergence of acute respiratory disease (ARD) outbreaks. The 2011 implementation of a replacement vaccine led to dramatic and sustained decreases in ARD cases, supporting continuation of vaccination in this population at high risk for ARD.
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Koren MA, Arnold JC, Fairchok MP, Lalani T, Danaher PJ, Schofield CM, Rajnik M, Hansen EA, Mor D, Chen WJ, Ridoré M, Burgess TH, Millar EV. Type-specific clinical characteristics of adenovirus-associated influenza-like illness at five US military medical centers, 2009-2014. Influenza Other Respir Viruses 2016; 10:414-20. [PMID: 27062998 PMCID: PMC4947946 DOI: 10.1111/irv.12392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 12/11/2022] Open
Abstract
Background Adenovirus is a recognized cause of influenza‐like illness (ILI). The proportion of ILI attributable to adenovirus is not known. Moreover, knowledge gaps remain with respect to the epidemiologic, virologic, and clinical characteristics of adenovirus‐associated ILI among otherwise healthy individuals. Methods An observational, longitudinal study of <65‐year‐old patients with febrile ILI at five medical centers was conducted from 2009 to 2014. Nasopharyngeal specimens obtained at enrollment were first tested by single‐reaction PCR for adenovirus, then further evaluated by a multiplex PCR assay for other respiratory viral pathogens. Symptoms over a 28‐day period were collected. Results We enrolled 1536 individuals, among whom 43 (2·8%) were positive for adenovirus. The median age of cases was 3·4 years (range: 4 months to 41 years). Three were hospitalized. Species and serotype information was available for 33 (76·7%) cases. Species C (n = 21) was the most common, followed by B3 (n = 9) and one each of E4a, D46, and A. Species C infections were more frequent in children (P < 0·01). Half of the cases were positive for at least one other respiratory viral pathogen. Symptoms were generally mild and most commonly included cough (90%), fatigue (79%), rhinorrhea (74%), loss of appetite (71%), and sore throat (64%). Children with non‐C adenovirus infection were more likely to report sore throat (P = 0·05) and hoarseness (P = 0·06) than those with species C infection. Conclusions Adenovirus is frequently detected with other respiratory viruses. Persons with non‐C adenovirus infections reported more severe symptoms, suggesting there may be species‐specific differences in virulence and/or host response to infection.
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Affiliation(s)
- Michael A Koren
- Walter Reed National Military Medical Center, Washington, DC, USA
| | | | - Mary P Fairchok
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.,Madigan Army Medical Center, Fort Lewis, WA, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.,Naval Medical Center, Portsmouth, VA, USA
| | | | | | - Michael Rajnik
- Walter Reed National Military Medical Center, Washington, DC, USA
| | - Erin A Hansen
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA.,Naval Health Research Center, San Diego, CA, USA
| | - Deepika Mor
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | | | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
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