Outbreak control of community acquired pneumonia in a large military training institution

Suryam, Vani; Bhatti, V.K.; Kulkarni, Aniket; Mahen, Ajoy; Nair, Velu

doi:10.1016/j.mjafi.2014.09.015

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…1 Refers to infections that spread through sustained close contact rather than through casual contact (i.e., cold/flu microbes) 2 Reported incidence is likely not the true incidence as many authors included only patient participants or did not include data for participants lost to follow-up 3 Methods of confirmation of disease include: (a) isolation of pathogen from normally sterile site, (b) using a plaque reduction neutralization test, (c) using a real-time reverse transcription polymerase chain reaction, (d) serologically positive for infection as per specific antibody testing 4 Refers to symptoms of disease without microbiological testing on the transfer of participants during the study resulting in further spread to other locations [18,[24][25][26], and on personnel lost to follow-up [27][28][29], so true disease incidence could not be determined. Moreover, a few studies reported on the presence of travelling military personnel in civilian areas (e.g., airports; public transit) [30,31], providing opportunities for transmission between military and civilian populations.…”

Section: Disease Transmission Populationsmentioning

confidence: 99%

“…This mechanism is only applicable to the subset of articles taking place in training facilities (24%; 51/210), of which a majority (84%; 43/51) reported on it. Training assignments in remote and/or unmaintained areas (e.g., marshes) and participation in exercises with heavy physical components [25] were significantly associated with disease transmission. Specifically, travel to endemic areas, nocturnal exercises, low crawl training, sleeping in tents, poor nutrition and/ or dehydration, and crowded training bases were identified among possible risk factors for infection [53,54].…”

Section: Institutionalmentioning

confidence: 99%

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The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review

Chaufan

Dutescu

Fekre

et al. 2021

glob health res policy

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Background The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed evidence in the medical and public health literature for the military as a disease vector. Methods We searched 3 electronic databases without temporal restrictions. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub-themes. A content analysis was later performed and frequency distributions for each theme were generated. Results Of 6477 studies, 210 met our inclusion criteria and provided evidence, spanning over two centuries (1810–2020), for the military as a pathogen transmitter, within itself or between it and civilians. Biological mechanisms driving transmission included person-to-person transmission, contaminated food and water, vector-borne, and airborne routes. Contaminated food and/or water were the most common biological transmission route. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high-risk behaviours, and occupation-specific freedom of movement. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Selected social mechanisms, such as employment-related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military. Conclusions This study identified features of the military that pose a significant threat to global health, especially to civilian health in countries with substantial military presence or underdeveloped health systems. While biological transmission mechanisms are shared by other social groups, selected social transmission mechanisms are unique to the military. As an increasingly interconnected world faces the challenges of COVID-19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable global public health policies.

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Section: Disease Transmission Populationsmentioning

confidence: 99%

Section: Institutionalmentioning

confidence: 99%

The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review

Chaufan

Dutescu

Fekre

et al. 2021

glob health res policy

View full text Add to dashboard Cite

show abstract

“…Specifically, studies reported on military personnel assigned to complete multinational exercises, [17][18][19] with leave granted upon exercise completion 14,20 and subsequent travel of suspected cases to other locations, likely spreading disease. Studies also reported on the arrival of returning infected soldiers and infected recruits leading to outbreaks in the study population, or on the transfer of participants during the study resulting in further spread to other locations, 15,[21][22][23] and on personnel lost to follow-up, 24-26 so true disease incidence could not be determined. Moreover, a few studies reported on the presence of travelling military personnel in civilian areas (e.g., airports; public transit), 27,28 providing opportunities for military-to-civilian or civilian-to-military transmission.…”

Section: Policymentioning

confidence: 99%

“…42 Similarly, another article found that prophylaxis non-compliance was significantly correlated with disease, 47 with numerous others identifying prophylaxis non-compliance as a probable factor. 22 Other behavioural factors likely correlated with infection included lack of use of mosquito nets and approved-grade insect repellent sprays, and failure to wear permethrin-dipped and skin-covering clothing. 15 High-risk behaviour.…”

Section: Individualmentioning

confidence: 99%

“…This mechanism is only applicable to the subset of articles taking place in training facilities (24%; 51/210), of which a majority (84%; 43/51) reported on it. Training assignments in remote and/or unmaintained areas (e.g., marshes) and participation in exercises with heavy physical components22 were significantly associated with disease transmission. Specifically, travel to endemic areas, nocturnal exercises, low crawl training, sleeping in tents, poor nutrition and/or dehydration, and crowded training bases were identified among possible risk factors for infection 50,51.…”

mentioning

confidence: 99%

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The military as a neglected pathogen transmitter, from the 19th century to COVID-19: A systematic review

Chaufan

Dutescu

Fekre

et al. 2021

Preprint

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Background: The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed the evidence for the military as a disease vector, an historically relevant one, yet overlooked in times of COVID-19. Methods: We searched 3 electronic databases without temporal restrictions. We identified 2010 of 6477 studies spanning over two centuries (1810 – 2020) that met our inclusion criteria and provided evidence for the military as a pathogen transmitter, within itself or between it and civilians. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub–themes. A content analysis was later performed and frequency distributions for each theme were generated. Results: Biological mechanisms driving transmission included person–to–person transmission, contaminated food and water, vector–borne, and airborne routes. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high–risk behaviours, and occupation–specific freedom of movement. Contaminated food and/or water was the most common biological transmission route. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Certain social mechanisms, such as employment–related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military. Conclusions: Features of the military identified in this study pose a significant public health threat, especially to countries with substantial military presence or underdeveloped health systems. Many social transmission mechanisms, unlike biological ones, were unique to the military, facilitating large–spreader events and affecting civilian health. As an increasingly interconnected world faces the challenges of COVID–19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable pandemic policies.

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Streptococcus pneumoniae outbreaks and implications for transmission and control: a systematic review

et al. 2018

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BackgroundStreptococcus pneumoniae is capable of causing multiple infectious syndromes and occasionally causes outbreaks. The objective of this review is to update prior outbreak reviews, identify control measures, and comment on transmission.MethodsWe conducted a review of published S. pneumoniae outbreaks, defined as at least two linked cases of S. pneumoniae.ResultsA total of 98 articles (86 respiratory; 8 conjunctivitis; 2 otitis media; 1 surgical site; 1 multiple), detailing 94 unique outbreaks occurring between 1916 to 2017 were identified. Reported serotypes included 1, 2, 3, 4, 5, 7F, 8, 12F, 14, 20, and 23F, and serogroups 6, 9, 15, 19, 22. The median attack rate for pneumococcal outbreaks was 7.0% (Interquartile range: 2.4%, 13%). The median case-fatality ratio was 12.9% (interquartile range: 0%, 29.2%). Age groups most affected by outbreaks were older adults (60.3%) and young adults (34.2%). Outbreaks occurred in crowded settings, such as universities/schools/daycares, military barracks, hospital wards, and long-term care facilities. Of outbreaks that assessed vaccination coverage, low initial vaccination or revaccination coverage was common. Most (73.1%) of reported outbreaks reported non-susceptibility to at least one antibiotic, with non-susceptibility to penicillin (56.0%) and erythromycin (52.6%) being common. Evidence suggests transmission in outbreaks can occur through multiple modes, including carriers, infected individuals, or medical devices. Several cases developed disease shortly after exposure (< 72 h). Respiratory outbreaks used infection prevention (55.6%), prophylactic vaccination (63.5%), and prophylactic antibiotics (50.5%) to prevent future cases. PPSV23 covered all reported outbreak serotypes. PCV13 covered 10 of 16 serotypes. For conjunctival outbreaks, only infection prevention strategies were used.ConclusionsTo prevent the initial occurrence of respiratory outbreaks, vaccination and revaccination is likely the best preventive measure. Once an outbreak occurs, vaccination and infection-prevention strategies should be utilized. Antibiotic prophylaxis may be considered for high-risk exposed individuals, but development of antibiotic resistance during outbreaks has been reported. The short period between initial exposure and development of disease indicates that pneumococcal colonization is not a prerequisite for pneumococcal respiratory infection.Electronic supplementary materialThe online version of this article (10.1186/s41479-018-0055-4) contains supplementary material, which is available to authorized users.

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Outbreak control of community acquired pneumonia in a large military training institution

Cited by 5 publications

References 10 publications

The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review

The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review

The military as a neglected pathogen transmitter, from the 19th century to COVID-19: A systematic review

Streptococcus pneumoniae outbreaks and implications for transmission and control: a systematic review

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