Respiratory infections in the military

O’Shea, Matthew K.; Wilson, David E.

doi:10.1136/jramc-2013-000110

Cited by 12 publications

(10 citation statements)

References 113 publications

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“…23 It is likely that where cases are infrequently encountered, individuals will be less practised at recognising heat illness and will rightly err on the side of overdiagnosis. This is one of the reasons that we expect reporting to the AHU and the AINC to have included episodes of incapacity that masqueraded as heat illness, but were not, such as disturbances of metabolic or cardiac origin.…”

Section: Discussionmentioning

confidence: 99%

Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009–2013

et al. 2015

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BackgroundHeat illness in the Armed Forces is considered preventable. The UK military relies upon dual Command and Medical reporting for case ascertainment, investigation of serious incidents and improvement of preventive practices and policy. This process could be vulnerable to under-reporting.ObjectivesTo establish whether heat illness in the British Army has been under-reported, by reviewing concordance of reporting to the Army Incident Notification Cell (AINC) and the Army Health Unit (AHU) and to characterise the burden of heat illness reported by these means.MethodsAnalysis of anonymised reporting databases held by the AHU and AINC, for the period 2009–2013.Results565 unique cases of heat illness were identified. Annual concordance of reporting ranged from 9.6% to 16.5%. The overall rate was 13.3%. July was the month with the greatest number of heat illness reports (24.4% of total reporting) and the highest concordance rate (30%). Reports of heat illness from the UK (n=343) exceeded overseas notifications (n=221) and showed better concordance (17.1% vs 12.8%). The annual rate of reported heat illness varied widely, being greater in full-time than reservist personnel (87 vs 23 per100 000) and highest in full-time untrained personnel (223 per100 000).ConclusionsThe risk of heat illness was global, year-round and showed dynamic local variation. Failure to dual-report casualties impaired case ascertainment of heat illness across Command and Medical chains. Current preventive guidance, as applied in training and on operations, should be critically evaluated to ensure that risk of heat illness is reduced as low as possible. Clear procedures for casualty notification and surveillance are required in support of this and should incorporate communication within and between the two reporting chains.

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Section: Discussionmentioning

confidence: 99%

Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009–2013

et al. 2015

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“…ARDs have been particularly problematic in recruit and other military training environments, where close and crowded living conditions (10), physical and psychological stresses (11), environmental challenges (12), and demanding physical training (13) lead to more intense exposure as well as a state of relative immune compromise (14). Higher ARD rates are routinely seen among recruits than among older, more experienced military personnel.…”

Section: The Military Trainee Environment and Increased Risks Relatedmentioning

confidence: 99%

“…Detailed examination of the interaction between these two pathogens suggested several possible mechanisms (422,424). First, pneumococcal NP carriage rates increase during the influenza season (425), with "baseline" NP carriage rates of 1% to 7% among healthy military recruits increasing to 30% to 44% during outbreaks (13). Second, higher pneumococcal NP carriage rates are seen during winter months due to increased crowding, reduced ventilation, and the facilitating effect of other upper respiratory tract viral infections (418).…”

Section: Pneumococcus and Influenza: What Is The Connection?mentioning

confidence: 99%

Respiratory Infections in the U.S. Military: Recent Experience and Control

et al. 2015

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SUMMARY This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.

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“…Historically, military populations have been at high risk of acute influenza-related respiratory illnesses, especially among recruits and during fall-winter months [2, 3]. The living, environmental, and physical conditions of US military personnel have been shown to compromise the immune systems of recruits leading to higher levels of respiratory disease when compared to non-military recruits [2, 4, 5]. The burden of severe illness due to influenza in the US military population as a whole, however, is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for severe outcomes among members of the United States military hospitalized with pneumonia and influenza, 2000–2012

Kerkhove

Cooper

Cost

et al. 2015

Vaccine

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Background The progression from hospitalization for a respiratory infection to requiring substantial supportive therapy is a key stage of the influenza severity pyramid. Respiratory infections are responsible for 300,000 to 400,000 medical encounters each year among US military personnel, some of which progress to severe acute respiratory infections. Methods We obtained data on 11,086 hospitalizations for pneumonia and influenza (P&I) among non-recruit US military service members during the period of 1 January 2000 through 31 December 2012. From these, we identified 512 P&I hospitalizations that progressed to severe episodes using standard case definitions. We evaluated the effect of demographic and occupational characteristics, comorbid conditions, and history of influenza vaccination on the risk of a hospitalized P&I case becoming a severe case. We also evaluated the risk of a severe outcome and the length of time since influenza vaccination (within 180, 60 and 30 days). Results The median age of subjects at the time of the P&I episode was 32 years (range, 28–40) and subjects were predominantly male (89.5%). In a univariate analysis, demographic risk factors for a severe episode included service in the US Air Force (RR=1.6 relative to US Army, 95%CI 1.3-2.1), US Coast Guard (RR=2.1, 1.2-3.7) or US Navy (RR=1.4, 1.1-1.8). Being born in the US and recent influenza vaccination (within 180 days of episode) were protective against developing severe disease. Among comorbid conditions, univariate risk factors for severe disease included chronic renal or liver disease (RR=4.98, 95%CI 4.1-6.1), diseases of the circulatory system (RR=3.1, 95%CI 2.6-3.7), diabetes mellitus (RR=2.3, 95%CI 1.5-3.6), obesity (RR=1.6, 95%CI 1.2-2.1), cancer (RR=1.6, 95%CI 1.3-2.0) and chronic obstructive pulmonary disease (RR=1.4, 95%CI 1.1-1.7). Although many of the risk factors found to be significant in univariate analysis were no longer significant under a multivariate analysis, receipt of any influenza vaccine within 180 days of episode remained protective (RR=0.81, 95%CI 0.67-0.99), while serving in the US Coast Guard (RR=1.9, 95%CI 1.1-3.4) or US Air Force (RR=1. 5, 95%CI 1.2-2.0), presence of renal or liver disease (RR=3.6, 95%CI 2.9-4.6) and diseases of the circulatory system (RR=2.2, 95%CI 1.8-2.8), remained significantly associated with a higher risk of developing severe disease. Conclusions In a large cohort, after adjusting for many possible risk factors, influenza vaccination was protective against severe episodes among P&I hospitalizations. The service-specific (US Coast Guard or US Air Force) increased risk may represent some differences in data (e.g., coding or reporting practices) as opposed to genuine differences in physiological outcome. Our findings suggest that renal and liver disease as well as diseases of the circulatory system may contribute to influenza severity in this population independently of age and other potential comorbidities. These findings provide additional evidence for the prioritization of speci...

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Respiratory infections in the military

Cited by 12 publications

References 113 publications

Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009–2013

Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009–2013

Respiratory Infections in the U.S. Military: Recent Experience and Control

Risk factors for severe outcomes among members of the United States military hospitalized with pneumonia and influenza, 2000–2012

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