Influenza Risk Management: Lessons Learned from an A(H1N1) pdm09 Outbreak Investigation in an Operational Military Setting

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Farrell, Margaret ; Sebeny, Peter ; Klena, John D. ; DeMattos, Cecilia ; Pimentel, Guillermo ; Turner, Mark ; Joseph, Antony ; Espiritu, Jennifer ; Zumwalt, John ; Dueger, Erica
• Description:
  Background
  
  At the onset of an influenza pandemic, when the severity of a novel strain is still undetermined and there is a threat of introduction into a new environment, e.g., via the deployment of military troops, sensitive screening criteria and conservative isolation practices are generally recommended.
  
  Objectives
  
  In response to elevated rates of influenza-like illness among U.S. military base camps in Kuwait, U.S. Naval Medical Research Unit No. 3 partnered with local U.S. Army medical units to conduct an A(H1N1) pdm09 outbreak investigation.
  
  Patients/Methods
  
  Initial clinical data and nasal specimens were collected via the existent passive surveillance system and active surveillance was conducted using a modified version of the World Health Organization/U.S. Centers for Disease Control and Prevention influenza-like illness case definition [fever (T > 100.5˚F/38˚C) in addition to cough and/or sore throat in the previous 72 hours] as the screening criteria. Samples were tested via real-time reverse-transcription PCR and sequenced for comparison to global A(H1N1) pdm09 viruses from the same time period.
  
  Results
  
  The screening criteria used in Kuwait proved insensitive, capturing only 16% of A(H1N1) pdm09-positive individuals. While still not ideal, using cough as the sole screening criteria would have increased sensitivity to 73%.
  
  Conclusions
  
  The results of and lessons learned from this outbreak investigation suggest that pandemic influenza risk management should be a dynamic process (as information becomes available regarding true attack rates and associated mortality, screening and isolation criteria should be re-evaluated and revised as appropriate), and that military operational environments present unique challenges to influenza surveillance.
  
  
• Subjects:
  Cough Disease Outbreaks DNA, Viral Fever Humans Influenza, Human Influenza A Virus, H1N1 Subtype Mass Screening Military Personnel Pharyngitis Phylogeny Real-Time Polymerase Chain Reaction Risk Management

  More +
• Source:
  PLoS One. 2013; 8(7).
• Document Type:
  Journal Article
• Place as Subject:
  Kuwait ; United States
• Volume:
  8
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:a037f8411f8f925ef5cb0a5e85f9b1f2b296ccfabde31f6f2ef5fc2188b55485
• Download URL:
  https://stacks.cdc.gov/view/cdc/19604/cdc_19604_DS1.pdf
• File Type:
  [PDF - 177.27 KB ]