Approaches to Prevent Influenza Transmission among New Conscripts in a Battalion during High Seasonality

Authors

  • Thanachol Wonghirundecha Field Epidemiology Training Program, Bureau of Epidemiology, Ministry of Public Health, Thailand
  • Worrayot Darasawang Field Epidemiology Training Program, Bureau of Epidemiology, Ministry of Public Health, Thailand
  • Tanaporn Tankasikit Wing 41 Military Hospital, Chiang Mai Province, Ministry of Public Health, Thailand
  • Thanaluck Sukprasan Office of Disease Prevention and Control Region 1, Chiang Mai, Ministry of Public Health, Thailand
  • Pornpimol Baramee Office of Disease Prevention and Control Region 1, Chiang Mai, Ministry of Public Health, Thailand
  • Pantasak Boonrat Chiang Mai Public Health Office, Ministry of Public Health, Thailand
  • Pantila Taweewigyakarn Field Epidemiology Training Program, Bureau of Epidemiology, Ministry of Public Health, Thailand
  • Panithee Thammawijaya Field Epidemiology Training Program, Bureau of Epidemiology, Ministry of Public Health, Thailand

DOI:

https://doi.org/10.59096/osir.v11i4.263050

Keywords:

influenza, outbreak, military, conscript

Abstract

On 1 Aug 2017, the Bureau of Epidemiology was notified that five conscripts from a single battalion unit in Chiang Mai Province presented with influenza-like illness (ILI) in two days. A joint investigation was performed to confirm the outbreak, describe the epidemiological characteristics, and identify the source of infection and risk factors. Active case finding was conducted, and either nasopharyngeal or throat swab from 11 patients were collected. Environment and activities in the unit were studied, and a retrospective cohort study was conducted. An influenza outbreak occurred in the new conscript unit during 17 Jul to 20 Aug 2017, with 40.6% attack rate. Major symptoms were fever (100%), cough (83.8%) and runny nose (75.0%). Out of 86 clinically diagnosed cases, 11 were laboratory confirmed. None developed pneumonia. Influenza A(H3N2) was identified in all 11 specimens tested by reverse transcription polymerase chain reaction. Basic reproductive number (R0) among conscripts in the affected unit was 1.3 (95% CI = 1.24-1.38). Close contact with an ILI case was a significant risk factor for influenza infection (adjusted odds ratio = 3.56, 95% CI = 1.68-7.45). A strict protocol for daily screening and early isolation during the epidemic season could prevent influenza outbreaks in a military setting.

References

Heymann DL. Control of communicable disease manual. 18th ed. Washington DC: American Public Health Association, 2004.

World Health Organization. Pandemic influenza A(H1N1). 2011 Mar 1 [cited 2018 Jul 15]. <http://www.who.int/csr/resources/publications/swineflu/h1n1_donor_032011.pdf>

Lessler J, Reich NG, Brookmeyer R, Perl TM, Nelson KE, Cummings DAT. Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infect Dis. 2009 May;9(5):291-300.

Centers for Disease Control and Prevention. How flu spread. 2018 Aug 27 [cited 2018 Oct 10]. <https://www.cdc.gov/flu/about/disease/spread.htm>

Carrat F, Vergu E, Ferguson NM, Lemaitre M, Cauchemez S, Leach S, et al. Timelines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol. 2008 Apr 1;167(7):775-85. Epub 2008 Jan 29.

Suess T, Remschmidt C, Schink SB, Schweiger B, Heider A, Milde J, et al. Comparison of shedding characteristics of seasonal influenza virus (sub)types and influenza A(H1N1)pdm09; Germany, 2007-2011. PLoS One. 2012;7(12):e51653. Epub 2012 Dec 11.

World Health Organization. Seasonal influenza and influenza A(H1N1) [cited 2018 Jul 15]. <http://www.who.int/ith/diseases/si_iAh1n1/en/>

Aungkulanon S, Cheng PY, Kusreesakul K, Bundhamcharoen K, Chittaganpitch M, Margaret M, et al. Influenza-associated mortality in Thailand, 2006-2011. Influenza Other Respir Viruses. 2015 Nov;9(6):298-304.

Bodelle P-Y, Obadia T. Estimation of R0 and real-time reproduction number from epidemics. 2015 [cited 2018 Jul 15]. <https://cran.r-project.org/web/packages/R0/R0.pdf>

Dietz K. The estimation of the basic reproduction number for infectious diseases. Stat Methods Med Res. 1993;2(1):23-41.

Mitamura K, Kawakami C, Shimizu H, Abe T, Konomi Y, Yasumi Y, et al. Evaluation of a new immunochromatographic assay for rapid identification of influenza A, B, and A(H1N1)2009 viruses. J Infect Chemother. 2013 Aug;19(4):633-8. Epub 2012 Dec 20.

Centers for Disease Control and Prevention. Information on rapid molecular assays, RT-PCR, and other molecular assays for diagnosis of influenza virus infection. 2018 Feb 10 [cited 2018 Jul 15]. <https://www.cdc.gov/flu/professionals/diagnosis/molecular-assays.htm>

Thailand. Bureau of Epidemiology. Department of Disease Control. Ministry of Public Health. Influenza surveillance data. Thai [cited 2018 Jun 15]. <http://www.boe.moph.go.th/boedb/surdata/disease.php?ds=15>

Sathawornwiwat A, Thaweewigyakarn P, Lekjcharoen P, Jindapom W, Changsan N, Thammawijaya P, et al. An outbreak investigation of influenza A H3N2 in battalion, Surat Thani province, Thailand, August 2014. Weekly Epidemiological Surveillance Report. 2016;47(6):81-8. Thai.

Duangsin A, Sirirungruang A, Mitrpanon S. An outbreak influenza A/H1N1 (2009) in a legion recruit training military camp, Roi Et Province, Thailand, April-May 2014. Weekly Epidemiological Surveillance Report. 2015;46(32):497-503. Thai.

Silarak K, Namwong T, Lerdsappoontawee S, Sangpakdi M, Buakeaw S, Kampat S, et al. An outbreak investigation of influenza A/H1N1 2009 in a training unit camp, Yasothon Province, Thailand, May 2017. Weekly Epidemiological Surveillance Report. 2018;48(52):817-24. Thai.

Oxford J, Berezin EN, Courvalin P, Dwyer DE, Exner M, Jana LA, et al. The survival of influenza A(H1N1)pdm09 virus on 4 household surfaces. Am J Infect Control. 2014 Apr;42(4):423-5.

Cosby MT, Pimentel G, Nevin RL, Fouad Ahmed S, Klena JD, Amir E, et al. Outbreak of H3N2 influenza at a US military base in Djibouti during the H1N1 pandemic of 2009. PLoS One. 2013;8(12):e82089.

Biggerstaff M, Cauchemez S, Reed C, Gambhir M, Finelli L. Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature. BMC Infect Dis. 2014 Sep 04;14:480.

Thailand. Health Promotion and Preventive Medicine Division. Royal Thai Army Medical Department. Influenza situation in Royal Thai army surveillance 2014-2017. Thai [cited 2018 Jul 15]. <https://tinyurl.com/yb7bf6ds>.

Gray GC, Callahan JD, Hawksworth AW, Fisher CA, Gaydos JC. Respiratory diseases among U.S. military personnel: countering emerging threats. Emerg Infect Dis. 1999 May-Jun;5(3):379-85.

National Vaccine Institute. The guidelines of the National Vaccine Institute Steering Committee and Steering Sub-Committee. 2010. Thai [cited 2018 Jul 20]. <http://nvi.ddc.moph.go.th/attach/e-book/update%20file/executive/executive.pdf>

Grabenstein JD, Pittman PR, Greenwood JT, Engler RJ. Immunization to protect the US Armed Forces: heritage, current practice, and prospects. Epidemiol Rev. 2006;28:3-26. Epub 2006 Jun 8.

Eick-Cost AA, Tastad KJ, Guerrero AC, Johns MC, Lee SE, Macintosh VH, et al. Effectiveness of seasonal influenza vaccines against influenza-associated illnesses among US military personnel in 2010-11: a case-control approach. PLoS One. 2012;7(7):e41435. Epub 2012 Jul 31.

MacIntosh VH, Tastad KJ, Eick-Cost AA. Mid-season influenza vaccine effectiveness 2011-2012: a Department of Defense Global, Laboratory-based, Influenza Surveillance System case-control study estimate. Vaccine. 2013 Mar 25;31(13):1651-5. Epub 2013 Feb 6.

Farrell M, Sebeny P, Klena JD, Demattos C, Pimentel G, Turner M, et al. Influenza risk management: lessons learned from an A(H1N1) pdm09 outbreak investigation in an operational military setting. PLoS One. 2013 Jul 10;8(7):e68639. Print 2013.

Centers for Disease Control and Prevention. Interim guidance on infection control measures for 2009 H1N1 influenza in healthcare settings, including protection of healthcare personnel. 2010 Jul 15 [cited 2018 Oct 10]. <https://www.cdc.gov/h1n1flu/guidelines_infection_control.htm>

Karnjanapiboonwong A, Iamsirithaworn S, Sudjai U, Kunlayanathee K, Kunlayanathee P, Chaipanna N, et al. Control of a pandemic influenza A (H1N1) 2009 outbreak in a prison, Saraburi Province, Thailand, August 2009. OSIR. 2011 Dec;4(2):12-6.

Thailand. Health Promotion and Preventive Medicine Division. Royal Thai Army Medical Department. Guidelines for heat stroke prevention. Thai [cited 2018 Jul 15]. <https://tinyurl.com/y6updoyo>

World Health Organization. Infection-control measures for health care of patients with acute respiratory diseases in community settings. Geneva: World Health Organization; 2009 [cited 2018 Jul 15]. <http://apps.who.int/iris/bitstream/10665/70093/1/WHO_HSE_GAR_BDP_2009.1_eng.pdf>

Published

2018-12-28

How to Cite

Wonghirundecha, T., Darasawang, W., Tankasikit, T., Sukprasan, T., Baramee, P., Boonrat, P., Taweewigyakarn, P., & Thammawijaya, P. (2018). Approaches to Prevent Influenza Transmission among New Conscripts in a Battalion during High Seasonality. Outbreak, Surveillance, Investigation & Response (OSIR) Journal, 11(4), 14–22. https://doi.org/10.59096/osir.v11i4.263050

Issue

Section

Original article