Febrile Respiratory Illness (FRI) Surveillance Update Operational Infectious Diseases, Naval Health Research Center, San Diego, CA Contact Information Address: Commanding Officer Attn: Code 66 Naval Health Research Center 4 Sylvester Rd. San Diego, CA 926 Web: NHRC Operational Infectious Diseases Email: NHRC FRI Surveillance Program Influenza NHRC Laboratory-Confirmed Influenza Cases, US Military Basic Trainees 26 Week 48 (through 3 December 26) Current Week* Since Oct., 26 Site A/ Untyp. A/H3 A/H B A/ Untyp. A/H3 A/H B No. Tested Ft. Benning 35 Ft. Jackson 5 9 Ft. Leonard Wood 7 NRTC Great Lakes 6 Lackland AFB 4 MCRD Parris Island 5 MCRD San Diego 42 CGTC Cape May 3 Total 5 58 Items of Note - Elevated FRI rates at Fort Benning and MCRD Parris Island NHRC also conducts shipboard FRI surveillance that includes large-deck ships of the US Fleet Forces (Atlantic), 3 rd (Pacific), and 7 th (Far East) Fleets. NHRC conducts FRI surveillance among (non-active duty) DoD beneficiaries in Illinois and San Diego (details on page 7). NHRC-CDC-BIDS collaborative border FRI/SARI surveillance program is ongoing at 7 US-Mexico border sites in San Diego (2) and Imperial (5) counties in California. Details on page 8. For more information about NHRC FRI surveillance programs, please contact NHRC. - NHRC is able to test for novel influenza strains, MERS coronavirus, enterovirus EV-68, Ebola virus, and Zika virus Number of Cases 5 4 3 2 Vaccination Status of Confirmed Influenza Cases Among US Military Basic Trainees, 24-6 Flu A -Vaccinated Flu A - Unvaccinated Flu B -Vaccinated Flu B - Unvaccinated Percent Flu Positive 8 7 6 5 4 3 2 Percent Flu Positive 4 44 48 52 3 7 5 9 23 27 3 35 39 43 47 5 3 7 5 9 23 27 3 35 39 43 47 5 24 25 Week of Illness 26 Other Items of Interest NHRC is conducting laboratory-based surveillance for meningococcal disease. The program s purpose is to track and characterize meningococcal cases among DoD medical beneficiaries. For more information and the most recent data, click here. - -
NHRC Respiratory Illness Update Week Ending: 3 December 26 Adenovirus Vaccination against types 4 and 7 adenovirus was instituted at all basic training centers by mid-november 2. FRI rates and the proportion of FRI cases positive for adenovirus have decreased markedly since vaccine was reintroduced. Sporadic adenovirus cases at basic training centers 22-6. FRI rates remain low in general. No. of Specimens 2 8 6 4 2 Adenovirus Vaccination Resumed Combined Adenovirus Serotype Distribution, FRI Rate, and Adenovirus Proportion, US Military Basic Training Centers AdV 4a AdV 4p AdV 3 AdV 7 AdV 2 AdV 4 B Untyped C Untyped Other/Untyped Combined FRI Rate Proportion Adeno..9.8.7.6.5.4.3.2. FRI Rate (cases/ trainees/week) or Proportion Adeno 24 28 32 36 4 44 48 52 4 8 2 6 2 24 28 32 36 4 44 48 52 2 2 4 8 2 6 2 24 28 32 36 4 44 48 52 4 8 2 6 2 24 28 32 36 4 44 48 52 4 8 2 6 2 24 28 32 36 4 44 48 52 3 7 5 9 23 27 3 35 39 43 47 5 3 7 5 9 23 27 3 22 23 24 25 26. FRI Rates FRI surveillance is ongoing at 8 U.S. military basic training centers, representing all service branches. As each week s FRI count is reported, FRI Rate Status is classified into one of 3 categories: At or below expected value (expected value shown as dashed line) Moderately elevated Substantially elevated Week ending 3 December 26: - At or below expected value: Fort Jackson Fort Leonard Wood Naval Recruit Training Command, Great Lakes Marine Corps Recruit Depot, San Diego Lackland Air Force Base (data through 29 Oct.) Coast Guard Training Center, Cape May Moderately elevated: None Substantially elevated: Fort Benning Marine Corps Recruit Depot, Parris Island - 2 -
Influenza Subtype Serotype Distribution Rate (cases/ trainees/week) Influenza Subtype Serotype Distribution Rate (cases/ trainees/week) FRI Rate FRI Rate NHRC Respiratory Illness Update Week Ending: 39 December January 28 26 Total Serotyped Total Received 2. % 24 46.5 2 56 7 83 7 76 6 84 Ft. Leonard Shaded Wood bars represent FRI monthly Rates proportions and of Adenovirus each pathogen (clear Serotype = no pathogen Distributions identified) Serotyping performed for all adenovirus positive cases (only a subset serotyped prior to April-7) 3 8 84 8 28 4 64 5 55 Ft. Benning FRI Rates and Diagnostic Test Results 46 7 88 26 28 5 9 6 74 6 38 2 55 22 6 39 7 66 83 46 7 4.2.8 75%..5 3.6.4.2 5%. Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year 25 26 27 2 Samples Received 3 6 2 27 26 24 35 4 4 8 2 9 26 3 38 24 25% Adenovirus 33% 4% 25% 6% % Influenza 25% 4% 6% 8% 8% 4% RSV C. pneumo % M. pneumo 2% 52% 3% 38% 29% 2% 7% 6% % 8% 3% M A M J J A S O N D J F M A M J J A S O N D J F M Rhinovirus 23% 6% 5% 9% 9% 3% 29% 5% 5% 57% % 33% 67% 5% 5% 45% 33% Other 2 4 7 4 Moderately Elevated Substantially Elevated Actual Rate Expected Rate 27 B % % % % % % A/H3 % % % % % % A/pH % % % % % % Untyped % % % % % % Ft. Jackson FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) Total Serotyped Total Received % 2..5 32 46. 27 85 7 2 8 84 9 7 NRTC Great Lakes FRI Rates and Adenovirus Serotype Distributions Serotyping performed for all adenovirus positive cases (only a subset serotyped prior to April-7) 68 2 58 9 33 84 9 69 2 8 8 83 3 94 6 76 77 87 74 8 75 88 65 86 45 7 52 7 4 7 4.2.8.6.4 75%.5 3.2. Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 5% Year 25 26 27 2 Samples Received 33 2 44 5 53 2 6 24 4 2 2 2 3 4 4 34 4 25% Adenovirus 5% 5% 4% 7% % Influenza 5% 2% 5% 5% 9% 24% RSV C. pneumo 2% 5% 8% M. pneumo 4% 4% 5% 6% 7% 5% 7% 3% M A M J J A S O N D J F M A M J J A S O N D J F M Rhinovirus 8% 4% 2% 24% 9% % 9% 29% 36% 35% 24% 36% 29% 46% 29% 36% 32% 34% Other 2 4 7 4 Moderately Elevated Substantially Elevated Actual Rate Expected Rate 27 B % % % % % % A/H3 % % % % % % A/pH % % % % % % Untyped % % % % % % Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - 3 -
Influenza Subtype Rate (cases/ trainees/week) Influenza Subtype Rate (cases/ trainees/week) NHRC Respiratory Illness Update Week Ending: 3 December 26 Ft. Leonard Wood FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) 2..2.5.8..6.5.4.2. Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year 25 26 27 Samples Received 26 3 2 9 25 22 3 2 42 5 24 6 3 8 3 Adenovirus 5% Influenza 4% 24% 7% 4% RSV 5% C. pneumo 8% 38% 25% 3% % 4% 9% 4% 5% % % 7% 4% 5% 6% M. pneumo 8% 5% 22% 2% 23% 2% 5% % 2% 33% Rhinovirus 38% 23% 3% 2% 22% 6% 9% % 8% 5% 24% 27% 4% 33% 22% 33% B % 2% % % A/H3 % % % % A/pH % 7% % % Untyped % % % % 2. Great Lakes FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified).5..5 9 8 7 6. Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year 25 26 27 5 Samples Received 3 4 5 3 6 7 2 3 2 26 25 3 32 5 5 Adenovirus 25% 4% Influenza 4% 5% % 2% RSV C. pneumo M. pneumo Rhinovirus % 4% % 33% 7% 4% 25% 27% 6% 47% 4% 6% 4% B % % 5% % A/H3 % % % % A/pH % % 5% % Untyped % % % % Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - 4 -
Influenza Subtype Nov-3 Dec-3 Jan-4 Feb-4 Mar-4 Apr-4 May-4 Jun-4 Jul-4 Aug-4 Sep-4 Oct-4 Nov-4 Dec-4 Jan-5 Feb-5 Mar-5 Apr-5 May-5 Jun-5 Jul-5 Aug-5 Sep-5 Oct-5 Nov-5 Rate (cases/ trainees/week) FRI Rate (cases/ trainees/ week). Influenza Subtype Nov-3 Dec-3 Jan-4 Feb-4 Mar-4 Apr-4 May-4 Jun-4 Jul-4 Aug-4 Sep-4 Oct-4 Nov-4 Dec-4 Jan-5 Feb-5 Mar-5 Apr-5 May-5 Jun-5 Jul-5 Aug-5 Sep-5 Oct-5 Nov-5 Rate (cases/ trainees/week) FRI Rate (cases/ trainees/ week). NHRC Respiratory Illness Update Week Ending: 3 December 26 Fort Benning FRI Rate Status 2. 3. 2.5 MCRD SD FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified).2.5 2..8..5.6.5..4.2..5 Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 25 26 27 Year. Samples Received 34 42 88 56 62 57 5 28 43 4 3 45 48 33 53 42 55 36 4 Adenovirus 2% 2% 4% 2% 7% 5% 4% 6% 8% Influenza 24% 2% % 6% 7% RSV 4% 3% 2% C. pneumo M. pneumo 4% 3% 7% 6% 2% 5% 5% 3% A t/ B e lo w Expe c te d M o de ra te ly Ele v a te d S ubs ta ntia lly Ele v a te d Expe c te d R a te Rhinovirus 24% 33% 42% 25% % 9% 6% 39% 33% 2% 3% 27% 25% 48% 62% 64% 53% 47% 5% B 76% % % % % A/H3 24% 89% % 86% % A/pH % % % 4% % Untyped % % % % % 2. 3. Fort Jackson FRI Rate Status MCRD PI FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified).2.5 2.5.8. 2..6.5.5.4.2.. Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 25 26 27 Year.5 Samples Received 2 2 2 4 25 4 4 25 7 9 23 8 8 59 2 6 8 3 Adenovirus. 4% 4% % Influenza 5% 3% % 47% % RSV C. pneumo M. pneumo 8% 5% 8% 43% 25% 4% 6% 6% 3% Rhinovirus 58% 58% 65% 56% 2% 29% 25% 6% 57% 42% 65% 44% 63% 27% 4% 67% 75% 33% B A t/ B e lo w Expe c te d M o de ra te ly Ele v a% te d % % S ubs ta ntia % lly Ele % v a te d Expe c te d R a te A/H3 % % % % % A/pH % % % % % Untyped % % % % % Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - 5 -
Influenza Subtype Rate (cases/ trainees/week) Influenza Subtype Rate (cases/ trainees/week) NHRC Respiratory Illness Update Week Ending: 3 December 26 Lackland AFB FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) 2..2.5.8..6.5.4.2. Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year 25 26 27 Samples Received 5 3 3 2 2 2 Adenovirus Influenza % RSV C. pneumo M. pneumo Rhinovirus 4% 46% 5% B 5% A/H3 % A/pH 5% Untyped % Cape May FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) 7. 6. 5. 4. 3. 2... Month Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Year Samples Received 9 6 9 3 25 5 2 7 4 7 3 5 6 5 2 6 26 24 27 Adenovirus % 7% % Influenza % 8% 54% 4% 5% 7% 29% RSV C. pneumo M. pneumo % % 8% 33% % 6% Rhinovirus 33% 7% 44% 38% 33% 38% 4% 25% 43% 2% 7% 8% 25% 83% 25% 39% 5% B % % % % % % % A/H3 % % % % % % 93% A/pH % % % % % % % Untyped % % % % % % 7% Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - 6 -
NHRC Respiratory Illness Update Week Ending: 3 December 26 DoD Beneficiary Surveillance NHRC conducts FRI surveillance among (non-active duty) DoD beneficiaries at Lovell FHCC (Great Lakes, IL) and in 4 NMC San Diego facilities: the Emergency Department, Pediatric Department, Naval Branch Health Clinic Kearny Mesa, and NH Camp Pendleton. For questions regarding surveillance in this population, please contact the principal investigators at NHRC-FRI_Ben@med.navy.mil. No. Specimens 4 35 3 25 2 5 5 Laboratory testing results - DoD beneficiaries, 25-6 7% 6% 5% 4% 3% 2% % % % Flu positive Week Flu A (H3) Flu A (phn) Flu B Rhinovirus M.pneumo Adenovirus C.pneumo RSV B. pertussis No Pathogen Identified Flu Rate - 7 -
NHRC Respiratory Illness Update Week Ending: 3 December 26 US-Mexico Border Surveillance In collaboration with the CDC Border Infectious Disease Surveillance program and San Diego/Imperial Counties, NHRC performs laboratory testing for FRI cases among civilians near the US-Mexico border. Both outpatient (FRI) and inpatient (Severe Acute Respiratory Illness; SARI) cases are included in the program. Current sites are located in San Diego (2) and Imperial (5) counties in California. U.S.-Mexico Border ILI, 26-7 Count 7 65 6 55 5 45 4 35 3 25 2 5 5 4 43 46 49 52 3 6 9 2 5 8 2 24 27 3 33 36 39 Week 8 6 4 2 % influenza positive Inf A/H Inf A/H3 Inf B Rhinovirus RSV adeno other no pathogen identified % flu U.S.-Mexico Border SARI, 26-7 Count 39 36 33 3 27 24 2 8 5 2 9 6 3 4 43 46 49 52 3 6 9 2 5 8 2 24 27 3 33 36 39 Week 8 6 4 2 % Influenza positive Inf A/H Inf A/H3 Inf B Rhinovirus RSV adeno other no pathogen identified % flu - 8 -
- 9 -
- -
- -
- 2 -
- 3 -
- 4 -
- 5 -
- 6 -
- 7 -
w - 8 -