Febrile Respiratory Illness (FRI) Surveillance Update Operational Infectious Diseases, Naval Health Research Center, San Diego, CA Contact Information Address: Commanding Officer Attn: Code 166 Naval Health Research Center 1 Sylvester Rd. San Diego, CA 9216 Web: NHRC Operational Infectious Diseases Email: NHRC FRI Surveillance Program NHRC Laboratory-Confirmed Cases, US Military Basic Trainees 17 Week (through May 17) Current Week* Since Oct.1, 16 Site A/ Untyp. A/H A/H1 B A/ Untyp. A/H A/H1 B No. Tested Ft. Benning 9 1 165 Ft. Jackson 16 2 216 Ft. Leonard Wood 6 1 54 NRTC Great Lakes 19 15 Lackland AFB 1 1 MCRD Parris Island 19 2 76 MCRD San Diego 21 1 2 218 CGTC Cape May 1 29 17 Total 2 119 2 16 18 Items of Note - FRI rates at all basic training centers are at/below expected values NHRC also conducts shipboard FRI surveillance that includes large-deck ships of the US Fleet Forces (Atlantic), 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 1 Vaccination Status of Confirmed Cases Among US Military Basic Trainees, 14-17 Flu A -Vaccinated Flu A - Unvaccinated Flu B -Vaccinated Flu B - Unvaccinated Percent Flu Positive 8 7 6 5 1 Percent Flu Positive 44 48 52 7 11 15 19 2 27 1 5 9 4 47 51 7 11 15 19 2 27 1 5 9 4 47 51 7 11 15 19 14 15 Week of Illness 16 17 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, view the Quarterly Meningococcal Report. - 1 -
NHRC Respiratory Illness Update Week Ending: May 17 Adenovirus Vaccination against types 4 and 7 adenovirus was instituted at all basic training centers by mid-november 11. 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 12-16. FRI rates remain low in general. No. of Specimens 1 1 8 6 Adenovirus Vaccination Resumed Combined Adenovirus Serotype Distribution, FRI Rate, and Adenovirus Proportion, US Military Basic Training Centers AdV 4a AdV 4p AdV AdV 21 AdV 14 B Untyped C Untyped Other/Untyped Combined FRI Rate Proportion Adeno 1..9.8.7.6.5.4..2.1 FRI Rate (cases/1 trainees/week) or Proportion Adeno 24 28 2 6 44 48 52 4 8 12 16 24 28 2 6 44 48 52 1 11 4 8 12 16 24 28 2 6 44 48 52 4 8 12 16 24 28 2 6 44 48 52 4 8 12 16 24 28 2 6 44 48 52 7 11 15 19 2 27 1 5 9 4 47 51 7 11 15 19 2 27 1 5 9 4 47 51 12 1 14 15 16 17 7 11. 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 categories: At or below expected value (expected value shown as dashed line) Moderately elevated Substantially elevated Week ending May 17: - At or below expected value: Fort Benning Fort Jackson Fort Leonard Wood Naval Recruit Training Command, Great Lakes Marine Corps Recruit Depot, San Diego Marine Corps Recruit Depot, Parris Island Lackland Air Force Base (data through 1 May) Coast Guard Training Center, Cape May Moderately elevated: None Substantially elevated: None - 2 -
NHRC Respiratory Illness Update Week Week Ending: Ending: 19 January May 8 17 Serotype Distribution Total Serotyped Total Received 1% 75% 5% 25% % 2. 24 46 56 17 8 7 76 16 84 Ft. Leonard Shaded Wood bars represent FRI monthly Rates proportions and Adenovirus of each pathogen Serotype (clear = no pathogen Distributions identified) Serotyping performed for all adenovirus positive cases (only a subset serotyped prior to April-7) 1 11 8 84 18 128 14 64 5 55 1 46 7 88 26 128. Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Year 15 16 17 Samples Received 24 5 1 4 14 18 12 9 26 1 8 26 26 27 16 26 26 28 1 Subtype Rate (cases/1 trainees/week) 1.5 1..5 Adenovirus 25% 6% 11% Ft. Benning FRI Rates and Diagnostic Test Results 25% 14% 6% 8% 8% 4% 27% 8% 4% RSV 4% 4% C. pneumo 6% 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 M. pneumo 8% 29% % 7% 6% 11% 8% % 4% 6% Rhinovirus 1% 29% 5% 5% 57% 11% % 67% 5% 15% 45% 1% 5% 41% 25% 19% 2% 18% 15% 51 91 Other 21 14 7 4 Moderately Elevated Substantially Elevated Actual Rate Expected Rate 61 74 16 8 21 55 22 6 9 7 7 B % 1% 1% 1% 1% % % % 1% A/H % % % % % 1% 1% 1% % A/pH1 1% % % % % % % % % Untyped % % % % % % % % % 66 8 46 71 4 2 1 FRI Rate Serotype Distribution Total Serotyped 2. Total Received 1% 75% 25% % 21.5 46 27 85 17 12 8 84 19 71 NRTC Great Lakes FRI Rates and Adenovirus Serotype Distributions Serotyping performed for all adenovirus positive cases (only a subset serotyped prior to April-7) 11 68 2 58 19 11 84 9 69 2 81 18 8 1 94. 5% 2 Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Year Rate (cases/1 trainees/week) 1..5 Samples Received 16 24 14 21 11 21 1 14 14 4 41 2 22 14 2 46 57 2 Adenovirus 4% 7% 5% 5% 9% 24% 19% 17% 7% 7% 4% RSV 4% 2% C. pneumo 5% 8% 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 M. pneumo 6% 7% 5% 7% % Ft. Jackson FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) 15 16 17 Rhinovirus 19% 29% 6% 5% 24% 6% 29% 46% 29% 6% 2% 4% 1% 5% 64% 17% 24% 18% 9% 61 76 77 87 74 81 75 88 65 86 45 7 7 52 71 41 7 4 1 FRI Rate Subtype B % % % % % 25% % 25% % A/H Other 21 14 % % 7 % 4 Moderately Elevated 1% 1% Substantially Elevated 75% 1% Actual 75% Rate 1% Expected Rate A/pH1 1% 1% 1% % % % % % % Untyped % % % % % % % % % Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - -
NHRC Respiratory Illness Update Week Ending: May 17 Ft. Leonard Wood FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) Rate (cases/1 trainees/week) 2. 1.5 1..5. Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Year 15 16 17 1.2 1.8.6.4.2 Samples Received 22 1 1 42 15 24 6 18 1 4 8 6 8 15 1 Adenovirus 5% 24% 7% 4% 25% % 25% 7% RSV 5% C. pneumo 9% % 15% 1% 1% 7% 4% 5% 6% % M. pneumo 2% % 15% 1% 2% % % 17% Rhinovirus 9% 1% 8% 15% 24% 27% 4% % 22% % 25% 1% 1% % 1% Subtype B % 1% 1% % % % % A/H 1% % % 1% 1% 1% % A/pH1 7% % % % % % 1% Untyped % % % % % % % 2. Great Lakes FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) 1 Rate (cases/1 trainees/week) 1.5 1..5 9 8 7 6. Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Year 15 16 17 5 Samples Received 1 6 7 2 26 25 2 15 12 8 24 12 28 25 4 8 Adenovirus 4% 14% 5% 1% 8% 4% 42% 29% 24% % RSV C. pneumo M. pneumo Rhinovirus 1% % 17% 14% 25% 27% 6% 47% 41% 6% 42% 8% 8% 8% 24% 21% 25% Subtype B % % 5% 1% % % % 17% % A/H % % % % 1% 8% 1% 8% 1% A/pH1 1% 1% 5% % % % % % % Untyped % % % % % % % % % Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - 4 -
NHRC Respiratory Illness Update Week Ending: May 17 Rate (cases/1 trainees/week) 2. 1.5 1..5 FRI Rate (cases/ 1 trainees/ week).. 2.5 2. 1.5 1..5 Fort Benning FRI Rate Status Year. Samples Received 5 28 4 1 45 48 5 4 62 25 21 18 45 7 27 1 Nov- Dec- Jan-4 Feb-4 Mar-4 Apr-4 MCRD SD FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified). Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 15 16 17 May-4 Jun-4 Jul-4 Adenovirus 7% 5% 4% 6% 8% % Aug-4 21% 1% 16% 7% 11% 25% 22% 4% RSV 4% % 2% 8% C. pneumo 2% M. pneumo 6% 2% 5% % % 2% 1% 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 16% 9% % % 1% 27% 25% 48% 62% 6% 56% 5% 44% 62% 9% % % 24% 15% % 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 1.2 1.8.6.4.2 Subtype B 11% % % 1% % 1% 1% % A/H 89% 1% 86% % 8% 9% 88% 1% A/pH1 % % 14% % % % % % Untyped % % % % % % % % Rate (cases/1 trainees/week) 2. 1.5 1..5 FRI Rate (cases/ 1 trainees/ week).. 2.5 2. 1.5 1. Fort Jackson FRI Rate Status. Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 15 16 17 Year.5 Samples Received 4 25 7 19 2 18 8 59 6 8 5 15 19 18 14 6 Adenovirus 4% 11%. 5% 1% 11% 47% 1% % 2% % 4% RSV C. pneumo Nov- Dec- Jan-4 Feb-4 Mar-4 Apr-4 May-4 Jun-4 Jul-4 Aug-4 Sep-4 Oct-4 M. pneumo 25% 4% 16% 6% 1% MCRD PI FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) 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 Rhinovirus 25% 16% 57% 42% 65% 44% 6% 27% % 67% 75% % 6% % 26% 17% 7% % 1.2 1.8.6.4.2 Subtype 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/H % % % 1% 1% 1% 1% 1% 67% A/pH1 1% 1% 1% % % % % % % Untyped % % % % % % % % % Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - 5 -
NHRC Respiratory Illness Update Week Ending: May 17 2. Lackland AFB FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) Rate (cases/1 trainees/week) 1.5 1..5. Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Year Samples Received 1 15 5 1 2 2 16 2 5 6 8 8 17 Adenovirus 1% 25% 25% RSV C. pneumo M. pneumo 67% Rhinovirus % 46% 5% % % 17% Subtype B 5% 5% 1% A/H % % % A/pH1 5% % % Untyped % 5% % Cape May FRI Rates and Diagnostic Test Results Shaded bars represent monthly proportions of each pathogen (clear = no pathogen identified) Rate (cases/1 trainees/week) 7. 6. 5. 4.. 2. 1.. Month Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Year Samples Received 17 15 4 7 1 5 6 5 12 16 6 24 11 22 11 8 22 42 6 12 17 Adenovirus 1% 1% 9% 18% 54% % 5% 71% 29% 8% 27% 8% RSV C. pneumo M. pneumo 6% 5% 2% Rhinovirus 41% 25% 4% % 17% 8% 25% 8% 25% 9% 55% 65% 55% 1% 18% 21% 17% 58% Subtype B % 1% 1% % % % 19% % % A/H 1% % % % 1% 9% 75% 1% 1% A/pH1 % % % 1% % % % % % Untyped % % % % % 7% 6% % % Observed FRI rate (expected rate = dashed line) Moderately elevated Substantially elevated Pneumonia rate (incl. afebrile) - 6 -
NHRC Respiratory Illness Update Week Ending: May 17 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 6 5 1 Laboratory testing results - DoD beneficiaries, 16-17 7% 6% 5% % % % 1% % % Flu positive Week Flu A (H) Flu A (ph1n1) Flu B Rhinovirus M.pneumo Adenovirus C.pneumo RSV B. pertussis No Pathogen Identified Flu Rate - 7 -
Count % positive Count % influenza positive NHRC Respiratory Illness Update Week Ending: May 17 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, 16-17 7 65 6 55 5 45 5 25 15 1 5 4 46 49 52 6 9 12 15 18 21 24 27 6 9 Week 1 8 6 Inf A/H1 Inf A/H Inf B Rhinovirus RSV adeno other no pathogen identified % flu U.S.-Mexico Border SARI, 16-17 9 6 27 24 21 18 15 12 9 6 4 46 49 52 6 9 12 15 18 21 24 27 6 9 Week 1 8 6 Inf A/H1 Inf A/H Inf B Rhinovirus RSV adeno other no pathogen identified % flu - 8 -
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