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

Abstract

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.

FIG 1

Joint Biological Agent Identification and Diagnostic System. This ruggedized, deployable, and portable system for the field environment was first developed by the U.S. military for the identification of biological agents (e.g., anthrax, plague, tularemia, and brucella). Influenza virus detection reagents and other testing materials were developed to identify generic subtypes A and B as well as to identify specific subtypes H1 (seasonal and pandemic variants), H3, H5, H7, H9 (avian variants), and H3 (swine variant).

FIG 2

Impact of adenovirus type 4 and 7 vaccination among recruits at eight training centers. Vaccination was reinstituted in late October 2011. The graph illustrates the number of adenovirus-positive specimens along with the rate of diagnosed FRIs (expressed in terms of the number of cases per 100 trainees per week). A significant decrease in FRIs occurred after reinstituting vaccine use, compared to the prevaccination period.