Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Jan 30;13(2):ofag036.
doi: 10.1093/ofid/ofag036. eCollection 2026 Feb.

The Molecular Epidemiology and Congregate Transmission Dynamics of Medically Attended Acute Respiratory Infections at the United States Naval Academy During Plebe Summer

Emily Hone  1   2 , Stephanie A Richard  1   2 , Kat Schmidt  1   2 , Jennifer Rothenberg  1   2 , Rezalina Tant  1   2 , Michele Wayman  1   2 , Chantele Friend  1   2 , Kamala Thapa  1   2 , Vivian Hogan  1   2 , Timothy H Burgess  1 , Robert J O'Connell  1 , Mark P Simons  1 , Anthony C Fries  3 , Drake H Tilley  1   4 , Simon D Pollett  1   2 , Rhonda E Colombo  1   2   5
Affiliations

The Molecular Epidemiology and Congregate Transmission Dynamics of Medically Attended Acute Respiratory Infections at the United States Naval Academy During Plebe Summer

Emily Hone et al. Open Forum Infect Dis. .

Abstract

Background: Understanding the epidemiology of acute respiratory infections (ARIs) in congregate military settings is vital to force health protection. This analysis describes insights gleaned from the "Acute Respiratory Infections at the Academy" (ARIA) study regarding respiratory virus incidence and impact at the United States Naval Academy during "Plebe Summer" 2023, an intense 6-week training for all incoming freshmen (plebes).

Methods: Residual nasal swabs collected as part of the standard-of-care work-up in midshipmen who presented to clinic with an ARI were sent for multiplex PCR testing and viral genomic sequencing. Corresponding patient demographics, symptoms, diagnoses, and outcomes were abstracted from medical records. Integrated epidemiological and viral genomic analyses were performed.

Results: During Plebe Summer 2023, 40% of incoming freshmen (473/1187) sought healthcare for at least 1 ARI, as did 71 upperclassmen. Swabs were collected in 598 of 615 ARIs (97%), among which 324 (54%) tested positive for at least 1 virus; 2 + viruses were detected in 52/324 (16%). Rhinovirus/enterovirus was most frequently detected, followed by SARS-CoV-2; several SARS-CoV-2 variants, all Omicron sub-lineages, were identified. There was considerable symptom overlap among MAARIs in which different viruses were detected. Most (83%) midshipmen with a medically attended ARI (MAARI) spent at least 1 day sick-in-quarters (SIQ). SARS-CoV-2 detections were associated with the longest SIQ durations.

Conclusions: Plebe Summer 2023 was characterized by high MAARI attack rates, considerable viral diversity and viral codetections, and substantial training days lost. ARIA highlights the importance of ongoing characterization of ARIs in congregate populations to help inform mitigation strategies.

Keywords: acute respiratory infections; military; military training; respiratory coinfections; viral infections.

PubMed Disclaimer

Conflict of interest statement

Potential Conflicts of Interest. No conflicts of interest exist.

Figures

Figure 1.
Figure 1.
(A) The graphs depict the 15 most common respiratory infection symptoms, sorted by frequency (most common symptom is at the top and decreases as you move clockwise around the circle). The points indicate the percentage of cases for which each symptom was documented by respiratory virus, for the 4 most commonly detected viruses, including codetections. (B-D) Comparison of symptoms by mono-detection and codetection: B, parainfluenza; C, SARS-CoV-2; D, rhinovirus/enterovirus. Abbreviations: HMPV, human metapneumovirus; PIV, parainfluenza virus; RV/EV, rhinovirus/enterovirus.
See this image and copyright information in PMC

References

    1. Armed Forces Health Surveillance Division . Absolute and relative morbidity burdens attributable to various illnesses and injuries among active component members of the US Armed Forces, 2023. MSMR 2024; 31:2–10. - PMC - PubMed
    1. Armed Forces Health Surveillance Division . Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2021. MSMR 2022; 29:2–9. - PubMed
    1. Armed Forces Health Surveillance Division . Absolute and relative morbidity burdens attributable to Various illnesses and injuries among active component members, U.S. Armed Forces, 2022. MSMR 2023; 30:3–11. - PubMed
    1. Korzeniewski K, Nitsch-Osuch A, Konior M, Lass A. Respiratory tract infections in the military environment. Respir Physiol Neurobiol 2015; 209:76–80. - PMC - PubMed
    1. Sanchez JL, Cooper MJ, Myers CA, et al. Respiratory infections in the U.S. Military: recent experience and control. Clin Microbiol Rev 2015; 28:743–800. - PMC - PubMed

LinkOut - more resources