Association Between Barracks Type and Acute Respiratory Infection in a Gender Integrated Army Basic Combat Training Population

Abstract

Background Acute respiratory infections (ARIs) are the leading cause of acute morbidity and lost work time in the United States. Few studies have looked at building design and transmission of ARIs. Objectives This study explores the association of ventilation design, room occupancy numbers, and training week with ARI rates in Army Basic Combat Training barracks. Methods This observational study captured the overall incidence of ARI in a cohort of 16,258 individuals attending basic combat training at Fort Jackson, South Carolina. Results ARI risk was higher among trainees living in the 60-person room barracks compared with those living in 8-person rooms, which increased rapidly for the first few weeks of training and then declined to baseline. Conclusions Findings support direct contact as primary ARI transmission mode in this study population based on observed lower ARI risk in smaller room barracks and similar risk in large room barracks despite heating, ventilation, and air conditioning system variability.

Evaluation of an Intervention to Reduce Tear Gas Exposures and Associated Acute Respiratory Illnesses in a US Army Basic Combat Training Cohort

“…In both pre and post ALARACT studies, week of chamber training and the barracks building type did not play a significant role in ARI outcomes during the surveillance period. This contradicts previous ARI studies that demonstrated that both building type and week of training had an impact on ARI outcomes [18]. Previous studies however, were conducted before mandatory adenovirus type 4 and 7 vaccine was reintroduced in this population [19].…”

“…Given this limitation, the number of febrile incident cases observed was small with febrile ARI rates lower than those observed by Army Public Health Command across the entire Fort Jackson trainee population during the study period (0.030 vs 0.087 cases/100-person weeks) [23]. Previous studies however show that febrile ARI rates tend to peak during weeks four through six of Army BCT, and this study did not capture these data since it focused on health outcomes associated with mask confidence chamber training generally completed during the first three weeks of BCT [18,19]. Without surveillance data for each company for the entire training cycle, it is difficult to determine whether the trends observed here are due to CS exposure or are part of an underlying disease trend that peaks later in the BCT cycle.…”

“…The overall, pre-chamber, and post-chamber ARI rates increased after implementation of the ALARACT; however only differences in pre-chamber ARI rates reached statistical significance (p=0.04). These results were expected since seasonality has been shown to be a predictor of ARI incidence in this population [18,21]. The pre-ALARACT study was conducted from August -September 2012 before the start of the cold and flu season and demonstrated a febrile ARI incidence rate of 0.030 cases/100 person-weeks and an afebrile ARI incidence rate of 1.20 cases/100 personweeks [10].…”

Risk factors for febrile respiratory illness and mono-viral infections in a semi-closed military environment: a case-control study

“…Identifying risk factors of infection may provide guidance on policies and strategies for the prevention and control of FRI. Previous documented risk factors of FRI in other countries included body mass index equal or greater than 25 kg/m 2 , previous respiratory tract infections [30], overcrowding and closed units [29,[31][32][33], presence of sand and dust storms, extreme temperature changes [34,35], smoking [36], female, Navy service, poor latrine facilities, increasing age and higher rank [37]. However, these risk factors may not be generalizable to different environments, and may differ between specific predominant aetiological agents.…”

Emerging and re-emerging infectious diseases: challenges and opportunities for militaries

“…These include, but are not limited to, gastroenteritis (particularly Norwalk-like/norovirus outbreaks) [12][13][14], acute respiratory infections (including influenza) [15][16][17] and conjunctivitis (particularly due to adenovirus) [18][19][20]. One report documented that US military trainees staying in a 60 person barracks were more susceptible to contracting acute respiratory infections than those in 8 person rooms, and that the risk was higher during the first few weeks of training before declining to baseline [21]. Similarly, ease of transmission due to close living quarters resulted in an Influenza A(H1N1) pdm09 outbreak in a Swiss military boot camp in 2010 involving 105 of 750 recruits [16].…”