Pertussis Outbreak Among Soldiers During Basic Training: The Need for Updated Protocols

Halhal, Basheer; Glick, Yuval; Galor, Inbal; Ankory, Ran; Bacon, David; Glassberg, Elon

doi:10.7205/milmed-d-16-00083

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Of the 180 studies identifying social mechanisms of transmission, 10% (18/180) reported suboptimal vaccination programs as contributing to disease incidence. Reasons included discontinuation of vaccines by suppliers during, or leading up to, the study period, 31 low vaccine supply during the study period, 33 or immunization not required for enrolment. 34 One study with two groups exposed to an infectious agent reported the outbreak almost entirely in the non-vaccinated group.…”

Section: Resultsmentioning

confidence: 99%

The military as a neglected pathogen transmitter, from the 19th century to COVID-19: A systematic review

Chaufan

Dutescu

Fekre

et al. 2021

Preprint

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Background: The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed the evidence for the military as a disease vector, an historically relevant one, yet overlooked in times of COVID-19. Methods: We searched 3 electronic databases without temporal restrictions. We identified 2010 of 6477 studies spanning over two centuries (1810 – 2020) that met our inclusion criteria and provided evidence for the military as a pathogen transmitter, within itself or between it and civilians. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub–themes. A content analysis was later performed and frequency distributions for each theme were generated. Results: Biological mechanisms driving transmission included person–to–person transmission, contaminated food and water, vector–borne, and airborne routes. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high–risk behaviours, and occupation–specific freedom of movement. Contaminated food and/or water was the most common biological transmission route. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Certain social mechanisms, such as employment–related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military. Conclusions: Features of the military identified in this study pose a significant public health threat, especially to countries with substantial military presence or underdeveloped health systems. Many social transmission mechanisms, unlike biological ones, were unique to the military, facilitating large–spreader events and affecting civilian health. As an increasingly interconnected world faces the challenges of COVID–19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable pandemic policies.

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Section: Resultsmentioning

confidence: 99%

The military as a neglected pathogen transmitter, from the 19th century to COVID-19: A systematic review

Chaufan

Dutescu

Fekre

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Vaccination programs Of the 180 studies identifying social mechanisms of transmission, 10% (18/180) reported suboptimal vaccination programs as contributing to disease incidence. Reasons included discontinuation of vaccines by suppliers during, or leading up to, the study period [32], low vaccine supply during the study period [34], or immunization not required for enrolment [35]. One study with two groups exposed to an infectious agent reported the outbreak almost entirely in the nonvaccinated group [36].…”

Section: Disease Transmission Populationsmentioning

confidence: 99%

The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review

Chaufan

Dutescu

Fekre

et al. 2021

glob health res policy

View full text Add to dashboard Cite

Background The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed evidence in the medical and public health literature for the military as a disease vector. Methods We searched 3 electronic databases without temporal restrictions. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub-themes. A content analysis was later performed and frequency distributions for each theme were generated. Results Of 6477 studies, 210 met our inclusion criteria and provided evidence, spanning over two centuries (1810–2020), for the military as a pathogen transmitter, within itself or between it and civilians. Biological mechanisms driving transmission included person-to-person transmission, contaminated food and water, vector-borne, and airborne routes. Contaminated food and/or water were the most common biological transmission route. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high-risk behaviours, and occupation-specific freedom of movement. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Selected social mechanisms, such as employment-related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military. Conclusions This study identified features of the military that pose a significant threat to global health, especially to civilian health in countries with substantial military presence or underdeveloped health systems. While biological transmission mechanisms are shared by other social groups, selected social transmission mechanisms are unique to the military. As an increasingly interconnected world faces the challenges of COVID-19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable global public health policies.

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“… 3 Numerous outbreaks of respiratory infections among military recruits have been reported in the literature, including outbreaks of influenza, adenovirus, 4 – 6 and pertussis. 7 Resumption of vaccination against adenovirus types 4 and 7 in the U.S. military is estimated to have resulted in a 7-fold decrease in acute respiratory disease 8 and a shift in the predominant adenovirus types from types 4, 3, and 7 to types 1 and 2.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Transmission of Respiratory Infections in Thai Army Recruits: A Prospective Cohort Study

Tam

Anderson

Offeddu

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.Military recruits are at high risk of respiratory infections. However, limited data exist on military populations in tropical settings, where the epidemiology of respiratory infections differs substantially from temperate settings. We enrolled recruits undertaking a 10-week military training at two Royal Thai Army barracks between May 2014 and July 2015. We used a multiplex respiratory panel to analyze nose and throat swabs collected at the start and end of the training period, and from participants experiencing respiratory symptoms during follow-up. Paired sera were tested for influenza seroconversion using a hemagglutinin inhibition assay. Overall rates of upper respiratory illness and influenza-like illness were 3.1 and 2.0 episodes per 100 person-weeks, respectively. A pathogen was detected in 96% of samples. The most commonly detected microbes were Haemophilus influenzae type B (62.7%) or non–type B (58.2%) and rhinovirus (22.4%). At baseline, bacterial colonization was high and included H. influenzae type B (82.3%), H. influenzae non–type B (31.5%), Klebsiella pneumoniae (14.6%), Staphylococcus aureus (8.5%), and Streptococcus pneumoniae (8.5%). At the end of follow-up, colonization with H. influenzae non–type B had increased to 74.1%, and S. pneumoniae to 33.6%. In the serology subset, the rate of influenza infection was 3.4 per 100 person-months; 58% of influenza infections resulted in clinical disease. Our study provides key data on the epidemiology and transmission of respiratory pathogens in tropical settings. Our results emphasize the need for improved infection prevention and control in military environments, given the high burden of illness and potential for intense transmission of respiratory pathogens.

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Pertussis Outbreak Among Soldiers During Basic Training: The Need for Updated Protocols

Cited by 4 publications

References 7 publications

The military as a neglected pathogen transmitter, from the 19th century to COVID-19: A systematic review

The military as a neglected pathogen transmitter, from the 19th century to COVID-19: A systematic review

The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review

Epidemiology and Transmission of Respiratory Infections in Thai Army Recruits: A Prospective Cohort Study

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