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

Abstract

SUMMARY 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.

Influenza in the US Military: An Overview

“…The US military led their development in the late 1930s when Dr's Jonas Salk and Thomas Francis developed the first inactivated vaccines which were used to protect US military personnel during World War II [68]. The US military was also the first institution which established a universal influenza vaccination policy which dates back to the early 1940s, many decades before widespread immunization of healthy young people was recommended by the CDC and other international health officials [1,69]. For many years, the CDC recommended influenza immunization only for aged and infirmed people, while the US military was immunizing the entire force.…”

“…Even though a large proportion of US military personnel are immunized with current influenza vaccines, influenza viruses continue to affect them; [1,70] this is most likely multifactorial in nature. First, humoral-mediated immunity is transitory requiring annual immunizations [71].…”

“…Because of its ability to detect newly emerging recombinant, drifted, or shifted influenza viruses, the PCR-ESI-MS typing analysis can be useful in detecting newly emerging influenza strains [40]. New PCR-based point-of-care tests have been developed and are more sensitive (>90 percent) than older RIDTs and are in wide use in the military [1,[41][42][43].…”

“…The US military requires influenza vaccination of military recruits as well as of all personnel on active duty status on a yearly basis [1]. The goal is to exceed 90-percent immunization of all military personnel by mid-December of each year; however, delays in receipt of vaccine and other logistic and access issues are taken into consideration, and all organizations are encouraged to continue their efforts to immunize throughout the influenza season [63].…”

“…In the recent past, mortality due to influenza viruses has been very low, although an influenza pandemic in 1918-1919 was associated with high mortality [1]. Only nine influenza-associated deaths among US military personnel have been documented during the past 16 years (1998-2014), three of these nine occurred during the 2009-2010 pandemic period (Potter R, personal communication).…”