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Respiratory viral pathogens among Singapore military servicemen 2009-2012: epidemiology and clinical characteristics.

Tan XQ, Zhao X, Lee VJ, Loh JP, Tan BH, Koh WH, Ng SH, Chen MI, Cook AR - BMC Infect. Dis. (2014)

Bottom Line: The sensitivity, specificity, positive predictive value and negative predictive value of ILI for influenza among FRI cases were 72%, 48%, 40% and 69% respectively.There are multiple viral etiologies for FRI and ILI with differing clinical symptoms in the Singapore military.Influenza and coxsackevirus were the most common etiology for FRI, while influenza and adenoviruses displayed the most febrile symptoms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Biodefence Centre, Ministry of Defence, Singapore, Singapore. vernonljm@hotmail.com.

ABSTRACT

Background: Few studies have comprehensively described tropical respiratory disease surveillance in military populations. There is also a lack of studies comparing clinical characteristics of the non-influenza pathogens with influenza and amongst themselves.

Methods: From May 2009 through October 2012, 7733 consenting cases of febrile respiratory illness (FRI) (temperature [greater than or equal to]37.5 degrees C with cough or sorethroat) and controls in the Singapore military had clinical data and nasal washes collected prospectively. Nasal washes underwent multiplex PCR, and the analysis was limited to viral mono-infections.

Results: 49% of cases tested positive for at least one virus, of whom 10% had multiple infections. 53% of the FRI cases fulfilled the definition of influenza-like illness (ILI), of whom 52% were positive for at least one virus. The most frequent etiologies for mono-infections among FRI cases were Influenza A(H1N1)pdm09 (13%), Influenza B (13%) and coxsackevirus (9%). The sensitivity, specificity, positive predictive value and negative predictive value of ILI for influenza among FRI cases were 72%, 48%, 40% and 69% respectively. On logistic regression, there were marked differences in the prevalence of different symptoms and signs between viruses with fever more prevalent amongst influenza and adenovirus infections than other viruses.

Conclusion: There are multiple viral etiologies for FRI and ILI with differing clinical symptoms in the Singapore military. Influenza and coxsackevirus were the most common etiology for FRI, while influenza and adenoviruses displayed the most febrile symptoms. Further studies should explore these differences and possible interventions.

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Related in: MedlinePlus

Distribution of weekly cases of febrile respiratory illness (FRI), viral mono-infections during study period*. *The top panel presents the weekly FRI cases together with viral mono-infection cases. The second panel is a frequency chart presenting the weekly viral mono-infection cases. The dominating virus was placed at the bottom of each bar. Viruses are shaded in different colors – Adenovirus E (ADV-E); Influenza A(H3N2) (FLU-A(H3N2)); Rhinovirus (RV); Coxsackie/Echovirus (CV); Influenza B (FLU-B) and influenza A(H1N1)pdm09 (FLU-A(H1N1)pdm09). Influenza A(H1N1) (FLU-A(H1N1) and Influenza (unknown type) (FLU-A(unknown)), Adenovirus B (ADV-B) and ADV(untyped), Enterovirus (EV), human metapneumovirus (hMPV), Parainfluenza 1 (hPIV-1), hPIV-2, hPIV-3 and hPIV-4,Coronavirus OC43 (CoV-OC43), CoV-NL63, CoV-229E, CoV-HKU1 and CoV(untyped), respiratory syncytial virus A (RSV-A) and RSV-B and Bocavirus (BV) are pooled as others in the bottom panel.
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Figure 1: Distribution of weekly cases of febrile respiratory illness (FRI), viral mono-infections during study period*. *The top panel presents the weekly FRI cases together with viral mono-infection cases. The second panel is a frequency chart presenting the weekly viral mono-infection cases. The dominating virus was placed at the bottom of each bar. Viruses are shaded in different colors – Adenovirus E (ADV-E); Influenza A(H3N2) (FLU-A(H3N2)); Rhinovirus (RV); Coxsackie/Echovirus (CV); Influenza B (FLU-B) and influenza A(H1N1)pdm09 (FLU-A(H1N1)pdm09). Influenza A(H1N1) (FLU-A(H1N1) and Influenza (unknown type) (FLU-A(unknown)), Adenovirus B (ADV-B) and ADV(untyped), Enterovirus (EV), human metapneumovirus (hMPV), Parainfluenza 1 (hPIV-1), hPIV-2, hPIV-3 and hPIV-4,Coronavirus OC43 (CoV-OC43), CoV-NL63, CoV-229E, CoV-HKU1 and CoV(untyped), respiratory syncytial virus A (RSV-A) and RSV-B and Bocavirus (BV) are pooled as others in the bottom panel.

Mentions: The temporal distribution of cases is described in Figure 1. No obvious overall seasonal pattern can be observed. The peak in June and July 2009 corresponds to the FLU-A(H1N1)pdm09 pandemic [16]. As this peak tailed off, we observed an increase in FLU-B cases (starting Feb–Mar 2010). Subsequently, as the FLU-B cases fell, Adenovirus E (ADV-E) cases started to increase. Coxsackie/echovirus (CV) and rhinovirus (RV) infections were consistently present in the earlier periods but appeared to tail off by 2012, corresponding to the rise in FRI cases due to other viruses.


Respiratory viral pathogens among Singapore military servicemen 2009-2012: epidemiology and clinical characteristics.

Tan XQ, Zhao X, Lee VJ, Loh JP, Tan BH, Koh WH, Ng SH, Chen MI, Cook AR - BMC Infect. Dis. (2014)

Distribution of weekly cases of febrile respiratory illness (FRI), viral mono-infections during study period*. *The top panel presents the weekly FRI cases together with viral mono-infection cases. The second panel is a frequency chart presenting the weekly viral mono-infection cases. The dominating virus was placed at the bottom of each bar. Viruses are shaded in different colors – Adenovirus E (ADV-E); Influenza A(H3N2) (FLU-A(H3N2)); Rhinovirus (RV); Coxsackie/Echovirus (CV); Influenza B (FLU-B) and influenza A(H1N1)pdm09 (FLU-A(H1N1)pdm09). Influenza A(H1N1) (FLU-A(H1N1) and Influenza (unknown type) (FLU-A(unknown)), Adenovirus B (ADV-B) and ADV(untyped), Enterovirus (EV), human metapneumovirus (hMPV), Parainfluenza 1 (hPIV-1), hPIV-2, hPIV-3 and hPIV-4,Coronavirus OC43 (CoV-OC43), CoV-NL63, CoV-229E, CoV-HKU1 and CoV(untyped), respiratory syncytial virus A (RSV-A) and RSV-B and Bocavirus (BV) are pooled as others in the bottom panel.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
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getmorefigures.php?uid=PMC4006965&req=5

Figure 1: Distribution of weekly cases of febrile respiratory illness (FRI), viral mono-infections during study period*. *The top panel presents the weekly FRI cases together with viral mono-infection cases. The second panel is a frequency chart presenting the weekly viral mono-infection cases. The dominating virus was placed at the bottom of each bar. Viruses are shaded in different colors – Adenovirus E (ADV-E); Influenza A(H3N2) (FLU-A(H3N2)); Rhinovirus (RV); Coxsackie/Echovirus (CV); Influenza B (FLU-B) and influenza A(H1N1)pdm09 (FLU-A(H1N1)pdm09). Influenza A(H1N1) (FLU-A(H1N1) and Influenza (unknown type) (FLU-A(unknown)), Adenovirus B (ADV-B) and ADV(untyped), Enterovirus (EV), human metapneumovirus (hMPV), Parainfluenza 1 (hPIV-1), hPIV-2, hPIV-3 and hPIV-4,Coronavirus OC43 (CoV-OC43), CoV-NL63, CoV-229E, CoV-HKU1 and CoV(untyped), respiratory syncytial virus A (RSV-A) and RSV-B and Bocavirus (BV) are pooled as others in the bottom panel.
Mentions: The temporal distribution of cases is described in Figure 1. No obvious overall seasonal pattern can be observed. The peak in June and July 2009 corresponds to the FLU-A(H1N1)pdm09 pandemic [16]. As this peak tailed off, we observed an increase in FLU-B cases (starting Feb–Mar 2010). Subsequently, as the FLU-B cases fell, Adenovirus E (ADV-E) cases started to increase. Coxsackie/echovirus (CV) and rhinovirus (RV) infections were consistently present in the earlier periods but appeared to tail off by 2012, corresponding to the rise in FRI cases due to other viruses.

Bottom Line: The sensitivity, specificity, positive predictive value and negative predictive value of ILI for influenza among FRI cases were 72%, 48%, 40% and 69% respectively.There are multiple viral etiologies for FRI and ILI with differing clinical symptoms in the Singapore military.Influenza and coxsackevirus were the most common etiology for FRI, while influenza and adenoviruses displayed the most febrile symptoms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Biodefence Centre, Ministry of Defence, Singapore, Singapore. vernonljm@hotmail.com.

ABSTRACT

Background: Few studies have comprehensively described tropical respiratory disease surveillance in military populations. There is also a lack of studies comparing clinical characteristics of the non-influenza pathogens with influenza and amongst themselves.

Methods: From May 2009 through October 2012, 7733 consenting cases of febrile respiratory illness (FRI) (temperature [greater than or equal to]37.5 degrees C with cough or sorethroat) and controls in the Singapore military had clinical data and nasal washes collected prospectively. Nasal washes underwent multiplex PCR, and the analysis was limited to viral mono-infections.

Results: 49% of cases tested positive for at least one virus, of whom 10% had multiple infections. 53% of the FRI cases fulfilled the definition of influenza-like illness (ILI), of whom 52% were positive for at least one virus. The most frequent etiologies for mono-infections among FRI cases were Influenza A(H1N1)pdm09 (13%), Influenza B (13%) and coxsackevirus (9%). The sensitivity, specificity, positive predictive value and negative predictive value of ILI for influenza among FRI cases were 72%, 48%, 40% and 69% respectively. On logistic regression, there were marked differences in the prevalence of different symptoms and signs between viruses with fever more prevalent amongst influenza and adenovirus infections than other viruses.

Conclusion: There are multiple viral etiologies for FRI and ILI with differing clinical symptoms in the Singapore military. Influenza and coxsackevirus were the most common etiology for FRI, while influenza and adenoviruses displayed the most febrile symptoms. Further studies should explore these differences and possible interventions.

Show MeSH
Related in: MedlinePlus