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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

Correlation of Symptoms and Signs Across all Viruses. Clinical signs or symptoms are listed by average frequency from the most to the least. Binomial test is used to assess the discrepancy between the observed proportion of symptom pairs and the expected proportion of symptom pairs which is the product of the two marginal distributions by assuming symptoms develop independently. Color cells represent differences that are significant at the 5% level, and the thickness of the cell wall represents the p-value (thin means 0.01 < p < 0.05; medium, 0.001 < p < 0.01; and thick, p < 0.001). The excess probability encoded by colors measures the effect size. If the observed proportion is lower than the expected proportion, the cell will be shaded by blue color, and red color otherwise.
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Figure 3: Correlation of Symptoms and Signs Across all Viruses. Clinical signs or symptoms are listed by average frequency from the most to the least. Binomial test is used to assess the discrepancy between the observed proportion of symptom pairs and the expected proportion of symptom pairs which is the product of the two marginal distributions by assuming symptoms develop independently. Color cells represent differences that are significant at the 5% level, and the thickness of the cell wall represents the p-value (thin means 0.01 < p < 0.05; medium, 0.001 < p < 0.01; and thick, p < 0.001). The excess probability encoded by colors measures the effect size. If the observed proportion is lower than the expected proportion, the cell will be shaded by blue color, and red color otherwise.

Mentions: In Figure 3, we explored the associations (and dissociations) between different clinical symptoms and signs across all viruses. Some are expected, such as association of fever ≥37.8°C and fever ≥38.0°C and dissociation of dry cough and cough with phlegm. Fever ≥38.0°C was also associated with systematic complaints, such as chills, bodyache, headache and eye pain. Sorethroat was associated with an injected pharynx.


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)

Correlation of Symptoms and Signs Across all Viruses. Clinical signs or symptoms are listed by average frequency from the most to the least. Binomial test is used to assess the discrepancy between the observed proportion of symptom pairs and the expected proportion of symptom pairs which is the product of the two marginal distributions by assuming symptoms develop independently. Color cells represent differences that are significant at the 5% level, and the thickness of the cell wall represents the p-value (thin means 0.01 < p < 0.05; medium, 0.001 < p < 0.01; and thick, p < 0.001). The excess probability encoded by colors measures the effect size. If the observed proportion is lower than the expected proportion, the cell will be shaded by blue color, and red color otherwise.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Correlation of Symptoms and Signs Across all Viruses. Clinical signs or symptoms are listed by average frequency from the most to the least. Binomial test is used to assess the discrepancy between the observed proportion of symptom pairs and the expected proportion of symptom pairs which is the product of the two marginal distributions by assuming symptoms develop independently. Color cells represent differences that are significant at the 5% level, and the thickness of the cell wall represents the p-value (thin means 0.01 < p < 0.05; medium, 0.001 < p < 0.01; and thick, p < 0.001). The excess probability encoded by colors measures the effect size. If the observed proportion is lower than the expected proportion, the cell will be shaded by blue color, and red color otherwise.
Mentions: In Figure 3, we explored the associations (and dissociations) between different clinical symptoms and signs across all viruses. Some are expected, such as association of fever ≥37.8°C and fever ≥38.0°C and dissociation of dry cough and cough with phlegm. Fever ≥38.0°C was also associated with systematic complaints, such as chills, bodyache, headache and eye pain. Sorethroat was associated with an injected pharynx.

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