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Retrospective analysis of demographic and clinical factors associated with etiology of febrile respiratory illness among US military basic trainees.

Padin DS, Faix D, Brodine S, Lemus H, Hawksworth A, Putnam S, Blair P - BMC Infect. Dis. (2014)

Bottom Line: Identifying demographic and clinical factors associated with the primary viral pathogens causing FRI epidemics among trainees will help improve differential diagnosis and allow for appropriate distribution of antiviral medications.Subjects were predominantly young men (86.8% men; mean age 20.8 ± 3.8 years) from Fort Jackson (18.8%), Great Lakes (17.1%), Fort Leonard Wood (16.3%), Marine Corps Recruit Depot (MCRD) San Diego (19.0%), Fort Benning (13.3%), Lackland (7.5%), MCRD Parris Island (8.7%), and Cape May (3.2%).Findings from this study can guide clinicians in the diagnosis and treatment of military trainees presenting with FRI.

View Article: PubMed Central - PubMed

Affiliation: Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA. dspadin@gmail.com.

ABSTRACT

Background: Basic trainees in the US military have historically been vulnerable to respiratory infections. Adenovirus and influenza are the most common etiological agents responsible for febrile respiratory illness (FRI) among trainees and present with similar clinical signs and symptoms. Identifying demographic and clinical factors associated with the primary viral pathogens causing FRI epidemics among trainees will help improve differential diagnosis and allow for appropriate distribution of antiviral medications. The objective of this study was to determine what demographic and clinical factors are associated with influenza and adenovirus among military trainees.

Methods: Specimens were systematically collected from military trainees meeting FRI case definition (fever ≥38.0°C with either cough or sore throat; or provider-diagnosed pneumonia) at eight basic training centers in the USA. PCR and/or cell culture testing for respiratory pathogens were performed on specimens. Interviewer-administered questionnaires collected information on patient demographic and clinical factors. Polychotomous logistic regression was employed to assess the association between these factors and FRI outcome categories: laboratory-confirmed adenovirus, influenza, or other FRI. Sensitivity, specificity, positive and negative predictive value were calculated for individual predictors and clinical combinations of predictors.

Results: Among 21,570 FRI cases sampled between 2004 and 2009, 63.6% were laboratory-confirmed adenovirus cases and 6.6% were laboratory-confirmed influenza cases. Subjects were predominantly young men (86.8% men; mean age 20.8 ± 3.8 years) from Fort Jackson (18.8%), Great Lakes (17.1%), Fort Leonard Wood (16.3%), Marine Corps Recruit Depot (MCRD) San Diego (19.0%), Fort Benning (13.3%), Lackland (7.5%), MCRD Parris Island (8.7%), and Cape May (3.2%). The best multivariate predictors of adenovirus were the combination of sore throat (odds ratio [OR], 2.94; 95% confidence interval [CI], 2.66-3.25), cough (OR, 2.33; 95% CI, 2.11-2.57), and fever (OR, 2.07; 95% CI, 1.90-2.26) with a PPV of 77% (p ≤ .05). A combination of cough, fever, training week 0-2 and acute onset were most predictive of influenza (PPV =38%; p ≤ .05).

Conclusions: Specific demographic and clinical factors were associated with laboratory-confirmed influenza and adenovirus among military trainees. Findings from this study can guide clinicians in the diagnosis and treatment of military trainees presenting with FRI.

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Related in: MedlinePlus

Results of multivariate analysis comparing demographic and clinical factors of military trainees with illness due to adenovirus. Training week was converted to a categorical variable for multivariate analysis (reference category = weeks 7+). Winter was used as the reference category for training season.
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Fig2: Results of multivariate analysis comparing demographic and clinical factors of military trainees with illness due to adenovirus. Training week was converted to a categorical variable for multivariate analysis (reference category = weeks 7+). Winter was used as the reference category for training season.

Mentions: Furthermore, influenza was associated with the first 2 weeks of training (OR, 1.82, 95% CI, 1.50–2.21). Adenovirus was associated with weeks 3 and 4 of training (OR, 1.61; 95% CI, 1.47–1.76), these odds increased during training weeks 5 and 6 (OR, 1.91; 95% CI, 1.74–2.10), with no association seen with influenza during training weeks 3–6. Clinical and demographic factors associated with the development of laboratory-confirmed adenovirus and influenza, as determined by multivariate polychotomous logistic regression analysis, are shown in Figures 2 and 3.Figure 2


Retrospective analysis of demographic and clinical factors associated with etiology of febrile respiratory illness among US military basic trainees.

Padin DS, Faix D, Brodine S, Lemus H, Hawksworth A, Putnam S, Blair P - BMC Infect. Dis. (2014)

Results of multivariate analysis comparing demographic and clinical factors of military trainees with illness due to adenovirus. Training week was converted to a categorical variable for multivariate analysis (reference category = weeks 7+). Winter was used as the reference category for training season.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4264259&req=5

Fig2: Results of multivariate analysis comparing demographic and clinical factors of military trainees with illness due to adenovirus. Training week was converted to a categorical variable for multivariate analysis (reference category = weeks 7+). Winter was used as the reference category for training season.
Mentions: Furthermore, influenza was associated with the first 2 weeks of training (OR, 1.82, 95% CI, 1.50–2.21). Adenovirus was associated with weeks 3 and 4 of training (OR, 1.61; 95% CI, 1.47–1.76), these odds increased during training weeks 5 and 6 (OR, 1.91; 95% CI, 1.74–2.10), with no association seen with influenza during training weeks 3–6. Clinical and demographic factors associated with the development of laboratory-confirmed adenovirus and influenza, as determined by multivariate polychotomous logistic regression analysis, are shown in Figures 2 and 3.Figure 2

Bottom Line: Identifying demographic and clinical factors associated with the primary viral pathogens causing FRI epidemics among trainees will help improve differential diagnosis and allow for appropriate distribution of antiviral medications.Subjects were predominantly young men (86.8% men; mean age 20.8 ± 3.8 years) from Fort Jackson (18.8%), Great Lakes (17.1%), Fort Leonard Wood (16.3%), Marine Corps Recruit Depot (MCRD) San Diego (19.0%), Fort Benning (13.3%), Lackland (7.5%), MCRD Parris Island (8.7%), and Cape May (3.2%).Findings from this study can guide clinicians in the diagnosis and treatment of military trainees presenting with FRI.

View Article: PubMed Central - PubMed

Affiliation: Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA. dspadin@gmail.com.

ABSTRACT

Background: Basic trainees in the US military have historically been vulnerable to respiratory infections. Adenovirus and influenza are the most common etiological agents responsible for febrile respiratory illness (FRI) among trainees and present with similar clinical signs and symptoms. Identifying demographic and clinical factors associated with the primary viral pathogens causing FRI epidemics among trainees will help improve differential diagnosis and allow for appropriate distribution of antiviral medications. The objective of this study was to determine what demographic and clinical factors are associated with influenza and adenovirus among military trainees.

Methods: Specimens were systematically collected from military trainees meeting FRI case definition (fever ≥38.0°C with either cough or sore throat; or provider-diagnosed pneumonia) at eight basic training centers in the USA. PCR and/or cell culture testing for respiratory pathogens were performed on specimens. Interviewer-administered questionnaires collected information on patient demographic and clinical factors. Polychotomous logistic regression was employed to assess the association between these factors and FRI outcome categories: laboratory-confirmed adenovirus, influenza, or other FRI. Sensitivity, specificity, positive and negative predictive value were calculated for individual predictors and clinical combinations of predictors.

Results: Among 21,570 FRI cases sampled between 2004 and 2009, 63.6% were laboratory-confirmed adenovirus cases and 6.6% were laboratory-confirmed influenza cases. Subjects were predominantly young men (86.8% men; mean age 20.8 ± 3.8 years) from Fort Jackson (18.8%), Great Lakes (17.1%), Fort Leonard Wood (16.3%), Marine Corps Recruit Depot (MCRD) San Diego (19.0%), Fort Benning (13.3%), Lackland (7.5%), MCRD Parris Island (8.7%), and Cape May (3.2%). The best multivariate predictors of adenovirus were the combination of sore throat (odds ratio [OR], 2.94; 95% confidence interval [CI], 2.66-3.25), cough (OR, 2.33; 95% CI, 2.11-2.57), and fever (OR, 2.07; 95% CI, 1.90-2.26) with a PPV of 77% (p ≤ .05). A combination of cough, fever, training week 0-2 and acute onset were most predictive of influenza (PPV =38%; p ≤ .05).

Conclusions: Specific demographic and clinical factors were associated with laboratory-confirmed influenza and adenovirus among military trainees. Findings from this study can guide clinicians in the diagnosis and treatment of military trainees presenting with FRI.

Show MeSH
Related in: MedlinePlus