Office of the Army Surgeon General

Respiratory Disease SurveillanceU.S. Army

P.K. Underwood

Preventive Medicine Staff Officer

Proponency Office for Preventive Medicine

Office of the Surgeon General

2Sep 2003

Respiratory Disease SurveillanceU.S. Army

• Acute Respiratory Disease (ARD) is a leading cause of morbidity

• Military is susceptible to outbreaks, especially in basic training

• Host, agent and environmental factors combine to provide “opportunity”

• Routine surveillance of ARD among Basic Trainees since 1967

3Sep 2003

Respiratory Disease SurveillanceU.S. Army

• For surveillance purposes, and ARD case is defined as a trainee with all of the following:• Oral temperature > 100.5 F.• Recent onset of at least one sign or

symptom of acute respiratory tract inflammation

• Given a limited duty profile or removed from duty for at least 8 hours

4Sep 2003

Respiratory Disease SurveillanceU.S. Army

• Routine tracking of indicators of streptococcal disease activity

• Weekly calculation of:• Strep Recovery Rate• Streptococcal-ARD Surveillance Index

(SASI)• Monitor sick call at TMCs for trends in

ARD

5Sep 2003

Respiratory Disease SurveillanceU.S. Army

Calculate weekly. If > 25 for 2 consecutive weeks, indicates significant strep disease activity

Strep Recovery Rate X (ARD Cases) X 100/ # Trainees

Strep-ARD Surveillance (SAS) Index

Calculate weekly. Observe over time for trends

Pos Strep Cultures Among ARD cases X 100/ Total cultures among ARD cases

Strep

Recovery

Rate

CommentsFormulaName of Index

6Sep 2003

•Respiratory Disease SurveillanceU.S. Army

• Vaccines have had remarkable success

• Trainees are given vaccines for:

• Influenza• Measles

• Rubella

• Meningococcal disease

7Sep 2003

Respiratory Disease SurveillanceU.S. Army

• Bicillin prophylaxis administered to trainees to prevent Group A, beta-hemolytic streptococcal (GABHS) disease

• Ft. Leonard Wood reports Bicillin prophylaxis used in trainees continuously since 1996. If streptococcal disease is found within a company or battalion of recruits 4 weeks or more after the original Bicillin prophylaxis, another dose is administered to the entire company or battalion

8Sep 2003

Respiratory Disease SurveillanceU.S. Army

• Ft. Knox reports Bicillin prophylaxis has not been used since 1996, except for one outbreak of streptococcal disease among trainees

• Ft. Sill reports Bicillin prophylaxis for every trainee since 1998. They also administer a 2nd dose if strep disease is found 4 or more weeks after original dose

9Sep 2003

Respiratory Disease SurveillanceU.S. Army

• Ft. Jackson reports that BP has not been used since 1998

• Ft. Benning reports BP used in trainees continuously since 1998.

10Sep 2003

Respiratory Disease SurveillanceU.S. Army

• Preventive Medicine Chiefs at BCT installations submit the Acute Respiratory Disease Surveillance Report (ARDSR) on a weekly basis

• AMSA consolidates and analyzes the ARDSR

11Sep 2003

ARD and GABHS surveillance results, basic trainees, Fort Leonard Wood, Missouri

Source: AMSA, 9 Sep 2003

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

6-Oct-

2001

1-Dec

-2001

26-Ja

n-20

02

23-M

ar-2

002

18-M

ay-2

002

13-Ju

l-200

2

7-Sep-

2002

2-Nov

-2002

28-D

ec-2

002

22-F

eb-2

003

19-A

pr-2

003

14-Ju

n-20

03

9-Aug-

2003

AR

D r

ate

(per

100

tra

inee

s pe

r w

eek)

0

10

20

30

40

50

60

SA

SI

(AR

D r

ate

x %

GA

BH

S+

)

ARD rate

SASI

Epidemic threshold

12Sep 2003

ARD and GABHS surveillance results, basic trainees, Fort Knox, Kentucky

Source: AMSA, 9 Sep 2003

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

6-Oct-

2001

1-Dec

-2001

26-Ja

n-20

02

23-M

ar-2

002

18-M

ay-2

002

13-Ju

l-200

2

7-Sep-

2002

2-Nov

-2002

28-D

ec-2

002

22-F

eb-2

003

19-A

pr-2

003

14-Ju

n-20

03

9-Aug-

2003

AR

D r

ate

(per

100

tra

inee

s pe

r w

eek)

0

10

20

30

40

50

60

SA

SI

(AR

D r

ate

x %

GA

BH

S+

)

ARD rate

SASI

Epidemic threshold

13Sep 2003

ARD and GABHS surveillance results, basic trainees, Fort Sill, Oklahoma

Source: AMSA, 9 Sep 2003

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

6-Oct-

2001

1-Dec

-2001

26-Ja

n-20

02

23-M

ar-2

002

18-M

ay-2

002

13-Ju

l-200

2

7-Sep-

2002

2-Nov

-2002

28-D

ec-2

002

22-F

eb-2

003

19-A

pr-2

003

14-Ju

n-20

03

9-Aug-

2003

AR

D r

ate

(per

100

tra

inee

s pe

r w

eek)

0

10

20

30

40

50

60

SA

SI

(AR

D r

ate

x %

GA

BH

S+

)

ARD rate

SASI

Epidemic threshold

14Sep 2003

ARD and GABHS surveillance results, basic trainees, Fort Jackson, South Carolina

Source: AMSA, 9 Sep 2003

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

6-Oct-

2001

1-Dec

-2001

26-Ja

n-20

02

23-M

ar-2

002

18-M

ay-2

002

13-Ju

l-200

2

7-Sep-

2002

2-Nov

-2002

28-D

ec-2

002

22-F

eb-2

003

19-A

pr-2

003

14-Ju

n-20

03

9-Aug-

2003

AR

D r

ate

(per

100

tra

inee

s pe

r w

eek)

0

10

20

30

40

50

60

SA

SI

(AR

D r

ate

x %

GA

BH

S+

)

ARD rate

SASI

Epidemic threshold

15Sep 2003

ARD and GABHS surveillance results, basic trainees, Fort Benning, Georgia

Source: AMSA, 9 Sep 2003

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

6-Oct-

2001

1-Dec

-2001

26-Ja

n-20

02

23-M

ar-2

002

18-M

ay-2

002

13-Ju

l-200

2

7-Sep-

2002

2-Nov

-2002

28-D

ec-2

002

22-F

eb-2

003

19-A

pr-2

003

14-Ju

n-20

03

9-Aug-

2003

AR

D r

ate

(per

100

tra

inee

s pe

r w

eek)

0

10

20

30

40

50

60

SA

SI

(AR

D r

ate

x %

GA

BH

S+

)

ARD rate

SASI

Epidemic threshold