Abstract
BackgroundRespiratory illnesses have been identified as a significant factor leading to lost training time and morbidity among Singapore military recruits. A surveillance programme has been put in place to determine etiological agents responsible for febrile, as well as afebrile respiratory illnesses in a military camp. The goal of the study is to better understand the epidemiology of these diseases and identify potential countermeasures to protect military recruits against them.MethodsFrom Jan 2016 - Jan 2017, a total of 2647 respiratory cases were enrolled into the surveillance programme. The cases were further stratified into Febrile Respiratory Illness (FRI, with body temperature > 37.5 °C) or Acute Respiratory Illness (ARI, with body temperature < 37.5 °C). Nasal washes were collected and tested by multiplex PCR to detect 26 different pathogens.ResultsOne thousand ninety five cases (41% of total cases) met the criteria of FRI in which 932 cases (85% of FRI cases) were screened positive for at least one virus. The most common etiological agents for FRI mono-infection cases were Adenovirus E and Rhinovirus. Recruits infected with H3N2 influenza, Influenza B and Adenovirus E viruses were most likely presented as FRI cases. Notably, H3N2 influenza resulted in the greatest rise in body temperature. The remaining 1552 cases (59% of total cases) met the criteria of ARI in which 1198 cases (77% of ARI cases) were screened positive for at least one virus. The most common etiological agent for ARI mono-infection was Rhinovirus. The distribution pattern for dual infections was different for ARI and FRI cases. Maximum number of pathogens detected in a sample was five for both groups.ConclusionPrevious studies on respiratory diseases in military focused largely on FRI cases. With the expanded surveillance to ARI cases, this study allows unbiased evaluation of the impact of respiratory disease pathogens among recruits in a military environment. The results show that several pathogens have a much bigger role in causing respiratory diseases in this cohort.
Highlights
Respiratory illnesses have been identified as a significant factor leading to lost training time and morbidity among Singapore military recruits
While the initial focus of the surveillance programme is on etiological agents that cause febrile illnesses, some recruits were excluded from the programme as they only presented respiratory symptoms without elevation in body temperature (termed as Acute Respiratory Illnesses (ARIs))
Distribution of etiological agents responsible for Febrile Respiratory Illness (FRI) and ARI cases A total of 2647 cases with respiratory symptoms were recruited in the study
Summary
Respiratory illnesses have been identified as a significant factor leading to lost training time and morbidity among Singapore military recruits. A surveillance programme has been put in place to determine etiological agents responsible for febrile, as well as afebrile respiratory illnesses in a military camp. To better protect the recruits and reduce loss in training time, a surveillance programme was put in place to monitor the etiological agents responsible for febrile respiratory illnesses (FRIs) among Singapore military recruits since 2009. Data from the surveillance programme showed that Influenza, Coxsackie, Rhinovirus and Adenovirus are the primary causative agents of FRIs in military camps [2, 3]. A subsequent study showed that routine administration of influenza vaccine to recruits resulted in significant protection against both A(H1N1)pdm and influenza B, and was recommended for all military personnel since [5]. There is a focus on significant relationship between pathogens presented as co-infections
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