Lessons Learnt from a Pneumonia Outbreak in a Naval Training Establishment

Abstract

Introduction: In August 2014, an unusually large number of cases of pneumonia was reported from amongst Naval Recruits in a Naval Training Establishment by the co-located Indian Naval Hospital Ship. Material and Methods: The study was descriptive observational (retrospective) in nature, which was carried out at Indian Naval Training Establishment and Indian Naval Hospital Ship. The following information was collected: (a) Batch-wise comparison of data of recruits at Indian Naval Training establishment (where two major batches undergo training every year) was done for the occurrence year (2014) and the preceding 03 years i.e 2011, 2012 and 2013. Further, data on cases of pneumonia was collected from Indian Naval Hospital Ship as recorded by the hospital for last 03 years (2011, 2012 & 2013) and the year 2014, using an epidemiological format. Results: (a) Overcrowding. (b) Confirmation of existence of Outbreak. (c) Distribution of cases as per symptomatology and X-ray findings. (d) Manmade overcrowding, physical and psychological stress of military training exposes non-immune persons to several pathogens. The study confirms overcrowding with per capita standard for floor space and air space being 5 sqm and 18 m 3. The recommended distance between two adjacent beds is 1.8m 1 Infact, they were even below the standard of 4 sqm recommended by WHO 4. A positive Correlation is known to exist between overcrowding and incidence of pneumonia 5. Conclusion: Batch-wise comparison of cases and incidence of LRTI/ Pneumonia confirmed the outbreak. Further, there were no cases of Pneumonia amongst training staff (officers & sailors) and other civilian in adjoining areas. Consequent to increase in induction pattern at Naval Training Establishment, coupled with absence of accompanying increase. Consequently, analysis of living conditions established that overcrowding existed in dormitories, dining areas and all facilities related to training.