Abstract
BackgroundBasic 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.MethodsSpecimens 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.ResultsAmong 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).ConclusionsSpecific 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0576-2) contains supplementary material, which is available to authorized users.
Highlights
Basic trainees in the US military have historically been vulnerable to respiratory infections
Descriptive analysis Among 21,570 febrile respiratory illness (FRI) cases sampled between November 2004 and October 2009, 63.6% were laboratory-confirmed adenovirus cases and 6.7% were laboratory-confirmed influenza cases
We found that influenza was more likely to occur within the first 2 weeks of training and during the winter season, whereas adenovirus was more likely to occur during weeks 3–6 of training and during the spring, summer, and fall seasons
Summary
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. The objective of this study was to determine what demographic and clinical factors are associated with influenza and adenovirus among military trainees. Military basic trainees have been vulnerable to severe epidemics of febrile respiratory illness (FRI) [1,2]. In the presence of an epidemic, it is generally acceptable to make a reasonable diagnosis based on clinical signs and symptoms until laboratory confirmation can be obtained. It is still debatable whether specific demographic and clinical symptoms can be used to distinguish among respiratory pathogens. Few studies have focused on other respiratory pathogens like adenovirus that have caused substantial morbidity among military trainees [10,11]
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