Rates Of Respiratory Illness Research Articles

High rates of respiratory illnesses upon arrival: lessons from Team USA at the Santiago 2023 Pan American and Parapan American Games

ObjectiveTo describe the incidence and characteristics of injuries and illnesses among Team USA athletes competing at the Santiago 2023 Pan American Games (PAG) and Parapan American Games (PPAG), with a...

Farm animal exposure, respiratory illnesses, and nasal cell gene expression

BackgroundFarm exposures in early life reduce the risks for childhood allergic diseases and asthma. There is less information about how farm exposures relate to respiratory illnesses and mucosal immune development. ObjectiveWe hypothesized that children raised in farm environments have a lower incidence of respiratory illnesses over the first two years of life than non-farm children. We also analyzed whether farm exposures or respiratory illnesses were related to patterns of nasal cell gene expression. MethodsThe Wisconsin Infant Study Cohort included farm (n=156) and non-farm (n=155) families with children followed to age 2 years. Parents reported prenatal farm and other environmental exposures. Illness frequency and severity were assessed using illness diaries and periodic surveys. Nasopharyngeal cell gene expression in a subset of 64 children at age two years was compared to farm exposure and respiratory illness history. ResultsFarm vs. non-farm children had nominally lower rates of respiratory illnesses (rate ratio 0.82 [0.69,0.97]) with a stepwise reduction in illness rates in children exposed to 0, 1, or ≥2 animal species, but these trends were non-significant in a multivariable model. Farm exposures and preceding respiratory illnesses were positively related to nasal cell gene signatures for mononuclear cells and innate and antimicrobial responses. ConclusionsMaternal and infant exposure to farms and farm animals was associated with nonsignificant trends for reduced respiratory illnesses. Nasal cell gene expression in a subset of children suggests that farm exposures and respiratory illnesses in early life are associated with distinct patterns of mucosal immune expression.

Associations of early-life exposures and socioeconomic status with cognitive development at preadolescence.

The long-term relations of socioeconomic status (SES) and early-life exposures with cognitive development at preadolescence are not fully understood, especially in low SES populations. We examined associations of SES and early-life exposures including feeding practices, physical growth and infections with cognitive development among preadolescents from underprivileged communities. A prospective study was conducted among 146 healthy children from two relatively low SES Arab villages in Israel, who were recruited at age 1-9 weeks and followed until age 18 months. Information was obtained on their feeding practices, health status and growth indicators. Cognitive development at age 10-12 years was assessed using the Wechsler Intelligence Scale, including the full-scale intelligence quotient (FSIQ) and scores of four cognitive domains. Multiple linear regression models were performed. Nearly all the children (98%) were breastfed in infancy. Bivariate correlations were found of SES, growth indices and rates of diarrheal and respiratory illnesses in infancy, but not of feeding practices, with cognitive scores. In multivariable models, SES was positively (p<0.001) associated with all the cognitive domains (beta coefficient ranges 4.3 to 8.2). Birthweight was positively associated with FSIQ (p=0.039) and the perceptual reasoning index (p=0.002). Weight for age Z score at age 10-14 months was positively associated with the verbal comprehension index (p=0.003). The rate of respiratory illnesses was negatively associated with the perceptual reasoning index (p=0.05). SES is strongly associated with cognitive development even in relatively low SES communities. Birthweight, weight indicators and respiratory illness in infancy might affect cognitive development through preadolescence.

Urban-Rural Disparity in Mortality Patterns of Respiratory Diseases Among Older Adults - China, 1987-2021.

Respiratory diseases (RDs) are the primary cause of death in older adults in China. However, there is limited evidence regarding the disparity in mortality rates of RDs between urban and rural areas among the elderly population. The age-standardized mortality rate (ASMR) due to RDs in the elderly population in both urban and rural areas of China has shown a consistent decrease. This trend is observed in both males and females. However, there was no significant change in the average annual percentage of ASMR for pneumonia among the urban elderly population and rural elderly men throughout the study period. Efforts should be made in China to reduce mortality from chronic lower respiratory disease and pneumonia among the elderly, particularly in urban populations.

The Impact of the COVID-19 Pandemic on Respiratory Illness Admissions at a Single Academic Institution in Arkansas.

Background: The first reported COVID-19 case in Arkansas was on 11 March 2020, two months after the first reported case in the United States. We sought to analyze rates of respiratory illness and influenza tests during the 2019/2020 influenza season compared to pre-pandemic years to assess whether there were higher rates of respiratory illness than expected, which may suggest undiagnosed COVID-19 cases. Methods: Using data collected from the data warehouse of the largest hospital in Arkansas, ICD-9 and ICD-10 codes related to respiratory illness were identified for 1 October to 1 May 2017–2020. Results: We identified 25,747 patients admitted with respiratory illness during the study. We found no significant difference in the rate of monthly admissions with respiratory illness between seasons (p = 0.14). We saw a significant increase in the number of influenza tests ordered in 2019/2020 (p < 0.01). Conclusions: The rate of hospitalizations with respiratory illness did not significantly increase during the 2019/2020 season; however, influenza testing increased without a statistically significant difference in positivity rate. The increase in ordered influenza tests indicates an increased clinical suspicion, which may suggest a rise in pre-hospital viral illness associated with COVID-19.

Aneurysmal Subarachnoid Hemorrhage during the Shutdown for COVID-19.

The aim was to evaluate hospitalization rates for aneurysmal subarachnoid hemorrhage (SAH) within an interdisciplinary multicenter neurovascular network (NVN) during the shutdown for the COVID-19 pandemic along with its modifiable risk factors. In this multicenter study, admission rates for SAH were compared for the period of the shutdown for the COVID-19 pandemic in Germany (calendar weeks (cw) 12 to 16, 2020), the periods before (cw 6–11) and after the shutdown (cw 17–21 and 22–26, 2020), as well as with the corresponding cw in the years 2015–2019. Data on all-cause and pre-hospital mortality within the area of the NVN were retrieved from the Department of Health, and the responsible emergency medical services. Data on known triggers for systemic inflammation, e.g., respiratory viruses and air pollution, were analyzed. Hospitalizations for SAH decreased during the shutdown period to one-tenth within the multicenter NVN. There was a substantial decrease in acute respiratory illness rates, and of air pollution during the shutdown period. The implementation of public health measures, e.g., contact restrictions and increased personal hygiene during the shutdown, might positively influence modifiable risk factors, e.g., systemic inflammation, leading to a decrease in the incidence of SAH.

Perceptions about air quality of individuals who work outdoors in the San Joaquin Valley, California

The San Joaquin valley (SJV) is known for having poor air quality and high rates of respiratory illnesses including asthma. This study was aimed to assess the perceptions about air quality of individuals who work outdoors in the San Joaquin Valley, California. Surveys were conducted with SJV residents (n = 198) to understand attitudes, perceptions of air quality, and behaviors related to air pollution of individuals who work outdoors. The results suggest that people who worry more about air quality tend to check air quality more often. It was found that individuals who suffer from asthma are more likely to check air quality when working and exercising outdoors. In addition, the differences on how people utilize informational sources regarding air quality were observed. Conclusion: Therefore, there is a need to further study attitudes and perceptions about air quality among populations who work outdoors.

Hemoglobin Levels Vary in Infants in Relation in Occurrence of Influenza Virus Infections

Iron deficiency anemia (IDA) screening in children, and its treatment is standard in general pediatrics. IDA has been linked to developmental concerns. However, iron supplementation recently has been shown to have risks in resource limited environments as it seems to be associated with increased risks of infections. The role of iron in bacterial survival is well established. However more difficult to explain are reports linking iron supplementation to higher rates of respiratory illness in children. Recent studies have identified hepcidin as an important mediator between inflammation from common infections, and iron repletion status (Prentice et al 2019). In the current study we hypothesized that overall hemoglobin levels in infants may fluctuate depending on birth cohorts, as 1) exposure to respiratory illnesses peaks in winter months, and 2) children aged 6-12 months have the highest incidence of respiratory illness of all age groups (up to 6-8 upper respiratory infections per year). Institutional review board permission (Children Health Care of Atlanta), was obtained and the billing registry, laboratory and patient records from an multiethinic urban clinic (n= 7,616) were reviewed. Influenzas' infection was defined as a patient presenting with an acute illness and a positive rapid influenza test. Hemoglobin was obtained at 9 to 12 months routine visit by capillary draw and point of care measure (HemoCue hb). A total of 1236 patient files were reviewed from 2007 until 2018. Each year was examined separately and then overlapped. Influenza rates were lowest in the summer, rose starting September, and peaked during the winter months. In the first year of life, hemoglobin levels peaked in March, with lowest levels observed in July and December. Infants with a diagnosis of influenza had lower hemoglobin levels and more pronounced fluctuations. At age 7-9 months, medial hemoglobin was 12.1 (95% confidence interval [CI] ±0.026) g/dl and for those infected with influenza 9.8% 95% CI ±0.138). These observations have implications regarding screening, lower limits of normal may vary during the year. supplement. Other viruses also occur during the winter months and could play a role. These results require further validations. Figure Disclosures No relevant conflicts of interest to declare.

"Youth Are More Aware and Intelligent than Imagined": The Mountain Air Youth Photovoice Project.

Appalachian Kentucky reports some of the highest rates of respiratory illness in the United States, including chronic obstructive pulmonary disease and asthma. While smoking rates are high in the region, unexplained variation remains, and community-engaged research approaches are warranted to identify contributing factors. The Mountain Air Project’s community advisory board recommended that investigators invite youth to provide their perspectives on possible contributing factors to respiratory illness, and we undertook an exploratory study to determine the utility of photovoice to elicit such perspectives with this population. While photovoice has been employed for other youth-focused health studies in Appalachia, to our knowledge, this work represents the region’s first environmental study using photovoice among youth. Over eight weeks, ten participants (age 12–18) represented their perspectives through photographs and accompanying narratives. A brief thematic content analysis of the youth narratives that accompanied the photos revealed three primary themes of environmental determinants of respiratory illness. These themes included compromises community members make regarding respiratory health in order to secure a livelihood; tension between cultural legacies and respiratory health; and consequences of geographic forces. This study demonstrates the value of incorporating youth perspectives in environmental health research, and that photovoice was a valuable approach to elicit such perspectives.

Carnitine Palmitoyl Transferase, Type 1A (CPT1A)

Carnitine Palmitoyl Transferase 1A (CPT1A) is a crucial enzyme needed for mitochondrial fatty acid oxidation and is fundamental for appropriate metabolic responses to prolonged fasting. Under normal conditions, the human body guarantees a constant energy supply, by metabolizing glucose in the short term and by oxidizing fatty acids into ketones during long term fasting or starvation. Fasting induces breakdown of the hepatic glycogen supply into glucose. Continued fasting eventually leads to glycogen depletion followed by a decrease in serum glucose and insulin levels, this decrease then activates hormone-sensitive lipases located in adipose tissues and causes the release of free fatty acids into the blood. Normally these free fatty acids would undergo beta-oxidation to produce energy, but CPT1A deficiency results in an 80% decrease in the activity of the CPT1A enzyme, leading to significant hepatic glycogen depletion and the inability to utilize ketones during periods of fasting. Preoperative fasting in these patients may result in vomiting, lethargy, hypoketotic hypoglycemia, seizures, liver failure, increased risk for infectious illnesses and higher rates of respiratory illnesses, placing this population at greater perioperative risk for anesthesia and surgery. Interventions include, but are not limited to, parent education and prevention techniques, recognition of symptoms, prompt treatment with glucose and even surgery cancellation. CPT1A deficiency is found in circum-arctic populations such as Alaskan Inupiat and Yupik, Canadian and Greenland Inuit, and Siberian Yupik and is thus known as the “Arctic Variant” of CPT1A. Once thought of as a rare disorder, the introduction of tandem mass spectrometry (MS/MS) to Alaska newborn screenings in 2003 revealed that the polymorphism c.1436C&gt;T variant in the CPT1A gene has an incidence as high as 80% in specific regions of Alaska. As of 2011, an estimated 700 Alaska Native Infants born each year are homozygous for the c.1436C&gt;T Arctic Variant. It is therefore important for anesthesia professionals in Alaska and other arctic regions to understand what CPT1A Arctic Variant is, and its implications for these patients in the perioperative period.

Upper respiratory illness in different tiers of rugby union

Rugby union is a team-based, high-impact ball sport with various training loads at different levels which may predispose players to increased but varied illness rates. The aim of the study was to characterise the incidence and duration of upper respiratory illness in school boy (three tiers), amateur, and professional rugby players to assess the typical illness rates across different levels. Participants were asked to complete a questionnaire twice a week for the duration of the active playing season investigating level of activity, well-being, and respiratory-related symptoms. Upper respiratory illness incidence per 1000 non-sick days (± SD) for the three tiers of school boy (Under 14 s, n = 9; 2nd XV, n = 15; 1st XV, n = 24), amateur (n = 18), and professional (n = 24) teams was 11.1 ± 9.7, 11.0 ± 17.8, 22.4 ± 30.9, 12.2 ± 21.8, and 12.4 ± 16.8, respectively. In addition, the duration of illness was 62.3 ± 116.1, 59.6 ± 183.2, 552.1 ± 1138.8, 64.3 ± 173.9, and 32.6 ± 59.7 days per 1000 non-sick days, respectively. This is the first study reporting the respiratory illness rates in different levels of rugby. Overall, the highest incidence observed was in the top echelon of school boy rugby, and this study provides a platform for further robust observational and interventional investigation at this level and others.

Risk factors for respiratory illness in a community of wild chimpanzees (Pan troglodytes schweinfurthii).

Respiratory illnesses have caused significant mortality in African great ape populations. While much effort has been given to identifying the responsible pathogens, little is known about the factors that influence disease transmission or individual susceptibility. In the Kanyawara community of wild chimpanzees, respiratory illness has been the leading cause of mortality over 31 years, contributing to 27% of deaths. Deaths were common in all age groups except juveniles. Over 22 years of health observations, respiratory signs were rare among infants and most common among older adults of both sexes. Respiratory signs were also common among males during the transition to adulthood (ages 10–20 years), particularly among those of low rank. Respiratory signs peaked conspicuously in March, a pattern that we could not explain after modelling climatic factors, group sizes, diet or exposure to humans. Furthermore, rates of respiratory illness in the chimpanzees did not track seasonal rates of illness in the nearby village. Our data indicate that the epidemiology of chimpanzee respiratory illness warrants more investigation but clearly differs in important ways from humans. Findings on individual susceptibility patterns suggest that respiratory signs are a robust indicator for investigating immunocompetence in wild chimpanzees.

Randomized phase 2 trial of monthly vitamin D to prevent respiratory complications in children with sickle cell disease

AbstractIn sickle cell disease, respiratory infection and asthma may lead to respiratory complications that are a leading cause of morbidity and mortality. Vitamin D has anti-infective and immunomodulatory effects that may decrease the risk for respiratory infections, asthma, and acute chest syndrome. We conducted a randomized double-blind active-controlled clinical trial to determine whether monthly oral vitamin D3 can reduce the rate of respiratory events in children with sickle cell disease. Seventy sickle cell subjects, ages 3-20 years, with baseline records of respiratory events over 1 year before randomization, underwent screening. Sixty-two subjects with 25-hydroxyvitamin D levels of 5-60 ng/mL were randomly assigned to oral vitamin D3 (100 000 IU or 12 000 IU, n = 31 each) under observed administration once monthly for 2 years. The primary outcome was the annual rate of respiratory events (respiratory infection, asthma exacerbation, or acute chest syndrome) ascertained by the use of a validated questionnaire administered biweekly. Analysis included 62 children (mean age of 9.9 years, 52% female, and predominantly with homozygous HbS disease [87%]) with mean baseline 25-hydroxyvitamin D of 14.3 ng/mL. The annual rates of respiratory events at baseline and intervention years 1 and 2 were 4.34 ± 0.35, 4.28 ± 0.36, and 1.49 ± 0.37 (high dose) and 3.91 ± 0.35, 3.34 ± 0.37, and 1.54 ± 0.37 (standard dose), respectively. In pediatric patients with sickle cell disease, 2-year monthly oral vitamin D3 was associated with a >50% reduction in the rate of respiratory illness during the second year (P = .0005), with similar decreases associated with high- and standard-dose treatment. This trial was registered at www.clinicaltrials.gov as #NCT01443728.

Characteristics of Children Prescribed Antipsychotics: Analysis of Routinely Collected Data.

Objective: Antipsychotics are licensed for psychosis and are also prescribed for behavior control. This study aims to examine characteristics and outcomes of children prescribed antipsychotics.Methods: A cohort study using general practice and hospital records linked with education records for 1,488,936 children living in Wales between 1999 and 2015. The characteristics of the children who were prescribed antipsychotics are presented using descriptive statistics and outcomes such as respiratory illness, diabetes, and injury were analyzed using multilevel logistic regression and the prior event rate ratio (PERR).Results: Children with intellectual difficulty/autism were more likely to be prescribed antipsychotics (2.8% have been prescribed an antipsychotic [75% with autism] compared with 0.15% of children without intellectual difficulty). Those with intellectual disabilities/autism were prescribed antipsychotics at a younger age and for a longer period. Antipsychotic use was associated with a higher rate of respiratory illness for all (PERR of hospital admission: 1.55 [95% CI: 1.51–1.598] or increase in rate of 2 per 100 per year in those treated), and for those with intellectual difficulty/autism, there was a higher rate of injury and hospitalized depression. However, among those without intellectual difficulty/autism, there were lower rates of depression (PERR: 0.55 [95% CI: 0.51–0.59]).Conclusions: This work shows real-world use of antipsychotics and provides information on the rate of possible adverse events in children treated. Antipsychotics are predominantly used for those with intellectual difficulty/autism rather than those with a psychotic diagnosis. There is evidence that rates of respiratory disease, epilepsy, and diabetes are also higher postantipsychotic use for all. In those with intellectual difficulty/autism, hospital-admitted depression and injury are higher postantipsychotic use. The use of antipsychotics for behavioral management is likely to have increased cost implications to the healthcare system.

The Trends in Cardiovascular Diseases and Respiratory Diseases Mortality in Urban and Rural China, 1990-2015.

With the rapid development of the economy over the past 20 years, the mortality rates from cardiovascular diseases (CVDs) and respiratory diseases (RDs) have changed in China. This study aimed to analyze the trends of mortality rates and years of life lost (YLLs) from CVDs and RDs in the rural and urban population from 1990 to 2015. Using data from Chinese yearbooks, joinpoint regression analysis was employed to estimate the annual percent change (APC) of mortality rates from CVDs and RDs. YLLs due to CVDs and RDs were calculated by a standard method, adopting recommended standard life expectancy at birth values of 80 years for men and 82.5 years for women. Age-standardized mortality rates and YLL rates were calculated by using the direct method based on the Chinese population from the sixth population census of 2010. Age-standardized mortality rates from CVDs for urban residents and from RDs for both urban and rural residents showed decreasing trends in China from 1990 to 2015. Age-standardized mortality rates from CVDs among rural residents remained constant during above period and outstripped those among urban residents gradually. The age-standardized YLL rates of CVDs for urban and rural residents decreased 35.2% and 8.3% respectively. Additionally, the age-standardized YLL rates of RDs for urban and rural residents decreased 64.2% and 79.0% respectively. The age-standardized mortality and YLL rates from CVDs and RDs gradually decreased in China from 1990 to 2015. We observed more substantial declines of the mortality rates from CVDs in urban areas and from RDs in rural areas.

0106 Evaluating preweaned calf housing and its impact on calf respiratory parameters on New York dairy farms

The objectives of this project were to (1) evaluate environmental and air quality parameters across different types of calf housing facilities; (2) evaluate rates of respiratory illness in preweaned calves; and (3) determine the impact of environmental factors, air quality, and housing type on calf health. This was an observational study in which calf facilities were evaluated on a single visit during June 2015. Housing included hutches (n = 9), individual pens in a barn (n = 11), and group pens in a barn (n = 9). Facility and calf pen evaluations included wind speed, temperature, relative humidity, heat stress index, bedding type, bedding composite sample for bacteria counts, nesting score of calf pens, calf health scoring, and airborne bacteria. Data were analyzed using SAS 9.3 to determine the impact of housing type, environmental, and air quality variables on calf respiratory score. A total of 29 facilities and 437 preweaned calves were evaluated. Calf facility temperature averaged 24.2°C (range 15.5 to 30.6°C) with a relative humidity of 21.5% (range 10 to 78%) and a heat index of 21.5°C (range 6 to 30.9°C). Temperature and airborne bacterial counts were greater in hutches as compared with individual and group pens (P < 0.01). Humidity was similar for hutches and group pens, but greater than individual pens. Gram negative airborne bacterial counts were lowest in individual pens. No difference in heat index was observed across housing type. Mean calf respiratory scores was 2.5 (range of 0 to 9) on a 12 point scale; 13.33% of calves evaluated scored greater than 5, indicating a respiratory challenge. Prevalence of respiratory illness in preweaned calves ranged from 0 to 50% of calves on a per farm basis (mean = 11.05% of calves/farm), with 44.82% of farms having no respiratory illness and 10.32% of farms having 30 to 50% of evaluated calves exhibiting signs of respiratory illness. There was a negative correlation between respiratory score and pen temperature (R2 = 0.90). There was no influence on respiratory score by housing system, bedding type, ventilation system, relative humidity, airflow, or airborne bacterial counts. Data collected from this study suggests that respiratory illness continues to be a challenge, even when weather is temperate. Additional research is needed to evaluate rates of respiratory illness during cold stress and transitional weather, as well as to evaluate management factors that increase the risk of infection.

Non-invasive quantification of immunoglobulin A in chimpanzees (Pan troglodytes schweinfurthii) at Gombe National Park, Tanzania.

Immunoglobulin A (IgA) is the primary antibody responsible for mucosal defense in mammals and has been used as a marker for chronic stress and immune status. Therefore, this antibody may provide a more reliable indicator of an individual's immunocompetence than is currently available through other methods. Immunoglobulin A has never before been quantified in a wild population of non-human primates using non-invasive sample collection techniques. In this study, we present methodology for non-invasive IgA extraction in the field and provide quantification of mean fecal IgA concentrations in wild chimpanzees (Pan troglodytes schweinfurthii). During the study period (November 2009-October 2010), we collected fecal samples (N = 1463) from 59 individuals at Gombe National Park, Tanzania. We modified a field extraction technique for steroidal hormones to extract IgA from the fecal samples and then quantified mean IgA concentrations (ng/g) using a commercial human IgA enzyme immunoassay. Mean IgA concentration varied among individuals but not by sex or reproductive status. Mature animals tended toward higher mean IgA concentration than immature. Mean IgA concentration differed by quartile season, following a similar pattern previously observed for respiratory illness rates in this population, with the late dry season having significantly higher averages than the late wet. A circadian rhythm was also evident with mean IgA concentrations higher in samples collected in the latter half of the day. These demographic and temporal patterns of IgA concentration provide baseline values necessary to interpret future results, which may be combined with other health values to better understand the role of health and long-term stress in wild great ape populations. Am. J. Primatol. 80:e22558, 2018. © 2016 Wiley Periodicals, Inc.

The impact of haze on the adolescent's acute respiratory disease: A single institution study

ObjectiveTo examine the impact of haze in the reduction of peak expiratory flow rate (PEFR) reading and identify the risk factors affecting respiratory function due to haze. MethodsThis study was conducted during haze period among secondary school students in Kota Bharu. We analyzed data on a total of 126 secondary school children measuring the respiratory health and symptoms in October 2015 using standardized questionnaire and PEFR measurement. Clinical characteristics on the risk factor and prevalence of haze effect were explored. Chi-square test and independent sample t-test was used to investigate the relationship between risk factors and haze effect and logistic regression analysis for the odds of having haze effect. ResultsThe findings revealed a significant reduction in PEFR reading of more than 15% from the expected PEFR values. It was also noted that the children with headache, cough, mucus and sore throat respiratory symptoms had consistently higher rates of respiratory illness of having haze effect compared to those who did not. ConclusionsStudent with haze effect documented much higher symptoms during haze especially female students. Symptoms such as headache, wheezing and mucus were noted among the normal secondary school children in Kota Bharu.

Elevated transmission of upper respiratory illness among new recruits in military barracks in Thailand.

BackgroundNew recruits within military barracks present conditions favorable for the spread of respiratory pathogens. However, respiratory pathogen transmission in such confined settings in the tropics has not been well studied.MethodsRecruits in four successive Royal Thai Army basic training classes living in military barracks were monitored for the symptoms of influenza-like illness (ILI) or upper respiratory illness (URI). Classes 1 and 2 were also monitored after basic training. Nasal/throat swabs from acute illnesses were collected and tested by influenza RT-PCR (all four classes). In addition, class 1 had multiplex PCR performed along with the analysis of bed locations within the barracks.ResultsInfluenza-like illness/upper respiratory illness rates ranged from 4·7 to 6·9 per 100 recruit-weeks in the four classes and generally decreased during the course of basic training (P < 0·05 in three of four classes). Rates during basic training were 1·7 (95% CI: 1·29, 2·29) and 2·5 (95% CI: 1·5, 4·1) times higher than after basic training (classes 1 and 2, respectively). In class 1, coronavirus, parainfluenza virus, and rhinovirus were the most commonly identified respiratory pathogens; only one influenza PCR-positive infection was detected in all four classes. Bed locations of URI/ILI cases in class 1 tended to be in closer proximity to each other.ConclusionBasic training recruits in military barracks in the tropics had high rates of acute respiratory illnesses with illness patterns consistent with external seeding followed by substantial internal transmission. Our findings may contribute to control measures in similar confined settings both within and outside the military.

Impact of influenza vaccination on respiratory illness rates in children attending private boarding schools in England, 2013-2014: a cohort study.

Several private boarding schools in England have established universal influenza vaccination programmes for their pupils. We evaluated the impact of these programmes on the burden of respiratory illnesses in boarders. Between November 2013 and May 2014, age-specific respiratory disease incidence rates in boarders were compared between schools offering and not offering influenza vaccine to healthy boarders. We adjusted for age, sex, school size and week using negative binomial regression. Forty-three schools comprising 14 776 boarders participated. Almost all boarders (99%) were aged 11-17 years. Nineteen (44%) schools vaccinated healthy boarders against influenza, with a mean uptake of 48·5% (range 14·2-88·5%). Over the study period, 1468 respiratory illnesses were reported in boarders (5·66/1000 boarder-weeks); of these, 33 were influenza-like illnesses (ILIs, 0·26/1000 boarder-weeks) in vaccinating schools and 95 were ILIs (0·74/1000 boarder-weeks) in non-vaccinating schools. The impact of vaccinating healthy boarders was a 54% reduction in ILI in all boarders [rate ratio (RR) 0·46, 95% confidence interval (CI) 0·28-0·76]. Disease rates were also reduced for upper respiratory tract infections (RR 0·72, 95% CI 0·61-0·85) and chest infections (RR 0·18, 95% CI 0·09-0·36). These findings demonstrate a significant impact of influenza vaccination on ILI and other clinical endpoints in secondary-school boarders. Additional research is needed to investigate the impact of influenza vaccination in non-boarding secondary-school settings.