DoD Global Influenza Surveillance Program

1
DoD Global Influenza Surveillance Program

• Report of the
• Joint Influenza Surveillance Working Group
• to the Armed Forces Epidemiological Board
• September 2002

Presenter James Neville, Col, USAF, MC,
FS Director, Surveillance Directorate AFIERA
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DoD Global Influenza Surveillance

• History
• Started by USAF in 1976 as Project Gargle
• Expanded, enhanced in 1998 with DoD-GEIS
• ASD(HA) Letter dated 3 Feb 99
• USAF/SG is Executive Agent
• DoD-GEIS provides professional guidance
• DMSS maintains surveillance database
• Each service has virology laboratory
• JISWG annual plan to ASD(HA) and SGs
• Influenza surveillance occurs among selected
  populations
• Report to the AFEB at least annually
• Selected highlights follow . . .

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Highlight 1
May 1999 A/New Caledonia/H1N1 Isolated from
Peruvian Military Cadets -First time seen in
Americas -Proved virus spreading -Vaccine
Component
4
Highlight 2
July 1999 Flu A confirmed
at Lackland AFB in training unit1100 at
risk Amantadine prophylaxis administered to
prevent a serious outbreak
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Highlight 3

• Collected samples from reported ILI outbreak in
  Panama
• Isolates identified as H3N2 variant
• A/Panama/2007/H3N2 became the seed virus for the
  H3N2 vaccine component 2000-2001
• 
  2001-2002
• 
  2002-2003

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Highlight 4
Surveillance site established at Kalisizo,
Uganda in association with existing Public
Health surveillance Project
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Overview of Current DoD Influenza Surveillance

• Two main components, largely funded by DoD-GEIS
• Population-based managed at NHRC San Diego
• FRI surveillance of trainee populations
• Military training centers track febrile
  respiratory incidence rates
• Systematically collect viral specimens
• Etiology-based managed at Brooks AFB
• Sentinel sites systematically collect specimens
  from FRI cases
• Clinical specimens from sentinel and non-sentinel
  sites included
• Ongoing interactions with CDC Influenza Branch
• Additional data collection clinical lab result
  summaries from Army MEDCENs
• No systematic collection clinical results only

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Virology Results from Army MEDCENs
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NHRCs Population-based FRI Surveillance Program

• FRI case numbers, denominators, and proportional
  specimens
• Focused on military training sites

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NHRC Distribution of Viral Test Results by Site
April 2001 - March 2002 n2071
n491 n322 n249
n356 n69 n401 n136
n47
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NHRC Influenza Infection Rates at Basic
Training Sites
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DoD Global Influenza Surveillance ................
................IN ACTION
Army, Navy input
CDC, VRBAC
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USAF-managed 2001-2002 Surveillance Sites
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ILI activity, 30/12/01 to 28/12/02, World
 No Participating Sporadic
   
Widespread Outbreak   No Report  
Local Outbreak No Activity  
Regional Outbreak
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2001-2002 SeasonSpecimens by Week
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CDC Data
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OCTOBER 9 (36/402) of samples pos for any
respiratory virus 21 (8/36) of all resp viruses
were Influenza A 25 (2/8) of the flus were typed
and all were H3N2 adjusted to exclude recruit
adenovirus samples
7
1

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NOVEMBER 25.5 (86/337) of all samples were pos
for any respiratory virus 58 (50/101) of all
resp viruses were Influenza A 2.9 (3/101) of all
resp viruses were Influenza B-all from Peru 30
of the Influenza As were typed (15/50) and all
were H3N2 adjusted to exclude recruit
adenovirus samples
41
2
2
4
1
3
19
5
5
1
DECEMBER 17.3 (43/248) of all samples were pos
for any respiratory virus 65 (28/43) of all
resp viruses were Influenza A 75 of the
Influenza As were typed (21/28) and 95
(20/21)were H3N2 The only H1N1 was from
Korea adjusted to exclude recruit adenovirus
samples
1
1
10
2
1
2
20
11
17
2
4
1
3
JANUARY 17.3 (83/480) of all samples were
positive for any respiratory virus 80 (66/83)
of all resp viruses were Influenza A 18 of the
Influenza As typed so far (12/66) have all been
H3N2 adjusted to exclude recruit adenovirus
samples
22
5
1
21
14
2
15
4
20
7
9
1
7
1
9
3
3
3
2
1
2
3
8
6
14
19
2
FEBRUARY More widespread activity A few more Bs
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22
4
9
4
21
10
3
14
3
2
5
2
5
March Activity dying down some More widespread B,
but most recovered from one site ( small
circle means one case)
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JISWG Summary Notes

• All isolates similar to vaccine strain
• NHRC presented data on rapid influenza tests
• indicates very limited clinical usefulness
• AFIP and NHRC researching ambient temperature
  shipping methods
• Little Creek Naval Base added to sentinel site
  list
• Vaccine effectiveness study at Misawa AB, Japan,
  2001-02
• No difference in survival to respiratory visit,
  but low power
• Improve efforts to market program to medical
  leaders
• DoD pandemic plan needs work (by whom?)
• Plans for response to large outbreak need work
• Pursue capability to obtain specimens from
  deployed forces

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JISWG Summary Notes (contd)

• Looking into the availability of VA data
• Improve regular reporting through USAF/SG to
  other service SGs and ASD(HA)
• Will not process non-human specimens
• Brooks AFB lab will pursue WHO Collaborating
  Center designation, as has NHRC already
• Consider expansion of JISWG meeting to include
  more scientific presentations, vaccine and policy
  issues, etc.
• Submit for publication an update of the DoD
  program
• Consider evaluation of vaccine failure
• This year, for example, 85 (121) of the cases
  among AD personnel were in people who had been
  vaccinated gt13 days.

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Back-up slides
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SENTINEL SITES

• USAF Academy COLORADO
• Andersen AFB GUAM
• Andrews AFB WASHINGTON DC
• Elmendorf AFB ALASKA
• Hawaii Army- Tripler
• Air
  Force- Hickam
• 
  Navy-Pearl Harbor
• Incirlik AFB TURKEY
• Kadena AFB OKINAWA
• Kunsan AFB KOREA
• Lakenheath AFB UNITED KINGDOM
• Maxwell AFB ALABAMA
• McGuire AFB NEW JERSEY
• Misawa AFB JAPAN
• Osan AFB KOREA
• Ramstein AFB GERMANY
• Sheppard AFB TEXAS
• Travis AFB CALIFORNIA
• Yokosuk NH JAPAN

• Armed Forces Research Institute of Medical
  Sciences (AFRIMS)
• NEPAL
• THAILAND
• Naval Medical Research Institute Detachment
  (NAMRID)
• PERU
• ECUADOR
• BOLIVIA
• ARGENTINA
• Walter Reed Army Institute of Research (WRAIR)
• UGANDA

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NHRC Febrile Respiratory Illness Rates at US
Army Training Installations
Epidemic Threshold
Febrile Respiratory Illness Rate (Cases per 100
trainees per week)
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Febrile Respiratory Illness Rates at US
Navy/Marine/Air Force/Coast Guard Training
Installations
Epidemic Threshold
Febrile Respiratory Illness Rate (Cases per 100
trainees per week)
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Influenza Vaccine Effectiveness StudySurvival
AnalysisAll Respiratory Visits
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Influenza Vaccine Effectiveness StudySurvival
AnalysisActive Duty Respiratory Visits
NOTE top line is unvaccinated
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CDC Phylogenetic AnalysisAll H1N1 Viruses 2001

Hawaii/1727/01
Japan/1852/01
Japan/1186/01
New Jersey/1611/01
England/1189/01
Florida/720/00
Ecuador/3003/00
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Significant Isolates Sequenced 2000-2001
Novel H1 variant characterized by Brooks AFB
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Influenza A H3N2 Hemagglutinin Gene (HA1),
2001-2002