COL Paula Underwood
15
Office of the Army Surgeon General Respiratory Disease Surveillance U.S. Army P.K. Underwood Preventive Medicine Staff Officer Proponency Office for Preventive Medicine Office of the Surgeon General
Transcript of COL Paula Underwood
Office of the Army Surgeon General
Respiratory Disease SurveillanceU.S. Army
P.K. Underwood
Preventive Medicine Staff Officer
Proponency Office for Preventive Medicine
Office of the Surgeon General
2Sep 2003
Respiratory Disease SurveillanceU.S. Army
• Acute Respiratory Disease (ARD) is a leading cause of morbidity
• Military is susceptible to outbreaks, especially in basic training
• Host, agent and environmental factors combine to provide “opportunity”
• Routine surveillance of ARD among Basic Trainees since 1967
3Sep 2003
Respiratory Disease SurveillanceU.S. Army
• For surveillance purposes, and ARD case is defined as a trainee with all of the following:• Oral temperature > 100.5 F.• Recent onset of at least one sign or
symptom of acute respiratory tract inflammation
• Given a limited duty profile or removed from duty for at least 8 hours
4Sep 2003
Respiratory Disease SurveillanceU.S. Army
• Routine tracking of indicators of streptococcal disease activity
• Weekly calculation of:• Strep Recovery Rate• Streptococcal-ARD Surveillance Index
(SASI)• Monitor sick call at TMCs for trends in
ARD
5Sep 2003
Respiratory Disease SurveillanceU.S. Army
Calculate weekly. If > 25 for 2 consecutive weeks, indicates significant strep disease activity
Strep Recovery Rate X (ARD Cases) X 100/ # Trainees
Strep-ARD Surveillance (SAS) Index
Calculate weekly. Observe over time for trends
Pos Strep Cultures Among ARD cases X 100/ Total cultures among ARD cases
Strep
Recovery
Rate
CommentsFormulaName of Index
6Sep 2003
•Respiratory Disease SurveillanceU.S. Army
• Vaccines have had remarkable success
• Trainees are given vaccines for:
• Influenza• Measles
• Rubella
• Meningococcal disease
7Sep 2003
Respiratory Disease SurveillanceU.S. Army
• Bicillin prophylaxis administered to trainees to prevent Group A, beta-hemolytic streptococcal (GABHS) disease
• Ft. Leonard Wood reports Bicillin prophylaxis used in trainees continuously since 1996. If streptococcal disease is found within a company or battalion of recruits 4 weeks or more after the original Bicillin prophylaxis, another dose is administered to the entire company or battalion
8Sep 2003
Respiratory Disease SurveillanceU.S. Army
• Ft. Knox reports Bicillin prophylaxis has not been used since 1996, except for one outbreak of streptococcal disease among trainees
• Ft. Sill reports Bicillin prophylaxis for every trainee since 1998. They also administer a 2nd dose if strep disease is found 4 or more weeks after original dose
9Sep 2003
Respiratory Disease SurveillanceU.S. Army
• Ft. Jackson reports that BP has not been used since 1998
• Ft. Benning reports BP used in trainees continuously since 1998.
10Sep 2003
Respiratory Disease SurveillanceU.S. Army
• Preventive Medicine Chiefs at BCT installations submit the Acute Respiratory Disease Surveillance Report (ARDSR) on a weekly basis
• AMSA consolidates and analyzes the ARDSR
11Sep 2003
ARD and GABHS surveillance results, basic trainees, Fort Leonard Wood, Missouri
Source: AMSA, 9 Sep 2003
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
6-Oct-
2001
1-Dec
-2001
26-Ja
n-20
02
23-M
ar-2
002
18-M
ay-2
002
13-Ju
l-200
2
7-Sep-
2002
2-Nov
-2002
28-D
ec-2
002
22-F
eb-2
003
19-A
pr-2
003
14-Ju
n-20
03
9-Aug-
2003
AR
D r
ate
(per
100
tra
inee
s pe
r w
eek)
0
10
20
30
40
50
60
SA
SI
(AR
D r
ate
x %
GA
BH
S+
)
ARD rate
SASI
Epidemic threshold
12Sep 2003
ARD and GABHS surveillance results, basic trainees, Fort Knox, Kentucky
Source: AMSA, 9 Sep 2003
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
6-Oct-
2001
1-Dec
-2001
26-Ja
n-20
02
23-M
ar-2
002
18-M
ay-2
002
13-Ju
l-200
2
7-Sep-
2002
2-Nov
-2002
28-D
ec-2
002
22-F
eb-2
003
19-A
pr-2
003
14-Ju
n-20
03
9-Aug-
2003
AR
D r
ate
(per
100
tra
inee
s pe
r w
eek)
0
10
20
30
40
50
60
SA
SI
(AR
D r
ate
x %
GA
BH
S+
)
ARD rate
SASI
Epidemic threshold
13Sep 2003
ARD and GABHS surveillance results, basic trainees, Fort Sill, Oklahoma
Source: AMSA, 9 Sep 2003
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
6-Oct-
2001
1-Dec
-2001
26-Ja
n-20
02
23-M
ar-2
002
18-M
ay-2
002
13-Ju
l-200
2
7-Sep-
2002
2-Nov
-2002
28-D
ec-2
002
22-F
eb-2
003
19-A
pr-2
003
14-Ju
n-20
03
9-Aug-
2003
AR
D r
ate
(per
100
tra
inee
s pe
r w
eek)
0
10
20
30
40
50
60
SA
SI
(AR
D r
ate
x %
GA
BH
S+
)
ARD rate
SASI
Epidemic threshold
14Sep 2003
ARD and GABHS surveillance results, basic trainees, Fort Jackson, South Carolina
Source: AMSA, 9 Sep 2003
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
6-Oct-
2001
1-Dec
-2001
26-Ja
n-20
02
23-M
ar-2
002
18-M
ay-2
002
13-Ju
l-200
2
7-Sep-
2002
2-Nov
-2002
28-D
ec-2
002
22-F
eb-2
003
19-A
pr-2
003
14-Ju
n-20
03
9-Aug-
2003
AR
D r
ate
(per
100
tra
inee
s pe
r w
eek)
0
10
20
30
40
50
60
SA
SI
(AR
D r
ate
x %
GA
BH
S+
)
ARD rate
SASI
Epidemic threshold
15Sep 2003
ARD and GABHS surveillance results, basic trainees, Fort Benning, Georgia
Source: AMSA, 9 Sep 2003
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
6-Oct-
2001
1-Dec
-2001
26-Ja
n-20
02
23-M
ar-2
002
18-M
ay-2
002
13-Ju
l-200
2
7-Sep-
2002
2-Nov
-2002
28-D
ec-2
002
22-F
eb-2
003
19-A
pr-2
003
14-Ju
n-20
03
9-Aug-
2003
AR
D r
ate
(per
100
tra
inee
s pe
r w
eek)
0
10
20
30
40
50
60
SA
SI
(AR
D r
ate
x %
GA
BH
S+
)
ARD rate
SASI
Epidemic threshold
