美国军事受益人群中新型 H1N1（猪源）流感 A 病毒爆发的临床和流行病学特征。
Clinical and epidemiologic characteristics of an outbreak of novel H1N1 (swine origin) influenza A virus among United States military beneficiaries.
机构信息
Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, California 92134-1005, USA.
出版信息
Clin Infect Dis. 2009 Dec 15;49(12):1801-10. doi: 10.1086/648508.
BACKGROUND
A novel swine-origin influenza A (H1N1) virus was identified in March 2009 and subsequently caused worldwide outbreaks. The San Diego region was an early focal point of the emerging pandemic. We describe the clinical and epidemiologic characteristics of this novel strain in a military population to assist in future outbreak prevention and control efforts.
METHODS
We performed an epidemiologic evaluation of novel H1N1 virus infections diagnosed in San Diego County among 96,258 local US military beneficiaries. The structured military medical system afforded the ability to obtain precise epidemiologic information on the impact on H1N1 virus infection in a population. The novel H1N1 virus was confirmed using real-time reverse transcriptase polymerase chain reaction (rRT-PCR).
RESULTS
From 21 April through 8 May 2009, 761 patients presented with influenza-like illness and underwent rRT-PCR testing. Of these patients, 97 had confirmed novel H1N1 virus infection, with an incidence rate of 101 cases per 100,000 persons. The median age of H1N1 patients with H1N1 virus infection was 21 years (interquartile range, 15-25 years). Fever was a universal symptom in patients with H1N1 virus infection; other symptoms included cough (present in 96% of patients), myalgia or arthralgia (57%), and sore throat (51%). Sixty-eight (70%) of our patients had an identifiable epidemiologic link to another confirmed patient. The largest cluster of cases of H1N1 virus infection occurred on a Navy ship and involved 32 (8%) of 402 crew members; the secondary attack rate was 6%-14%. The rapid influenza testing that was used during this outbreak had a sensitivity of 51% and specificity of 98%, compared with rRT-PCR. Only 1 patient was hospitalized, and there were no deaths.
CONCLUSIONS
A novel H1N1 influenza A virus caused a significant outbreak among military beneficiaries in San Diego County, including a significant cluster of cases onboard a Navy ship. The outbreak described here primarily affected adolescents and young adults and resulted in a febrile illness without sequelae.
背景
一种新型猪源甲型 H1N1 流感病毒于 2009 年 3 月被发现，随后在全球范围内引发了疫情。圣地亚哥地区是新出现的大流行的早期焦点。我们描述了这种新型病毒在军事人群中的临床和流行病学特征，以协助未来的疫情防控工作。
方法
我们对圣地亚哥县的 96258 名当地美国军事受益人的新型 H1N1 病毒感染进行了流行病学评估。这种新型 H1N1 病毒是通过实时逆转录聚合酶链反应（rRT-PCR）确认的。
结果
从 2009 年 4 月 21 日至 5 月 8 日，761 名流感样疾病患者接受了 rRT-PCR 检测。这些患者中有 97 人被确诊为新型 H1N1 病毒感染，发病率为每 10 万人中有 101 例。H1N1 患者的中位年龄为 21 岁（四分位间距，15-25 岁）。发热是 H1N1 病毒感染患者的普遍症状；其他症状包括咳嗽（96%的患者出现）、肌痛或关节痛（57%）和咽痛（51%）。我们的 68 名患者（70%）有可识别的与另一名确诊患者的流行病学联系。H1N1 病毒感染的最大病例群发生在一艘海军舰艇上，涉及 402 名船员中的 32 名（8%）；二次攻击率为 6%-14%。在这次疫情中使用的快速流感检测与 rRT-PCR 相比，其敏感性为 51%，特异性为 98%。只有 1 名患者住院，无死亡病例。
结论
一种新型 H1N1 甲型流感病毒在圣地亚哥县的军事受益人群中引发了一次重大疫情，包括一艘海军舰艇上的一个重大病例群。这里描述的疫情主要影响青少年和年轻人，导致无后遗症的发热性疾病。
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