Padin Damaris S, Faix Dennis, Brodine Stephanie, Lemus Hector, Hawksworth Anthony, Putnam Shannon, Blair Patrick
Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
BMC Infect Dis. 2014 Dec 5;14:576. doi: 10.1186/s12879-014-0576-2.
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. 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.
Specimens 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.
Among 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).
Specific 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.
美国军队中的基础训练学员历来易患呼吸道感染。腺病毒和流感是学员中引起发热性呼吸道疾病（FRI）最常见的病原体，且表现出相似的临床体征和症状。确定与导致学员中FRI流行的主要病毒病原体相关的人口统计学和临床因素，将有助于改善鉴别诊断，并实现抗病毒药物的合理分配。本研究的目的是确定军队学员中哪些人口统计学和临床因素与流感和腺病毒相关。
在美国八个基础训练中心，对符合FRI病例定义（发热≥38.0°C，伴有咳嗽或咽痛；或经医生诊断为肺炎）的军队学员进行系统的标本采集。对标本进行呼吸道病原体的PCR和/或细胞培养检测。通过访员管理的问卷收集患者人口统计学和临床因素的信息。采用多分类逻辑回归评估这些因素与FRI结果类别之间的关联：实验室确诊的腺病毒、流感或其他FRI。计算个体预测因素及预测因素临床组合的敏感性、特异性、阳性和阴性预测值。
在2004年至2009年间抽取的21,570例FRI病例中，63.6%为实验室确诊的腺病毒病例，6.6%为实验室确诊的流感病例。受试者主要为年轻男性（86.8%为男性；平均年龄20.8±3.8岁），来自杰克逊堡（18.8%）、五大湖（17.1%）、伦纳德·伍德堡（16.3%）、圣地亚哥海军陆战队新兵训练营（MCRD）（19.0%）、本宁堡（13.3%）、拉克兰德（7.5%）、帕里斯岛海军陆战队新兵训练营（MCRD）（8.7%）和梅角（3.2%）。腺病毒的最佳多变量预测因素是咽痛（比值比[OR]，2.94；95%置信区间[CI]，2.66 - 3.25）、咳嗽（OR，2.33；95% CI，2.11 - 2.57）和发热（OR，2.07；95% CI，1.90 - 2.26）的组合，阳性预测值为77%（p≤0.05）。咳嗽、发热、第0 - 2周训练以及急性起病的组合对流感的预测性最强（阳性预测值 = 38%；p≤0.05）。
特定的人口统计学和临床因素与军队学员中实验室确诊的流感和腺病毒相关。本研究结果可为临床医生诊断和治疗出现FRI的军队学员提供指导。
