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Military Health System

Respiratory Infections (RI) Surveillance

Pictures of MERS-CoV (photo by NIAID) and two N95-type masks; source is CDC to depict Respiratory Infections (RI) Surveillance.

RI surveillance projects address rapid detection and response to respiratory pathogens, especially those with pandemic potential in humans through surveillance of:

  • U.S. military, including recruit, shipboard, and deployed populations, and in foreign military and civilian populations
  • The human – animal interface, designed to develop knowledge regarding zoonotic transmission of emerging RIs
  • Advanced characterization of viruses, designed to monitor viral drift and potential shift
  • Vaccine effectiveness and response studies

U.S. Air Force Staff Sgt. Bianca Raleigh, 31st Medical Operations Squadron, allergy and immunizations, administers a patient's shot, at Aviano Air Base, Italy. (U.S. Air Force photo by Senior Airman Areca T. Wilson). Second image is the H1N1 influenza virus particles; source is NIAID.

Importance of RI Surveillance within the U.S. Military

Viral respiratory pathogens are easily transmitted person-to-person, and some, such as influenza and coronaviruses, mutate frequently, increasing the risk of the emergence of a novel pathogen with pandemic potential.

Historically, military populations have been at high risk for acute respiratory infections, especially among recruits and deployed personnel. At times, the living conditions under which U.S. military members operate are austere, crowded, and stressful, which makes these individuals particularly vulnerable to infection and transmission of respiratory pathogens compared to civilian populations. During 2016, more than 250,000 active duty military members had a medical encounter for a respiratory infection. This high burden of disease creates a substantial public health and economic stress for the military population.

RI Focus Area Strategy

  • Provide timely, accurate, and actionable RI surveillance data for decision makers within the Department of Defense and global public health community
  • Identify changes in circulating influenza virus subtypes and genotypes that affect disease severity, transmissibility, treatment, and prevention effectiveness across time and geography
  • Increase One Health work to determine zoonotic transmission and risk factors for influenza infections within the human-animal interface, especially for high-risk populations
    • One Health seeks to improve the lives of all species through the integration of human medicine, veterinary medicine, and environmental science. The GEIS One Health focus is to estimate and predict the risk of human disease by conducting surveillance in animal populations or the environment. 
  • Conduct surveillance in military populations such as recruits and special warfare operators where there is an increased risk of RI transmission
  • Provide support for outbreaks of RIs as requested by U.S. government or partners

Pathogens of interest include: 

Influenza, Adenovirus, Enteroviruses, Coronaviruses, Chlamydia pneumoniae, Mycoplasma pneumoniae, Streptococcus pneumoniae, Rhinoviruses, and Pharyngeal Group A Streptococcus.

Images: Photo 1: Service member being administered a seasonal influenza injectable vaccine. Photos 2 and 3: Pig and chicken are carriers of the influenza virus that result in spillover to humans.  Photo 4: This highly-magnified transmission electron microscopic (TEM) image depicted numbers of virions from a Novel Flu H1N1 isolate. Photo credit by CDC. Photo 5: Service members wearing two N95-type masks. Photo 6: Image of the globe.

RI Focus Area Activities

  • RI surveillance in the U.S. and overseas hub and satellite laboratories, specialized laboratories, and medical treatment facilities within the Military Health System, in collaboration with partner nations
  • RI surveillance at the human-animal interface that incorporates the One Health initiative to determine zoonotic transmission and risk factors
  • Serologic studies designed to answer questions regarding immune response to influenza and adenovirus vaccines and their effectiveness, as well as to inform future influenza vaccine strain selection

What's New in the RI Focus Area for FY17

The RI focus area provides approximately $20.1 million of funding to support partner projects.

New projects include:

  • Assessment of respiratory laboratory testing options to inform laboratory-based surveillance program test selection
  • Surveillance of acute respiratory infection etiology in high-risk agricultural workers in Cambodia to establish surveillance at the human-animal interface and provide faster response to potential emerging diseases

Where We're Going

  • Expanding surveillance at the human-animal interface, especially in locations where spillover is likely
  • Augmenting existing influenza sites with ability to conduct surveillance for additional respiratory pathogens
  • Establishing a standardized testing algorithm for severe respiratory illness
  • Expanding use of the Department of Defense Serum Repository for analyses that might provide information for force health protection

See what GEIS is doing to combat antimicrobial resistant infections and sexually transmitted infections, enteric infections, and febrile and vector-borne infections.

If you are involved with the Department of Defense medical community and are interested in partnering with GEIS, or if you would like more information, please contact us.

Last Updated: December 13, 2017
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