Epidemiology and transmission of respiratory infections in Thai Army recruits: A prospective cohort study

Clarence C. Tam, Kathryn B. Anderson, Vittoria Offeddu, Alden Weg, Louis R. Macareo, Damon W. Ellison, Ram Rangsin, Stefan Fernandez, Robert V. Gibbons, In Kyu Yoon, Sriluck Simasathien

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Military recruits are at high risk of respiratory infections. However, limited data exist on military populations in tropical settings, where the epidemiology of respiratory infections differs substantially from temperate settings. We enrolled recruits undertaking a 10-week military training at two Royal Thai Army barracks between May 2014 and July 2015.Weused a multiplex respiratory panel to analyze nose and throat swabs collected at the start and end of the training period, and from participants experiencing respiratory symptoms during follow-up. Paired sera were tested for influenza seroconversion using a hemagglutinin inhibition assay. Overall rates of upper respiratory illness and influenza-like illness were 3.1 and 2.0 episodes per 100 person-weeks, respectively. A pathogen was detected in 96% of samples. The most commonly detected microbes were Haemophilus influenzae type B (62.7%) or non-type B (58.2%) and rhinovirus (22.4%). At baseline, bacterial colonization was high and included H. influenzae type B (82.3%), H. influenzae non-type B (31.5%), Klebsiella pneumoniae (14.6%), Staphylococcus aureus (8.5%), and Streptococcus pneumoniae (8.5%). At the end of follow-up, colonization with H. influenzae non-type B had increased to 74.1%, and S. pneumoniae to 33.6%. In the serology subset, the rate of influenza infection was 3.4 per 100 person-months; 58% of influenza infections resulted in clinical disease. Our study provides key data on the epidemiology and transmission of respiratory pathogens in tropical settings. Our results emphasize the need for improved infection prevention and control in military environments, given the high burden of illness and potential for intense transmission of respiratory pathogens.

Original languageEnglish (US)
Pages (from-to)1089-1095
Number of pages7
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number4
StatePublished - 2018

Bibliographical note

Funding Information:
Financial support: This work was supported by the United States Department of Defense—Global Emerging Infectious Disease Surveillance (DoD—GEIS), Protocol 989A.

Publisher Copyright:
Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.


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