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Jeremy Sueker J.,U.S. Army | Blazes D.L.,U.S. Army | Johns M.C.,U.S. Army | Blair P.J.,Naval Health Research Center | And 15 more authors.
Influenza and other Respiratory Viruses | Year: 2010

The US Department of Defense influenza surveillance system now spans nearly 500 sites in 75 countries, including active duty US military and dependent populations as well as host-country civilian and military personnel. This system represents a major part of the US Government's contributions to the World Health Organization's Global Influenza Surveillance Network and addresses Presidential Directive NSTC-7 to expand global surveillance, training, research and response to emerging infectious disease threats. Since 2006, the system has expanded significantly in response to rising pandemic influenza concerns. The expanded system has played a critical role in the detection and monitoring of ongoing H5N1 outbreaks worldwide as well as in the initial detection of, and response to, the current (H1N1) 2009 influenza pandemic. This article describes the system, details its contributions and the critical gaps that it is filling, and discusses future plans. Published 2010. This article is a US Government work and is in the public domain in the USA.

Kasper M.R.,Us Naval Medical Research Unit 2 | Wierzba T.F.,Us Naval Medical Research Unit No 2 | Sovann L.,Kingdom of Cambodia Ministry of Health | Blair P.J.,Us Naval Medical Research Unit 2 | Putnam S.D.,Us Naval Medical Research Unit 2
BMC Infectious Diseases | Year: 2010

Background: Influenza-like illness (ILI) is often defined as fever (>38.0°C) with cough or sore throat. In this study, we tested the sensitivity, specificity, and positive and negative predictive values of this case definition in a Cambodia patient population.Methods: Passive clinic-based surveillance was established at nine healthcare centers to identify the causes of acute undifferentiated fever in patients aged two years and older seeking treatment. Fever was defined as tympanic membrane temperature >38°C lasting more than 24 hours and less than 10 days. Influenza virus infections were identified by polymerase chain reaction.Results: From July 2008 to December 2008, 2,639 patients were enrolled. From 884 (33%) patients positive for influenza, 652 presented with ILI and 232 acute fever patients presented without ILI. Analysis by age group identified no significant differences between influenza positive patients from the two groups. Positive predictive values (PPVs) varied during the course of the influenza season and among age groups.Conclusion: The ILI case definition can be used to identify a significant percentage of patients with influenza infection during the influenza season in Cambodia, assisting healthcare providers in its diagnosis and treatment. However, testing samples based on the criteria of fever alone increased our case detection by 34%. © 2010 Kasper et al; licensee BioMed Central Ltd.

Kasper M.R.,Us Naval Medical Research Unit 6 | Putnam S.D.,Us Naval Medical Research Unit 6 | Sovann L.,Ministry of Health | Yasuda C.Y.,Us Naval Medical Research Unit No 2 | And 2 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2011

Influenza can be manifested as an acute febrile illness, with symptoms similar to many pathogens endemic to Cambodia. The objective of this study was to evaluate the Quickvue influenza A+B rapid test to identify the etiology of acute febrile illness in Cambodia. During December 2006-May 2008, patients enrolled in a study to identify the etiology of acute febrile illnesses were tested for influenza by real-time reverse transcriptase PCR (RT-PCR) and Quickvue influenza A+B rapid test. The prevalence of influenza was 19.7% by RT-PCR. Compared with RT-PCR, the sensitivity and specificity of the rapid test were 52.1% and 92.5%, respectively. The influenza rapid test identified the etiology in 10.2% of enrollees and ≥ 35% during peak times of influenza activity. This study suggests that rapid influenza tests may be useful during peak times of influenza activity in an area where several different etiologies can present as an acute febrile illness. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.

Blair P.J.,Us Naval Medical Research Unit No 2 | Wierzba T.F.,Us Naval Medical Research Unit No 2 | Touch S.,Kingdom of Cambodia Ministry of Health | Vonthanak S.,National Institute of Public Health | And 6 more authors.
Epidemiology and Infection | Year: 2010

The epidemiology, symptomology, and viral aetiology of endemic influenza remain largely uncharacterized in Cambodia. In December 2006, we established passive hospital-based surveillance to identify the causes of acute undifferentiated fever in patients seeking healthcare. Fever was defined as tympanic membrane temperature >38C. From December 2006 to December 2008, 4233 patients were screened for influenza virus by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). Of these patients, 1151 (272%) were positive for influenza. Cough (688% vs. 505%, P<00001) and sore throat (550% vs. 419%, P<00001) were more often associated with laboratory-confirmed influenza-infected patients compared to influenza-negative enrollees. A clear influenza season was evident between July and December with a peak during the rainy season. Influenza A and B viruses were identified in 768 (663%) and 388 (337%) of the influenza-positive population (n=1153), respectively. In December 2008, passive surveillance identified infection of the avian influenza virus H5N1 in a 19-year-old farmer from Kandal province who subsequently recovered. From a subset of diagnostic samples submitted in 2007, 15 A(H1N1), seven A(H3N2) and seven B viruses were isolated. The predominant subtype tested was influenza A(H1N1), with the majority antigenically related to the A/Solomon Island/03/2006 vaccine strain. The influenza A(H3N2) isolates and influenza B viruses analysed were closely related to A/Brisbane/10/2007 or B/Ohio/01/2005 (B/Victoria/2/87-lineage) vaccine strains, respectively. Phylogenetic analysis of the HA1 region of the HA gene of influenza A(H1N1) viruses demonstrated that the Cambodian isolates belonged to clade 2C along with representative H1N1 viruses circulating in SE Asia at the time. These viruses remained sensitive to oseltamivir. In total, our data suggest that viral influenza infections contribute to nearly one-fifth of acute febrile illnesses and demonstrate the importance of influenza surveillance in Cambodia. © 2009 Cambridge University Press.

Kasper M.R.,Us Naval Medical Research Unit No 2 | Sokhal B.,National Institute of Public Health | Blair P.J.,Us Naval Medical Research Unit No 2 | Wierzba T.F.,Us Naval Medical Research Unit No 2 | Putnam S.D.,Us Naval Medical Research Unit No 2
Diagnostic Microbiology and Infectious Disease | Year: 2010

From December 2006 to April 2009, we conducted an etiology study among Cambodian patients presenting with acute fever of unknown origin. Salmonella enterica serovar Typhi was detected in 0.9% (41/4985) blood cultures. Antimicrobial susceptibility testing showed decreased susceptibility to ampicillin (56% resistant; MIC90, >256 μg/mL), chloramphenicol (56% resistant; MIC90, >256 μg/mL), trimethoprim/sulfamethoxazole (56% resistant; MIC90, >256 μg/mL), nalidixic acid (81% resistant; MIC90, not defined), ciprofloxacin (0% resistant; MIC90, 0.5 μg/mL), and ceftriaxone (0% resistant; MIC90, 0.094 μg/mL). Multidrug resistance, defined as antimicrobial resistance to ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole, was found in 56% of the isolates, and 80% had reduced susceptibility to ciprofloxacin (defined as MIC ≥0.12 μg/mL).

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