Original article
Vol. 141 No. 4748 (2011)
H1N1 outbreak in a Swiss military boot camp – observations and suggestions
- V Jeger
- A Dünki
- M Germann
- A Faas
- A Stettbacher
- CA Fux
Summary
QUESTIONS UNDER STUDY: The A(H1N1)pdm09 influenza virus is a highly contagious pathogen which caused the 2009 influenza pandemic. The virus is known to affect mainly younger people and may be a problem in crowded living conditions. The aim of the study was to describe a major A(H1N1)pdm09 outbreak in a Swiss military boot camp and to develop suggestions for similar future situations.
METHODS: Retrospective chart analysis of a A(H1N1)pdm09 outbreak between 14 December and 23 December 2010. Symptoms, signs and lab parameters were documented.
RESULTS: 105 of 750 male recruits were affected by the outbreak. All nasopharyngeal swabs of 16 patients with high fever were tested positive. Common clinical symptoms included high fever, myalgia and bronchitis with persistent cough and throat aches. Fever progression typically occurred in two peaks within three days. Median length of stay at the infirmary was 3 days (range: 0.5–9 days).
CONCLUSION: A(H1N1)pdm09 has become a ubiquitous seasonal virus in the region. Complications were uncommon and non life threatening. In the event of new influenza outbreaks, hygienic and containment measures must be quickly and correctly implemented, in order to avoid an epidemic. This should also be considered in non-military settings like school camps or in retirement homes.
References
- Influenza-like illness in the United States and Mexico [Internet]. Geneva: World Health Organization; c2011 [updated 2009 Apr 24; cited 2011 Apr 6]. Available from: http://www.who.int/csr/don/2009_04_24/en/
- In focus. H1N1 now in the post-pandemic period [Internet]. Geneva: World Health Organization; c2011 [updated 2010 Aug 10; cited 2011 Apr 6]. Available from: http://www.who.int/csr/disease/swineflu/en/index.html
- Myers KP, Olsen CW, Gray GC. Cases of swine influenza in humans: a review of the literature. Clin Infect Dis.2007;44(8):1084–8.
- Garten RJ, Davis CT, Russell CA, Shu B, Lindstrom S, Balish A, et al. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans. Science.2009;325(5937):197–201.
- Trifonov V, Khiabanian H, Rabadan R. Geographic dependence, surveillance, and origins of the 2009 influenza A (H1N1) virus. N Engl J Med. 2009;361(2):115–9.
- Updated CDC estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the United States, April 2009 – April 10, 2010 [Internet]. Atlanta: United States Centers for Disease Control and Prevention; c2010 [updated 2010 May 14; cited 2011 Apr 6]. Available from: http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm
- Interim guidance on infection control measures for 2009 h1n1 influenza in healthcare settings, including protection of healthcare personnel [Internet]. Atlanta: United States Centers for Disease Control and Prevention; c2010 [updated 2010 Jul 15; cited 2011 Apr 6]. Available from: http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
- Yoo SJ, Moon SJ, Kuak EY, Yoo HM, Kim CK, Chey MJ et al. Frequent detection of pandemic (H1N1) 2009 virus in stools of hospitalized patients. J Clin Microbiol. 2010;48(6):2314–5.
- Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009;360(25):2605–15.
- Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA. 2009;302(17):1896–902.
- Gaydos JC, Top FH Jr, Hodder RA, Russell PK. Swine influenza a outbreak, Fort Dix, New Jersey, 1976. Emerg Infect Dis. 2006;12(1):23–8.
- Heederik D. Micro-epidemiology of the healthy worker effect? Occup Environ Med. 2006;63(2):83.
- Mayet A, Pommier de Santi V, Manet G, Nivoix P, Ligier C, Faure N, et al. A(H1N1) influenza surveillance in the French armed forces: adapting the surveillance systems to the pandemic setting. Med Mal Infect. 2010;40(7):404–11.
- Witkop CT, Duffy MR, Macias EA, Gibbons TF, Escobar JD, Burwell KN, et al. Novel Influenza A (H1N1) outbreak at the U.S. Air Force Academy: epidemiology and viral shedding duration. Am J Prev Med. 2010;38(2):121–6.
- Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009;361(20):1935–44.
- Gail MH, Benichou J. Encyclopedia of epidemiologic methods. New York: Wiley; 2000.
- Nickel CH, Stephan FP, Dangel M, Blume K, Gehrisch R, Dumoulin A, et al. First wave of the influenza A/H1N1v pandemic in Switzerland. Swiss Med Wkly. 2009;139(51-52):731–7.
- Empfehlungen zur Impfung gegen die saisonale Grippe (2010–2011). Bull BAG. 2010;25:624–27.
- Influenza activity and virology in Switzerland [Internet]. Geneva: HUG – Laboratoire central de virologie; c2011 [updated 2011 Apr 04; cited 2011 Jun 7]. Available from: http://virologie.hug-ge.ch/centres_reference/CNI_surveillance_en.html
- Reichert T, Chowell G, Nishiura H, Christensen RA, McCullers JA. Does Glycosylation as a modifier of Original Antigenic Sin explain the case age distribution and unusual toxicity in pandemic novel H1N1 influenza? BMC Infect Dis. 2010;10:5.
- McCullers JA, Van De Velde LA, Allison KJ, Branum KC, Webby RJ, Flynn PM. Recipients of vaccine against the 1976 “swine flu” have enhanced neutralization responses to the 2009 novel H1N1 influenza virus. Clin Infect Dis. 2010;50(11):1487–92.
- Cao B, Li XW, Mao Y, Wang J, Lu HZ, Chen YS, et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med.2009;361(26):2507–17.
- Bautista E, Chotpitayasunondh T, Gao Z, Harper SA, Shaw M, Uyeki TM, et al. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010;362(18):1708–19.
- Lessler J, Reich NG, Cummings DA, Nair HP, Jordan HT, Thompson N. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med. 2009;361(27):2628–36.
- Yang Y, Sugimoto JD, Halloran ME, Basta NE, Chao DL, Matrajt L et al. The transmissibility and control of pandemic influenza A (H1N1) virus. Science.2009;326(5953):729–33.
- Cauchemez S, Donnelly CA, Reed C, Ghani AC, Fraser C, Kent CK, et al. Household transmission of 2009 pandemic influenza A (H1N1) virus in the United States. N Engl J Med.2009;361(27):2619–27.
- Greenberg ME, Lai MH, Hartel GF, Wichems CH, Gittleson C, Bennet J, et al. Response to a monovalent 2009 influenza A (H1N1) vaccine. N Engl J Med. 2009;361(25):2405–13.
- Khazeni N, Hutton DW, Garber AM, Hupert N, Owens DK. Effectiveness and cost-effectiveness of vaccination against pandemic influenza (H1N1) 2009. Ann Intern Med. 2009;151(12):829–39.
- Lee VJ, Yap J, Cook AR, Chen MI, Tay JK, Tan BH, et al. Oseltamivir ring prophylaxis for containment of 2009 H1N1 influenza outbreaks. N Engl J Med.2010;362(23):2166–74.
- Khazeni N, Hutton DW, Garber AM, Owens DK. Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic. Ann Intern Med. 2009;151(12):840–53.
- 2009-2010 influenza season week 20 ending May 22, 2010 [Internet]. Atlanta: United States Centers for Disease Control and Prevention; c2010 [updated 2010 May 28; cited 2011 Apr 6]. Available from: http://www.cdc.gov/flu/weekly/weeklyarchives2009-2010/weekly20.htm
- Oseltamivir-resistant pandemic (H1N1) 2009 influenza virus [Internet]. Stockholm: European Center for Disease Prevention and Control; c2005 - 2011 [updated 2009 Nov 18; cited 2011 Apr 6]. Available from: http://www.ecdc.europa.eu/en/activities/sciadvice/Lists/ECDC%20Reviews/ECDC_DispForm.aspx?List=512ff74f-77d4-4ad8-b6d6-bf0f23083f30&ID=683
- Graitcer SB, Gubareva L, Kamimoto L, Doshi S, Vandermeer M, Louie J, et al. Characteristics of patients with oseltamivir-resistant pandemic (H1N1) 2009, United States. Emerg Infect Dis. 2011;17(2):255–7.