DoD Global Laboratory- Based Influenza Surveillance Program Endof-Year Report,

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AFRL-SA-WP-SR-2015-0019 DoD Global Laboratory- Based Influenza Surveillance Program Endof-Year Report, 2013-2014

Case Number: 88ABW-2015-2196, 1 May 2015 STINFO COPY Air Force Research Laboratory 711 th Human Performance Wing U.

1 AFRL-SA-WP-SR DoD Global Laboratory- Based Influenza Surveillance Program Endof-Year Report, Tiffany Parms July 2015 Distribution A: Approved for public release; distribution is unlimited. Case Number: 88ABW , 1 May 2015 STINFO COPY Air Force Research Laboratory 711 th Human Performance Wing U.S. Air Force School of Aerospace Medicine Public Health & Preventive Medicine Dept 2510 Fifth St. Wright-Patterson AFB, OH

2 NOTICE AND SIGNATURE PAGE Using Government drawings, specifications, or other data included in this document for any purpose other than Government procurement does not in any way obligate the U.S. Government. The fact that the Government formulated or supplied the drawings, specifications, or other data does not license the holder or any other person or corporation or convey any rights or permission to manufacture, use, or sell any patented invention that may relate to them. Qualified requestors may obtain copies of this report from the Defense Technical Information Center (DTIC) ( AFRL-SA-WP-SR HAS BEEN REVIEWED AND IS APPROVED FOR PUBLICATION IN ACCORDANCE WITH ASSIGNED DISTRIBUTION STATEMENT. //SIGNATURE// //SIGNATURE// LT COL MELINDA EATON COL PAUL A. SJOBERG Chief, Epidemiology Consult Service Chair, Public Health & Preventive Med Dept This report is published in the interest of scientific and technical information exchange, and its publication does not constitute the Government s approval or disapproval of its ideas or findings.

3 REPORT DOCUMENTATION PAGE Form Approved OMB No Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports ( ), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 2. REPORT TYPE 3. DATES COVERED (From To) 22 Jul 2015 Special Report September 2013 September TITLE AND SUBTITLE 5a. CONTRACT NUMBER DoD Global Laboratory-Based Influenza Surveillance Program End-of-Year Report, AUTHOR(S) Tiffany Parms 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) USAF School of Aerospace Medicine Public Health & Preventive Medicine Dept/PHR 2510 Fifth St. Wright-Patterson AFB, OH PERFORMING ORGANIZATION REPORT NUMBER AFRL-SA-WP-SR SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSORING/MONITOR S ACRONYM(S) 12. DISTRIBUTION / AVAILABILITY STATEMENT 11. SPONSOR/MONITOR S REPORT NUMBER(S) Distribution A: Approved for public release; distribution is unlimited. Case Number: 88ABW , 1 May SUPPLEMENTARY NOTES 14. ABSTRACT During the influenza season (29 September September 2014), results were finalized for 3,871 specimens from 85 locations. There were 1,163 specimens positive for influenza (913 A(H1N1)pdm09, 122 A(H3N2), one A(H3N2)v, two A/not subtyped, 29 B/Victoria, 65 B/Yamagata, 22 B/unknown lineage, and nine influenza co-infections). See Table 2 on pages 4 & 5 for these results and other respiratory pathogens identified. Differences between specimens collected and tested are due to pending results and/or specimens sent for sequencing only. This is the cumulative report for specimens tested at USAFSAM during the influenza season. 15. SUBJECT TERMS Influenza, surveillance, USAF 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT a. REPORT U b. ABSTRACT U c. THIS PAGE U SAR 18. NUMBER OF PAGES 11 19a. NAME OF RESPONSIBLE PERSON Tiffany Parms 19b. TELEPHONE NUMBER (include area code) Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39.18

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USAF School of Aerospace Medicine 2013-2014 Cumulative Results Season Locations* 85 Collected 4,155 Influenza A 1,046 A(H1N1)pdm09 913 A(H3N2) 122 A(H3N2)v 1 A(H1N1)pdm09 & Adenovirus A(H1N1)pdm09 &

include specimens for sequencing only and the locations they have been sent from. Unable to determine lineage.

1 B/Unknown or pending lineage 22 B/Victoria 29 B/Yamagata 65 172 Respiratory Highlights 2013-2014 Influenza Season (29 September 2013-27 September 2014) During the 2013-2014 influenza season (29

There were 1,163 specimens positive for influenza (913 A(H1N1)pdm09, 122 A(H3N2), one A(H3N2)v, two A/not subtyped, 29 B/Victoria, 65 B/Yamagata, 22 B/unknown lineage, and nine influenza

Differences between specimens collected and tested are due to pending results and/or specimens sent for sequencing only.

5 USAF School of Aerospace Medicine Cumulative Results Season Locations* 85 Collected 4,155 Influenza A 1,046 A(H1N1)pdm A(H3N2) 122 A(H3N2)v 1 A(H1N1)pdm09 & Adenovirus A(H1N1)pdm09 & Coronavirus A(H1N1)pdm09 & Parainfluenza A(H1N1)pdm09 & RSV 2 A(H1N1)pdm09 & Rhinovirus/Enterovirus A/not subtyped 2 Other Respiratory Pathogens 1,485 Adenovirus 86 Chlamydophila pneumoniae *Does not include specimens for sequencing only and the locations they have been sent from. Unable to determine lineage Coronavirus 230 Human Metapneumovirus Mycoplasma pneumoniae Parainfluenza 89 RSV 189 Rhino/Enterovirus 491 Non-influenza Co-infections Tested* 3,870 Influenza B 117 B & Coronavirus 1 B/Unknown or pending lineage 22 B/Victoria 29 B/Yamagata Respiratory Highlights Influenza Season (29 September September 2014) During the influenza season (29 September September 2014), results were finalized for 3,871 specimens from 85 locations. There were 1,163 specimens positive for influenza (913 A(H1N1)pdm09, 122 A(H3N2), one A(H3N2)v, two A/not subtyped, 29 B/Victoria, 65 B/Yamagata, 22 B/unknown lineage, and nine influenza co-infections). See Table 2 on pages 4 & 5 for these results and other respiratory pathogens identified. Differences between specimens collected and tested are due to pending results and/or specimens sent for sequencing only. This is the cumulative report for specimens tested at USAFSAM during the influenza season. Table 1. ILI by age group for the surveillance year Age Group Frequency Percent Unknown Demographic Summary Of 3,870 ILI cases, 1,604 are service members (41.4%), 1,288 are children (33.3%), 691 (17.9%) are spouses, and 287 (7.4%) are retirees & other beneficiaries. There are no unknown beneficiary types. The median age of ILI cases with known age (n=3,851) is 25.0 (range 0, 98) and 1,323 (34.2%) of these specimens are from ILI cases 18 years of age or younger. Table of Contents Respiratory Highlights Page 1 Demographic Summary Page 1 Laboratory Results - Cumulative for Season Pages 2 & 3 Vaccination Status by Beneficiary Type Page 3 Cumulative Results by Region and Location Pages 4 & 5 Cumulative Non-Influenza Co-Infection Results Page 6 Lab data are current as of 20 October Results are preliminary and may change as more results are received. DoD Global Laboratory-Based Influenza Surveillance Program Background Page 7 1

6 Laboratory Results - Cumulative for Season Graph 1. Percent influenza positive by week for the surveillance year * Last season, there were five influenza A specimens not subtyped and a total of seven influenza co-infections. This season there are two influenza A/not subtyped & nine influenza co-infections. These infections are not included in the graph. Graph 2. Other respiratory pathogen results by week for the surveillance year Data not displayed as expanding testing procedures are in place for the season that were not in place for the season. This season there are a total of 181 co-infections. These infections are not included in the graph. 2

7 Graph 3. Vaccination status by beneficiary type for the surveillance year Influenza Injectable Vaccine (trivalent) Influenza Injectable Vaccine (quadrivalent) Live Attenuated Influenza Vaccine (quadrivalent) Graph 4. Influenza subtype trends by week for the surveillance year A(H1N1)pdm A(H3N2) B/Victoria B/Yamagata B A/Not Subtyped This season one influenza A(H3N2)v was identified. It is not included in the graph. 3

8 Region* Deployed PACOM Region 1 Region 2 Region 3 Region 4 Laboratory Results surveillance year Table 2. Cumulative results by region and location *US Regions are based on Health & Human Services regions. Other locations are defined by COCOM. ** Refer to Table 3 for more detailed information on non-influenza co-infections. A(H1N1)pdm09 A(H3N2) A(H3N2)v A/not subtyped A(H1N1)pdm09 & Adeno 4 A(H1N1)pdm09 & Corona A(H1N1)pdm09 & Para Country 1, Location A Country 1, Location B Country 1, Location D Country 7, Location A CFA Okinawa, Japan Camp Zama, Japan Eielson AFB, AK JB Elmendorf-Richardson, AK JR Marianas (Andersen AFB), Guam Kadena AB, Japan Kunsan AB, South Korea Misawa AB, Japan Osan AB, South Korea Tripler AMC, HI Yokota AB, Japan Hanscom AFB, MA USCG Academy, CT Ft Drum, NY JB McGuire-Dix-Lakehurst, NJ West Point USMA, NY CG Base Portsmouth, VA Dover AFB, DE JB Anacostia-Bolling, DC JB Andrews, MD JB Langley-Eustis, VA NMC Portsmouth, VA WRNMMC, MD CGS Mobile, AL Camp Lejeune, NC Columbus AFB, MS Eglin AFB, FL Ft Bragg, NC Ft Campbell, KY Hurlburt Field, FL JB Charleston (AF), SC JB Charleston (Navy), SC Keesler AFB, MS MacDill AFB, FL Maxwell AFB, AL Moody AFB, GA NH Beaufort, SC NH Jacksonville, FL Patrick AFB, FL Robins AFB, GA Seymour Johnson AFB, NC Shaw AFB, SC Tyndall AFB, FL USCG Base Elizabeth City, NC A(H1N1)pdm09 & RSV A(H1N1)pdm09 & Rhino/Entero B B/Victoria B/Yamagata B & Corona Adenovirus C. pneumoniae Coronavirus hmnv M. pneumoniae Parainfluenza RSV Rhinovirus/Enterovirus Non-Influenza Co-Infection ** No Pathogen Total Continued on page 5

9 Laboratory Results surveillance year Table 2. Cumulative results by region and location (continued from page 4) Region* Region 5 Region 6 Region 7 Region 8 Region 9 Region 10 Total A(H1N1)pdm09 A(H3N2) A(H3N2)v A/not subtyped A(H1N1)pdm09 & Adeno A(H1N1)pdm09 & Corona A(H1N1)pdm09 & Para A(H1N1)pdm09 & RSV A(H1N1)pdm09 & Rhino/Entero B B/Victoria B/Yamagata B & Corona Adenovirus C. pneumoniae Coronavirus hmnv M. pneumoniae Parainfluenza RSV Rhinovirus/Enterovirus Non-Influenza Co-Infection ** No Pathogen Total Scott AFB, IL USCG Air Station Traverse City, MI Wright-Patterson AFB, OH Altus AFB, OK Barksdale AFB, LA Cannon AFB, NM Ft Bliss, TX Ft Hood, TX Laughlin AFB, TX Little Rock AFB, AR Sheppard AFB, TX Tinker AFB, OK Ft Leavenworth, KS McConnell AFB, KS Offutt AFB, NE Whiteman AFB, MO Ellsworth AFB, SD FE Warren AFB, WY Hill AFB, UT Malmstrom AFB, MT Minot AFB, ND Peterson AFB, CO USAF Academy, CO Beale AFB, CA CGS Petaluma, CA Davis-Monthan AFB, AZ Edwards AFB, CA Los Angeles AFB, CA Luke AFB, AZ NH Lemoore, CA Nellis AFB, NV Travis AFB, CA USCG Island Alameda, CA Vandenberg AFB, CA Fairchild AFB, WA Mt Home AFB, ID NH Bremerton, WA *US Regions are based on Health & Human Services regions. Other locations are defined by COCOM. ** Refer to Table 3 for more detailed information on non-influenza co-infections. 5

10 Laboratory Results surveillance year Table 3. Cumulative non-influenza co-infection results by region and location Region* PACOM Region 2 Region 3 Region 4 Adeno & C. pneumoniae Adeno & C. pneumoniae & Rhino/Entero Adeno & Corona Adeno & Corona & hmnv Adeno & Corona & RSV & Rhino/Entero Adeno & Corona & Rhino/Entero Adeno & hmnv Adeno & hmnv & Rhino/Entero Adeno & Para Adeno & Para & Rhino/Entero CFA Okinawa, Japan Eielson AFB, AK JR Marianas (Andersen AFB), Guam Misawa AB, Japan Osan AB, South Korea Yokota AB, Japan Ft Drum, NY JB McGuire-Dix-Lakehurst, NJ West Point USMA, NY CG Base Portsmouth, VA JB Anacostia-Bolling, DC JB Langley-Eustis, VA WRNMMC, MD CGS Mobile, AL Eglin AFB, FL Ft Bragg, NC Ft Campbell, KY Hurlburt Field, FL Keesler AFB, MS MacDill AFB, FL Maxwell AFB, AL Moody AFB, GA NH Beaufort, SC Robins AFB, GA Shaw AFB, SC Tyndall AFB, FL Region 5 Wright-Patterson AFB, OH Region 6 Altus AFB, OK Barksdale AFB, LA Cannon AFB, NM Laughlin AFB, TX Sheppard AFB, TX Tinker AFB, OK Region 7 McConnell AFB, KS Offutt AFB, NE Whiteman AFB, MO Region 8 Ellsworth AFB, SD FE Warren AFB, WY Hill AFB, UT Peterson AFB, CO USAF Academy, CO Region 9 Davis-Monthan AFB, AZ NH Lemoore, CA Nellis AFB, NV Travis AFB, CA Vandenberg AFB, CA Region 10 Fairchild AFB, WA Mt Home AFB, ID NH Bremerton, WA Total Adeno & RSV Adeno & RSV & Rhino/Entero Adeno & Rhino/Entero B. pertussis & Rhino/Entero B. pertussis & hmnv C. pneumoniae & Rhino/Entero Coronavirus & hmnv Coronavirus & hmnv & Rhino/Entero Coronavirus & Para Coronavirus & Para & Rhino/Entero Coronavirus & RSV Coronavirus & Rhino/Entero hmnv & Parainfluenza & Rhino/Entero hmnv & RSV hmnv & Rhino/Entero M. pneumoniae & Rhino/Entero Parainfluenza & RSV Parainfluenza & Rhino/Entero Parainfluenza & RSV & Rhino/Entero RSV & Rhino/Entero Total *US Regions are based on Health & Human Services regions. Other locations are defined by COCOM. 6

Sentinel Sites Submit to USAFSAM *CENTCOM sites have been masked Submit to LRMC Submit to TAMC Partner Laboratories TAMC LRMC NHRC NAMRU-6 NAMRU-2 AFRIMS USAMRU-K NAMRU-3 DoD Global

Aerospace Medicine 2510 5th Street, Bldg 20840 Wright-Patterson AFB, OH 45433-7913 For Public Health Services 937-938-3196; DSN 798-3196 For Laboratory Services 937-938-3163; DSN

The surveillance network includes the US Air Force School of Aerospace Medicine (USAFSAM) (sentinel site respiratory surveillance), the Naval Health Research Center (recruit and

Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand, the Naval Medical Research Unit-6 (NAMRU-6) in Lima, Peru, and the United States Army Medical

This work is supported by the Air Force and the Division of Global Emerging Infections Surveillance and Response System (GEIS) Operations, a Division of the Armed Forces Health

Sentinel Site Surveillance at USAFSAM Contributions to the CDC for National Influenza Surveillance All sequence data are sent to the CDC and selected original specimens or isolates are

In 1976, the US Air Force Medical Service began conducting routine, global, laboratory-based influenza surveillance. Air Force efforts expanded to DoD-wide in 1997.

These sites collect specimens from local residents in surrounding countries that may not otherwise be covered in existing surveillance efforts.

The initiative seeks to provide more timely results and efficient transport of specimens. For an expanded view of this report, visit our website.

11 Sentinel Sites Submit to USAFSAM *CENTCOM sites have been masked Submit to LRMC Submit to TAMC Partner Laboratories TAMC LRMC NHRC NAMRU-6 NAMRU-2 AFRIMS USAMRU-K NAMRU-3 DoD Global Laboratory-Based Influenza Surveillance Program USAF School of Aerospace Medicine Respiratory Surveillance Year (beginning 29 September 2013) USAF School of Aerospace Medicine th Street, Bldg Wright-Patterson AFB, OH For Public Health Services ; DSN For Laboratory Services ; DSN Background The DoD-wide program was established by the Global Emerging Infections Surveillance and Response System (GEIS) in The surveillance network includes the US Air Force School of Aerospace Medicine (USAFSAM) (sentinel site respiratory surveillance), the Naval Health Research Center (recruit and shipboard population-based respiratory surveillance), the Naval Medical Research Unit (NAMRU-3) in Cairo, Egypt, the Naval Medical Research Unit (NAMRU-2) in Phnom Penh, Cambodia, the Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand, the Naval Medical Research Unit-6 (NAMRU-6) in Lima, Peru, and the United States Army Medical Research Unit-Kenya (USAMRU-K) located in Nairobi, Kenya. This work is supported by the Air Force and the Division of Global Emerging Infections Surveillance and Response System (GEIS) Operations, a Division of the Armed Forces Health Surveillance Center (AFHSC). Sentinel Site Surveillance at USAFSAM Contributions to the CDC for National Influenza Surveillance All sequence data are sent to the CDC and selected original specimens or isolates are sent for further characterization and possible use as influenza vaccine seed viruses. Specimens may also undergo antiviral testing. In 1976, the US Air Force Medical Service began conducting routine, global, laboratory-based influenza surveillance. Air Force efforts expanded to DoD-wide in USAFSAM manages the surveillance program that includes global surveillance among DoD beneficiaries at over 80 sentinel sites (including deployed locations) and many non-sentinel sites (please see map on the left). Unique sentinel sites include three DoD overseas medical research laboratories (AFRIMS, NAMRU-6, USAMRU-K) and the US Army Public Health Command Region South (PHCR-S). These sites collect specimens from local residents in surrounding countries that may not otherwise be covered in existing surveillance efforts. Since the season, Landstuhl Regional Medical Center (LRMC) has served EUCOM as a USAFSAM contributing laboratory. The initiative seeks to provide more timely results and efficient transport of specimens. For an expanded view of this report, visit our website. Also available on the website is a list of previous weekly surveillance reports, program information (including an educational briefing and instruction pamphlets for clinic staff), and an overview of historical data. Please visit the AFHSC/GEIS website for an overview of influenza surveillance at all collaborating organizations. DoD Global Influenza Surveillance Program epi-consult/influenza/ Errata: Three specimens were incorrectly included in prior reports this season; they were later deleted from laboratory data. Additionally, the number of locations on page 1 was changed to exclude locations submitting specimens for sequencing only. We regret the errors. Collaborating Partners In addition to all participating DoD military sentinel sites, several collaborating partners (described above) may be further understood by reviewing the partner s website. 7

DoD Global, Laboratory-Based, Influenza Surveillance Program

A(H3N2) A/not subtyped A(H3N2) & Corona B Adenovirus Parainfluenza RSV Rhinovirus/Enterovirus No Pathogen DoD Global, Laboratory-Based, Influenza Surveillance Program USAF School of Aerospace Medicine