703. Adenovirus and Novel H1N1 Influenza Among Military Trainees: Epidemiology, Comparison of Clinical Presentations, and Coinfection
Session: Abstracts: Virology
Friday, October 22, 2010
Background: Upper respiratory infection (URI), largely due to adenovirus (AD), is a major cause of morbidity in military trainees.   In 2009, novel H1N1 influenza emerged as a common cause of URI.  Whether clinical presentations differ or excess morbidity results from coinfection is unclear. 

Methods: The Advanced Diagnostics Laboratory was established in 2003 to prospectively evaluate epidemiology and rapid diagnostics of respiratory pathogens in trainees with URI.  From 5/1/2009 to 3/30/2010, demographic, clinical, and PCR data from throat and nasal specimens for AD and novel H1N1 were collected.  Clinical laboratory data obtained during clinical care were retrospectively obtained.

Results: 664 trainees with URI enrolled (median age 20; 90% male).   AD PCR was positive in 61% (97.5% serotype 4; 0.9% serotype 14) and novel H1N1 in 18.6%.  Compared to AD, subjects with H1N1 were more likely to be female (16.7% vs. 8.1%, p = .04), present earlier in training (week 5 vs. week 6, p < .01), and report higher stress levels (median 5 vs. 4/10, p = .05).   Subjects with H1N1 had shorter illness duration before enrollment (2 vs. 3 days, p < .01), less sore throat (73.3% vs. 93.8%, p < .01), diarrhea (0 vs. 9.3%, p = .02), and abnormal findings on throat exam.  Coryza (76.7% vs. 62.4%, p = .04) and cough (98.3% vs. 89.2%, p = .01) were more common with H1N1 compared to AD, and fevers were higher (102.50F vs. 101.20F, p = .01). Subjects with H1N1 were much less likely to have AD than those without, despite high rates of AD during peak H1N1 months (16.4% vs. 78%, p<0.01).  Coinfection with AD and H1N1 was rare (2.1%) and was associated with less sore throat, fewer abnormalities on throat exam, and shorter duration of symptoms prior to enrollment compared to AD alone.  Rates of hospitalization did not differ between the AD, H1N1, or coinfected groups (1.2%, 0, 0, respectively), nor did rates of pneumonia (1.5%, 1.7%, 0).

Conclusion: Military trainees with H1N1 vs. AD have differing clinical presentations and are more often female.  Despite high rates of AD infection, coinfection with AD and H1N1 is rare and apparently does not result in increased morbidity.


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Speakers:
Heather C. Yun, MD , Brooke Army Medical Center, Fort Sam Houston, TX
William H. Fugate, BS, MBA , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX
Clinton Murray, MD, FIDSA , Brooke Army Medical Center, Fort Sam Houston, TX
Francine F. Stotler, BS , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX
Thomas L. Cropper, DVM , Trainee Health Surveillance, Lackland AFB, TX
Lisa M. Lott, PhD , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX
J. Matthew McDonald, PhD , Eagle Applied Sciences Advanced Diagnostics Laboratory, Lackland AFB, TX

Disclosures:

H. C. Yun, None

W. H. Fugate, None

C. Murray, None

F. F. Stotler, Yes
Eagle Applied Sciences: Employee,

T. L. Cropper, None

L. M. Lott, Yes
Eagle Applied Sciences: Employee,

J. M. McDonald, Yes
Eagle Applied Sciences: Employee,

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