517. A Multi-Year, Symptoms Directed, Index-Cluster Study of Viral Respiratory Infection in a University Cohort
Session: Poster Abstract Session: Influenza and other Respiratory Viral Infections Epidemiology Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background: Outbreaks of respiratory viral infections, RVI, in an ‘at risk’ population, (e.g. students living in dormitories) have demonstrated the potential for disruption of daily life or severe illness during an epidemic.  Early detection may help halt outbreak spread.

Methods: During enrollment we collected a basic health questionnaire and baseline samples; blood for serology and a nasal swab for surveillance of RVI.  We developed a web-based instrument for daily self-reporting of 8 symptoms scored 0-4.  Subjects with suspected RVI, increased aggregate symptom scoring over the individual’s historic baseline, were asked to provide blood, saliva and nasal swab samples at the time of illness.  Viral etiology was confirmed using a commercial multiplex RT-PCR assay (ResPlex II v2.0, Qiagen).  Subjects who were symptomatic at the time of sampling were referred to as ‘T’s.  An Index Case (IC) was a subject with a potential RVI living near asymptomatic Close Contacts (CCs).  Symptomatic conversion in CCs was monitored through an Index-Cluster approach.  Healthy CCs living in proximity to an IC were provided samples for up to five consecutive days and monitored for symptomatic conversion and viral shedding.

Results: With the assistance of Residence Life at Duke University we have developed a symptom surveillance driven Index-Cluster based study of viral respiratory infection.  After a pilot in spring semester of 2009 we have enrolled large cohorts for the 2009-10 and 2010-11 academic years.  The study year spanned September to April, similar to seasonal respiratory illness.  To date we have enrolled 928 subjects, in 16 different dorms.  We have had 136 symptomatic subjects with 30% positive for a respiratory virus.   There have been 37 CC cohorts based on 75 index cases, 52% viral positive and comprising 425 CCs, with 11% viral positive.  

Conclusion: Using this method of daily symptom monitoring, we have been able to rapidly identify symptomatic subjects, collect samples and confirm the agent in presymptomatic RVI.  Not all symptomatic subjects were virus positive, suggesting other viral agents not present in the assay.  Conversely, there was viral shedding in some asymptomatic subjects.  This work will be the basis of further research in the early detection and identification of RVI.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Bradly P. Nicholson, PhD1, Stephanie Dobos, BA2, Monica Jimenez, MPH2, Ryan Mather, BS2 and Christopher Woods, MD, MPH3,4, (1)Institute for Medical Research, Durham VAMC, Durham, NC, (2)Institute for Medical Research, Durham, NC, (3)Durham Veterans Affairs Medical Center (DVAMC), Durham, NC, (4)Duke University Medical Center, Durham, NC


B. P. Nicholson, None

S. Dobos, None

M. Jimenez, None

R. Mather, None

C. Woods, None

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