Park, Won-Ju
(Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital)
,
Yoo, Seok-Ju
(Aerospace Medical Research Center, Republic of Korea Air Force)
,
Lee, Suk-Ho
(Aerospace Medical Research Center, Republic of Korea Air Force)
,
Chung, Jae-Woo
(Department of Laboratory Medicine, Dongguk University Ilsan Hospital)
,
Jang, Keun-Ho
(Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital)
,
Moon, Jai-Dong
(Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital)
Objectives: An outbreak of acute febrile illness occurred in the Republic of Korea Air Force boot camp from May to July 2011. An epidemiological investigation of the causative agent, which was of a highly infective nature, was conducted. Methods: Throat swabs were carried out and a multiplex reverse...
Objectives: An outbreak of acute febrile illness occurred in the Republic of Korea Air Force boot camp from May to July 2011. An epidemiological investigation of the causative agent, which was of a highly infective nature, was conducted. Methods: Throat swabs were carried out and a multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay was performed to identify possible causative factors. Results: The mean age of patients who had febrile illness during the study period was 20.24 years. The multiplex RT-PCR assay identified respiratory syncytial virus (RSV) as the causative agent. The main symptoms were sore throat (76.0%), sputum (72.8%), cough (72.1%), tonsillar hypertrophy (67.9%), and rhinorrhea (55.9%). The mean temperature was $38.75^{\circ}C$ and the attack rate among the recruits was 15.7% (588 out of 3750 recruits), while the mean duration of fever was 2.3 days. The prognosis was generally favorable with supportive care but recurrent fever occurred in 10.1% of the patients within a month. Conclusions: This is the first epidemiological study of an RSV outbreak that developed in a healthy young adult group. In the event of an outbreak of an acute febrile illness of a highly infective nature in facilities used by a young adult group, RSV should be considered among the possible causative agents.
Objectives: An outbreak of acute febrile illness occurred in the Republic of Korea Air Force boot camp from May to July 2011. An epidemiological investigation of the causative agent, which was of a highly infective nature, was conducted. Methods: Throat swabs were carried out and a multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay was performed to identify possible causative factors. Results: The mean age of patients who had febrile illness during the study period was 20.24 years. The multiplex RT-PCR assay identified respiratory syncytial virus (RSV) as the causative agent. The main symptoms were sore throat (76.0%), sputum (72.8%), cough (72.1%), tonsillar hypertrophy (67.9%), and rhinorrhea (55.9%). The mean temperature was $38.75^{\circ}C$ and the attack rate among the recruits was 15.7% (588 out of 3750 recruits), while the mean duration of fever was 2.3 days. The prognosis was generally favorable with supportive care but recurrent fever occurred in 10.1% of the patients within a month. Conclusions: This is the first epidemiological study of an RSV outbreak that developed in a healthy young adult group. In the event of an outbreak of an acute febrile illness of a highly infective nature in facilities used by a young adult group, RSV should be considered among the possible causative agents.
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문제 정의
The significance of this study is that it is the first investigation of an RSV outbreak that developed in a healthy young adult group. This epidemiological investigation suggests the prospect of RSV as a causative pathogen of respiratory tract infections that could intensively occur among young recruits undergoing basic military training.
This study also examined cases with upper respiratory infection (URI) that occurred in the basic training camp of the ROKAF for the last three years. This investigation also examined all the URI-associated diseases in the military. The numbers of patients with diseases recorded as acute nasopharyngitis, acute laryngopharyngitis, acute tonsillitis, tonsillitis, acute URI, or URI were acquired from the system of military medical information management.
This study investigates the significance and clinical features of RSV in respiratory infections in a healthy young adult group. This study intends to describe the clinical course of this infection and to suggest strategies for treatment and prevention in cases of an RSV outbreak.
We conducted an epidemiological investigation of the causative agent, which was of a highly infective nature. This study investigates the significance and clinical features of RSV in respiratory infections in a healthy young adult group. This study intends to describe the clinical course of this infection and to suggest strategies for treatment and prevention in cases of an RSV outbreak.
제안 방법
A multiplex RT-PCR assay identified RSV as the causative agent in this study. The mean age of the febrile patients was 20.
Preventative measures included the management of personal hygiene, such as the wearing of a mask by all recruits, thorough hand washing, and restricted sharing of personal items. Further measures comprised instantaneous reporting of symptom development, medical diagnosis, treatment, and segregation. Additional preventative measures for food-associated personnel were reinforced.
Owing to the characteristics of frequent military mobility, there is a high tendency for propagation of respiratory viral infections to personnel in other military units. In an attempt to prevent those military trainees with high infectivity from moving to other military units during this epidemic, they were directed to move to other military facilities after they had been completely recovered and their infectivity lost. Such measures could have prevented the further spread of this epidemic to other military units.
The clinical characteristics of the disease and types of therapeutic regimens were obtained from these records. This study also examined cases with upper respiratory infection (URI) that occurred in the basic training camp of the ROKAF for the last three years. This investigation also examined all the URI-associated diseases in the military.
This study was conducted to find any difference in the duration of fever depending on the type of treatment method. The selection of treatment method was made by Air Force physicians, without consultation with regulatory guidelines.
대상 데이터
A case patient was a person, among military recruits in this boot camp, who was admitted to the medical care center in the boot camp with chief complaints of fever and symptoms of upper respiratory tract illness after May 26, 2011. The hospitalization criteria include cases with an objectively confirmed fever greater than 37.
Subjects in this study included new recruits in training at the boot camp of the ROKAF. All ROKAF recruits are trained at this camp.
Among them, 5 patients who underwent diagnostic tests were selected through random sampling by utilizing Microsoft Office Excel 2003. The throat swab samples collected from these 5 patients were sent to the Seoul Clinical Laboratories and Seoul Medical Science Institute for analysis. Throat swab was carried out by smearing the posterior aspect of the pharynx with a sterile cotton swab while the tongue was pressed down with a tongue depressor.
The test for finding the causative pathogen was carried out on June 14, 2011, at the time when the number of new patients had peaked. Twenty-two patients were admitted to the hospital with cardinal symptoms of respiratory tract infection. Among them, 5 patients who underwent diagnostic tests were selected through random sampling by utilizing Microsoft Office Excel 2003.
이론/모형
Viral transport media were utilized to transport the samples in a refrigerated condition. A multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay was performed with a Seeplex RV6 detection kit (Seegene Inc., Seoul, Korea) for six types of respiratory viruses (RSV, adenovirus, influenza A, influenza B, para-influenza, and metapneumovirus). The PCR amplification was performed using a T3000 thermocycler (Biometra, Göttingen, Germany).
성능/효과
The fact that patients with fever largely had similar clinical manifestations, and that five randomly selected patients, among 22 symptomatic subjects, were all RSV positive, would highly support the idea of RSV as the causative agent of this epidemic. In the test performed after 5 patients had been randomly selected from 22 inpatients, the fact that all 5 patients were positive suggested the probability that many more of the inpatients might have been RSV positive. Utilizing the fever management protocol, the ROKAF has monitored the collective development of acute febrile illness since 2008.
A multiplex RT-PCR assay was carried out for six types of respiratory viruses (RSV, adenovirus, influenza A, influenza B, parainfluenza, and metapneumovirus). The assay result was RSV-positive for all 5 subjects, and it was negative for all other viruses.
The major limitations of this study were the fact that the PCR assay only measured samples from five patients, and also that RSV subtypes have not been investigated. The fact that patients with fever largely had similar clinical manifestations, and that five randomly selected patients, among 22 symptomatic subjects, were all RSV positive, would highly support the idea of RSV as the causative agent of this epidemic.
The prognosis was generally favorable with supportive care. The results of this study support existing data that not only infants but also healthy adults are readily infected, and that the disease in a healthy young adult group tends to be milder and the individuals are able to fight off the virus with relative ease [18-22]. The recurrence rate within a month is about 10%.
This would provide the basis for a suggestion that favorable prognosis in RSV infections might be attained by supportive care in a healthy young adult group. This study verified that there could be a possibility of reoccurrences of RSV-induced epidemics, and supportive care alone would lead to an amicable prognosis in a healthy young adult group.
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