A microscopic photo of the pandemic H1N1 virus

Of note in the latest Department of Defense report on novel H1N1 or swine flu are these statements:

• Fort Bliss (Texas) and Fort Sam Houston (Texas) and Tripler Army Medical Center (Hawaii) continue to report increases in pH1N1cases
• Isolated cluster of hospital-acquired pH1N1 observed among healthcare workers at Landstuhl Regional Medical Center
• Marines and Navy personnel in Okinawa, Guam and Hawaii are seeing increases in clinically mild influenza activity in active duty service members returning from joint military exercises in the Southern Hemisphere.
• Febrile respiratory illness (FRI) rates in recruits at MCRD-SD and Parris Island are substantially elevated.
• States experiencing noticeably higher ILI visit counts include South Carolina (Fort Jackson, Parris Island), New Jersey (Cape May) and California (NMCSD, MCRD-SD, Camp Pendleton)

The Landstuhl report is significant because of the phrase hospital-acquired. It suggests that universal precautions are not being used effectively. We saw failures of similar nature in the SARS epidemic, and those in the Canadian healthcare system were especially deadly.

Hawaii has just opened its schools for the fall. As our only tropical state, the pandemic never reduced in severity as we saw it do in northern states. The potential for clusters in school settings is high and should be evident by August 14 or so. One concern is the nature of the infections arriving from the Southern Hemisphere. Any genetic variance could alter the expected virulence of the pandemic in the islands.

The United States military has been experiencing its own version of the pandemic. We’ve discussed it here before and the situation continues to evolve.

Ships at sea are a natural place for outbreaks to occur, with a crew of young people in close quarters and isolated for several days at a time. USS Boxer has reported 69 cases of pandemic H1N1 or swine flu. USS BonHomme Richard has reported 128 cases.

Another military location ideal for a flu outbreak is recruit training. The Air Force Academy in Colorado Springs is a case in point, with well over 100 cases in its incoming freshman class. Lackland AFB has seen an outbreak among recruits. Camp LeJeune in North Carolina is having such an outbreak, as well.

The Texas bases for all services are experiencing the pandemic. The San Antonio region is especially feeling the effects, and the Rio Grande river valley is the hotspot for Texas as a whole. Fort Bliss near El Paso is reporting 208 cases.

The DoD is doing its best, treating both active duty personnel as well as family and retired service members. You may recall that a military hospital in Texas identified two of the first four cases of pandemic flu in the United States.

The Department of Defense is following its civilian counterparts with reporting on the pandemic swine flu’s effects its personnel and dependents.

All of the cases in the DoD report that are in the United States are also part of a state report. Just as with the states and the CDC, there can be a delay in the data being reported between sources.

Since April 1, military facilities have treated 1,327 cases of pandemic swine flu, also called pandemic novel H1N1. 722 of these patients have been active duty personnel. 31 cases have been found in recruits, with the Marines having just over half of the cases.

These military facilities also treat family members and retirees. Only 14 retirees have been found with pandemic influenza and 510 dependents.

Colonel Jonathan Jaffin, director, Health Policy and Services, Office of the Surgeon General, discussed the military’s response to the pandemic in a recent Bloggers’ Roundtable. One of the points he made was that they are not just looking for pandemic flu, but a wide variety of illnesses that are common in situation where people are in close quarters. ILI’s (influenza like illnesses) and noroviruses are two of the illnesses that can break out aboard ship or in a barracks.

Jaffin stressed the importance of service members not reporting for duty if they are ill. He reviewed a number of preventative measures such as frequent hand washing.

Col. Jaffin revealed that all soldiers are being screened for pandemic H1N1 before they are sent overseas. The screening is also being done on returning troops from certain theaters of operation. In response to a question, he was able to report that the pandemic flu had not affected any Army operations.

The following images are from the most recent DoD report. Please note the median ages for family and retirees. These are much younger ages than are seen with seasonal influenza.

DoD statistics of pandemic swine flu patients treat at military facilities 6-23-2009

DoD report of clusters of pandemic swine flu activity in the military 6-23-2009