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Two Aircraft Carriers’ Perspectives: A Comparative of Control Measures in Shipboard H1N1 Outbreaks
The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned. Data were collated from bo...
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| Published in: | Disaster medicine and public health preparedness 2013-02, Vol.7 (1), p.29-35 |
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| creator | Harwood, Jared L. LaVan, Joseph T. Brand, George J. |
| description | The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned.
Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis.
Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction.
GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact. |
| doi_str_mv | 10.1001/dmp.2012.53 |
| format | article |
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Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis.
Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction.
GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.</description><identifier>ISSN: 1935-7893</identifier><identifier>EISSN: 1938-744X</identifier><identifier>DOI: 10.1001/dmp.2012.53</identifier><identifier>PMID: 23086263</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Adult ; Aircraft carriers ; Antiviral Agents - therapeutic use ; Biological and medical sciences ; Clinical Protocols ; Disease ; Disease Outbreaks - prevention & control ; Drug therapy ; Epidemics ; Female ; Human viral diseases ; Humans ; Illnesses ; Immunization ; Infection Control - methods ; Infectious diseases ; Influenza A Virus, H1N1 Subtype ; Influenza, Human - prevention & control ; Influenza, Human - transmission ; Male ; Masks ; Medical personnel ; Medical sciences ; Middle Aged ; Military Personnel ; Miscellaneous ; Original Research ; Oseltamivir - therapeutic use ; Pandemics ; Ports ; Public health ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quarantine ; Ships ; Swine flu ; Time Factors ; Viral diseases ; Viral diseases of the respiratory system and ent viral diseases</subject><ispartof>Disaster medicine and public health preparedness, 2013-02, Vol.7 (1), p.29-35</ispartof><rights>Copyright © Society for Disaster Medicine and Public Health, Inc. 2013</rights><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c385t-f732e192d2ab7aa8a553fc1ac45eb450070e4b9e7c45844a6f198892de4e60e23</citedby><cites>FETCH-LOGICAL-c385t-f732e192d2ab7aa8a553fc1ac45eb450070e4b9e7c45844a6f198892de4e60e23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S1935789313000281/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,73317</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27349185$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23086263$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Harwood, Jared L.</creatorcontrib><creatorcontrib>LaVan, Joseph T.</creatorcontrib><creatorcontrib>Brand, George J.</creatorcontrib><title>Two Aircraft Carriers’ Perspectives: A Comparative of Control Measures in Shipboard H1N1 Outbreaks</title><title>Disaster medicine and public health preparedness</title><addtitle>Disaster med. public health prep</addtitle><description>The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned.
Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis.
Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction.
GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.</description><subject>Adult</subject><subject>Aircraft carriers</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Clinical Protocols</subject><subject>Disease</subject><subject>Disease Outbreaks - prevention & control</subject><subject>Drug therapy</subject><subject>Epidemics</subject><subject>Female</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Immunization</subject><subject>Infection Control - methods</subject><subject>Infectious diseases</subject><subject>Influenza A Virus, H1N1 Subtype</subject><subject>Influenza, Human - prevention & control</subject><subject>Influenza, Human - transmission</subject><subject>Male</subject><subject>Masks</subject><subject>Medical personnel</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Military Personnel</subject><subject>Miscellaneous</subject><subject>Original Research</subject><subject>Oseltamivir - therapeutic use</subject><subject>Pandemics</subject><subject>Ports</subject><subject>Public health</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Quarantine</subject><subject>Ships</subject><subject>Swine flu</subject><subject>Time Factors</subject><subject>Viral diseases</subject><subject>Viral diseases of the respiratory system and ent viral diseases</subject><issn>1935-7893</issn><issn>1938-744X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNptkM2K1UAQhRtRnB9duZcGEQYk1_5Nd2Z3uagjjI7gCO6aSlLRHpN07E4Ud76Gr-eT2HGuDoirqlN8nFMcQh5wtuGM8aftMG0E42Kj5S1yyCtpC6PU-9u_d10YW8kDcpTSFWO6NLq6Sw6EZLYUpTwk7eXXQLc-NhG6me4gRo8x_fz-g77Jc8Jm9l8wndIt3YVhggirpqHLcpxj6OkrhLRETNSP9O1HP9UBYkvP-GtOL5a5jgif0j1yp4M-4f39PCbvnj-73J0V5xcvXu6250UjrZ6LzkiBvBKtgNoAWNBadg2HRmmslWbMMFR1hSYfrFJQdryyNvOosGQo5DE5ufadYvi8YJrd4FODfQ8jhiU5rrm1XFdWZvTRP-hVWOKYv3NCMCO5kmw1fHJNNTGkFLFzU_QDxG-OM7eW73L5bi3f6dXz4d5zqQds_7J_2s7A4z0AqYG-izA2Pt1wRqqKW525Yh8LQx19-wFvvvtf8C_WKpsN</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Harwood, Jared L.</creator><creator>LaVan, Joseph T.</creator><creator>Brand, George J.</creator><general>Cambridge University Press</general><general>Lippincott, Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8C1</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20130201</creationdate><title>Two Aircraft Carriers’ Perspectives: A Comparative of Control Measures in Shipboard H1N1 Outbreaks</title><author>Harwood, Jared L. ; LaVan, Joseph T. ; Brand, George J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c385t-f732e192d2ab7aa8a553fc1ac45eb450070e4b9e7c45844a6f198892de4e60e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aircraft carriers</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Clinical Protocols</topic><topic>Disease</topic><topic>Disease Outbreaks - prevention & control</topic><topic>Drug therapy</topic><topic>Epidemics</topic><topic>Female</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Immunization</topic><topic>Infection Control - methods</topic><topic>Infectious diseases</topic><topic>Influenza A Virus, H1N1 Subtype</topic><topic>Influenza, Human - prevention & control</topic><topic>Influenza, Human - transmission</topic><topic>Male</topic><topic>Masks</topic><topic>Medical personnel</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Military Personnel</topic><topic>Miscellaneous</topic><topic>Original Research</topic><topic>Oseltamivir - therapeutic use</topic><topic>Pandemics</topic><topic>Ports</topic><topic>Public health</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Quarantine</topic><topic>Ships</topic><topic>Swine flu</topic><topic>Time Factors</topic><topic>Viral diseases</topic><topic>Viral diseases of the respiratory system and ent viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Harwood, Jared L.</creatorcontrib><creatorcontrib>LaVan, Joseph T.</creatorcontrib><creatorcontrib>Brand, George J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Public Health Database</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Disaster medicine and public health preparedness</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Harwood, Jared L.</au><au>LaVan, Joseph T.</au><au>Brand, George J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Two Aircraft Carriers’ Perspectives: A Comparative of Control Measures in Shipboard H1N1 Outbreaks</atitle><jtitle>Disaster medicine and public health preparedness</jtitle><addtitle>Disaster med. public health prep</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>7</volume><issue>1</issue><spage>29</spage><epage>35</epage><pages>29-35</pages><issn>1935-7893</issn><eissn>1938-744X</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned.
Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis.
Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction.
GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>23086263</pmid><doi>10.1001/dmp.2012.53</doi><tpages>7</tpages></addata></record> |
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| ispartof | Disaster medicine and public health preparedness, 2013-02, Vol.7 (1), p.29-35 |
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| source | Cambridge University Press |
| subjects | Adult Aircraft carriers Antiviral Agents - therapeutic use Biological and medical sciences Clinical Protocols Disease Disease Outbreaks - prevention & control Drug therapy Epidemics Female Human viral diseases Humans Illnesses Immunization Infection Control - methods Infectious diseases Influenza A Virus, H1N1 Subtype Influenza, Human - prevention & control Influenza, Human - transmission Male Masks Medical personnel Medical sciences Middle Aged Military Personnel Miscellaneous Original Research Oseltamivir - therapeutic use Pandemics Ports Public health Public health. Hygiene Public health. Hygiene-occupational medicine Quarantine Ships Swine flu Time Factors Viral diseases Viral diseases of the respiratory system and ent viral diseases |
| title | Two Aircraft Carriers’ Perspectives: A Comparative of Control Measures in Shipboard H1N1 Outbreaks |
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