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Retrospective investigation of an influenza A/H1N1pdm outbreak in an Italian military ship cruising in the Mediterranean Sea, May-September 2009.
PLoS One. 2011 Jan 20; 6(1):e15933.Plos

Abstract

BACKGROUND

Clinical surveillance may have underestimated the real extent of the spread of the new strain of influenza A/H1N1, which surfaced in April 2009 originating the first influenza pandemic of the 21(st) century. Here we report a serological investigation on an influenza A/H1N1pdm outbreak in an Italian military ship while cruising in the Mediterranean Sea (May 24-September 6, 2009).

METHODS

The contemporary presence of HAI and CF antibodies was used to retrospectively estimate the extent of influenza A/H1N1pdm spread across the crew members (median age: 29 years).

FINDINGS

During the cruise, 2 crew members fulfilled the surveillance case definition for influenza, but only one was laboratory confirmed by influenza A/H1N1pdm-specific RT-PCR; 52 reported acute respiratory illness (ARI) episodes, and 183 reported no ARI episodes. Overall, among the 211 crew member for whom a valid serological result was available, 39.3% tested seropositive for influenza A/H1N1pdm. The proportion of seropositives was significantly associated with more crowded living quarters and tended to be higher in those aged <40 and in those reporting ARI or suspected/confirmed influenza A/H1N1pdm compared to the asymptomatic individuals. No association was found with previous seasonal influenza vaccination.

CONCLUSIONS

These findings underline the risk for rapid spread of novel strains of influenza A in confined environment, such as military ships, where crowding, rigorous working environment, physiologic stress occur. The high proportion of asymptomatic infections in this ship-borne outbreak supports the concept that serological surveillance in such semi-closed communities is essential to appreciate the real extent of influenza A/H1N1pdm spread and can constitute, since the early stage of a pandemic, an useful model to predict the public health impact of pandemic influenza and to establish proportionate and effective countermeasures.

Authors+Show Affiliations

Inspectorate of Health, ITA Navy, Rome, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21283749

Citation

Tarabbo, Mario, et al. "Retrospective Investigation of an Influenza A/H1N1pdm Outbreak in an Italian Military Ship Cruising in the Mediterranean Sea, May-September 2009." PloS One, vol. 6, no. 1, 2011, pp. e15933.
Tarabbo M, Lapa D, Castilletti C, et al. Retrospective investigation of an influenza A/H1N1pdm outbreak in an Italian military ship cruising in the Mediterranean Sea, May-September 2009. PLoS One. 2011;6(1):e15933.
Tarabbo, M., Lapa, D., Castilletti, C., Tommaselli, P., Guarducci, R., Lucà, G., Emanuele, A., Zaccaria, O., La Gioia, V. F., Girardi, E., Capobianchi, M. R., & Ippolito, G. (2011). Retrospective investigation of an influenza A/H1N1pdm outbreak in an Italian military ship cruising in the Mediterranean Sea, May-September 2009. PloS One, 6(1), e15933. https://doi.org/10.1371/journal.pone.0015933
Tarabbo M, et al. Retrospective Investigation of an Influenza A/H1N1pdm Outbreak in an Italian Military Ship Cruising in the Mediterranean Sea, May-September 2009. PLoS One. 2011 Jan 20;6(1):e15933. PubMed PMID: 21283749.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrospective investigation of an influenza A/H1N1pdm outbreak in an Italian military ship cruising in the Mediterranean Sea, May-September 2009. AU - Tarabbo,Mario, AU - Lapa,Daniele, AU - Castilletti,Concetta, AU - Tommaselli,Pietro, AU - Guarducci,Riccardo, AU - Lucà,Giuditta, AU - Emanuele,Alessandro, AU - Zaccaria,Onofrio, AU - La Gioia,Vincenzo F P, AU - Girardi,Enrico, AU - Capobianchi,Maria R, AU - Ippolito,Giuseppe, Y1 - 2011/01/20/ PY - 2010/11/08/received PY - 2010/11/30/accepted PY - 2011/2/2/entrez PY - 2011/2/2/pubmed PY - 2011/8/4/medline SP - e15933 EP - e15933 JF - PloS one JO - PLoS One VL - 6 IS - 1 N2 - BACKGROUND: Clinical surveillance may have underestimated the real extent of the spread of the new strain of influenza A/H1N1, which surfaced in April 2009 originating the first influenza pandemic of the 21(st) century. Here we report a serological investigation on an influenza A/H1N1pdm outbreak in an Italian military ship while cruising in the Mediterranean Sea (May 24-September 6, 2009). METHODS: The contemporary presence of HAI and CF antibodies was used to retrospectively estimate the extent of influenza A/H1N1pdm spread across the crew members (median age: 29 years). FINDINGS: During the cruise, 2 crew members fulfilled the surveillance case definition for influenza, but only one was laboratory confirmed by influenza A/H1N1pdm-specific RT-PCR; 52 reported acute respiratory illness (ARI) episodes, and 183 reported no ARI episodes. Overall, among the 211 crew member for whom a valid serological result was available, 39.3% tested seropositive for influenza A/H1N1pdm. The proportion of seropositives was significantly associated with more crowded living quarters and tended to be higher in those aged <40 and in those reporting ARI or suspected/confirmed influenza A/H1N1pdm compared to the asymptomatic individuals. No association was found with previous seasonal influenza vaccination. CONCLUSIONS: These findings underline the risk for rapid spread of novel strains of influenza A in confined environment, such as military ships, where crowding, rigorous working environment, physiologic stress occur. The high proportion of asymptomatic infections in this ship-borne outbreak supports the concept that serological surveillance in such semi-closed communities is essential to appreciate the real extent of influenza A/H1N1pdm spread and can constitute, since the early stage of a pandemic, an useful model to predict the public health impact of pandemic influenza and to establish proportionate and effective countermeasures. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/21283749/Retrospective_investigation_of_an_influenza_A/H1N1pdm_outbreak_in_an_Italian_military_ship_cruising_in_the_Mediterranean_Sea_May_September_2009_ L2 - https://dx.plos.org/10.1371/journal.pone.0015933 DB - PRIME DP - Unbound Medicine ER -