Review of the DoD-GEIS Influenza Programs Strengthening Global Surveillance and Response (2008) / Chapter Skim
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9 Air Force Institute for Operational Health San Antonio Avian and Pandemic Influenza Activities
9 Air Force Institute for Operational Health San Antonio Avian and Pandemic Influenza Activities
Pages 183-202
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From page 183... ...
A DoD policy, Health Affairs Policy Memo 99-081, was signed, and the Air Force Surgeon General was appointed as the executive agent of the new DoD Global Laboratory-Based Influenza Surveillance Program, with management responsibility given to the Air Force Institute for Operational Health (AFIOH)
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From page 184... ...
The AFIOH program is expecting a move to Wright-Patterson Air Force Base in Dayton, Ohio, by 2011, and personnel involved in the influenza program are aware that this move will be a challenge for their program. The issues that they expect include retaining personnel in San Antonio until the site closes, side-by-side operations for some period of time, the potential need to rebuild the program in Dayton, and the reluctance to make neces Prior to the committee's visit to AFIOH, the laboratory staff provided the committee with detailed background information on AFIOH and the pandemic/avian influenza activities it was supporting.
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From page 185... ...
Staffing The Air Force Institute for Operational Health (AFIOH) has two divisions that deal with the surveillance program for viral and bacterial agents.
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From page 186... ...
The epidemiology staff is charged with tracking the effectiveness of influenza vaccination and the epidemiological pattern of individuals participating in the DoD-GEIS influenza surveillance program. It is not clear that the present staff has the experience and the determination to collect the necessary raw data and then to provide compelling epidemiological assessments.
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From page 187... ...
Graphs showing overall ILI activity among each service branch are included in the weekly Influenza Surveillance Update published by AFIOH. In addition, DoD-wide respiratory disease laboratory data gathered through the composite health care system is collected and uploaded to the Centers for Disease Control and Prevention (CDC)
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From page 188... ...
Factors considered in the selection of a sentinel site are the potential for emergence of new strains of influenza virus, the potential for importation of new strains, the impact of an outbreak or novel influenza virus on military operations, and whether an area has high troop concentrations and highly mobile or rapidresponse units. Sentinel sites are required to institute an active influenza surveillance and identification program.
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From page 189... ...
educational pamphlets, a guidance sheet, influenza surveillance questionnaires, and specimen collection kits. Sites are requested to collect six to ten viral culture specimens per week Figure 9-1 along with case data from patients meeting the ILI case definition.
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From page 190... ...
LABORATORY AFIOH is the central laboratory for the DoD influenza program. It serves as both a clinical and a public health laboratory, generating both active and passive surveillance data.
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From page 191... ...
This is a valuable service offered by AFIOH and should be supported. However, it is critical that the laboratory work with partners to further maximize the use of valuable samples collected by the DoD influenza program (both original patient samples and virus samples)
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From page 192... ...
While the sample flow from different international sites appears to be adequate, the present staff has not taken full advantage of modern diagnostic techniques. For example, in the AFIOH weekly influenza surveillance report of March 18-24, 2007, it is suggested that "over 90 percent of the influenza isolates have been molecularly sequenced." In fact, only the hemagglutinin genes had been sequenced (not the entire viral genome)
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From page 193... ...
RESPONSE CAPACITY In the six months since October 1, 2006, only 1,613 samples were processed, resulting in the laboratory isolation of 414 influenza viruses. The relatively low number of processed isolates over a period of six months should allow for a considerable surge capacity should there be need for it.
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From page 194... ...
pillars of this plan are the stockpiling of approximately 500 frozen R-Mix ReadyCells, which are regularly tested and have been validated to detect influenza in 24 to 48 hours, and the cross-training of all medical laboratory AFIOH personnel to assist in nasal wash specimen handling, screening, sub-typing, and sequencing. It is stated that this plan will increase the sample throughput threefold, from the present capacity of 300 specimens per day screened with RT-PCR up to 900 specimens per day.
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From page 195... ...
AFIOH collects surveillance data from sentinel sites, drawing on the strategic positions of DoD overseas medical research laboratories, including the Naval Medical Research Center Detachment in Lima (collecting specimens from Argentina, Bolivia, Ecuador, Peru, and Colombia) , the Armed Forces Research Institute of Medical Sciences in Bangkok (collecting specimens from local residents in Nepal, Thailand, and Vietnam)
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From page 196... ...
. In order to stay connected with the scientific community and to share findings, AFIOH staff also participate in national and international conferences, such as the meetings of the Vaccines and Related Biological Products Advisory Committee, the International Conference for Emerging Infectious Diseases, the Asia Pacific Military Medicine Conference, and the Council for State and Territorial Epidemiologists.
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From page 197... ...
The value of the surveillance data currently being collected is diminished by an inability to collect it and report it through a single entity. The DoD influenza and respiratory disease surveillance program has evolved in recent years in response to the potential of pandemic influenza.
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From page 198... ...
2006. Global influenza surveillance at Air Force Institute for Operational Health.
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From page 199... ...
Johns, Pandemic Influenza Preparedness, Air Force Institute for Operational Health, Brooks City-Base, Texas Christine Lopez, Pandemic Influenza Preparedness, Air Force Institute for Operational Health, Brooks City-Base, Texas Samuel J.P. Livingstone, Epidemic Outbreak Surveillance Program, Lackland Air Force Base, Texas Elizabeth Macias, Epidemiological Surveillance Division, Air Force Institute for Operational Health, San Antonio, Texas Edwin Matos, Pandemic Influenza Preparedness, Air Force Institute for Operational Health, Brooks City-Base, Texas Candace McCall, Risk Assessment Division, Air Force Institute for Operational Health, San Antonio, Texas Carolyn Miller, Surveillance Directorate, Air Force Institute for Operational Health, San Antonio, Texas James Neville, 311th Human Systems Wing, Air Force Institute for Operational Health, San Antonio, Texas Angela Owens, Risk Assessment Division, Air Force Institute for Operational Health, San Antonio, Texas Leslie M
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From page 200... ...
Leo Cropper, Influenza Surveillance Program lead 0825 Depart to Building 150 Escorted by: Lt.
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From page 201... ...
Edwin Matos 1430-1630 Review of the DoD-GEIS Influenza program, projects, and future plans Interaction with AFIOH team members Thursday, March 29, 2007 0800-1000 Arrive at Building 180 to continue review of the DoD GEIS influenza program, projects, and future plans Met by: Lt, Col, Paul Sjoberg, branch chief, AFIOH/RSRH Dr. Leo Cropper, Influenza Surveillance Program lead 1000-1100 Visit to Texas Metro Health 1130 Lunch 1245-1430 Site visit to Lackland AFB, tour of the EOS Project Escorted by: Lt.
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