# Presentation: 005189

## DoD Global Influenza Surveillance Program Sentinel Site Surveillance at AFIOH

**Sequence Analysis **
**And **
**Vaccine Effectiveness Overview**

**Luke T. Daum, PhD, Molecular Biologist**
**Angela Owens, MPH, Epidemiologist**
- Air Force Institute for Operational Health
- Brooks City-Base, TX

## Sentinel Sites

## 2006-2007 Season (as of 23 Feb 07)

**Influenza A: **266 (84.2%)
**Influenza B:**   50 (15.8%)

**Notes:**
We’ve processed about 1,200 specimens to date: 26% were lab-confirmed influenza (84% influenza A; 16% influenza B).  Average of 26% of the total specimens received are positive for influenza by culture.

## 2006-2007 Season (as of 23 Feb 07)

**A(H1)**:** **217 (85.4%)     **B/Victoria Lineage**:    27 (93.1%)
**A(H3)**:   37 (14.6%)    **B/Yamagata Lineage**: 02 (06.9%)

***2006-2007 Season ****(as of 23 Feb 07)*

**Notes:**
At this time, we’ve molecularly characterized 90% of the isolates.  The majority of the influenza A were H1....(Luke) 

## Influenza B Field Isolates

**Influenza B Field Isolates**
- HA1 HA Phylogenetic Analysis
- 2006/07

**HA1 Hemagglutinin of >40 globally obtained DoD strains**
**5 Strains (~9%) were Yamagata lineage: 2 U.S., 3 Peru **
**3 Peru’s collected in July/Aug 06, 2 U.S. in Sept/Oct 06**
**Majority were B/Victoria lineage**
**B/Malaysia sequence identity:  99.0-99.6% **

***B/Victoria lineage***

***B/Yamagata lineage***

## Influenza A (H3N2) Field Isolates

**Influenza A (H3N2) Field Isolates**
- HA1 HA Phylogenetic Analysis
- 2006/07 Season

**R142G**

-    **~50% of DoD isolates show mutation at **
**     ****R142G**
**   ****Isolates from this clade obtained from  **
**   ****Nepal, Korea, Japan, and the U.S.   **
**   ****Collected between July 2006 (Nepal) - Present (Washington,  **
**   ****Korea).**

- K173E

**R142G**

- K173E

## Influenza A (H1N1) Field Isolates

- HA1 HA Phylogenetic Analysis
- 2006/07 Season

**Clade 1 isolates are from U.S., Peru, Antarctica. **
**HA is genetically similar to A/New Caledonia          **
**vaccine strain (red box).**

**Clade 2 isolates obtained from Peru, Nepal, and    Saipan.**
**Genetically defined by several AA changes.**
**Many of these show reduced titers in CDC HI.**

**CLADE 1**

**CLADE 2**

## Vaccine EffectivenessDescriptive Review - Preliminary

- Period of Review
- 01 October 2006 – 12 February 2007
- Population
- US Military Treatment Facilities (MTFs)
- Outcome
- Laboratory-confirmed influenza (viral culture)
- Fully Vaccinated
- Vaccination date >14 days prior to clinic visit date
- Patients with vaccination date prior to August classified as unvaccinated
- Vaccination data gathered from Defense Enrollment Eligibility Reporting System (DEERS) and Influenza surveillance questionnaire

## Vaccine EffectivenessDescriptive Review - Preliminary

- 796 total specimens; 170 (21.4%) influenza samples
- 65 of 170 (38.2%) identified vaccination status
- 13 (20%) FluMist; 52 (80%) Injection

** ****Possible Vaccine breakthrough**
-   23 of 65 (35.4%) patients
-   3 Children; 3 Spouse; 17 AD
-   All age groups represented
- AL, CA, OK, SC, TX, Antarctica, and South Korea

## Vaccine EffectivenessDescriptive Review - Preliminary

- 796 total specimens; 170 (21.4%) influenza samples
- 65 of 170 (38.2%) identified vaccination status
- 13 (20%) FluMist; 52 (80%) Injection

-  Possible **Vaccine breakthrough**
-   23 of 65 (35.4%) patients
-   3 Child; 3 Spouse; 17 AD
-   All age groups represented
- AL, CA, OK, SC, TX, Antarctica, and South Korea

## Vaccine EffectivenessDescriptive Review - Preliminary

- 796 total specimens; 170 (21.4%) influenza samples
- 65 of 170 (38.2%) identified vaccination status
- 13 (20%) FluMist; 52 (80%) Injection

-  Possible **Vaccine breakthrough**
-   23 of 65 (35.4%) patients
-   3 Child; 3 Spouse; 17 AD
-   All age groups represented
- AL, CA, OK, SC, TX, Antarctica, and South Korea

## Vaccine EffectivenessDescriptive Review - Preliminary

- 796 total specimens; 170 (21.4%) influenza samples
- 65 of 170 (38.2%) identified vaccination status
- 13 (20%) FluMist; 52 (80%) Injection

-  Possible **Vaccine breakthrough**
-   23 of 65 (35.4%) patients
-   3 Child; 3 Spouse; 17 AD
-   All age groups represented
- AL, CA, OK, SC, TX, Antarctica, and South Korea

## Vaccine EffectivenessDescriptive Review - Preliminary

**Naval Health Research Center, San Diego**
**Annual estimate of VE against laboratory-confirmed influenza (LCI) at 6 US military “boot camps”**
- All trainees vaccinated upon arrival during fall/winter
- Cases occurring during first 14 days considered “unvaccinated”

**Preliminary 2006-07 data shows 91% VE against LCI**
- 38/48 (79%) of cases to date were unvaccinated
- Estimate could be biased toward higher VE if flu infection was more likely in first 2 weeks of training
- However, low VE against any-cause ILI tends to support the finding of high VE against LCI

- 91% overall VE

## Acknowledgements

**Global Emerging Infections Surveillance and Response System (GEIS)**
**Centers for Health Promotion and Preventive Medicine (CHPPM) / Army Medical Surveillance Activity**
**Air Force Population Health Support Division**
**Centers for Disease Control and Prevention (CDC)**
**Sentinel sites in the DoD Global Influenza Surveillance Program**

## Contact Information

**E-mail**
- _[Influenza@brooks.af.mil](mailto:Influenza@brooks.af.mil)_
- _[Luke.daum@brooks.af.mil](mailto:Luke.daum@brooks.af.mil)_
- _[Angela.](mailto:Angela.owens@brooks.af.mil)__[owens](mailto:Angela.owens@brooks.af.mil)__[@brooks.](mailto:Angela.owens@brooks.af.mil)__[af](mailto:Angela.owens@brooks.af.mil)__[.mil](mailto:Angela.owens@brooks.af.mil)_
**Telephone**
- AFIOH Laboratory
- (210) 536-8383
- AFIOH Epidemiology Services
- (210) 536-3471

**Notes:**
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