BACKGROUND: The progression from hospitalization for a @entity1729 to requiring substantial supportive therapy is a key stage of the @entity683 severity pyramid. @entity1729 are responsible for 300,000-400,000 medical encounters each year among @entity10479 military personnel, some of which progress to severe @entity1729 . METHODS: We obtained data on 11,086 hospitalizations for @entity55 and @entity683 (P_I) among non-recruit @entity10479 military service members during the period of 1 January 2000 through 31 December 2012. From these, we identified 512 P_I hospitalizations that progressed to severe @entity2749 using standard case definitions. We evaluated the effect of demographic and occupational characteristics, co-morbid conditions, and history of @entity683 vaccination on the risk of a hospitalized P_I case becoming a severe case. We also evaluated the risk of a severe outcome and the length of time since @entity683 vaccination (within 180, 60, and 30 days). RESULTS: The median age of subjects at the time of the P_I episode was 32 years (range, 28-40) and subjects were predominantly male (89.5%). In a univariate analysis, demographic risk factors for a severe episode included service in the @entity10479 Air Force (RR=1.6 relative to @entity10479 Army, 95%CI 1.3-2.1), @entity10479 Coast Guard (RR=2.1, 1.2-3.7) or @entity10479 Navy (RR=1.4, 1.1-1.8). Being born in the @entity10479 and recent @entity683 vaccination (within 180 days of episode) were protective against developing severe disease. Among co-morbid conditions, univariate risk factors for severe disease included @entity8 (RR=4.98, 95%CI 4.1-6.1), @entity262 (RR=3.1, 95%CI 2.6-3.7), @entity6 (RR=2.3, 95%CI 1.5-3.6), @entity28 (RR=1.6, 95%CI 1.2-2.1), @entity5 (RR=1.6, 95%CI 1.3-2.0), and @entity1030 (RR=1.4, 95%CI 1.1-1.7). Although many of the risk factors found to be significant in univariate analysis were no longer significant under a multivariate analysis, receipt of any @entity683 vaccine within 180 days of episode remained protective (RR=0.81, 95%CI 0.67-0.99), while serving in the @entity10479 Coast Guard (RR=1.9, 95%CI 1.1-3.4) or @entity10479 Air Force (RR=1. 5, 95%CI 1.2-2.0), presence of @entity409 (RR=3.6, 95%CI 2.9-4.6), and @entity262 (RR=2.2, 95%CI 1.8-2.8), remained significantly associated with a higher risk of developing severe disease. CONCLUSIONS: In a large cohort, after adjusting for many possible risk factors, @entity683 vaccination was protective against severe @entity2749 among P_I hospitalizations. The service-specific ( @entity10479 Coast Guard or @entity10479 Air Force) increased risk may represent some differences in data (e.g., coding or reporting practices) as opposed to genuine differences in physiological outcome. Our findings suggest that @entity409 as well as @entity262 may contribute to @entity683 severity in this population independently of age and other potential comorbidities. These findings provide additional evidence for the prioritization of specific risk groups within the @entity10479 military for @entity683 vaccination.

Risk factors for severe outcomes among members of the United States military hospitalized with @entity55 and XXXX , 2000-2012.

@entity8 :: ('MESH:D007674', 'Disease') :: ['chronic renal or liver disease'] @entity10479 :: ('MESH:D065309', 'Disease') :: ['US'] @entity2749 :: ('MESH:C580065', 'Disease') :: ['episodes'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes mellitus'] @entity55 :: ('MESH:D011014', 'Disease') :: ['pneumonia'] @entity28 :: ('MESH:D009765', 'Disease') :: ['obesity'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer'] @entity409 :: ('MESH:D008107', 'Disease') :: ['renal and liver disease', 'renal or liver disease'] @entity262 :: ('MESH:D034721', 'Disease') :: ['diseases of the circulatory system'] @entity683 :: ('MESH:D007251', 'Disease') :: ['influenza'] @entity1729 :: ('MESH:D012141', 'Disease') :: ['Respiratory infections', 'acute respiratory infections', 'respiratory infection'] @entity1030 :: ('MESH:D029424', 'Disease') :: ['chronic obstructive pulmonary disease']
@entity683 :: (MESH:D007251,Disease) :: ['influenza']
