AFIERA is also unusual in its capability to sequence

positive.  The laboratory found adenovirus in patho 

the hemagglutinin gene of influenza.  In a phenomenal

logic specimens from two military recruits who died

accomplishment that will enhance surveillance for

following an episode of acute respiratory illness.  This

strain evolution, this year AFIERA became one of

provided further impetus for DoD to find a manufac 

the few labs (and the only DoD lab) capable of neu 

turing partner willing to begin production of the

raminidase characterization.  They also made great

adenovirus vaccine again.  Molecular characteriza 

advances in the use of PCR techniques for real time

tion of adenovirus surveillance strains isolated from

detection of influenza viruses, keeping DoD on the

recruits is also ongoing and may help identify sig 

cutting edge of surveillance for what caused more

nificant differences from vaccine strains.  

deaths (over 40,000) among military personnel during

the last century than any other infectious disease.

Recognizing the emergence of antibiotic resistant

Such real time capabilities can help rapidly distinguish

Streptococcus pyogenes in recruits, NHRC has also

between influenza and more worrisome causes of

continued surveillance for this pathogen.  Between

influenza like illnesses, such as anthrax.  DoD GEIS

February 1998 and September 2001, 622 isolates

funding provided to AFIERA is also helping to conduct

from training centers have been studied, with resistance

an influenza vaccine effectiveness study in young

documented at 8% for erythromycin (an important

health care personnel at Misawa Air Base in Japan.

second line drug for penicillin allergic recruits during

This is designed to help define levels of vaccine

the common recruit center epidemics).  Testing for

breakthrough, risk factors for vaccine failure, ideal

invasive S. pneumoniae in 282 isolates from seven

immunization frequency, and cost effectiveness

military medical centers also documented resistance.

issues in the active duty setting.

Full or partial penicillin resistance was documented

in 34% of these specimens and 22% had resistance to

The Naval Health Research Center (NHRC) in San

three or more antibiotics.  Pertussis is an increasingly

Diego provided an outstanding complement to the

recognized problem for young adults, and recruits

AFIERA efforts.  NHRC used its specialized laboratory

seem to be no exception.  NHRC has established

capabilities to conduct rigorous in depth respiratory

surveillance for Bordetella pertussis at four basic

disease surveillance at military training centers.  The

training centers and have enrolled more than 150

impact of NHRC's College of American Pathologists

recruits.  Using culture, serology, and PCR, 34 of 65

certified lab was felt during FY 2001 through work

(52%) recruits were positive on at least one test for

involving 17 collaborating military commands in the

pertussis.  Using cell culture, PCR, and serology,

U.S.  Many of the respiratory bacteria and virus

respiratory syncytial virus (RSV) was also documented

laboratory capabilities that DoD GEIS supports at

as a concern through surveillance at Fort Benning,

NHRC are unique within DoD and are providing

GA, the Marine Corps Recruit Depot in San Diego,

insight into potentially preventable, previously

and at the Royal Navy Recruit camp in the United

uncharacterized causes of morbidity.  NHRC has

Kingdom.  Three hundred and ten recruits meeting

also completed the application for status as a WHO

the  suspect  case definition submitted specimens,

Collaborating Center.  

with rates for RSV ranging from 11.5% to 15.3%

by training center. 

Active surveillance for febrile respiratory illnesses

(FRI) was conducted at 8 tri service basic training

NHRC has used and expanded on GEIS supported

centers with weekly rates reported and specimens

infrastructure in many ways.  It has enabled them to

sent to San Diego for laboratory testing.  Data are

embark on many valuable projects, such as the evalu 

rapidly made available via the NHRC web site

ation of rapid tests for influenza and a collaboration

(www.nhrc.navy.mil/geis).  Among 7,888 specimens

with the AFIP to develop a PCR test for influenza and

evaluated this fiscal year, 61% were adenovirus 

adenovirus that can be used on specimens shipped at

12