Wei-Ju Chen

Species-specific clinical characteristics of human coronavirus infection among otherwise healthy adolescents and adults

Human coronavirus (HCoV) is a known cause of influenza‐like illness (ILI). In a multisite, observational, longitudinal study of ILI among otherwise healthy adolescents and adults, 12% of subjects were PCR‐positive for HCoV. The distribution of species was as follows: HCoV‐OC43 (34%), HCoV‐229E (28%), HCoV‐NL63 (22%), and HCoV‐HKU1 (16%). We did not observe species‐specific differences in the clinical characteristics of HCoV infection, with the exception of HCoV‐HKU1, for which the severity of gastrointestinal symptoms trended higher on the fourth day of illness.

Type-specific clinical characteristics of adenovirus-associated influenza-like illness at five US military medical centers, 2009-2014.

Adenovirus is a recognized cause of influenza‐like illness (ILI). The proportion of ILI attributable to adenovirus is not known. Moreover, knowledge gaps remain with respect to the epidemiologic, virologic, and clinical characteristics of adenovirus‐associated ILI among otherwise healthy individuals.

Etiology and clinical characteristics of influenza-like illness in healthy adults by hospitalization status

Abstract Background Viral respiratory infections are a common cause of hospitalization for younger, otherwise-healthy populations. In this study, we describe the epidemiology of influenza-like illness in non-elderly adults within the U.S. Military Health System (MHS) by pathogen and hospitalization status. Methods The Acute Respiratory Infection Consortium (ARIC) is a prospective cohort of patients with influenza-like illness within the MHS. Participants between 18 and 65 years of age were identified in outpatient settings between 2012 and 2017, and were excluded if pregnant, if reporting chronic cardiac, respiratory, renal, or neurologic disease, or if on long-term aspirin therapy. Demographics, nasopharyngeal swabs and symptom data were collected; swabs were tested for viral pathogens using a target-enriched multiplex PCR panel (TEM-PCRTM, Diatherix LLC). Data were analyzed to compare clinical features and risks for hospitalization. Results 397 participants met inclusion criteria. 34 participants required hospitalization; 363 were outpatients. Median length of hospitalization was 2 days. A virus was identified in 58.4% of outpatients (OP) and 55.9% of inpatients (IP); coronaviruses (63/363), enteroviruses (50/363), and influenza A (73/363) predominated in OP, whereas influenza A predominated among IP (35.3%, 12/34). There were no significant differences between OP and IP in terms of age, gender, ethnicity, or tobacco use. IP were more likely to be obese (BMI ≥30, 43.3% vs. 20.5%, P = 0.004) and less likely to have received influenza vaccination (45.5% vs. 16.9%, P > 0.001). IP with influenza did not report more severe symptoms (chills, cough, sore throat, diarrhea, myalgia, or headache) on enrollment but were more likely to have fever (temperature ≥38.0⁰ C) than OP (92.9 vs. 57.1%, P = 0.014). Conclusion Influenza A is the most frequently identified cause of hospitalization among healthy, non-elderly adults with viral respiratory infection. Although age and tobacco use may be risks for viral acquisition, they do not appear to increase the risk of hospitalization in infected patients. Non-obese BMI and influenza vaccination appear protective against hospitalization, even in a relatively healthy cohort. Disclosures L. Malone, Diatherix Laboratories: Employee, Salary; E. Grigorenko, Diatherix Laboratories: Employee, Salary; D. Stalons, Diatherix Laboratories: Employee, Salary

Study to Address Threats of Acute Respiratory Infections among Congregate Military Populations (ATARI)

Abstract Background More than 90% of active duty personnel receive influenza vaccinations yearly. Despite high coverage, influenza-like illnesses (ILI) remain a frequent cause of missed duty and hospitalizations, particularly in U.S. military recruits. More research is needed on the epidemiology and etiology of ILI to reduce the burden of respiratory infections in congregated military settings. Methods We conducted a prospective cohort study to assess ILI patterns among US Army recruits in a 9-week basic combat training course at Ft. Benning, GA. Demographic data, vaccination history, and information on recent illness were collected at enrollment in January 2017. Participants were divided into two platoons with staggered biweekly visit schedules. Visits occurred from reception through training, with nasal swabs and symptom surveys (all visits) and blood draws (weeks 8 and 9). Nasal specimens were used to detect clinical and colonizing pathogens using the Diatherix TEM-PCR Respiratory Panel. Results A total of 90 recruits were enrolled in the study. Twelve recruits were lost due to training attrition in the first week of the study. The participants were male and the mean age was 23 yo (SD 4.9). There were 10 (13%) cases of ILI reported among the 78 remaining participants, 6 in week 1, 3 in week 2 and 1 in week 9. The most frequently detected pathogens in the 10 symptomatic cases were coronavirus (5, 50%), rhinovirus (4, 40%), other enterovirus (3, 30%), and influenza A (2, 20%). Pathogen co-detections were common, 8 out 10 cases were associated with 2 pathogens, representing 7 unique combinations. While rhinovirus and coronavirus were most common among asymptomatic trainees, 10% had detectable influenza A. Detection of multiple pathogens was common in the first two weeks of training (50% among those who had viral detection). The study is still in progress. Conclusion Symptomatic ILI was associated with coronavirus, rhinovirus, and enterovirus, in addition to influenza in the early weeks of training. Coronavirus and rhinovirus also circulated widely among healthy recruits, along with influenza. The findings will inform ILI control strategies for congregated military trainees. Disclosures E. Grigorenko, Diatherix Laboratories: Employee, Salary.L. Malone, Diatherix Laboratories: Employee, Salary.

Burden of Influenza-like Illness among military personnel receiving advanced training at Ft. Sam Houston, TX

Abstract Background Influenza-like illness (ILI) places a significant burden on operational readiness in the U.S. military, particularly in trainees who live and work in congregated settings. ILI incidence rates for the trainees are based on passive surveillance of those presenting to medical clinics. Such clinic-based surveillance may under-estimate the true ILI burden because trainees with ILI may not seek health care due to mild symptoms or fear of missing training. We aimed to estimate the hidden ILI burden among trainees and behaviors related to healthcare seeking for ILI. Methods A 1-page voluntary, anonymous ILI survey was administered during the end of program sessions for military medical trainees at Fort Sam Houston (JBSA-FSH), TX. The survey was started in January 2017 and is ongoing. Results Between January and April 2017, 724 surveys were returned: respondents were aged 17–42 years (median 20 yo), 299 (41%) were female, and 442 (62%) white. The trainees maintained a healthy and active life style: 94% exercised at least 3 times a week; 79% never smoked and only 3% were obese. Overall, 68% trainees reported ILI symptoms during training: the proportion decreased from 75% in January to 46% in April (P-for-trend <0.01). History of travel and self-reported contact to people with ILI were associated with reporting having ILI. Of those reporting ILI, only 36% sought health care, and the proportion did not change over the four month period. Females were more likely to seek health care if they developed ILI: 43% of females vs. 31% of males (P = 0.02). While the majority of trainees washed their hands or used hand sanitizer at least 4 times a day, only 60% of trainees washed their hands after covering their mouth/nose for a sneeze, which may facilitate ILI circulation in the population. Conclusion Among young and healthy medical trainees at JBSA-FSH, ILI was reported frequently during winter and decreased in spring. Trainees often did not seek health care for mild symptoms. The high prevalence of self-reported ILI among trainees despite their healthy life styles and good daily hand hygiene warrants further study. A better understanding of the impact of self-reported ILI on performance and of factors associated with health-care seeking are needed. Disclosures All authors: No reported disclosures.

Comparative Evaluation of Diatherix Target Enriched Multiplex Polymerase Chain Reaction and BioFire FilmArray in the Detection of Viral and Bacterial Respiratory Pathogens

238. Comparative Evaluation of Diatherix Target Enriched Multiplex Polymerase Chain Reaction and BioFire FilmArray in the Detection of Viral and Bacterial Respiratory Pathogens Wei-Ju Chen, PhD; John Arnold, MD; Mary Fairchok, MD; Erin Hansen, BS; Leslie Malone, MS, MB(ASCP)CM; Elena Grigorenko, PhD; Donald Stalons, PhD, D (ABMM), MPH; Jacqueline Owens Milzman, MS; Michelande Ridore, MS; Christian Coles, PhD; Timothy Burgess, MD; Eugene Millar, PhD; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Naval Medical Center San Diego, San Diego, California; Madigan Army Medical Center, Tacoma, Washington; Naval Health Research Center, San Diego, California; Diatherix Laboratories, LLC, Huntsville, Alabama; Children’s National Medical Center, Washington, District of Columbia

Epidemiologic, Clinical, and Virologic Characteristics of Respiratory Syncytial Virus Infection among Otherwise Healthy Adults

www.PosterPresentations.com Epidemiologic, clinical, and virologic characteristics of Respiratory Syncytial Virus infection among otherwise healthy adults Anjali Kunz, MD3, Levi Strube, MD3, Christina Schofield, MD3, Tahaniyat N. Lalani MD4,9, Patrick J. Danaher MD5, Michael Rajnik MD6, Leslie Malone MS MB(ASCP)CM8, Elena Grigorenko PhD8, Donald Stalons PhD8, Deepika Mor MS2,9, Michelande Ridore, MS2,9, Wei-Ju Chen, PhD2,9, John C. Arnold MD1, Eugene Millar, PhD2,9, Mary P. Fairchok, MD2,3,9

Etiology Unknown: Are Less Recognized Respiratory Pathogens Associated With a Milder Course of Illness?

1Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD; 2 Naval Medical Center San Diego CA; 3 Madigan Army Medical Center, Fort Lewis WA; 4 Naval Medical Center Portsmouth VA; 5 San Antonio Military Health System, San Antonio TX; 6 Walter Reed National Military Medical Center, Washington DC; 7 Naval Health Research Center, San Diego CA; 8 Diatherix Laboratories, Inc., Huntsville AL; 9 Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda MD

11412013-2014 Resurgence of 2009 Influenza A (H1N1) Infection among Adults: Has the Epidemiology and Clinical Severity of Disease Changed?

Adults: Has the Epidemiology and Clinical Severity of Disease Changed? John Arnold, MD; Wei-Ju Chen, PhD; Mary Fairchok, MD; Christina Schofield, MD FACP; Tahaniyat Lalani, MBBS, MHS; Patrick Danaher, MD; Michael Rajnik, MD; Erin Mcdonough, BS; Deepika Mor, MS; Michelande Ridore, BA; Timothy Burgess, MD, MPH; Eugene Millar, PhD; Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD; Infectious Disease Clinical Research Program, Tacoma, WA; Madigan Army Medical Center, Tacoma, WA; Naval Medical Center Portsmouth, Portsmouth, VA; San Antonio Military Medical Center, Fort Sam Houston, TX; Walter Reed National Military Medical Center, Bethesda, MD; Naval Health Research Center, San Diego, CA; Infectious Disease Clinical Research Program, Rockville, MD