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Introduction Influenza is a globally occurring viral respiratory infection that can lead to hospitalizations and death. An influenza outbreak can interfere with combat readiness in a military setting, as the infection can incapacitate soldiers. Vaccination remains the most effective tool to prevent and mitigate seasonal influenza. Although influenza vaccinations for U.S. Army soldiers can be monitored through military health systems, those systems cannot capture DoD civilians and Army dependents who may not use military health services. This study aims to gauge flu vaccine uptake and perceptions in U.S. Army civilians and dependents. Materials and Methods An online survey was e-mailed to civilian and dependent enrollees of Landstuhl Regional Medical Center. The survey contained 24 questions pertaining to demographics, vaccine history, history of the flu, and beliefs toward vaccines. Chi-square tests, t-tests, and logistic regressions were performed to investigate the association between demographic, behavior, and belief factors with vaccine uptake. Free-text answers were coded and categorized by themes. Results Over 70% of respondents were vaccinated for the flu. There were differences between vaccinated and unvaccinated respondents regarding their perceptions of barriers to vaccination, benefits of the flu vaccine, severity of flu symptoms, and personal risk of getting ill with the flu. After controlling for confounders, flu vaccination in the previous season and healthcare worker status were associated with increased vaccine uptake, while perceived barriers to influenza vaccination were associated with decreased vaccine uptake. Conclusions Flu vaccine uptake may be increased by increasing access to vaccination, promoting vaccination and addressing concerns at the provider level, and engaging positively framed public messaging. Increasing flu vaccine uptake is of particular importance as the flu season approaches during the COVID-19 (Coronavirus disease 2019) pandemic.

Background Behavioral health units (BHU) have been implicated in influenza outbreaks due to group activities, low availability of alcohol-based hand gels and unique host factors. We describe the management of an unusual influenza outbreak, which started in the BHU and then spilled over to the acute care hospital (ACH). Methods University of Maryland Harford Memorial Hospital is a 95-bed ACH with a 14-bed closed-door adult BHU located on the fifth floor. Two cases each of hospital-acquired influenza were identified in our BHU during 2016 and 2017. In January 2018, however, hospital-acquired influenza cases in the BHU spilled over to the adjacent ACH to cause an outbreak. A case was defined as a patient with fever of >100.4°F, presence of influenza-like illness, and a positive influenza test >72 hours after admission. Outbreak control measures included twice daily fever screening, enhanced droplet precautions, visitor restrictions, discontinuing community activities, enforcing hand hygiene at all hospital entrances, and hospital-wide chemoprophylaxis with oseltamivir. Results On January 15, 2018, the index patient developed influenza in the BHU followed by a second case in BHU 4-days later. Over the next 10 days, five more patients on the third and fourth floors of ACH tested positive. Attack rate was 3% and average length of stay was 8.9 days. Chemoprophylaxis with oseltamivir 75 mg orally once a day was given to 71% of all eligible hospitalized patients for a week (at a cost of $17,000). All seven patients yielded influenza A, subtype H3N2 and were successfully treated with oseltamivir 75 mg orally twice a day for 7 days. The outbreak lasted 11 days. Figure 1 shows the epidemiologic curve. Conclusion Special attention should be paid to influenza prevention in the BHUs due to the risk of spillover effect to sicker patients in the adjacent ACH. A short, 7-day course of hospital-wide oseltamivir chemoprophylaxis, in addition to promptly implementing the infection prevention measures was effective in controlling the outbreak. Disclosures All authors: No reported disclosures.

to determine risk factors for ILI transmission. Because the investigators had the foresight to evaluate these quickly, they were able to assess ILI in household members before the virus was established in the community; thus, incident ILI was probably due to household transmission. Planning for a novel influenza outbreak has been a priority for public health officials since the recognition of H5N1 influenza in Hong Kong in 1997, especially from 2003, when H5N1 outbreaks in birds and infections in people were detected in multiple geographic areas. The 2003 outbreak of severe acute respiratory syndrome taught us that new viruses can spread rapidly across continents. Indeed, the 2009 pandemic H1N1 virus spread globally within 6‐8 weeks. Planning has included strategies to mitigate spread of a new virus; this was particularly crucial in the initial months when a vaccine was not yet available. It is important to determine protective and risk factors for infection in households, because a standard public health recommendation is that ill individuals stay isolated at home to decrease the spread of infection in the community. Evaluating influenza virus transmission

In this issue of Clinical Infectious Diseases, Rubin et al. [ 1 ] discuss postexposure chemoprophylaxis against influenza A in long-term care facilities (LTCFs). They report that amantadine chemoprophylaxis initiated ^5 days after the beginning of an influenza outbreak reduces outbreak duration, incidence of influenza symptoms, and case-fatality rate. Their findings make sense: the earlier the diagnosis, the quicker the introduction of barriers to transmission (such as speedier chemoprophylaxis initiation), the lower the number of new vectors, and the lower the impact and extent of an influenza outbreak. These

Wu DBC1, Chaiyakunapruk N1,2,3,4, Pratoomsoot C5, Lee KKC1, Chong HY1, Nelson RE6, Smith PF7, Kirkpatrick C8, Kamal MA9, Nieforth K7, Dall G7, Toovey S10, Kong DCM8, Kamauu A11, Rayner CR7 1School of Pharmacy, Monash University, Sunway, Malaysia ,2 Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Thailand, 3 School of Pharmacy, University of Wisconsin, Madison, USA, 4 School of Population Health, University of Queensland, Brisbane, Australia, 5Faculty of Public Health, Naresuan University, Thailand, 6University of Utah, Salt Lake City, UT, 7 d3 Medicine LLC, 8Monash University, Melbourne, Australia, 9Hoffman-La Roche, Inc., Nutley, NJ, 10Royal Free and University College Medical School, London, UK, 11Anolinx LLC, Salt Lake City

Prompted by a clinical observation of an increase in hospital admissions for acute myocardial infarction during an influenza outbreak, a study was designed to examine the number of deaths from ischaemic heart disease (IHD) at the time of influenza. Deaths from IHD were found to be increased at all ages, and particularly in younger age groups when deaths attributed specifically to acute myocardial infarction are considered. The question of whether influenza could act as a precipitating factor in acute myocardial infarction is discussed, together with a possible mechanism.