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The crew of USS Kidd experienced a COVID-19 outbreak identified in April 2020. This is the earliest documented COVID-19 study with RT-PCR, serology, and pre-exposure test data on the entirety of the exposed population (n=333). Case definitions included 121 confirmed (36.3% of crewmembers) and 18 probable (5.4% of crewmembers) based on laboratory diagnostic test results. At the time of testing positive, 62 (44.6%) cases reported no symptoms. Hispanic ethnicity (AOR: 2.71, CI: 1.40-5.25) and non-smoker status (AOR: 2.28, CI: 1.26-4.12) were identified as statistically significant risk factors. This study highlights the value of rapid, onboard diagnostic testing to quickly identify an outbreak and enumerate cases, as well as the serological testing to flag potential cases missed with standard viral case identification methodologies.

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Kimberly A. Bishop-Lilly reports support from the Armed Forces Health Surveillance Division, Global Emerging Infections Surveillance Branch. No other potential conflicts of interest were disclosed.

Background: An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt , a nuclear-powered aircraft carrier with a crew of 4779 personnel., Methods: We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms., Results: The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected., Conclusions: SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt . Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms., (Copyright © 2020 Massachusetts Medical Society.)

Background: Acute respiratory infections are recognized as a significant source of morbidity for military populations, particularly for recruits. This analysis aims to describe the pneumonia burden at Marine Corps Recruit Depots (MCRD) in Parris Island and San Diego during 2007-2014, as these two depots maintain noteworthy comparisons in vaccine and prophylaxis policies. First, both depots reinstated the adenovirus vaccine in October 2011. Second, San Diego provides the pneumococcal polysaccharide vaccine to all recruits within the first 2 days of arrival, although Parris Island does not routinely vaccinate for Streptococcus pneumoniae. Third, recruits at San Diego routinely receive three doses of penicillin G benzathine for group A Streptococcus bacterium prophylaxis, although those at Parris Island receive one dose year-round and a second dose during the winter months when group A Streptococcus bacterium burden is expected to increase., Methods: Monthly pneumonia rates were estimated using diagnostic codes from ambulatory encounters and inpatient discharge records, and specific causative organisms were assessed using code extenders within the International Classification of Diseases, Ninth Revision. Regression analyses and Spearman's correlation rank tests were used to describe significant trends and the relationship between ambulatory and inpatient rates at each depot., Findings: Although our results indicate the majority of ambulatory encounters and inpatient discharges are attributed to unspecified pneumonia diagnostic codes at both locations, these data still lend noteworthy trends. At both locations, linear trends in ambulatory pneumonia rates significantly declined over the 8-year period, whereas inpatient rates demonstrated less variability and did not significantly decline. Both depots experienced prolonged, heightened pneumonia trends from early 2009-2010, a period which included the global influenza pandemic. Following reimplementation of the adenovirus vaccine during October 2011, the average ambulatory rates at MCRD San Diego (38.02 per 1,000 recruit-months vs. 65.59 per 1,000 recruit-months) and MCRD Parris Island (10.9 per 1,000 recruit-months vs. 22.8 per 1,000 recruit-months) were approximately half the average rate before utilization of the adenovirus vaccine. At MCRD San Diego, a weak correlation between monthly inpatient and ambulatory pneumonia rates suggests that trends for potentially severe pneumonia do not follow those for generalized disease (r s = 0.43; p < 0.05), whereas correlation results at MCRD Parris Island indicate these monthly trends are positively associated (r s = 0.71; p < 0.05)., Discussion: These observations underscore the evidence that pneumonia burden among military recruits is not associated with one single etiology. Recruits are at risk for a range of etiologic agents, and control measures should include a combination of specific medical countermeasures that focus on a single bacterial or viral disease as well as nonmedical public health measures that reduce the overall burden of circulating infectious respiratory agents. The trends described in this report, coupled with the similarities and dissimilarities for public health prevention practices at each depot, may warrant further investigation for a systematic review of social and environmental factors within recruit populations at these two locations., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Reported cases of malaria in the Navy and Marine Corps were reviewed from the Naval Disease Reporting System (NDRS) and the Defense Medical Epidemiological Database (DMED). For 1997 through 2000, NDRS identified 62 cases of malaria and DMED identified 162 cases. Further analysis compared NDRS and DMED information with Composite Health Care System (CHCS) records in the Hampton Roads catchment area. The review of 46 patient records available in CHCS found that 30 patient encounters were miscoded in DMED for malaria treatment when they were actually for malaria chemoprophylaxis, 12 visits were coded for malaria treatment, and 4 visits had no apparent relationship to malaria. Ten of the 12 patients reported as treated for malaria in CHCS were also recorded in NDRS. This review suggests a need for further analysis and additional efforts to improve reporting and coding compliance to enhance medical surveillance and force health protection.