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Background Although a human adenovirus (HAdV) vaccine is available for military use, officers-in-training are not routinely vaccinated. We describe an HAdV-associated respiratory outbreak among unvaccinated cadets at the US Coast Guard Academy and its impact on cadet training. Methods We defined a case as a cadet with new onset cough or sore throat during August 1–October 4, 2019. We reviewed medical records and distributed a questionnaire to identify cases and to estimate impact on cadet training. We performed real-time polymerase chain reaction testing on patient and environmental samples and whole genome sequencing on a subset of positive patient samples. Results Among the 1072 cadets, 378 (35%) cases were identified by medical records (n = 230) or additionally by the questionnaire (n = 148). Of the 230 cases identified from medical records, 138 (60%) were male and 226 (98%) had no underlying conditions. From questionnaire responses, 113 of 228 (50%) cases reported duty restrictions. Of cases with respiratory specimens, 36 of 50 (72%) were HAdV positive; all 14 sequenced specimens were HAdV-4a1. Sixteen (89%) of 18 environmental specimens from the cadet dormitory were HAdV-positive. Conclusions The HAdV-4-associated outbreak infected a substantial number of cadets and significantly impacted cadet training. Routine vaccination could prevent HAdV respiratory outbreaks in this population.

Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged

BackgroundInfectious disease forecasting aims to predict characteristics of both seasonal epidemics and future pandemics. Accurate and timely infectious disease forecasts could aid public health responses by informing key preparation and mitigation efforts.Main bodyFor forecasts to be fully integrated into public health decision-making, federal, state, and local officials must understand how forecasts were made, how to interpret forecasts, and how well the forecasts have performed in the past. Since the 2013–14 influenza season, the Influenza Division at the Centers for Disease Control and Prevention (CDC) has hosted collaborative challenges to forecast the timing, intensity, and short-term trajectory of influenza-like illness in the United States. Additional efforts to advance forecasting science have included influenza initiatives focused on state-level and hospitalization forecasts, as well as other infectious diseases. Using CDC influenza forecasting challenges as an example, this paper provides an overview of infectious disease forecasting; applications of forecasting to public health; and current work to develop best practices for forecast methodology, applications, and communication.ConclusionsThese efforts, along with other infectious disease forecasting initiatives, can foster the continued advancement of forecasting science.

Public health agencies strive to develop and maintain cost-effective disease surveillance systems to better understand the burden of disease within their jurisdiction. The emergence of novel avian influenza and other respiratory viruses such as MERS-CoV along with other emerging diseases including Ebola virus disease offer new challenges to public health practitioners. The authors conducted a series of surveys of influenza surveillance coordinators to identify and define these challenges. The results emphasize the importance of maintaining sufficient infrastructure and the trained personnel needed to operate these surveillance systems for optimal disease detection and public health preparedness and response readiness.

During the spring of 2009, pandemic influenza A (H1N1) virus (pH1N1) was recognized and rapidly spread worldwide. To describe the geographic distribution and patient characteristics of pH1N1-associated deaths in the United States, the Centers for Disease Control and Prevention requested information from health departments on all laboratory-confirmed pH1N1 deaths reported from 17 April through 23 July 2009. Data were collected using medical charts, medical examiner reports, and death certificates. A total of 377 pH1N1-associated deaths were identified, for a mortality rate of .12 deaths per 100,000 population. Activity was geographically localized, with the highest mortality rates in Hawaii, New York, and Utah. Seventy-six percent of deaths occurred in persons aged 18-65 years, and 9% occurred in persons aged ≥ 65 years. Underlying medical conditions were reported for 78% of deaths: chronic lung disease among adults (39%) and neurologic disease among children (54%). Overall mortality associated with pH1N1 was low; however, the majority of deaths occurred in persons aged

Public health agencies strive to develop and maintain cost-effective disease surveillance systems to better understand the burden of disease within their jurisdiction. The emergence of novel influenza and other respiratory viruses such as MERS-CoV along with other emerging diseases including Ebola virus disease offer new challenges to public health practitioners. The authors conducted a series of surveys of influenza surveillance coordinators to identify and define these challenges. The results emphasize the importance of maintaining sufficient infrastructure and the trained personnel needed to operate these surveillance systems for optimal disease detection and public health preparedness and response readiness.

This project reviewed approaches used by public health agencies for alerting health care providers and enhancing surveillance systems to identify the presence of novel respiratory disease and to characterize their recent experience in searching for globally emerging viruses. Public health agencies continue to endeavor to develop and maintain cost-effective disease surveillance systems to better understand the burden of illness, especially newly emerging disease, within their jurisdiction. The importance of maintaining sufficient infrastructure and the trained personnel needed to operate these surveillance systems for optimal disease detection and public health response readiness cannot be understated.

More than a decade into the 21 st century, the ability to effectively monitor community health status, as well as forecast, detect, and respond to disease outbreaks and other events of public health significance, remains a major challenge. As an issue that affects population health, economic stability, and global security, the public health surveillance enterprise warrants the attention of decision makers at all levels. Public health practitioners responsible for surveillance functions are best positioned to identify the key elements needed for creating and maintaining effective and sustainable surveillance systems. This paper presents the recommendations of the Sustainable Surveillance Workgroup convened by the International Society for Disease Surveillance (ISDS) to identify strategies for building, strengthening, and maintaining surveillance systems that are equipped to provide data continuity and to handle both established and new data sources and public health surveillance practices.

Objective This project was organized to facilitate discussions on whether successful novel flu surveillance can be conducted by jurisdictions with limited resources. The discussions will focus on gathering opinions regarding the best combination of surveillance systems to quickly and efficiently identify the presence of influenza A (H3N2)v and other novel influenza viruses in circulation. Introduction The past decade has witnessed rapid development and implementation of numerous syndromic and other advanced surveillance systems to supplement traditional laboratory testing to identify the presence of novel influenza strains and track the impact on local populations. While much of the development and widespread implementation of these systems had been supported by public health preparedness funding, the loss of these monies has greatly constrained the ability of public health agencies to staff and maintain these systems. The periodic appearance of novel flu viruses, such as H3N2v, requires agencies to carefully choose which systems will provide the most cost-effective data to support their public health practice. Methods This project will be facilitated by an experienced public health practitioner who has conducted surveillance for a variety of disease agents. Additional public health practitioners are being recruited among members of the International Society for Disease Surveillance (ISDS) Public Health Practice Committee (PHPC) to contribute information on comparative approaches to cost effective surveillance. Questions were selected for discussion and responses will be collected from influenza surveillance coordinators using a web-based survey tool managed by ISDS staff on behalf of the PHPC. Survey responses and subsequent recommendations will be presented at a PHPC meeting. Results Initial questions selected for the survey tool and subsequent discussions include: What surveillance systems does your agency use for conducting influenza surveillance? Which surveillance systems require trained and experienced public health and informatics staff to maintain? Is your agency having difficulties in recruiting and retaining trained surveillance staff? Has influenza A (H3N2)v been identified in your state or jurisdiction? Does your agency have sufficient staff and other resources to be able to conduct targeted surveillance of novel influenza strains, such as identifying H3N2v cases associated with agricultural fairs or school surveillance for ILI cases? Which surveillance systems provide useful data for monitoring health impact during seasons with highly pathological influenza strains? Which surveillance systems provide useful data for identifying the presence of novel influenza strains and conducting situational awareness?