Acute febrile respiratory illness aboard ships in the US Navy
Acute Febrile Respiratory Illness (A/FRI) is a common but significant category of illness with world wide effect and impact on morbidity and mortality. In the shipboard environment the environmental, susceptibility and exposure factors that favor the spread of A/FRI are augmented. This paper assesses the risk of A/FRI aboard US Navy ships and compares that risk to preparations and policy already in place to reduce the risk of epidemics aboard ships. For ships to have the best chance at avoiding disabling epidemics, improvements are needed in the following five areas: 1) accurate and timely medical intelligence about A/FRI outbreaks worldwide, disseminated to all ships medical departments, as well as aggressive ship board surveillance programs with rapid testing Influenza kits and real time submission up the chain of command, 2) mandated education for all shipboard personnel about proper hygiene, the avoidance of disease, and self reporting of symptoms to facilitate early diagnosis and intervention if needed, 3) facilitation of early detection of outbreaks through the widespread availability and use of point of care rapid testing for influenza A & B with reflex testing to identify Avian Flu or novel strains, 4) early treatment with antiviral medications including keeping supplies aboard for ready use to avoid time delay in procurement, and 5) development of effective respiratory isolation methods and procedures standardized by ship class, established, in place and ready for immediate use. Improvements in these five critical areas are necessary to avoid the potential of an A/FRI epidemic aboard ship and its resultant impact on morbidity, mortality and operational readiness.