Seroepidemiologic investigation of an outbreak of pandemic influenza A H1N1 2009 aboard a US Navy Vessel-San Diego, 2009

Background During summer 2009, a US Navy ship experienced an influenza-like illness outbreak with 126 laboratory-confirmed cases of pandemic influenza A (H1N1) 2009 virus among the approximately 2000-person crew. Methods During September 24-October 9, 2009, a retrospective seroepidemiologic investigation was conducted to characterize the outbreak. We administered questionnaires, reviewed medical records, and collected post-outbreak sera from systematically sampled crewmembers. We used real-time reverse transcription-PCR or microneutralization assays to detect evidence of H1N1 virus infection. Results Retrospective serologic data demonstrated that the overall H1N1 virus infection attack rate was 32%. Weighted H1N1 virus attack rates were higher among marines (37%), junior-ranking personnel (34%), and persons aged 19-24 years (36%). In multivariable analysis, a higher risk of illness was found for women versus men (odds ratio [OR]=2.2; 95% confidence interval [CI]: 1.1-4.4), marines versus navy personnel (OR=1.7; 95% CI, 1.0-2.9), and those aged 19-24 versus >= 35 years (OR=3.9; 95% CI, 1.2-12.8). Fifty-three percent of infected persons did not recall respiratory illness symptoms. Among infected persons, only 35% met criteria for acute respiratory illness and 11% for influenza-like illness. Conclusions Approximately half of H1N1 infections were asymptomatic, and thus, the attack rate was higher than estimated by clinical illness alone. Enhanced infection control measures including pre-embarkation illness screening, improved self-reporting of illness, isolation of ill and quarantine of exposed contacts, and prompt antiviral chemoprophylaxis and treatment might be useful in controlling shipboard influenza outbreaks.