JMIR Publications

ABSTRACT

Background:

Acute respiratory infections (ARI) are common in military settings due to close communal living. A variety of respiratory pathogens are involved in ARI, each varying in prevalence, severity and impact on organisational productivity. Understanding and mitigating the impact of ARI is critical for optimizing the health of military servicemen and organisational productivity.

Objective:

This surveillance study aims to identify pathogens causing ARI among servicemen and pathogens contributing most to medical absenteeism (MA), defined by the combined duration of medical certificate (MC) and light duty (LD) issued.

Methods:

From September 2023 to August 2024, anonymous nasopharyngeal swabs (BioFire® FilmArray® Respiratory Panel) were collected from SAF servicemen presenting with ARI symptoms, after the doctor’s consultation, in a local military camp’s medical centre. The presence of fever and duration of MC/LD were self-reported by SAF servicemen.

Results:

A total of 1,095 nasopharyngeal swabs were collected, of which 608 (55.5%) tested positive. The commonest respiratory pathogen was human rhinovirus/enterovirus (HRV/HEV) (303 cases, 27.7%). The highest proportions of fever were observed in servicemen with influenza (62.8%), SARS-CoV-2 (34.3%) and parainfluenza (31.6%). The odds of influenza patients having fever was 5.80 times (p<0.001, 95% CI 2.95 – 11.40) that of patients infected with HRV/HEV. The median duration of MC, LD and MA were 0 (IQR=0), 2 (IQR=2) and 2 (IQR=0) days respectively. The odds of influenza patients having MC ≥1 day was 5.34 times (p<0.001, 95% CI 2.63 – 10.88) that of HRV/HEV patients. No significant differences in duration of MA were found between HRV/HEV and other pathogens.

Conclusions:

Compared to HRV/HEV, influenza infections were significantly associated with longer MC. Nonetheless, there were no significant differences in duration of MA across pathogens, because servicemen infected with other pathogens were given LD instead, emphasizing the need for pathogen-agnostic ARI measures. While influenza vaccinations are already mandatory for servicemen in local military camps, encouraging additional public health measures (e.g., mask-wearing among symptomatic servicemen, COVID-19 vaccinations) can further reduce ARI incidence, minimize duration of MA and mitigate the impact on organisational productivity. Clinical Trial: Not applicable.