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Containing the Spread of Infectious Disease in Tight Spaces October 2007
Last year, when a sailor aboard the USS Ronald Reagan developed a cough, subsequent chest x-rays revealed he had tuberculosis. The U.S. Navy quickly screened more than 700 personnel on board the newly commissioned aircraft carrier who might have come into contact with the ill sailor. Testing was soon expanded to include the ship's entire crew, air wing, and civilian guests returning to San Diego during the final leg of a six-month deployment—about 6,000 people in all. This incident highlights the risks associated with the spread of infectious disease among the nation's armed forces—especially those who work alongside each other in contained environments. "It's not a question of if an influenza pandemic could occur, but when," says Dr. Lynn Cooper, a microbiologist at MITRE. "Infectious diseases tend to thrive in crowded, confined spaces." To address this looming threat, which is considered a national security priority, a team of MITRE researchers are investigating disease transmission dynamics in confined spaces and developing a set of best practices for prevention and control. "For example, if 30 percent of the workforce becomes sick, we're examining options as to how the rest of the crew could continue carrying out the mission," explains Olivia Peters, a lead signal processing engineer and co-principal investigator of the project, along with Cooper. Their work, entitled "Pandemic Influenza: Containment and Countermeasures in Closed Environments," is a biotechnology initiative within the MITRE Technology Program (MTP). The MTP is the corporate vehicle for harnessing and disseminating relevant knowledge throughout the corporation and applying innovative technology to solve the needs of the company's sponsors. The researchers' mission partner is the U.S. Navy's Third Fleet, based in San Diego, which must form a response plan to the threat of pandemic. To tackle this challenge, the MITRE engineers are exploring infection scenarios using a novel blend of modeling tools and simulation techniques, while analyzing infection circumstances across a spectrum of population and disease parameters. A Panoply of Possibilities Predicting exactly what type of influenza could afflict service personnel who are in close proximity to each other is a tricky task in itself. "The strain of virus that will cause the next pandemic isn't really known," Cooper points out. "One possibility is the H5N1 virus, commonly known as avian flu, which has had several outbreaks in Southeast Asia over the past decade. But there are 16 different types of the 'H,' [a protein on the surface of the virus], and similarly, there are nine different types of 'N.' Any combination that people haven't been exposed to before could form the next pandemic." To prepare for their undertaking, the team of five MITRE researchers received training on a modeling and simulation tool developed by the Navy. Their technical approach involves evidence-based modeling and leveraging a software application that analyzes pre-existing statistics. "For our evidence modeling, we're using an epidemiological framework, which means looking at data from previous pandemics," notes Peters. "One of the more significant outbreaks was the 1918 influenza epidemic that infected 28 percent of Americans, but hit the military especially hard because it spread through cramped quarters." Peters says the team is also using modeling and simulation measures to determine how disease could spread, taking into account characteristics of the population—this case, the social structure of the military. By carefully considering the hierarchy and segmentation of the military population to understand who actually comes into contact, the researchers are able to calculate more accurate probabilities of infection of different groups. Similarly, modeling is taking place within the test platforms of the physical layouts of a Navy ship, strike force, and fleet. "Each of these ships is like its own island," says Cooper. "Based on all of these inputs, we're creating our best estimates as to what could be best- and worst-case scenarios for whatever virus emerges." Putting Data into Action The second mission of this research initiative is to suggest appropriate courses of action depending on the scenario and the particular disease, whether it's influenza, tuberculosis, or gastrointestinal illness. To that end, the MITRE team is preparing a risk communication guidance packet to help naval decision makers and line commanders make decisions during real disease outbreaks. "We're putting together a playbook for the Navy that offers guidelines for different situations," says James Diggans, a technical lead on the project. "What if there are five patients on respirators on Monday, and four more on Tuesday? How transmissible is the infection, how many people are likely to be afflicted, and should they all be transferred from the ship?" Using the same modeling techniques, the project is also analyzing scenarios to gain insight into how quickly medical capabilities would be overwhelmed, and what types of interventions the Navy might carry out to mitigate the effects of an outbreak. "We look at factors such as when an infected individual first displays symptoms, when and how the disease is transmitted to new people," explains Cooper. "We're also investigating how soon techniques such as isolation or quarantine must be implemented to stop disease transmission." It's expected that this research will offer the U.S. Navy practical methods for mitigating the medical and operational risks that come with disease outbreaks. And although this undertaking focuses exclusively on the spread of disease in naval vessels, the team's findings are pertinent to other contained locations, such as cruise ships, nursing homes, and hospitals. "While we hope to provide our military sponsors with practical methods for mitigating medical and operational risks associated with an influenza pandemic, our work is applicable to other sponsors who also must carry on their mission during an outbreak," Cooper says. —by Cheryl Scaparrotta Related Information Articles and News
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| Page last updated: October 25, 2007 | Top of page |
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