BEGIN:VCALENDAR VERSION:2.0 PRODID:-//swoogo.com//NONSGML kigkonsult.se iCalcreator 2.41.90// CALSCALE:GREGORIAN UID:64353137-3535-4737-b833-333836386666 BEGIN:VEVENT UID:107556c12cd7e9bac90f7181e6ec483c032b3e67@swoogo.com DTSTAMP:20261008T002254Z DESCRIPTION:The United States Coast Guard (USCG) Training Center Cape May ( TCCM) experienced an outbreak of influenza in July 2023. TCCM is the only recruit training center within the USCG and its training mission is critic al to USCG operations. The 2023-24 influenza vaccine was not yet available for distribution and any recruits who might have received vaccination fro m the preceding year would no longer have adequate protection due to wanin g effectiveness. Recruits are grouped into companies of 85-110 individuals and arrive weekly to in-process and begin an eight-week rigorous training program before graduating and moving out to join USCG operations across t he country. Each company is billeted in its own barrack equipped with rows of bunkbeds with shared bathroom facilities. Recruits eat together as com panies in an enclosed dining hall and separation from other companies is c hallenging due to limited space in the dining facility and time to separat e meals among companies of recruits. USCG headquarters (HQ) noted an incid ental case of influenza identified in a recruit hospitalized for an unrela ted issue on 17 July 23. The TCCM medical clinic director and laboratorian were advised to report any additional cases and to use the 4-plex PCR (SA RS-CoV-2/FLUA/FLUB/RSV) testing on any symptomatic individuals with sore t hroat\, congestion\, fever\, and/or myalgias. On 20 July 23\, HQ was notif ied of 15 total cases at TCCM. Immediate public health measures were imple mented to include hand washing\, disinfection of surfaces\, and social dis tancing where possible. Implementation of universal oseltamivir prophylaxi s (recommended but not required) followed and all identified positive infl uenza cases were given treatment with oseltamivir. Active case finding thr ough quasi-random sampling of 10 persons from each of four affected compan ies over five days provided information about the effectiveness of the out break measures through identification of symptomatic individuals who would not have presented to the medical clinic for diagnostic testing. Active c ase-finding provided confidence that mitigation strategies were effective and ensured an accurate understanding of the outbreak. Public health contr ol measures effectively reduced the propagation of cases to zero within tw o weeks of implementation. Close coordination with the Commanding Officer of TCCM along with incident command meetings of essential partners on the ground and an in-person public health team from HQ staff were critical to ensuring implementation of public health interventions and active case fin ding. Effective communication among all partners ensured TCCM training ope rations continued without pause. The response to the TCCM influenza outbre ak provides lessons for management of an influenza outbreak in congregate (and\, by extension\, deployed) settings when personnel are often barracke d together and work closely together as teams. Fundamental incident respon se measures in a congregate/deployed setting can be transformed into a dir ect public health incident response\, critical to ensuring congregate/depl oyed personnel can effectively continue their operations. Part 2. An asses sment of vaccine status and immunity in 26 recruit companies at USCG Train ing Center Cape May\, New Jersey (TCCM) during the period of 14 June 2023 through 24 January 2024 demonstrated an average of 26% of recruits lacking immunity when MMR titers were assessed. The Defense Health Board evaluate d MMR booster immunization practices in a report dated May 18\, 2020 and d etermined that universal vaccination to all service members in the wake of mumps outbreaks aboard U.S. Naval vessels and within ground units of the U. S. military were warranted. However\, the recommendations were not adop ted by the DOD and military services continue the practice of evaluating t iters and administering vaccinations according to individual need. Recruit vaccination records are evaluated on the first day of arrival by medical clinic personnel. Any recruit with unknown vaccination status is evaluated with laboratory testing for titers. If titers are not detected\, the recr uit is administered the vaccine on Day 2. A single dose of MMR results in 93%\, 78%\, and 97% effectiveness for measles\, mumps\, and rubella respec tively. Two doses are 97% and 88% effective for measles and mumps. A singl e dose of rubella vaccine confers long-term\, probably lifelong\, protecti on. Vaccine induced measles immunity appears to be long- term and probably lifelong in most persons\; however\, the effectiveness of two doses of MM R against mumps suggest that the effectiveness decreases with time and a t hird dose of MMR can provide added short term protection for those who are likely to have close contact with a mumps patient. Therefore\, a 75% sero prevalence for titers for measles\, mumps\, and rubella among recruits sug gest that a quarter have received zero doses of MMR. Due to high transmiss ibility of measles\, 90% seroprevalence is minimally needed for herd immun ity\, and 95% population immunity is important to prevent sustained transm ission in an outbreak. Measles is not endemic in the US and therefore any case is usually due to importation. However\, the consequences of measles occurring at the only recruit training center in the USCG would be signifi cant\, with a single case potentially affecting as many as 25 out of 100 r ecruits in a company\, if the case were in the infectious stage. There mig ht be added potential of transmission to recruits in the cohorts from the two preceding weeks since full immunity may not be achieved during that ti me. Isolation of any recruit with measles would be extremely challenging d ue to limited capacity at the medical clinic\, with minimal potential to i solate within barracks. One can also consider the potential for a mumps ou tbreak within close living quarters considering waning immunity\, and only 88% effectiveness in fully vaccinated individuals. The question is\, “Is it time to look again at whether universal vaccination of military recruit s is cost and operationally warranted given the findings of undetectable t iters in 25% of recruits?” DTSTART:20250306T163000Z DTEND:20250306T173000Z LAST-MODIFIED:20261008T002254Z LOCATION: SEQUENCE:0 STATUS:CONFIRMED SUMMARY:CANCELLED US Coast Guard Training Center Cape May: 1. Influenza Outbreak\, Lessons for Congregate Settings: 2. Measles\, Mumps\, Rubella ( MMR) Vaccination status among USCG Recruits: Is it Time to Reconsider our Vaccination Strategy? TRANSP:OPAQUE X-ALT-DESC;FMTTYPE=text/html:

The United States Coast Guard (USCG) Traini ng Center Cape May (TCCM) experienced an outbreak of influenza in July 202 3. TCCM is the only recruit training center within the USCG and its traini ng mission is critical to USCG operations. The 2023-24 influenza vaccine w as not yet available for distribution and any recruits who might have rece ived vaccination from the preceding year would no longer have adequate pro tection due to waning effectiveness. Recruits are grouped into companies o f 85-110 individuals and arrive weekly to in-process and begin an eight-we ek rigorous training program before graduating and moving out to join USCG operations across the country. Each company is billeted in its own barrac k equipped with rows of bunkbeds with shared bathroom facilities. Recruits eat together as companies in an enclosed dining hall and separation from other companies is challenging due to limited space in the dining facility and time to separate meals among companies of recruits. USCG headquarters (HQ) noted an incidental case of influenza identified in a recruit hospit alized for an unrelated issue on 17 July 23. The TCCM medical clinic direc tor and laboratorian were advised to report any additional cases and to us e the 4-plex PCR (SARS-CoV-2/FLUA/FLUB/RSV) testing on any symptomatic ind ividuals with sore throat\, congestion\, fever\, and/or myalgias. On 20 Ju ly 23\, HQ was notified of 15 total cases at TCCM. Immediate public health measures were implemented to include hand washing\, disinfection of surfa ces\, and social distancing where possible. Implementation of universal os eltamivir prophylaxis (recommended but not required) followed and all iden tified positive influenza cases were given treatment with oseltamivir. Act ive case finding through quasi-random sampling of 10 persons from each of four affected companies over five days provided information about the effe ctiveness of the outbreak measures through identification of symptomatic i ndividuals who would not have presented to the medical clinic for diagnost ic testing. Active case-finding provided confidence that mitigation strate gies were effective and ensured an accurate understanding of the outbreak. Public health control measures effectively reduced the propagation of cas es to zero within two weeks of implementation. Close coordination with the Commanding Officer of TCCM along with incident command meetings of essent ial partners on the ground and an in-person public health team from HQ sta ff were critical to ensuring implementation of public health interventions and active case finding. Effective communication among all partners ensur ed TCCM training operations continued without pause. The response to the T CCM influenza outbreak provides lessons for management of an influenza out break in congregate (and\, by extension\, deployed) settings when personne l are often barracked together and work closely together as teams. Fundame ntal incident response measures in a congregate/deployed setting can be tr ansformed into a direct public health incident response\, critical to ensu ring congregate/deployed personnel can effectively continue their operatio ns. Part 2. An assessment of vaccine status and immunity in 26 recruit com panies at USCG Training Center Cape May\, New Jersey (TCCM) during the per iod of 14 June 2023 through 24 January 2024 demonstrated an average of 26% of recruits lacking immunity when MMR titers were assessed. The Defense H ealth Board evaluated MMR booster immunization practices in a report dated May 18\, 2020 and determined that universal vaccination to all service me mbers in the wake of mumps outbreaks aboard U.S. Naval vessels and within ground units of the U. S. military were warranted. However\, the recommend ations were not adopted by the DOD and military services continue the prac tice of evaluating titers and administering vaccinations according to indi vidual need. Recruit vaccination records are evaluated on the first day of arrival by medical clinic personnel. Any recruit with unknown vaccination status is evaluated with laboratory testing for titers. If titers are not detected\, the recruit is administered the vaccine on Day 2. A single dos e of MMR results in 93%\, 78%\, and 97% effectiveness for measles\, mumps\ , and rubella respectively. Two doses are 97% and 88% effective for measle s and mumps. A single dose of rubella vaccine confers long-term\, probably lifelong\, protection. Vaccine induced measles immunity appears to be lon g- term and probably lifelong in most persons\; however\, the effectivenes s of two doses of MMR against mumps suggest that the effectiveness decreas es with time and a third dose of MMR can provide added short term protecti on for those who are likely to have close contact with a mumps patient. Th erefore\, a 75% seroprevalence for titers for measles\, mumps\, and rubell a among recruits suggest that a quarter have received zero doses of MMR. D ue to high transmissibility of measles\, 90% seroprevalence is minimally n eeded for herd immunity\, and 95% population immunity is important to prev ent sustained transmission in an outbreak. Measles is not endemic in the U S and therefore any case is usually due to importation. However\, the cons equences of measles occurring at the only recruit training center in the U SCG would be significant\, with a single case potentially affecting as man y as 25 out of 100 recruits in a company\, if the case were in the infecti ous stage. There might be added potential of transmission to recruits in t he cohorts from the two preceding weeks since full immunity may not be ach ieved during that time. Isolation of any recruit with measles would be ext remely challenging due to limited capacity at the medical clinic\, with mi nimal potential to isolate within barracks. One can also consider the pote ntial for a mumps outbreak within close living quarters considering waning immunity\, and only 88% effectiveness in fully vaccinated individuals. Th e question is\, “Is it time to look again at whether universal vaccination of military recruits is cost and operationally warranted given the findin gs of undetectable titers in 25% of recruits?”

BEGIN:VALARM UID:62383164-3933-4566-b830-646165386237 ACTION:DISPLAY DESCRIPTION:The United States Coast Guard (USCG) Training Center Cape May ( TCCM) experienced an outbreak of influenza in July 2023. TCCM is the only recruit training center within the USCG and its training mission is critic al to USCG operations. The 2023-24 influenza vaccine was not yet available for distribution and any recruits who might have received vaccination fro m the preceding year would no longer have adequate protection due to wanin g effectiveness. Recruits are grouped into companies of 85-110 individuals and arrive weekly to in-process and begin an eight-week rigorous training program before graduating and moving out to join USCG operations across t he country. Each company is billeted in its own barrack equipped with rows of bunkbeds with shared bathroom facilities. Recruits eat together as com panies in an enclosed dining hall and separation from other companies is c hallenging due to limited space in the dining facility and time to separat e meals among companies of recruits. USCG headquarters (HQ) noted an incid ental case of influenza identified in a recruit hospitalized for an unrela ted issue on 17 July 23. The TCCM medical clinic director and laboratorian were advised to report any additional cases and to use the 4-plex PCR (SA RS-CoV-2/FLUA/FLUB/RSV) testing on any symptomatic individuals with sore t hroat\, congestion\, fever\, and/or myalgias. On 20 July 23\, HQ was notif ied of 15 total cases at TCCM. Immediate public health measures were imple mented to include hand washing\, disinfection of surfaces\, and social dis tancing where possible. Implementation of universal oseltamivir prophylaxi s (recommended but not required) followed and all identified positive infl uenza cases were given treatment with oseltamivir. Active case finding thr ough quasi-random sampling of 10 persons from each of four affected compan ies over five days provided information about the effectiveness of the out break measures through identification of symptomatic individuals who would not have presented to the medical clinic for diagnostic testing. Active c ase-finding provided confidence that mitigation strategies were effective and ensured an accurate understanding of the outbreak. Public health contr ol measures effectively reduced the propagation of cases to zero within tw o weeks of implementation. Close coordination with the Commanding Officer of TCCM along with incident command meetings of essential partners on the ground and an in-person public health team from HQ staff were critical to ensuring implementation of public health interventions and active case fin ding. Effective communication among all partners ensured TCCM training ope rations continued without pause. The response to the TCCM influenza outbre ak provides lessons for management of an influenza outbreak in congregate (and\, by extension\, deployed) settings when personnel are often barracke d together and work closely together as teams. Fundamental incident respon se measures in a congregate/deployed setting can be transformed into a dir ect public health incident response\, critical to ensuring congregate/depl oyed personnel can effectively continue their operations. Part 2. An asses sment of vaccine status and immunity in 26 recruit companies at USCG Train ing Center Cape May\, New Jersey (TCCM) during the period of 14 June 2023 through 24 January 2024 demonstrated an average of 26% of recruits lacking immunity when MMR titers were assessed. The Defense Health Board evaluate d MMR booster immunization practices in a report dated May 18\, 2020 and d etermined that universal vaccination to all service members in the wake of mumps outbreaks aboard U.S. Naval vessels and within ground units of the U. S. military were warranted. However\, the recommendations were not adop ted by the DOD and military services continue the practice of evaluating t iters and administering vaccinations according to individual need. Recruit vaccination records are evaluated on the first day of arrival by medical clinic personnel. Any recruit with unknown vaccination status is evaluated with laboratory testing for titers. If titers are not detected\, the recr uit is administered the vaccine on Day 2. A single dose of MMR results in 93%\, 78%\, and 97% effectiveness for measles\, mumps\, and rubella respec tively. Two doses are 97% and 88% effective for measles and mumps. A singl e dose of rubella vaccine confers long-term\, probably lifelong\, protecti on. Vaccine induced measles immunity appears to be long- term and probably lifelong in most persons\; however\, the effectiveness of two doses of MM R against mumps suggest that the effectiveness decreases with time and a t hird dose of MMR can provide added short term protection for those who are likely to have close contact with a mumps patient. Therefore\, a 75% sero prevalence for titers for measles\, mumps\, and rubella among recruits sug gest that a quarter have received zero doses of MMR. Due to high transmiss ibility of measles\, 90% seroprevalence is minimally needed for herd immun ity\, and 95% population immunity is important to prevent sustained transm ission in an outbreak. Measles is not endemic in the US and therefore any case is usually due to importation. However\, the consequences of measles occurring at the only recruit training center in the USCG would be signifi cant\, with a single case potentially affecting as many as 25 out of 100 r ecruits in a company\, if the case were in the infectious stage. There mig ht be added potential of transmission to recruits in the cohorts from the two preceding weeks since full immunity may not be achieved during that ti me. Isolation of any recruit with measles would be extremely challenging d ue to limited capacity at the medical clinic\, with minimal potential to i solate within barracks. One can also consider the potential for a mumps ou tbreak within close living quarters considering waning immunity\, and only 88% effectiveness in fully vaccinated individuals. The question is\, “Is it time to look again at whether universal vaccination of military recruit s is cost and operationally warranted given the findings of undetectable t iters in 25% of recruits?” TRIGGER:-PT15M END:VALARM END:VEVENT END:VCALENDAR