Staphylococcus argenteus transmission among healthy Royal Marines: A molecular epidemiology case-study.

Objectives During a prospective study of S. aureus carriage in Royal Marines recruits, six S. argenteus strains were identified in four recruits. As S. argenteus sepsis leads to mortality similar to S. aureus, we determined the potential for within same troop transmission, to evaluate future outbreak risk. Methods We used whole-genome sequencing to characterise S. argenteus and investigate phylogenetic relationships between isolates. Results S. argenteus strains (t5078, ST2250) were detected in 4/40 recruits in the same troop (training cohort) in weeks 1, 6 or 15 of training. No mec, tsst or LukPV genes were detected. We identified differences of 1-17 core SNPs between S. argenteus from different recruits. In two recruits, two S. argenteus strains were isolated; these could be distinguished by 2 and 15 core SNPs. Conclusions The identification of S. argenteus within a single troop from the total recruit population suggests a common source for transmission, though high number of SNPs were identified, both within-host and within-cluster. The high number of SNPs between some isolates may indicate a common source of diverse isolates or a high level of S. argenteus mutation in carriage. S. argenteus is newly recognized species; and understanding of the frequency of genetic changes during transmission and transition from asymptomatic carriage to disease is required.

Operation RUMAN and Hurricane IRMA: planning, execution and recovery.

Operation RUMAN was the UK response in the Autumn of 2017 to the Category 5 Hurricane IRMA, which affected the British Overseas Territories in the Caribbean. The Joint Operations Area (JOA) spanned an archipelago of Islands over 1000 nm across, stretching logistical and medical doctrinal clinical timelines in a rapidly changing and generally high risk medical environment. Despite significant challenges and a relatively suboptimal start line position, the Operation was a success from a medical perspective, with lower than expected dNBI rates. This paper, written from the medical Operational in-Theatre HQ perspective, charts the phases of Operation RUMAN during Planning, Execution and Recovery. It examines the context and lessons that arose from the Operation RUMAN that could inform future fast-moving Humanitarian Aid and Disaster Relief Operations.

Incidence and Time to Return to Training for Stress Fractures during Military Basic Training.

Currently, little is known about the length of time required to rehabilitate patients from stress fractures and their return to preinjury level of physical activity. Previous studies have looked at the return to sport in athletes, in a general population, where rehabilitation is not as controlled as within a captive military population. In this study, a longitudinal prospective epidemiological database was assessed to determine the incidence of stress fractures and the time taken to rehabilitate recruits to preinjury stage of training. Findings demonstrated a background prevalence of 5% stress fractures in Royal Marine training; femoral and tibial stress fractures take 21.1 weeks to return to training with metatarsal stress fractures being the most common injury taking 12.2 weeks. Rehabilitation from stress fractures accounts for 814 weeks of recruit rehabilitation time per annum. Stress fracture incidence is still common in military training; despite this stress fracture recovery times remain constant and represent a significant interruption in training. It takes on average 5 weeks after exercise specific training has restarted to reenter training at a preinjury level, regardless of which bone has a stress fracture. Further research into their prevention, treatment, and rehabilitation is required to help reduce these burdens.