This week I have been in Bangkok visiting our virology colleagues at the United States Armed Forces Research Institute of Medical Sciences (AFRIMS), with whom we are collaborating on the Flu-Barracks study. AFRIMS Virology has had a presence in Thailand since the 1960s and has a long and distinguished history of medical research, having been involved in key evaluations of hepatitis A and Japanese Encephalitis vaccines. More recently, their work has focused on dengue fever and influenza. They have conducted some landmark studies to understand the clinical and epidemiological features of dengue fever in children in rural Thailand, and have supported a number of the field sites involved in the recent phase III trial of the dengue CYD vaccine, in Thailand and the Philippines.
For the Flu-Barracks study, we are collecting data from military recruits at some of the training camps in Bangkok, where AFRIMS is conducting surveillance of respiratory infections. A number of studies in military populations have shown that rates of respiratory infections are very high, particularly in the first few weeks of training when a large number of individuals from geographically diverse origins come together in a new setting where they spend an extended period of time. The study aims to characterise the epidemiology of respiratory infections in military recruits in a tropical setting, find out what types of pathogens cause these infections, and make recommendations for disease control in this population. Our AFRIMS colleagues have an immense amount of experience in conducting field studies, and do an incredible job of organising and managing all the enrollment of participants, data and specimen collection, follow-ups, and diagnostics, not to mention all the accompanying paperwork. For this study, they were kind enough to let us tag on a study to measure contact patterns between recruits using radio frequency identification tags that our collaborators at the Institute for Scientific Interchange (ISI) Foundation developed and have used in a number of studies. The tags measure how often recruits come into close contact with each other, and we can use this information to reconstruct the social network of the barracks population and how it changes over time, to study if patterns of contact influence how influenza and other viruses are transmitted. You can see an example of this type of data here.
We went to visit one of the camps in Bangkok. Not exactly in the middle of nowhere, but working in an army camp has its own set of challenges – tropical storms often cause power cuts, which interferes with the wireless receivers we use to collect and store the data, and squirrels sometime chew up the power cables! And though you may think that doing research with army recruits in a confined space is easy, Institutional Review Boards that oversee research in the military often have some of the strictest oversight procedures. Though it seems strange to think of young men as vulnerable, from an ethical standpoint vulnerability is related to context, and the structure of military life is such that young recruits are theoretically more susceptible to coercion, so having adequate procedures to safeguard their autonomy and ensure informed consent in research participation is important. We will be posting some more updates on this project, so watch this space!