title: Epidemic of adenovirus-induced respiratory illness among US military recruits: epidemiologic and immunologic risk factors in healthy, young adults.
abstract: Adenovirus (Ad)-induced acute respiratory illnesses resurged among civilian adults and selected military training populations in the United States during the late 1990s. We examined the epidemiologic and immunologic correlates of Ad-induced respiratory illnesses during a large outbreak at an Army basic training installation in southeast United States during a 9-day period in November 1997. A total of 79 recruits hospitalized with acute respiratory illnesses were evaluated during the outbreak period; confirmation of Ad infection by isolation of Ad-like cytopathic agents from throat cultures was detected in 71 (90%) of these patients. Serotyping of 19 (27%) of these 71 isolates identified the etiologic agent to be Ad type 4 (Ad4). In addition, 30 (81%) of 37 patients in whom paired sera were collected demonstrated significant increases (i.e., 4-fold or higher) in serum anti-Ad4 neutralizing antibodies. Anti-Ad4 immunity in new recruits was found to be very low (15 to 22%). A case-control study involving 66 of the 79 hospitalized cases and 189 non-ill controls from the same units was conducted. A lower risk of hospitalization for acute respiratory illnesses was documented for female recruits (odds ratio[OR] = 0.47, P <.05) whereas, a higher risk was noted for smokers (OR = 1.89, P <.05). Unit (training company) attack rates as high as 8 to 10% per week were documented and the outbreak quickly subsided after live, oral Ad types 4 and 7 vaccination was resumed in November 1997. Re-establishment of a military Ad vaccination program is critical for control of Ad-induced acute respiratory illnesses.
authors.affiliation: Directorate of Epidemiology and Disease Surveillance and Clinical Preventive Medicine, US Army Center for Health Promotion and Preventive Medicine (USACHPPM), Aberdeen Proving Ground, Maryland, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Sanchez
authors.forename: L N
authors.initials: LN
authors.lastname: Binn
authors.forename: B L
authors.initials: BL
authors.lastname: Innis
authors.forename: R D
authors.initials: RD
authors.lastname: Reynolds
authors.forename: T
authors.initials: T
authors.lastname: Lee
authors.forename: F
authors.initials: F
authors.lastname: Mitchell-Raymundo
authors.forename: S C
authors.initials: SC
authors.lastname: Craig
authors.forename: J P
authors.initials: JP
authors.lastname: Marquez
authors.forename: G A
authors.initials: GA
authors.lastname: Shepherd
authors.forename: C S
authors.initials: CS
authors.lastname: Polyak
authors.forename: J
authors.initials: J
authors.lastname: Conolly
authors.forename: K F
authors.initials: KF
authors.lastname: Kohlhase
mesh_terms: D000208:Acute Disease; D000256:Adenoviridae / Q000145:classification / Q000276:immunology* / Q000302:isolation & purification; D000257:Adenoviridae Infections / Q000453:epidemiology* / Q000821:virology; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D016022:Case-Control Studies; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008889:Military Personnel; D009500:Neutralization Tests; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012307:Risk Factors; D012703:Serotyping; D012907:Smoking; D014481:United States / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral