title: Dramatic decline of respiratory illness among US military recruits after the renewed use of adenovirus vaccines.
abstract: BACKGROUND
  In late 2011, after a 12-year hiatus, oral vaccines against adenovirus types 4 (Ad4) and 7 (Ad7) were again produced and administered to US military recruits. This study examined the impact of the new adenovirus vaccines on febrile respiratory illness (FRI) and adenovirus rates and investigated if new serotypes emerged. FRI rates and their associated hospitalizations had markedly risen since vaccine production ceased in 1999.
  
  
  METHODS
  From 1996 to 2013, the Naval Health Research Center conducted FRI surveillance at 8 military recruit training centers in the United States. During this period, 58 103 FRI pharyngeal swab specimens were studied, yielding 37 048 adenovirus-positive cases, among which 64% were typed.
  
  
  RESULTS
  During the 2 years after reintroduction of the vaccines, military trainees experienced a 100-fold decline in adenovirus disease burden (from 5.8 to 0.02 cases per 1000 person-weeks, P < .0001), without evidence that vaccine pressure had increased the impact of adenovirus types other than Ad4 and Ad7. Although the percentage of type 14 increased following reintroduction of the vaccination, the actual number of cases decreased. We estimate that the vaccines prevent approximately 1 death, 1100-2700 hospitalizations, and 13 000 febrile adenovirus cases each year among the trainees.
  
  
  CONCLUSIONS
  These data strongly support the continued production and use of Ad4 and Ad7 vaccines in controlling FRI among US military trainees. Continued surveillance for emerging adenovirus subtypes is warranted.
authors.affiliation: Operational Infectious Diseases Department, Naval Health Research Center Joint Doctoral Program in Public Health (Epidemiology), San Diego State University/University of California.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Radin
authors.affiliation: Operational Infectious Diseases Department, Naval Health Research Center.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Hawksworth
authors.affiliation: Operational Infectious Diseases Department, Naval Health Research Center.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Blair
authors.affiliation: Deployment Health Research Department, Naval Health Research Center.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Faix
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego.
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.affiliation: Armed Forces Health Surveillance Center, Silver Spring, Maryland.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Russell
authors.affiliation: College of Public Health and Health Professions Emerging Pathogens Institute, University of Florida, Gainesville.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Gray
mesh_terms: D062705:Adenovirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008889:Military Personnel; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
chemical_list: D062705:Adenovirus Vaccines
keywords: adenovirus; febrile respiratory illness; military; surveillance; vaccine