TY - JOUR
T1 - Vaccine-preventable adenoviral respiratory illness in US military recruits, 1999-2004
AU - Russell, Kevin L.
AU - Hawksworth, Anthony W.
AU - Ryan, Margaret A.K.
AU - Strickler, Jennifer
AU - Irvine, Marina
AU - Hansen, Christian J.
AU - Gray, Gregory C.
AU - Gaydos, Joel C.
N1 - Funding Information:
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. Work presented herein was financially supported by the US Department of Defense and the Global Emerging Infections Surveillance and Response System (GEIS) under Award # 61102A-M0101-60501. This manuscript is approved for public release; distribution is unlimited. This work has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research under protocol #NHRC.1999.0002.
Funding Information:
Although the literature on adenoviral infections in immunocompromised populations and people in health care institutions has been growing, the significance of adenovirus-associated respiratory disease in civilian community populations is still unclear. Early studies recognized the significance of serotype 3 among civilians, but found little evidence of illness caused by serotype 4 [50] . This early study estimated that with a low disease burden, a 100% efficacious vaccine would only decrease the number of respiratory illnesses suffered in the <10 years age group by 6%. This was judged an insufficient proportion to recommend vaccination in the civilian sector. More recent reports, although sparse, suggest that serotype 4 comprises 2–3% of the adenovirus strains found globally [51,52] and is associated with nosocomial outbreaks [53] . Adenovirus serotype 7, in contrast, comprises up to 20% of all reported adenovirus strains globally [51] , is associated with numerous documented outbreaks [54–56] , and is an important pathogen resulting in serious illness in children younger than 5 years of age [57–59] . It is felt, however, that the true incidence of adenovirus serotype 4 and serotype 7 disease is unknown and probably underestimated in civilian populations, given the current sparse capabilities and inconsistent efforts to identify the agents of respiratory illness outbreaks. To address this need, the National Institutes of Allergy and Infectious Disease is currently sponsoring a large, multi-center civilian adenovirus surveillance project (NIH grant number 1R01AI053034-01A2).
PY - 2006/4/5
Y1 - 2006/4/5
N2 - Background and Methods: The high burden of respiratory infections in military populations is well documented throughout history. The primary pathogen responsible for morbidity among US recruits in training was shown to be adenovirus. Highly efficacious oral vaccines were used for 25 years, but vaccine production ceased in 1996, and available stores were depleted by early 1999. Surveillance for acute febrile respiratory illness was performed at eight military recruit training sites throughout the United States from July 1999 through June 2004 to document rates after loss of the vaccines. Laboratory diagnoses complimented the surveillance efforts. Results: Over the 5 years, nearly 12 million person-weeks were followed and an estimated 110,172 febrile respiratory illness cases and 73,748 adenovirus cases were identified. Rates of illness were highest at the Navy and Air Force training centers, with average annual rates of 1.20 and 1.35 cases per 100 recruit-weeks, respectively. Adenoviral-associated illness rates peaked in weeks 3-5 of training, depending upon service. Conclusions: The burden of adenoviral illness among US recruit populations has returned to high levels since loss of the vaccines. Restoration of an effective adenovirus vaccine effort within the military is anticipated by 2008, potentially reducing the adenovirus morbidity suffered in this vulnerable population. Efforts to determine the burden of adenovirus and potential benefits of vaccination in civilian populations are being renewed.
AB - Background and Methods: The high burden of respiratory infections in military populations is well documented throughout history. The primary pathogen responsible for morbidity among US recruits in training was shown to be adenovirus. Highly efficacious oral vaccines were used for 25 years, but vaccine production ceased in 1996, and available stores were depleted by early 1999. Surveillance for acute febrile respiratory illness was performed at eight military recruit training sites throughout the United States from July 1999 through June 2004 to document rates after loss of the vaccines. Laboratory diagnoses complimented the surveillance efforts. Results: Over the 5 years, nearly 12 million person-weeks were followed and an estimated 110,172 febrile respiratory illness cases and 73,748 adenovirus cases were identified. Rates of illness were highest at the Navy and Air Force training centers, with average annual rates of 1.20 and 1.35 cases per 100 recruit-weeks, respectively. Adenoviral-associated illness rates peaked in weeks 3-5 of training, depending upon service. Conclusions: The burden of adenoviral illness among US recruit populations has returned to high levels since loss of the vaccines. Restoration of an effective adenovirus vaccine effort within the military is anticipated by 2008, potentially reducing the adenovirus morbidity suffered in this vulnerable population. Efforts to determine the burden of adenovirus and potential benefits of vaccination in civilian populations are being renewed.
KW - Adenovirus respiratory illness
KW - Adenovirus vaccine
KW - Military recruits
KW - Respiratory illness rates
UR - http://www.scopus.com/inward/record.url?scp=33644880223&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2005.12.062
DO - 10.1016/j.vaccine.2005.12.062
M3 - Article
C2 - 16480793
AN - SCOPUS:33644880223
SN - 0264-410X
VL - 24
SP - 2835
EP - 2842
JO - Vaccine
JF - Vaccine
IS - 15
ER -