Epidemic of adenovirus‐induced respiratory illness among US military recruits: Epidemiologic and immunologic risk factors in healthy, young adults*†

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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. J. Med. Virol. 65:710–718, 2001.

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