Production of Illness with a Small-Particle Aerosol of Coxsackie A21*

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Abstract
To evaluate the effect of deposition of a respiratory virus, Coxsackie A21, in the lower respiratory tract, volunteers were given graduated doses of 3 virus inocula in a 0.3-2.5[mu] diameter particle aerosol. Serum antibody protected against infection and illness. For antibody-free volunteers the 50%; human infectious dose corresponded to 30, 50% tissue culture infectious doses, and the characteristic clinical response was a brief febrile respiratory illness. For two of the inocula, including resuspended natural virus, illness was predominantly upper respiratory but for the third it was predominantly lower, including pneumonia. Since the latter inoculum had previously produced upper respiratory illness when inoculated into the nasopharynx it is suggested that deposition in the lower respiratory tract can be an important factor in determining the illness response. This finding, in combination with failure of the 2 other inocula, which also deposited in the lower respiratory tract, to produce lower respiratory disease, suggests that strain differences as well as deposition site may account at least in part for the varied clinical spectrum of naturally-occurring disease.