Adenovirus

Military trainees suffer significant morbidity from acute respiratory tract infections, including the development of adenovirus pneumonia. Recruits are housed in close quarters and subjected to the intense physical challenges of basic training, sleep deprivation, hygiene challenges, environmental exposures to dust, smoke, air contaminants, and extremes of temperature and intense psychological stress. Under such conditions, recruits have higher rates of respiratory diseases compared with seasoned personnel. Infections caused by adenoviruses are particularly challenging. It is estimated that 75% of all acute respiratory infections in this population are caused by adenoviruses. Unit-specific attack rates can be as high as 80%. Between 1940 and 1960, approximately 80% of military recruits were infected with adenovirus serotypes 4 and/or 7 during training. More than 40% developed significant illness and approximately 20% required hospitalization for respiratory support. By 1957, working together, the Walter Reed Army Institute of Research (WRAIR), National Institute of Allergy and Infectious Diseases (NIAID), and Wyeth Laboratories had developed an investigational adenovirus vaccine. The field trials performed between 1964 and 1969 to test the vaccine were successful. Vaccine was introduced to military recruits starting in 1971. By 1982 all US Army, Navy, and Marine recruits were receiving vaccine. Outbreaks of adenovirus infection rates were reduced to nearly zero. In 1994, Wyeth stopped vaccine manufacturing. Existing vaccine stockpiles were used among new recruits until they were completely depleted in 1999. In less than 1 year, adenovirus outbreaks began to be reported from training posts. Between 2000 and 2005, respiratory virus surveillance at 8 military sites identified ~15,000 cases of adenovirus infection annually at an estimated cost between $10 and $26 million. In response to the obvious need to re-establish the vaccination program, the Department of Defense arranged for seed viruses and production methodology for the previously successful vaccine to be transferred from Wyeth to Barr Laboratories, a subsidiary of Teva Pharmaceutical Industries. Vaccine was manufactured, and the requisite clinical vaccine trials were performed. The new production line was approved for use by the FDA in 2011. Vaccine was distributed to all military basic training installations later that year. Within 1 year after resuming the vaccination program for all military recruits, outbreaks from adenoviruses were no longer reported. Prevaccine baseline infection rate of 5.8 cases per 1000 person-weeks was reduced to 0.02 cases per 1000 person-weeks.