Spread of Adenovirus to Geographically Dispersed Military Installations, May–October 2007

Jill S. Trei; Natalie M. Johns; Jason L. Garner; Lawrence B. Noel; Brian V. Ortman; Kari L. Ensz; Matthew C. Johns; Michel L. Bunning; Joel C. Gaydos


Emerging Infectious Diseases. 2010;16(5) 

In This Article


From May 25 through October 31, 2007, USAFSAM received 959 respiratory specimens from the 12 secondary training sites that initially participated in enhanced surveillance and from 9 additional sites (Table 1). Adenovirus accounted for 413 (89.8%) of the 460 specimens with known etiologic agents; the other viruses identified included parainfluenza (31 [6.7%]), influenza type A (5 [1.1%]), respiratory syncytial virus (2 [0.4%]), and enterovirus (1 [0.2%]). Among the specimens that were culture positive for adenovirus, 358 (86.7%) were tested for Ad14, of which 341 (95.3%) were positive. Ad14 was identified at 8 secondary sites located in California, Florida, Mississippi, Texas, and South Korea; collection dates of the first Ad14-positive specimen at each site ranged from May 30 through October 30. Most patients (331 [97.1%]) with confirmed Ad14 infection were advanced training students, while 9 (2.6%) infections occurred in active duty members outside the training population, and 1 (0.03%) occurred in a dependent child.

Patient survey data were available for 538 of the 959 (56.1%) patients from whom specimens were collected; of these, 220 (40.9%) were Ad14 positive. The following results are only for those 220 patients with confirmed Ad14 infection and available patient survey data (Table 2). Patient ages spanned 17–29 years, though most (183 [84.7%]) patients were 18–22 years of age; the median age was 19 years. In addition, most (197 [89.5%]) patients were male. Regarding patient symptoms, the median temperature recorded was 101.0°F. The most common signs and symptoms reported by patients were sore throat (90.9%), chills (83.2%), fatigue (78.6%), cough (78.2%), headache (75.9%), body aches (70.0%), and nasal congestion (61.4%). One patient was hospitalized with pneumonia and recovered fully without complications. A total of 191 (86.8%) patients were placed on quarters. Of the 125 patients for whom length of quarters information was available, most (108 [86.4%]) were placed on quarters for 24 hours. In addition, 147 (66.8%) patients had recently traveled; of these, most (143 [97.3%]) had recently traveled from Lackland AFB.

At the 3 secondary sites receiving the most BMT graduates, Sheppard AFB, Goodfellow AFB, and Keesler AFB, AdARD incidence rates among active duty personnel were tracked and compared with concurrent rates calculated at Lackland AFB (Figure 3). AdARD rates at Lackland AFB ranged from 0.1–2.0 cases per 100 personnel, with 2 peaks in June and September 2007. AdARD activity at Sheppard AFB waxed and waned throughout the surveillance period, ranging from 0.2–0.8 ARD cases per 100 personnel. The largest peak of activity occurred on September 22, 2007, 2 weeks following the onset of Lackland AFB's second wave of activity. However, this AdARD activity was short lived, decreasing over a course of 4 weeks to 0.2 cases per 100 personnel. Activity at Goodfellow AFB and Keesler AFB was highest following the initial peak at Lackland AFB, and then tapered off. All 3 sites placed ill students on quarters, which resulted in the short-term removal of >600 students from training activities. Only 1 person required hospitalization for adenovirus-associated pneumonia, at Sheppard AFB, during this time (0.01/100 trainees for this 23-week time period). As of October 31, 2007, prevention and control efforts were terminated at Goodfellow AFB and Keesler AFB but continued at Sheppard AFB.

Figure 3.

Rates of confirmed adenovirus for secondary training students at Sheppard Air Force Base, Texas, USA (A); Goodfellow Air Force Base, Texas, USA (B); and Keesler Air Force Base, Mississippi, USA (C), compared with rates for basic military trainees at Lackland Air Force Base, Texas, USA, May 25–October 31, 2007.