February 15, 2012 — Deaths resulting from adenoviral respiratory disease increased among US military recruits during the period when vaccination ceased, supporting recent resumption of the practice, according to a study published online February 15 in Emerging Infectious Diseases.
Adenovirus has been a major cause of respiratory illness and death among US active-duty military personnel for half a century, but a vaccine tempered the incursions of serotypes 4 and 7 from 1971 through 1999. From 1967 through 1998, 5 active-duty military personnel died from adenovirus infection of either type 4 or type 7. Those deaths occurred before 1975, presumably reflecting vaccine protection. The military phased out adenovirus vaccination from 1996 to 1999 because the only manufacturer halted production.
To assess the effect of vaccination cessation, Robert N. Potter, DVM, MPH, from the Armed Forces Medical Examiner System, Rockville, Maryland, and colleagues analyzed records for active-duty military personnel who died between 1998 and 2010. They identified 8 cases during the 12-year period and list the major characteristics of the patients in their report.
From 1998 to 2010, approximately 18,500 active-duty personnel died; about 14,000 of these deaths were not the result of combat or hostile action. Of these noncombat deaths, 121 (0.9%) were attributed to primary infections, including the 8 deaths in which adenovirus was either a primary or contributing cause.
Mean age of the 8 patients was 21.3 years. Six patients were white, 1 was black, and 1 was of unknown race. Two of the 8 patients had adenovirus type 14 infections.
None of the individuals who died of adenovirus infection from 1998 to 2010 had been vaccinated. Several had multiple infections. "Of these 8 patients, only 3 had an adenovirus infection identified before death. The remaining 5 patients received a diagnosis on the basis of postmortem tissue examination," the researchers write. All deaths occurred at basic training centers.
The researchers caution that differences in laboratory capabilities and medical surveillance techniques over the many years complicate associating adenovirus deaths with the presence or absence of vaccination.
Vaccination for adenovirus among military recruits resumed in October 2011, using a second-generation live oral vaccine against types 4 and 7. The present study provides evidence supporting resumption of vaccination. Surveillance will continue to evaluate the effectiveness of this new adenovirus vaccination program.
The study was supported by the Global Emerging Infections Surveillance and Response System of the Armed Forces Health Surveillance Center, Silver Spring, Maryland. The authors have disclosed no relevant financial relationships.
Emerg Infect Dis. Published online February 15, 2012.
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