Adenovirus vaccine cuts rate of BMT upper respiratory infections Published March 8, 2012 By Maj. (Dr.) Kevin Fajardo 559th Medical Group LACKLAND AIR FORCE BASE, Texas -- Adenoviruses have been an important cause of upper respiratory infections, or URIs, in basic military training for decades. There are 50 different variations of adenovirus, called serotypes, and they cause a variety of illnesses, including the common cold, conjunctivitis, and pneumonia. Even though most infections are very mild, adenoviruses can spread rapidly in the close living conditions of military recruits. Strict infection control principles must be enforced daily to prevent outbreaks of illness, as a single sneeze can deposit virus on a doorknob or bedrail that can remain infectious for two weeks. Until 1996 a vaccine against Adenovirus serotypes 4 and 7 was given to all Air Force trainees to reduce their risk of infection. At that time the sole manufacturer of the vaccine ceased production citing an unfavorable cost-benefit analysis as their only customer was the military. Without a vaccine, Adenovirus 4 returned as the major cause of URIs in Air Force basic military trainees, accounting for up to 90 percent of all cases by 2011. A cold or sore throat from Adenovirus 4 would only sideline a recruit for 2 days, on average. But as the number of infections grew, so did the direct impact to the training mission and medical costs. In 2011, an average of 115 trainees per month needed to be temporarily removed from training to recuperate from a URI, resulting in more than 4,000 lost training days at a cost of almost $1 million. Medical costs were also significant, with outpatient costs alone estimated at $1.2 million per year. Good news arrived during the summer of 2011, however, with the announcement that the Department of Defense would again receive an adenovirus vaccine for BMTs. Developed by Barr Pharmaceuticals, the two-pill vaccine would once again offer protection against Adenovirus serotypes 4 and 7. The first doses of the new vaccine were given on Nov. 9, 2011, to almost 800 new Air Force trainees. While only four months have passed, the vaccination campaign has already had a tremendous effect. The rate of upper respiratory infections in basic trainees has fallen a staggering 87 percent. Further, laboratory studies have confirmed that Adenovirus 4 has all but disappeared from the basic trainee population on Lackland AFB. Preventive medicine experts were anticipating a rise in infections caused by other viruses once Adenovirus 4 was better controlled, but this has not yet been seen. Despite the enormous success, preventive medicine physicians at Lackland caution that this vaccine will not eliminate all upper respiratory infections in basic training. There are a multitude of other viruses and bacteria that regularly circulate around the base and local civilian community that can spread quickly among trainees. Therefore, it is essential that training instructors continue to teach trainees about the basic infection control practices that have proven so successful in the past at reducing large-scale outbreaks. These include hand washing, cough etiquette, and common contact surface disinfection measures that are equally important in every household. The long term effectiveness of the vaccine will only be fully determined over the course of many more months of analysis. But for the first time in over two years, Adenovirus 4 infections are finally under control, delighting trainees, training instructors, and medical staff alike.