Changes in Clinical Presentation and Epidemiology of Respiratory Pathogens Associated With Acute Respiratory Illness in Military Trainees After Reintroduction of Adenovirus Vaccine

Yun, Heather C.; Young, Adam N.; Caballero, Manuel Y.; Lott, Lisa; Cropper, Thomas L.; Murray, Clinton K.

From June 2008 to August 2013, 2660 trainees enrolled and had specimens tested for respiratory pathogens. Ad VI took place week 48, 2011; 72% of this cohort enrolled pre-VI vs 28% post-VI. None of the pre-VI subjects received Ad vaccine, vs 93% post-VI. Overall, 86% were male, with a median age of 20 years. Enrollments ranged from 437 to a peak of 757 in 2009 for years with a complete calendar-year of data. Trainees reported a perceived stress level of 4 on a 10-point Likert scale. Post-VI, the male predominance of enrolled subjects decreased from 89% to 79% (P < .01) (see Table 1 ). Clinical characteristics are presented in Table 2 . Before VI, 91% of subjects had a recorded oral temperature >100.4°F, vs 10% afterward. One or more diagnoses representative or URI, LRTI, or both, were present in 64.3% pre-VI and 74.5% post-VI. Terms associated with lower respiratory tract infection (LRTI) were more commonly included post-VI (26.1% vs 12.9%, P < .01) and terms associated with URI were less commonly included post-VI (79.0% vs 89.5%, P < .01). Those with the diagnosis of "pneumonia" in the post-VI period were predominantly afebrile (89.5%). Supporting radiographs, if performed, were unavailable. The term "allergic" or "allergy" was included in none of the diagnoses pre-VI, but was included in 8.1% post-VI (P < .01); 75% of these were listed in combination with some other diagnosis of URI or LRTI. Clinical signs and symptoms specifically associated with Ad vs rhinovirus were also compared, with similar findings as those seen in general for pre-and post-VI (data not shown). The exceptions were the loss of statistical significance between those describing malaise and with abnormal tympanic membrane examinations. Those with Ad vs rhinovirus also more often described sore throat (90.8%, 83.1%, P < .01) and had more documented tonsillitis (23.5% vs 13.8%, P < .01).