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.

Since 2003, the Center for Advanced Molecular Detection (59th Medical Wing/Science and Technology, Air Education and Training Command) has prospectively evaluated epidemiology of respiratory pathogens and novel technologies for detection. For the purposes of this substudy, data were evaluated from June 2008 to August 2013. Ill recruits presenting for clinical care of ARI at the outpatient clinic or hospital were approached by study personnel regarding participation. Inclusion criteria were met if the trainee was ≥17 years of age and endorsed any symptom of respiratory infection, including cough, coryza, sore throat, or nasal or sinus congestion. For those consenting to enroll in the study, demographic information was collected, along with a symptom questionnaire, including self-reported stress levels, and clinical signs, including vital signs and physical examination findings recorded during the medical encounter. Provider diagnoses given at the time of the visit were also recorded when available. Provider clinical diagnosis extracted from the note, if any, associated with the visit, was also explored with reference to diagnoses of upper respiratory tract infection (URTI) vs lower respiratory tract infection (LRTI). The diagnoses, "rhinitis, conjunctivitis, otitis, sinusitis, pharyngitis, sore throat" were considered to be representative of URTI, and the terms "bronchitis, pneumonia" were representative of LRTI. Terms including "common cold", "viral syndrome", "fever", or "cough" were not included in the URTI vs LRTI analysis given their lack of anatomical description. Nasal washes and throat swabs were collected for polymerase chain reaction (PCR) assays. Duplicate presentations for multiple ARI-related visits were excluded; each case represents an individual subject.