Burton A. Dudding

Fatal pneumonia associated with adenovirus type 7 in three military trainees.

Abstract Despite its relatively common occurrence in infants and young children, fatal pneumonia associated with adenovirus Type 7 (ADV-7) in previously healthy adults appears to be very rare. We observed three fatal cases in young male adults, previously in good health, while they were undergoing Army basic training. Each case was associated with absolute lymphopenia and followed a similar clinical course. In the terminal stages, multisystem disease, including disseminated intravascular coagulation, developed in all three. Post-mortem findings revealed extensive pulmonary damage, with bronchial epithelial necrosis, interstitial alveolar thickening and hyaline membranes; small vessels contained hyaline thrombi. ADV-7 was recovered from the upper respiratory tract of each man shortly after hospitalization and again, in high titer, from lung tissue obtained after death. Serum specimens obtained before death revealed high titers of ADV-7 neutralizing antibody.

AN ANALYSIS OF HOSPITALIZATIONS FOR ACUTE RESPIRATORY DISEASE IN RECRUITS IMMUNIZED WITH ADENOVIRUS TYPE 4 AND TYPE 7 VACCINES

Abstract Dudding, B. A., F. H. Top, Jr., R. M. Scott, P. K. Russell and E. L. Buescher (Walter Reed Army Institute of Research, Washington, D. C. 20012). An analysis of hospitalizations for acute respiratory disease in recruits immunized with adenovirus type 4 and type 7 vaccines. Am J Epidemiol 95: 140–147, 1972.—Among 911 recruits immunized with live, oral adenovirus types 4 and 7 (ADV-4 and 7) vaccines, there were 149 hospital admissions to the acute respiratory disease (ARD) wards during the study. Eighteen admissions were not associated with ARD (15 rubella infections, 3 immunization reactions). Of the remaining 131 ARD admissions, 17 were complicated by pneumonia and 114 were judged to have uncomplicated ARD. Within the latter group, evidence for infection by a single respiratory pathogen was obtained from 68 admissions; 11 admissions were associated with multiple infectious agents; and 35 admissions yielded no infectious agent(s). Despite immunization, adenoviruses, primarily ADV-4, were still the most common cause of ARD. Among non-adenovirus associated ARD admissions, rhinoviruses were the most common (10), followed by influenza A2 virus (7), group A streptococci (2) and herpesvirus hominis (2). Thus, in this initial study of ARD among recruits immunized with ADV-4 and ADV-7 vaccines, no other respiratory pathogens emerged to replace adenovirus types 4 and 7 as the major causes of ARD in military trainees.