Introduction

Adenoviruses are a group of common viruses that infect the lining of your eyes, airways and lungs, intestines, urinary tract, and nervous system. They're common causes of fever, coughs, sore throats, diarrhoea, and pink eye. Infections happen in children more often than in adults, but anyone can get them.

Adenoviruses most commonly cause respiratory illness. However, depending on the infecting serotype, adenoviruses may also cause conjunctivitis, gastroenteritis, cystitis, and, less commonly, neurologic illness. Respiratory illness symptoms caused by adenovirus infection range from common cold symptoms, pharyngitis, and rhinitis, to bronchitis or pneumonia. Young infants and patients with compromised immune systems are more susceptible to severe complications from adenovirus infection.

Adenovirus vaccines are live-virus vaccines approved for one-time use in new military members, ages 17 to 50 years. The vaccines are administered orally, as a single dose of two enteric-coated tablets; one tablet protects against adenovirus serotype 4 (white tablet) and one tablet protects against adenovirus serotype 7 (peach-coloured tablet). Each tablet must be swallowed whole and cannot be chewed or crushed. The most common adverse events after adenovirus vaccine receipt are headaches, stuffy nose, sore throat, joint pain, abdominal pain, cough, nausea, diarrhoea, or fever.

History of disease

In the 1950s, multiple researchers identified new viruses as the cause of acute respiratory disease (ARD), pharyngitis, conjunctivitis, and pneumonitis. Soon afterward, these viruses were recognized to be a related group of viruses and given their present name: adenoviruses.

Importance of vaccine

The adenoviruses are often the cause of respiratory illness among U.S. military trainees4,5 and children.6–13 In the 1960s, adenoviruses were recognized to infect as many as 80% of trainees, with 20% requiring hospitalization.5 Median attack rates for trainees ranged from 6 to 16.7/100 per month at the most affected northern and Midwestern U.S. military bases, and from 2.3 to 2.6/100 per month for posts in the South and West.14 Up to 40% of the trainees in a unit were lost to illness within a 2-week period, and many who were hospitalized had to restart training.15 Adenoviruses were also recognized to cause as much as 15% of instances of gastroenteritis in infants and children, and up to 10% of instances of pneumonia among hospitalized children.16–18 Adenovirus morbidity can be severe and lead to death, especially in young children, transplantation recipients, and other immune-compromised patients. The search for vaccines against adenoviruses was driven by adenovirus morbidity among military trainees, their disruption to military training, and their medical care costs.15 In 1971, after a series of miss-tarts, military recruits began routinely receiving live oral enteric-coated vaccines for adenovirus types 4 and 7 (Ad4 and Ad7), which were safe and effective.19 With few exceptions, adenovirus morbidity was markedly con-trolled. However, in 1996, the sole manufacturer of these vaccines ceased production. As vaccine stores were depleted, U.S. military trainees again experienced large outbreaks of adenovirus disease, with some deaths reminding public health officials of the impact of adenoviruses.20–22 In one comprehensive 2006 study, Russell and colleagues documented 98% Ad4 attack rates among 180 susceptible military recruits during 4 weeks of training.23 The importance of these pathogens has been further emphasized through the recent emergence of multiple novel Ad3, Ad7, and Ad14 strains and the subsequent epidemics and deaths they caused.

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