Adenovirus
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photo of adenovirus

There are 52 distinct types of adenovirus. Various types of adenovirus can cause respiratory illness, gastroenteritis, conjunctivitis, bladder infections, and rashes. Adenoviruses are spread through direct contact, fecal-oral transmission, and occasionally water-borne transmission. Some types can establish persistent infections in the tonsils, adenoids, and intestines without causing any visible symptoms; however, those infected can continue to spread the virus to others for months or years without realizing they are even infected.

This section will be concerned with the respiratory illnesses that can be caused by adenovirus type 4 and type 7. In the United States, acute respiratory disease (ARD) is often associated with these two adenovirus types. Symptoms include fever, sore throat, cough, conjunctivitis, runny nose, headache, and pneumonia. The incubation period can vary between 2 and 14 days, with an average of 5-8 days. Symptoms generally last 3 to 10 days.

Adenovirus has been identified as a cause of severe epidemics of ARD in military recruit populations. Studies have shown that up to 80% of recruits develop adenovirus infections, and 20% require hospitalization. Of those hospitalized and found to have adenovirus respiratory infections, adenovirus type 4 and type 7 accounted for 60% of the cases.

About the Vaccine

From 1971 until 1999, US military recruits routinely recevied a live, oral adenovirus vaccine against types 4 and 7. In 2011, the Food and Drug Administration (FDA) approved a new adenovirus vaccine that protects against types 4 and 7. This is a live, non-attenuated oral vaccine consisting of two enteric-coated tablets.

Adenovirus Vaccine Licensed for Use in the U.S.

Product: Adenovirus Type 4 and Type 7 Vaccine, Live, Oral
Manufacturer: Barr Labs, Inc. (Distributed by Teva Pharmaceuticals USA, Inc.)
Year licensed: 2011
Product Insert

Indications Contraindications and precautions
  • All military recruits aged 17 to 50 years of age.
  • People younger than 17 or older than 50 years of age.
  • People who have had a severe allergic reaction to any vaccine component.
  • People who are moderately or severely ill, who should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication. Postpone administration in persons with vomiting and/or diarrhea.
  • Women who are pregnant. Women should also avoid pregnancy for at least 6 weeks following vaccination.
  • People unable to swallow an entire tablet, whole, without chewing.
  • Vaccinees should use precaution when around children younger than 7 years of age, persons who are immunocompromised, and pregnant women during the 28 days following vaccination because vaccine virus can be shed in the stool for up to 28 days following vaccination.
Vaccine Dose/Route Routine Administration Schedule
Adenovirus Type 4 and Type 7, Live, Oral Dose: Two tablets, one for Type 4 and one for Type 7

Route: Orally, must be swallowed whole.
Administer a single dose of two tablets.
Adenovirus Side Effects
The most commonly reported side effects following vaccination were:
  • Upper respiratory infection
  • Headache
  • Nasal congestion
  • Sore throat
  • Cough
  • Arthralgia (joint pain)
  • Nausea
  • Abdominal pain
  • Diarrhea
  • Vomiting

Serious adverse events occurring within 6 months of vaccination (in approximately 1.2% of vaccinated) were:
  • Blood in urine or stool
  • Pneumonia
  • Febrile gastroenteritis
  • Gastritis
Product Name Supplied Storage and Handling
Adenovirus Type 4 and Type 7, Live, Oral
Barr Labs, Inc.
Two bottles, one for Type 4 and one for Type 7 (100 doses of each type) Store refrigerated between 2° to 8°C (36° to 46°F). Do not freeze. Keep bottles tightly closed and protect from moisture. Do NOT remove desiccant canister from bottles.

Adenovirus Type 4 tablet is a white to off-white round coated tablet. Adenovirus Type 7 tablet is a light peach round coated tablet.
After a 12-year hiatus, military recruit training centers resumed administration of adenovirus type 4 and type 7 vaccine, live, oral (adenovirus vaccine) to trainees beginning in October of 2011. Subsequently, rates of febrile respiratory illnesses (FRI) and adenovirus isolations markedly declined. These findings are consistent with those of a placebo-controlled efficacy trial conducted prior to the vaccine’s licensure by the FDA.  Continued surveillance will clarify the longer term impact of vaccine use.
This is a 3 module online course (plus quiz) that will provide Military Healthcare Personnel with important and comprehensive information concerning the adenovirus vaccine.
AIG 4905 PDF 26 Jul 11
IMPLEMENTATION OF ADENOVIRUS TYPES 4 AND 7, LIVE, ORAL PROGRAM
ALARACT PDF 21 Jul 11
IMPLEMENTATION OF ADENOVIRUS TYPES 4 AND 7, LIVE, ORAL VACCINE
03 May 12

Sample Q&A: The Disease

What can be done to prevent transmission of respiratory infections including adenovirus infection?
To prevent spread of disease, it is important to practice good hand hygiene and infection control. Some respiratory diseases are vaccine-preventable including adenovirus types 4 and 7.
Information on DoD Online Adenovirus Vaccine Training
Recommendations of the Armed Forces Epidemiological Board (AFEB)
Recommendations of the Armed Forces Epidemiological Board (AFEB)
Recommendations of the Armed Forces Epidemiological Board (AFEB)
ADENOVIRUS Type 4 and Type 7 LIVE, ORAL VACCINE, ADMINISTRATION COMPETENCY ASSESSMENT Patient Population Served: Recruits (17-50 yrs)
MMQC-11-1660 17 Oct 11
MANUFACTURER WILL BEGIN SHIPMENT OF THE ADENOVIRUS TYPE 4 AND TYPE 7 VACCINE LIVE, ORAL
MMQC-11-1643 03 Oct 11
DELAY IN SHIPMENT OF THE ADENOVIRUS TYPE 4 AND TYPE 7 VACCINE LIVE, ORAL
MMQC-11-1589 01 Sep 11
IMPLEMENTATION GUIDANCE FOR THE ADENOVIRUS TYPE 4 AND TYPE 7 VACCINE LIVE, ORAL
VIS
Vaccine Information Statement