THE YALE JOURNAL OF BIOLOGY AND MEDICINE
48, 167-169 (1975)
SYMPOSIUM: ACUTE RESPIRATORY INFECTIONS IN MILITARY PERSONNEL Introduction. Alfred S. Evans Current Patterns of Acute Respiratory Disease in the United States Navy and Marine Corps. Dennis F. Hoeffler Acute Respiratory Disease in the United States Army in the Republic of Viet Nam, 1965-1970. Jay P. Sanford Control of Adenovirus Acute Respiratory Disease in U.S. Army Trainees. Franklin H. Top, Jr. Control of Meningococcal Meningitis with Vaccines. Malcolm S. Artenstein Serologic Studies of Acute Respiratory Infections in Military Personnel. Alfred S. Evans
Introduction ALFRED S. EVANS Department EPH, Yale Medical School, 333 Cedar Street, New Haven, Connecticut 06510 Received March 27, 1975
Acute respiratory diseases (ARD) are the most common cause of morbidity and lost time in military personnel just as they are in the civilian population. Very high rates of infection occur during basic recruit training. The major causes of respiratory illness during this period have been adenovirus, types 4 and 7, influenza, Mycoplasma pneumoniae, group A hemolytic streptococcus, and the meningococci. Excellent studies of acute respiratory disease (ARD), mostly at Fort Bragg, North Carolina were made by the Commission on Acute Respiratory Diseases during World War II which have been well summarized by Langmuir and Dingle (1). The fine investigations carried out in naval recruits over a 10-yr period at the Great Lakes Naval Training Station in Great Lakes, Illinois have also been published (2). The major differences in the pattern of infections in recruits as compared with college adults of the same age (3-5) have been the very high attack rates for all respiratory pathogens in military personnel and the unusual activity of adenoviruses during basic training. In college adults only 1-4% of respiratory illnesses are due to adenoviruses (3-7) whereas they constituted up to 60% of the causes of all acute respiratory infection in some recruit camps in prevaccine days (8). Since World War II enormous advances have been made in the control of specific acute respiratory infections in recruits and other military personnel. Influenza vaccine has been improved and is in regular use in all three services with an effectiveness 'Presented at the Society of Medical Consultants to the Armed Forces, Nov. 10, 1974, Washington, D.C. Papers on Mycoplasma pneumoniae infections by Dr. Floyd Denny and on acute respiratory diseases in the U.S. Army and Air Force by Maj. Dennis Swanson and Col. William Howell, respectively, were not available for publication in this series.
167 Copyright © 1975 by Academic Press, Inc. All rights of reproduction in any form reserved.
ALFRED S. EVANS
ratio against strains contained in the vaccine of the order 70-90% (9). An oral, live adenovirus vaccine containing types 4 and 7 has been prepared and routinely used in the successful control of these infections in recruit populations (10, 11). A meningococcal vaccine against types A and C has been developed at the Walter Reed Army Institute of Research, its effectiveness has been demonstrated in military personnel, and it now is routinely employed on entry into the service (12, 13). Streptococcal infections have been controlled in some settings by use of long acting penicillin administered on arrival in recruit training (2). Mycoplasma pneumoniae remains a major challenge to both civilian and military populations (15), although trials of some vaccine preparations have proved promising (15, 16). However, there is evidence that an inactivated vaccine may induce cell-mediated but not humoral immunity in sero-negative individuals (17). The purpose of this symposium is to review the current experiences of the three services in the U.S. Armed Forces with acute respiratory illnesses, including the recent experience in Viet Nam, to detail the advances made with adenovirus and meningococcal vaccines, and to demonstrate the usefulness of serological surveys in investigating respiratory infections in South American recruits. We are fortunate in having some of the major developers of these vaccines with us as well as other distinguished investigators of respiratory disease in military personnel. REFERENCES 1. Dingle, J. H. and Langmuir, A. D., Epidemiology of acute respiratory disease in military recruits. Amer. Rev. Resp. Dis. 97, 1-53 (1968). 2. Rosenbaum, M. T., Edwards, E. A., and Frank, P. F. et al., Epidemiology and prevention of acute respiratory disease in Naval recruits. 1. Ten years experience with microbial agents isolated from Naval recruits with acute respiratory diseases. Amer. J. Pub!. Hlth. 55, 38-46 (1965). 3. Evans, A. S., Acute respiratory disease in University of Wisconsin students. N. Engl. J. Med. 256, 377-384 (1957). 4. Greble, H. G., Jackson, G. G., and Dowling, H. F., Etiology of common respiratory infections in civilian adult populations. Amer. J. Med. Sci. 235, 245-260 (1958). 5. Evans, A. S. and Warren, J., Patterns of illness in University of Wisconsin students. Arch. Env. Health 4, 579-587 (1962). 6. Evans, A. S., Adenovirus infections in children and young adults. With comments on vaccination. N. Engl. J. Med. 259,464-468 (1958). 7. Jordan, W. S., Jr., Occurrence of adenovirus infections in civilian populations. Arch. Int. Med. 101, 54-59 (1958). 8. Hilleman, M. R., Epidemiology of adenovirus respiratory infections in military recruit populations. Ann. N.Y. A cad. Sci. 67, 262-272 (1957). 9. WHO, Respiratory viruses. Report of a scientific group. WHO Tech. Rept. Ser. 408, Geneva (1969). 10. Top, F. H., Jr., Dudding, B. A., Russell, P. K., and Buescher, E. L., Control of adenovirus respiratory disease in recruits with types 4 and 7 vaccines. Amer. J. Epid. 94, 142-146 (1971). 11. Top, F. H., Jr., Buescher, E. L., Bancroft, W. H., and Russell, P. K., Immunization with live types 7 and 4 adenovirus vaccines. II. Antibody response and protective effect against acute respiratory disease due to adenovirus type 7. J. InfJ Dis. 124, 155-160 (1971). 12. Artenstein, M. S., Gold, R., Zimmerly, J. G., Wyle, F. A., Schneider, H., and Harkness, C., Prevention of meningococcal disease by group B polysaccharide vaccine. N. Engi. J. Med. 282, 417-420
(1970). 13. Wyle, F. A., Artenstein, M. S., Brandt, B. L., Tramont, E. C., Kasper, D. L., Alteri, P. L., Berman, S. L., and Lowenthal, J. P., Immunologic response of man to group B meningococcal vaccine. J. Inf: Dis. 126, 514-521 (1972). 14. Artenstein, M. S., Brandt, B. L., Tramont, E. C., Branche, W. C., Fleet, H. D., and Cohen, R. L., Serologic studies of meningococcal infection and polysaccharide vaccination. J. Inf: Dis. 124, 277288 (1971). 15. Denny, F. W., Clyde, W. A., and Glezon, W. P., Mvcoplasma pneumoniae disease: Clinical spectrum, pathophysiology, epidemiology and control. J. InfJ Dis. 123, 74-92 (1972).
16. Mogabgab, W. J., Protective effects of inactive Mycoplasma pneumoniae vaccine in military personnel, 1964-1966. Amer. Rev. Resp. Dis. 97, 359-365 (1968). 17. Fernald, G. W., and Clyde, W. A., Protective effect of vaccines in experimental Mycoplasma pneumoniae disease. Inf: Immun. 1, 559-565 (1970). 18. Fernald, G. W. and Glezen, W. P., Humoral and cellular immune response to an inactivated Mycoplasma pneumoniae vaccine in children. J. Inf: Dis. 127, 498-504 (1973).