What is the role of vaccination in the prevention of adenovirus infections?

Updated: Apr 15, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

After a 12-year hiatus, the FDA approved a live oral vaccine against adenovirus types 4 and 7 in 2011. It is indicated for use only by the US Department of Defense for military recruits entering basic training. No commercial vaccine is currently approved for public use.

Vaccination has been limited to military use because of the increased risk of clinically significant disease and potential for hospitalization. In 1971, the administration of live enteric-coated adenovirus vaccine (serotypes 4 and 7) was begun, with notable effectiveness. When given orally, these serotypes induce effective humoral immunity without producing disease. Because of economic factors, vaccine production was ceased in 1996, and rates of ARD in the military rose significantly. A large outbreak of ARD (serotype 4; >1000 cases) between May and December 1997 reinforced the need for immunization. [53] A live oral enteric-coated vaccine against adenovirus types 4 and 7 was approved by the FDA in 2011 for use only by the US Department of Defense in new military recruits entering basic training.

Approximately 80% of current isolates remain serotypes 4 and 7. However, serotypes 3 and 21 also appear to cause significant disease and may be appropriate targets of future immunization. [54] Further, breakthrough infection may occur with nonvaccine strains in persons who have been immunized, and vaccination programs may promote emergence of new epidemic strains. Surveillance and modification of vaccine strains may become necessary over time.

Genotyping of serotype 4 strains during outbreaks has demonstrated stable populations that vary geographically by training site. This suggests that epidemics arise from an endemic environmental source rather than from new recruits, and prevention programs may further require effective environmental control. [14, 55]


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