BACKGROUND: Although a human adenovirus (HAdV) vaccine is available for military use, officers-in-training are not routinely vaccinated. We describe an HAdV-associated respiratory outbreak among unvaccinated cadets at the U.S. Coast Guard Academy and its impact on cadet training. METHODS: We defined a case as a cadet with new onset cough or sore throat during August 1-October 4, 2019. We reviewed medical records and distributed a questionnaire to identify cases and to estimate impact on cadet training. We performed real-time PCR testing on patient and environmental samples and whole genome sequencing on a subset of positive patient samples. RESULTS: Among the 1,072 cadets, 378 (35%) cases were identified by medical records (n=230) or additionally by the questionnaire (n=148). Of the 230 cases identified from medical records, 138 (60%) were male and 226 (98%) had no underlying conditions. From questionnaire responses, 113/228 (50%) cases reported duty restrictions. Of cases with respiratory specimens, 36/50 (72%) were HAdV positive; all 14 sequenced specimens were HAdV-4a1. Sixteen (89%) of 18 environmental specimens from the cadet dormitory were HAdV-positive. CONCLUSIONS: The HAdV-4-associated outbreak infected a substantial number of cadets and significantly impacted cadet training. Routine vaccination could prevent HAdV respiratory outbreaks in this population.

Expanding behavior change programs into widespread use with meaningful population impact is a public health challenge. This report described the CDC Arthritis Program's strategic approach to fostering widespread availability and sustainability of community-based self-management education and physical activity interventions, and reviews common errors observed in efforts to disseminate and implement these interventions. The Arthritis Program strategic approach focuses on embedding interventions in delivery systems to facilitate spread and sustainability. Minimizing common implementation errors, such as pay-to-play partnerships, unsustainable delivery models, non-strategic growth strategies, non-selective training, imbalance between delivery and demand, infrequent interventions, and inadequate attention to data collection, can also enhance scaling up and sustaining behavior change interventions. (2011 Society of Behavioral Medicine.)