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By Rob Stein
Washington Post Staff Writer
Tuesday, December 11, 2007

Infectious-disease expert David N. Gilbert was making rounds at the
Providence Portland Medical Center in Oregon in April when he realized that
an unusual number of patients, including young, vigorous adults, were being
hit by a frightening pneumonia.

"What was so striking was to see patients who were otherwise healthy be
just devastated," Gilbert said. Within a day or two of developing a cough
and high fever, some were so sick they would arrive at the emergency room
gasping for air.

"They couldn't breathe," Gilbert said. "They were going to die if we didn't
get more oxygen into them."

Gilbert alerted state health officials, a decision that led investigators
to realize that a new, apparently more virulent form of a virus that
usually causes nothing worse than a nasty cold was circulating around the
United States. At least 1,035 Americans in four states have been infected
so far this year by the virus, known as an adenovirus. Dozens have been
hospitalized, many requiring intensive care, and at least 10 have died.

Health officials say the virus does not seem to be causing life-threatening
illness on a wide scale, and most people who develop colds or flulike
symptoms are at little or no risk. Likewise, most people infected by the
suspect adenovirus do not appear to become seriously ill. But the germ
appears to be spreading, and investigators are unsure how much of a threat
it poses.

"This virus has the capability of causing severe respiratory illness in
people of all ages, regardless of their medical condition," said John Su, a
disease investigator for the Centers for Disease Control and Prevention
based in Texas, where the largest outbreak is tapering off at an Air Force
base after 10 months. Other outbreaks have been reported in Washington
state and South Carolina, along with a single case in an infant in New York
City.

"What people need to understand is that there is a virus out there that can
make you very, very sick," Su said. "If you have a bad cold and your
symptoms keep getting worse, go see your doctor. This is nothing to be
necessarily alarmed about. But it is important to be aware that this bug is
out there."

The emergence of the virus is the latest example of how new, potentially
dangerous pathogens can suddenly appear.

"Infectious agents have the capacity to mutate and change form, and from
time to time, either genuinely new agents appear or old agents appear in
new guises," said William Schaffner, an infectious-disease expert at
Vanderbilt University. "This appears to be another one of those emerging
infections that has taken on genetic material or mutated so that it is now
more virulent than it used to be."

The virus, which spreads like those that cause flu or colds, raises many
questions: Why has it suddenly become more common? Why is it apparently
more dangerous? How often does it make people seriously ill? Who is most
vulnerable? Is the threat growing or fading?

"We don't know why it's associated with these severe cases," said Dean D.
Erdman, who is studying the virus at CDC headquarters in Atlanta. "We don't
know whether it's going to become a bigger problem in the future or whether
we'll see more outbreaks of severe disease. These are all questions we're
trying to answer."

There are 51 known strains of adenovirus, ubiquitous germs that cause many
illnesses, including colds, pinkeye, bronchitis, stomach flu and a
respiratory infection called boot camp flu that has long plagued soldiers.
But adenovirus infections rarely have been life-threatening, especially for
healthy young adults.

The new adenovirus is a variant of a strain known as adenovirus 14. First
identified in Holland in 1955, it has caused sporadic outbreaks in Europe
and Asia. No outbreaks, however, had ever been documented in the Western
Hemisphere.

But then Gilbert started seeing patients like Joseph Spencer, 18, a high
school varsity swimmer who was suddenly racked by fever, chills and
vomiting.

"At first I thought it was just the flu," Spencer said. "But then it was
the worst feeling I ever had. I felt so miserable. I really felt like I was
dying."

Spencer's mother took him to the emergency room, where he was placed in
intensive care, sedated and put on a respirator. "Even then, we told the
family we didn't think he was going to survive," Gilbert said.

The teen spent 18 days in the hospital and was able to return home. But
after weeks of bed rest and physical therapy, he remains short of breath
and weak, and he is having memory problems.

"I don't know if I'll ever be fully recovered," Spencer said. "I never
imagined anything like this would ever happen to me."

Spencer was not even the sickest. Of the 30 patients Oregon officials
identified as having the virus, seven died. "That's an incredibly high
mortality rate," Gilbert said.

At about the same time, health officials learned of another outbreak
affecting four residents of a nursing home in Washington state, including
one person who died, as well as a far larger outbreak at Lackland Air Force
Base in Texas. At least 579 recruits have been infected since February at
the base, including at least 24 who had to be hospitalized. One recruit,
Paige Villers, 19, of Norton, Ohio, died after getting mononucleosis and
the virus.

"All of a sudden out of nowhere she just got sick," said Villers's mother,
Michelle. "She thought it was just something she needed to fight off. But
instead of getting better, she just got worse and worse."

Another 220 cases later turned up at other Texas military bases, along with
about 200 more cases at the Marine Corps' Parris Island installation in
South Carolina.

Investigators also determined that an otherwise healthy 12-day-old girl who
died in Manhattan in May 2006 had been infected with the same strain.

A genetic analysis of the microbe at the CDC revealed that the currently
circulating version of the virus is slightly different from the original
1955 strain, suggesting the microbe had mutated in some way to make it more
virulent.

"There are some suspicious changes in certain genes," Erdman said. "What
we're trying to do now is link those changes to behavioral changes in the
virus."

Because doctors do not routinely test for adenovirus, investigators are
uncertain how common it is. But recent surveys, including testing at
military bases around the country, indicate that the virus suddenly
appeared widely across the United States in 2006, showing up in significant
numbers at military bases in San Diego, near Chicago and in Georgia.

"It had been looked for but never identified prior to that," said David
Metzgar of the Naval Health Research Center in San Diego, who has been
tracking the virus among military recruits. "It was a very widespread
emergence."

The CDC reported the emergence of the virus and 362 cases on Nov. 16, but
additional infections have since occurred in Texas and the report did not
include the South Carolina patients.

In Oregon, further testing has shown that the virus now accounts for more
than half of all adenovirus infections. "That's shocking," said Paul Lewis,
a state health investigator. "It went from being imperceptible to being the
majority."

Officials emphasize that the virus, even if it is widespread, may be only
rarely causing serious illness.

"It's like the blind person touching different parts of the elephant. We're
touching the part of the elephant that is the sickest," said Ann Thomas of
the Oregon Department of Human Services.

The outbreak in Texas, which appears to be tapering off, supports that
theory.

"Even though it was more common to get more serious illness than is usual
for adenovirus, most of the people who got infected had just a cold, and a
small percentage had the more serious complications," said Larry J.
Anderson, director of the CDC's division of viral diseases. "Why some who
were infected got more serious illness we do not know."

Some people may be genetically prone to the infection or have weaker immune
systems, he said. Or it could just take time for people to build up
immunity. But other experts say they believe the virus is inherently more
dangerous.

"My gestalt is that it's more virulent than average," said Gregory C. Gray,
director of the Center for Emerging Infectious Diseases at the University
of Iowa. "The consensus among people who look at adenovirus is this is a
particularly virulent strain."

In the meantime, researchers are trying to determine whether any antiviral
drugs are effective against the bug and whether vaccines that protect
against other strains offer any defense. They are on the lookout for the
virus.

"Are we going to have another huge outbreak, or will it disappear?" Gilbert
said. "We just don't know."

Michelle Villers said she hoped her daughter's death might at least alert
others.

"After my daughter's funeral in August, my son got sick in September with
very similar symptoms," she said. "It turned out he just had strep throat.
But parents need to press their doctor for tests, ask for tests, and keep
pressing until you get results. My daughter, she had symptoms that just
looked like the cold or like the flu. You hear of people dying of
pneumonia, but it's usually older people. Not a 19-year-old in the prime of
her life."