Respiratory Illness Associated With Emergent Human Adenovirus Genome Type 7d, New Jersey, 2016-2017

Abstract

Background: Human adenoviruses (HAdVs) are known causes of respiratory illness outbreaks in congregate settings, but cases and clusters are less well described from community settings in the United States. During December 2016-February 2017, the New Jersey Department of Health received reports of HAdV infections from 3 sources in 3 adjacent counties. We investigated to characterize the epidemiologic, laboratory, and clinical features of this HAdV outbreak.

Methods: A case was defined as a New Jersey resident with acute respiratory illness during December 1, 2016-March 31, 2017 with laboratory identification of HAdV genome type 7d (HAdV-7d). Human adenovirus was detected by real-time and conventional polymerase chain reaction and molecular typed by partial hexon capsid protein gene sequencing. The HAdV genome type was identified by whole genome sequencing analysis. Available medical, public health, and surveillance records were reviewed.

Results: We identified 12 cases, including 3 treatment facility patients, 7 college students, and 2 cases at a tertiary-care hospital. Four cases died; all had underlying comorbidities. Nine HAdV-7d whole genome sequences obtained from all 3 sites were nearly identical.

Conclusions: Transmission of HAdV-7d occurred in community and congregate settings across 3 counties and resulted in severe morbidity and mortality in some cases with underlying comorbidities. Clinicians and local and state health departments should consider HAdV in patients with severe respiratory infection.

Keywords: acute respiratory disease; human adenovirus; outbreak; respiratory virus.

Figure 1.

Number of influenza-like illness (ILI) cases, and number of cases testing positive for influenza, human adenovirus (HAdV)-B/E, and HAdV genome type 7 (HAdV-7), College A, New Jersey, December 2016–March 2017.

Figure 2.

Counts of confirmed human adenovirus genome type 7 (HAdV-7) cases at a Substance Use Rehabilitation Facility, College, and in the Community, New Jersey, December–March 2017.

Figure 3.

Phylogenetic analysis of human adenovirus genome type 7d (HAdV-7d) whole genome sequences from New Jersey (NJ) and Pennsylvania (PA), 2016–2017. The 9 sequences labeled with NJ and PA were obtained from the 9 isolates described in this manuscript. Genomic sequences were aligned using ClustalW implemented in BioEdit (version 7.2.5), and the neighbor joining phylogenetic tree was constructed using MEGA7 software. Numbers at selected nodes indicate level of support using 1000 bootstrap replicates. The scale bar indicates the estimated number of nucleotide substitutions per site. Sequence names are derived from the GenBank accession number, geographic location, and year of sample collection and virus genome type identified. The sequence obtained from the case, which had a deletion variant coinfection containing a 12-nucleotide, in-frame deletion located in early region 4 open reading frame 2, is marked with *.