Human adenovirus species in children with acute respiratory illnesses

Abstract

Background: Human adenovirus (HAdV) species B, C, and E are commonly associated with acute respiratory illnesses (ARI). We sought to determine the association between HAdV species and ARI severity in children over one respiratory season at Monroe Carell Jr. Children's Hospital at Vanderbilt.

Methods: We conducted a retrospective cohort study of children with HAdV from a provider-ordered BioFire® FilmArray Respiratory Pathogen Panel 2.0 (RPP) from 05/2018-06/2019. Type-specific PCR assays for HAdV-B3, B7, B11, B14, B16, B21, HAdV-C1, C2, C5, C6, and HAdV-E4 were performed. Demographics, clinical characteristics, and outcome data were compared between HAdV species.

Results: Of 4514 respiratory specimens collected, 2644 (59 %) had at least one pathogen detected by RPP, and 384 (15 %) were HAdV-positive; 342 (89 %) were available for research testing with 306 (89 %) specimens from unique symptomatic individuals; 237 (77 %) were positive for the following species: 104 (44 %) HAdV-B, 114 (48 %) HAdV-C, 9 (4%) HAdV-E, and 10 (4%) with co-detection between species. The majority with identified HAdV species were seen in the ED (62 %), and approximately one-third were hospitalized. Patients with HAdV-C were more likely to be younger, hospitalized, and have a higher frequency of seizures compared to HAdV-B.

Conclusion: HAdV-C and HAdV-B were the most common species detected, with differences in clinical characteristics and outcomes noted. Additional studies with larger sample sizes focusing on a high-risk pediatric population are necessary to determine if differences in illness severity across individual HAdV types exist to guide further type-specific HAdV vaccine development.

Keywords: Adenovirus; Epidemiology; Respiratory; Species.

Fig. 1.

Study Inclusion Algorithm and Results of Respiratory Specimen Testing. Abbreviation: RPP, BioFire respiratory pathogen panel; HAdV, human adenovirus; HAI, hospital-acquired infection. ^§ Two or more respiratory swabs were collected and tested by RPP from the same patient during study period (either during the same or different healthcare encounter). * 2 symptomatic patients were admitted for surgical procedure (liver biopsy and appendectomy).

Fig. 2.

a: Distribution of HAdV Species Among Symptomatic Cases. b. Distribution of HAdV Types Among Symptomatic Cases.

Fig. 3.

a: Distribution of HAdV Species by Age. b: Distribution of HAdV Species by Healthcare Settings.

Fig. 4.

a: Comparison of Cycle Threshold (Ct) Value of Nontype-specific HAdV Between Single HAdV. Dectecion and HAdV Co-detection with Other Respiratory Infections in Symptomatic Cases. b: Comparison. of Ct Value Between HAdV Species in Symptomatic HAdV-single Cases. c: Comparison of Ct Value Between. Healthcare Settings by HAdV Species Groups in Symptomatic HAdV-single Cases. Data are median with IQR; p-values calculated using median test. Analysed Ct Value of Non-type. Specific HAdV. Abbreviation: NS, Not Significant. * 3 cases with type-specific HAdV positive PCR were exclluded from analysis given negative. HAdV nontype-specific PCR.