A cluster of adenovirus type B55 infection in a neurosurgical inpatient department of a general hospital in Guangdong, China

Abstract

BackgroundHuman adenovirus type 55 is a re‐emerging human respiratory pathogen that is associated with several respiratory infections outbreaks in military and school populations. In this study, we describe the first HAdV55‐associated hospital outbreak documented in Guangdong, China.MethodsActive surveillance was conducted in the involved neurosurgical inpatient department. All staff and patients in the involved neurosurgical department were surveyed for any symptoms of fever (≥38°C) and enlarged tonsils during the outbreak period. Throat swabs and demographic information were collected for all cases. For each specimen, assays for common respiratory viruses were performed using one‐step reverse transcription‐polymerase chain reaction. HAdV‐positive samples were inoculated onto Hep‐2 cells for isolation. Hexon genes, fiber genes, penton genes, and whole genomes were sequenced. A phylogenetic tree was constructed.Results and ConclusionsForty‐three cases, including 24 laboratory‐confirmed cases and 19 possible cases, were identified. Nurses had the highest attack rate of infection, with a rate of 36.4%. The attack rate for doctors and inpatients was 20.0% and 16.7%, respectively. HAdV55 was the sole pathogen identified during this outbreak. The hexon, fiber, and penton genes from seven isolated HAdV55 stains were sequenced. All these genes showed 100% homology and fell into the HAdV55 [P14H11F14] cluster, indicating that HAdV55 was the single viral strain for the outbreak. While not conclusive, the epidemic investigation revealed that the outbreak was introduced by nurses from sources outside the hospital. It was likely that a transmission from staff to inpatients had occurred.

Comparative Genomic Analysis of Re-emergent Human Adenovirus Type 55 Pathogens Associated With Adult Severe Community-Acquired Pneumonia Reveals Conserved Genomes and Capsid Proteins

“…In 2011, 5 years after the emergence of the first HAdV-B55 strain QS-DLL in China ( Walsh et al, 2010 ), HAdV-B55 re-emerged and caused a CAP outbreak in China ( Gu et al, 2012 ; Zhang et al, 2012a ; Cao et al, 2014 ). Since then, there have been more than 10 HAdV-B55-associated ARD outbreaks in China, for example, in Shanxi province, Chongqing, Beijing, Jiangsu province, Hebei province, Jinan, Tianjin, and Guangdong province ( Yang et al, 2009 ; Walsh et al, 2010 ; Zhang et al, 2012a ; Li et al, 2014 ; Chen et al, 2016 ; Gao et al, 2016 ; Tan et al, 2016 ; Yi et al, 2017 ), with severe and fatal cases ( Zhu et al, 2009 ; Cao et al, 2014 ; Tan et al, 2016 ; Zhang S.Y. et al, 2016 ).…”

“…The acquisition both loops of HAdV-B11 is beneficial to the survival and spreading of the recombinant HAdV-B55, because the previous absence of circulating HAdV-B11 in China ( Han et al, 2013 ; Chen et al, 2016 ; Yu et al, 2016 ) led to a corresponding low level of herd immunity, which might be associated with the subsequent more and more ARD outbreaks caused by HAdV-B55 ( Yang et al, 2009 ; Zhu et al, 2009 ; Walsh et al, 2010 ; Zhang et al, 2012a ; Zhang S.Y. et al, 2016 ; Cao et al, 2014 ; Li et al, 2014 ; Chen et al, 2016 ; Gao et al, 2016 ; Tan et al, 2016 ; Yi et al, 2017 ). This is one of the immune escape capabilities of HAdVs.…”

Real-time Utilization of Metagenomic Sequencing in the Diagnosis and Treatment Monitoring of an Invasive Adenovirus B55 Infection and Subsequent Herpes Simplex Virus Encephalitis in an Immunocompetent Young Adult

“…Since then, numerous outbreaks have been reported from northern China (Shaanxi, Hebei, Henan, Shangdong, Beijing, Tianjin, Chongqing, and Gansu) [5–7, 12–14], and recently more from the southern and western regions (Tibet, Sichuan, Yunnan, Guangdong) [3, 15]. Notably, our patient was from Yunnan.…”

“…The high number of adenovirus reads were sufficient for de novo assembly into several large contigs (max size, 4800 bp), which were closely matched to human adenovirus B55 (HAdV-B55). Of note, this is the same strain that has been reported to cause numerous outbreaks in military units, hospitals, and schools in China, and that often causes deaths in immunocompetent young patients [3–7]. With this information, it was very clear that this patient was suffering an invasive HAdV-B55 infection that started from pneumonia and progressed into viremia.…”

“…In the blood sample, 743/795 reads were used to produce 125 contigs with a total length of 23951 bases (N50, 213 bp). The most closely related adenovirus reference genome was found to be human adenovirus 55 isolate 60-GD-2016 (accession KY070248; genome size, 34 759 bp), which was isolated from an outbreak in a neurosurgical department of a general hospital in Guangdong, a province in southern China during the summer of 2016 [3]. Genetic analysis by mapping the adenovirus reads from the BAL to this genome showed 97.7% coverage with 98.2% pairwise identity and 94.8% identical sites.…”