An adenovirus outbreak occurred in New Haven, Connecticut in 2006-2007. Molecular typing revealed a 2-fold increase in adenovirus type 3 infections. Restriction enzyme analysis indicated that the CT outbreak was largely due to a marked increase in the novel Ad3a51 strain. This outbreak represents the first detection of Ad3a51 in the United States. While most infections were mild, children under 3 were at increased risk for severe disease and one patient with underlying disease died.
KeywordsAdenoviridae; Adenovirus; epidemiology; respiratory tract diseases; communicable diseases; infectious diseases; emerging; outbreak Adenovirus infections are associated with a variety of clinical syndromes, and are usually selflimited. However, severe illness has been reported, especially in military recruits and compromised hosts, but has also been associated with new genomic variants [Kajon et al., 1990;Louie et al., 2008]. In order to investigate the current epidemiology of adenovirus infections in the United States, the University of Iowa Center for Emerging Infectious Diseases (CEID) and 22 US laboratories collaborated in a national surveillance program for emerging adenovirus infections from July 2004 through April of 2007. Laboratories routinely sent adenovirus-positive clinical specimens to the University of Iowa where the specimens were sequence typed using a hexon gene typing strategy [Lu and Erdman, 2006]. The collaboration resulted in the characterization of more than 3000 clinical adenovirus isolates. In November 2006, the Clinical Virology Laboratory at Yale New Haven Hospital (YNHH) in New Haven, Connecticut, experienced a marked increase in the number of clinical specimens that were adenovirus positive. This report summarizes an investigation into this increase.
Methods
Patient samplesSamples were submitted to clinical laboratories for diagnostic testing and were not solicited for the purposes of the study. Specimens positive for adenovirus by direct fluorescent antibody staining (DFA), PCR, other rapid test, or culture were sent to the University of Iowa from 22 participating laboratories, including 14 civilian and 8 military sites, for typing and further analysis. Prior to participation, the study was approved by each institution's Institutional Review Board.
Clinical informationLimited demographic and clinical data was also submitted by each laboratory: collection date, collection site, specimen source, patient birth date, gender, hospitalized when specimen was collected, and if the subject had received a cellular or solid organ transplant during the previous six months. Because of their risk for severe disease, additional information was obtained from adenovirus patients <7 yrs of age or who had received a transplant procedure within six months of their adenovirus detection: race and ethnicity, clinical presentation, hospitalization, intensive care, disposition, cancer, and chronic disease.After recognition of the CT adenovirus outbreak, supplemental clinical information was obtained on the 218 Ad3...