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

Abstract

BackgroundHuman 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.MethodsA 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.ResultsWe 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.ConclusionsTransmission 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.

Genetic variability of human adenovirus type 7 circulating in mainland China

“…Subtype 2 virus, including some known types of HAdV-7 identified by REA (e.g., HAdV-7a, -7b, -7d2, -7d, and -7l), was also first detected in the 1950s. In contrast to subtype 1, subtype 2 viruses have been greatly expanding worldwide since the 1980s [2,4,14,[25][26][27], and this subtype has gradually became the predominant subtype worldwide, causing substantial increases in mortality and morbidity in recent years. In China, a long-term survey of adenoviral-related pneumonia since 1958 indicated that HAdV-7b was the predominant type before 1980; HAdV-7d then became the predominant type from 1980 to approximately 1990 [19,28].…”

“…Among these genotypes, HAdV-3 and -7 are the most common causative agents worldwide [4][5][6][7]; HAdV-7 is the most pathogenic and can cause more severe respiratory illness and higher fatality rates than other HAdV types [8]. Outbreaks of HAdV-7 have been reported at military training bases, school clusters, and communities around the world [2,[9][10][11][12][13][14].…”

Human Adenovirus B7d–Associated Urethritis after Suspected Sexual Transmission, Japan

“…Seven species (A-G) and >100 types have been recognized so far. Among them, HAdV-E4, HAdV-B7, and HAdV-B14 cause severe acute respiratory illness, including severe acute respiratory distress syndrome (2). HAdV-B7d, a genome type of HAdV-B7, was originally designated in 1986 using restriction analysis (3) and classified as genotype B7d on the basis of complete genome analysis in 2013 (4).…”

“…During 2016-2017, a total of 12 cases were reported, including 3 patients in a residential rehabilitation center, 7 college students, and 2 patients at a tertiary care hospital. Four of those 12 case-patients died; all 4 were in 3 adjacent New Jersey counties and had underlying conditions (2,13,14). In 2018, an HAdV-B7d outbreak at multiple facilities in several US regions resulted in the deaths of 11 infants at rehabilitation center in New Jersey and an 18-year-old freshman at the University of Maryland (15).…”

Adenovirus serotype 26 utilises sialic acid bearing glycans as a primary cell entry receptor

“…Some adenoviruses have been associated with acute infection of the eye( 3 ), respiratory( 4, 5 ), and gastrointestinal tract( 1, 6 ). In rare cases infections prove fatal, as observed in a recent neonatal infection of HAdV-D56( 7 ), among adult patients in New Jersey with HAdV-B7d( 8 ), and infamously with HAdV-E4 where large epidemics of adenovirus infection have been seen in military recruits( 9, 10 ). However, most fatal infections are observed in immunocompromised individuals( 11 ), such as those suffering from graft versus host disease (GVHD)( 12 ) or HIV( 13, 14 ).…”