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Atom RSS 1. In , a large community outbreak of human adenovirus HAdV in Taiwan was detected by a nationwide surveillance system. The epidemic lasted from week 11 through week 41 of March 14—October 16, Clinical information was collected for inpatients infected with HAdV; 31 Absence of circulating HAdV-7 in previous years and introduction of an emerging strain are 2 factors that caused this outbreak. Since the discovery of these viruses in , more than 50 types have been isolated, some directly linked to specific human diseases, e.
Adenoviruses also are common causes of lower respiratory tract infections in children 4 , but surveillance for these infections is lacking in most countries. Pneumonia caused by adenoviruses cannot be easily differentiated from other types of viral pneumonia, and culturing and typing of adenoviruses is not routinely performed in hospital or public health laboratories. Therefore, community-wide outbreaks of adenovirus are not easily detected; previous reports are limited to those occurring in hospital, school, or military settings 5 — 7.
In , after a enterovirus 71 epidemic, the Taiwan Centers for Disease Control established a nationwide surveillance system using contract virologic laboratories CVLs to perform continuous virologic surveillance for respiratory viruses, especially influenza and enteroviruses 8. The network consists of 12 CVLs located in the northern, central, southern, and eastern regions of Taiwan 9.
The apparent outbreak prompted us to use several existing surveillance systems to describe the characteristics of this outbreak.
Adenovirus-associated acute conjunctivitis in Beijing, China, 2011–2013
Virus isolates found are then sent to the reference laboratory at the Taiwan Centers for Disease Control for identification, sequencing, and typing. For this study, we reviewed virologic surveillance data from week 1 of through week 43 of January 1, —October 30, The weekly adenovirus-positive rate is defined as the number of adenoviruses isolated from respiratory tract specimens divided by the number of all specimens submitted from patients with ILI for respiratory virus surveillance in the corresponding week.
The start and end of the epidemic were defined accordingly. We conducted a retrospective study of adenovirus-infected children treated as inpatients in the National Taiwan University Hospital NTUH , a tertiary hospital in northern Taiwan. All medical records of enrolled inpatients were reviewed. Demographics, medical history, clinical signs and symptoms, diagnoses, and treatments were recorded by using a structured questionnaire. Patients who had been admitted to the intensive care unit were classified as having severe infection; all other patients were classified as having nonsevere infection.
We typed selected adenovirus isolates collected as part of the virologic surveillance program and all isolates obtained from inpatients from NTUH. If a cytopathic effect was observed, the presence of adenovirus was further confirmed by direct immunofluorescence staining with a virus-specific monoclonal antibody. Multiple sequence alignments, protein translation, and phylogenetic analysis were performed on the basis of the nucleotide sequences by using MEGA4 11 and BioEdit software www. For phylogenetic analyses, we included the full-length sequences of the hexon and fiber genes 2, bp and bp, respectively from 5 HAdV-7 isolates collected in in Taiwan and some reference sequences available in the National Center for Biotechnology Information database www.
A phylogenetic tree was constructed by the neighbor-joining method, and 1, bootstrap replications were performed to evaluate the reliabilities of the relationships. All statistical operations were 2-tailed and were performed with SPSS version Figure 1. Weekly adenovirus-positive rates for respiratory specimens from patients with influenza-like illness sent to contract virologic laboratories at the Taiwan Centers for Disease Control and weekly number of inpatients From week 1 of through week 43 of , an average of respiratory tract specimens from ILI outpatients were collected each week by the CVLs range 27—1,, SD Weekly adenovirus-positive rates are shown in Figure 1.
The baseline adenovirus-positive rate in — was 5. Mean adenovirus-positive rate during the epidemic was Figure 2. Among the adenovirus isolates collected during — that were typed, only 3 0. We enrolled inpatients at the NTUH pediatric department who tested positive for adenovirus from November 1, week 44, , through June 30, week 26, All but 3 of these patients had positive test results for adenovirus by culture; the remaining 3 patients had positive test results by PCR only.
The number of hospitalized patients increased following week 43 of and remained high in the following months, a trend that is congruent with virologic surveillance results Figure 1. Of the patients, 31 had severe infections requiring admission to the intensive care unit and had nonsevere infections. The dominant HAdV type differed for patients with versus without severe infection.
Demographic data on inpatients is shown in Table 1.
Median age was 40 months range 1— months ; the male:female ratio was 1. Patients with severe infection had longer hospital stays than did those with nonsevere infection median 18 vs.
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Clinical and laboratory characteristics of HAdV infections among inpatients are shown in Table 2 and Table 3. Compared with patients who had nonsevere infection, patients with severe infection had a longer fever duration median 11 vs. Patients with severe infection also had more signs and symptoms of lower respiratory tract involvement than did patients with nonsevere infection, e. One fourth of all patients had gastrointestinal manifestations, regardless of infection severity. Compared with nonsevere infection patients, patients with severe infection had lower hemoglobin levels 9.
Holdings: The Molecular Biology of Adenoviruses 1
Lactate dehydrogenase level was elevated in all patients, but the level was significantly higher among those in the severe infection group 3, vs. Median copy numbers were 2. Viral load did not differ between patients with severe versus nonsevere infection. One child in whom Kawasaki disease was initially diagnosed later was determined to be infected with HAdV HAdV-6 was isolated from the throat of a child in whom acute myocarditis had been diagnosed.
Other diagnoses included orbital cellulitis, viral exanthem, acute hepatitis, young infant fever, and febrile convulsions. Parenteral or oral antimicrobial drugs were given to Ten percent of patients required mechanical ventilation during hospitalization; all were in the severe group. Intravenous immunoglobulin IVIG was given to 6 patients 3.
Extracorporeal membrane oxygenation was used for 5 patients with respiratory or cardiovascular failure; 3 survived. All of these patients were in the severe group and had underlying diseases; 6 were bedridden before hospital admission. During hospitalization, all of these patients had secondary bacterial pneumonia develop; pathogens involved were Pseudomonas aeruginosa , Staphylococcus aureus , Acinetobacter baumannii , and Escherichia coli.