January 18, 2019
3 min read

HAdV-7d outbreak underscores need to consider adenoviruses as cause of respiratory illness

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Marie Elisabeth Killerby, VetMB, MPH
Marie Elisabeth Killerby

Researchers reporting on a deadly outbreak of human adenovirus type 7d, or HAdV-7d, said clinicians and public health authorities should consider adenoviruses as a cause of severe respiratory illness in patients, “including during the influenza season.”

The outbreak occurred in three adjacent New Jersey counties from December 2016 to March 2017, with transmission occurring at a college, a substance use rehabilitation facility and in the community, according to CDC epidemiologist Marie Elisabeth Killerby, VetMB, MPH, and colleagues. Four of the 12 patients died.

“Human adenoviruses are known causes of respiratory illness outbreaks in congregate settings but cases and clusters are less well-described from community settings in the U.S.,” Killerby and colleagues wrote. “We investigated to characterize the epidemiologic, laboratory, and clinical features of this HAdV outbreak.”

According to the study, any New Jersey resident with an acute respiratory illness from Dec. 1, 2016, to March 31, 2017, with a laboratory identification of HAdV was considered a case. The 12 detected cases included two patients admitted to a hospital in neighboring Philadelphia, three patients from treatment facilities and seven college students. All of the patients who died had underlying comorbidities, the researchers reported. All three transmission sites had nine nearly identical HAdV-7d genome sequences.

According to the study, all seven cases at the unnamed college experienced symptoms, with 100% reporting fever and sore throat, 86% reporting myalgia and 71% reporting a cough. Symptom onset for five of the seven cases occurred between Dec. 10 and Dec. 18, 2016, whereas the other two cases had symptom onset between Feb. 13 and Feb. 14, 2017. Killerby and colleagues reported the median age was 19 years. Additionally, none of the cases required hospitalization and no deaths were reported.

Between Jan. 1, 2017 and March 31, 2017, an outbreak of 79 acute respiratory infection cases was reported at an alcohol and substance use rehabilitation facility, according to the report. Of these, four tested positive for HAdV-7d and all required hospitalization. According to Killerby and colleagues, the age range of the cases was 54 to 64 years. Three deaths occurred among patients with comorbidities, which included hepatic cirrhosis and diabetes mellitus type 2, and all had a history of alcoholism.

On Jan. 31, 2017, the New Jersey Department of Health received reports of two HAdV-7d-postive cases from the Philadelphia Department of Health, according to the report. Both cases were residents of New Jersey, but no epidemiologic links were observed, Killerby and colleagues said.

According to the study, the first case was a 53-year-old woman who required a chronic low-dose oral corticosteroid regimen after undergoing radiation and chemotherapy for non-Hodgkin’s lymphoma. She also had secondary chemotherapy-induced congestive heart failure, the investigators noted. Moreover, she was initially treated for influenza and sinusitis at a local ED and urgent care center. She was transferred to the ICU 4 days after admission to the hospital and died a few days later, according to Killerby and colleagues.

The second case was a 53-year-old man with type 2 diabetes, hypertension, chronic kidney disease, a past history of smoking, morbid obesity and obstructive sleep apnea, according to the study. He was almost immediately admitted to the ICU and required intubation 3 days after admission. After 42 days in the hospital, he was transferred to a long-term respiratory care facility with a tracheostomy and night-time ventilatory requirements. In June, he was discharged home with long-term tracheostomy requirements.

There is an oral vaccine for HAdV-4 and HAdV-7, but its use is restricted to the military. Killerby told Infectious Disease News that adenovirus outbreaks can be controlled with appropriate infection control measures specific to the virus, including active surveillance, isolating ill patients when possible, restricting visitors and new admissions, monitoring staff for illness and sending them home when sick, environmental cleaning, using personal protective equipment, and frequent handwashing or sanitizing.

"Health professionals should consider adenoviruses as possible causes of upper respiratory illness, and lower respiratory illness such as pneumonia,” Killerby said. “Clinicians should report unusual clusters of illness (eg, respiratory, conjunctivitis) potentially caused by adenoviruses to the state or local health department.” – by Marley Ghizzone

Disclosures: Killerby reports no relevant financial disclosures.