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Severity of adenovirus serotype 14 may be increasing
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Eight deaths related to adenovirus 14 infection from two outbreaks in separate states occurred in 2006 and 2007. However, the latest data indicate previous infection with a relatively common serotype may provide protection against the uncommon but more severe serotype 14.
Seven patients died in the 2006-2007 community outbreak of adenovirus serotype 14 (AdV14) in Oregon. The one additional death was a military trainee in Texas in 2007. A review of data from the outbreak involving military personnel demonstrated that previous infection with adenovirus 7 (AdV7) may provide protection against AdV14.
To determine risk factors for severe AdV14 infection, public health officials in Portland, Ore., conducted a retrospective review of medical records of patients in Oregon with confirmed AdV infection between Nov. 1, 2006, and July 31, 2007. Medical records were available for 38 of 40 AdV14 infections.
Fever and cough were the most common symptoms of AdV14 infection at the time of initial presentation. Analysis revealed that 76% of patients required hospitalization, 61% required supplemental oxygen, 47% required critical care, 24% required vasopressors and seven patients (18%) died. Smoking cigarettes within the previous 30 days was reported by 60% of adult patients with AdV14.
Among patients who were hospitalized, lobar infiltrates on chest radiographs suggesting bacterial pneumonia were common, according to the results. Risk factors for severe illness included:
- older age (OR, 1.04 per year of age; 95% CI, 1.01-1.06)
- chronic underlying conditions (OR, 6.06; 95% CI, 1.49-24.76)
- lymphocyte count of <1.0 × 109 cells/L (OR, 9.1; 95% CI, 1.95-42.89)
- serum creatinine level > 1.2 mg/dL (OR, 7.6; 95% CI, 1.37-42.71)
These risk factors were observed in a univariate analysis but not in a multivariate analysis.
Texas outbreak
Researchers collected data from ongoing febrile respiratory illness surveillance among Air Force trainees to examine trends in AdV14 infection rates. There were 551 AdV14 infections observed among 1,147 patients with febrile respiratory illness.
Among these patients, there were 23 hospitalizations for pneumonia, four admissions to the ICU and one death.
The researchers conducted a more detailed analysis on a cohort of 173 trainees from four units at the facility. Among cohort members, 50% were infected with AdV14 and 40% had febrile respiratory illness. There were no hospitalizations among cohort members.
Men had a RR for AdV14 infection of 4.7 (95% CI, 2.2-10.1). Close contact with a person who had been infected carried an RR for AdV14 of 1.6 (95% CI, 1.2-2.2).
The rate of preexisting AdV7 antibodies was 37% among trainees who tested positive for AdV14 and had mild illness (P=.007). However, among trainees with AdV14 pneumonia, none had AdV7 antibodies (P=.007).
Jacqueline Tate, PhD, epidemiologist in the division of viral disease at the National Center for Immunization and Respiratory Diseases at CDC, was involved in the research for the Texas outbreak. “While this emergent variant of AdV14 appeared to be circulating widely in the military training population during 2007, it does not currently seem to be a public health threat to the general population,” she told Infectious Disease News.
. “However, clinicians should be aware that AdV14 can cause more severe disease in certain individuals. Prior infection with AdV7 appears to offer some protection against severe disease.”
For more information:
- Lewis P. J Infect Dis. 2009;199:1427-1434.
- Tate J. J Infect Dis. 2009:199:1419-1426.