Severe Pediatric Adenovirus 7 Disease in Singapore Linked to Recent Outbreaks across Asia - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

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Severe Pediatric Adenovirus 7 Disease in Singapore Linked to Recent Outbreaks across Asia - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 7—July 2015

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Severe Pediatric Adenovirus 7 Disease in Singapore Linked to Recent Outbreaks across Asia

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Oon Tek Ng , Koh Cheng Thoon, Hui Ying Chua, Natalie Woon Hui Tan, Chia Yin Chong, Nancy Wen Sim Tee, Raymond Tzer Pin Lin, Lin Cui, Indumathi Venkatachalam, Paul Anantharajah Tambyah, Jonathan Chew, Raymond Kok Choon Fong, Helen May Lin Oh, Prabha Unny Krishnan, Vernon Jian Ming Lee, Boon Huan Tan, Sock Hoon Ng, Pei Jun Ting, Sebastian Maurer-Stroh, Vithiagaran Gunalan, and Wei Xin Khong

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Abstract

During November 2012–July 2013, a marked increase of adenovirus type 7 (Ad7) infections associated with severe disease was documented among pediatric patients in Singapore. Phylogenetic analysis revealed close genetic links with severe Ad7 outbreaks in China, Taiwan, and other parts of Asia.

Human adenoviruses (HAdVs) are classified into >50 types and are associated with clinical manifestations that include respiratory, gastrointestinal, ocular, genitourinary, and neurologic disease (1). HAdV infections have been estimated to cause 5%–10% of acute respiratory illnesses in children <5 years of age. Although most infections are subclinical or result in mild upper respiratory tract illnesses, HAdVs can also cause severe pneumonia. Among the HAdV types, type 7 (Ad7) has most often been associated with severe respiratory disease (2).

Recent reports have noted increased incidence of severe Ad7 disease in Asia: among the general population and pediatric inpatients in Taiwan; among persons in a military training camp in Shaanxi, China; and among those in a police training center in Kuala Lumpur, Malaysia (2–4). During January–June 2013, physicians in Singapore noted an increase in HAdV pediatric inpatients. Here we characterize the clinical and molecular epidemiology of this outbreak by reviewing data from government hospitals, the military, and a nationwide influenza-like illness (ILI) laboratory surveillance network in Singapore.

Acknowledgments

We thank the staff of all participating institutions who contributed to patient care and data collection for this analysis.

This study was supported by the Transition Award (NMRC/TA/0009/2012) grant, the Singapore National University Health System H7N9 grant (NUHSRO/2013/144/H7N9/06), and the NHG Small Innovative Grant (SIG/14015). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Dr. Ng is an Infectious Disease Consultant at Tan Tock Seng Hospital. His primary research interests are pathogen molecular epidemiology, emerging infectious diseases, and HIV.

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Figures

• Figure 1. Number of adenovirus cases by month, January 2011–July 2013, Singapore. A) The first confirmed case of adenovirus type 7 was reported in November 2012 in KK Women’s and Children’s...
• Figure 2. Phylogenetic analysis of adenovirus type 7 (Ad7) sequences from this study based on sequenced Ad7 hexon gene hypervariable regions 1–6 (Ad7 reference Gomen AY594255 hexon gene nt 324 to...

Tables

• Table 1. Demographics and clinical features of 188 hospitalized children with adenovirus, by age group, Singapore
• Table 2. Number and percentages of 188 hospitalized pediatric adenovirus case-patients with noninvasive and invasive infection, by key characteristics, and risk factors associated with invasive infection, Singapore

Suggested citation for this article: Ng OT, Thoon KC, Chua HY, Tan NWH, Chong CY, Tee NWS, et al. Severe pediatric adenovirus 7 disease in Singapore linked to recent outbreaks across Asia. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.141443

DOI: 10.3201/eid2107.141443