Severe adenovirus infection ups mortality risk in children

Patients with severe human adenovirus (HAdV) infections appear to be at increased risk of mortality, with HAdV-7 and HAdV-3 being the most common genotypes identified, reveals a recent study.

“An increase in HAdV infections among hospitalized children in Singapore was observed since 2013,” the researchers said. “Young age (<2 years) and significant comorbidities have been associated with severe HAdV infections which can result in significant morbidity and mortality.”

A total of 1,167 children (aged 1 month to 17 years) admitted for laboratory-confirmed severe HAdV infection to a paediatric tertiary care hospital in Singapore between January 2013 and September 2017 were included in this retrospective, observational review.

Severe infection was defined as requiring intensive care unit or high dependency care at any point during hospital admission. Finally, the researchers examined clinical characteristics, potential risk factors for mortality, and outcome of cases treated with cidofovir.

Of the admitted patients, 85 (7.3 percent) had severe infection (median age, 1.5 years; interquartile range, 0.72–3.2 years). Most patients had comorbidities (69.4 percent) and presented with pneumonia (32.9 percent). The most common genotypes identified were HAdV-7 (29.4 percent) and HAdV-3 (27.0 percent). [Pediatr Infect Dis J 2020;39:907-913]

Thirteen patients (15.3 percent) succumbed to death, and these children had a higher proportion of existing neurologic comorbidity (46.2 percent vs 13.9 percent; p=0.014) and presentation with pneumonia (69.2 percent vs 26.4 percent; p=0.008) compared with survivors. Those who had pneumonia were at an increased risk of 30-day mortality (odds ratio, 4.3, 95 percent confidence interval, 1.0–28.6; p<0.05).

Seventeen children (20 percent) were administered cidofovir primarily for viraemia (47.1 percent) and/or pneumonia (41.2 percent). Mortality rate stood at 41.2 percent for severe HAdV patients treated with cidofovir.

Notably, a greater proportion of patients who died presented with pneumonia as compared with those who recovered (85.7 percent vs 10 percent; p=0.004). All eight patients who had viraemia were given cidofovir and had survived.

“Pneumonia is a potential risk factor for mortality in severe HAdV infections in our cohort,” the investigators said. “Early cidofovir administration may be considered in patients with severe HAdV infection and existing comorbidities but more studies are required.”

An earlier study in Singapore pointed to the emergence of HAdV-7 in a population where other HAdV types had circulated previously as the cause of an outbreak in 2013. Such genotype was associated with more serious infections in children. [Ann Acad Med Singap 2015;44:50-59]

“The predominant type in 2013 was HAdV-7, which differed from 2011 and 2012, when HAdV-3 was more common,” the authors said. “There was a trend towards pneumonia being more common in patients infected with HAdV-7 than in patients infected with other types, although this did not reach statistical significance.”