Outbreak of febrile respiratory illness associated with human adenovirus type 14p1 in Gansu Province, China

Huang, Guohong; Yu, Deshan; Zhu, Zhen; Zhao, Hai; Wang, Peng; Gray, Gregory C.; Meng, Lei; Xu, Wenbo

Since their discovery in 1953, human adenovirus strains (HAdVs) have been classified into seven species (A-G). More than 52 unique types [1] [2] [3] [4] have been found. HAdVs are widely distributed 5 and cause a broad spectrum of clinical diseases, including febrile respiratory illness (FRI), pneumonia, conjunctivitis, gastroenteritis, cardiomyopathy, and urinary tract infection. Severe disease and death caused by HAdV infections are rare among otherwise healthy individuals. 6, 7 Certain HAdV species, including B, C, and E, are wellknown causes of respiratory disease outbreaks. 8, 9 HAdVs belonging to species C (types 1, 2, 5, and 6) are generally endemic in children and adolescents. [9] [10] [11] Species E, comprising only HAdV type 4, is the most common pathogen in outbreaks of FRI among military recruits. 12, 13 The large HAdV species B includes two subspecies: B1 (types 3, 7, 16, 21, and 50) and B2 (types 11, 14, 34, and 35) . HAdV-3, 7, and 21 generally cause outbreaks of FRI and pneumonia among adolescents and adults 7 , whereas HAdV-34 and 35 are often associated with sporadic kidney and urinary tract infections. 1 HAdV-11, 14, and 16 have been infrequently associated with outbreaks of FRI 14, 15 until the strain HAdV-14p1 emerged in the United States in 2006. 15 In China, HAdVs have not been well studied. However, outbreaks of HAdV infection (i.e., HAdV-3, 7, and 11) have been previously described, particularly among primary and middle school students. [16] [17] [18] [19] In April 2011, the Institute for Viral Disease Control and Prevention in the Chinese Center for Disease and Prevention was notified of a cluster of HAdV respiratory infections in Tongwei County in the Gansu province. Throat swab specimens were collected from patients with FRI. HAdV-14p1 was determined as the causative pathogen for this outbreak. This is the first report of an FRI outbreak caused by HAdV-14p1 at a primary and middle school in China, as well as the first report of HAdV-14p1 infections in schoolaged children in the world.