Human Adenovirus in Children with Acute Gastroenteritis in the New Vaccine Surveillance Network (NVSN)

Acute gastroenteritis (AGE) is a leading global cause of pediatric morbidity and mortality. Human adenoviruses (HAdV) are a cause, but the burden is not fully defined. We sought to determine the prevalence and clinical features of HAdV F40/41 in pediatric patients at seven U.S. children’s hospitals. We enrolled children with AGE or age-matched healthy controls between 12/5/2016-11/30/2017 in the Centers for Disease Control and Prevention (CDC) New Vaccine Surveillance Network (NVSN). Seven NVSN sites enrolled a total of 4,831 subjects between inpatient, ED, and healthy controls. Demographic and clinical data and stool samples were prospectively collected. Stool samples were tested for HAdV using multiplex PCR. HAdV-positive samples from Pittsburgh and Kansas City sites were sequenced for genotyping. A total of 1,980 subjects were included in the study. In the ED and inpatient settings, 108 (16.7%) and 77 (10%) patients tested positive for HAdV, respectively, while only 19 (3.4%) healthy control patients tested positive. Among all subjects with AGE, the overall average age was 2.1 years old (SD ± 3.1y), but inpatients were older (3 + 4.1 years) compared to healthy controls (1.6 ± 2.3y) and ED patients (1.2 ± 1.7y). The most common symptoms of HAdV in both inpatient and ED settings were fever, diarrhea, and vomiting. HAdV+ children experienced significantly more diarrhea than HAdV- children in both inpatient and ED. Six genotypes were detected: B3 (2/120), C1 (5/120), C2 (2/120), C5 (1/120), F40 (4/120) with majority F41 (106/120). There was no difference in genotypes by site or clinical setting. HAdVs are a leading cause of AGE in young children, often resulting in hospitalization. The majority of cases were type F41, which has implications for vaccine development