INFECTIOUS DISEASES
Back to School: Tracking Adenovirus Outbreaks Impacting
College Campuses and Other Institutions
By Erik Reisdorf, MPH, M(ASCP)CM, surveillance and virology team lead, Wisconsin State Laboratory of Hygiene
Adenoviruses, especially types 4 and 7,
have long been associated with severe
acute respiratory disease in military
recruits, which has been linked to close
quarters and high-stress levels found in
this population. A combined adenovirus
vaccine specific to these types is licensed
for military use only and has been
successful in preventing illness in recruit
populations. Recently, there has been
increasing awareness that adenoviruses
can severely impact other populations
where communal living and high-stress
levels are encountered, such as college
campuses.
Looking at Other Populations to
Find Trends
In November 2018, ProMED reported that
an adenovirus outbreak at the University
of Maryland sickened more than 40
students, with 15 hospitalizations and
one death resulting. This outbreak was
attributed to adenovirus type 7. Similarly,
during the 2019 fall semester, Penn State
University and at least three college
campuses in Wisconsin experienced
outbreaks with adenovirus type 4 that
resulted in more than 60 lab confirmed
cases and one severe hospitalized case in
Wisconsin.
Adenoviruses are a common group of respiratory viruses affecting all ages and are usually
associated with mild upper respiratory tract infections; however, more severe lower respiratory
illness (e.g., acute bronchitis, croup and pneumonia) can result from infection. Depending on the
type, adenoviruses can cause other illnesses including gastroenteritis, conjunctivitis (“pink eye”),
bladder infection and, less commonly, neurological disease. More than 50 adenovirus types have
been identified.
(NATRS) in 2014 to better understand
trends of circulating adenoviruses in the
United States. However, participation
of public health laboratories has been
limited (e.g., only public health labs
from seven states reported from 2014 to
2016). To address this gap in surveillance
activities, CDC is developing standardized
adenovirus diagnostic protocols and
providing control material for public
health laboratories interested in building
typing capabilities.
College campuses are not the only places
impacted by adenovirus outbreaks. In
2017, the New Jersey Department of
Health investigated a severe respiratory
illness outbreak associated with
adenovirus type 7 at a substance abuse
facility that resulted in 79 probable cases
and three fatalities in high-risk patients.
Another adenovirus type 7 outbreak
occurred at a New Jersey long term care
facility for children with weakened
immune systems that ultimately led
to the deaths of eleven children at the
facility.
Seeking the Long-Term Benefits
With the recognition of the increased
public health importance of adenoviruses,
the US Centers for Disease Control and
Prevention (CDC) created the National
Adenovirus Type Reporting System
PublicHealthLabs
@APHL
There are numerous benefits to
building laboratory capacity at public
health laboratories to identify and type
adenoviruses. These include providing
adenovirus typing data to NATRS to
further strengthen national surveillance
capacity, informing public health officials
on the potential benefits of licensing
the adenovirus vaccine to other at risk
populations, providing rapid identification
APHL.org
of non-influenza respiratory pathogens
causing outbreaks and informing those
most at risk of developing severe disease.
Gaining a better understanding of the
impact of adenoviruses on community
health clearly warrants more attention by
the public health community. Even though
adenovirus infections are difficult to
distinguish from other respiratory viruses
such as influenza without laboratory
testing, many commercially available
respiratory pathogen panel kits include
adenovirus. APHL and CDC are working
to support public health laboratories’
implementation of relevant laboratory
methods. n
DIGITAL EXTRA:
For more information on CDC protocols
for typing adenoviruses, contact
[email protected].
Winter 2020 LAB MATTERS
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