Lab Matters Winter 2020 - Page 21

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 infectious.diseases@aphl.org. Winter 2020 LAB MATTERS 19