Prevalence of human adenovirus in children with acute gastroenteritis in the New Vaccine Surveillance Network (NVSN) from 2016 to 2019

Background

Acute gastroenteritis (AGE) is a leading cause of pediatric morbidity and mortality. However, the AGE burden from human adenoviruses (HAdV) is not fully defined.

Objective

To determine the prevalence and characteristics associated with HAdV in U.S. children.

Study design

We enrolled AGE case-patients <18 years of age in inpatient and emergency department (ED) settings and healthy controls <11 years of age between December 2016 and November 2019 at seven pediatric medical centers. Demographic and clinical data and stools were prospectively collected. Stools were tested for HAdV F40/41 using multiplex molecular panels. A subset of 120 HAdV-positive samples was genotyped.

Results

HAdV was detected in 168 (8 %) of 2229 ED patients, 164 (8 %) of 2151 inpatients, and 23 (1 %) of 2090 healthy controls. AGE case-patients positive for HAdV were more likely to be <3 years of age and more likely to report diarrhea (86 % vs 67 %) and dehydration (43 % vs 31 %) than HAdV-negative case-patients (p < 0.0001, all comparisons). Age did not differ significantly between HAdV-positive and negative controls. HAdV-positive AGE case-patients were less likely to have acute respiratory symptoms than HAdV-negative case-patients (8 % vs 18 %, p < 0.0001). The most frequently detected HAdV genotype was F41 (n = 106, 88 %). Other potential pathogens were detected in 36 % of HAdV-positive AGE case-patients and 43 % of controls; Clostridioides difficile was most common.

Conclusions

HAdV accounted for 8 % of medically attended AGE in both inpatient and ED settings in the U.S., primarily in young children. The majority of cases were type F41, which may inform future vaccine development.