Adenovirus Type 14 Acute Respiratory Disease

Summary and Comment |
December 5, 2007

Adenovirus Type 14 Acute Respiratory Disease

  1. Stephen G. Baum, MD

An unusual adenovirus, type 14, has caused several outbreaks of respiratory disease, with considerable morbidity and mortality.

  1. Stephen G. Baum, MD

Many adenovirus serotypes cause disease in humans: Serotypes 2, 3, and 5 are ubiquitous among children and cause upper respiratory infection and conjunctivitis. Serotypes 4 and 7 have caused outbreaks in military recruits and have prompted vaccine development. Serotypes 8 and 19 often cause conjunctivitis in adults. Now, a lesser-known serotype, Ad14, has been implicated in several outbreaks of acute severe respiratory disease in the U.S.

In May 2006, a 12-day-old infant in New York City died of pneumonia caused by Ad14. No other local cases of Ad14-associated illness have been identified.

In April 2007, multiple patients with severe pneumonia were identified at a single Oregon hospital. Of the 17 specimens obtained from these patients, 15 yielded Ad14. State public health officials also retrospectively analyzed 68 laboratory specimens that had tested positive for adenovirus between November 1, 2006, and April 30, 2007. Of the 50 typable isolates, 31 (62%) were positive for Ad14. Most of the patients with this pathogen were adults (83%); 22 patients required hospitalization (16 in ICUs), and 7 died.

In May 2007, four residents of a residential-care facility in Washington were hospitalized with severe pneumonia. All four tested positive for adenovirus, and the three with typable specimens had Ad14. One patient (with underlying AIDS) died.

Finally, an outbreak of respiratory illness has been ongoing at Lackland Air Force Base in Texas since February 2007. Of 423 respiratory specimens collected, 63% were positive for adenovirus; of those serotyped, 90% yielded Ad14. From February through mid-June, 2007, 27 patients were hospitalized with pneumonia; 1 died. Ad14 was identified in all 16 of the patients who were tested.

Comment

This report documents several outbreaks of severe respiratory disease, in disparate parts of the U.S., that were associated with relatively high mortality and were caused by the uncommon adenovirus serotype 14. Mortality from adenovirus infection is rare, except in immunosuppressed patients after organ transplantation. No highly effective therapy for adenovirus infection exists, and vaccines are available only to military personnel. Given that emergence of this pathogen could prompt commercial vaccine development, physicians should be sure to report cases of severe respiratory infection for which other etiologies are not suspected.

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