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Epidemiologic and Clinical Features of Adenovirus Pneumonia in Children During the 2019 Outbreak in Xiamen, China
Jinqiang Zhang1,2, Zhiqiang Zhuo1,2, Yongjun Xu1,3
1From the Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
Insights
Adenovirus types 7 and 3 caused a significant outbreak of pneumonia in children in Xiamen during 2019. Adenovirus type 7 was linked to more severe cases and higher mortality rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Adenovirus pneumonia is a significant concern in pediatric populations.
- Understanding regional epidemiology and clinical features is crucial for managing outbreaks.
Purpose of the Study:
- To investigate the epidemiology and clinical characteristics of adenovirus pneumonia in hospitalized children.
- To analyze the 2019 adenovirus outbreak in Xiamen, China.
Main Methods:
- Retrospective analysis of 9890 hospitalized children with acute lower respiratory tract infections.
- Adenovirus detection via direct fluorescent antibody.
- Molecular typing of adenovirus strains and clinical data collection.
Main Results:
- Adenovirus was detected in 6.2% of children, with higher rates in boys.
- Adenovirus activity peaked from April to August, with types 7 (70.6%) and 3 (28.8%) predominating.
- Severe pneumonia occurred in 29.6% of cases, associated with younger age, prolonged fever, and adenovirus type 7.
Conclusions:
- Adenovirus types 7 and 3 were the primary causes of the 2019 pneumonia outbreak in Xiamen.
- Adenovirus pneumonia often mimics bacterial pneumonia.
- Adenovirus type 7 prevalence correlated with increased severity and mortality.
Background:
To understand the regional epidemiology and clinical characteristics of adenovirus pneumonia in hospitalized children during the 2019 outbreak of respiratory adenoviruses in China.
Methods:
We analyzed the epidemiologic trend of adenovirus in children hospitalized for acute lower respiratory tract infections in Xiamen in 2019. Adenovirus was identified using direct fluorescent antibody detection. During the peak seasons of adenovirus epidemic, 170 adenovirus-positive specimens were obtained for molecular typing, and the clinical data were collected.
Results:
Among the 9890 children hospitalized for acute lower respiratory tract infection, 609 (6.2%) were tested positive for adenovirus. The detection rate of adenovirus was significantly higher in boys than in grils (9.5% vs. 4.6%, P < 0.05). Adenovirus activity increased markedly between April and August with the prevalence of 7.3%-12.4%. During the outbreak season, type 7 accounted for 70.6%, followed by type 3 (28.8%) and type 4 (0.6%). Of the 155 cases of adenovirus pneumonia, the median age was 3.0 years (range: 4 month to 9 years), 153 (98.7%) had fever with a mean fever duration of 9.04 ± 5.52 days, 28 (16.5%) had wheezing, 93 (60%) showed segmental or lobar consolidation with atelectasis and 13 (8.4%) showed pleural effusion. Forty-six (29.6%) cases developed severe pneumonia, 7 (4.1%) required mechanical ventilation and 2 (1.2%) died. Younger age, longer duration of fever and higher fever spike were more frequently seen in severe cases (P < 0.05). Twenty-five (16.2%) had C-reactive protein ≥ 40 mg/L, and 91 (58.7%) had procalcitonin ≥ 0.25 mg/L.
Conclusions:
Adenovirus types 7 and 3 caused the outbreak of adenovirus pneumonia in community children during late spring to summer in 2019 in Xiamen. The majority of adenovirus pneumonia resembles bacterial pneumonia. The incidence of severe pneumonia was high when type 7 predominantly prevailed. Adenovirus type 7 was more common in severe cases than in nonsevere cases.
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