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Published on: December 10, 2013
Respiratory adenovirus infections in children: a focus on Africa
Marieke M van der Zalm1, Nadia A Sam-Agudu2,3,4, Lilly M Verhagen1,5,6
1Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
Human adenovirus (HAdV) is a significant cause of severe lower respiratory tract infections (LRTIs) in African children, leading to mortality and long-term lung damage. Increased surveillance and diagnostics are crucial for better management and outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Lower respiratory tract infections (LRTIs) are a major cause of child morbidity and mortality globally, particularly in African children under five.
- Human adenoviruses (HAdVs) are increasingly recognized as significant viral pathogens contributing to pediatric LRTIs, including fatal pneumonias.
- The impact and epidemiology of HAdV infections in African children remain under-recognized, despite evidence of severe clinical manifestations and sequelae.
Purpose of the Study:
- To review the epidemiology, clinical manifestations, sequelae, and treatment of adenovirus respiratory infections in African children.
- To highlight the underappreciated role of HAdVs in pediatric LRTIs in Africa.
- To identify gaps in knowledge and recommend strategies for improved surveillance and care.
Main Methods:
- Systematic review of existing literature on HAdV infections in African children.
- Analysis of epidemiological data on HAdV prevalence in pediatric LRTIs.
- Synthesis of clinical findings, including manifestations, severity, and long-term sequelae.
Main Results:
- HAdV is the third most common viral pathogen in fatal pneumonias among African children under five, accounting for 5.5% of deaths.
- HAdV ranks second in hospital-associated viral pneumonia deaths in this demographic.
- Disease-causing HAdV serotypes vary by region and have evolved over time; risk factors for severe disease and sequelae are not well-defined.
Conclusions:
- Adenovirus infections pose a substantial threat to child lung health in Africa, leading to severe outcomes and chronic sequelae like bronchiectasis.
- There is a critical need for scaled-up HAdV surveillance and consistent inclusion in LRTI assessments.
- Expanded access to diagnostics and further research into HAdV epidemiology and clinical outcomes are essential for effective public health interventions.
Purpose Of Review:
Lower respiratory tract infections (LRTIs) are an important cause of child morbidity and mortality globally, especially in children under the age of 5 years in Africa. Respiratory viruses, including human adenoviruses (HAdVs), are common causes of LRTIs in children. This review aims to shed light on the epidemiology, clinical manifestations, sequelae, and treatment options specific to adenovirus respiratory infections in African children.
Recent Findings:
Recent evidence has challenged the perception that adenovirus is a negligible cause of LRTIs. Studies show HAdV emerging as the third most common viral pathogen in fatal pneumonias among under-5 children in low-income and middle-income African countries, contributing to 5.5% of all pneumonia deaths and ranking second in hospital-associated viral pneumonia deaths. Predominant HAdV serotypes associated with disease differ by country and region, and have changed over time. Risk factors for increased disease severity and long-term respiratory sequelae in previously healthy African children with HAdV LRTIs are not well established.
Summary:
Although respiratory viruses, including HAdV, are recognized contributors to LRTIs, the prevalence and impact of adenovirus infections have been under-recognized and understated. Available data suggests that African children, particularly those under 5 years old, are at risk of severe sequelae from respiratory HAdV infections. Long-term sequelae, including bronchiectasis and postinfectious bronchiolitis obliterans, further underscore the significant impact of HAdV infections. However, the scarcity of comprehensive data hampers our understanding of the extent of the impact of HAdV infections on child lung health in Africa. We recommend scaled-up HAdV surveillance, ensuring its consistent inclusion in population-level LRTI assessments, and expanded and equitable access to diagnostics for early recognition of African children at risk of developing chronic sequelae and death. Enhanced understanding of adenovirus epidemiology and clinical outcomes and the availability of therapeutic options are essential for informed public health strategies and clinical care.
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