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Adenoviruses are not a nationally notifiable disease in the U.S. (not required to test or notify the CDC), and many outbreaks go undetected or unreported. An adenovirus infection can cause many illnesses in the pediatric population (5). In patients with weakened immune systems or with chronic medical diseases, certain care areas in addition to community members, especially the elderly, are at risk for severe complications, even death (2).  

Educating and empowering parents and children to engage in behaviors and develop habits that prevent the spread of an adenovirus infection is vital; as it can work toward decreasing the chance of serious infections, and outbreaks that can extend beyond pediatric patient care areas. 

As we start to feel some relief from the global COVID-19 pandemic, we must remember to remain mindful of and attentive to the prevention of a common year-round virus that causes a great deal of distress, discomfort, and potential harm. 

Introduction   

The adenoviruses are DNA viruses that affect humans and animals and are common in adults and children (9). They develop primarily in children under ten but can also arise in teens and adults. The illnesses are generally mild and typically run their course within a few days, though specific patient populations can develop severe complications from adenovirus infections (9). 

This course explores the adenovirus and associated illnesses and their impact on pediatric patients and communities. We will also examine diagnosis, testing, treatment, prevention, and surveillance.  ​

What is an Adenovirus Infection? 

Adenoviruses are medium-sized (90-100 nm), non-enveloped icosahedral viruses with double-stranded DNA. There are more than 100 serologically distinct adenoviruses, and 49 of them can cause human infections. The virus is separated into two categories: avian (aviadenoviruses) and mammalian (mastadenovirus) (9). Scientists first isolated the adenovirus in the adenoids, which gave rise to the name “adenovirus.” Unfortunately, the viruses are unusually stable and resistant, allowing them to survive outside the body for prolonged periods, thus being with us year-round (3, 7, 9). 

Associated Illness, Infection, and Symptoms of an Adenovirus Infection 

• Bronchitis: Cough, runny nose, fever, chills,  
• Colds and other respiratory infections: Stuffy and runny nose, cough, sore throats, and swollen glands 
• Croup: Barking cough, trouble breathing, high-pitched sound when breathing 
• Ear infection: Ear pain, irritability, and fever  
• Pink eye (conjunctivitis): Red eye discharge from your eyes, tearing, feeling as if there’s something in your eye. 
• Pneumonia: Fever, cough, trouble breathing,  
• Stomach and intestinal infections: Diarrhea, vomiting, headaches, fever, stomach cramps, 
• Swelling of the brain and spinal meningitis and encephalitis: Headaches, fever, stiff neck, nausea, and vomiting (this event is rare) 
• Urinary tract infections: Burning and pain while urinating, frequent need to go, blood in your urine (2) ​

Spread and Prevention of Adenovirus Infections

Children gather in groups, daycare centers, schools, summer camps, and family units. Being in close contact makes exposure and spread by coughing and sneezing (droplet spread) very easy. Kids touching contaminated objects and then touching their eyes, nose, and mouth can also quickly spread an adenovirus infection. For adults, changing a dirty diaper, eating food handled by someone who did not wash their hands properly, and swimming in lakes and pools are all situations that can lead to an adenovirus infection (5). Closed, crowded dormitories, military quarters, nursing homes, hospitals, and long-term pediatric facilities also create a higher contraction risk (5). 

Analogous to other pediatric viruses such as influenza or COVID-19, taking simple precautions can prevent the spread of an adenovirus infection. As healthcare providers working directly with sick patients, we need to ensure that we practice and reinforce frequent hand washing with soap and warm water for at least 20 seconds. If a patient with an adenovirus infection is hospitalized, isolation protocols include personal protective equipment such as gowns, masks, and gloves (9).   

Lastly, some serotype adenoviruses can live on dry, inanimate surfaces for up to 30 days (5). Frequent cleaning of all environmental surfaces, including shared equipment, toys, and touchpoints such as telephones, doorknobs, and light switches, is essential in preventing the spreading of adenoviruses (4). ​

Diagnosis, Testing, and Complications of Adenovirus Infections

Healthcare providers must recognize that upper and lower respiratory infections (i.e., pneumonia) and conjunctivas are the most common adenovirus-associated illnesses for children, especially those six months to two years of age who participate in daycare. Respiratory symptoms occur most often in the late winter, spring, and early summer and may start two to 14 days after exposure. Symptoms of respiratory infections include a runny nose, sore throat, fever, cough, swollen lymph nodes, headache, and pink eye (8). 

Gastrointestinal illnesses are most common in children under five and can start three to ten days after exposure. Symptoms of digestive tract infections include watery diarrhea that begins suddenly, fever, belly pain, and vomiting (8). 

Children who are very sick or have serious underlying health problems are tested for the presence of an adenovirus. These tests include blood, urine, stool, ears, nose, throat, and chest X-rays (8). 

Healthcare providers must educate parents and children on severe symptoms that may require a call or visit to the doctor; these include: 

• Labored or trouble breathing (pneumonia) 
• Swelling or drainage around the eyes (conjunctivitis) 
• Pain or drainage from ears (ear infection) 
• A fever that doesn’t go away in a few days. 
• A headache, fever, or stiff neck (meningitis) 
• Dehydration, for infants, means fewer tears and fewer wet diapers.  
• More severe complications include: 
  • Chronic lung disease 
  • A severe infection of those noted above 
  • Intussusception (intestinal blockage) (8). ​

Treatment of Adenovirus Infection 

The current treatment for an adenovirus infection is palliative. 

However, for more serious cases (especially patients with weakened immune systems), the use of antivirals may be a choice. These include Cidofovir (1-5mg/kg/day until blood PCR tests are negative x2) and Ribavirin. Both antivirals are used as the first line of defense, though they are not FDA-approved.  

Another medication in line with use for those with an underlying disease or illness is Immunoglobulin, at a dose of 500mg/kg/day over three weeks (6). 

Hospitals provide treatments such as IV fluids, bronchodilators, extra oxygen, and mechanical ventilation (8). 

The FDA has approved a vaccine against serotypes 4 and 7, but it is only accessible to the military and not the general public (5). 

Otherwise, healthcare providers must educate the parents and children alike on treatments that can relieve symptoms; these include: 

• Drinking plenty of water and clear liquids (popsicles). 
• Washing hands often. 
• Bed rest. 
• Staying away from other members of the family and schoolmates. 
• Pain relievers such as Acetaminophen or Ibuprofen for fever and headaches. Current practice contraindicates the use of aspirin for viral illnesses, especially for those under 12 years of age (6). 
• Saline nasal drops, humidifiers, and tablets. ​

Surveillance  

The National Respiratory and Enteric Virus Surveillance System (NREVSS) is a laboratory-based surveillance system developed in 1989 to monitor circulation patterns and trends for: 

• Influenza 
• Seasonal respiratory syncytial virus (RSV) 
• Human parainfluenza virus (HPIV) 
• Respiratory Adenovirus 
• Enterovirus 
• Human metapneumovirus (HMPV) 
• Respiratory adenovirus 
• Human coronavirus, rotavirus, and norovirus.  

Participating U.S. laboratories, university and community hospitals, and public health departments voluntarily report testing and positive results (1). The CDC makes this information available to healthcare providers and the public. It can be found in periodic summaries, alerts, weekly reports, and peer-reviewed journals (1). 

In 2014, the U.S. National Adenovirus Type Reporting System (NATRS) became active and has been collecting data on human adenovirus types. Collected data from clinical laboratories are developed for quarterly reports and are based on the following information: species and human adenovirus type, specimen type, collection date, age, and sex.  

The reports generated recognize type-specific human adenovirus circulation, trends, and outbreaks. Each surveillance system mentioned above is crucial in alerting healthcare professionals to incidence trends and outbreaks across the country and their region (1). 

Outbreak: Sudden increases in cases of a disease above average for that specific patient population, often localized to a geographic area. Healthcare providers should notify the infectious control personnel at their facility or contact the local and state health departments for suspected outbreaks (3). Please visit the CDC website for more information on outbreaks, reporting, and current surveillance information. https://www.cdc.gov/adenovirus/reporting-surveillance/index.html 

Conclusion 

Although illnesses caused by the adenovirus are commonplace in the pediatric population, as healthcare providers, it is essential to recognize the associated infections and possible outbreaks that can develop. We must be adamant about preventing, spreading, and potential complications in clinics, hospitals, schools, homes, public recreation facilities, and long-term pediatric facilities (9). 

Keeping up to date through the CDC surveillance system and knowing how, when, and to whom to talk about suspected outbreaks can make a difference in outcomes, infection rates, and complications. 

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