Burden, Clinical Characteristics, Risk Factors, and Seasonality of Adenovirus 40/41 Diarrhea in Children in Eight Low-Resource Settings. (13th May 2022)

• Record Type: Journal Article
• Authors: Guga, Godfrey; Elwood, Sarah; Kimathi, Caroline; Kang, Gagandeep; Kosek, Margaret N; Lima, Aldo A M; Bessong, Pascal O; Samie, Amidou; Haque, Rashidul; Leite, Jose Paulo; Bodhidatta, Ladaporn; Iqbal, Najeeha; Page, Nicola; Kiwelu, Ireen; Bhutta, Zulfiqar A; Ahmed, Tahmeed; Liu, Jie; Rogawski McQuade, Elizabeth T; Houpt, Eric; Platts-Mills, James A; Mduma, Estomih R
• Is Part Of: Open forum infectious diseases. Volume 9:Number 7(2022)
• Publication Date: 2022-05-13
• Subjects: adenovirus -- children -- diarrhea -- qPCR -- seasonality; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac241
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The application of molecular diagnostics has identified enteric group adenovirus serotypes 40 and 41 as important causes of diarrhea in children. However, many aspects of the epidemiology of adenovirus 40/41 diarrhea have not been described. Methods: We used data from the 8-site Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project birth cohort study to describe site- and age-specific incidence, risk factors, clinical characteristics, and seasonality. Results: The incidence of adenovirus 40/41 diarrhea was substantially higher by quantitative polymerase chain reaction than enzyme immunoassay and peaked at ∼30 episodes per 100 child-years in children aged 7–15 months, with substantial variation in incidence between sites. A significant burden was also seen in children 0–6 months of age, higher than other viral etiologies with the exception of rotavirus. Children with adenovirus 40/41 diarrhea were more likely to have a fever than children with norovirus, sapovirus, and astrovirus (adjusted odds ratio [aOR], 1.62; 95% CI, 1.16–2.26) but less likely than children with rotavirus (aOR, 0.66; 95% CI, 0.49–0.91). Exclusive breastfeeding was strongly protective against adenovirus 40/41 diarrhea (hazard ratio, 0.64; 95% CI, 0.48–0.85), but no other risk factors were identified. The seasonality of adenovirus 40/41 diarrhea varied substantially between sites and did not have clear associations with seasonal variations in temperature or rainfall. Conclusions: This study supports the situation of adenovirus 40/41 as a pathogen of substantial importance, especially in infants. Fever was a distinguishing characteristic in comparison to other nonrotavirus viral etiologies, and promotion of exclusive breastfeeding may reduce the high observed burden in the first 6 months of life.