vol21no7_pdf-version

Pediatric Adenovirus 7 Disease, SingaporeFigure 1. Number of adenoviruscases by month, January2011–July 2013, Singapore.A) The first confirmed caseof adenovirus type 7 wasreported in November 2012 inKK Women’s and Children’sHospital. The number of humanadenovirus cases among thepediatric inpatient populationincreased and peaked inMay 2013. B) A retrospectiveexamination of the militarysurveillance data revealed thefirst appearance of adenovirustype 7 among military personnelin September 2012 and a smallincrease and decline over thenext few months.of HAdV hexon gene hypervariable regions 1–6 (HVR 1–6)(Ad7 reference Gomen AY594255 hexon gene nt 324–1123) (7). To assess whether Ad7 was associated with severedisease, diagnoses of inpatients were dichotomisedas invasive (pneumonia, gastroenteritis, disseminated disease,or hemorrhagic cystitis) and noninvasive (upper respiratorytract infection, acute laryngotracheobronchitis,bronchitis, bronchiolitis, tonsillitis, otitis media, or conjunctivitis)on the basis of clinical syndromes identifiedby physicians.During January 2011–July 2013, samples from 421pediatric inpatients, 752 military personnel, and 85 pediatricoutpatients from the NPHL ILI surveillance networkwere positive for adenovirus. During August 2011–July2013, a total of 289 (96.0%) pediatric inpatient cases weregenotyped. The number of pediatric inpatients increasedfrom 32 during January–July 2012 to 200 cases duringJanuary–July 2013 (Figure 1). This increase was predominantlyrelated to Ad7 infections, which were first detectedin November 2012 and represented 48.5% (n = 97) of allgenotyped adenovirus cases in the first 7 months of 2013.The increase in Ad7 pediatric inpatients was accompaniedby a smaller increase in detection of subgroup B HAdVinfections (n = 47) among military personnel, from September2012 to July 2013; all patients recovered with outpatienttreatment. Of the samples from military personnel,35 (74.5%) were genotyped; all were Ad7. During September2012–July 2013, of 19 HAdV cases among pediatricpatients (