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Coleman KK, Wong CC, Jayakumar J, Nguyen TT, Wong AWL, Yadana S, Thoon KC, Chan KP, Low JG, Kalimuddin S, Dehghan S, Kang J, Shamsaddini A, Seto D, Su YCF, Gray GC. Adenoviral Infections in Singapore: Should New Antiviral Therapies and Vaccines Be Adopted? J Infect Dis 2020; 221:566-577. [PMID: 31563943 PMCID: PMC7107482 DOI: 10.1093/infdis/jiz489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/25/2019] [Indexed: 01/09/2023] Open
Abstract
Background A number of serious human adenovirus (HAdV) outbreaks have been recently reported: HAdV-B7 (Israel, Singapore, and USA), HAdV-B7d (USA and China), HAdV-D8, -D54, and -C2 (Japan), HAdV-B14p1 (USA, Europe, and China), and HAdV-B55 (China, Singapore, and France). Methods To understand the epidemiology of HAdV infections in Singapore, we studied 533 HAdV-positive clinical samples collected from 396 pediatric and 137 adult patients in Singapore from 2012 to 2018. Genome sequencing and phylogenetic analyses were performed to identify HAdV genotypes, clonal clusters, and recombinant or novel HAdVs. Results The most prevalent genotypes identified were HAdV-B3 (35.6%), HAdV-B7 (15.4%), and HAdV-E4 (15.2%). We detected 4 new HAdV-C strains and detected incursions with HAdV-B7 (odds ratio [OR], 14.6; 95% confidence interval [CI], 4.1–52.0) and HAdV-E4 (OR, 13.6; 95% CI, 3.9–46.7) among pediatric patients over time. In addition, immunocompromised patients (adjusted OR [aOR], 11.4; 95% CI, 3.8–34.8) and patients infected with HAdV-C2 (aOR, 8.5; 95% CI, 1.5–48.0), HAdV-B7 (aOR, 3.7; 95% CI, 1.2–10.9), or HAdV-E4 (aOR, 3.2; 95% CI, 1.1–8.9) were at increased risk for severe disease. Conclusions Singapore would benefit from more frequent studies of clinical HAdV genotypes to identify patients at risk for severe disease and help guide the use of new antiviral therapies, such as brincidofovir, and potential administration of HAdV 4 and 7 vaccine.
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Affiliation(s)
- Kristen K Coleman
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Chui Ching Wong
- Department of Microbiology, Singapore General Hospital, Singapore
| | - Jayanthi Jayakumar
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Tham T Nguyen
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Abigail W L Wong
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Su Yadana
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Koh C Thoon
- Department of Paediatrics, Infectious Disease Service, KK Women's and Children's Hospital, Singapore
| | - Kwai Peng Chan
- Department of Microbiology, Singapore General Hospital, Singapore.,Academic Clinical Programme for Pathology, Duke-NUS Medical School, Singapore
| | - Jenny G Low
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Shoaleh Dehghan
- Bioinformatics and Computational Biology Program, School of Systems Biology, George Mason University, Manassas, Virginia, USA.,Chemistry Department, American University, Washington, District of Columbia, USA
| | - June Kang
- Bioinformatics and Computational Biology Program, School of Systems Biology, George Mason University, Manassas, Virginia, USA
| | - Amirhossein Shamsaddini
- Bioinformatics and Computational Biology Program, School of Systems Biology, George Mason University, Manassas, Virginia, USA
| | - Donald Seto
- Bioinformatics and Computational Biology Program, School of Systems Biology, George Mason University, Manassas, Virginia, USA
| | - Yvonne C F Su
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore
| | - Gregory C Gray
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore.,Division of Infectious Diseases, Global Health Institute, and Nicholas School of the Environment, Duke University, Durham, North Carolina, USA.,Global Health Center, Duke Kunshan University, Kunshan, China
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