Information on Adenovirus Infection

Adenoviruses most commonly cause respiratory illness; however, depending on the infecting serotype, they may also cause various other illnesses, such as gastroenteritis, conjunctivitis, cystitis, and rash illness. Symptoms of respiratory illness caused by adenovirus infection range from the common cold syndrome to pneumonia, croup, and bronchitis. Patients with compromised immune systems are especially susceptible to severe complications of adenovirus infection. Acute respiratory disease (ARD), first recognized among military recruits during World War II, can be caused by adenovirus infections during conditions of crowding and stress.

A severe complication of intestinal adenovirus is intussusception (an intestinal blockage that occurs when one part of the intestine slides over another section like a telescope.) This is a medical emergency and most often occurs in babies. The symptoms of intussusception may include bloody stool, vomiting, abdominal swelling, knees flexed to chest, loud cries from pain, weakness, and lethargy.

Adenoviral infections are difficult to prevent, as vaccines are not available. Parents and caregivers should encourage frequent hand washing, keep countertops and toys clean, and remove children with infections from group settings. Vaccines were developed for some types of adenovirus, but were available only to the military. Adequate chlorination of pools is necessary to prevent outbreaks of adenovirus conjunctivitis.

Some types of adenoviruses are endemic (constantly present) in some parts of the world, and infection is usually acquired during childhood. Other types of adenoviruses cause sporadic infection and occasional outbreaks. For example, epidemic keratoconjunctivitis (eye infection) is associated with certain adenoviruses (serotypes 8, 19, and 37). Epidemics of fever with conjunctivitis are associated with waterbourne transmission of some adenovirus types, often centering around inadequately chlorinated swimming pools and small lakes. ARD is most often associated with adenovirus types 4 and 7 in the US. Enteric adenoviruses 40 and 41 cause gastroenteritis, usually in children.

Adenoviruses are spread like the common cold. The viruses can be spread from person to person via coughing or sneezing. People may also become infected by touching something with adenovirus on it and then touching their mouth, nose, or eyes. For example, adenoviruses can be transferred to a doorknob when an infected person sneezes into his/her hands and then touches the doorknob before washing. Germs can also be spread if an infected person sneezes or coughs onto tabletops or other items that might be touched by other people. To prevent the spread of disease, it is important to practice good health habits.

In one mode of adenovirus infection (called lytic infection because it destroys large numbers of cells), adenoviruses kill healthy cells and replicate up to one million new viruses per cell killed (of which 1-5% are infectious). People with this kind of infection feel sick. In chronic or latent infection, a much smaller number of viruses are released and healthy cells can multiply more rapidly than they are destroyed. People who have this kind of infection don't seem to be sick. This is probably why many adults have immunity to adenoviruses without realizing they have been infected.

Adenovirus is highly contagious, as indicated by the occurrence of multiple cases in situations of close contact, such as child-care centers, schools, hospitals, and summer camps. The types of adenovirus that cause respiratory and intestinal infections spread from person to person through respiratory secretions (coughs or sneezes) or fecal contamination. Fecal material can be ingested through contamination of water supplies, poor hand washing between the bathroom and the kitchen, eating food contaminated by houseflies, or poor hygiene after handling diapers.

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