Adenovirus serotype 3 and 7 infection with acute respiratory failure in children in Taiwan, 2010-2011

PLoS One. 2013;8(1):e53614. doi: 10.1371/journal.pone.0053614. Epub 2013 Jan 10.


Objective: Increased incidence of adenovirus infection in children was noticed since September 2010 in Taiwan and severe cases requiring intensive care were noted later. We did this study to find the clinical characteristics and risk factors associated with severe adenovirus infection.

Patients and methods: We collected cases of severe adenovirus infection between November 2010 and June 2011 to analyze their clinical characteristics in two medical centers in northern Taiwan. Severe adenovirus infection was defined as laboratory-confirmed adenovirus cases with required intensive care. Hexon gene sequencing was performed for molecular genotyping.

Results: 45 patients were included, 22 cases (49%) were infected with serotype 7, 19 (42%) with serotype 3, and 4 with serotype 2. The median age (range) was 2.75 years (0.08-15.43 years); 87% were below 5 years. Male to female ratio was 1.65 (28 to 17). Of these patients, 56% had underlying neurological diseases, 50% experienced fever higher than 40°C and 69% suffered fever longer than one week. The clinical diagnosis included pneumonia in 40 (89%) patients, bronchopneumonia in 5 (11%), and encephalitis in 7 (16%). At least 22 patients had pleural effusion. They had complications of respiratory failure (53%), acute respiratory distress syndrome (24%), hypotension (40%), and 6 (13%) patients needed extracorporeal membranous oxygenation. Ten (22%) patients died, all with underlying major systemic diseases and 7 (70%) infected with serotype 7.

Conclusions: Adenovirus serotype 7 and 3 can cause severe disease-even death-in children, especially those with underlying neurological diseases. Patients infected with adenovirus serotype 7 tended to have a higher case-fatality rate.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adenovirus Infections, Human / diagnostic imaging
  • Adenovirus Infections, Human / epidemiology*
  • Adenovirus Infections, Human / virology*
  • Adenoviruses, Human / classification*
  • Adenoviruses, Human / genetics
  • Adolescent
  • Child
  • Child, Preschool
  • Demography
  • Female
  • Humans
  • Infant
  • Intensive Care Units / statistics & numerical data
  • Male
  • Phylogeny
  • Radiography, Thoracic
  • Respiratory Insufficiency / diagnostic imaging
  • Respiratory Insufficiency / epidemiology*
  • Respiratory Insufficiency / virology*
  • Serotyping
  • Taiwan
  • Treatment Outcome

Grant support

This work was supported by National Taiwan University Hospital (A1 program), National Science Council (grant number NSC 99-2321-B-002-025 and NSC 100-2321-B-002-012) and the Taiwan National Health Research Institutes. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.