Dean D Erdman

Publications of Dean D Erdman

• Outbreak of lower respiratory tract illness associated with human enterovirus 68 among American Indian children.

  Authors: Lara M Jacobson, John T Redd, Eileen Schneider, Xiaoyan Lu, Shur-Wern W Chern, M Steven Oberste, Dean D Erdman, Gayle E Fischer, Gregory L Armstrong, Maja Kodani, Jennifer Montoya, Julie M Magri, James E Cheek

  The Pediatric infectious disease journal. 03/2012; 31(3):309-12.

  Human enterovirus 68 (EV68) infections are rarely reported. We describe a respiratory outbreak associated with EV68 among 18 children admitted to a remote Indian Health Service facility during AugustHuman enterovirus 68 (EV68) infections are rarely reported. We describe a respiratory outbreak associated with EV68 among 18 children admitted to a remote Indian Health Service facility during August 11, 2010 through September 14, 2010. Clinical illness was characterized by pneumonia and wheezing. EV68 should be considered as an etiology in outbreaks of lower respiratory tract illness.

• Human rhinovirus species associated with hospitalizations for acute respiratory illness in young US children.

  Authors: Marika K Iwane, Mila M Prill, Xiaoyan Lu, E Kathryn Miller, Kathryn M Edwards, Caroline B Hall, Marie R Griffin, Mary A Staat, Larry J Anderson, John V Williams, Geoffrey A Weinberg, Asad Ali, Peter G Szilagyi, Yuwei Zhu, Dean D Erdman

  The Journal of infectious diseases. 12/2011; 204(11):1702-10.

  The contribution of human rhinovirus (HRV) to severe acute respiratory illness (ARI) is unclear. To assess the association between HRV species detection and ARI hospitalizations. Children <5 yearsThe contribution of human rhinovirus (HRV) to severe acute respiratory illness (ARI) is unclear. To assess the association between HRV species detection and ARI hospitalizations. Children <5 years old hospitalized for ARI were prospectively enrolled between December 2003 and April 2005 in 3 US counties. Asymptomatic controls were enrolled between December 2003 and March 2004 and between October 2004 and April 2005 in clinics. Nasal and throat swab samples were tested for HRV and other viruses (ie, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, and influenza virus) by reverse-transcription-polymerase chain reaction, and genetic sequencing identified HRV species and types. HRV species detection was compared between controls and patients hospitalized during months in which controls were enrolled. A total of 1867 children with 1947 ARI hospitalizations and 784 controls with 790 clinic visits were enrolled and tested for HRV. The HRV-A detection rate among participants ≥24 months old was 8.1% in the hospitalized group and 2.2% in the control group (P = .009), and the HRV-C detection rates among those ≥6 months old were 8.2% and 3.9%, respectively (P = .002); among younger children, the detection rates for both species were similar between groups. The HRV-B detection rate was ≤1%. A broad diversity of HRV types was observed in both groups. Clinical presentations were similar among HRV species. Compared with children infected with other viruses, children with HRV detected were similar for severe hospital outcomes and more commonly had histories or diagnoses of asthma or wheezing. HRV-A and HRV-C were associated with ARI hospitalization and serious illness outcomes.

• Human Coronavirus in Young Children Hospitalized for Acute Respiratory Illness and Asymptomatic Controls.

  Authors: Mila M Prill, Marika K Iwane, Kathryn M Edwards, John V Williams, Geoffrey A Weinberg, Mary A Staat, Melisa J Willby, H Keipp Talbot, Caroline B Hall, Peter G Szilagyi, Marie R Griffin, Aaron T Curns, Dean D Erdman

  The Pediatric infectious disease journal. 11/2011; 31(3):235-240.

  BACKGROUND:: Human coronaviruses (HCoVs) have been detected in children with upper and lower respiratory symptoms, but little is known about their relationship with severe respiratory illness.BACKGROUND:: Human coronaviruses (HCoVs) have been detected in children with upper and lower respiratory symptoms, but little is known about their relationship with severe respiratory illness. OBJECTIVE:: To compare the prevalence of HCoV species among children hospitalized for acute respiratory illness and/or fever (ARI/fever) with that among asymptomatic controls and to assess the severity of outcomes among hospitalized children with HCoV infection compared with other respiratory viruses. METHODS:: From December 2003 to April 2004 and October 2004 to April 2005, we conducted prospective, population-based surveillance of children <5 years of age hospitalized for ARI/fever in 3 US counties. Asymptomatic outpatient controls were enrolled concurrently. Nasal/throat swabs were tested for HCoV species HKU1, NL63, 229E, and OC43 by real-time reverse-transcription polymerase chain reaction. Specimens from hospitalized children were also tested for other common respiratory viruses. Demographic and medical data were collected by parent/guardian interview and medical chart review. RESULTS:: Overall, HCoV was detected in 113 (7.6%) of 1481 hospitalized children (83 [5.7%] after excluding 30 cases coinfected with other viruses) and 53 (7.1%) of 742 controls. The prevalence of HCoV or individual species was not significantly higher among hospitalized children than controls. Hospitalized children testing positive for HCoV alone tended to be less ill than those infected with other viruses, whereas those coinfected with HCoV and other viruses were clinically similar to those infected with other viruses alone. CONCLUSIONS:: In this study of children hospitalized for ARI/fever, HCoV infection was not associated with hospitalization or with increased severity of illness.

• Serology as an adjunct to polymerase chain reaction assays for surveillance of acute respiratory virus infections.

  Authors: Pongpun Sawatwong, Malinee Chittaganpitch, Henrietta Hall, Leonard F Peruski, Xiyan Xu, Henry C Baggett, Alicia M Fry, Dean D Erdman, Sonja J Olsen

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 11/2011; 54(3):445-6.

• Deaths associated with human adenovirus-14p1 infections, Europe, 2009-2010.

  Authors: Michael J Carr, Adriana E Kajon, Xiaoyan Lu, Linda Dunford, Paul O'Reilly, Paul Holder, Cillian F De Gascun, Suzie Coughlan, Jeff Connell, Dean D Erdman, William W Hall

  Emerging infectious diseases. 08/2011; 17(8):1402-8.

  Human adenovirus (HAdV) serotype 14 is rarely identified. However, an emerging variant, termed HAdV-14p1, recently has been described in the United States in association with outbreaks of acuteHuman adenovirus (HAdV) serotype 14 is rarely identified. However, an emerging variant, termed HAdV-14p1, recently has been described in the United States in association with outbreaks of acute respiratory disease with high rates of illness and death. We retrospectively analyzed specimens confirmed positive for HAdV by immunofluorescence, virus culture, or real-time PCR during July 1, 2009-July 31, 2010, and describe 9 cases of HAdV-14p1 infection with characteristic mutations in the fiber and E1A genes that are phylogenetically indistinguishable from the viruses previously detected in the United States. Three patients died; 2 were immunocompromised, and 1 was an immunocompetent adult. We propose that surveillance should be increased for HAdV-14p1 and recommend that this virus be considered in the differential diagnosis of sudden-onset acute respiratory disease, particularly fatal infections, for which an etiology is not clear.

• A naturally occurring human adenovirus type 7 variant with a 1743 bp deletion in the E3 cassette.

  Authors: Juliana C Marinheiro, Tatiana G Dos Santos, Joselma Siqueira-Silva, Xiaoyan Lu, Daniela Carvalho, Ataíde A da Camara, Eurico Arruda, Karla Arruda, Dean D Erdman, Charlotte M Hársi

  The Journal of general virology. 06/2011; 92(Pt 10):2399-404.

  Human adenovirus type 7 (HAdV-7) is an important cause of acute respiratory disease (ARD). Different genomic variants of HAdV-7 have been described, designated 7a-7l. In a previous study toHuman adenovirus type 7 (HAdV-7) is an important cause of acute respiratory disease (ARD). Different genomic variants of HAdV-7 have been described, designated 7a-7l. In a previous study to investigate risk factors for ARD and wheezing, nasopharyngeal samples were collected from 90 ill children seeking medical attention in Ribeirão Preto, São Paulo, Brazil. HAdVs were identified in 31 samples and were characterized by serum neutralization and genome restriction analysis. Eleven HAdVs were identified as being HAdV-7, five of which were classified as being of genome type 7p (Gomen). Six other HAdV-7 isolates gave new restriction profiles with all enzymes used and were classified as being a new genomic variant, 7m. These isolates were further characterized by sequencing. The hexon and fiber genes of the 7m variant were nearly identical to the prototype, 7p. However, nucleotide sequences from the E3 cassette revealed a 1743 bp deletion affecting the 16.1K, 19K, 20.1K and 20.5K ORFs.

• Application of TaqMan low-density arrays for simultaneous detection of multiple respiratory pathogens.

  Authors: Maja Kodani, Genyan Yang, Laura M Conklin, Tatiana C Travis, Cynthia G Whitney, Larry J Anderson, Stephanie J Schrag, Thomas H Taylor, Bernard W Beall, Robert F Breiman, Daniel R Feikin, M Kariuki Njenga, Leonard W Mayer, M Steven Oberste, Maria Lucia C Tondella, Jonas M Winchell, Stephen L Lindstrom, Dean D Erdman, Barry S Fields

  Journal of clinical microbiology. 04/2011; 49(6):2175-82.

  The large and growing number of viral and bacterial pathogens responsible for respiratory infections poses a challenge for laboratories seeking to provide rapid and comprehensive pathogenThe large and growing number of viral and bacterial pathogens responsible for respiratory infections poses a challenge for laboratories seeking to provide rapid and comprehensive pathogen identification. We evaluated a novel application of the TaqMan low-density array (TLDA) cards for real-time PCR detection of 21 respiratory-pathogen targets. The performance of the TLDA was compared to that of individual real-time PCR (IRTP) assays with the same primers and probes using (i) nucleic acids extracted from the 21 pathogen strains and 66 closely related viruses and bacteria and (ii) 292 clinical respiratory specimens. With spiked samples, TLDA cards were about 10-fold less sensitive than IRTP assays. By using 292 clinical specimens to generate 2,238 paired individual assays, the TLDA card exhibited 89% sensitivity (95% confidence interval [CI], 86 to 92%; range per target, 47 to 100%) and 98% specificity (95% CI, 97 to 99%; range per target, 85 to 100%) overall compared to IRTP assays as the gold standard with a threshold cycle (C(T)) cutoff of 43. The TLDA card approach offers promise for rapid and simultaneous identification of multiple respiratory pathogens for outbreak investigations and disease surveillance.

• Toward an integrated human adenovirus designation system that utilizes molecular and serological data and serves both clinical and fundamental virology.

  Authors: Koki Aoki, Mária Benkö, Andrew J Davison, Marcela Echavarria, Dean D Erdman, Balázs Harrach, Adriana E Kajon, David Schnurr, Göran Wadell

  Journal of virology. 03/2011; 85(11):5703-4.

  The following proposals contribute towards elaborating a robust system for designating human adenovirus (HAdV) types....

• Outbreak of pneumonia associated with emergent human adenovirus serotype 14--Southeast Alaska, 2008.

  Authors: Douglas H Esposito, Tracie J Gardner, Eileen Schneider, Lauren J Stockman, Jacqueline E Tate, Catherine A Panozzo, Cheryl L Robbins, Sue A Jenkerson, Lorita Thomas, Colleen M Watson [......] Dean D Erdman, Xiaoyan Lu, Theresa Cromeans, Mary Westcott, Catherine Humphries, Jayme Ballantyne, Gayle E Fischer, Joseph B McLaughlin, Gregory Armstrong, Larry J Anderson

  The Journal of infectious diseases. 07/2010; 202(2):214-22.

  In September 2008, an outbreak of pneumonia associated with an emerging human adenovirus (human adenovirus serotype 14 [HAdV-14]) occurred on a rural Southeast Alaska island. Nine patients requiredIn September 2008, an outbreak of pneumonia associated with an emerging human adenovirus (human adenovirus serotype 14 [HAdV-14]) occurred on a rural Southeast Alaska island. Nine patients required hospitalization, and 1 patient died. To investigate the outbreak, pneumonia case patients were matched to control participants on the basis of age, sex, and community of residence. Participants in the investigation and their household contacts were interviewed, and serum samples and respiratory tract specimens were collected. Risk factors were evaluated by means of conditional logistic regression. Among 32 pneumonia case patients, 21 (65%) had confirmed or probable HAdV-14 infection. None of 32 matched control participants had evidence of HAdV-14 infection (P<.001 for the difference). Factors independently associated with pneumonia included contact with a known HAdV-14-infected case patient (odds ratio [OR], 18.3 [95% confidence interval {CI}, >or=2.0]), current smoking (OR, 6.7 [95% CI, >or=0.9]), and having neither traveled off the island nor attended a large public gathering (OR, 14.7 [95% CI, >or=2.0]). Fourteen (67%) of 21 HAdV-14-positive case patients belonged to a single network of people who socialized and often smoked together and infrequently traveled off the island. HAdV-14 infection occurred in 43% of case-patient household contacts, compared with 5% of control-participant household contacts (P = .005). During a community outbreak in Alaska, HAdV-14 appeared to have spread mostly among close contacts and not widely in the community. Demographic characteristics and illness patterns among the case patients were similar to those observed in other recent outbreaks of HAdV-14 infection in the United States.

• Molecular epidemiology and brief history of emerging adenovirus 14-associated respiratory disease in the United States.

  Authors: Adriana E Kajon, Xiaoyan Lu, Dean D Erdman, Janice Louie, David Schnurr, Kirsten St George, Marion P Koopmans, Taslim Allibhai, David Metzgar

  The Journal of infectious diseases. 07/2010; 202(1):93-103.

  First isolated in the Netherlands in 1955 during an outbreak of acute respiratory disease (ARD) among military recruits, human adenovirus 14 (HAdV-14) has historically been considered rare. With noFirst isolated in the Netherlands in 1955 during an outbreak of acute respiratory disease (ARD) among military recruits, human adenovirus 14 (HAdV-14) has historically been considered rare. With no precedent of circulation in North America, HAdV-14 has been isolated from military and civilian cases of ARD of variable severity since 2003 in the United States. Ninety-nine isolates from military and civilian cases from different geographic locations and circulation periods were characterized by restriction enzyme analysis of viral DNA and select gene sequencing. All examined viruses were found to be identical and to belong to a new genome type designated "HAdV-14p1" (formerly known as "14a"). Comparative alignments of E1A, hexon, and fiber gene sequences with other subspecies B2 HAdVs suggest that HAdV-14p1, like the closely related HAdV-11a, arose from recombination among similar HAdV-11 and HAdV-14 ancestral strains. A deletion of 2 amino acids in the knob region of the fiber protein is the only identified unique characteristic of HAdV-14p1. The current geographic distribution of HAdV-14p1 involves at least 15 states in the Unites States. The role of the fiber mutations in the recent emergence of HAdV-14p1 ARD in North America warrants further study.

• Human bocavirus species 2 and 3 in Brazil.

  Authors: Norma Santos, Teresa C T Peret, Charles D Humphrey, Maria Carolina M Albuquerque, Raquel Cirlene Silva, Fabrício José Benati, Xiaoyan Lu, Dean D Erdman

  Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 04/2010; 48(2):127-30.

  The newly described human bocavirus (HBoV) species 2 and 3 have been repeatedly detected in stool strengthening the possibility that these viruses might present a tropism for the gastrointestinalThe newly described human bocavirus (HBoV) species 2 and 3 have been repeatedly detected in stool strengthening the possibility that these viruses might present a tropism for the gastrointestinal tract and may be etiological agents of diarrhea. In this study we assessed the presence of HBoV2 and HBoV3 in stool specimens from Brazilians with acute gastroenteritis. Stool samples from Brazilian patients with acute diarrhea were analyzed for HBoV2 and HBoV3 by PCR assay. Full or partial genome sequences were obtained for selected isolates. Electron microscopy analysis was used to investigate virus morphology. Electron microscopy confirmed the presence of virus-like particles in HBoV PCR-positive specimens, with morphology similar to other members of the Parvoviridae family. Five samples out of 807 (0.6%) were positive for HBoV3. Three of the HBoV3-positive patients were HIV/AIDS positive. A selected group of 144 samples was also tested for HBoV2 and 30 samples (20.8%) were positive, 11 of which were HIV/AIDS positive. This study reports the detection and genetic characterization of HBoV3 and HBoV2 in the stool of Brazilian patients with acute diarrhea. This is the first description of HBoV3 outside Australia, suggesting a wide global distribution of this virus. Further studies are needed to better understand the role of HBoV in gastrointestinal infections, particularly among patients with HIV/AIDS.

• The burden of hospitalized lower respiratory tract infection due to respiratory syncytial virus in rural Thailand.

  Authors: Alicia M Fry, Malinee Chittaganpitch, Henry C Baggett, Teresa C T Peret, Ryan K Dare, Pongpun Sawatwong, Somsak Thamthitiwat, Peera Areerat, Wichai Sanasuttipun, Julie Fischer, Susan A Maloney, Dean D Erdman, Sonja J Olsen

  PloS one. 01/2010; 5(11):e15098.

  We describe the epidemiology of hospitalized RSV infections for all age groups from population-based surveillance in two rural provinces in Thailand. From September 1, 2003 through December 31, 2007,We describe the epidemiology of hospitalized RSV infections for all age groups from population-based surveillance in two rural provinces in Thailand. From September 1, 2003 through December 31, 2007, we enrolled hospitalized patients with acute lower respiratory tract illness, who had a chest radiograph ordered by the physician, from all hospitals in SaKaeo and Nakhom Phanom Provinces. We tested nasopharyngeal specimens for RSV with reverse transcriptase polymerase chain reaction (RT-PCR) assays and paired-sera from a subset of patients with IgG enzyme immunoassay. Rates were adjusted for enrollment. Among 11,097 enrolled patients, 987 (8.9%) had RSV infection. Rates of hospitalized RSV infection overall (and radiographically-confirmed pneumonia) were highest among children aged<1 year: 1,067/100,000 (534/100,000 radiographically-confirmed pneumonia) and 1-4 year: 403/100,000 (222/100,000), but low among enrolled adults aged≥65 years: 42/100,000. Age<1 year (adjusted odds ratio [aOR]=13.2, 95% confidence interval [CI] 7.7, 22.5) and 1-4 year (aOR=8.3, 95% CI 5.0, 13.9) were independent predictors of hospitalized RSV infection. The incidence of hospitalized RSV lower respiratory tract illness among children<5 years was high in rural Thailand. Efforts to prevent RSV infection could substantially reduce the pneumonia burden in children aged<5 years.

• Frequent detection of human adenovirus from the lower gastrointestinal tract in men who have sex with men.

  Authors: Marcel E Curlin, Meei-Li Huang, Xiaoyan Lu, Connie L Celum, Jorge Sanchez, Stacy Selke, Jared M Baeten, Richard A Zuckerman, Dean D Erdman, Lawrence Corey

  PloS one. 01/2010; 5(6):e11321.

  The association between baseline seropositivity to human adenovirus (HAdV) type 5 and increased HIV acquisition in the Step HIV Vaccine Study has raised questions concerning frequency of acquiredThe association between baseline seropositivity to human adenovirus (HAdV) type 5 and increased HIV acquisition in the Step HIV Vaccine Study has raised questions concerning frequency of acquired and/or persistent Adenovirus infections among adults at high risk of HIV-1 infection. To evaluate the frequency and pattern of HAdV shedding from the lower GI tract, we retrospectively tested rectal swabs for HAdVs in a cohort of 20 HSV-2 positive HIV-positive Peruvian men who have sex with men (MSM) undergoing rectal swabbing three times/week for 18 consecutive weeks, in a prospective study of HSV-2 suppression in HIV infection. Viral DNA was extracted and amplified using a sensitive multiplex PCR assay that detects all currently recognized HAdV types. Molecular typing of viruses was performed on selected samples by hexon gene sequencing. Baseline neutralizing antibody titers to HAdVs -5, -26, -35 and -48 were also assessed. 15/20 individuals had HAdV detected during follow up. The median frequency of HAdV detection was 30% of samples (range 2.0% to 64.7%). HAdV shedding typically occurred on consecutive days in clustered episodes lasting a median of 4 days (range 1 to 9 days) separated by periods without shedding, suggesting frequent new infections or reactivation of latent infections over time. 8 of the 15 shedders had more than one type detected in follow-up. 20 HAdV types from species B, C, and D were identified, including HAdV-5, -26 and -48, HAdV types under development as potential vaccine candidates. 14/20 subjects were seropositive for HAdV-5; 15/20 for HAdV-26; 3/20 for HAdV-35; and 2/20 for HAdV-48. HAdV shedding did not correlate with CD4 count, plasma HIV-1 viral load, or titers to HAdV-5 or HAdV-35. The sole individual with HAdV-5 shedding was HAdV-5 seropositive. HAdV shedding was highly prevalent and diverse, including types presently under consideration as HIV vaccine vectors. Subclinical HAdV infection of the GI tract is common among MSM in Peru; the prevalence of HAdV in the enteric tract should be evaluated in other populations. The association between ongoing recent enteric HAdV and the immune response to recombinant HAdV vaccines should be evaluated.

• Health care transmission of a newly emergent adenovirus serotype in health care personnel at a military hospital in Texas, 2007.

  Authors: Fernanda C Lessa, Philip L Gould, Neil Pascoe, Dean D Erdman, Xiaoyan Lu, Michel L Bunning, Vincent C Marconi, Lisa Lott, Marc-Alain Widdowson, Larry J Anderson, Arjun Srinivasan

  The Journal of infectious diseases. 12/2009; 200(11):1759-65.

  BACKGROUND: Adenoviruses can cause outbreaks of febrile respiratory illness in military trainees, but until 2007, adenovirus serotype 14 (Ad14) was never associated with such outbreaks. From AprilBACKGROUND: Adenoviruses can cause outbreaks of febrile respiratory illness in military trainees, but until 2007, adenovirus serotype 14 (Ad14) was never associated with such outbreaks. From April through June 2007, 15 trainees at one base were hospitalized for pneumonia due to Ad14. Subsequent reports of febrile respiratory illness among health care personnel suggested nosocomial transmission. METHODS: Health care personnel participants completed a questionnaire and provided blood and nasal wash specimens for Ad14 diagnostic testing. We defined a confirmed case of Ad14 infection as one with titers > or = 1:80 or nasal wash specimens positive for Ad14 by polymerase chain reaction, whereas a possible case was defined by titers of 1:20 or 1:40. We also collected environmental samples. RESULTS: Among 218 tested health care personnel, 35 (16%) had titers > or = 1:20; of these, 7 had possible cases and 28 had confirmed cases of infection. Confirmed case patients were more likely to report febrile respiratory illness (57% vs 11%; P< .001) and to have had direct contact with patients with Ad14 infection (82% vs 62%; P.04 ). Of the 23 confirmed case patients with direct contact with Ad14-infected patients, 52% reported that patients were not in contact and droplet precautions at the time of exposure. Ad14 was recovered from several hospital surfaces. CONCLUSION: Our findings of possible nosocomial transmission of Ad14 highlight the need to reinforce infection control guidelines.

• Evaluation of Tetramethylrhodamine and Black Hole Quencher 1 labeled probes and Five Commercial Amplification Mixes in TaqMan((R)) Real-time RT-PCR Assays for Respiratory Pathogens.

  Authors: Genyan Patrick Yang, Dean D Erdman, Maria L Tondella, Barry S Fields

  Journal of virological methods. 09/2009;

  Tetramethylrhodamine (TAMRA((R))) and Black Hole Quencher 1 (BHQ1((R))) quenched probes and five one-step RT-PCR kits were evaluated in TaqMan((R)) real-time RT-PCR assays for detection ofTetramethylrhodamine (TAMRA((R))) and Black Hole Quencher 1 (BHQ1((R))) quenched probes and five one-step RT-PCR kits were evaluated in TaqMan((R)) real-time RT-PCR assays for detection of respiratory pathogens. The intra-assay variability of the BHQ1((R)) probes were 1.2-2.8-fold lower than those of the TAMRA((R)) probes. All kits amplified the specific targets, but differed in their sensitivity by up to 3-orders of magnitude. The AgPath-ID(TM) kit provided the best overall performance for all assay targets.

• Control of an Outbreak of Human Parainfluenza Virus 3 in Hematopoietic Stem Cell Transplant Recipients.

  Authors: Richard T Maziarz, Praseeda Sridharan, Susan Slater, Gabrielle Meyers, Mary Post, Dean D Erdman, Teresa C T Peret, Randy A Taplitz

  Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 09/2009;

  Human parainfluenza virus 3 (HPIV3) infection can cause significant morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. There are no standard guidelines on prevention andHuman parainfluenza virus 3 (HPIV3) infection can cause significant morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. There are no standard guidelines on prevention and control of HPIV3 in the outpatient setting. After two HSCT inpatients diagnosed with HPIV3 were noted to have had multiple recent HSCT outpatient clinic (OPC) visits, an investigation of policy and procedures in the HSCT OPC was undertaken and active surveillance for respiratory viral illness was instituted in the at risk HSCT population. Between July 19th and Aug 30(th), 2005, 13 patients were diagnosed with HPIV3 infection. Morbidity in affected patients was significant, mortality was high (38.5%) and was not affected by antiviral therapy. Molecular typing identified several genetically distinct groups of the hemagglutinin-neuraminidase gene of the 11 available isolates. Based on sequence relatedness among the isolates and the demographic and exposure history of the patients, acquisition of HPIV3 infection in many of these cases likely took place in the HSCT OPC. The major infection control (IC) interventions were introduced between August 20(th) and August 24(th). An epidemic curve revealed that HPIV3 infection frequency peaked between August 17(th) and August 26(th), with no cases identified after Aug 30(th). Prompt attention and focus on IC interventions were associated with a rapid decrease in the number of incident cases. Policies and procedures regarding patients with respiratory viral illnesses in HSCT OPC populations should be formulated and universally reinforced with HSCT clinic staff to prevent spread of these infections.

• Outbreak of Severe Respiratory Disease Associated with Emergent Human Adenovirus Serotype 14 at a US Air Force Training Facility in 2007.

  Authors: Jacqueline E Tate, Michel L Bunning, Lisa Lott, Xiaoyan Lu, John Su, David Metzgar, Lorie Brosch, Catherine A Panozzo, Vincent C Marconi, Dennis J Faix, Mila Prill, Brian Johnson, Dean D Erdman, Vincent Fonseca, Larry J Anderson, Marc-Alain Widdowson

  The Journal of infectious diseases. 05/2009;

  Background. In 2007, a US Air Force training facility reported a cluster of severe respiratory illnesses associated with a rare human adenovirus (Ad) serotype, Ad14. We investigated this outbreak toBackground. In 2007, a US Air Force training facility reported a cluster of severe respiratory illnesses associated with a rare human adenovirus (Ad) serotype, Ad14. We investigated this outbreak to better understand its epidemiology, clinical spectrum, and associated risk factors. Methods. Data were collected from ongoing febrile respiratory illness (FRI) surveillance and from a retrospective cohort investigation. Because an Ad7 vaccine is in development, Ad7 antibody titers in pretraining serum samples from trainees with mild and those with severe Ad14 illness were compared. Results. During 2007, an estimated 551 (48%) of 1147 trainees with FRI were infected with Ad14; 23 were hospitalized with pneumonia, 4 required admission to an intensive care unit, and 1 died. Among cohort members ([Formula: see text]), the Ad14 infection rate was high (50%). Of those infected, 40% experienced FRI. No cohort members were hospitalized. Male sex (risk ratio [RR], 4.7 [95% confidence interval {CI}, 2.2-10.1]) and an ill close contact (RR, 1.6 [95% CI, 1.2-2.2]) were associated with infection. Preexisting Ad7 neutralizing antibodies were found in 7 (37%) of 19 Ad14-positive trainees with mild illness but in 0 of 16 trainees with Ad14 pneumonia ([Formula: see text]). Conclusions. Emergence of Ad14, a rare Ad serotype, caused a protracted outbreak of respiratory illness among military recruits. Most infected recruits experienced FRI or milder illnesses. Some required hospitalization, and 1 died. Natural Ad7 infection may protect against severe Ad14 illness.

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• A Community-Based Outbreak of Severe Respiratory Illness Caused by Human Adenovirus Serotype 14.

  Authors: Paul F Lewis, Mark A Schmidt, Xiaoyan Lu, Dean D Erdman, Mary Campbell, Ann Thomas, Paul R Cieslak, La Donna Grenz, Laura Tsaknardis, Curt Gleaves, Brian Kendall, David Gilbert

  The Journal of infectious diseases. 05/2009;

  Background. Human adenoviruses (Ads) typically cause mild illnesses in otherwise healthy hosts. We investigated a community-based outbreak that had substantial morbidity caused primarily by Ad14, anBackground. Human adenoviruses (Ads) typically cause mild illnesses in otherwise healthy hosts. We investigated a community-based outbreak that had substantial morbidity caused primarily by Ad14, an uncommon serotype. Methods. We retrospectively reviewed the medical records of all patients with confirmed cases of Ad infection from 1 November 2006 through 31 July 2007 in Oregon. Isolates were typed by sequencing. We analyzed clinical and laboratory variables to identify risk factors for severe Ad14 disease. Results. Ad14 first emerged in Oregon in 2005. Of 67 cases of Ad infection detected during the study period, 40 (60%) involved Ad14. Most of the 38 Ad14-infected patients who had medical records available for review presented with fever and cough; 29 (76%) required hospitalization, 23 (61%) required supplemental oxygen, 18 (47%) required critical care, 9 (24%) required vasopressors, and 7 (18%) died. Lobar infiltrates on chest radiographs suggestive of bacterial pneumonia were common among those needing hospitalization. Older age, chronic underlying condition, low absolute lymphocyte counts, and elevated creatinine levels were associated with severe illness. Except for 1 case of possible hospital transmission, we identified no epidemiological links among patients. Conclusion. Ad14 emerged in Oregon in 2005 and became the predominant circulating type by 2007. Infection with this uncommon virus was primarily associated with a community-acquired pneumonia syndrome and caused substantial morbidity and mortality.

• Parainfluenza Virus Infection of Young Children: Estimates of the Population-Based Burden of Hospitalization.

  Authors: Geoffrey A Weinberg, Caroline B Hall, Marika K Iwane, Katherine A Poehling, Kathryn M Edwards, Marie R Griffin, Mary Allen Staat, Aaron T Curns, Dean D Erdman, Peter G Szilagyi

  The Journal of pediatrics. 01/2009;

  OBJECTIVE: To determine the population-based inpatient disease burden of parainfluenza virus in children <5 years of age. STUDY DESIGN: The New Vaccine Surveillance Network (NVSN) enrolled childrenOBJECTIVE: To determine the population-based inpatient disease burden of parainfluenza virus in children <5 years of age. STUDY DESIGN: The New Vaccine Surveillance Network (NVSN) enrolled children <5 years of age who were hospitalized with febrile or acute respiratory illnesses. Surveillance hospitals admitted >95% of all hospitalized children from each county. Combined nasal turbinate/throat swabs were tested for parainfluenza virus (PIV), respiratory syncytial virus, and influenza virus with culture and reverse-transcription-polymerase chain reaction. Both parental interviews and medical chart reviews were conducted. Age-specific population-based hospitalization rates were calculated. RESULTS: From October 2000 through September 2004, 2798 children were enrolled. A total of 191 PIVs were identified from 189 children (6.8% of enrolled: 73 PIV type 1, 23 PIV type 2, and 95 PIV type 3), compared with 521 respiratory syncytial viruses and 159 influenza viruses. Mean PIV hospitalization rates were 3.01, 1.73, 1.53, 0.39, and 1.02 per 1000 children per year for ages 0 to 5 months, 6 to 11 months, 12 to 23 months, 24 to 59 months, and 0 to 59 months, respectively. CONCLUSIONS: PIV accounted for 6.8% of all hospitalizations for fever, acute respiratory illnesses, or both in children <5 years of age. The pediatric PIV inpatient burden is substantial and highlights the need to find an effective vaccine candidate.

• Novel human rhinoviruses and exacerbation of asthma in children.

  Authors: Nino Khetsuriani, Xiaoyan Lu, W Gerald Teague, Neely Kazerouni, Larry J Anderson, Dean D Erdman

  Emerging infectious diseases. 12/2008; 14(11):1793-6.

  To determine links between human rhinoviruses (HRV) and asthma, we used data from a case-control study, March 2003-February 2004, among children with asthma. Molecular characterization identifiedTo determine links between human rhinoviruses (HRV) and asthma, we used data from a case-control study, March 2003-February 2004, among children with asthma. Molecular characterization identified several likely new HRVs and showed that association with asthma exacerbations was largely driven by HRV-A and a phylogenetically distinct clade of 8 strains, genogroup C.