A Prolonged Outbreak of Human Adenovirus A31 (HAdV-A31) Infection on a Pediatric Hematopoietic Stem Cell Transplantation Ward with Whole Genome Sequencing Evidence of International Linkages.

Autor:	Fattouh R; Division of Microbiology, The Hospital for Sick Childrengrid.42327.30 (SickKids), Toronto, Ontario, Canada.; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada., Stapleton PJ; Division of Microbiology, The Hospital for Sick Childrengrid.42327.30 (SickKids), Toronto, Ontario, Canada.; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada., Eshaghi A; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada.; Public Health Ontariogrid.415400.4 Laboratories, Public Health Ontario, Toronto, Ontario, Canada., Thomas AD; Infection Prevention and Control, The Hospital for Sick Childrengrid.42327.30, Toronto, Ontario, Canada., Science ME; Division of Infectious Diseases, The Hospital for Sick Childrengrid.42327.30, Toronto, Ontario, Canada.; Department of Paediatrics, University of Torontogrid.17063.33, Toronto, Ontario, Canada., Schechter T; Department of Paediatrics, University of Torontogrid.17063.33, Toronto, Ontario, Canada.; Division of Hematology/Oncology, The Hospital for Sick Childrengrid.42327.30, Toronto, Ontario, Canada., Streitenberger L; Infection Prevention and Control, The Hospital for Sick Childrengrid.42327.30, Toronto, Ontario, Canada., Hubacek P; Department of Medical Microbiology, University Hospital Motol, Prague, Czech Republic.; Charles University, Prague, Czech Republic., Yau YCW; Division of Microbiology, The Hospital for Sick Childrengrid.42327.30 (SickKids), Toronto, Ontario, Canada.; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada., Brown M; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada., Graham MR; National Microbiology Laboratory, Public Health Agency of Canadagrid.415368.d, Winnipeg, Manitoba, Canada.; University of Manitoba, Winnipeg, Manitoba, Canada., Gubbay JB; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada.; Public Health Ontariogrid.415400.4 Laboratories, Public Health Ontario, Toronto, Ontario, Canada., Campigotto AJ; Division of Microbiology, The Hospital for Sick Childrengrid.42327.30 (SickKids), Toronto, Ontario, Canada.; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada., Patel SN; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada.; Public Health Ontariogrid.415400.4 Laboratories, Public Health Ontario, Toronto, Ontario, Canada., Richardson SE; Division of Microbiology, The Hospital for Sick Childrengrid.42327.30 (SickKids), Toronto, Ontario, Canada.; Department of Laboratory Medicine and Pathobiology, University of Torontogrid.17063.33, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Journal of clinical microbiology [J Clin Microbiol] 2022 Nov 16; Vol. 60 (11), pp. e0066522. Date of Electronic Publication: 2022 Oct 12.
DOI:	10.1128/jcm.00665-22
Abstrakt:	A surge in hematopoietic stem cell transplantation (HSCT) human adenovirus A31 (HAdV-A31) infections was initially observed in late 2014/2015 at SickKids (SK) Hospital, Toronto, Canada. In response, enhanced laboratory monitoring for all adenovirus infections was conducted. Positive samples underwent genotyping, viral culture, and, in selected cases, whole-genome sequencing (WGS). HAdV-A31 specimens/DNA obtained from four international pediatric HSCT centers also underwent WGS. During the SK outbreak period (27 October 2014 to 31 October 2018), 17/20 HAdV-A31 isolates formed a distinct clade with 0 to 8 mutations between the closest neighbors. Surveillance before and after the outbreak detected six additional HAdV-A31 HSCT cases; three of the four sequenced cases clustered within the outbreak clade. Two SK outbreak isolates were identical to sequences from two patients in an outbreak in England. Three SK non-outbreak sequences also had high sequence similarity to strains from three international centers. Environmental PCR testing of the HSCT ward showed significant adenovirus contamination. Despite intense infection control efforts, we observed re-occurrence of infection with the outbreak strain. Severe but nonfatal infection was observed more commonly with HAdV-A31 compared to other genotypes, except HAdV-C1. Our findings strongly implicate nosocomial spread of HAdV-A31 over 10 years on a HSCT unit and demonstrate the value of WGS in defining and mapping the outbreak. Close linkages among strains in different countries suggest international dissemination, though the mechanism is undetermined. This large, extended outbreak emphasizes the pre-eminent role of HAdV-A31 in causing intractable pediatric HSCT outbreaks of severe illness worldwide.
Databáze:	MEDLINE
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