Adenoviral Infections in Singapore: Should New Antiviral Therapies and Vaccines Be Adopted?

Kristen K. Coleman, Chui Ching Wong, Jayanthi Jayakumar, Tham T. Nguyen, Abigail W.L. Wong, Su Yadana, Koh C. Thoon, Kwai Peng Chan, Jenny G. Low, Shirin Kalimuddin, Shoaleh Dehghan, June Kang, Amirhossein Shamsaddini, Donald Seto, Yvonne C.F. Su, Gregory C. Gray

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)566-577
Number of pages12
JournalJournal of Infectious Diseases
Issue number4
StatePublished - Feb 3 2020
Externally publishedYes


  • adenovirus
  • genotyping
  • molecular epidemiology
  • pediatric disease
  • respiratory disease

ASJC Scopus subject areas

  • General Medicine


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