title: Epidemiology of severe pediatric adenovirus lower respiratory tract infections in Manitoba, Canada, 1991-2005.
abstract: BACKGROUND
  Most pediatric adenovirus respiratory infections are mild and indistinguishable from other viral causes. However, in a few children, the disease can be severe and result in substantial morbidity. We describe the epidemiologic, clinical, radiologic features and outcome of adenovirus lower respiratory tract infections (LRTI) in Aboriginal and Non-Aboriginal children in Manitoba, Canada during the years 1991 and 2005.
  
  
  METHODS
  This was a retrospective study of 193 children who presented to the department of pediatrics at Winnipeg Children's Hospital, Manitoba, Canada with LRTI and had a positive respiratory culture for adenovirus. Patients' demographics, clinical and radiologic features and outcomes were collected. Adenovirus serotype distributions and temporal associations were described. Approximate incidence comparisons (detection rates) of adenovirus LRTI among Aboriginal and Non-Aboriginal children were estimated with 95% confidence intervals.
  
  
  RESULTS
  Adenovirus infections occurred throughout the year with clusters in the fall and winter. Serotypes 1 to 3 were the predominant isolates (two thirds of the cases). The infection was more frequent among Canadian Aboriginals, as illustrated in 2004, where its incidence in children 0-4 years old was 5.6 fold higher in Aboriginals (13.51 vs. 2.39 per 10,000, p < 0.000). There were no significant differences in length of hospitalization and use of ventilator assistance between the two groups (p > 0.185 and p > 0.624, respectively) nor across serotypes (p > 0.10 and p > 0.05, respectively). The disease primarily affected infants (median age, 9.5 months). Most children presented with bronchiolitis or pneumonia, with multi-lobar consolidations on the chest x-ray. Chronic (residual) changes were documented in 16 patients, with eight patients showing bronchiectasis on the chest computerized tomography scan.
  
  
  CONCLUSIONS
  Adenovirus infection is associated with significant respiratory morbidities, especially in young infants. The infection appears to be more frequent in Aboriginal children. These results justify a careful follow-up for children with adenovirus LRTI.
authors.affiliation: Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Saleh
authors.initials: S
authors.lastname: Alharbi
authors.forename: Paul
authors.initials: P
authors.lastname: Van Caeseele
authors.forename: Raquel
authors.initials: R
authors.lastname: Consunji-Araneta
authors.forename: Taoufik
authors.initials: T
authors.lastname: Zoubeidi
authors.forename: Sergio
authors.initials: S
authors.lastname: Fanella
authors.forename: Abdul-Kader
authors.initials: AK
authors.lastname: Souid
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: Alsuwaidi
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D000260:Adenoviruses, Human / Q000302:isolation & purification*; D001996:Bronchopneumonia / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D002675:Child, Preschool; D005006:Ethnicity; D006801:Humans; D015994:Incidence; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008350:Manitoba / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors