title: Risk factor analysis and molecular epidemiology of respiratory adenovirus infections among children in northern Taiwan, 2009-2013.
abstract: OBJECTIVE
  Respiratory infections caused by human adenoviruses (HAdV) are worldwide, and have significantly increased recently in Taiwan. This study aimed to clarify the molecular epidemiology and risk factors of HAdV severe infections and pneumonia among Taiwanese children.
  
  
  METHODS
  Patients with HAdV infections and hospitalized in a medical center between 2009 and 2013 were divided into severe or nonsevere HAdV infections based on whether or not they received intensive care. HAdV pneumonia was identified for comparison. The HAdV genotype was determined by sequencing the partial hexon and fiber genes. The nucleotide sequences were compared by phylogenetic analysis.
  
  
  RESULTS
  The 176 patients (97 boys, 79 girls) had a median age of 3.7 years. The HAdV infections circulated year-round. HAdV B3 (54.5%) was the most common genotype, followed by HAdV C2 (21%), HAdV E4 (8%), and HAdV B7 (6.8%). Thirty-two patients needed intensive care. In multivariate analysis, the risk factors for severe HAdV infections were underlying neurologic diseases [odds ratio (OR): 164.9; p < 0.001], prematurity (OR: 10.9; p = 0.042), and HAdV B7 (OR: 39.5; p = 0.011). Twenty-nine patients had HAdV pneumonia. Patients with underlying neurologic diseases (OR 76.8; p < 0.001), airway anomaly (OR 15.1; p = 0.033), chronic lung diseases (OR 12.5; p = 0.047), weight < 3rdpercentile (OR 5.5; p = 0.027), and HAdV B7 (OR 4.2; p = 0.002) had higher incidences of pneumonia. Four with underlying neurologic diseases died of acute respiratory distress syndrome.
  
  
  CONCLUSIONS
  HAdV infections circulate all year-round. HAdV B7 is strongly related to severe infections and pneumonia. Underlying neurologic diseases and prematurity are risk factors for severe HAdV infections.
authors.affiliation: Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
authors.forename: Jia Lu
authors.initials: JL
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Peng
authors.affiliation: Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan.
authors.forename: Nan-Chang
authors.initials: NC
authors.lastname: Chiu
authors.affiliation: Section of Microbiology, Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Li-Chuan
authors.initials: LC
authors.lastname: Weng
authors.affiliation: Department of Clinical Virology of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Yu-Ying
authors.initials: YY
authors.lastname: Chiu
authors.affiliation: Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
authors.forename: Lung
authors.initials: L
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
authors.forename: Daniel Tsung-Ning
authors.initials: DT
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Huang
authors.affiliation: Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Section of Microbiology, Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chang-Pan
authors.initials: CP
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan; Section of Microbiology, Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan. Electronic address: chi.4531@mmh.org.tw.
authors.forename: Hsin
authors.initials: H
authors.lastname: Chi
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology* / Q000821:virology; D000260:Adenoviruses, Human / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005838:Genotype; D060005:Genotyping Techniques; D006801:Humans; D007223:Infant; D008297:Male; D017720:Molecular Epidemiology; D010802:Phylogeny; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D013624:Taiwan / Q000453:epidemiology
keywords: adenovirus; children; genotypes; pneumonia; severe infection