Adenovirus (Types 1, 2, 3, 4, 5 and 7)

Pathogen Safety Data Sheets: Infectious Substances – Adenovirus types 1, 2, 3, 4, 5 and 7

SECTION I – INFECTIOUS AGENT

NAME: Adenovirus (excluding serotypes 40 and 41)

SYNONYM OR CROSS REFERENCE: Acute respiratory disease (ARD), childhood febrile illness, adenovirus species A, B, C, D, E, F, G, pharyngoconjunctival fever.

CHARACTERISTICS: Human adenoviruses are members of the family Adenoviridae and genus Mastadenovirus. Within the almost 100 different serotypes of human adenovirus, 51 are known to be pathogenic in humans ^{1 2}. The virus is nonenveloped with an icosahedral capsid at 70-90 nm in diameter and each contains a single linear, double-stranded DNA genome of approximately 36 kb ².

SECTION II – HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: Adenovirus cause generally mild respiratory tract infections which are self-limiting and generally asymptomatic despite virologic and serologic proof of infection ³, and only around 45% of infections are manifested by disease ¹. It is a major agent of acute respiratory disease, mainly caused by serotypes 4 and 7, and is characterized by fever, rhinitis, pharyngitis, cough, and conjunctivitis ¹. Other common illnesses can be observed in the respiratory tract, gastrointestinal tract, and eyes (acute follicular conjunctivitis) ². Common diseases caused by various adenovirus serotypes are:

• Childhood febrile illness and pharyngoconjunctival fever – 1, 2, 3, 5, 7 ¹
• Pneumonia and other acute respiratory illnesses – 1, 2, 3, 5, 7, 14 ¹⁴
• Pertussis-like illness – 1, 2, 3, 5, 19, 21 ¹
• Conjunctivitis – 1-4, 5, 7, 8, 19, 21 ¹²
• Keratoconjunctivitis – 3, 8, 9, 19, 37 ¹
• Acute hemorrhagic cystitis – 11 ¹
• Upper respiratory illness and hepatitis – 1-3, 5, 7 ²
• Lower respiratory illness – 3, 4, 7, 21 ²

General infections are commonly observed in young children, particularly by serotypes 1, 2, and 5 ¹. Symptoms of infection may include fever, nasal congestion, coryza, and pharyngitis. Other more serious illnesses such as nephritis, neutropenia, myocarditis, hepatitis, disseminated intravascular coagulation and meningoencephalitis can occur ^{2 5}. Eye infections such as acute follicular conjunctivitis, often accompanied by significant periauricular lymphadenopathy, are often mild and complete recovery is common ⁶. Neonatal disease, meningoencephalitis, myocarditis, and venereal diseases are uncommon ².

EPIDEMIOLOGY: Adenovirus is of worldwide prevalence, and is ubiquitous throughout the year, especially during later winter and early spring ⁵. Serotype 5 is the most common, with serotypes 1 and 2 being highly endemic ¹. Children are especially susceptible to infection ^{2 5 7}. Adenovirus serotypes 3, 4, 7, and 21 have been associated with outbreaks of acute respiratory disease among military recruits ^{3 8}. These outbreaks have resulted in hospitalization and some mortality ⁸. Smaller outbreaks of serotypes 3, 4, and 7 occur in the summertime due to contaminated swimming pool water, which commonly resulted in conjunctivitis ^{1 2}. Serious adenovirus infections occur more frequently in immunocompromised individuals ^{2 7}.

HOST RANGE: Humans.

INFECTIOUS DOSE: Inhalation of as few as 5 adenovirus particles can cause disease in susceptible individuals ³. The National Institutes of Health lists the infectious dose for adenovirus serotype 7 as >150 viral units, administered as nasal drops ⁹.

MODE OF TRANSMISSION: Respiratory and fecal-oral routes. Infection can also spread through contaminated fomites, fingers, ophthalmic solutions, and airborne particulates^{2 5 1}

INCUBATION PERIOD: Approximately 2 to 14 days ².

COMMUNICABILITY: Children shed non enteric adenovirus in throat and stool samples for 3 to 6 weeks following lower respiratory infection or generalized illness. Chance of transmission is high in crowded and closed settings such as day cares, boarding schools and long-term care facilities. Transmission between family members is common. In rare cases, virus shedding may last for 18 months or longer ².

SECTION III – DISSEMINATION

RESERVOIR: Humans ^{3 6}. Experimentally, human adenovirus can infect virtually all mammalian species, including monkeys, cotton rats, rabbits, and rodents ⁶.

ZOONOSIS: None.

VECTORS: None.

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: None. Many reports indicate cidofovir to be effective against adenoviruses; however, no controlled trials have been performed so far, and the drug is not currently licensed for use Footnote 5.

SUSCEPTIBILITY TO DISINFECTANTS: Adenoviruses are resistant to lipid disinfectants, but are inactivated by formaldehyde and chlorine ⁵. They can be inactivated by contact with 1:5 dilution of bleach for 1 minute or 2 minutes contact with alcohol-based hand gels ².

PHYSICAL INACTIVATION: Adenovirus can be inactivated by heat ⁵: heating to 56 °C for 30 min, 60 °C for 2 min, and autoclaving will destroy infectivity ².

SURVIVAL OUTSIDE HOST: Most serotypes are stable at 36 °C for a week, for several weeks at room temperature, and for several months at 4 °C ^{2 10}. Adenoviruses are very stable in the environment and persist for 7 days to 3 months on dry inanimate surfaces ¹⁰. They can also survive for weeks in tap water, sewage effluent and sea water ¹¹. Adenovirus type 2 can survive on common environmental surfaces for up to 8 weeks at room temperature ¹².

SECTION V – FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Infected cells can be observed by microscopy, and adenoviruses can be detected using immunofluorescence, enzyme-linked immunoassay, or PCR for antigen detection ².

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: No formally approved effective antiviral agents exist for treatment of adenoviral infections ⁷. Illness is generally self-limiting and treatment is supportive ⁵. It has been suggested that immunocompromised patients may require drug treatment with cidofovir or other antiviral drugs ⁷.

IMMUNIZATION: A vaccine for adenovirus strains 4 and 7 was developed but is no longer in production (economic reasons) ^{2 8}.

PROPHYLAXIS: None.

SECTION VI – LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: At least 10 cases of laboratory-acquired adenovirus infections have occurred up to 2006; however, the serotypes involved were not reported Footnote 13.

SOURCES/SPECIMENS: Generally, fecal samples, and respiratory secretions from an infected individual contain infectious virus. Other tissues may contain virus depending on symptoms ².

PRIMARY HAZARDS: Contact of mucous membranes (mouth or eyes) with virus, ingestion, or inhalation of viral particles ^{2 13 14}.

SPECIAL HAZARDS: None.

SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 ¹⁵. This risk group applies to the species as a whole, and may not apply to every serotype within the species.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials. These containment requirements apply to the species as a whole, and may not apply to each serotype within the species.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes ¹⁶.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities ¹⁶.

SECTION VIII – HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up ¹⁶.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration ¹⁶.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled ¹⁶.

SECTION IX – REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: November 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright © Public Health Agency of Canada, 2011 Canada

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