Infect Chemother.  2019 Jun;51(2):119-129. 10.3947/ic.2019.51.2.119.

Epidemiological Investigation of the Outbreak of Acute Respiratory Infection caused by Adenovirus Type B55 in a Physical Education School in 2017

• Song J
• Lee H
• Cho E

• KMID: 2450868
• DOI: http://doi.org/10.3947/ic.2019.51.2.119

Abstract

BACKGROUND
On May 19, 2017, the cluster of 6 acute respiratory infections due to adenovirus in the swimming department of a physical education school (School J) was reported to Korea Centers for Disease Control and Prevention. An epidemiological investigation was conducted to identify the transmission route of the infection and to control the outbreak.
MATERIALS AND METHODS
A retrospective cohort study (Study 1) was conducted on students and teachers of the athletic departments using the swimming pool, and a prospective surveillance (Study 2) was conducted on all students and teachers of the School J. A case was defined as any student and school personnel who developed more than two of the following symptoms from April 10 to July 2, 2017: fever, sore throat, cough, rhinorrhea, or headache. Relative risks (RRs) were calculated to compare the attack rates according to potential risk factors. Multivariable logistic regression was performed to identify the risk factors for infection in the outbreak.
RESULTS
47 cases were identified: 33 (55.9%) cases occurred among 59 students and teachers in Study 1 and 14 (3.9%) among 362 students and school personnel in Study 2. There were 18 laboratory confirmed adenovirus infection cases. The common symptoms were headache (71.7%), fever (69.6%), rhinorrhea (63.0%), sputum (56.5%), and sore throat (54.3%). 23.9% of the cases were accompanied with diarrhea and 19.6% with eye congestion. None of the cases developed pneumonia. 32.6% of the cases were hospitalized. In Study 1, attack rate in the swimming department was higher than that in others (RR: 1.90; 95% confidence interval [CI]: 1.01-3.60). In Study 2, being a member of the shooting department (RR: 20.70; 95% CI: 4.90-87.47) and being a first year high school student (RR: 10.95; 95% CI: 2.90-41.33) were identified as risk factors for the infections. Genetic analyses of the adenoviruses showed 100% identical sequence in homology and confirmed the human adenovirus B55 (HAdV-B55). No adenovirus was detected at examining the water and environment of the swimming pool and dormitory.
CONCLUSION
The outbreak is inferred to be occurred via propagated transmission among the students in the same athletic department, while the students with symptoms of respiratory infection continued performing school activities without any restrictions. Infection control measures such as early detection of symptoms of respiratory infection and restriction of group activity are necessary to prevent respiratory infection outbreak in the communal living setting.

Keyword

Human adenovirus; Outbreak; Acute respiratory infection; School

MeSH Terms

Adenoviridae Infections
Adenoviridae*
Adenoviruses, Human
Centers for Disease Control and Prevention (U.S.)
Cohort Studies
Cough
Diarrhea
Estrogens, Conjugated (USP)
Fever
Headache
Humans
Infection Control
Korea
Logistic Models
Pharyngitis
Physical Education and Training*
Pneumonia
Prospective Studies
Respiratory Tract Infections
Retrospective Studies
Risk Factors
Sports
Sputum
Swimming
Swimming Pools
Water
Estrogens, Conjugated (USP)
Water

Figure

• 

  Figure 1 Epidemic curve of adenovirus respiratory infection in the retrospective investigation for departments using the swimming pool (Study 1), and in prospective surveillance for entire members in the physical education school (Study 2). A: Retrospective investigation of members of departments using the swimming pool (Study 1). B: Prospective surveillance of the entire members of the physical education school (Study 2). The case marked “◎” was identified after the first field investigation on May 22. This case was enrolled in Study 2, not in Study 1.

• 

  Figure 2 Epidemic curve of the outbreak by the athletic departments.

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