van der Zalm Marieke M, Sam-Agudu Nadia A, Verhagen Lilly M
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
Curr Opin Pediatr. 2024 Jun 1;36(3):342-348. doi: 10.1097/MOP.0000000000001335. Epub 2024 Feb 29.
Lower respiratory tract infections (LRTIs) are an important cause of child morbidity and mortality globally, especially in children under the age of 5 years in Africa. Respiratory viruses, including human adenoviruses (HAdVs), are common causes of LRTIs in children. This review aims to shed light on the epidemiology, clinical manifestations, sequelae, and treatment options specific to adenovirus respiratory infections in African children.
Recent evidence has challenged the perception that adenovirus is a negligible cause of LRTIs. Studies show HAdV emerging as the third most common viral pathogen in fatal pneumonias among under-5 children in low-income and middle-income African countries, contributing to 5.5% of all pneumonia deaths and ranking second in hospital-associated viral pneumonia deaths. Predominant HAdV serotypes associated with disease differ by country and region, and have changed over time. Risk factors for increased disease severity and long-term respiratory sequelae in previously healthy African children with HAdV LRTIs are not well established.
Although respiratory viruses, including HAdV, are recognized contributors to LRTIs, the prevalence and impact of adenovirus infections have been under-recognized and understated. Available data suggests that African children, particularly those under 5 years old, are at risk of severe sequelae from respiratory HAdV infections. Long-term sequelae, including bronchiectasis and postinfectious bronchiolitis obliterans, further underscore the significant impact of HAdV infections. However, the scarcity of comprehensive data hampers our understanding of the extent of the impact of HAdV infections on child lung health in Africa. We recommend scaled-up HAdV surveillance, ensuring its consistent inclusion in population-level LRTI assessments, and expanded and equitable access to diagnostics for early recognition of African children at risk of developing chronic sequelae and death. Enhanced understanding of adenovirus epidemiology and clinical outcomes and the availability of therapeutic options are essential for informed public health strategies and clinical care.
下呼吸道感染（LRTIs）是全球儿童发病和死亡的重要原因，在非洲5岁以下儿童中尤为如此。包括人腺病毒（HAdVs）在内的呼吸道病毒是儿童LRTIs的常见病因。本综述旨在阐明非洲儿童腺病毒呼吸道感染的流行病学、临床表现、后遗症及治疗选择。
最近的证据对腺病毒是LRTIs的可忽略病因这一观念提出了挑战。研究表明，在非洲低收入和中等收入国家5岁以下儿童的致命肺炎中，HAdV成为第三大常见病毒病原体，占所有肺炎死亡病例的5.5%，在医院相关病毒性肺炎死亡病例中排名第二。与疾病相关的主要HAdV血清型因国家和地区而异，且随时间发生了变化。先前健康的非洲儿童感染HAdV导致LRTIs后，疾病严重程度增加和长期呼吸道后遗症的危险因素尚未明确。
尽管包括HAdV在内的呼吸道病毒被认为是LRTIs的病因，但腺病毒感染的患病率和影响一直未得到充分认识和重视。现有数据表明，非洲儿童，尤其是5岁以下儿童，有因呼吸道HAdV感染而出现严重后遗症的风险。长期后遗症，包括支气管扩张和感染后闭塞性细支气管炎，进一步凸显了HAdV感染的重大影响。然而，全面数据的匮乏阻碍了我们对HAdV感染对非洲儿童肺部健康影响程度的理解。我们建议扩大HAdV监测，确保其始终纳入人群水平的LRTI评估，并扩大和公平提供诊断方法，以便早期识别有发展为慢性后遗症和死亡风险的非洲儿童。深入了解腺病毒流行病学和临床结局以及提供治疗选择对于制定明智的公共卫生策略和临床护理至关重要。
