Human adenovirus outbreak at a university campus monitored by wastewater and clinical surveillance

Abstract

Areas of dense population congregation are prone to experience respiratory virus outbreaks. We monitored wastewater and clinic patients for the presence of respiratory viruses on a large, public university campus. Campus sewer systems were monitored in 16 locations for the presence of viruses using next generation sequencing over 22 weeks in 2023. During this period, we detected a surge in human adenovirus (HAdV) levels in wastewater. Hence, we initiated clinical surveillance at an on-campus clinic from patients presenting with acute respiratory infection. From whole genome sequencing of 123 throat and/or nasal swabs collected, we identified an outbreak of HAdV, specifically of HAdV-E4 and HAdV-B7 genotypes overlapping in time. The temporal dynamics and proportions of HAdV genotypes found in wastewater were corroborated in clinical infections. We tracked specific single nucleotide polymorphisms (SNPs) found in clinical virus sequences and showed that they arose in wastewater signals concordant with the time of clinical presentation, linking community transmission of HAdV to the outbreak. This study demonstrates how wastewater-based epidemiology can be integrated with surveillance at ambulatory healthcare settings to monitor areas prone to respiratory virus outbreaks and provide public health guidance.

Respiratory human adenovirus outbreak captured in wastewater surveillance

“…Holland et al recently applied sequencing to specify the relative abundances of different HAdV-4 and HAdV-7 in samples from manholes at a public university campus in Arizona. 9 Our work suggests that quantitative PCR results from HAdV-pan assays would be unlikely to detect an outbreak of HAdV associated with respiratory illnesses given the high signals of HAdV associated with gastrointestinal illness. While management of patients with adenovirus infections does not vary based on adenovirus type, determination of adenovirus type is essential to identify an outbreak as early as possible.…”

“…The clinical data generated from respiratory panels are widely available but lack resolution to determine the specific adenovirus type causing an outbreak. 9,20 Typing is typically achieved by sequencing and often only applied retrospectively when an outbreak is suspected. In this outbreak, typing helped confirm that all the respiratory adenovirus cases were related and caused by HAdV-4.…”

“…7 More recently, efforts have shifted to detecting and quantifying adenoviruses in wastewater for epidemiological purposes. [9][10][11] The Wastewater Sewer Coronavirus Alert Network (WastewaterSCAN) network recently demonstrated a positive correlation between the concentrations of adenovirus types 40/41 in wastewater primary solids and clinical data. 12 Adenovirus species B and C have also been detected in wastewater; 6,8,9 however there is still a lack of evidence that respiratory HAdV levels in wastewater correlate with clinical cases.…”

“…[9][10][11] The Wastewater Sewer Coronavirus Alert Network (WastewaterSCAN) network recently demonstrated a positive correlation between the concentrations of adenovirus types 40/41 in wastewater primary solids and clinical data. 12 Adenovirus species B and C have also been detected in wastewater; 6,8,9 however there is still a lack of evidence that respiratory HAdV levels in wastewater correlate with clinical cases. The signals of many other respiratory viruses have been measured in wastewater and correlated with clinical cases.…”