Respiratory human adenovirus outbreak captured in wastewater surveillance

Abstract

Adenoviruses present challenges for traditional surveillance methods since there are more than 60 types that infect humans. Wastewater-based surveillance can supplement traditional surveillance methods for gastrointestinal-associated adenoviruses, but the ability to detect trends of respiratory-associated adenoviruses in wastewater remains unclear. We quantified human adenovirus type 4 (HAdV-4) in wastewater settled solids and compared wastewater measurements to clinical cases from an outbreak investigation beginning in late September 2023. The human adenovirus type 4 target was positively correlated with clinical cases (Spearman’s rho = 0.5470, p < 0.0001) and followed a similar trend during the outbreak. We also quantified human adenovirus types 3, 7, 14, 21, 40/41, and a pan-adenovirus assay that targets all types that infect humans. The respiratory adenoviruses comprised a small fraction of the adenoviruses in wastewater and types 40/41, which typically cause gastrointestinal disease, comprised the majority of the detected adenoviruses. The efficacy of adenovirus wastewater surveillance will depend on assay specificity and the public health action available for adenovirus types.WATER IMPACT STATEMENTCommunity adenovirus surveillance is strengthened by wastewater measurements. We evaluated the correlation between wastewater measurements and clinical cases during an outbreak of respiratory adenovirus type 4 infections on a college campus. Results indicate respiratory adenoviruses comprise a small portion of the adenoviruses measured in wastewater and the utility of adenovirus wastewater surveillance depends on the type and public health actionability.GRAPHICAL ABSTRACT