Incidence and Outcomes of Human Adenovirus Infection and Disease in a Multicenter Cohort of Pediatric Allogeneic Hematopoietic Cell Transplant Recipients.

Creator(s)

• Brian T. Fisher
• Jesse A. Blumenstock
• Craig L K Boge
• Sydney Shuster
• Alix E. Seif
• Michael Green
• Marian G. Michaels
• Jessie L. Alexander
• Monica I. Ardura
• Jeffery J. Auletta
• Tamara P. Miller
• Diego R. Hijano
• William J. Muller
• Jennifer E. Schuster, Children's Mercy HospitalFollow
• Abby M. Green
• Daniel E. Dulek
• Yun Li
• Adriana E. Kajon
• Michael Grimley
• Lara Danziger-Isakov

Document Type

Article

Publication Date

10-28-2026

Identifier

DOI: 10.1093/cid/ciag398; PMCID: PMC13715987

Abstract

BACKGROUND: Human adenovirus (HAdV) among pediatric allogeneic hematopoietic cell transplant (allo-HCT) recipients can result in asymptomatic infection with risk for disease progression. There are limited data defining HAdV infection, disease, and case-fatality rates in a HAdV polymerase chain reaction (PCR) surveillance testing era. The current study aimed to define these outcomes using a priori definitions applied by a central review committee.

METHODS: Pediatric allo-HCT recipients were followed up for 180 days after HCT at 10 pediatric institutions. Blood and stool specimens were collected 0-7 days prior to allo-HCT for serum HAdV immunoglobulin G and stool HAdV PCR testing. Clinical data, including HAdV PCR testing results, informed central review committee-designated outcomes of HAdV infection, including DNAemia, disease, and deaths (case-fatality rate). Outcomes were reported by HAdV surveillance testing status and by pretransplant research specimen results.

RESULTS: The cohort included 819 allo-HCT recipients; 649 (79.2%) were under HAdV surveillance. The HAdV infection and DNAemia incidence among surveilled patients was 27.1% and 16.0%, respectively. The incidence of proven or probable HAdV disease was 10.9% for the cohort and, 12.6% for those under surveillance. The HAdV infection incidence was highest (13 of 25 [52.0%]) in patients with pre-HCT HAdV immunoglobulin G and stool PCR positivity. The attributable case-fatality rate for those with proven or probable disease was 13.5%.

CONCLUSIONS: HAdV infection and disease are common among pediatric allo-HCT recipients. HAdV disease is associated with a substantial HAdV-attributable mortality rate. Clinical trials assessing novel HAdV in pediatric allo-HCT recipients are needed. Pretransplant serology and stool PCR testing could identify high-risk patients for trial enrollment.

Journal Title

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Volume

83

Issue

4

First Page

858

Last Page

866

MeSH Keywords

Humans; Hematopoietic Stem Cell Transplantation; Male; Child; Female; Child, Preschool; Incidence; Infant; Transplantation, Homologous; Adolescent; Adenovirus Infections, Human; Adenoviruses, Human; Transplant Recipients; Feces; Cohort Studies; DNA, Viral; Polymerase Chain Reaction

PubMed ID

42619328

Keywords

adenovirus; hematopoietic cell transplantation; pediatrics

Comments

Grants and funding

• National Institute for Allergy and Infectious Diseases
• FD/FDA HHS/United States
• FD/FDA HHS/United States

This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.

Publisher's Link: https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciag398

Recommended Citation

Fisher BT, Blumenstock JA, Boge CLK, et al. Incidence and Outcomes of Human Adenovirus Infection and Disease in a Multicenter Cohort of Pediatric Allogeneic Hematopoietic Cell Transplant Recipients. Clin Infect Dis. 2026;83(4):e858-e866. doi:10.1093/cid/ciag398