Incidence and Outcomes of Human Adenovirus Infection and Disease in a Multicenter Cohort of Pediatric Allogeneic Hematopoietic Cell Transplant Recipients
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.
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BibTeX
@article{fisher2026incidence,
title = {{Incidence and Outcomes of Human Adenovirus Infection and Disease in a Multicenter Cohort of Pediatric Allogeneic Hematopoietic Cell Transplant Recipients}},
author = {Brian T Fisher and Jesse A Blumenstock and Craig L K Boge and Sydney Shuster and Alix E Seif and Michael Green and Marian G Michaels and Jessie L Alexander and Monica I Ardura and Jeffery J Auletta and Tamara P Miller and Diego R Hijano and William J Muller and Jennifer E Schuster and Abby M Green and Daniel E Dulek and Yun Li and Adriana E Kajon and Michael Grimley and Lara Danziger-Isakov},
journal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},
year = {2026},
month = aug,
doi = {10.1093/cid/ciag398},
url = {https://doi.org/10.1093/cid/ciag398},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Incidence and Outcomes of Human Adenovirus Infection and Disease in a Multicenter Cohort of Pediatric Allogeneic Hematopoietic Cell Transplant Recipients
AU - Brian T Fisher
AU - Jesse A Blumenstock
AU - Craig L K Boge
AU - Sydney Shuster
AU - Alix E Seif
AU - Michael Green
AU - Marian G Michaels
AU - Jessie L Alexander
AU - Monica I Ardura
AU - Jeffery J Auletta
AU - Tamara P Miller
AU - Diego R Hijano
AU - William J Muller
AU - Jennifer E Schuster
AU - Abby M Green
AU - Daniel E Dulek
AU - Yun Li
AU - Adriana E Kajon
AU - Michael Grimley
AU - Lara Danziger-Isakov
PY - 2026
DA - 2026/08/20
JO - Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
DO - 10.1093/cid/ciag398
UR - https://doi.org/10.1093/cid/ciag398
AB - 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.
SN - 1058-4838
SN - 1537-6591
ER -