Adenovirus 14 (Ad14)

Adenovirus 14 (Ad14) facts

• Adenovirus 14 (Ad14) is termed the killer cold virus because of the high incidence of hospitalizations and deaths attributed to the viral strain.
• Ad14 viruses are passed person to person or picked up from items touched by infected people and then initially invade cells in the eye, nose, or mouth that subsequently allow further spread to other body organs.
• Symptoms and signs resemble those of a cold (cough, runny nose, mild fever) for about three to five days; the majority of people clear the disease, but up to about 40% may need hospitalization with severe symptoms of pneumonia, and shortness of breath; other organ related symptoms may develop such as eye, bladder, and GI problems.
• Ad14 is presumptively diagnosed by history, physical exam, X-ray, and in association with other Ad14-diagnosed patients in the community; definitive diagnosis is completed with isolation of the virus from the patient, a rising titer of antibodies against Ad14, immunofluorescence of Ad14 virus particles in tissues, or fluids and PCR tests.
• Treatments are mainly supportive; antivirals have been used by some clinicians but there are no studies that prove efficacy, only case reports.
• Complications of Ad14 are related to the severity of infection; the majority of patients have no complications but hospitalized patients may have mild to serious complications which are related to the organ system most damaged (eyes, GI tract, bladder and most notably, lung problems such as ARDS that may lead to death).
• The majority of patients have an excellent prognosis; however, about 40% of infected patients may have a wide range of suboptimal outcomes, depending on the severity of the Ad14 infection.
• Ad14 infections can be reduced or prevented by careful hygiene methods; there is no vaccine currently available against Ad14.

What are symptoms and signs of an Adenovirus 14 infection?

Adenovirus 14 infections usually begin with cold symptoms such as a cough, "runny nose," and mild fever and possibly throat irritation. The majority of infected people have these symptoms for several days (about three to five days), and then the infection clears without any medical treatment. However, with some individuals, infection with the adenovirus 14 strain (and rarely a few other strains such as 3, 7, 21, 30) progresses past the three to five days, causing additional symptoms. These symptoms may include diarrhea, bronchitis, eye infections, bladder infection, rash, high fevers, pneumonia, and shortness of breath (dyspnea). Although infection with Ad14 has been found in a few isolated individuals, most recent outbreaks have occurred with groups of individuals living in close contact. For example, the 2007 outbreak occurred in a military installation in San Antonio, TX, while the 2008 outbreak was in a small community in Alaska. A group of individuals that appears very ill (require hospitalization) due to respiratory problems, and are likely due to a "virus," should make clinicians suspect Ad14 as a possible cause of infection.

What are complications of an Adenovirus 14 infection?

Most people require neither treatment nor hospitalization, and they do not develop complications. However, complications may be mild to dire if the Ad14 disease progresses and the complication types are related to the organ system(s) bearing the most severe infection. Complications include bronchitis, conjunctivitis, pneumonia, meningitis, hepatitis, bladder infection (cystitis), diarrhea, ARDS (acute respiratory distress syndrome), and death.

Can an Adenovirus 14 infection be prevented?

The only Adenovirus vaccines are against Ad4 and Ad7 and are not available to the general public, but are restricted to the military in the U.S. Currently, there is no commercially available vaccine against Ad14. Fortunately, the number of people infected with this strain has been very low, and to date, there is no good evidence this strain will rapidly cause global problems like HIV or Enterovirus strains. However, because this virus can be deadly and can be transmitted from person to person by droplets, it has the potential to become widespread. Also, there can be some confusion in the medical literature about Adenovirus "vaccines" as the virus has been used as a genetic carrier for other viral genomic elements to make research vaccines against other viruses; these should be listed as recombinant vaccines and not confused with the limited production of Ad4 and Ad7 vaccines.
Good hand washing techniques, avoiding close contact with infected people, and avoidance of touching people or potentially contaminated surfaces and then touching eyes, nose, or mouth are some of the best ways to reduce the chance of getting infected with Ad14. These techniques are used to help avoid many other viral illnesses such as influenza, RSV, and other Enteroviruses. Patients with the disease should always cover their cough or sneeze and avoid touching others. Potentially contaminated items such as food, plates, utensils, and other handled items should be discarded or cleaned carefully before reuse to help reduce Ad14 transfer to others.