The epidemiology and clinical burden of human adenovirus respiratory infections among hospitalized children under 5 years in Jordan

Journal article

Background:
Human Adenovirus (HAdV) is a significant pathogen associated with severe acute respiratory infections, especially in children under 5. Despite its global impact, its epidemiological and clinical burden in Jordan, particularly post-COVID-19, is limited.

Methods:
We conducted a multicenter cross-sectional study across 4 hospitals in Jordan from November 2022 to April 2023. Nasopharyngeal swabs were collected from children <5 years old hospitalized with respiratory symptoms. HAdV positivity was determined using real-time polymerase chain reaction. Demographic, clinical and laboratory data were analyzed to identify predictors of HAdV positivity and complications.

Results:
Among 1000 enrolled participants (median age 9.68 months, 59% male), the HAdV positivity rate was 10.9%, highest in children 49–60 months of age. HAdV-positive cases had higher rates and longer duration of sore throat compared with HAdV-negative cases. Coinfections with respiratory syncytial viruses or influenza were present in 34.9% of HAdV-positive cases and were associated with increased rates of cough, wheezing and respiratory crackles. Logistic regression revealed lower odds of HAdV positivity in children under six months [odds ratio (OR) 0.31, P < 0.001], while invasive ventilation was associated with higher odds of positivity (OR 5.01, P < 0.001). HAdV infection without coinfection was associated with reduced odds of complications (OR 0.06, P < 0.001).

Conclusions:
This is the first comprehensive study in Jordan to document the epidemiologic and clinical burden of HAdV in children post-COVID-19. HAdV remains a major cause of respiratory morbidity, with significant coinfection rates. Further research is needed to explore the nonrespiratory manifestations, identify HAdV common local serotypes and genetic characteristics.

Authors: Abu-Helalah, M; Al-Hanaktah, M; Abu Lubad, M; Al Tibi, A; Alhousani, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Lippincott, Williams & Wilkins
• Journal: The Pediatric Infectious Disease Journal
• Volume: 45
• Issue: 3
• Pages: 229-235
• Place of publication: United States
• Publication date: 2025-10-22
• Acceptance date: 2025-09-09
• DOI: 10.1097/inf.0000000000005020
• EISSN: 1532-0987
• ISSN: 0891-3668
• Pmid: 41121498
• Language: English
• Keywords: clinical; Jordan; children; human adenovirus; epidemiologic; below age of 5