Adenovirus Follow-up

Updated: May 18, 2017
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Further Outpatient Care

Most disease is self-limited, and reassurance suffices; however, patients with keratoconjunctivitis or significant respiratory disease may need a follow-up evaluation within 2 weeks to monitor resolution. Immunosuppression often warrants hospitalization.

Consultation with an ophthalmologist may be indicated in the setting of corneal opacities. In addition, if hemorrhagic cystitis does not resolve within 5 days, consider noninfectious etiologies as the cause and refer the patient to a urologist or nephrologist, as appropriate.


Further Inpatient Care

Patients with meningoencephalitis or severe respiratory disease, including pneumonia, or those who are immunosuppressed require hospitalization.

Patients with severe keratitis who are suggested to have bacterial superinfection may require hospitalization.



Hospitalized patients who are immunosuppressed and have suspected adenoviral disease may benefit from early transfer to centers experienced in the treatment of critically ill immunosuppressed patients because rapid decompensation may occur.



Vaccination has been limited to military use because of the increased risk of clinically significant disease and potential for hospitalization. In 1971, the administration of live enteric-coated adenovirus vaccine (serotypes 4 and 7) was begun, with notable effectiveness. When given orally, these serotypes induce effective humoral immunity without producing disease. Because of economic factors, vaccine production was ceased in 1996, and rates of ARD in the military rose significantly. A large outbreak of ARD (serotype 4; >1000 cases) between May and December 1997 reinforced the need for immunization. [32] A live oral enteric-coated vaccine against adenovirus types 4 and 7 was approved by the FDA in 2011 for use only by the US Department of Defense in new military recruits entering basic training.

Approximately 80% of current isolates remain serotypes 4 and 7. However, serotypes 3 and 21 also appear to cause significant disease and may be appropriate targets of future immunization. [33] Further, breakthrough infection may occur with nonvaccine strains in persons who have been immunized, and vaccination programs may promote emergence of new epidemic strains. Surveillance and modification of vaccine strains may become necessary over time.

Genotyping of serotype 4 strains during outbreaks has demonstrated stable populations that vary geographically by training site. This suggests that epidemics arise from an endemic environmental source rather than from new recruits, and prevention programs may further require effective environmental control. [10, 34]

Isolation procedures, handwashing, and sterilization of instruments

Effective isolation procedures, handwashing, and sterilization of instruments can prevent nosocomial infection. [35]

Hospitalized patients with adenoviral conjunctivitis require contact precautions. Adenoviral pneumonia requires both droplet and contact precautions.

Health care workers with any adenoviral syndrome should be relieved of patient care duties and sent home until symptoms resolve. Health care workers should be educated to report to the employee health office if they develop symptoms that suggest conjunctivitis.

Strict hand hygiene should be emphasized, particularly in ophthalmologic care settings. Hand-sanitizing solutions containing 70% ethanol are effective against adenovirus. Careful attention to labeling is necessary to ensure coverage of adenovirus. 

Elimination of environmental reservoirs and fomites includes proper disinfection of tonometry and ophthalmologic instruments according to local infection control and manufacturer guidelines. Proper use and monitoring of open, multiple-use ophthalmic solutions (and timely discarding of these) according to local infection control and manufacturer guidelines is essential.

Chlorination of swimming pools

Adequate chlorination of swimming pools may prevent waterborne outbreaks. Adenovirus is relatively hardy and survives long periods on surfaces and in fresh water. Like norovirus and rotavirus, adenovirus is resistant to many common disinfectants, but chlorine is virucidal at a concentration of 2 parts per million (ppm).



Meningoencephalitis rarely occurs, usually in association with pneumonia. No pathognomonic features distinguish adenovirus aseptic meningitis or meningoencephalitis from other causes.

Immunosuppression in the host permits more severe manifestations. Pediatric liver transplantation, AIDS, and hematopoietic stem cell transplantation have been associated with protean adenovirus infections.



Overall, prognosis is good, except in cases of immunosuppressed patients with severe disease.


Patient Education

Frequent hand hygiene with soap and water or sanitizers that specify coverage of adenoviruses and avoidance of towel and pillow sharing among household contacts of patients with conjunctivitis is helpful.

Hygienic measures in children are difficult to enforce, but they should be taught regardless.

Patients should be advised of the contagiousness and possible long-term ocular sequelae of ophthalmologic disease.