Detection of human adenovirus F41 in wastewater and its relationship to clinical cases of acute hepatitis of unknown aetiology
Marina Reyne, Danielle M Allen, Ashley Levickas, Pearce Allingham, Jonathan Lock, Arthur Fitzgerald, Cormac McSparron, Behnam Firoozi Nejad, Jennifer McKinley, Andrew Lee, Stephen H. Bell, Joshua Quick, Charlotte J. Houldcroft, Connor Bamford, D.F. Gilpin, John W. McGrath
Abstract
As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases. • Correlation between Adenovirus (HAdV) F41 detection in wastewater and reported cases of acute hepatitis of unknown aetiology. • HAdV-F41 sequences from wastewater belong to F41 lineage 2b. • HAdV-F41 genome sequences from wastewater were homologous to sequences obtained from clinical cases. • Wastewater detection presents an effective tool for community surveillance of HAdV-F41.